Π”ΠΈΠΏΠ»ΠΎΠΌ, курсовая, ΠΊΠΎΠ½Ρ‚Ρ€ΠΎΠ»ΡŒΠ½Π°Ρ Ρ€Π°Π±ΠΎΡ‚Π°
ΠŸΠΎΠΌΠΎΡ‰ΡŒ Π² написании студСнчСских Ρ€Π°Π±ΠΎΡ‚

ΠžΠ±ΠΎΡΡ‚Ρ€Π΅Π½ΠΈΠ΅ Π₯ΠžΠ‘Π›: диагностичСскоС ΠΈ прогностичСскоС Π·Π½Π°Ρ‡Π΅Π½ΠΈΠ΅ биологичСских ΠΌΠ°Ρ€ΠΊΠ΅Ρ€ΠΎΠ²

Π”ΠΈΡΡΠ΅Ρ€Ρ‚Π°Ρ†ΠΈΡΠŸΠΎΠΌΠΎΡ‰ΡŒ Π² Π½Π°ΠΏΠΈΡΠ°Π½ΠΈΠΈΠ£Π·Π½Π°Ρ‚ΡŒ ΡΡ‚ΠΎΠΈΠΌΠΎΡΡ‚ΡŒΠΌΠΎΠ΅ΠΉ Ρ€Π°Π±ΠΎΡ‚Ρ‹

ΠœΠ°Ρ€ΠΊΠ΅Ρ€ поврСТдСния ΠΌΠΈΠΎΠΊΠ°Ρ€Π΄Π° H-FABP Π·Π½Π°Ρ‡ΠΈΠΌΠΎ ΠΏΠΎΠ²Ρ‹ΡˆΠ΅Π½ Ρƒ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… с Π₯ΠžΠ‘Π› ΠΏΡ€ΠΈ Ρ€Π°Π·Π²ΠΈΡ‚ΠΈΠΈ ΠΈΠ½Ρ„Π΅ΠΊΡ†ΠΈΠΈ Π½ΠΈΠΆΠ½ΠΈΡ… Π΄Ρ‹Ρ…Π°Ρ‚Π΅Π»ΡŒΠ½Ρ‹Ρ… ΠΏΡƒΡ‚Π΅ΠΉ. ВыявлСнныС Π·Π½Π°Ρ‡ΠΈΠΌΡ‹Π΅ ΠΏΠΎΠ»ΠΎΠΆΠΈΡ‚Π΅Π»ΡŒΠ½Ρ‹Π΅ коррСляции Ρƒ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… с ΠΈΠ½Ρ„Π΅ΠΊΡ†ΠΈΠΎΠ½Π½Ρ‹ΠΌ обострСниСм (Π±Ρ€ΠΎΠ½Ρ…ΠΈΡ‚, пнСвмония) ΠΌΠ΅ΠΆΠ΄Ρƒ H-FABP с BNP-fragment, Π²Ρ‹Ρ€Π°ΠΆΠ΅Π½Π½ΠΎΡΡ‚ΡŒΡŽ ΠΎΠ΄Ρ‹ΡˆΠΊΠΈ, ΠΊΠΎΠ½Π΅Ρ‡Π½ΠΎ-дистоличСским Π΄ΠΈΠ°ΠΌΠ΅Ρ‚Ρ€ΠΎΠΌ Π»Π΅Π²ΠΎΠ³ΠΎ ΠΆΠ΅Π»ΡƒΠ΄ΠΎΡ‡ΠΊΠ° ΡΠ²ΠΈΠ΄Π΅Ρ‚Π΅Π»ΡŒΡΡ‚Π²ΡƒΡŽΡ‚ ΠΎ ΠΊΠ°Ρ€Π΄ΠΈΠ°Π»ΡŒΠ½ΠΎΠΌ стрСссС ΠΏΡ€ΠΈ обострСнии Π₯ΠžΠ‘Π›. ΠŸΠΎΠ²Ρ‹ΡˆΠ΅Π½Π½Ρ‹Π΅ ΡƒΡ€ΠΎΠ²Π½ΠΈ… Π§ΠΈΡ‚Π°Ρ‚ΡŒ Π΅Ρ‰Ρ‘ >

Π‘ΠΎΠ΄Π΅Ρ€ΠΆΠ°Π½ΠΈΠ΅

  • Бписок сокращСний
  • Π’Π’Π•Π”Π•ΠΠ˜Π•
  • 2. ΠžΠ‘Π—ΠžΠ  Π›Π˜Π’Π•Π ΠΠ’Π£Π Π«
    • 2. 1. Π‘ΠΈΠΎΠΌΠ°Ρ€ΠΊΠ΅Ρ€Ρ‹, ΠΊΠ°ΠΊ Π½ΠΎΠ²Ρ‹ΠΉ инструмСнт вСдСния Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… Π₯ΠžΠ‘Π›
    • 2. 2. Π‘ΠΈΠΎΠΌΠ°Ρ€ΠΊΠ΅Ρ€Ρ‹ воспалСния ΠΏΡ€ΠΈ обострСнии Π₯ΠžΠ‘Π›
    • 2. 3. Π’Π½Π΅Π±ΠΎΠ»ΡŒΠ½ΠΈΡ‡Π½Π°Ρ пнСвмония ΠΊΠ°ΠΊ ΠΏΡ€ΠΈΡ‡ΠΈΠ½Π° обострСния Π₯ΠžΠ‘Π›
    • 2. 4. ΠΠΎΠ·ΠΎΠΊΠΎΠΌΠΈΠ°Π»ΡŒΠ½Ρ‹Π΅ ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠΈ Ρƒ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… Π₯ΠžΠ‘Π›
    • 2. 5. БСрдСчная дисфункция Ρƒ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… Π₯ΠžΠ‘Π›
    • 2. 6. Π‘ΠΈΠΎΠΌΠ°Ρ€ΠΊΠ΅Ρ€Ρ‹ поврСТдСния ΠΌΠΈΠΎΠΊΠ°Ρ€Π΄Π° ΠΏΡ€ΠΈ обострСнии Π₯ΠžΠ‘Π›
    • 2. 7. Π’Π΅Π½ΠΎΠ·Π½Ρ‹Π΅ тромбоэмболии Ρƒ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… Π₯ΠžΠ‘Π›
    • 2. 8. ЛСптинСмия Ρƒ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… Π₯ΠžΠ‘Π› ΠΈ ΡΠΈΠ½Π΄Ρ€ΠΎΠΌΠΎΠΌ Π°Π»ΡŒΠ²Π΅ΠΎΠ»ΡΡ€Π½ΠΎΠΉ 48 гиповСнтиляции
  • 3. ΠœΠΠ’Π•Π Π˜ΠΠ› И ΠœΠ•Π’ΠžΠ”Π« Π˜Π‘Π‘Π›Π•Π”ΠžΠ’ΠΠΠ˜Π―
    • 3. 1. ΠŸΠ°Ρ†ΠΈΠ΅Π½Ρ‚Ρ‹
    • 3. 2. ΠœΠ΅Ρ‚ΠΎΠ΄Ρ‹ исслСдования
    • 3. 3. Π˜Π·ΠΌΠ΅Ρ€Π΅Π½ΠΈΠ΅ ΡƒΡ€ΠΎΠ²Π½Π΅ΠΉ сывороточных/ΠΏΠ»Π°Π·ΠΌΠ΅Π½Π½Ρ‹Ρ… Π±ΠΈΠΎΠΌΠ°Ρ€ΠΊΠ΅Ρ€ΠΎΠ²
    • 3. 4. Π”ΠΈΠ·Π°ΠΉΠ½ исслСдования
    • 3. 5. БтатистичСский Π°Π½Π°Π»ΠΈΠ·
  • 4. Π Π΅Π·ΡƒΠ»ΡŒΡ‚Π°Ρ‚Ρ‹ собствСнных исслСдований
    • 4. 1. ДиагностичСская ΠΈ ΠΏΡ€ΠΎΠ³Π½ΠΎΡΡ‚ичСская Ρ€ΠΎΠ»ΡŒ Π±ΠΈΠΎΠΌΠ°Ρ€ΠΊΠ΅Ρ€ΠΎΠ² 61 воспалСния ΠΏΡ€ΠΈ обострСнии Π₯ΠžΠ‘Π›
    • 4. 2. ΠžΡΠΎΠ±Π΅Π½Π½ΠΎΡΡ‚ΠΈ тСчСния, ΠΏΡ€ΠΎΠ³Π½ΠΎΠ· Π²Π½Π΅Π±ΠΎΠ»ΡŒΠ½ΠΈΡ‡Π½ΠΎΠΉ ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠΈ Ρƒ 70 Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… Π₯ΠžΠ‘Π›
    • 4. 3. Нозокомиальная пнСвмония ΠΈ Π±ΠΈΠΎΠΌΠ°Ρ€ΠΊΠ΅Ρ€Ρ‹ воспалСния Ρƒ 76 Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… Π₯ΠžΠ‘Π›
    • 4. 4. Π˜Π·ΡƒΡ‡Π΅Π½ΠΈΠ΅ диагностичСской ΠΈ ΠΏΡ€ΠΎΠ³Π½ΠΎΡΡ‚ичСской Ρ€ΠΎΠ»ΠΈ ΠΌΠ°Ρ€ΠΊΠ΅Ρ€Π° 82 сСрдСчной дисфункции β„–-Ρ€Π³ΠΎ-Π’β„– ΠΏΡ€ΠΈ обострСнии Π₯ΠžΠ‘Π›
    • 4. 5. Π˜Π·ΡƒΡ‡Π΅Π½ΠΈΠ΅ диагностичСской ΠΈ ΠΏΡ€ΠΎΠ³Π½ΠΎΡΡ‚ичСской Ρ€ΠΎΠ»ΠΈ 89 Π±ΠΈΠΎΠΌΠ°Ρ€ΠΊΠ΅Ρ€ΠΎΠ² поврСТдСния ΠΌΠΈΠΎΠΊΠ°Ρ€Π΄Π° (Troponin I, H-FABP) ΠΈ BNP-fragment Ρƒ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… с ΠΎΠ±ΠΎΡΡ‚Ρ€Π΅Π½ΠΈΠ΅ΠΌ Π₯ΠžΠ‘Π›
    • 4. 6. Вромбоэмболия Π»Π΅Π³ΠΎΡ‡Π½ΠΎΠΉ Π°Ρ€Ρ‚Π΅Ρ€ΠΈΠΈ Ρƒ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… Π₯ΠžΠ‘Π›. 96 4.7 Π˜Π·ΡƒΡ‡Π΅Π½ΠΈΠ΅ Π΄ΠΈΠ½Π°ΠΌΠΈΠΊΠΈ сывороточного Π»Π΅ΠΏΡ‚ΠΈΠ½Π° Ρƒ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… Π₯ΠžΠ‘Π› ΠΏΡ€ΠΈ синдромС Π°Π»ΡŒΠ²Π΅ΠΎΠ»ΡΡ€Π½ΠΎΠΉ гиповСнтиляции ΠΈ ΠΏΡ€ΠΎΠ²Π΅Π΄Π΅Π½ΠΈΠΈ НВЛ
  • ΠšΠ»ΠΈΠ½ΠΈΡ‡Π΅ΡΠΊΠΈΠ΅ ΠΏΡ€ΠΈΠΌΠ΅Ρ€Ρ‹
  • 5. ΠžΠ‘Π‘Π£Π–Π”Π•ΠΠ˜Π• Π Π•Π—Π£Π›Π¬Π’ΠΠ’ΠžΠ’
    • 5. 1. Роль Π±ΠΈΠΎΠΌΠ°Ρ€ΠΊΠ΅Ρ€ΠΎΠ² воспалСния ΠΏΡ€ΠΈ обострСнии Π₯ΠžΠ‘Π›
    • 5. 2. Π’Π½Π΅Π±ΠΎΠ»ΡŒΠ½ΠΈΡ‡Π½Π°Ρ пнСвмония ΠΊΠ°ΠΊ ΠΏΡ€ΠΈΡ‡ΠΈΠ½Π° обострСния Π₯ΠžΠ‘Π›. 119 5.3 ΠžΡΠΎΠ±Π΅Π½Π½ΠΎΡΡ‚ΠΈ нозокомиальной ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠΈ Ρƒ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… Π₯ΠžΠ‘Π›
    • 5. 4. ДиагностичСская ΠΈ ΠΏΡ€ΠΎΠ³Π½ΠΎΡΡ‚ичСская Π·Π½Π°Ρ‡ΠΈΠΌΠΎΡΡ‚ΡŒ Nt-pro-BNP 132 ΠΏΡ€ΠΈ обострСнии Π₯ΠžΠ‘Π›
    • 5. 5. ДиагностичСская ΠΈ ΠΏΡ€ΠΎΠ³Π½ΠΎΡΡ‚ичСская Ρ€ΠΎΠ»ΡŒ Π±ΠΈΠΎΠΌΠ°Ρ€ΠΊΠ΅Ρ€ΠΎΠ² 136 поврСТдСния ΠΌΠΈΠΎΠΊΠ°Ρ€Π΄Π° (Troponin I, H-FABP) ΠΈ BNP-fragment Ρƒ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… с ΠΎΠ±ΠΎΡΡ‚Ρ€Π΅Π½ΠΈΠ΅ΠΌ Π₯ΠžΠ‘Π›
    • 5. 6. ВЭЛА Ρƒ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… Π₯ΠžΠ‘Π›

