Нейротрофический фактор мозга в патогенезе посттравматического стрессового расстройства: от нейробиологии к биомаркеру

Актуальность. Посттравматическое стрессовое расстройство (ПТСР) одно из наиболее распро­страненных и социально значимых последствий воздействия экстремального стресса. В основе его патогенеза лежат нарушения нейропластичности, ключевую роль в которых играет мозговой ней­ротрофический фактор (BDNF). В последние десятилетия активно изучается возможность использо­вания показателей системы BDNF в качестве биомаркеров для объективизации диагностики, прогно­за течения и персонализации терапии ПТСР, однако данные остаются противоречивыми и требуют систематизации.

Цель. Систематизировать и обобщить сведения о роли BDNF в патогенезе ПТСР, рассмотреть молекулярные, генетические и эпигенетические аспекты его дисфункции, а также оце­нить диагностический и прогностический потенциал компонентов системы BDNF как возможных биомаркеров.

Материалы и методы. В соответствии с критериями PRISMA проведен систематический поиск в базах PubMed, Scopus, Web of Science, eLibrary и Google Scholar за 2000-2025 гг. с исполь­зованием ключевых слов, отражающих связь BDNF и ПТСР. Включены оригинальные клинические и экспериментальные исследования, метаанализы и систематические обзоры на английском и рус­ском языках.

Результаты. Показано, что дисфункция системы BDNF при ПТСР носит многоуровневый характер: от регион-специфичных изменений экспрессии белка до генетических и эпигенетических нарушений. Выявлены противоречия в данных об уровне периферического BDNF, обусловленные ти­пом биоматериала, формой белка и гетерогенностью выборок. Установлено, что определение зрелой формы BDNF, соотношения proBDNF/mBDNF, метилирования промотора гена BDNF и регуляторных микроРНК (miR-182-5p, miR-9-5p, miR-204-5p) обладает прогностической значимостью, ассоциируясь с тяжестью течения, хронификацией и ответом на терапию.

Выводы. Использование общего BDNF в качестве самостоятельного диагностического маркера ПТСР в настоящее время нецелесообразно. Наиболее перспективным является включение комплекса показателей системы BDNF (генотип, эпи­генетические метки, уровень зрелого белка, микроРНК) в мультифакторные модели для прогноза течения и персонализации терапии.

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