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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">lvrach</journal-id><journal-title-group><journal-title xml:lang="ru">Лечащий Врач</journal-title><trans-title-group xml:lang="en"><trans-title>Lechaschi Vrach</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">1560-5175</issn><issn pub-type="epub">2687-1181</issn><publisher><publisher-name>ООО «Издательство "Открытые системы"»</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.51793/OS.2023.26.6.007</article-id><article-id custom-type="elpub" pub-id-type="custom">lvrach-1085</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ПЕДИАТРИЯ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>PEDIATRICS</subject></subj-group></article-categories><title-group><article-title>Тирозинемия 1-го типа у ребенка с множественными врожденными пороками развития: обзор литературы и клиническое наблюдение</article-title><trans-title-group xml:lang="en"><trans-title>Hereditary tyrosinemia type 1 in an infant with multiple congenital defects</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-7305-9036</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Саркисян</surname><given-names>Е. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Sarkisyan</surname><given-names>H. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Саркисян Егине Альбертовна, к.м.н., доцент кафедры госпитальной педиатрии имени академика В. А. Таболина; неонатолог</p><p>117997, Москва, ул. Островитянова, 1 </p><p>123317, Москва, Шмитовский проезд, 29</p></bio><bio xml:lang="en"><p> </p><p>Heghine A. Sarkisyan, MD, Associate professor of Academician; neonatologist  V. A. Tabolin Department of Hospital Paediatrics </p><p>1 Ostrovityanova str., 117997</p><p>29 Shmitovsky Proezd, Moscow, 123317</p></bio><email xlink:type="simple">heghinesarg@gmail.com</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Черкасова</surname><given-names>С. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Cherkasova</surname><given-names>S. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Черкасова Светлана Вячеславовна, к.м.н., доцент кафедры госпитальной педиатрии имени академика В. А. Таболина; заведующая отделением патологии новорожденных и недоношенных </p><p>117997, Москва, ул. Островитянова, 1</p><p> 123001, Москва, ул. Садовая-Кудринская, 15</p></bio><bio xml:lang="en"><p>Svetlana V. Cherkasova, MD, Associate professor of Academician V. A. Tabolin Department of Hospital Paediatrics; Head of the Department of Pathology of Newborns and Premature Babies</p><p>1 Ostrovityanova str., 117997</p><p>15 Sadovaya-Kudrinskaya str., Moscow, 123001</p></bio><email xlink:type="simple">cherkasovasv@mail.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0001-0614-9215</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Фадеева</surname><given-names>А. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Fadeeva</surname><given-names>A. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Фадеева Анастасия Андреевна, студентка 6-го курса педиатрического факультета </p><p>117997, Москва, ул. Островитянова, 1</p></bio><bio xml:lang="en"><p>Anastasia A. Fadeeva, 6th-year student of Paediatric faculty </p><p>1 Ostrovityanova str., 117997</p></bio><email xlink:type="simple">anastasiyyarrr@gmail.com</email><xref ref-type="aff" rid="aff-3"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-2279-5230</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Ярушникова</surname><given-names>А. С.</given-names></name><name name-style="western" xml:lang="en"><surname>Yarushnikova</surname><given-names>A. S.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Ярушникова Анастасия Сергеевна, студентка 6-го курса педиатрического факультета </p><p>117997, Москва, ул. Островитянова, 1</p></bio><bio xml:lang="en"><p>Anastasia S. Yarushnikova, 6th-year student of Paediatric faculty </p><p>1 Ostrovityanova str., 117997</p></bio><email xlink:type="simple">anastasiyyarrr@gmail.com</email><xref ref-type="aff" rid="aff-3"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0003-2946-4773</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Пилюзина</surname><given-names>Ю. С.</given-names></name><name name-style="western" xml:lang="en"><surname>Piliuzina</surname><given-names>Yu. S.