pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2024-34-6-896-903pulmo-4404Research ArticleОБЗОРЫREVIEWБиомаркеры и генетические предикторы при гиперчувствительном пневмонитеBiomarkers and genetic predictors of hypersensitivity pneumonitishttps://orcid.org/0000-0002-0685-4133ТрушенкоН. В.TrushenkoN. V.

Трушенко Наталья Владимировна – к. м. н., доцент кафедры пульмонологии Института клинической медицины имени Н.В. Склифосовского Первый МГМУ имени И.М. Сеченова; научный сотрудник лаборатории клинической пульмонологии НИИП Федерального медико-биологического агентства.

119991, Москва, ул. Трубецкая, 8, стр. 2; 115682, Москва, Ореховый бульвар, 28; тел.: (495) 708-35-76

Natal’ya V. Trushenko - Candidate of Medicine, Associate Professor, Department of Pulmonology, N.V.Sklifosovsky Institute of Clinical Medicine, FSAEI HE I.M. Sechenov FMSMU of the Ministry of Health of the Russian Federation (Sechenov University); Researcher, Laboratory of Clinical Pulmonology, Federal State Budgetary Institution “Pulmonology Scientific Research Institute” under Federal Medical and Biological Agency RF.

Ul. Trubetskaya 8, build. 2, Moscow, 119991; Orekhovyy bul’var 28, Moscow, 115682; tel.: (495) 708-35-76

trushenko.natalia@yandex.ruhttps://orcid.org/0000-0001-8299-0025НиколенкоА. М.NikolenkoA. M.

Николенко Александра Михайловна – аналитик Первый МГМУ имени И.М. Сеченоваю

119991, Москва, ул. Трубецкая, 8, стр. 2; тел.: (499) 245-47-94

Alexandra M. Nikolenko - Analyst, Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov.

Ul. Trubetskaya 8, build. 2, Moscow, 119991; tel.: (499) 245-47-94

alexandranik.an@gmail.comhttps://orcid.org/0000-0001-9661-7213СувороваО. А.SuvorovaO. A.

Суворова Ольга Александровна – ассистент кафедры пульмонологии Института клинической медицины имени Н.В. Склифосовского.

119991, Москва, ул. Трубецкая, 8, стр. 2; тел.: (495) 708-35-76

Olga A. Suvorova - Assistant, Department of Pulmonology, N.V.Sklifosovsky Institute of Clinical Medicine, Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov.

Ul. Trubetskaya 8, build. 2, Moscow, 119991; tel.: (495) 708-35-76

olga.a.suvorova@mail.ruhttps://orcid.org/0000-0002-5999-2150АвдеевС. Н.AvdeevS. N.

Авдеев Сергей Николаевич – д. м. н., профессор, академик Российской академии наук, проректор по научной и инновационной работе, заведующий кафедрой пульмонологии Института клинической медицины имени Н.В. Склифосовского Первый МГМУ имени И.М. Сеченова; ведущий научный сотрудник НИИП Федерального медико-биологического агентства; главный внештатный специалист-пульмонолог Министерства здравоохранения Российской Федерации; директор Национального медицинского исследовательского центра по профилю «Пульмонология»; главный внештатный специалист-пульмонолог Министерства здравоохранения РФ.

119991, Москва, ул. Трубецкая, 8, стр. 2; 115682, Москва, Ореховый бульвар, 28; тел.: (499) 246-75-18

Sergey N. Avdeev, Doctor of Medicine, Professor, Academician of Russian Academy of Sciences - Vice-Rector for Research and Innovation, Head of the Department of Pulmonology, N.V. Sklifosovsky Institute of Clinical Medicine, FSAEI HE I.M. Sechenov FMSMU of the Ministry of Health of the Russian Federation (Sechenov University); Leading Researcher, Federal Pulmonology Research Institute, Federal Medical and Biological Agency of Russia; Chief Freelance Pulmonologist of the Ministry of Health of the Russian Federation; Director of the National Medical Research Center for Pulmonology; Chief Freelance Pulmonologist of the MHRF.

