gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLC10.22416/1382-4376-2024-34-1-85-100gastro-j-945Research ArticleСОГЛАШЕНИЕ СПЕЦИАЛИСТОВEXPERTS’ AGREEMENTДиагностическое и прогностическое значение гипераммониемии у пациентов с циррозом печени, печеночной энцефалопатией и саркопенией (соглашение специалистов)Diagnostic and Prognostic Value of Hyperammonemia in Patients with Liver Cirrhosis, Hepatic Encephalopathy, and Sarcopenia (Experts’ Agreement)https://orcid.org/0000-0002-1210-2528НадинскаяМ. Ю.NadinskaiaM. Yu.

Надинская Мария Юрьевна — кандидат медицинских наук, доцент кафедры пропедевтики внутренних болезней, гастроэнтерологии и гепатологии 

1190fi8, г. Москва, ул. Трубецкая, 8, стр. 2

Maria Yu. Nadinskaia — Cand. Sci. (Med.), Associate Professor at the Department of Propaedeutics of Internal Diseases, Gastroenterology and Hepatology

119048, Moscow, Trubetskaya str., 8/2

nadinskaya_m_yu@staff.sechenov.ruhttps://orcid.org/0000-0001-8913-140XМаевскаяМ. В.MaevskayaM. V.

Маевская Марина Викторовна — доктор медицинских наук, профессор 

1190fi8, г. Москва, ул. Трубецкая, 8, стр. 2

Marina V. Maevskaya — Dr. Sci. (Med.), Professor

119048, Moscow, Trubetskaya str., 8/2

mvmaevskaya@me.comhttps://orcid.org/0000-0002-6151-2021БакулинИ. Г.BakulinI. G.

Бакулин Игорь Геннадьевич — доктор медицинских наук, профессор, заведующий кафедрой пропедевтики внутренних болезней, гастроэнтерологии и диетологии им. С.М. Рысса 

191015, г. Санкт-Петербург, ул. Кирочная, 41

Igor G. Bakulin — Dr. Sci. (Med.), Professor, Head of the Department of Propaedeutics of Internal Medicine, Gastroenterology and Dietetics named after S.M. Ryss

191015, St. Petersburg, Kirochnaya str., 41

igbakulin@yandex.ruhttps://orcid.org/0000-0002-4223-3473БессоноваЕ. Н.BessonovaE. N.

Бессонова Елена Николаевна — доктор медицинских наук, главный внештатный гастроэнтеролог Министерства здравоохранения Свердловской области; руководитель Свердловского областного гепатологического центра 

620102, г. Екатеринбург, ул. Волгоградская, 185

Elena N. Bessonova — Dr. Sci. (Med.), Chief Freelance Gastroenterologist of the Ministry of Health of the Sverdlovsk Region, Head of the Sverdlovsk Regional Hepatological Center

620102, Yekaterinburg, Volgogradskaya str., 185

benbessonova@yandex.ruhttps://orcid.org/0000-0002-5041-3466БуеверовА. О.BueverovA. O.

Буеверов Алексей Олегович — доктор медицинских наук, профессор кафедры медико-социальной экспертизы, неотложной и патогенетической терапии ФГАОУ ВО «Первый Московский государственный университет им. И.М. Сеченова» Министерства здравоохранения Российской Федерации (Сеченовский университет); ведущий научный сотрудник отделения гепатологии ГБУЗ МО «Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского»

129110, г. Москва, ул. Щепкина, 61/2

Alexey O Bueverov — Dr. Sci. (Med.), Professor at the Department of Medical and Social Expertise,  Emergency and Pathogenetic Therapy, I.M. Sechenov First Moscow State Medical University (Sechenov University); Leading Researcher, Department of Hepatology, M.F. Vladimirsky Moscow Regional Research and Clinical Institute

129110, Moscow, Shchepkina str., 61/2

bcl72@yandex.ruhttps://orcid.org/0000-0001-5939-1032ЖарковаМ. С.ZharkovaM. S.