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Пилюзина Юлия Сергеевна, студентка 6-го курса педиатрического факультета </p><p>117997, Москва, ул. Островитянова, 1</p></bio><bio xml:lang="en"><p>Yulia S. Piliuzina, 6th-year student of Paediatric faculty </p><p>1 Ostrovityanova str., 117997</p></bio><email xlink:type="simple">miss.piliuzina@yandex.ru</email><xref ref-type="aff" rid="aff-3"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-8342-405X</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Смольянникова</surname><given-names>А. Б.</given-names></name><name name-style="western" xml:lang="en"><surname>Smolyannikova</surname><given-names>A.  B.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Смольянникова Анастасия Борисовна, студентка 6-го курса педиатрического факультета </p><p>117997, Москва, ул. Островитянова, 1</p></bio><bio xml:lang="en"><p>Anastasia B. Smolyannikova, 6th-year student of Paediatric faculty </p><p>1 Ostrovityanova str., 117997</p></bio><email xlink:type="simple">anas24smol@mail.ru</email><xref ref-type="aff" rid="aff-3"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Шабельникова</surname><given-names>Е. И.</given-names></name><name name-style="western" xml:lang="en"><surname>Shabelnikova</surname><given-names>E. I.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Шабельникова Екатерина Игоревна, к.м.н., ассистент кафедры госпитальной педиатрии имени академика В. А. Таболина </p><p>117997, Москва, ул. Островитянова, 1</p></bio><bio xml:lang="en"><p> </p><p>Ekaterina I. Shabelnikova, MD, assistant of Academician V. A. Tabolin Department of Hospital Paediatrics </p><p>1 Ostrovityanova str., 117997</p></bio><email xlink:type="simple">eishabelnikova@rambler.ru</email><xref ref-type="aff" rid="aff-3"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Макарова</surname><given-names>Л. М.</given-names></name><name name-style="western" xml:lang="en"><surname>Makarova</surname><given-names>L. M. </given-names></name></name-alternatives><bio xml:lang="ru"><p>Макарова Людмила Михайловна, заведующая 8-м инфекционным отделением (для новорожденных</p><p>123317, Москва, Шмитовский проезд, 29</p></bio><bio xml:lang="en"><p>Lyudmila M. Makarova, MD, Head of the Infectious Diseases Department for Newborns № 8</p><p>29 Shmitovsky Proezd, Moscow, 123317</p></bio><email xlink:type="simple">makarova.inf8@yandex.ru</email><xref ref-type="aff" rid="aff-4"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Овсянникова</surname><given-names>М. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Ovsyannikova</surname><given-names>M. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Овсянникова Марина Анатольевна, неонатолог 8-го инфекционного отделения (для новорожденных) </p><p>123317, Москва, Шмитовский проезд, 29</p></bio><bio xml:lang="en"><p>Marina A. Ovsyannikova, MD, Neonatologist of the Infectious Diseases Department for Newborns № 8 </p><p>29 Shmitovsky Proezd, Moscow, 123317</p></bio><email xlink:type="simple">marinaovs81@mail.ru</email><xref ref-type="aff" rid="aff-4"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-0172-0520</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Левченко</surname><given-names>Л. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Levchenko</surname><given-names>L. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Левченко Людмила Анатольевна, доктор медицинских наук, профессор кафедры госпитальной педиатрии имени академика В. А. Таболина; неонатолог </p><p>117997, Москва, ул. Островитянова, 1</p><p>123001, Москва, ул. Садовая-Кудринская, 15</p></bio><bio xml:lang="en"><p>Lyudmila A. Levchenko, Dr. of Sci. (Med.), Professor professor of Academician V. A. Tabolin Department of Hospital Paediatrics</p><p>1 Ostrovityanova str., 117997 </p><p>15 Sadovaya-Kudrinskaya str., Moscow, 123001</p></bio><email xlink:type="simple">levchenko.doctor@gmail.com</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0008-5910-023X</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Демьянова</surname><given-names>Т. Г.</given-names></name><name name-style="western" xml:lang="en"><surname>Demyanova</surname><given-names>T. G.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Демьянова Татьяна Геннадьевна, кандидат медицинских наук, доцент кафедры госпитальной педиатрии имени академика В. А.