Диагностическое и прогностическое значение гипераммониемии у пациентов с циррозом печени, печеночной энцефалопатией и саркопенией (соглашение специалистов)

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

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