Современные подходы к обострению идиопатического легочного фиброза


DOI: https://dx.doi.org/10.18565/therapy.2019.6.127-138

С.Н. Авдеев

1) ФГАОУ ВО «Первый Московский государственный медицинский университет имени И.М. Сеченова» Минздрава России (Сеченовский университет); 2) ФГБУ «Научно-исследовательский институт пульмонологии» ФМБА России, г. Москва
Обострение идиопатического легочного фиброза (ИЛФ) определяется как острое, клинически значимое респираторное ухудшение, обычно развивающееся в сроки менее 1 мес, которое характеризуется такими новыми изменениями на высоко разрешающейся компьютерной томографии (ВРКТ), как диффузные, двусторонние изменения по типу «матового стекла» и/или консолидатов, и отсутствием других явных клинических причин ухудшения, таких как перегрузка объемом, сердечная недостаточность, тромбоэмболия легочных артерий (ТЭЛА) и др. Обострения ИЛФ подразделяют на «вызванные», т.е. имеющие причины (например, инфекции, хирургические операции, лекарственная токсичность и др.), и идиопатические, когда причину установить не удается.
В рандомизированных исследованиях годичная заболеваемость обострениями ИЛФ составляет около 8%, а в ретроспективных исследованиях достигает 19%. Тяжелые формы ИЛФ являются важным фактором риска развития обострений этого заболевания. Внутригоспитальная летальность при обострении ИЛФ составляет более 50%, а средняя выживаемость после обострения –
1–4 мес.
В настоящее время отсутствуют методы терапии, эффективность которых была бы доказана при обострении ИЛФ. В реальной клинической практике пациентам с обострением ИЛФ чаще всего назначают высокие дозы глюкокортикостероидов (ГКС) и антибиотики. Антифибротическая терапия способна уменьшить риск развития обострений: показано, что терапия нинтеданибом приводит к снижению числа подтвержденных/подозреваемых обострений ИЛФ на 68%. Необходимо дальнейшее изучение возможных методов профилактики и терапии обострений ИЛФ в клинических исследованиях.
Ключевые слова: обострение, антифибротическая терапия, идиопатический легочный фиброз, прогноз
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Об авторах / Для корреспонденции

Сергей Николаевич Авдеев, д.м.н., профессор, член-корр. РАН, зав. кафедры пульмонологии лечебного факультета ФГАОУ ВО «Первый Московский государственный медицинский университет имени И. М. Сеченова» Минздрава России (Сеченовского университета), руководитель клинического отдела ФГБУ «Научно-исследовательский институт пульмонологии» ФМБА России. Адрес: 105077, г. Москва, Ореховый бульвар, д. 28. Тел./факс: 8 (495) 395-63-93. E-mail: serg_avdeev@list.ru. https://orcid.org/0000-0002-5999-2150


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