Обострение идиопатического легочного фиброза
https://doi.org/10.18093/0869-0189-2018-28-4-469-482
Аннотация
Обострение идиопатического легочного фиброза (ИЛФ) определяется как острое, клинически значимое респираторное ухудшение, обычно развивающееся в сроки < 1 мес., характеризующееся при проведении компьютерной томографии высокого разрешения новыми изменениями, такими как диффузные двусторонние изменения по типу матового стекла и / или консолидаты, а также отсутствием других явных клинических причин ухудшения – перегрузка объемом, сердечная недостаточность, тромбоэмболия легочной артерии и т. п. Обострения ИЛФ подразделяются на «вызванные», т. е. имеющие причины (например, инфекции, хирургические операции, лекарственная токсичность и др.), и идиопатические обострения – случаи, где причину установить не удается. По результатам рандомизированных исследований 1-годичная заболеваемость обострением ИЛФ составляет около 8 %, а по результатам ретроспективных исследований – 19 %. Важным фактором риска развития обострений ИЛФ являются тяжелые формы ИЛФ. Внутригоспитальная летальность при обострении ИЛФ составляет > 50 %, а средняя выживаемость больных после обострения ИЛФ – 1–4 мес. В настоящее время методы терапии, эффективность которых была бы доказана при обострении ИЛФ, отсутствуют. В реальной клинической практике пациентам с обострением ИЛФ чаще всего назначаются глюкокортикостероиды в высоких дозах и антибактериальные препараты. Риск развития обострений уменьшается при назначении антифибротической терапии, а при терапии нинтеданибом число подтвержденных / подозреваемых обострений ИЛФ снижается на 68 %. Отмечается необходимость дальнейшего изучения потенциальных методов профилактики и терапии обострений ИЛФ в клинических исследованиях.
Об авторе
С. Н. Авдеев
Федеральное государственное бюджетное образовательное учреждение высшего образования «Первый Московский государственный медицинский университет имени И.М.Сеченова» Министерства здравоохранения Российской Федерации
Федеральное государственное бюджетное учреждение «Научно-исследовательский институт пульмонологии» Федерального медико-биологического агентства
Россия
Россия
д. м. н., член-корр. Российской академии наук, профессор, заведующий кафедрой пульмонологии Федерального государственного бюджетного образовательного учреждения высшего образования «Первый Московский государственный медицинский университет имени И.М.Сеченова» Министерства здравоохранения Российской Федерации, руководитель клинического отдела Федерального государственного бюджетного учреждения «Научно- исследовательский институт пульмонологии» Федерального медико-биологического агентства
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Рецензия
Для цитирования:
Авдеев С.Н. Обострение идиопатического легочного фиброза. Пульмонология. 2018;28(4):469-482. https://doi.org/10.18093/0869-0189-2018-28-4-469-482
For citation:
Avdeev S.N. Acute exacerbation of idiopathic pulmonary fibrosis. PULMONOLOGIYA. 2018;28(4):469-482. (In Russ.) https://doi.org/10.18093/0869-0189-2018-28-4-469-482
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