Жаркова Мария Сергеевна — кандидат медицинских наук, заведующая отделением гепатологии Клиники пропедевтики внутренних болезней, гастроэнтерологии, гепатологии им. В.Х. Василенко 

1190fi8, г. Москва, ул. Трубецкая, 8, стр. 2

Maria S. Zharkova — Cand. Sci. (Med.), Head of the Hepatology Department, V.Kh. Vasilenko Clinic of Internal Disease Propaedeutics, Gastroenterology and Hepatology

119048, Moscow, Trubetskaya str., 8/2

zharkova_m_s@staff.sechenov.ruhttps://orcid.org/0000-0003-4294-5531ОковитыйС. В.OkovityiS. V.

Оковитый Сергей Владимирович — доктор медицинских наук, профессор, заведующий кафедрой фармакологии и клинической фармакологии 

197376, г. Санкт-Петербург, ул. Профессора Попова, 14а

Sergey V. Okovityi — Dr. Sci. (Med.), Professor, Head of the Department of Pharmacology and Clinical Pharmacology

197376, St. Petersburg, Professor Popov str., 14А

sergey.okovity@pharminnotech.comhttps://orcid.org/0000-0002-9152-1279ОстровскаяА. С.OstrovskayaA. S.

Островская Анна Сергеевна — врач-специалист отделения гепатологии клиники пропедевтики внутренних болезней, гастроэнтерологии, гепатологии им. В.Х. Василенко 

1190fi8, г. Москва, ул. Трубецкая, 8, стр. 2

Anna S. Ostrovskaya — Physician at the Department of Hepatology, V.Kh. Vasilenko Clinic of Internal Disease Propaedeutics, Gastroenterology and Hepatology

119048, Moscow, Trubetskaya str., 8/2

ostrovskaya_a_s@staff.sechenov.ruhttps://orcid.org/0000-0002-3462-0123ГуляеваК. А.GulyaevaK. A.

Гуляева Ксения Александровна — аспирант кафедры пропедевтики внутренних болезней, гастроэнтерологии и гепатологии 

1190fi8, г. Москва, ул. Трубецкая, 8, стр. 2

Kseniya A. Gulyaeva — Postgraduate, Department of Propaedeutics of Internal Diseases, Gastroenterology and Hepatology

119048, Moscow, Trubetskaya str., 8/2

xen59@mail.ruhttps://orcid.org/0000-0002-6815-6015ИвашкинВ. Т.IvashkinV. T.

Ивашкин Владимир Трофимович — доктор медицинских наук, академик РАН, профессор, заведующий кафедрой пропедевтики внутренних болезней, гастроэнтерологии и гепатологии ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Министерства здравоохранения Российской Федерации (Сеченовский Университет); Главный внештатный специалист гастроэнтеролог МЗ РФ; Президент Российского общества по изучению печени (РОПИП)

1190fi8, г. Москва, ул. Трубецкая, 8, стр. 2

Vladimir T. Ivashkin — Dr. Sci. (Med.), Academician of the Russian Academy of Sciences, Professor, Head of the Department of Propaedeutics of Internal Diseases, Gastroenterology and Hepatology