ΠžΠ±ΠΎΡΡ‚Ρ€Π΅Π½ΠΈΠ΅ Π₯ΠžΠ‘Π›: диагностичСскоС ΠΈ прогностичСскоС Π·Π½Π°Ρ‡Π΅Π½ΠΈΠ΅ биологичСских ΠΌΠ°Ρ€ΠΊΠ΅Ρ€ΠΎΠ² (Ρ€Π΅Ρ„Π΅Ρ€Π°Ρ‚, курсовая, Π΄ΠΈΠΏΠ»ΠΎΠΌ, ΠΊΠΎΠ½Ρ‚Ρ€ΠΎΠ»ΡŒΠ½Π°Ρ)

1. ΠžΠ‘Π©ΠΠ― Π₯ΠΠ ΠΠšΠ’Π•Π Π˜Π‘Π’Π˜ΠšΠ Π ΠΠ‘ΠžΠ’Π«.

ΠΠΊΡ‚ΡƒΠ°Π»ΡŒΠ½ΠΎΡΡ‚ΡŒ исслСдования.

Π₯роничСская обструктивная болСзнь Π»Π΅Π³ΠΊΠΈΡ… (Π₯ΠžΠ‘Π›) являСтся ΠΎΠ΄Π½ΠΎΠΉ ΠΈΠ· Π²Π΅Π΄ΡƒΡ‰ΠΈΡ… ΠΏΡ€ΠΈΡ‡ΠΈΠ½ заболСваСмости ΠΈ ΡΠΌΠ΅Ρ€Ρ‚ности Π²ΠΎ Π²ΡΠ΅ΠΌ ΠΌΠΈΡ€Π΅, ΠΈ ΠΏΡ€Π΅Π΄ΡΡ‚авляСт собой Π·Π½Π°Ρ‡ΠΈΠΌΡƒΡŽ ΡΠΊΠΎΠ½ΠΎΠΌΠΈΡ‡Π΅ΡΠΊΡƒΡŽ ΠΈ ΡΠΎΡ†ΠΈΠ°Π»ΡŒΠ½ΡƒΡŽ ΠΏΡ€ΠΎΠ±Π»Π΅ΠΌΡƒ. Π›Π΅Ρ‚Π°Π»ΡŒΠ½ΠΎΡΡ‚ΡŒ ΠΎΡ‚ Π₯ΠžΠ‘Π› Π·Π°Π½ΠΈΠΌΠ°Π΅Ρ‚ 4-Π΅ мСсто срСди всСх ΠΏΡ€ΠΈΡ‡ΠΈΠ½ смСрти Π² ΠΎΠ±Ρ‰Π΅ΠΉ популяции, Ρ‡Ρ‚ΠΎ составляСт ΠΎΠΊΠΎΠ»ΠΎ 4% Π² ΡΡ‚Ρ€ΡƒΠΊΡ‚ΡƒΡ€Π΅ ΠΎΠ±Ρ‰Π΅ΠΉ Π»Π΅Ρ‚Π°Π»ΡŒΠ½ΠΎΡΡ‚ΠΈ [GOLD, 2011], ΠΈ ΠΊ 2020 Π³. ΠΎΠΆΠΈΠ΄Π°Π΅Ρ‚ся, Ρ‡Ρ‚ΠΎ ΠΎΠ½Π° Π±ΡƒΠ΄Π΅Ρ‚ Π½Π°Ρ…ΠΎΠ΄ΠΈΡ‚ΡŒΡΡ Π½Π° 3-ΠΌ мСстС [Murray & Lopez, 1997].

Π­ΠΏΠΈΠ·ΠΎΠ΄Ρ‹ обострСний Π₯ΠžΠ‘Π› ΠΈΠ³Ρ€Π°ΡŽΡ‚ ΡΡƒΡ‰Π΅ΡΡ‚Π²Π΅Π½Π½ΡƒΡŽ Ρ€ΠΎΠ»ΡŒ Π² ΡƒΠ²Π΅Π»ΠΈΡ‡Π΅Π½ΠΈΠΈ заболСваСмости, смСртности ΠΈ Π·Π°Ρ‚Ρ€Π°Ρ‚ Π½Π° Π»Π΅Ρ‡Π΅Π½ΠΈΠ΅ заболСвания. ЧастоС Ρ€Π°Π·Π²ΠΈΡ‚ΠΈΠ΅ обострСний Ρƒ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… Π₯ΠžΠ‘Π› ΠΏΡ€ΠΈΠ²ΠΎΠ΄ΠΈΡ‚ ΠΊ Π±ΠΎΠ»Π΅Π΅ Π½ΠΈΠ·ΠΊΠΎΠΌΡƒ качСству ΠΆΠΈΠ·Π½ΠΈ [Seemungal et al., 1998], быстрому сниТСнию Ρ„ΡƒΠ½ΠΊΡ†ΠΈΠΈ Π»Π΅Π³ΠΊΠΈΡ… ΠΈ ΠΏΡ€ΠΎΠ³Ρ€Π΅ΡΡΠΈΡ€ΠΎΠ²Π°Π½ΠΈΡŽ заболСвания [Donaldson et al., 2002, Perera, et al., 2007]. ВяТСлоС обострСниС заболСвания, приводящСС ΠΊ ΠΎΡΡ‚Ρ€ΠΎΠΉ Π΄Ρ‹Ρ…Π°Ρ‚Π΅Π»ΡŒΠ½ΠΎΠΉ нСдостаточности (ΠžΠ”Π), являСтся основной ΠΏΡ€ΠΈΡ‡ΠΈΠ½ΠΎΠΉ смСрти Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… Π₯ΠžΠ‘Π› [Zielinski et al., 1997].

Как извСстно, 50−70% всСх обострСний Π₯ΠžΠ‘Π› обусловлСны ΠΈΠ½Ρ„Π΅ΠΊΡ†ΠΈΠ΅ΠΉ Π½ΠΈΠΆΠ½ΠΈΡ… Π΄Ρ‹Ρ…Π°Ρ‚Π΅Π»ΡŒΠ½Ρ‹Ρ… ΠΏΡƒΡ‚Π΅ΠΉ [Sapey & Stockley, 2006], 10% Ρ€Π°Π·Π²ΠΈΠ²Π°ΡŽΡ‚ΡΡ Π·Π° ΡΡ‡Π΅Ρ‚ атмосфСрных ΠΏΠΎΠ»Π»ΡŽΡ‚Π°Π½Ρ‚ΠΎΠ², Π΄ΠΎ 20−40% эпизодов обострСния приходится Π½Π° ΡΠ΅Ρ€Π΄Π΅Ρ‡Π½ΠΎ-сосудистыС события (ВЭЛА, дСкомпСнсация хроничСской сСрдСчной нСдостаточности (Π₯БН) ΠΈ Π΄Ρ€.) [Janssens, 2001, Rutten et al., 2005, Tapson, 2008]. Этиология 30% всСх обострСний Π₯ΠžΠ‘Π› Π½Π΅ Π²Ρ‹ΡΡΠ½Π΅Π½Π° [Sapey & Stockley, 2006].

ΠžΠ±ΠΎΡΡ‚Ρ€Π΅Π½ΠΈΡ любой этиологии Ρƒ ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚ΠΎΠ² с Π»ΡŽΠ±ΠΎΠΉ ΡΡ‚Π΅ΠΏΠ΅Π½ΡŒΡŽ тяТСсти заболСвания ΠΌΠΎΠ³ΡƒΡ‚ ΡΠ²Π»ΡΡ‚ΡŒΡΡ ΠΏΡ€ΠΈΡ‡ΠΈΠ½ΠΎΠΉ ослоТнСнного тСчСния ΠΈ Π»Π΅Ρ‚Π°Π»ΡŒΠ½ΠΎΡΡ‚ΠΈ Π₯ΠžΠ‘Π› [Calverley et al., 2007, Wedzicha et al., 2008, Ferguson et al., 2008, Fernandez Π‘., et al., 2009, Huiart et al., 2005], Π° Π²Ρ‹ΡΠ²Π»Π΅Π½ΠΈΠ΅ ΠΏΡ€ΠΈΡ‡ΠΈΠ½Ρ‹ обострСния, особСнно ΠΏΡ€ΠΈ Π½Π°Π»ΠΈΡ‡ΠΈΠΈ слоТного ΠΊΠΎΠΌΠΎΡ€Π±ΠΈΠ΄Π½ΠΎΠ³ΠΎ Ρ„ΠΎΠ½Π°, 5 прСдставляСт Π·Π½Π°Ρ‡ΠΈΡ‚Π΅Π»ΡŒΠ½Ρ‹Π΅ трудности [Lesser et al., 1992, Hull et al., 1997, Rutten et al., 2005, Hunt et al., 2001]. Π‘Π»Π΅Π΄ΠΎΠ²Π°Ρ‚Π΅Π»ΡŒΠ½ΠΎ, идСнтификация ΠΏΡ€ΠΈΡ‡ΠΈΠ½Ρ‹ обострСния Π±ΠΎΠ»Π΅Π·Π½ΠΈ являСтся Π²Π°ΠΆΠ½ΠΎΠΉ ΠΏΡ€ΠΎΠ±Π»Π΅ΠΌΠΎΠΉ Π² Π²Π΅Π΄Π΅Π½ΠΈΠΈ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… Π₯ΠžΠ‘Π›.

