pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2018-28-5-519-529pulmo-1053Research ArticleПЕРЕДОВАЯ СТАТЬЯEDITORIALACOS – самостоятельная нозологическая форма? Клиническая картина и диагностика ACOSIs ACOS an independent nosology? Clinical signs and diagnosis of ACOSФедосеевГ. Б.FedoseevG. B.

Федосеев Глеб Борисович – доктор медицинских наук, член-корреспондент Российской академии наук, профессор кафедры госпитальной терапии им. акад. М.В.Черноруцкого

197022, Санкт-Петербург, ул. Льва Толстого, 6–8

Gleb B. Fedoseev – Associate Member of Russian Academy of Sciences, Doctor of Medicine, Professor of Chair of Hospital Therapy named after Academician M.V.Chernorutsky

ul. L'va Tolstogo 6/8, Saint-Petersburg, 197022

fedoseevsp@mail.ruТрофимовВ. И.TrofimovV. I.

Трофимов Василий Иванович – доктор медицинских наук, профессор, заведующий кафедрой терапии госпитальной с курсом аллергологии и иммунологии имени академика М.В.Черноруцкого

197022, Санкт-Петербург, ул. Льва Толстого, 6–8

Vasiliy I. Trofimov – Doctor of Medicine, Professor, Head of Chair of Hospital Therapy with the Course of Allergology and Immunology named after Academician M.V.Chernorutsky

ul. L'va Tolstogo 6/8, Saint-Petersburg, 197022

trofvi@mail.ruНегруцаК. В.NegrutsaK. V.

Негруца Катрина Владимировна – аспирант кафедры госпитальной терапии им. акад. М.В.Черноруцкого

197022, Санкт-Петербург, ул. Льва Толстого, 6–8

Katrina V. Negrutsa – Head of Chair of Hospital Therapy with the Course of Allergology and Immunology named after Academician M.V.Chernorutsky

ul. L'va Tolstogo 6/8, Saint-Petersburg, 197022

fedoseevsp@mail.ruТимчикВ. Г.TimchikV. G.

Тимчик Виктория Геннадьевна – кандидат медицинских наук, врач функциональной диагностики отделения функциональной диагностики № 2 научно-клинического исследовательского центра

197022, Санкт-Петербург, ул. Льва Толстого, 6–8

Viktoriya G. Timchik – Candidate of Medicine, Functional Diagnostics Physician, Functional Diagnostics Department No.2, Scientific Clinical Research Center

ul. L'va Tolstogo 6/8, Saint-Petersburg, 197022

fedoseevsp@mail.ruГолубеваВ. И.GolubevaV. I.

Голубева Вера Игоревна – биолог лаборатории клинической иммунологии и молекулярной диагностики

197022, Санкт-Петербург, ул. Льва Толстого, 6–8

Vera I. Golubeva – Biologist, Clinical Immunology and Molecular Diagnostics Laboratory

ul. L'va Tolstogo 6/8, Saint-Petersburg, 197022

fedoseevsp@mail.ruАлександринВ. А.AleksandrinV. A.

Александрин Виктор Альбертович – кандидат медицинских наук, доцент кафедры госпитальной терапии им. акад. М.В.Черноруцкого

197022, Санкт-Петербург, ул. Льва Толстого, 6–8

Viktor A. Aleksandrin – Candidate of Medicine, Associate Professor of Chair of Hospital Therapy named after Academician M.V.Chernorutsky

ul. L'va Tolstogo 6/8, Saint-Petersburg, 197022

victoralexandrin@list.ruРазумовскаяТ. С.RazumovskayaT. S.

Разумовская Татьяна Сергеевна – ведущий инженер отделения функциональной диагностики № 2 научно-клинического исследовательского центра

197022, Санкт-Петербург, ул. Льва Толстого, 6–8

Tatyana S. Razumovskaya – Lead Engineer, Functional Diagnostics Department No.2, Scientific Clinical Research Center

ul. L'va Tolstogo 6/8, Saint-Petersburg, 197022

fedoseevsp@mail.ruРабикЮ. Д.RabikYu. D.

Рабик Юлия Дмитриевна – врач функциональной диагностики, заведующая отделением функциональной диагностики № 2 научно-клинического исследовательского центра 

197022, Санкт-Петербург, ул. Льва Толстого, 6–8

Yuliya D. Rabik – Functional Diagnostics Physician, Functional Diagnostics Department No.2 Officer, Scientific Clinical Research Center

ul. L'va Tolstogo 6/8, Saint-Petersburg, 197022

fedoseevsp@mail.ruКрякуновК. Н.KryakunovK. N.

