pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2011-0-4-58-66pulmo-360Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL STUDIESГодичное наблюдение за больными, перенесшими острое повреждение легких / острый респираторный дистресс синдром, вызванный вирусом гриппа А / H1N1A one-year follow-up study of patients survived after ALI / ARDS caused by influenza A / H1N1АвдеевС. Н.AvdeevS. N.

д. м. н., проф., руководитель клинического отдела 

105077, Москва, ул. 11-я Парковая, 32, корп. 4. Тел. / факс: (495) 465-52-64.

serg_avdeev@list.ruКарчевскаяН. А.KarchevskayaN. A.

научный сотрудник лаборатории интенсивной терапии и дыхательной недостаточности

105077, Москва, ул. 11-я Парковая, 32, корп. 4. Тел. / факс: (495) 465-74-15.

karchevskaia@mail.ruБаймакановаГ. Е.BaimakanovaG. E.

к. м. н., старший научный сотрудник лаборатории интенсивной терапии и дыхательной недостаточности

105077, Москва, ул. 11-я Парковая, 32, корп. 4. Тел. / факс: (495) 465-74-15.

gulsara.bai@mail.ruЧернякА. В.CherniakA. V.

к. м. н., зав. лабораторией функциональных и ультразвуковых методов исследования

105077, Москва, ул. 11-я Парковая, 32, корп. 4. Тел. / факс: (495) 465-53-84.

achi2000@mail.ruФГУ "НИИ пульмонологии" ФМБА РоссииRussian Federation201128082011045866Copyright © Авдеев С.Н., Карчевская Н.А., Баймаканова Г.Е., Черняк А.В., 20112011Авдеев С.Н., Карчевская Н.А., Баймаканова Г.Е., Черняк А.В.Avdeev S.N., Karchevskaya N.A., Baimakanova G.E., Cherniak A.V.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/360

Резюме. Задачей исследования было изучение долгосрочных последствий у больных, переживших острое повреждение легких / острый респираторный дистресс-синдром (ОПЛ / ОРДС), вызванный вирусом гриппа A / H1N1, а также анализ влияния длительной терапии N-ацетилцистеином – NAC (Флуимуцил, Zambon Group, Италия) на динамику клинических и функциональных изменений у данных пациентов.

Исследование длительностью 12 мес. имело проспективный, открытый дизайн. В него были включены 22 больных, перенесших ОПЛ / ОРДС, вызванный вирусом гриппа A / H1N1. Через 3, 6 и 12 мес. после выписки пациентам проводились измерение функции внешнего дыхания (ФВД), газовый анализ артериальной крови, 6-минутный шаговый тест (6-МШТ) и компьютерная томография (КТ) грудной клетки.

В течение 1-го года у больных наблюдалось улучшение всех параметров ФВД: прирост ФЖЕЛ, ОЕЛ, DLCO к 12-му мес. – на 28,7; 17,5 и 31,4 % соответственно (для всех p < 0,05). Через 1 год после выписки DLCO < 80 % сохранялось у 23 % больных. Средняя дистанция в 6-МШТ за 12 мес. возросла от 454 Ѓ} 37 до 568 Ѓ} 47 м (р = 0,002). За время наблюдения отмечена значительная положительная динамика КТ-изменений легких, к 12-му мес. исследования у 41 % больных КТ-картина легких была практически нормальной. Терапия NAC (n = 11) привела к более быстрому улучшению DLCO через 3 мес. (76,3 Ѓ} 11,8 % vs 63,0 Ѓ} 10,6 % у пациентов контрольной группы; р = 0,012) и дистанции в 6-МШТ через 3 мес. (533 Ѓ} 42 м vs 490 Ѓ} 46 м; р = 0,033).

Таким образом, у пациентов, выживших после ОПЛ / ОРДС, вызванного вирусом гриппа A / H1N1, в течение 1-го года наблюдается значительная положительная динамика показателей ФВД, газообмена, КТ легких и физической выносливости, однако у ряда больных даже через 1 год после выписки сохраняются изменения ФВД (преимущественно DLCO) и КТ легких. Терапия NAC приводит к более быстрому улучшению DLCO и приросту дистанции в нагрузочном тесте.

Summary. The study analyzed long-term consequences of acute lung injury / acute respiratory distress syndrome (ALI / ARDS) caused by influenza A / H1N1 and effects of long-term treatment with N-acetylcysteine (NAC) on clinical and functional recovery of survived patients. This was an open, prospective, 12-month study involved 22 patients survived from ALI / ARDS caused by influenza A / H1N1. The patients' lung function, arterial blood gases, physical tolerance in 6-min walking test (6MWT) and computed tomography (CT) of the lungs were monitored in 3, 6, and 12 months after discharge.

During the follow-up, all lung function parameters improved: FVC, TLC, and DLCO increased by 28.7 %, 17.5 % and 31.4 %, respectively (p < 0.05 for all). In a year after discharge, DLCO < 80 %pred. was found in 23 % of patients. At 12 months, the mean 6MWT distance increased from 454 Ѓ} 37 to 568 Ѓ} 47 m (р = 0.002). Significant improvement was noted in CT findings and 41% of patients had quite normal lung CT at 12 months. Therapy with NAC (n = 11) has led to more rapid improvement in DLCO (76.3 Ѓ} 11.8 %pred. vs 63.0 Ѓ} 10.6 %pred. in controls; р = 0.012) and 6MWT distance (533 Ѓ} 42 m vs 490 Ѓ} 46 m, respectively; р = 0.033) at 3 months.

Therefore, patients survived from ALI / ARDS caused by influenza A / H1N1 demonstrated significant recovery of lung function, gas exchange, lung CT picture and physical tolerance but in some of them, persistent disorders of lung function (mainly in DLCO) and lung CT have been still found at 1 year after discharge. Treatment with NAC allowed more rapid improvement in DLCO and exercise tolerance.

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