ИспользованиС ΠΊΡƒΠ»ΡŒΡ‚ΡƒΡ€Π°Π»ΡŒΠ½Ρ‹Ρ… ΠΌΠ΅Ρ‚ΠΎΠ΄ΠΎΠ² диагностики для установлСния ΠΏΡ€ΠΈΡ‡ΠΈΠ½Ρ‹ обострСния Π₯ΠžΠ‘Π› остаСтся спорным ΠΈΠ·-Π·Π° хроничСской ΠΊΠΎΠ»ΠΎΠ½ΠΈΠ·Π°Ρ†ΠΈΠΈ ΠΌΠΈΠΊΡ€ΠΎΠΎΡ€Π³Π°Π½ΠΈΠ·ΠΌΠ°ΠΌΠΈ Π΄Ρ‹Ρ…Π°Ρ‚Π΅Π»ΡŒΠ½Ρ‹Ρ… ΠΏΡƒΡ‚Π΅ΠΉ Ρƒ Π±ΠΎΠ»ΡŒΡˆΠΈΠ½ΡΡ‚Π²Π° ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚ΠΎΠ² Π₯ΠžΠ‘Π› [Lacoma et al., 2009]. Π’Ρ€Π°Π΄ΠΈΡ†ΠΈΠΎΠ½Π½Ρ‹ΠΉ ΠΌΠ°Ρ€ΠΊΠ΅Ρ€ прогрСссирования Π₯ΠžΠ‘Π› — объСм форсированного Π²Ρ‹Π΄ΠΎΡ…Π° Π·Π° 1 с (OOBi) -слабо ΠΊΠΎΡ€Ρ€Π΅Π»ΠΈΡ€ΡƒΡŽΡ‚ с ΡΠΈΠΌΠΏΡ‚ΠΎΠΌΠ°ΠΌΠΈ Π±ΠΎΠ»Π΅Π·Π½ΠΈ ΠΈ Π½Π΅ ΠΎΡ‚Ρ€Π°ΠΆΠ°Π΅Ρ‚ эффСкты Π²Π½Π΅Π»Π΅Π³ΠΎΡ‡Π½Ρ‹Ρ… проявлСний [Jones & Agusti, 2006]. Π’ ΡΠ²ΡΠ·ΠΈ с ΡΡ‚ΠΈΠΌ, Π½ΠΎΠ²Ρ‹Π΅ стратСгии вСдСния Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… Π₯ΠžΠ‘Π› ΡΠ²Π»ΡΡŽΡ‚ΡΡ Π½Π΅ΠΎΠ±Ρ…ΠΎΠ΄ΠΈΠΌΡ‹ΠΌΠΈ Π½Π΅ Ρ‚ΠΎΠ»ΡŒΠΊΠΎ для выявлСния ΠΏΡ€ΠΈΡ‡ΠΈΠ½Ρ‹ обострСния Π±ΠΎΠ»Π΅Π·Π½ΠΈ, Π½ΠΎ ΠΈ Π΄Π»Ρ ΠΎΡ†Π΅Π½ΠΊΠΈ ΠΈΠ½Π΄ΠΈΠ²ΠΈΠ΄ΡƒΠ°Π»ΡŒΠ½ΠΎΠ³ΠΎ риска для ΠΊΠ°ΠΆΠ΄ΠΎΠ³ΠΎ ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚Π°.

Π’ Π½Π°ΡΡ‚оящСС врСмя ΠΎΡ†Π΅Π½ΠΊΠ° биологичСских ΠΌΠ°Ρ€ΠΊΠ΅Ρ€ΠΎΠ² стала Π½ΠΎΠ²Ρ‹ΠΌ инструмСнтом вСдСния Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… Π₯ΠžΠ‘Π›. БиологичСскиС ΠΌΠ°Ρ€ΠΊΠ΅Ρ€Ρ‹, ΠΊΠΎΡ‚ΠΎΡ€Ρ‹Π΅ ΠΌΠΎΠ³ΡƒΡ‚ ΠΎΡ†Π΅Π½ΠΈΡ‚ΡŒ Ρ€Π°Π·Π»ΠΈΡ‡Π½Ρ‹Π΅ аспСкты Π₯ΠžΠ‘Π›, Ρ‚Π°ΠΊΠΈΠ΅ ΠΊΠ°ΠΊ ΠΏΠ°Ρ‚ΠΎΠ³Π΅Π½Π΅Π·, Ρ‚ΡΠΆΠ΅ΡΡ‚ΡŒ, ΠΏΡ€ΠΎΠ³Π½ΠΎΠ· Π±ΠΎΠ»Π΅Π·Π½ΠΈ ΠΈ ΠΎΡ‚Π²Π΅Ρ‚ Π½Π° Ρ‚Π΅Ρ€Π°ΠΏΠΈΡŽ, Π±Ρ‹Π»ΠΈ ΠΈΠ·ΡƒΡ‡Π΅Π½Ρ‹ Π²ΠΎ ΠΌΠ½ΠΎΠ³ΠΈΡ… исслСдованиях [Barnes et al., 2006, Cazzola & Novelli, 2010], ΠΎΠ΄Π½Π°ΠΊΠΎ ΠΏΠΎ ΠΌΠ΅Ρ€Π΅ накоплСния объСма Π΄Π°Π½Π½Ρ‹Ρ… Π²ΠΎΠ·Π½ΠΈΠΊΠ»ΠΎ ΠΌΠ½ΠΎΠ³ΠΎ слоТностСй ΠΏΠΎ ΠΈΡ… ΠΈΠ½Ρ‚Π΅Ρ€ΠΏΡ€Π΅Ρ‚Π°Ρ†ΠΈΠΈ, воспроизводимости ΠΈ ΠΊΠΎΡ€Ρ€Π΅Π»ΡΡ†ΠΈΠΈ с Π΄Ρ€ΡƒΠ³ΠΈΠΌΠΈ ΠΏΠ°Ρ€Π°ΠΌΠ΅Ρ‚Ρ€Π°ΠΌΠΈ Π₯ΠžΠ‘Π› [Ilyin 2004, Cazzola & Novelli, 2010]. Π’ ΡΠ²ΡΠ·ΠΈ с ΡΡ‚ΠΈΠΌ, дальнСйшСС ΠΈΠ·ΡƒΡ‡Π΅Π½ΠΈΠ΅ профиля Π±ΠΈΠΎΠΌΠ°Ρ€ΠΊΠ΅Ρ€ΠΎΠ² являСтся Π½Π΅ΠΎΠ±Ρ…ΠΎΠ΄ΠΈΠΌΠΎΠΉ ΠΈ Π²Π°ΠΆΠ½ΠΎΠΉ Π·Π°Π΄Π°Ρ‡Π΅ΠΉ для Π²Π΅Ρ€ΠΈΡ„ΠΈΠΊΠ°Ρ†ΠΈΠΈ ΠΏΡ€ΠΈΡ‡ΠΈΠ½ обострСния Π₯ΠžΠ‘Π› ΠΈ ΠΏΠΎΠΈΡΠΊΠ° Π²ΠΎΠ·ΠΌΠΎΠΆΠ½Ρ‹Ρ… взаимосвязСй с ΠΎΡ€ΠΈΠ΅Π½Ρ‚ΠΈΡ€ΠΎΠ²Π°Π½Π½Ρ‹ΠΌΠΈ Π½Π° ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚Π° Ρ€Π΅Π·ΡƒΠ»ΡŒΡ‚Π°Ρ‚Π°ΠΌΠΈ.

ЦСль исслСдования: — ΠΈΠ·ΡƒΡ‡ΠΈΡ‚ΡŒ ΠΏΡ€ΠΈΡ‡ΠΈΠ½Ρ‹ обострСния, особСнности ΠΈΡ… ΠΊΠ»ΠΈΠ½ΠΈΡ‡Π΅ΡΠΊΠΎΠΉ ΠΊΠ°Ρ€Ρ‚ΠΈΠ½Ρ‹, тСчСния, ΠΏΡ€ΠΎΠ³Π½ΠΎΠ·Π° ΠΈ ΠΏΡ€ΠΎΠ²Π΅ΡΡ‚ΠΈ ΠΊΠΎΠΌΠΏΠ»Π΅ΠΊΡΠ½ΡƒΡŽ ΠΎΡ†Π΅Π½ΠΊΡƒ диагностичСской ΠΈ ΠΏΡ€ΠΎΠ³Π½ΠΎΡΡ‚ичСской значимости сывороточных Π±ΠΈΠΎΠΌΠ°Ρ€ΠΊΠ΅Ρ€ΠΎΠ² Ρƒ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… с ΠΎΠ±ΠΎΡΡ‚Ρ€Π΅Π½ΠΈΠ΅ΠΌ Π₯ΠžΠ‘Π›.

Π—Π°Π΄Π°Ρ‡ΠΈ исслСдования:

1. Π˜Π·ΡƒΡ‡ΠΈΡ‚ΡŒ особСнности тСчСния, Π΄ΠΈΠ°Π³Π½ΠΎΡΡ‚ΠΈΡ‡Π΅ΡΠΊΡƒΡŽ ΠΈ ΠΏΡ€ΠΎΠ³Π½ΠΎΡΡ‚ΠΈΡ‡Π΅ΡΠΊΡƒΡŽ Ρ€ΠΎΠ»ΡŒ сывороточных Π±ΠΈΠΎΠΌΠ°Ρ€ΠΊΠ΅Ρ€ΠΎΠ² воспалСния (CRP, IL-6, TNF-a) ΠΏΡ€ΠΈ обострСниях Π₯ΠžΠ‘Π›, Π²Ρ‹Π·Π²Π°Π½Π½Ρ‹Ρ… ΠΈΠ½Ρ„Π΅ΠΊΡ†ΠΈΠΎΠ½Π½Ρ‹ΠΌΠΈ ΠΏΡ€ΠΈΡ‡ΠΈΠ½Π°ΠΌΠΈ (ΠΈΠ½Ρ„Π΅ΠΊΡ†ΠΈΠΈ Π½ΠΈΠΆΠ½ΠΈΡ… Π΄Ρ‹Ρ…Π°Ρ‚Π΅Π»ΡŒΠ½Ρ‹Ρ… ΠΏΡƒΡ‚Π΅ΠΉ, Π²Π½Π΅Π±ΠΎΠ»ΡŒΠ½ΠΈΡ‡Π½Π°Ρ ΠΈ Π½ΠΎΠ·ΠΎΠΊΠΎΠΌΠΈΠ°Π»ΡŒΠ½Π°Ρ ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠΈ).

2. ΠžΡ†Π΅Π½ΠΈΡ‚ΡŒ Π΄ΠΈΠ°Π³Π½ΠΎΡΡ‚ΠΈΡ‡Π΅ΡΠΊΡƒΡŽ ΠΈ ΠΏΡ€ΠΎΠ³Π½ΠΎΡΡ‚ΠΈΡ‡Π΅ΡΠΊΡƒΡŽ Ρ€ΠΎΠ»ΡŒ Π±ΠΈΠΎΠΌΠ°Ρ€ΠΊΠ΅Ρ€ΠΎΠ² сСрдСчной дисфункции (Nt-pro-BNP, BNP-fragment) ΠΏΡ€ΠΈ обострСнии Π₯ΠžΠ‘Π›.

3. Π˜Π·ΡƒΡ‡ΠΈΡ‚ΡŒ Π΄ΠΈΠ°Π³Π½ΠΎΡΡ‚ΠΈΡ‡Π΅ΡΠΊΡƒΡŽ ΠΈ ΠΏΡ€ΠΎΠ³Π½ΠΎΡΡ‚ΠΈΡ‡Π΅ΡΠΊΡƒΡŽ Π·Π½Π°Ρ‡ΠΈΠΌΠΎΡΡ‚ΡŒ Π±ΠΈΠΎΠΌΠ°Ρ€ΠΊΠ΅Ρ€ΠΎΠ² поврСТдСния ΠΌΠΈΠΎΠΊΠ°Ρ€Π΄Π° (Troponin I, H-FABP) ΠΏΡ€ΠΈ обострСнии Π₯ΠžΠ‘Π›.

4. Π˜Π·ΡƒΡ‡ΠΈΡ‚ΡŒ частоту, клиничСскиС особСнности ΠΈ ΠΈΡΡ…ΠΎΠ΄Ρ‹ ВЭЛА, Π° Ρ‚Π°ΠΊΠΆΠ΅ Ρ€ΠΎΠ»ΡŒ Π±ΠΈΠΎΠΌΠ°Ρ€ΠΊΠ΅Ρ€ΠΎΠ² (D-Π΄ΠΈΠΌΠ΅Ρ€, Nt-proBNP) Π² Π΅Π΅ Π΄ΠΈΠ°Π³Π½ΠΎΡΡ‚ΠΈΠΊΠ΅ Ρƒ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… с ΠΎΠ±ΠΎΡΡ‚Ρ€Π΅Π½ΠΈΠ΅ΠΌ Π₯ΠžΠ‘Π›.

