Международные клинические рекомендации для практических врачей по диагностике и лечению облитерирующего бронхиолита


https://doi.org/10.18093/0869-0189-2015-25-4-403-424

Полный текст:


Аннотация

Синдром облитерирующего бронхиолита (СОБ) – серьезное осложнение трансплантации легких, при котором сокращается выживаемость больных. Международным обществом по трансплантации легких и сердца, Американским торакальным и Европейским респираторным обществами созданы Международный комитет экспертов для разработки клинических рекомендаций по ведению пациентов с СОБ. В этих Рекомендациях дано определение СОБ, описаны факторы риска, диагностика, ведение больных и профилактика СОБ. Для разработки Рекомендаций собрана доказательная информация по СОБ с 1980 г. до марта 2013 г. Комитетом экспертов обсуждались доступные научные доказательства. Оценка Рекомендаций проводилась по системе GRADE. Термин СОБ относится к поздней дисфункции трансплантата с неуклонным снижением объема форсированного выдоха за 1ю секунду, необъяснимое другими причинами. В данных Рекомендациях обсуждаются вопросы использования системных глюкокортикостероидов, циклоспорина, такролимуса, азитромицина и ретрансплантации у больных с предполагаемым и подтвержденным СОБ. В случае диагноза СОБ требуется тщательное исключение других посттрансплантационных осложнений с поздней дисфункцией трансплантата. Выявлено несколько факторов риска, тесно связанных с развитием СОБ. В настоящее время отсутствует лечение, при помощи которого можно бы предотвратить или существенно повлиять на СОБ. Для поиска оптимальных методов лечения и эффективных мер профилактики необходимы хорошо спланированные рандомизированные контролируемые исследования, в которых прослеживались бы все значимые для пациента показатели.


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Для цитирования: статья Р. Международные клинические рекомендации для практических врачей по диагностике и лечению облитерирующего бронхиолита.  Пульмонология. 2015;25(4):403-424. https://doi.org/10.18093/0869-0189-2015-25-4-403-424

For citation: article E. International practical guidelines on diagnosis, prevention and treatment of bronchiolitis obliterans syndrome. Russian Pulmonology. 2015;25(4):403-424. (In Russ.) https://doi.org/10.18093/0869-0189-2015-25-4-403-424

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