МЕХАНИЗМЫ ВЗАИМОДЕЙСТВИЯ HELICOBACTER PYLORI C ЭПИТЕЛИЕМ СЛИЗИСТОЙ ОБОЛОЧКИ ЖЕЛУДКА. I. ФАКТОРЫ ПАТОГЕННОСТИ, СПОСОБСТВУЮЩИЕ УСПЕШНОЙ КОЛОНИЗАЦИИ

Helicobacter pylori — грамотрицательная, извитая, подвижная бактерия, способная колонизировать слизистую оболочку желудка (СОЖ) человека и выживать в этих крайне неблагоприятных условиях у более чем половины населения нашей планеты. Показано, что микроорганизм может обитать на СОЖ в течение всей жизни хозяина, но при этом вызывает клинически выраженные заболевания лишь у незначительной группы инфицированных лиц. К причинам, способствующим развитию заболеваний, как правило, относят: сопутствующие инфекции желудочно-кишечного тракта, неправильную стерилизацию медицинских инструментов (как правило эндоскопов), несоблюдение правил личной гигиены, длительный контакт с инфицированными или носителями, в том числе с членами семьи, и ряд других факторов. Хорошо известно, что персистирование H. pylori имеет этиологическое значение в развитии широкого спектра болезней желудочно-кишечного тракта, включая хронический гастрит, язвенную болезнь желудка и двенадцатиперстной кишки, аденокарциному желудка и MALT-лимфомы. Глобальное распространение носительства H. pylori позволяет предположить наличие у бактерии «умных» стратегий, способствующих ее адаптации к агрессивной среде желудка и пожизненному персистированию в организме человека. Даже спустя 34 года после открытия микроорганизма остается множество вопросов, не имеющих своего ответа, в том числе о роли факторов патогенности, способствующих выживанию микроорганизма в суровых условиях микробиома СОЖ. Изучение и понимание механизмов, способствующих колонизации и персистированию H. pylori, позволит оптимизировать прогноз повышенного риска тяжелых заболеваний у лиц, колонизированных этим микроорганизмом. Сложившийся в ходе эволюции долгосрочный баланс между человеком и H. pylori определяет микробное постоянство в микробиоме желудка, но в ряде случаев это совместное сосуществование приводит к риску развития вышеперечисленных тяжелых патологий. В данном обзоре предпринято обсуждение характера взаимоотношений H. pylori с эпителием, участие факторов патогенности бактерии (уреазы, ЛПС, комплекса поверхностных белков, токсинов и протеаз, способствующих инвазии) в колонизации и длительном персистировании на СОЖ. Приведенная информация о механизмах, связанных с колонизацией эпителия желудка H. pylori позволяет создать предпосылки для более эффективной терапии заболеваний гастродуоденальной зоны. Cведения, представленные в данном обзоре, важны для объяснения стратегий, используемых H. pylori для выживания в крайне неблагоприятных условиях микробиома желудка.

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