5. ΠŸΡ€ΠΎΠ°Π½Π°Π»ΠΈΠ·ΠΈΡ€ΠΎΠ²Π°Ρ‚ΡŒ Π΄ΠΈΠ½Π°ΠΌΠΈΠΊΡƒ Π±ΠΈΠΎΠΌΠ°Ρ€ΠΊΠ΅Ρ€Π° Π»Π΅ΠΏΡ‚ΠΈΠ½Π° сыворотки Ρƒ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… с ΠΎΠ±ΠΎΡΡ‚Ρ€Π΅Π½ΠΈΠ΅ΠΌ Π₯ΠžΠ‘Π› ΠΏΡ€ΠΈ синдромС Π°Π»ΡŒΠ²Π΅ΠΎΠ»ΡΡ€Π½ΠΎΠΉ гиповСнтиляции.

Научная Π½ΠΎΠ²ΠΈΠ·Π½Π°:

Π’ΠΏΠ΅Ρ€Π²Ρ‹Π΅ ΠΏΠΎΠΊΠ°Π·Π°Π½ΠΎ, Ρ‡Ρ‚ΠΎ:

— Π‘-Ρ€Π΅Π°ΠΊΡ‚ΠΈΠ²Π½Ρ‹ΠΉ ΠΏΡ€ΠΎΡ‚Π΅ΠΈΠ½ (CRP) являСтся Ρ‡ΡƒΠ²ΡΡ‚Π²ΠΈΡ‚Π΅Π»ΡŒΠ½Ρ‹ΠΌ ΠΈ ΡΠΏΠ΅Ρ†ΠΈΡ„ΠΈΡ‡Π½Ρ‹ΠΌ ΠΌΠ°Ρ€ΠΊΠ΅Ρ€ΠΎΠΌ для диагностики Π±Π°ΠΊΡ‚Π΅Ρ€ΠΈΠ°Π»ΡŒΠ½ΠΎΠΉ ΠΈΠ½Ρ„Π΅ΠΊΡ†ΠΈΠΈ ΠΈ ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠΈ Ρƒ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… Π₯ΠžΠ‘Π›: ΠΏΠΎΡ€ΠΎΠ³ΠΎΠ²ΠΎΠ΅ Π·Π½Π°Ρ‡Π΅Π½ΠΈΠ΅ CRP для диагностики Π±Π°ΠΊΡ‚Π΅Ρ€ΠΈΠ°Π»ΡŒΠ½ΠΎΠΉ ΠΈΠ½Ρ„Π΅ΠΊΡ†ΠΈΠΈ Ρƒ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… с ΠΎΠ±ΠΎΡΡ‚Ρ€Π΅Π½ΠΈΠ΅ΠΌ Π₯ΠžΠ‘Π› составляСт >16,5 ΠΌΠ³/Π» (Ρ‡ΡƒΠ²ΡΡ‚Π²ΠΈΡ‚Π΅Π»ΡŒΠ½ΠΎΡΡ‚ΡŒ 93%, ΡΠΏΠ΅Ρ†ΠΈΡ„ΠΈΡ‡Π½ΠΎΡΡ‚ΡŒ 93%), ΠΏΠΎΡ€ΠΎΠ³ΠΎΠ²ΠΎΠ΅ Π·Π½Π°Ρ‡Π΅Π½ΠΈΠ΅.

CRP для диагностики ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠΈ Ρƒ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… Π₯ΠžΠ‘Π› составляСт >51,5 ΠΌΠ³/Π» (Ρ‡ΡƒΠ²ΡΡ‚Π²ΠΈΡ‚Π΅Π»ΡŒΠ½ΠΎΡΡ‚ΡŒ 87%, ΡΠΏΠ΅Ρ†ΠΈΡ„ΠΈΡ‡Π½ΠΎΡΡ‚ΡŒ 91%);

— 30-днСвная Π»Π΅Ρ‚Π°Π»ΡŒΠ½ΠΎΡΡ‚ΡŒ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… Π₯ΠžΠ‘Π› с Π²Π½Π΅Π±ΠΎΠ»ΡŒΠ½ΠΈΡ‡Π½ΠΎΠΉ ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠ΅ΠΉ ΠΌΠΎΠΆΠ΅Ρ‚ Π±Ρ‹Ρ‚ΡŒ прСдсказана ΠΊΠΎΠ½Ρ†Π΅Π½Ρ‚Ρ€Π°Ρ†ΠΈΠ΅ΠΉ CRP Π½Π° ΠΌΠΎΠΌΠ΅Π½Ρ‚ госпитализации ΠΈ ΠΈΠ½Π΄Π΅ΠΊΡΠΎΠΌ коморбидности Charlson- 6 мСсячная Π»Π΅Ρ‚Π°Π»ΡŒΠ½ΠΎΡΡ‚ΡŒ — индСксом коморбидности Charlson;

— ΠΏΡ€Π΅Π΄ΠΈΠΊΡ‚ΠΎΡ€Π°ΠΌΠΈ ΠΏΠΎΠ²Ρ‚ΠΎΡ€Π½ΠΎΠΉ госпитализации Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… послС обострСния Π₯ΠžΠ‘Π› Π² Ρ‚Π΅Ρ‡Π΅Π½ΠΈΠ΅ 6 мСс ΡΠ²Π»ΡΡŽΡ‚ΡΡ индСкс коморбидности Charlson, частота обострСний Π₯ΠžΠ‘Π› >3 Ρ€Π°Π· Π² Π³ΠΎΠ΄ ΠΈ ΠΊΡ€Π°ΠΉΠ½Π΅ тяТСлоС Ρ‚Π΅Ρ‡Π΅Π½ΠΈΠ΅ Π₯ΠžΠ‘Π› (ст. IV ΠΏΠΎ ΠΊΠ»Π°ΡΡΠΈΡ„ΠΈΠΊΠ°Ρ†ΠΈΠΈ GOLD);

— ΠΊΠΎΠ½Ρ†Π΅Π½Ρ‚Ρ€Π°Ρ†ΠΈΠΈ Nt-proBNP ΠΈ BNP-fragment ΡΠ²Π»ΡΡŽΡ‚ΡΡ ΠΏΡ€Π΅Π΄ΠΈΠΊΡ‚ΠΎΡ€Π°ΠΌΠΈ Π³ΠΎΡΠΏΠΈΡ‚Π°Π»ΡŒΠ½ΠΎΠΉ Π»Π΅Ρ‚Π°Π»ΡŒΠ½ΠΎΡΡ‚ΠΈ ΠΎΡ‚ Π²ΡΠ΅Ρ… ΠΏΡ€ΠΈΡ‡ΠΈΠ½ Ρƒ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… с ΠΎΠ±ΠΎΡΡ‚Ρ€Π΅Π½ΠΈΠ΅ΠΌ Π₯ΠžΠ‘Π›;

— Π²Ρ‹ΡΠ²Π»Π΅Π½Π½Ρ‹Π΅ коррСляционныС связи ΡƒΠΊΠ°Π·Ρ‹Π²Π°ΡŽΡ‚ Π½Π° Π°ΡΡΠΎΡ†ΠΈΠ°Ρ†ΠΈΡŽ ΠΏΠΎΠ²Ρ‹ΡˆΠ΅Π½Π½Ρ‹Ρ… ΡƒΡ€ΠΎΠ²Π½Π΅ΠΉ Nt-proBNP ΠΈ BNP-fragment с Π΄ΠΈΡΡ„ΡƒΠ½ΠΊΡ†ΠΈΠΉ ΠΏΡ€Π°Π²ΠΎΠ³ΠΎ ΠΈ Π»Π΅Π²ΠΎΠ³ΠΎ ΠΆΠ΅Π»ΡƒΠ΄ΠΎΡ‡ΠΊΠΎΠ², Π»Π΅Π³ΠΎΡ‡Π½ΠΎΠΉ Π³ΠΈΠΏΠ΅Ρ€Ρ‚Π΅Π½Π·ΠΈΠ΅ΠΉ, с Π³ΠΈΠΏΠΎΠΊΡΠ΅ΠΌΠΈΠ΅ΠΉ ΠΏΡ€ΠΈ обострСнии Π₯ΠžΠ‘Π›;

— ΠΊΠΎΠ½Ρ†Π΅Π½Ρ‚Ρ€Π°Ρ†ΠΈΠΈ Π±ΠΈΠΎΠΌΠ°Ρ€ΠΊΠ΅Ρ€ΠΎΠ² поврСТдСния ΠΌΠΈΠΎΠΊΠ°Ρ€Π΄Π° (H-FABP ΠΈ Tn I) ΠΏΠΎΠ²Ρ‹ΡˆΠ°ΡŽΡ‚ΡΡ ΠΏΡ€ΠΈ обострСниях Π₯ΠžΠ‘Π›, Π²Ρ‹Π·Π²Π°Π½Π½Ρ‹Ρ… ΠΈΠ½Ρ„Π΅ΠΊΡ†ΠΈΠΎΠ½Π½Ρ‹ΠΌΠΈ Ρ„Π°ΠΊΡ‚ΠΎΡ€Π°ΠΌΠΈ ΠΈ Π΄Π΅ΠΊΠΎΠΌΠΏΠ΅Π½ΡΠ°Ρ†ΠΈΠ΅ΠΉ хроничСской сСрдСчной нСдостаточности;

— ΠΏΡ€ΠΈ обострСнии Π₯ΠžΠ‘Π› ΠΏΠΎΠ²Ρ‹ΡˆΠ΅Π½Π½Ρ‹Π΅ ΡƒΡ€ΠΎΠ²Π½ΠΈ Π±ΠΈΠΎΠΌΠ°Ρ€ΠΊΠ΅Ρ€ΠΎΠ² поврСТдСния ΠΌΠΈΠΎΠΊΠ°Ρ€Π΄Π° (H-FABP ΠΈ Tn I) ассоциированы с 30-Π΄Π½Π΅Π²Π½ΠΎΠΉ Π»Π΅Ρ‚Π°Π»ΡŒΠ½ΠΎΡΡ‚ΡŒΡŽ ΠΎΡ‚ Π²ΡΠ΅Ρ… ΠΏΡ€ΠΈΡ‡ΠΈΠ½;

— Π»Π΅Ρ‚Π°Π»ΡŒΠ½ΠΎΡΡ‚ΡŒ ΠΎΡ‚ Π²ΡΠ΅Ρ… ΠΏΡ€ΠΈΡ‡ΠΈΠ½ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… Π₯ΠžΠ‘Π› Π² Ρ‚Π΅Ρ‡Π΅Π½ΠΈΠ΅ 6 мСс послС эпизода обострСния опрСдСляСтся уровнями BNP-fragment Π²ΠΎ Π²Ρ€Π΅ΠΌΡ госпитализации ΠΈ Ρ‡Π°ΡΡ‚ΠΎΡ‚ΠΎΠΉ обострСния Π±ΠΎΠ»Π΅Π·Π½ΠΈ > 3 Ρ€Π°Π· Π² Π³ΠΎΠ΄;

— Π΄ΠΈΠ½Π°ΠΌΠΈΠΊΠ° ΠΊΠΎΠ½Ρ†Π΅Π½Ρ‚Ρ€Π°Ρ†ΠΈΠΈ Π»Π΅ΠΏΡ‚ΠΈΠ½Π° сыворотки Ρƒ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… с ΠΎΠ±ΠΎΡΡ‚Ρ€Π΅Π½ΠΈΠ΅ΠΌ Π₯ΠžΠ‘Π› ΠΈ ΡΠΈΠ½Π΄Ρ€ΠΎΠΌΠΎΠΌ Π°Π»ΡŒΠ²Π΅ΠΎΠ»ΡΡ€Π½ΠΎΠΉ гиповСнтиляции позволяСт ΠΏΡ€ΠΎΠ³Π½ΠΎΠ·ΠΈΡ€ΠΎΠ²Π°Ρ‚ΡŒ эффСкты рСспираторной ΠΏΠΎΠ΄Π΄Π΅Ρ€ΠΆΠΊΠΈ Π²ΠΎ Π²Ρ€Π΅ΠΌΡ эпизода ΠžΠ”Π.

