pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2015-25-4-433-439pulmo-600Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL STUDIESОпределение фенотипов обострения хронической обструктивной болезни легких при использовании компьютерной томографииDetermination of chronic obstructive pulmonary disease exacerbation phenotypes using computed tomographyЦеймахИ. Я.TseymakhI. Ya.

к. м. н., доцент кафедры терапии и семейной медицины ГБОУ ВПО "Алтайский государственный медицинский университет" Минздрава России; тел.: (909) 5053537, факс (3852) 685023

PhD, Associate Professor at Department of Therapy and Family Medicine, Faculty of Postgraduate Physician Training, Altay State Medical University, Healthcare Ministry of Russia; tel.: (909) 5053537, fax: (3852) 685023

irintsei@mail.ruКоноваловВ. К.KonovalovV. K.

д. м. н., профессор кафедры лучевой диагностики и лучевой терапии ГБОУ ВПО "Алтайский государственный медицинский университет" Минздрава России; тел. / факс: (3852) 243381

MD, Professor at Department of Radiology and Radiation Therapy, Altay State Medical University, Healthcare Ministry of Russia; tel. / fax: (3852) 243381

kon4867@gmail.comСоколИ. Н.SokolI. N.

старший ординатор КГБУЗ "Диагностический центр Алтайского края; тел.: (3852) 243381

Chief resident at State Regional Diagnostic Center of the Altay kray; tel. / fax: (3852) 243381

isokol@dcak.ruУсольцеваС. Г.Usol'tsevaS. G.

врачординатор рентгенологического отделения КГБУЗ "Городская больница № 5, г. Барнаул"; тел.: (3852) 688406

Attending Physician at Radiological Division, City State Hospital N5, tel.: (3852) 688406

svetlanus09@mail.ruКостюченкоГ. И.KostyuchenkoG. I.

д. м. н., профессор, заместитель главного врача по научной работе КГБУЗ "Краевая клиническая больница"; тел.: (3852) 689856

MD, Professor, Deputy Director for Science, State Regional Clinical Hospital; tel. / fax: (3852) 689856

gkostyuchenko@mail.ruГБОУ ВПО "Алтайский государственный медицинский университет" Минздрава России: 656038, Барнаул, пр. Ленина 40РоссияAltay State Medical University, Healthcare Ministry of Russia: 75, Zmeinogorskiy trakt, Barnaul, 656045, RussiaRussian FederationКГБУЗ "Краевой диагностический центр Алтайского края": 656038, Барнаул, Комсомольский прт, 75аРоссияState Regional Diagnostic Center of the Altay kray: 75A, Komsomol'skiy av., Barnaul, 656038, RussiaRussian FederationКГБУЗ "Городская больница № 5, г. Барнаул": 656045, Барнаул, Змеиногорский тракт, 75РоссияCity State Hospital N5, Barnaul: 75, Zmeinogorskiy trakt, Barnaul, 656045, RussiaRussian FederationКГБУЗ "Краевая клиническая больница": 656024, Барнаул, ул. Ляпидевского, 1РоссияState Regional Clinical Hospital: 1, Lyapidevskogo str., Barnaul, 656024, RussiaRussian Federation201521102015254433439Copyright © Цеймах И.Я., Коновалов В.К., Сокол И.Н., Усольцева С.Г., Костюченко Г.И., 20152015Цеймах И.Я., Коновалов В.К., Сокол И.Н., Усольцева С.Г., Костюченко Г.И.Tseymakh I.Y., Konovalov V.K., Sokol I.N., Usol'tseva S.G., Kostyuchenko G.I.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/600

У больных с обострением хронической обструктивной болезни легких (ХОБЛ) изучались типы структурных изменений нижних дыхательных путей при использовании компьютерной томографии (КТ) во взаимосвязи с клинико-функциональными характеристиками и биологическими маркерами воспаления. В обсервационное когортное исследование были включены больные (n = 101) с клиническими признаками инфекционного обострения ХОБЛ, включая 2 или 3 положительных критерия по N.R.Anthonisen et al. (1987). По результатам КТ высокого разрешения пациенты были разделены на 2 подгруппы: в 1ю вошли больные ХОБЛ (n = 57) с бронхиолитом, во 2ю (n = 44) – пациенты с ХОБЛ без признаков патологии бронхиол. Проанализированы клинические симптомы, показатели легочных функциональных тестов и дыхательной недостаточности (ДН), структурные изменения паренхимы легких и маркеров адаптивного иммунного ответа. У больных с инфекционным обострением ХОБЛ вовлечение в воспалительный процесс мелких бронхов и бронхиол ассоциировалось с более тяжелым течением обострения, ДН, необходимостью респираторной поддержки, симптомами консолидации легочной паренхимы, увеличением гнойности мокроты, более низким уровнем маркера гуморального иммунного ответа общего сывороточного иммуноглобулина Е.

The objective of this study was to investigate structural changes of the lower respiratory tract using clinical and functional characteristics and biomarkers of inflammation in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD).

Methods

Methods. This observational cohort study involved 101 symptomatic patients with acute exacerbation of COPD who met 2 or 3 Anthonisen's criteria. According to high resolution computed tomography (HRCT) findings patients were divided into two groups: 57 patients with COPD and bronchiolitis and 44 people with COPD and no signs of bronchiole lesion. Clinical manifestation, lung function, respiratory failure, structural changes in the lung parenchyma and biomarkers of adaptive immune response were analyzed.

Results

Results. Inflammatory changes in small bronchi and bronchioles in patients with acute COPD exacer bation was associated with more severe exacerbation, occurrence of the respiratory failure, need in respiratory support, lung parenchyma consolidation, increased sputum purulence, lower total serum immunoglobulin E as a marker of humoral immune response.

Conclusion

Conclusion. Inflammation in bronchioles in patients with acute exacerbation of COPD is associated with more severe respiratory failure and need in respiratory support. Consolidation of the lung parenchyma is noted more often in patients with COPD and co existing bronchiolitis. Exacerbation of COPD accompanied by bronchiolitis is characterized by less prominent humoral immune hypersensitivity response that could be diagnosed by the total serum

immunoglobulin E level

immunoglobulin E level.

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