LIVER CONDITION IN BURN DISEASE PATHOGENETIC MECHANISMS, CLINICAL MANIFESTATIONS AND APPROACHES TO THERAPY
Keywords:
burn disease, liver, hepatoprotection, bilirubin, cytokines, transaminases, detoxification, hypoperfusionAbstract
Burn disease causes a systemic inflammatory response and multiple organ dysfunction, primarily affecting the liver as the central organ of metabolic and detoxification regulation. This article discusses the main pathogenetic mechanisms of liver damage in burns, including ischemia, cytokine storm, oxidative stress and metabolic overload. Biochemical and ultrasound markers of hepatocellular and cholestatic syndromes reflecting the severity of the lesion are summarized. Based on the data of domestic and international studies, modern approaches to diagnostics and therapy of liver dysfunction are discussed, including the use of hepatoprotectors, detoxification techniques and microcirculation monitoring. The findings emphasize the need for systemic monitoring of liver function in the management of patients with burn injury and the relevance of integrating liver parameters into intensive care standards.
References
Bajt, M. L., Ramachandran, A., Yeh, B. N., Cho, E., Szabo, G. (2011). Hepatic responses to severe burn injury: pathophysiology and clinical implications. Burns, 37(1), 8–16.
Church, D., Le, T. D., Christopherson, A., Stewart, D. J., McKee, N. H., & Orsted, H. L. (2007). Burn wound infections. Clinical Microbiology Reviews, 20(1), 48–96.
Fialkow, L., Wang, Y., & Downey, G. P. (2007). Активные формы кислорода и азота как сигнальные молекулы, регулирующие функцию нейтрофилов. Free Radical Biology and Medicine, 42, 153–164.
Herndon, D. N., Barrow, R. E., Rutan, R. L., Monroe, G. R., Ireton, M. J., & Abumrad, N. N. (2000). Metabolic changes after burn. Journal of Burn Care & Rehabilitation, 21(6 Pt 1), 533–541.
Jeschke, M. G., & Barrow, R. E. (2007). The hepatic acute phase response in thermal injury. Shock, 28(5), 497–504.
Ministry of Health of Russian Federation. (2020). Порядок организации оказания специализированной медицинской помощи при ожоговой болезни (Приказ № 123-н).
Pérez-de la Cruz, V., et al. (2017). Early changes in liver function biomarkers and imaging in burned patients: a cohort study. Burns, 43(2), 388–396.
Stoeckelhuber, M., Arnaud, E., & Jeon, B. (2019). Liver dysfunction in burn patients: clinical implications and management. Burns, 45(5), 1049–1058.
Белова М.И., Иванов П.А., Реанимация при ожогах. Москва: Медицина; 2018
Faunce DE, et al. Tumor necrosis factor-α mediates acute hepatic injury in a murine model of thermal trauma. Shock. 1997;7(5): 389–394
Kraft R, et al. Ischemia-reperfusion injury of the liver after thermal trauma. J Surg Res. 2003;113(1):39–46
Shackleford A, et al. Impact of massive blood transfusion on liver function in burn patients. Burns. 2001;27(8):807–811
Кузнецов А.В., Плазмаферез при ожоговой болезни. Российская гастроэнтерология. 2019;июнь:45–52