ΠŸΡ€Π°ΠΊΡ‚ΠΈΡ‡Π΅ΡΠΊΠ°Ρ Π·Π½Π°Ρ‡ΠΈΠΌΠΎΡΡ‚ΡŒ:

ΠžΠΏΡ€Π΅Π΄Π΅Π»Π΅Π½ΠΈΠ΅ CRP являСтся Ρ†Π΅Π½Π½Ρ‹ΠΌ ΠΌΠ°Ρ€ΠΊΠ΅Ρ€ΠΎΠΌ для скрининга ΠΈ ΠΏΠΎΠ΄Ρ‚вСрТдСния Π°ΠΊΡ‚ΠΈΠ²Π½ΠΎΠ³ΠΎ ΠΈΠ½Ρ„Π΅ΠΊΡ†ΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ обострСния Π₯ΠžΠ‘Π›, Π²Π½Π΅Π±ΠΎΠ»ΡŒΠ½ΠΈΡ‡Π½ΠΎΠΉ ΠΈ Π½ΠΎΠ·ΠΎΠΊΠΎΠΌΠΈΠ°Π»ΡŒΠ½ΠΎΠΉ ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠΈ, Ρ‡Ρ‚ΠΎ Π²Π°ΠΆΠ½ΠΎ для Ρ€Π΅ΡˆΠ΅Π½ΠΈΡ Ρ‚Π°ΠΊΡ‚ΠΈΠΊΠΈ лСчСния Ρƒ Π΄Π°Π½Π½ΠΎΠΉ ΠΊΠ°Ρ‚Π΅Π³ΠΎΡ€ΠΈΠΈ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ….

Π£ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… Π₯ΠžΠ‘Π› с Π²Π½Π΅Π±ΠΎΠ»ΡŒΠ½ΠΈΡ‡Π½ΠΎΠΉ ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠ΅ΠΉ ΠΎΡ‚ΠΌΠ΅Ρ‡Π΅Π½ΠΎ Π±ΠΎΠ»Π΅Π΅ Π·Π½Π°Ρ‡ΠΈΠΌΠΎΠ΅ ΠΏΠΎΠ²Ρ‹ΡˆΠ΅Π½ΠΈΠ΅ Ρ‚Π΅ΠΌΠΏΠ΅Ρ€Π°Ρ‚ΡƒΡ€Ρ‹ Ρ‚Π΅Π»Π°, Π±ΠΎΠ»Π΅Π΅ частыС ΠΎΠ·Π½ΠΎΠ±Ρ‹ ΠΈ Π±ΠΎΠ»ΠΈ Π² Π³Ρ€ΡƒΠ΄Π½ΠΎΠΉ ΠΊΠ»Π΅Ρ‚ΠΊΠ΅, ΠΏΠΎ ΡΡ€Π°Π²Π½Π΅Π½ΠΈΡŽ с Π±ΠΎΠ»ΡŒΠ½Ρ‹ΠΌΠΈ Π₯ΠžΠ‘Π› Π±Π΅Π· ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠΈ. НаличиС Π²Π½Π΅Π±ΠΎΠ»ΡŒΠ½ΠΈΡ‡Π½ΠΎΠΉ ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠΈ ΡƒΡ…ΡƒΠ΄ΡˆΠ°Π΅Ρ‚ ΠΏΡ€ΠΎΠ³Π½ΠΎΠ· Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… Π₯ΠžΠ‘Π›.

ΠšΠΎΠ½Ρ†Π΅Π½Ρ‚Ρ€Π°Ρ†ΠΈΠΈ NT-pro-BNP ΠΈ BNP-fragment Π·Π½Π°Ρ‡ΠΈΠΌΠΎ ΠΏΠΎΠ²Ρ‹ΡˆΠ΅Π½Ρ‹ Ρƒ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… с ΠΎΠ±ΠΎΡΡ‚Ρ€Π΅Π½ΠΈΠ΅ΠΌ Π₯ΠžΠ‘Π› ΠΈ Π»Π΅Π³ΠΎΡ‡Π½ΠΎΠΉ Π³ΠΈΠΏΠ΅Ρ€Ρ‚Π΅Π½Π·ΠΈΠ΅ΠΉ, Π° Ρ‚Π°ΠΊΠΆΠ΅ с ΡΠΈΡΡ‚оличСской дисфункциСй Π»Π΅Π²ΠΎΠ³ΠΎ ΠΆΠ΅Π»ΡƒΠ΄ΠΎΡ‡ΠΊΠ°. ΠŸΠΎΠ²Ρ‹ΡˆΠ΅Π½ΠΈΠ΅ ΡƒΡ€ΠΎΠ²Π½Π΅ΠΉ NT-pro-BNP ΠΈ BNP-fragment являСтся нСблагоприятным прогностичСским Ρ„Π°ΠΊΡ‚ΠΎΡ€ΠΎΠΌ для Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… с ΠΎΠ±ΠΎΡΡ‚Ρ€Π΅Π½ΠΈΠ΅ΠΌ Π₯ΠžΠ‘Π›. ΠžΠ±ΠΎΡΡ‚Ρ€Π΅Π½ΠΈΠ΅ Π₯ΠžΠ‘Π› сопровоТдаСтся ΠΏΠΎΠ²Ρ‹ΡˆΠ΅Π½ΠΈΠ΅ΠΌ ΡƒΡ€ΠΎΠ²Π½Π΅ΠΉ Π±ΠΈΠΎΠΌΠ°Ρ€ΠΊΠ΅Ρ€ΠΎΠ² поврСТдСния ΠΌΠΈΠΎΠΊΠ°Ρ€Π΄Π° (H-FABP ΠΈ Tn I), Ρ‡Ρ‚ΠΎ Ρ‚Π°ΠΊΠΆΠ΅ являСтся ΠΏΡ€Π΅Π΄ΠΈΠΊΡ‚ΠΎΡ€ΠΎΠΌ Π³ΠΎΡΠΏΠΈΡ‚Π°Π»ΡŒΠ½ΠΎΠΉ Π»Π΅Ρ‚Π°Π»ΡŒΠ½ΠΎΡΡ‚ΠΈ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… с Π₯ΠžΠ‘Π›.

ΠžΡ†Π΅Π½ΠΊΠ° Π΄ΠΈΠ½Π°ΠΌΠΈΠΊΠΈ Π»Π΅ΠΏΡ‚ΠΈΠ½Π΅ΠΌΠΈΠΈ Ρƒ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… с Π₯ΠžΠ‘Π› ΠΈ ΡΠΈΠ½Π΄Ρ€ΠΎΠΌΠΎΠΌ Π°Π»ΡŒΠ²Π΅ΠΎΠ»ΡΡ€Π½ΠΎΠΉ гиповСнтиляции ΠΏΡ€ΠΈ Ρ€Π°Π·Π²ΠΈΡ‚ΠΈΠΈ острой гипСркапничСской Π΄Ρ‹Ρ…Π°Ρ‚Π΅Π»ΡŒΠ½ΠΎΠΉ нСдостаточности позволяСт ΠΏΡ€ΠΎΠ³Π½ΠΎΠ·ΠΈΡ€ΠΎΠ²Π°Ρ‚ΡŒ эффСкты Π½Π΅ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΠΎΠΉ вСнтиляции Π»Π΅Π³ΠΊΠΈΡ… ΠΈ ΠΏΠΎΠΌΠΎΠ³Π°Π΅Ρ‚ ΠΊΠΎΡ€Ρ€Π΅ΠΊΡ‚ΠΈΡ€ΠΎΠ²Π°Ρ‚ΡŒ Π΅Π΅ ΠΏΠ°Ρ€Π°ΠΌΠ΅Ρ‚Ρ€Ρ‹.

ΠžΡΠ½ΠΎΠ²Π½Ρ‹Π΅ полоТСния диссСртации, выносимыС Π½Π° Π·Π°Ρ‰ΠΈΡ‚Ρƒ:

ΠžΠ±ΠΎΡΡ‚Ρ€Π΅Π½ΠΈΠ΅ Π₯ΠžΠ‘Π› характСризуСтся усилСниСм локального ΠΈ ΡΠΈΡΡ‚Π΅ΠΌΠ½ΠΎΠ³ΠΎ воспалСния, Π° Ρ‚Π°ΠΊΠΆΠ΅ ΠΏΠΎΠ²Ρ‹ΡˆΠ΅Π½Π½Ρ‹ΠΌ риском сСрдСчнососудистых событий.

Π˜Π·ΡƒΡ‡Π΅Π½Π½Ρ‹ΠΉ спСктр Π±ΠΈΠΎΠΌΠ°Ρ€ΠΊΠ΅Ρ€ΠΎΠ² ΠΎΡ‚Ρ€Π°ΠΆΠ°Π΅Ρ‚ Ρ€ΠΎΠ»ΡŒ Ρ€Π°Π·Π»ΠΈΡ‡Π½Ρ‹Ρ… Π»Π΅Π³ΠΎΡ‡Π½Ρ‹Ρ… ΠΈ Π²Π½Π΅Π»Π΅Π³ΠΎΡ‡Π½Ρ‹Ρ… Ρ„Π°ΠΊΡ‚ΠΎΡ€ΠΎΠ² Π² ΠΏΠ°Ρ‚ΠΎΠ³Π΅Π½Π΅Π·Π΅ обострСния Π₯ΠžΠ‘Π› ΠΈ ΠΈΡ… ΡΠ²ΡΠ·ΡŒ с Ρ‚Π΅Ρ‡Π΅Π½ΠΈΠ΅ΠΌ ΠΈ ΠΏΡ€ΠΎΠ³Π½ΠΎΠ·ΠΎΠΌ заболСвания.

Π˜Π·ΡƒΡ‡Π΅Π½Π½Ρ‹Π΅ ΠΌΠ°Ρ€ΠΊΠ΅Ρ€Ρ‹ ΠΏΠΎΠ·Π²ΠΎΠ»ΡΡŽΡ‚ ΠΏΡ€ΠΎΠ³Π½ΠΎΠ·ΠΈΡ€ΠΎΠ²Π°Ρ‚ΡŒ Ρ‚Π΅Ρ‡Π΅Π½ΠΈΠ΅ Π±ΠΎΠ»Π΅Π·Π½ΠΈ (CRP, Nt-proBNP, BNP-fragment, Troponin I, H-FABP, Π»Π΅ΠΏΡ‚ΠΈΠ½, D-Π΄ΠΈΠΌΠ΅Ρ€), ΠΌΠΎΠ½ΠΈΡ‚ΠΎΡ€ΠΈΡ€ΠΎΠ²Π°Ρ‚ΡŒ эффСкты Ρ‚Π΅Ρ€Π°ΠΏΠΈΠΈ (CRP, Π»Π΅ΠΏΡ‚ΠΈΠ½) — ΠΏΡ€ΠΎΠ³Π½ΠΎΠ·ΠΈΡ€ΠΎΠ²Π°Ρ‚ΡŒ клиничСскиС исходы (CRP, Nt-proBNP, BNP-fragment, Troponin I, H-FABP, Π»Π΅ΠΏΡ‚ΠΈΠ½) — ΠΏΡ€ΠΎΠ²ΠΎΠ΄ΠΈΡ‚ΡŒ ΠΌΠΎΠ½ΠΈΡ‚ΠΎΡ€ΠΈΠ½Π³ нСблагоприятных Ρ€Π΅Π°ΠΊΡ†ΠΈΠΉ (CRP, Nt-proBNP, BNP-fagment, Troponin I, H-FABP, Π»Π΅ΠΏΡ‚ΠΈΠ½), Π²Ρ‹ΡΠ²Π»ΡΡ‚ΡŒ Π½ΠΎΠ²Ρ‹Π΅ биологичСскиС ΠΌΠ΅Ρ…Π°Π½ΠΈΠ·ΠΌΡ‹, ΡƒΡ‡Π°ΡΡ‚Π²ΡƒΡŽΡ‰ΠΈΠ΅ Π² ΠΏΠ°Ρ‚ΠΎΠ³Π΅Π½Π΅Π·Π΅ обострСния Π₯ΠžΠ‘Π› (CRP, Nt-proBNP, BNP-fragment, Troponin I, H-FABP, Π»Π΅ΠΏΡ‚ΠΈΠ½, D-Π΄ΠΈΠΌΠ΅Ρ€), ΠΈ Ρ€Π°ΡΡΠΌΠ°Ρ‚Ρ€ΠΈΠ²Π°Ρ‚ΡŒ вопросы ΠΎ ΠΊΠΎΡ€Ρ€Π΅ΠΊΡ†ΠΈΠΈ Ρ‚Π΅Ρ€Π°ΠΏΠΈΠΈ (CRP, BNP-fragment, Troponin I, H-FABP, Π»Π΅ΠΏΡ‚ΠΈΠ½).

