Идиопатический легочный фиброз: новые международные клинические рекомендации

Данныеклиническиерекомендацииподиагностикеидиопатическоголегочногофиброза (ИЛФ)  явилисьрезультатомсовместной  работыАмериканскоготоракального (American Thoracic Society – ATS), Европейскогореспираторного (European Respiratory Society – ERS), Японскогореспираторного (Japanese Respiratory Society – JRS) иЛатиноамериканскоготоракального (Latin American Thoracic Society – ALAT) обществ.  Методы. Экспертами многопрофильного комитета  по ИЛФ  обсуждена  доказательная база и сформулированы рекомендации. Проанализированные  доказательства   и  рекомендации  сформулированы,  написаны  и  оценены   по  системе  GRADE.   Результаты. Экспертами Рабочей группы обновлены  диагностические критерии  ИЛФ.  Ранее описанные паттерны  обычной  интерстициальной пневмонии  (ОИП) уточнены и обозначены как паттерны  ОИП, вероятной ОИП, неопределенный и альтернативный диагнозы.  Для больных с впервые выявленным интерстициальным заболеванием легких (ИЗЛ) с паттернами  вероятной ОИП, неопределенного или альтернативного диагнозов  по данным компьютерной томографии легких высокого разрешения (КТВР)  разработана условная рекомендация выполнения бронхоальвеолярного лаважа (БАЛ) и хирургической биопсии  легких. Рекомендации «за» или «против» выполнения трансбронхиальной биопсии  (ТББЛ)  или криобиопсии (КБЛ) легких не разработаны по причине  недостаточности доказательств. Напротив, для больных с впервые выявленным ИЗЛ и паттерном ОИП по данным КТВР выработана сильная рекомендация НЕ выполнять хирургическую биопсию, ТББЛ и КБЛ; выработана условная рекомендация против использования БАЛ. Дополнительные рекомендации включают условную рекомендацию по многопрофильному обсуждению и сильную рекомендацию против измерения сывороточных биомаркеров с целью дифференциации ИЛФ от других ИЗЛ. Заключение. Экспертами Рабочей группы разработаны рекомендации по диагностике ИЛФ.

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