Биомаркеры и генетические предикторы при гиперчувствительном пневмоните

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.

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