Современное состояние проблемы терапии описторхоза: празиквантел и соединения растительного происхождения

Представлен обзор современных стратегий терапии описторхоза. Особое внимание уделяется инвазии печеночным сосальщиком Opisthorchis felineus, эндемичным на территории Западной Сибири. Несмотря на длительное применение празиквантела в качестве препарата первой линии, его использование сопряжено с рядом существенных ограничений, включая неэффективность против личиночных стадий и потенциальную резистентность у паразитов. Рассматриваются альтернативные подходы к лекарственной терапии с использованием синтетических препаратов, соединений комбинированного состава и агентов, направленных на специфические метаболические системы паразита. Отдельно приводится исчерпывающий обзор биологически активных веществ растительного происхождения, продемонстрировавших в экспериментах противоописторхозную активность (куркумин, экстракты Thunbergia laurifolia и Allium sativum, ксантогумол). Ценность этих соединений заключается не только в их потенциальных противопаразитарных свойствах, но и в способности модулировать ключевые патофизиологические процессы на фоне инвазии: подавлять окислительный и нитрозативный стресс, уменьшать выраженность воспалительных реакций и замедлять развитие фиброза гепатобилиарной системы. Наиболее обоснованной стратегией представляется комбинированная терапия, объединяющая противопаразитарное действие празиквантела с разнонаправленными эффектами растительных антиоксидантов и противовоспалительных агентов. Такой подход позволяет повысить эффективность эрадикации паразита, снизить нежелательные побочные эффекты антигельминтной терапии и минимизировать риск развития хронических осложнений инвазии. Подчеркивается необходимость дальнейших исследований для оптимизации комбинированных схем, разработки систем направленной доставки действующих веществ и поиска новых высокоактивных соединений для преодоления текущих ограничений синтетических антигельминтных лекарственных средств.

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