pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2017-27-2-198-205pulmo-843Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL STUDIESРоль молекулярно-генетических исследований в диагностике и профилактике развития профессиональных заболеваний органов дыханияA role of molecular analysis for diagnosis and prevention of occupational lung diseasesВасильеваО. С.Vasil'evaO S.

Васильева Ольга Сергеевна – доктор медицинских наук, профессор, заведующая лабораторией экологозависимых и профессиональных легочных заболеваний 

105077, Москва, ул. 11-я Парковая, 32, корп. 4

Ol'ga S. Vasil'eva, Doctor of Medicine, Professor, Head of Laboratory of Environmental and Occupational Pulmonary Diseases 

Odinnadtsataya Parkovaya ul. 32, build. 4, Moscow, 105077

ovasil@mail.ruКузьминаЛ. П.Kuz'minaL. P.

Кузьмина Людмила Павловна – доктор биологических наук, профессор, заведующая клиническим отделом профессиональных и производственно обусловленных заболеваний, заведующая лабораторией медико-биологических исследований 

105118, Москва, Проспект Буденного, 31

Lyudmila P. Kuz'mina, Doctor of Biology, Professor, Head of Clinical Division of Occupational and Work-Related Diseases, Head of Laboratory of Medical and Biological Investigations 

Prospekt Budennogo 31, Moscow, 105118

lpkuzmina@mail.ruКравченкоН. Ю.KravchenkoN. Yu.

Кравченко Наталья Юрьевна – научный сотрудник лаборатории экологозависимых и профессиональных легочных заболеваний 

105077, Москва, ул. 11-я Парковая, 32, корп. 4

Natal'ya Yu. Kravchenko, Researcher, Laboratory of Environmental and Occupational Pulmonary Diseases 

Odinnadtsataya Parkovaya ul. 32, build. 4, Moscow, 105077

pulmokongress@mail.ruФедеральное государственное бюджетное учреждение «Научно-исследовательский институт пульмонологии Федерального медико-биологического агентства России»РоссияFederal Pulmonology Research Institute, Federal Medical and Biological Agency of RussiaRussian FederationФедеральное государственное бюджетное научное учреждение «Научно-исследовательский институт медицины труда»РоссияFederal Research Institute of Occupational MedicineRussian Federation201705072017272198205Copyright © Васильева О.С., Кузьмина Л.П., Кравченко Н.Ю., 20172017Васильева О.С., Кузьмина Л.П., Кравченко Н.Ю.Vasil'eva O.S., Kuz'mina L.P., Kravchenko N.Y.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/843

Развитие профессиональных респираторных заболеваний, в частности бронхиальной астмы (БА) и хронической обструктивной болезни легких (ХОБЛ), зависит не только от условий труда, свойств и дозы экспонированных аэрозолей в зоне дыхания, но и от индивидуальной восприимчивости организма к воздействию чужеродных агентов и способности им противостоять, т. е. от генотипа. Оценкой индивидуального риска развития легочного заболевания профессионального генеза и системы защиты от воздействия производственных аэрозолей служат исследования гипосекреторных мутаций – PiMZ гена α1-ингибитора протеаз (ИП), а также гена детоксикации системы глутатион-трансферазы – GST. Цель. Изучение молекулярно-генетических особенностей формирования БА и ХОБЛ у лиц, работающих в условиях воздействия токсических аэрозолей и определение возможных путей профилактики заболеваний. Материалы и методы. При проведении когортного рандомизированного проспективного исследования с участием работников (n = 159) пищевого производства установлено, что у лиц с профессиональным риском развития заболеваний органов дыхания, имевших контакт с биологически активными аэрозолями (n = 126), выявлены нарушения функции внешнего дыхания (29,3 %) с гиперчувствительностью к производственным факторам (20,6 %). Диагнозы БА и ХОБЛ установлены у 17,4 и 11,9 % работников соответственно. У 5,5 % выявлены гипосекреторные варианты гена α1-ИП (PiMS, PiMZ). Число лиц с отсутствием ферментов GSTM1 и GSTT1 составило 65 и 60 % соответственно. У 20 % работников с респираторными симптомами найдены аллели риска гена ангиотензинпревращающего фермента (ID, DD), свидетельствующие о восприимчивости к сердечно-сосудистой патологии, что характерно для лиц, экспонированных к пылевым частицам и чужеродным агентам. Результаты. Полученные данные не только демонстрируют значимость проведения молекулярно-генетических исследований с определением биомаркеров индивидуальной восприимчивости организма к профессиональным факторам, но и позволяют определить степень риска развития респираторных заболеваний, прогнозировать тяжесть их течения и обосновать лечебно профилактические мероприятия. Заключение. При изучении генетической предрасположенности к вредным факторам, присутствующим на рабочем месте, появляется возможность идентификации лиц, особо чувствительных к экспозиции вредных веществ, и установления предельно допустимых уровней содержания поллютантов на рабочем месте, что, в свою очередь, позволит осуществить персонифицированный подход к профилактике легочных заболеваний.

Morbidity of occupational respiratory diseases depends on workplace environmental and individual genotype as well. The aim of our study was to investigate molecular biomarkers of bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD) in workers exposed to toxic aerosols. The second aim was to develop preventive measures for these diseases. Methods. This was a randomized prospective cohort study that involved workers of food industry. Results. The study involved 159 food industry workers. Lung function abnormalities (29.3%) and hyperresponsiveness to workrelated factors (20.6%) were found in 126 of 159 workers who were at risk of occupational respiratory diseases and were exposed to biological active aerosols. BA and COPD were diagnosed in 17.4% and 11.9% of workers, respectively. Hyposecretory variants (PiMS, PiMZ) of alfa-1-protease inhibitor (API) gene were found in 5.5% of workers. Proportions of workers with deficit of GSTM1 and GSTT1 enzymes were 65% and 60%, respectively. Risk alleles (ID, DD) of the angiotensin converting enzyme (ACE) gene that indicate the susceptibility to cardiovascular diseases and are typical for subjects exposed to dust particles and other hazardous agents were found in 20% of workers. Conclusion. Our results have demonstrated the role of molecular biomarkers of individual susceptibility to occupational factors. Molecular biomarkers could define the risk of occupational respiratory diseases, predict their course and help to choose therapeutic and preventive measures. Identifying the susceptible workers could underlie personalized approach to prevention of respiratory diseases.

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