Идиопатическая легочная артериальная гипертензия: современный подход к диагностике и лекарственной терапии


https://doi.org/10.18093/0869-0189-2017-27-2-216-231

Полный текст:


Аннотация

Рассматриваются современные аспекты диагностики, классификации и лечения легочной гипертензии (ЛГ). Представлена новая классификация, включающая все известные на сегодняшний день формы ЛГ. Приводится функциональная классификация данной патологии. Подробно изложена диагностическая программа, включающая как рутинные методы обследования больных, так и высокочувствительные и инновационные исследования (компьютерно-томографическая ангиография сосудов легких, перфузионная сцинтиграфия легких, катетеризация правых отделов сердца и т. д.) Отражены факторы прогноза 1-годичной выживаемости пациентов с ЛГ. Приводятся характеристики основных звеньев патогенеза. Рассматриваются эндотелиновый и простациклиновый пути патофизиологии ЛГ, а также роль оксида азота и стимуляторов растворимой гуанилатциклазы. Изложены традиционные подходы, используемые при терапии ЛГ, включающие применение антагонистов кальция, кислорода, антикоагулянтов и диуретиков. Приводится характеристика критериев проведения «острого» теста на вазореактивность. Представлены основные классы лекарственных препаратов (антагонисты рецепторов к эндотелину, простациклины, стимуляторы растворимой гуанилатциклазы, ингибиторы фосфодиэстеразы 5-го типа, селективные агонисты рецепторов простациклина). Подробно рассматриваются современные пути патогенетической терапии ЛГ, а также основные направления поиска новых эффективных и безопасных лекарственных средств, способных улучшить прогноз, замедлить прогрессирование заболевания, а также повлиять на качество жизни пациентов.


Об авторе

Н. А. Царева
Федеральное государственное бюджетное учреждение «Научно-исследовательский институт пульмонологии Федерального медико-биологического агентства России»
Россия

Царева Наталья Анатольевна – кандидат медицинских наук, заведующая лабораторией интенсивной пульмонологии и дыхательной недостаточности 

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



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Для цитирования: Царева Н.А. Идиопатическая легочная артериальная гипертензия: современный подход к диагностике и лекарственной терапии.  Пульмонология. 2017;27(2):216-231. https://doi.org/10.18093/0869-0189-2017-27-2-216-231

For citation: Tsareva N.A. Idiopathic pulmonary arterial hypertension: current approach to diagnosis and pharmacological treatment. Russian Pulmonology. 2017;27(2):216-231. (In Russ.) https://doi.org/10.18093/0869-0189-2017-27-2-216-231

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