119048, Moscow, Trubetskaya str., 8/2

ivashkin_v_t@staff.sechenov.ruФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Министерства здравоохранения Российской Федерации (Сеченовский университет)РоссияI.M. Sechenov First Moscow State Medical University (Sechenov University)Russian FederationФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Министерства здравоохранения Российской Федерации.РоссияNorth-Western State Medical University named after I.I. MechnikovRussian FederationГАУЗ Свердловской области «Свердловская областная клиническая больница № 1»РоссияSverdlovsk Regional Clinical Hospital No. 1Russian FederationФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Министерства здравоохранения Российской Федерации (Сеченовский университет); ГБУЗ МО «Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского»РоссияI.M. Sechenov First Moscow State Medical University (Sechenov University); M.F. Vladimirsky Moscow Regional Research and Clinical InstituteRussian FederationФГБОУ ВО «Санкт-Петербургский государственный химико-фармацевтический университет» Министерства здравоохранения Российской ФедерацииРоссияSaint Petersburg State Chemical Pharmaceutical UniversityRussian Federation20241903202434185100Copyright © Надинская М.Ю., Маевская М.В., Бакулин И.Г., Бессонова Е.Н., Буеверов А.О., Жаркова М.С., Оковитый С.В., Островская А.С., Гуляева К.А., Ивашкин В.Т., 20242024Надинская М.Ю., Маевская М.В., Бакулин И.Г., Бессонова Е.Н., Буеверов А.О., Жаркова М.С., Оковитый С.В., Островская А.С., Гуляева К.А., Ивашкин В.Т.Nadinskaia M.Y., Maevskaya M.V., Bakulin I.G., Bessonova E.N., Bueverov A.O., Zharkova M.S., Okovityi S.V., Ostrovskaya A.S., Gulyaeva K.A., Ivashkin V.T.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gastro-j.ru/jour/article/view/945Введение

Введение. У пациентов с циррозом печени в результате нарушения процессов обезвреживания аммиака и портосистемного шунтирования крови может развиваться гипераммониемия, которая наиболее часто ассоциирована с печеночной энцефалопатией и саркопенией. На сегодняшний день остаются вопросы по диагностике гипераммониемии и влиянию гипоаммониемической терапии на исходы заболевания.

Материалы и методы

Материалы и методы. Российское общество по изучению печени объединило семь экспертов в области изучения цирроза печени и ведения пациентов с этим заболеванием для вынесения аргументированных рекомендаций и положений по проблеме «Диагностическое и прогностическое значение гипераммониемии у пациентов с циррозом печени, печеночной энцефалопатией и саркопенией».

Результаты

Результаты. Эксперты работали по упрощенному дельфийскому методу, определение наиболее актуальных проблем осуществляли по принципу PICO (patient or population, intervention, comparison, outcome). Эксперты сформулировали шесть актуальных для клинической практики вопросов и дали на них аргументированные ответы, оформленные как «рекомендации и положения для клинической практики» с комментариями на основе доказательной медицины. В основу формулировки вопросов, рекомендаций и положений лег критический анализ медицинской литературы, найденной по ключевым словам в англоязычных и русскоязычных базах данных. Объединить сформулированные вопросы можно в четыре категории: печеночная энцефалопатия, саркопения, гипераммониемия, гипоаммониемическая терапия.

Выводы

Выводы. Результаты работы экспертов имеют прямое отношение к качественному ведению пациентов с циррозом печени, сформулированные ими рекомендации и положения могут использоваться в клинической практике.

Introduction

Introduction. In cirrhotic patients, hyperammonemia develops due to impaired ammonia detoxification and portosystemic blood shunting and is most commonly associated with hepatic encephalopathy and sarcopenia. Currently, there are questions regarding the diagnosis of hyperammonemia and the effect of ammonia-lowering therapy on disease outcomes.

Materials and methods

Materials and methods. The Russian Scientific Liver Society selected a panel of seven experts in liver cirrhosis research and management of patients with this disease to make reasoned statements and recommendations on the issue of diagnostic and prognostic value of hyperammonemia in patients with liver cirrhosis, hepatic encephalopathy and sarcopenia.

Results

Results. The Delphi panel identified the most relevant topics, in the form of PICO questions (patient or population, intervention, comparison, outcome). The Delphi panel made six questions relevant to clinical practice and gave reasoned answers, framed as ‘clinical practice recommendations and statements’ with evidence-based comments. The questions and statements were based on the search and critical analysis of medical literature by keywords in Englishand Russian-language databases. The formulated questions could be combined into four categories: hepatic encephalopathy, sarcopenia, hyperammonemia, and ammonia-lowering therapy.

Conclusions

Conclusions. The results of the experts' work are directly relevant to the quality management of patients with liver cirrhosis, and their recommendations and statements can be used in clinical practice.

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The authors declare that there are no conflicts of interest present.