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Федеральное государственное бюджетное учреждение науки
Институт теоретической и экспериментальной биофизики
Российской академии наук


ООО "ИЦ КОМКОН"

ФГБУ НКЦТ им. С.Н. Голикова ФМБА России

Адрес редакции и реквизиты

192012, Санкт-Петербург, ул.Бабушкина, д.82 к.2, литера А, кв.378

Свидетельство о регистрации электронного периодического издания ЭЛ № ФС 77-37726 от 13.10.2009
Выдано - Роскомнадзор

ISSN 1999-6314


Клиническая медицина » Терапия • Кардиология

Том: 27
Статья: « 33 »
Страницы:. 777-814
Опубликована в журнале: 29 июля 2026 г.
English version

Роль фиброза и ожирения сердца в патогенезе фибрилляции предсердий

Силкин М.С., Митрофанова Л.Б.

Федеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр имени В. А. Алмазова» Министерства здравоохранения Российской Федерации; 197341, Российская Федерация, г. Санкт-Петербург, ул. Аккуратова, д. 2


Резюме
В литературном обзоре систематизированы современные представления о роли фиброза миокарда и эпикардиальной жировой ткани как фундаментальных патоморфологических субстратов фибрилляции предсердий. Поиск и отбор литературы проводились в электронных базах данных PubMed, Scopus, eLIBRARY и Web of Science за период с 1995 по 2026 год. Поиск проводился с помощью ключевых слов и их комбинаций. В обзор включались оригинальные экспериментальные, клинико-морфологические и аутопсийные исследования, а также международные клинические рекомендации. В работе подробно рассмотрены основные молекулярно-клеточные каскады фиброгенеза, включая сигнальные пути трансформирующего фактора роста-бета, ангиотензина II и фактора, индуцируемого гипоксией-1-альфа. Описано влияние гемодинамического, ишемического и окислительного стресса на трансформацию фибробластов в миофибробласты. Проанализирована роль нарушений пространственной архитектоники экстрацеллюлярного матрикса, в частности изменения соотношения коллагена I и III типов, способствующих эндо-эпикардиальной диссоциации и замедлению проведения импульса. Обосновано особое значение эпикардиальной жировой ткани как паракринно-активного органа, выделяющего профибротические цитокины и инфильтрирующего миокард предсердий с формированием зон для микро-re-entry. Отдельно выделены существующие в литературе противоречия относительно единых пороговых значений патологического фиброза и диагностической ценности циркулирующих биомаркеров. Сделан вывод о высокой значимости морфологических исследований для стандартизации критериев структурного ремоделирования предсердий.


Ключевые слова
фибрилляция предсердий; фиброз предсердий; патологическая анатомия; экстрацеллюлярный матрикс; коллаген I и III типа; эпикардиальная жировая ткань; миофибробласты; структурное ремоделирование; литературный обзор


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