uzspbgmuУчёные записки Первого Санкт-Петербургского государственного медицинского университета имени академика И. П. ПавловаThe Scientific Notes of the Pavlov University1607-41812541-8807Academician I.P. Pavlov First St. Petersburg State Medical University10.24884/1607-4181-2026-33-1-30-39uzspbgmu-1325Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESИммунопатогенез и иммунотерапия при контроле инфекционного процесса огнестрельных раненийImmunopathogenesis and immunotherapy in the control of the infectious process of gunshot woundshttps://orcid.org/0000-0002-0132-167XКиселевскийМ. В.KiselevskiiM. V.

Киселевский Михаил Валентинович, доктор медицинских наук, профессор, зав. лабораторией клеточного иммунитета

115522, Москва, Каширское шоссе, д. 24

Kiselevskii Mikhail V., Dr. of Sci. (Med.), Professor, Head of the Laboratory of Cellular Immunity

24, Kashirskoe shosse, Moscow, 115522

kisele@inbox.ruhttps://orcid.org/0000-0003-3948-6928ИванусаС. Я.IvanusaS. Ia.

Ивануса Сергей Ярославович, доктор медицинских наук, профессор, полковник медицинской службы, начальник кафедры общей хирургии

194044, Санкт-Петербург, ул. Академика Лебедева, д. 6

Ivanusa Sergei Ia., Dr. of Sci. (Med.), Professor, Colonel of the Medical Service, Head of the Department of General Surgery

6, Academica Lebedeva str., Saint Petersburg, 194044

https://orcid.org/0000-0003-4971-7734ЛазуткинМ. В.LazutkinM. V.

Лазуткин Максим Витальевич, доктор медицинских наук, профессор, полковник медицинской службы, зам. начальника кафедры общей хирургии

194044, Санкт-Петербург, ул. Академика Лебедева, д. 6

Lazutkin Maksim V., Dr. of Sci. (Med.), Professor, Colonel of the Medical Service, Deputy Head of the Department of General Surgery

6, Academica Lebedeva str., Saint Petersburg, 194044

https://orcid.org/0009-0001-0379-5334ДрагуновС. Г.DragunovS. G.

Драгунов Сергей Геннадьевич, майор медицинской службы, адъюнкт кафедры общей хирургии

194044, Санкт-Петербург, ул. Академика Лебедева, д. 6

Dragunov Sergei G., Major of the Medical Service, Associate Professor of the Department of General Surgery

6, Academica Lebedeva str., Saint Petersburg, 194044

https://orcid.org/0009-0005-4974-4646ПетроваЕ. И.PetrovaE. I.

Петрова Екатерина Ивановна, клинический ординатор кафедры общей хирургии

194044, Санкт-Петербург, ул. Академика Лебедева, д. 6

Petrova Ekaterina I., Clinical Resident of the Department of General Surgery

6, Academica Lebedeva str., Saint Petersburg, 194044

Национальный медицинский исследовательский центр онкологии имени Н. Н. БлохинаРоссияN. N. Blokhin National Medical Research Center of OncologyRussian FederationВоенно-медицинская академия имени С. М. КироваРоссияMilitary Medical AcademyRussian Federation2026090620263313039Copyright © Киселевский М.В., Ивануса С.Я., Лазуткин М.В., Драгунов С.Г., Петрова Е.И., 20262026Киселевский М.В., Ивануса С.Я., Лазуткин М.В., Драгунов С.Г., Петрова Е.И.Kiselevskii M.V., Ivanusa S.I., lazutkin M.V., Dragunov S.G., Petrova E.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.sci-notes.ru/jour/article/view/1325

У пациентов, получивших огнестрельное ранение, в 82,5 % развиваются инфекционные осложнения, что является одной из основных причин летальности. Повышенная восприимчивость пациентов с огнестрельными ранениями к инфекциям обусловлена подавленным состоянием иммунной системы, которое развивается после ранения. Иммунологические нарушения являются последствиями травмы и представляют серьезную проблему в комплексном лечении инфекционных осложнений. Общий иммунный ответ на множественную травму представляет собой многоуровневый комплекс нейрогормональных, клеточных и гемодинамических факторов, приводящих вначале к чрезмерной активации иммунной системы, а затем, вследствие ее истощения, к иммуносупрессии, вплоть до иммунопаралича. Иммунопаралич характеризуется снижением способности антигенпрезентирующих клеток (макрофагов и дендритных клеток) выполнять антигенпрезентирующую функцию, обеспечивающую адекватный ответ на патогены и резкое снижение Т-клеток, прежде всего Т-хелперов, осуществляющих регуляцию клеточного звена иммунитета. Активация иммунокомпетентных и функционально с ними связанных клеток в ответ на травму приводит к гиперпродукции эндогенных провоспалительных биорегуляторов, играющих ведущую роль в развитии системной воспалительной реакции, органной и полиорганной недостаточности. Гиперактивация иммунитета, в конечном счете, приводит к истощению секреторной активности и гибели иммунокомпетентных клеток, способствуя развитию иммуносупрессии. Депрессия иммунитета является непосредственной причиной снижения защитных сил организма и присоединения инфекций, вызванных условно-патогенными, как правило, антибиотико-резистентными микроорганизмами. Таким образом, сохранение и восстановление иммунной функции является важной стратегией, которая наряду с противодействием чрезмерной продукции медиаторов воспаления может существенно улучшить результаты лечения пациентов с огнестрельными ранениями.

Infectious complications develop in 82.5% of patients with a gunshot wound, which is one of the main causes of mortality. The increased susceptibility of patients with gunshot wounds to infections is due to the suppressed state of the immune system that develops after injury. Immunological disorders are the consequences of trauma and pose a serious problem in the combined treatment of infectious complications. The general immune response to multiple trauma is a multilevel complex of neurohormonal, cellular, and hemodynamic factors that first lead to excessive activation of the immune system, and then, due to its depletion, to immunosuppression, up to immunoparalysis. Immunoparalysis is characterized by a decrease in the ability of antigen-presenting cells (macrophages and dendritic cells) to perform an antigen-presenting function, providing an adequate response to pathogens and a sharp decrease in T-cells, primarily T helper cells, which regulate the cellular link of immunity. Activation of immunocompetent and functionally related cells in response to trauma leads to hyperproduction of endogenous pro-inflammatory bioregulators, which play a leading role in the development of systemic inflammatory reactions, organ and multiple organ failure. Hyperactivation of the immune system ultimately leads to depletion of secretory activity and death of immunocompetent cells, contributing to the development of immunosuppression. Immune depression is the direct cause of a decrease in the body defenses and the addition of infections caused by opportunistic, usually antibiotic-resistant microorganisms. Thus, the preservation and restoration of immune function is an important strategy, which, along with countering the excessive production of inflammatory mediators, can significantly improve the treatment outcomes of patients with gunshot wounds.

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