Бвязь Ρ€Π°Π±ΠΎΡ‚Ρ‹ с Π½Π°ΡƒΡ‡Π½Ρ‹ΠΌΠΈ ΠΏΡ€ΠΎΠ³Ρ€Π°ΠΌΠΌΠ°ΠΌΠΈ.

ИсслСдованиС Π²Ρ‹ΠΏΠΎΠ»Π½Π΅Π½ΠΎ Π² ΡΠΎΠΎΡ‚вСтствии с ΠΏΠ»Π°Π½ΠΎΠΌ Π½Π°ΡƒΡ‡Π½ΠΎ-ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Ρ‚Π΅Π»ΡŒΡΠΊΠΎΠΉ Ρ€Π°Π±ΠΎΡ‚Ρ‹ Π€Π“Π£ «ΠΠ˜Π˜ ΠΏΡƒΠ»ΡŒΠΌΠΎΠ½ΠΎΠ»ΠΎΠ³ΠΈΠΈ» Π€ΠœΠ‘Π России (Π½ΠΎΠΌΠ΅Ρ€ государствСнной рСгистрации Ρ‚Π΅ΠΌΡ‹ 1 201 180 319).

Π’Π½Π΅Π΄Ρ€Π΅Π½ΠΈΠ΅ Ρ€Π΅Π·ΡƒΠ»ΡŒΡ‚Π°Ρ‚ΠΎΠ² исслСдования.

Π Π΅Π·ΡƒΠ»ΡŒΡ‚Π°Ρ‚Ρ‹, ΠΏΠΎΠ»ΡƒΡ‡Π΅Π½Π½Ρ‹Π΅ Π² Ρ…ΠΎΠ΄Π΅ Ρ€Π°Π±ΠΎΡ‚Ρ‹ Π½Π°Π΄ диссСртациСй, Π²Π½Π΅Π΄Ρ€Π΅Π½Ρ‹ Π² ΠΊΠ»ΠΈΠ½ΠΈΡ‡Π΅ΡΠΊΡƒΡŽ Ρ€Π°Π±ΠΎΡ‚Ρƒ ΠΏΡƒΠ»ΡŒΠΌΠΎΠ½ΠΎΠ»ΠΎΠ³ΠΈΡ‡Π΅ΡΠΊΠΎΠ³ΠΎ ΠΈ 1-Π³ΠΎ ΠΈ 2-Π³ΠΎ тСрапСвтичСских ΠΎΡ‚Π΄Π΅Π»Π΅Π½ΠΈΠΉ, отдСлСния Ρ€Π΅Π°Π½ΠΈΠΌΠ°Ρ†ΠΈΠΈ ΠΈ ΠΈΠ½Ρ‚Снсивной Ρ‚Π΅Ρ€Π°ΠΏΠΈΠΈ Π“ΠšΠ‘ № 57 Π³. ΠœΠΎΡΠΊΠ²Ρ‹. ΠžΡΠ½ΠΎΠ²Π½Ρ‹Π΅ полоТСния диссСртации Π²ΠΊΠ»ΡŽΡ‡Π΅Π½Ρ‹ Π² ΡƒΡ‡Π΅Π±Π½ΡƒΡŽ ΠΏΡ€ΠΎΠ³Ρ€Π°ΠΌΠΌΡƒ ΠΊΠ°Ρ„Π΅Π΄Ρ€Ρ‹ ΠΏΡƒΠ»ΡŒΠΌΠΎΠ½ΠΎΠ»ΠΎΠ³ΠΈΠΈ Π“Π‘ΠžΠ£ Π’ΠŸΠž РНИМУ ΠΈΠΌ Н. И. ΠŸΠΈΡ€ΠΎΠ³ΠΎΠ²Π° ΠœΠΈΠ½Π·Π΄Ρ€Π°Π²ΡΠΎΡ†Ρ€Π°Π·Π²ΠΈΡ‚ΠΈΡ России.

Апробация Ρ€Π°Π±ΠΎΡ‚Ρ‹.

ΠžΡΠ½ΠΎΠ²Π½Ρ‹Π΅ полоТСния Ρ€Π°Π±ΠΎΡ‚Ρ‹ Π΄ΠΎΠ»ΠΎΠΆΠ΅Π½Ρ‹ ΠΈ ΠΎΠ±ΡΡƒΠΆΠ΄Π΅Π½Ρ‹ Π½Π°:

— 16-ΠΌ, 17-ΠΌ, 18-ΠΌ, 19-ΠΌ, 20-ΠΌ Π•ΠΆΠ΅Π³ΠΎΠ΄Π½ΠΎΠΌ ΠšΠΎΠ½Π³Ρ€Π΅ΡΡΠ΅ ЕвропСйского РСспираторного ΠžΠ±Ρ‰Π΅ΡΡ‚Π²Π° (КопСнгагСн, 2007; ΠœΡŽΠ½Ρ…Π΅Π½, 2008; Π’Π΅Π½Π°, 2009; БарсСлона, 2010, АмстСрдам, 2011 Π³Π³.);

— 16-ΠΌ, 17-ΠΌ, 18-ΠΌ, 19-ΠΌ, 20-ΠΌ, 21-ΠΌ ΠΠ°Ρ†ΠΈΠΎΠ½Π°Π»ΡŒΠ½Ρ‹Ρ… конгрСссах ΠΏΠΎ Π±ΠΎΠ»Π΅Π·Π½ΡΠΌ ΠΎΡ€Π³Π°Π½ΠΎΠ² дыхания (Π‘Π°Π½ΠΊΡ‚-ΠŸΠ΅Ρ‚Π΅Ρ€Π±ΡƒΡ€Π³, 2006; Казань, 2007; Π•ΠΊΠ°Ρ‚Π΅Ρ€ΠΈΠ½Π±ΡƒΡ€Π³, 2008; Москва, 2009;10- Π£Ρ„Π°, 2011 Π³Π³);

— ΠΠ°ΡƒΡ‡Π½Ρ‹Ρ… сСссиях Π€Π“Π£ «ΠΠ˜Π˜ ΠΏΡƒΠ»ΡŒΠΌΠΎΠ½ΠΎΠ»ΠΎΠ³ΠΈΠΈ» Π€ΠœΠ‘Π России (Москва 2007, 2008, 2009, 2010, 2011 Π³Π³.);

— Π‘овмСстном засСдании Π€Π“Π£ «ΠΠ˜Π˜ ΠΏΡƒΠ»ΡŒΠΌΠΎΠ½ΠΎΠ»ΠΎΠ³ΠΈΠΈ» Π€ΠœΠ‘Π России ΠΈ ΠΊΠ°Ρ„Π΅Π΄Ρ€Ρ‹ Π³ΠΎΡΠΏΠΈΡ‚Π°Π»ΡŒΠ½ΠΎΠΉ Ρ‚Π΅Ρ€Π°ΠΏΠΈΠΈ пСдиатричСского Ρ„Π°ΠΊΡƒΠ»ΡŒΡ‚Π΅Ρ‚Π° Π“ΠžΠ£ Π’ΠŸΠž Π Π“ΠœΠ£ ΠΈΠΌ. Π. И. ΠŸΠΈΡ€ΠΎΠ³ΠΎΠ²Π° ΠœΠΈΠ½Π·Π΄Ρ€Π°Π²Π° Π Π€ (Москва, 2009, 2010, 2011 Π³.).

ΠŸΡƒΠ±Π»ΠΈΠΊΠ°Ρ†ΠΈΠΈ.

По Ρ‚Π΅ΠΌΠ΅ диссСртации ΠΎΠΏΡƒΠ±Π»ΠΈΠΊΠΎΠ²Π°Π½ΠΎ 35 ΠΏΠ΅Ρ‡Π°Ρ‚Π½Ρ‹Ρ… Π½Π°ΡƒΡ‡Π½Ρ‹Ρ… Ρ€Π°Π±ΠΎΡ‚ Π² ΠΎΡ‚СчСствСнных ΠΈ Π·Π°Ρ€ΡƒΠ±Π΅ΠΆΠ½Ρ‹Ρ… изданиях, ΠΈΠ· ΠΊΠΎΡ‚ΠΎΡ€Ρ‹Ρ… 14 — ΡΡ‚Π°Ρ‚ΡŒΠΈ Π² ΠΆΡƒΡ€Π½Π°Π»Π°Ρ…, входящих Π² ΠΏΠ΅Ρ€Π΅Ρ‡Π΅Π½ΡŒ Π²Π΅Π΄ΡƒΡ‰ΠΈΡ… Ρ€Π΅Ρ†Π΅Π½Π·ΠΈΡ€ΡƒΠ΅ΠΌΡ‹Ρ… Π½Π°ΡƒΡ‡Π½Ρ‹Ρ… ΠΆΡƒΡ€Π½Π°Π»ΠΎΠ² ΠΈ ΠΈΠ·Π΄Π°Π½ΠΈΠΉ, Ρ€Π΅ΠΊΠΎΠΌΠ΅Π½Π΄ΠΎΠ²Π°Π½Π½Ρ‹Ρ… Π’ΠΠš Π Π€.

ОбъСм ΠΈ ΡΡ‚Ρ€ΡƒΠΊΡ‚ΡƒΡ€Π° Ρ€Π°Π±ΠΎΡ‚Ρ‹.

ДиссСртация ΠΈΠ·Π»ΠΎΠΆΠ΅Π½Π° Π½Π° 214 страницах машинописи. Бостоит ΠΈΠ· Π²Π²Π΅Π΄Π΅Π½ΠΈΡ, Π³Π»Π°Π²: ΠΎΠ±Π·ΠΎΡ€ Π»ΠΈΡ‚Π΅Ρ€Π°Ρ‚ΡƒΡ€Ρ‹, ΠΌΠ°Ρ‚Π΅Ρ€ΠΈΠ°Π» ΠΈ ΠΌΠ΅Ρ‚ΠΎΠ΄Ρ‹ исслСдования, Ρ€Π΅Π·ΡƒΠ»ΡŒΡ‚Π°Ρ‚Ρ‹ собствСнных исслСдований, обсуТдСниС Ρ€Π΅Π·ΡƒΠ»ΡŒΡ‚Π°Ρ‚ΠΎΠ², Π·Π°ΠΊΠ»ΡŽΡ‡Π΅Π½ΠΈΡ, Π²Ρ‹Π²ΠΎΠ΄ΠΎΠ², практичСских Ρ€Π΅ΠΊΠΎΠΌΠ΅Π½Π΄Π°Ρ†ΠΈΠΉ, прилоТСния. Π˜Π»Π»ΡŽΡΡ‚Ρ€ΠΈΡ€ΠΎΠ²Π°Π½Π° 15 рисунками ΠΈ 52 Ρ‚Π°Π±Π»ΠΈΡ†Π°ΠΌΠΈ. БиблиографичСский ΡƒΠΊΠ°Π·Π°Ρ‚Π΅Π»ΡŒ содСрТит 26 отСчСствСнных ΠΈ 411 Π·Π°Ρ€ΡƒΠ±Π΅ΠΆΠ½Ρ‹Ρ… источников. ДиссСртация ΠΈΠ·Π»ΠΎΠΆΠ΅Π½Π° Π½Π° Ρ€ΡƒΡΡΠΊΠΎΠΌ языкС.