Ul. Trubetskaya 8, build. 2, Moscow, 119991; Orekhovyy bul’var 28, Moscow, 115682; tel.: (499) 246-75-18

serg_avdeev@list.ruФедеральное государственное автономное образовательное учреждение высшего образования Первый Московский государственный медицинский университет имени И.М. Сеченова Министерства здравоохранения Российской Федерации (Сеченовский Университет); Федеральное государственное бюджетное учреждение «Научно-исследовательский институт пульмонологии» Федерального медико-биологического агентства России»РоссияFederal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University); Federal State Budgetary Institution “Pulmonology Scientific Research Institute” under Federal Medical and Biological Agency of Russian FederationRussian FederationФедеральное государственное автономное образовательное учреждение высшего образования Первый Московский государственный медицинский университет имени И.М. Сеченова Министерства здравоохранения Российской Федерации (Сеченовский Университет)РоссияFederal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)Russian FederationФедеральное государственное автономное образовательное учреждение высшего образования Первый Московский государственный медицинский университет имени И.М. Сеченова Министерства здравоохранения Российской Федерации (Сеченовский Университет)РоссияFederal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University); Federal State Budgetary Institution “Pulmonology Scientific Research Institute” under Federal Medical and Biological Agency of Russian FederationRussian Federation202411122024346896903Copyright © Трушенко Н.В., Николенко А.М., Суворова О.А., Авдеев С.Н., 20242024Трушенко Н.В., Николенко А.М., Суворова О.А., Авдеев С.Н.Trushenko N.V., Nikolenko A.M., Suvorova O.A., Avdeev S.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/4404

Гиперчувствительный пневмонит (ГП) является воспалительным иммуноопосредованным интерстициальным заболеванием лег ких (ИЗЛ), которое развивается в ответ на повторные ингаляционные воздействия различных низкомолекулярных соединений у восприимчивых лиц. Согласно последним рекомендациям, выделяются нефибротический (нфГП) и фибротический (фГП) фенотипы ГП, при этом фГП ассоциирован с прогрессированием и худшим прогнозом. Дифференциальная диагностика ГП может быть сложной, при этом требуется тщательный сбор анамнеза заболевания, мультидисциплинарное обсуждение клинических и рентгенологических данных, оценка лимфоцитоза бронхоальвеолярной лаважной жидкости (БАЛЖ) и результатов гистопатологического исследования. Дифференцировать ГП от других ИЗЛ, в т. ч. фГП от идиопатического легочного фиброза, может быть непросто, поскольку клинические, рентгенологические и гистопатологические признаки ГП весьма вариабельны и схожи с признаками других ИЗЛ.

Целью обзора явилась систематизация имеющихся данных о предикторах ГП для использования их в диагностике.

Заключение. Установление диагноза имеет решающее значение для выбора тактики лечения и определения прогноза. Для диагностики ГП, прогнозирования его развития и течения могут использоваться такие показатели, как генетические предикторы, биомаркеры сыворотки крови и БАЛЖ. Ряд биомаркеров, такие как лимфоцитоз БАЛЖ и специфические преципитирующие IgG-антитела, уже широко используются в клинической практике. Другие показатели находятся на этапе исследований и могут быть в будущем внедрены в рутинное обследование пациентов с ГП.

Hypersensitivity pneumonitis (HP) is an inflammatory immune-mediated interstitial lung disease that develops in response to repeated inhalation exposures to various low molecular weight compounds in susceptible individuals. The current guidelines distinguish non-fibrotic and fibrotic phenotypes of HP, with fibrotic HP associated with progression and worse prognosis. The differential diagnosis of HP can be complex and requires careful historytaking, multidisciplinary discussion of clinical and radiological findings, evaluation of lymphocytosis in bronchoalveolar lavage (BAL), and histopathological examination. Differentiating HP from other interstitial lung diseases (ILDs), including fibrotic HP from idiopathic pulmonary fibrosis (IPF), can be difficult, as the clinical, radiological, and histopathological features of HP are highly variable and similar to those of other ILDs.

The aim of this review is to systematize the available evidence on predictors of HP for the use in diagnosis.

Conclusion. Making the diagnosis is crucial for selecting treatment strategies and prognosis. Indicators such as genetic predictors, serum biomarkers, and BAL can be used to diagnose HP, predict its development and course. Several biomarkers, such as BAL lymphocytosis and specific IgG – precipitating antibodies, are already widely used in clinical practice. Other indicators are still under investigation and may be implemented in the routine patient evaluation in the future.

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