Таболина</p><p>117997, Москва, ул. Островитянова, 1</p></bio><bio xml:lang="en"><p>Tatyana G. Demyanova, MD, Associate professor of Academician V. A. Tabolin Department of Hospital Paediatrics </p><p>1 Ostrovityanova str., 117997</p></bio><email xlink:type="simple">demyanovat@yandex.ru</email><xref ref-type="aff" rid="aff-3"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>Федеральное государственное автономное образовательное учреждение высшего образования Российский национальный исследовательский медицинский университет имени Н. И. Пирогова Министерства здравоохранения Российской Федерации; Государственное бюджетное учреждение здравоохранения города Москвы Детская городская клиническая больница № 9 имени Г. Н. Сперанского Департамента здравоохранения города Москвы</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Federal State Autonomous Educational Institution of Higher Education N. I. Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation; State Budgetary Healthcare Institution of the City of Moscow Children's City Clinical Hospital No. 9 named after G. N. Speransky of the Department of Health of the City of Moscow</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>Федеральное государственное автономное образовательное учреждение высшего образования Российский национальный исследовательский медицинский университет имени Н. И. Пирогова Министерства здравоохранения Российской Федерации; Государственное бюджетное учреждение здравоохранения города Москвы детская городская клиническая больница имени Н. Ф. Филатова Департамента здравоохранения города Москвы</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Federal State Autonomous Educational Institution of Higher Education N. I. Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation; State Budgetary Healthcare Institution of the City of Moscow Filatov N. F. Children's City Hospital of the Department of Health of the City of Moscow</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-3"><aff xml:lang="ru"><institution>Федеральное государственное автономное образовательное учреждение высшего образования Российский национальный исследовательский медицинский университет имени Н. И. Пирогова Министерства здравоохранения Российской Федерации</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Federal State Autonomous Educational Institution of Higher Education N. I. Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-4"><aff xml:lang="ru"><institution>Государственное бюджетное учреждение здравоохранения города Москвы Детская городская клиническая больница № 9 имени Г. Н. Сперанского Департамента здравоохранения города Москвы</institution><country>Россия</country></aff><aff xml:lang="en"><institution>State Budgetary Healthcare Institution of the City of Moscow Children's City Clinical Hospital No. 9 named after G. N. Speransky of the Department of Health of the City of Moscow</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2023</year></pub-date><pub-date pub-type="epub"><day>18</day><month>07</month><year>2023</year></pub-date><volume>0</volume><issue>6</issue><fpage>48</fpage><lpage>54</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Саркисян Е.А., Черкасова С.В., Фадеева А.А., Ярушникова А.С., Пилюзина Ю.С., Смольянникова А.Б., Шабельникова Е.И., Макарова Л.М., Овсянникова М.А., Левченко Л.А., Демьянова Т.Г., 2023</copyright-statement><copyright-year>2023</copyright-year><copyright-holder xml:lang="ru">Саркисян Е.А., Черкасова С.В., Фадеева А.А., Ярушникова А.С., Пилюзина Ю.С., Смольянникова А.Б., Шабельникова Е.И., Макарова Л.М., Овсянникова М.А., Левченко Л.А., Демьянова Т.Г.</copyright-holder><copyright-holder xml:lang="en">Sarkisyan H.A., Cherkasova S.V., Fadeeva A.A., Yarushnikova A.S., Piliuzina Y.S., Smolyannikova A.B., Shabelnikova E.I., Makarova L.M., Ovsyannikova M.A., Levchenko L.A., Demyanova T.G.