Π²Ρ‹Π²ΠΎΠ΄Ρ‹.

1. Π’Π½Π΅Π±ΠΎΠ»ΡŒΠ½ΠΈΡ‡Π½Π°Ρ пнСвмония ΠΊΠ°ΠΊ ΠΏΡ€ΠΈΡ‡ΠΈΠ½Π° обострСния Π₯ΠžΠ‘Π› встрСчаСтся Π² -19% всСх наблюдСний. НСзависимыми ΠΏΡ€Π΅Π΄ΠΈΠΊΡ‚ΠΎΡ€Π°ΠΌΠΈ 30-Π΄Π½Π΅Π²Π½ΠΎΠΉ Π»Π΅Ρ‚Π°Π»ΡŒΠ½ΠΎΡΡ‚ΠΈ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… Π₯ΠžΠ‘Π› с Π’ΠŸ ΡΠ²Π»ΡΡŽΡ‚ΡΡ ΡƒΡ€ΠΎΠ²Π½ΠΈ CRP Π½Π° ΠΌΠΎΠΌΠ΅Π½Ρ‚ госпитализации ΠΈ ΠΈΠ½Π΄Π΅ΠΊΡ коморбидности Charlson. ΠŸΡ€Π΅Π΄ΠΈΠΊΡ‚ΠΎΡ€Π°ΠΌΠΈ ΠΏΠΎΠ²Ρ‚ΠΎΡ€Π½ΠΎΠΉ госпитализации Π² Ρ‚Π΅Ρ‡Π΅Π½ΠΈΠ΅ 6 мСсяцСв ΡΠ²Π»ΡΡŽΡ‚ΡΡ индСкс коморбидности Charlson, частота обострСний Π₯ΠžΠ‘Π› > 3 Ρ€Π°Π· Π² Π³ΠΎΠ΄ ΠΈ ΠΊΡ€Π°ΠΉΠ½Π΅ тяТСлоС Ρ‚Π΅Ρ‡Π΅Π½ΠΈΠ΅ Π₯ΠžΠ‘Π› (стадия IV ΠΏΠΎ ΠΊΠ»Π°ΡΡΠΈΡ„ΠΈΠΊΠ°Ρ†ΠΈΠΈ GOLD).

2. Нозокомиальная пнСвмония срСди госпитализированных Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… Π₯ΠžΠ‘Π› выявлСна Π² 12% наблюдСний. Π£Ρ€ΠΎΠ²Π΅Π½ΡŒ сывороточного CRP Π·Π½Π°Ρ‡ΠΈΠΌΠΎ ΠΏΠΎΠ²Ρ‹ΡˆΠ°Π΅Ρ‚ΡΡ ΠΏΡ€ΠΈ Ρ€Π°Π·Π²ΠΈΡ‚ΠΈΠΈ нозокомиальной ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠΈ ΠΏΠΎ ΡΡ€Π°Π²Π½Π΅Π½ΠΈΡŽ с ΠΈΡΡ…ΠΎΠ΄Π½Ρ‹ΠΌΠΈ значСниями CRP Π² ΠΏΠ΅Ρ€Π²Ρ‹Π΅ Π΄Π½ΠΈ госпитализации. ΠšΠΎΠ½Ρ†Π΅Π½Ρ‚Ρ€Π°Ρ†ΠΈΠΈ CRP ΠΏΡ€ΠΈ Ρ€Π°Π·Π²ΠΈΡ‚ΠΈΠΈ ΠΠŸ ΠΈΠΌΠ΅ΡŽΡ‚ ΠΏΡ€ΡΠΌΡƒΡŽ Π·Π°Π²ΠΈΡΠΈΠΌΠΎΡΡ‚ΡŒ со ΡˆΠΊΠ°Π»Π°ΠΌΠΈ CPIS ΠΈ APACHE II.

3. ΠŸΠΎΡ€ΠΎΠ³ΠΎΠ²ΠΎΠ΅ Π·Π½Π°Ρ‡Π΅Π½ΠΈΠ΅ CRP для диагностики Π±Π°ΠΊΡ‚Π΅Ρ€ΠΈΠ°Π»ΡŒΠ½ΠΎΠΉ ΠΈΠ½Ρ„Π΅ΠΊΡ†ΠΈΠΈ Ρƒ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… с ΠΎΠ±ΠΎΡΡ‚Ρ€Π΅Π½ΠΈΠ΅ΠΌ Π₯ΠžΠ‘Π› составляСт >16,5 ΠΌΠ³/Π» (Ρ‡ΡƒΠ²ΡΡ‚Π²ΠΈΡ‚Π΅Π»ΡŒΠ½ΠΎΡΡ‚ΡŒ 0,931, ΡΠΏΠ΅Ρ†ΠΈΡ„ΠΈΡ‡Π½ΠΎΡΡ‚ΡŒΡŽ 0,932).

4. ΠŸΠΎΡ€ΠΎΠ³ΠΎΠ²Ρ‹ΠΉ ΡƒΡ€ΠΎΠ²Π΅Π½ΡŒ CRP>51,5 ΠΌΠ³/Π» являСтся ΠΏΡ€Π΅Π΄ΠΈΠΊΡ‚ΠΎΡ€ΠΎΠΌ наличия Π²Π½Π΅Π±ΠΎΠ»ΡŒΠ½ΠΈΡ‡Π½ΠΎΠΉ ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠΈ Ρƒ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… Π₯ΠžΠ‘Π› (Ρ‡ΡƒΠ²ΡΡ‚Π²ΠΈΡ‚Π΅Π»ΡŒΠ½ΠΎΡΡ‚ΡŒ 0,870, ΡΠΏΠ΅Ρ†ΠΈΡ„ΠΈΡ‡Π½ΠΎΡΡ‚ΡŒ 0,910). ΠŸΡ€ΠΈ Ρ€Π°Π·Π²ΠΈΡ‚ΠΈΠΈ ослоТнСний ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠΈ ΠΊΠΎΠ½Ρ†Π΅Π½Ρ‚Ρ€Π°Ρ†ΠΈΠΈ сывороточного CRP достовСрно ΠΏΠΎΠ²Ρ‹ΡˆΠ°ΡŽΡ‚ΡΡ.

5. Π£Ρ€ΠΎΠ²Π½ΠΈ NT-pro-BNP ΠΈ BNP-fragment ΠΏΠΎΠ²Ρ‹ΡˆΠ΅Π½Ρ‹ Ρƒ Π±ΠΎΠ»ΡŒΡˆΠΈΠ½ΡΡ‚Π²Π° ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚ΠΎΠ² с ΠΎΠ±ΠΎΡΡ‚Ρ€Π΅Π½ΠΈΠ΅ΠΌ Π₯ΠžΠ‘Π›. ΠŸΠΎΠ²Ρ‹ΡˆΠ΅Π½ΠΈΠ΅ ΠΊΠΎΠ½Ρ†Π΅Π½Ρ‚Ρ€Π°Ρ†ΠΈΠΉ NT-pro-BNP ΠΈ BNP-fragment ΠΏΡ€ΠΈ обострСнии Π₯ΠžΠ‘Π› Π½Π°Π±Π»ΡŽΠ΄Π°Π΅Ρ‚ΡΡ ΠΏΡ€ΠΈ Π½Π°Π»ΠΈΡ‡ΠΈΠΈ Π»Π΅Π³ΠΎΡ‡Π½ΠΎΠΉ Π³ΠΈΠΏΠ΅Ρ€Ρ‚Π΅Π½Π·ΠΈΠΈ ΠΈ ΡΠΈΡΡ‚оличСской дисфункции Π»Π΅Π²ΠΎΠ³ΠΎ ΠΆΠ΅Π»ΡƒΠ΄ΠΎΡ‡ΠΊΠ°. ΠŸΠΎΠ²Ρ‹ΡˆΠ΅Π½ΠΈΠ΅ ΡƒΡ€ΠΎΠ²Π½Π΅ΠΉ NT-pro-BNP ΠΈ BNP-fragment являСтся нСблагоприятным прогностичСским Ρ„Π°ΠΊΡ‚ΠΎΡ€ΠΎΠΌ для ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚ΠΎΠ² с ΠΎΠ±ΠΎΡΡ‚Ρ€Π΅Π½ΠΈΠ΅ΠΌ Π₯ΠžΠ‘Π›.

6. Π£Ρ€ΠΎΠ²Π½ΠΈ Π±ΠΈΠΎΠΌΠ°Ρ€ΠΊΠ΅Ρ€Π° поврСТдСния ΠΌΠΈΠΎΠΊΠ°Ρ€Π΄Π° H-FABP ΠΏΠΎΠ²Ρ‹ΡˆΠ΅Π½Ρ‹ Ρƒ Π±ΠΎΠ»ΡŒΡˆΠΈΠ½ΡΡ‚Π²Π° Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… с ΠΎΠ±ΠΎΡΡ‚Ρ€Π΅Π½ΠΈΠ΅ΠΌ Π₯ΠžΠ‘Π› (92,5%). ΠŸΠΎΠ²Ρ‹ΡˆΠ΅Π½ΠΈΠ΅ Tn I (>0,5 Π½Π³/ΠΌΠ») ΠΎΡ‚ΠΌΠ΅Ρ‡Π΅Π½ΠΎ Π² 21,3% случаСв всСх обострСний Π₯ΠžΠ‘Π›.

7. ΠŸΡ€Π΅Π΄ΠΈΠΊΡ‚ΠΎΡ€Π°ΠΌΠΈ Π³ΠΎΡΠΏΠΈΡ‚Π°Π»ΡŒΠ½ΠΎΠΉ Π»Π΅Ρ‚Π°Π»ΡŒΠ½ΠΎΡΡ‚ΠΈ ΠΏΡ€ΠΈ обострСнии Π₯ΠžΠ‘Π› ΡΠ²Π»ΡΡŽΡ‚ΡΡ ΡƒΡ€ΠΎΠ²Π½ΠΈ BNP-fragment ΠΈ H-FABP.

8. ΠœΠ°Ρ€ΠΊΠ΅Ρ€ поврСТдСния ΠΌΠΈΠΎΠΊΠ°Ρ€Π΄Π° H-FABP Π·Π½Π°Ρ‡ΠΈΠΌΠΎ ΠΏΠΎΠ²Ρ‹ΡˆΠ΅Π½ Ρƒ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… с Π₯ΠžΠ‘Π› ΠΏΡ€ΠΈ Ρ€Π°Π·Π²ΠΈΡ‚ΠΈΠΈ ΠΈΠ½Ρ„Π΅ΠΊΡ†ΠΈΠΈ Π½ΠΈΠΆΠ½ΠΈΡ… Π΄Ρ‹Ρ…Π°Ρ‚Π΅Π»ΡŒΠ½Ρ‹Ρ… ΠΏΡƒΡ‚Π΅ΠΉ. ВыявлСнныС Π·Π½Π°Ρ‡ΠΈΠΌΡ‹Π΅ ΠΏΠΎΠ»ΠΎΠΆΠΈΡ‚Π΅Π»ΡŒΠ½Ρ‹Π΅ коррСляции Ρƒ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… с ΠΈΠ½Ρ„Π΅ΠΊΡ†ΠΈΠΎΠ½Π½Ρ‹ΠΌ обострСниСм (Π±Ρ€ΠΎΠ½Ρ…ΠΈΡ‚, пнСвмония) ΠΌΠ΅ΠΆΠ΄Ρƒ H-FABP с BNP-fragment, Π²Ρ‹Ρ€Π°ΠΆΠ΅Π½Π½ΠΎΡΡ‚ΡŒΡŽ ΠΎΠ΄Ρ‹ΡˆΠΊΠΈ, ΠΊΠΎΠ½Π΅Ρ‡Π½ΠΎ-дистоличСским Π΄ΠΈΠ°ΠΌΠ΅Ρ‚Ρ€ΠΎΠΌ Π»Π΅Π²ΠΎΠ³ΠΎ ΠΆΠ΅Π»ΡƒΠ΄ΠΎΡ‡ΠΊΠ° ΡΠ²ΠΈΠ΄Π΅Ρ‚Π΅Π»ΡŒΡΡ‚Π²ΡƒΡŽΡ‚ ΠΎ ΠΊΠ°Ρ€Π΄ΠΈΠ°Π»ΡŒΠ½ΠΎΠΌ стрСссС ΠΏΡ€ΠΈ обострСнии Π₯ΠžΠ‘Π›. ΠŸΠΎΠ²Ρ‹ΡˆΠ΅Π½Π½Ρ‹Π΅ ΡƒΡ€ΠΎΠ²Π½ΠΈ H-FABP ΠΏΡ€ΠΈ ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠΈ ΠΎΡ‚Ρ€Π°ΠΆΠ°ΡŽΡ‚ Π΅Π΅ Ρ‚ΡΠΆΠ΅ΡΡ‚ΡŒ. Π”ΠΎΠΊΠ°Π·Π°Π½Π° прогностичСская Ρ€ΠΎΠ»ΡŒ H-FABP Ρƒ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… с ΠΎΠ±ΠΎΡΡ‚Ρ€Π΅Π½ΠΈΠ΅ΠΌ Π₯ΠžΠ‘Π›.