Крякунов Константин Николаевич – кандидат медицинских наук, доцент кафедры госпитальной терапии им. акад. М.В.Черноруцкого

197022, Санкт-Петербург, ул. Льва Толстого, 6–8

Konstantin N. Kryakunov – Candidate of Medicine, Associate Professor of Chair of Hospital Therapy named after Academician M.V. Chernorutsky

ul. L'va Tolstogo 6/8, Saint-Petersburg, 197022

 

fedoseevsp@mail.ruФедеральное государственное бюджетное образовательное учреждение высшего образования «Первый Санкт-Петербургский государственный медицинский университет имени академика И.П.Павлова» Министерства здравоохранения Российской ФедерацииРоссияAcademician I.P.Pavlov First Federal Saint-Petersburg State Medical University of the Ministry of Health of the Russian FederationRussian Federation201824122018285519529Copyright © Федосеев Г.Б., Трофимов В.И., Негруца К.В., Тимчик В.Г., Голубева В.И., Александрин В.А., Разумовская Т.С., Рабик Ю.Д., Крякунов К.Н., 20182018Федосеев Г.Б., Трофимов В.И., Негруца К.В., Тимчик В.Г., Голубева В.И., Александрин В.А., Разумовская Т.С., Рабик Ю.Д., Крякунов К.Н.Fedoseev G.B., Trofimov V.I., Negrutsa K.V., Timchik V.G., Golubeva V.I., Aleksandrin V.A., Razumovskaya T.S., Rabik Y.D., Kryakunov K.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.pulmonology.ru/pulm/article/view/1053

На данный момент изучение синдрома перекреста бронхиальной астмы (БА) и хронической обструктивной болезни легких (ХОБЛ) – asthma-COPD overlap syndrome (ACOS) находится на начальном этапе, при этом исследования в области этиологии, фенотипов и персонализированной терапии данного заболевания отсутствуют. Актуальность данной работы обусловлена не только недостаточной изученностью данного патологического состояния, но и все более очевидными серьезностью, распространенностью и недостаточной курабельностью ACOS. Целью исследования явилось определение особенностей воспаления и возможности этиологической диагностики больных ACOS. Материалы и методы. В рамках исследования (n = 175) у лиц с БА (n = 78), ХОБЛ (n = 38), ACOS (n = 39) и практически здоровых (n = 20) проводилось общее клиническое и лабораторное обследование, определялись уровни α1-антитрипсина (ААТ), иммуноглобулинов (Ig)-G и IgE к 4 бактериальным антигенам (Streptococcus pneumoniae, Haemophilus influenzae, Neisseria perflava и Staphylococcus aureus), а также показатели функции внешнего дыхания (ФВД). Результаты. Определены особенности не только клинического течения ACOS по сравнению с таковым при БА, ХОБЛ и у здоровых лиц, но и воспаления у больных БА, ACOS и ХОБЛ с учетом корреляционных связей между маркером воспаления ААТ и показателями ФВД. Для этиологической диагностики у больных ACOS оценены возможности использования титров специализированных IgG и IgE к бактериальным антигенам. Заключение. Наличие у больных ACOS достоверной отрицательной связи ААТ с показателями ФВД и высоких уровней IgG к бактериальным антигенам и отсутствие этих связей у больных БА и ХОБЛ позволяет считать ACOS самостоятельной, отличной от БА и ХОБЛ, связанной с микробным воспалением и маркируемой ААТ нозологической формой.

The aim of this study was to analyze inflammation features and possible causes of asthma-COPD overlap syndrome (ACOS). Methods. Clinical examination was performed for all patients included in the study. Blood levels of alpha-1-antitripsin (AAT), immunoglobulin (Ig) G and E antibodies against four bacterial antigens (Streptococcus pneumoniae, Haemophilus influenzae, Neisseria perflava, and Staphylococcus aureus), and lung function were measured in all the patients. Results. The study involved 175 patients including 78 patients with bronchial asthma, 39 patients with ACOS, 38 patients with COPD, and 20 healthy individuals. AAT blood level was reversely related to lung function and to increased IgG-antibody levels against bacterial antigens. Conclusion. Due to this fact, the authors suppose that the ACOS should be considered as an independent nosology distinct from asthma and COPD, and related to microbial inflammation and AAT level.

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