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://journal.lvrach.ru/jour/article/view/1085">https://journal.lvrach.ru/jour/article/view/1085</self-uri><abstract><p>Наследственная тирозинемия 1-го типа, или гепаторенальная тирозинемия, – тяжелое орфанное аутосомнорецессивное заболевание с нарушением обмена тирозина, вызванное дефицитом фермента фумарилацетоацетатгидролазы (fumarylacetoacetate hydrolase, FAH). Заболевание встречается с частотой 1:100 000-1:120 000 случаев живорождения, в ряде регионов (например, на территории Чеченской Республики) наследственная тирозинемия 1-го типа может встречаться значительно чаще. При наследственной тирозинемии 1-го типа отмечается повышение тирозина, сукцинилацетона и других токсических метаболитов в крови, а также их накопление в органах-мишенях, что приводит к поражению печени с развитием цирроза и печеночно-клеточной недостаточности, почечных канальцев – с развитием синдрома Фанкони и гипофосфатемического рахита, а также центральной нервной системы. В ряде случаев в патологический процесс может вовлекаться миокард с формированием гипертрофической кардиомиопатии. Заболевание представляет большую сложность для дифференциальной диагностики ввиду полиорганности поражения, частого сочетания с другими наследственными патологиями. Лечение наследственной тирозинемии 1-го типа на современном этапе основано на применении элиминационной диетотерапии и препаратов для патогенетической терапии. Активно изучаются возможности генно-инженерных методов в этиотропной терапии данного заболевания. В представленной статье описан случай острой формы наследственной тирозинемии 1-го типа у ребенка с множественными врожденными пороками развития центральной нервной системы, включающими в себя синдром Денди – Уокера, с нарушением формирования челюстно-лицевого аппарата, с проявлениями иммунодефицитного состояния и тяжелым генерализованным редицивирующим инфекционным процессом, обусловленным полирезистентной смешанной бактериально-грибковой флорой. Описана динамика неврологической симптоматики у пациента на первом году жизни на фоне патогенетической терапии основного заболевания, приведены лабораторные показатели функции печени. </p></abstract><trans-abstract xml:lang="en"><p>Hereditary tyrosinemia type 1 or hepatorenal tyrosinemia is a severe orphan autosomal-recessive disorder of tyrosine metabolism caused by a deficiency of the enzyme fumarylacetoacetate hydrolase (FAH). The disease is diagnosed in approximately 1:100 000-1:120 000 cases of live births, and in certain regions (such as the Chechen Republic in Russian Federation) the estimated frequency of diagnosis can be significantly higher. In hereditary tyrosinemia type 1, blood levels of tyrosine, succinylacetone and other toxic metabolites are increased, which results in the accumulation of the toxic metabolites in target organs causingliver damage with progressive development of liver failure and liver cirrhosis, damage to the renal tubules resulting in Fanconi syndrome and hypophosphatemic rickets, and central nervous system. In some patients, myocardium could be involved in the pathological process, resulting in the development of hypertrophic cardiomyopathy. The disease presents a great challenge for differential diagnosis due to its polyorganic nature and frequent combination with other hereditary disorders. The modern treatment of hereditary tyrosinemia type 1 includes an elimination-based diet and pathogenetic drug therapy. The potential of genetic engineering methods in target therapy of hereditary tyrosinemia type 1 is being actively researched. Within the article if presented a case of early onset hereditary tyrosinemia type 1 in an infant with multiple congenital defects of central nervous system, including Dandy – Walker syndrome, and congenital defects of maxillofacial area, with signs of an immunodeficiency state and a severe generalized recurring infectious process involving poly-resistant mixed flora. The dynamic changes of neurologic signs are provided for the first year of life of the patient receiving the pathogenetic therapy for the main disease. Laboratory findings are provided, showing the dynamic changes in liver function of the patient.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>тирозинемия 1-го типа</kwd><kwd>гепаторенальная тирозинемия</kwd><kwd>множественные врожденные пороки развития</kwd><kwd>синдром Денди — Уокера</kwd><kwd>тубулопатия</kwd></kwd-group><kwd-group xml:lang="en"><kwd>tyrosinemia type 1</kwd><kwd>hepatorenaltyrosinemia</kwd><kwd>multiple congenital defects</kwd><kwd>Dandy — Walker syndrome</kwd><kwd>tubulopathy</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Russo P. A., Mitchell G. A., and Tanguay R. M. Tyrosinemia: a review // Pediatr Dev Pathol. 2001;4(3):212-221. DOI: 10.1007/s100240010146.</mixed-citation><mixed-citation xml:lang="en">Russo P. A., Mitchell G. A., and Tanguay R. M. Tyrosinemia: a review // Pediatr Dev Pathol. 2001;4(3):212-221. 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