9. ΠŸΡ€ΡΠΌΡ‹Π΅ коррСляции CRP с Ρ€Π°Π·ΠΌΠ΅Ρ€Π°ΠΌΠΈ Π»Π΅Π²ΠΎΠ³ΠΎ ΠΆΠ΅Π»ΡƒΠ΄ΠΎΡ‡ΠΊΠ° (ΠΊΠΎΠ½Π΅Ρ‡Π½ΠΎ-систоличСским ΠΈ ΠΊΠΎΠ½Π΅Ρ‡Π½ΠΎ-диастоличСским Π΄ΠΈΠ°ΠΌΠ΅Ρ‚Ρ€Π°ΠΌΠΈ), ΠΎΡ‚Ρ€ΠΈΡ†Π°Ρ‚Π΅Π»ΡŒΠ½Π°Ρ связь с Ρ„Ρ€Π°ΠΊΡ†ΠΈΠ΅ΠΉ выброса Π»Π΅Π²ΠΎΠ³ΠΎ ΠΆΠ΅Π»ΡƒΠ΄ΠΎΡ‡ΠΊΠ° Π² Π³Ρ€ΡƒΠΏΠΏΠ΅ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… с ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠ΅ΠΉ, Π° Π² Π³Ρ€ΡƒΠΏΠΏΠ΅ Π₯БН — с ΡƒΡ€ΠΎΠ²Π½Π΅ΠΌ BNP-fragment ΡΠ²ΠΈΠ΄Π΅Ρ‚Π΅Π»ΡŒΡΡ‚Π²ΡƒΡŽΡ‚ ΠΎΠ± ΡƒΡ‡Π°ΡΡ‚ΠΈΠΈ систСмного воспалСния Π² ΠΏΠ°Ρ‚ΠΎΠ³Π΅Π½Π΅Π·Π΅ сСрдСчной дисфункции.

10. Частота встрСчаСмости ВЭЛА ΠΏΡ€ΠΈ обострСнии Π₯ΠžΠ‘Π› составляСт 3%. Π‘Ρ€ΠΎΠΊΠΈ госпитализации Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… с Π’ЭЛА Π±Ρ‹Π»ΠΈ дольшС, Ρ‡Π΅ΠΌ ΠΏΡ€ΠΈ Π΄Ρ€ΡƒΠ³ΠΈΡ… ΠΏΡ€ΠΈΡ‡ΠΈΠ½Π°Ρ… обострСния Π₯ΠžΠ‘Π›, ΠΏΠΎΠΊΠ°Π·Π°Ρ‚Π΅Π»ΠΈ Π³ΠΎΡΠΏΠΈΡ‚Π°Π»ΡŒΠ½ΠΎΠΉ Π»Π΅Ρ‚Π°Π»ΡŒΠ½ΠΎΡΡ‚ΠΈ Π½Π΅ Ρ€Π°Π·Π»ΠΈΡ‡Π°Π»ΠΈΡΡŒ.

11. ΠžΡ‚ΡΡƒΡ‚ΡΡ‚Π²ΠΈΠ΅ Π΄ΠΈΠ½Π°ΠΌΠΈΠΊΠΈ Π»Π΅ΠΏΡ‚ΠΈΠ½Π΅ΠΌΠΈΠΈ Ρƒ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… Π₯ΠžΠ‘Π› с Π°Π»ΡŒΠ²Π΅ΠΎΠ»ΡΡ€Π½ΠΎΠΉ гиповСнтиляциСй ΠΏΡ€ΠΈ Ρ€Π°Π·Π²ΠΈΡ‚ΠΈΠΈ гипСркапничСской ΠžΠ”Π ассоциируСтся с ΠΌΠ΅Π΄Π»Π΅Π½Π½Ρ‹ΠΌ сниТСниСм Π³ΠΈΠΏΠ΅Ρ€ΠΊΠ°ΠΏΠ½ΠΈΠΈ, Ρ‡Ρ‚ΠΎ Ρ‚Ρ€Π΅Π±ΡƒΠ΅Ρ‚ ΠΊΠΎΡ€Ρ€Π΅ΠΊΡ†ΠΈΠΈ ΠΏΠ°Ρ€Π°ΠΌΠ΅Ρ‚Ρ€ΠΎΠ² рСспираторной ΠΏΠΎΠ΄Π΄Π΅Ρ€ΠΆΠΊΠΈ.

ΠŸΠ ΠΠšΠ’Π˜Π§Π•Π‘ΠšΠ˜Π• Π Π•ΠšΠžΠœΠ•ΠΠ”ΠΠ¦Π˜Π˜.

1. Для диагностики Π±Π°ΠΊΡ‚Π΅Ρ€ΠΈΠ°Π»ΡŒΠ½ΠΎΠΉ ΠΈΠ½Ρ„Π΅ΠΊΡ†ΠΈΠΈ Ρƒ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… ΠΏΡ€ΠΈ обострСнии Π₯ΠžΠ‘Π› Π·Π½Π°Ρ‡Π΅Π½ΠΈΠ΅ CRP составляСт >16,5 ΠΌΠ³/Π»;

2. ΠŸΡ€ΠΈ диагностикС ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΠΈ Ρƒ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… Π₯ΠžΠ‘Π› ΠΏΠΎΡ€ΠΎΠ³ΠΎΠ²ΠΎΠ΅ Π·Π½Π°Ρ‡Π΅Π½ΠΈΠ΅ CRP составляСт >51,5 ΠΌΠ³/Π».

3. ΠŸΡ€ΠΎΠ³Π½ΠΎΡΡ‚ΠΈΡ‡Π΅ΡΠΊΠΎΠ΅ Π·Π½Π°Ρ‡Π΅Π½ΠΈΠ΅ для Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… Π₯ΠžΠ‘Π› с Π’ΠŸ ΠΈΠΌΠ΅ΡŽΡ‚ ΡƒΡ€ΠΎΠ²Π½ΠΈ CRP Π½Π° ΠΌΠΎΠΌΠ΅Π½Ρ‚ госпитализации ΠΈ ΠΈΠ½Π΄Π΅ΠΊΡ коморбидности Charlson.

4. ΠŸΡ€ΠΎΠ³Π½ΠΎΡΡ‚ΠΈΡ‡Π΅ΡΠΊΠΎΠ΅ Π·Π½Π°Ρ‡Π΅Π½ΠΈΠ΅ для Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… Π₯ΠžΠ‘Π› с ΠΠŸ ΠΈΠΌΠ΅ΡŽΡ‚ значСния ΡˆΠΊΠ°Π»Ρ‹ APACHE II ΠΈ ΠΊΠΎΠ½Ρ†Π΅Π½Ρ‚Ρ€Π°Ρ†ΠΈΠΈ CRP ΠΈ IL-6 Π² ΡΡ‹Π²ΠΎΡ€ΠΎΡ‚ΠΊΠ΅ ΠΊΡ€ΠΎΠ²ΠΈ.

5. ΠŸΡ€ΠΈ диагностикС Π‘Π” Π›Π– ΠΏΠΎΡ€ΠΎΠ³ΠΎΠ²ΠΎΠ΅ Π·Π½Π°Ρ‡Π΅Π½ΠΈΠ΅ уровня Nt-proBNP составляСт 902,1 Ρ„ΠΌΠΎΠ»ΡŒ/ΠΌΠ», BNP-fragment — 943,0 Ρ„ΠΌΠΎΠ»ΡŒ/ΠΌΠ».

6. ΠŸΡ€ΠΈ ΠΏΠΎΠ²Ρ‹ΡˆΠ΅Π½ΠΈΠΈ БДЛА >35 ΠΌΠΌ Ρ€Ρ‚ ΡΡ‚ Ρƒ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… Π₯ΠžΠ‘Π› ΠΏΠΎΡ€ΠΎΠ³ΠΎΠ²ΠΎΠ΅ Π·Π½Π°Ρ‡Π΅Π½ΠΈΠ΅ уровня Nt-proBNP составляСт 585,2 Ρ„ΠΌΠΎΠ»ΡŒ/ΠΌΠ», BNP-fragment -369,5 Ρ„ΠΌΠΎΠ»ΡŒ/ΠΌΠ».

7. Π£Ρ€ΠΎΠ²Π½ΠΈ Nt-pro-BNP >932,4 Ρ„ΠΌΠΎΠ»ΡŒ/ΠΌΠ» ΠΈ BNP-fragment >1364,9 Ρ„ΠΌΠΎΠ»ΡŒ/ΠΌΠ» ΡΠ²Π»ΡΡŽΡ‚ΡΡ нСблагоприятными прогностичСскими Ρ„Π°ΠΊΡ‚ΠΎΡ€Π°ΠΌΠΈ Π»Π΅Ρ‚Π°Π»ΡŒΠ½ΠΎΡΡ‚ΠΈ ΠΎΡ‚ Π²ΡΠ΅Ρ… ΠΏΡ€ΠΈΡ‡ΠΈΠ½ Ρƒ ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚ΠΎΠ² с ΠΎΠ±ΠΎΡΡ‚Ρ€Π΅Π½ΠΈΠ΅ΠΌ Π₯ΠžΠ‘Π›.

8. Π£ ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚ΠΎΠ² с ΠΎΠ±ΠΎΡΡ‚Ρ€Π΅Π½ΠΈΠ΅ΠΌ Π₯ΠžΠ‘Π› прогностичСски нСблагоприятными Ρ„Π°ΠΊΡ‚ΠΎΡ€Π°ΠΌΠΈ ΡΠ²Π»ΡΡŽΡ‚ΡΡ значСния H-FABP >6594,2 ΠΏΠ³/ΠΌΠ» ΠΈ Tn I >0,5 Π½Π³/ΠΌΠ».

9. Π”ΠΈΠ½Π°ΠΌΠΈΠΊΠ° сывороточного Π»Π΅ΠΏΡ‚ΠΈΠ½Π° ΠΏΡ€ΠΈ синдромС Π°Π»ΡŒΠ²Π΅ΠΎΠ»ΡΡ€Π½ΠΎΠΉ гиповСнтиляции Ρƒ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… Π₯ΠžΠ‘Π› ΠΎΡ‚Ρ€Π°ΠΆΠ°Π΅Ρ‚ ΡΡ„Ρ„Π΅ΠΊΡ‚ΠΈΠ²Π½ΠΎΡΡ‚ΡŒ ΠΏΡ€ΠΎΠ²ΠΎΠ΄ΠΈΠΌΠΎΠΉ рСспираторной ΠΏΠΎΠ΄Π΄Π΅Ρ€ΠΆΠΊΠΈ.

ΠŸΠΎΠΊΠ°Π·Π°Ρ‚ΡŒ вСсь тСкст

Бписок Π»ΠΈΡ‚Π΅Ρ€Π°Ρ‚ΡƒΡ€Ρ‹

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