References

mimmun

Медицинская иммунология

Medical Immunology (Russia)

1563-06252313-741X

SPb RAACI

10.15789/1563-0625-IPO-3399

mimmun-3399

Research Article

ОБЗОРЫ

REVIEWS

ИММУНОЛОГИЧЕСКИЕ ПРЕДИКТОРЫ ТЯЖЕЛОГО ТЕЧЕНИЯ И ЛЕТАЛЬНОГО ИСХОДА ВНЕБОЛЬНИЧНОЙ ПНЕВМОНИИ (ОБЗОР ЛИТЕРАТУРЫ)

IMMUNOLOGICAL PREDICTORS OF SEVERE COURSE AND FATAL OUTCOME OF COMMUNITY-ACQUIRED PNEUMONIA (LITERATURE REVIEW)

https://orcid.org/0000-0002-4806-050X

Золотов

М. О.

Zolotov

M. O.

PhD, Associate Professor of the Department of Medical Microbiology and Immunology, Head of the Laboratory of Translational Technologies and Interdisciplinary Relations of the Professional Center for Education and Research in Genetic and Laboratory Technologies

m.o.zolotov@gmail.com

https://orcid.org/0000-0003-0941-9871

Мигачёва

Н. Б.

Migacheva

N. B.

PhD, MD (Medicine), Associate Professor, Head of the Department of Pediatrics IPE

n.b.migacheva@samsmu.ru

https://orcid.org/0000-0002-5905-1895

Лямин

А. В.

Lyamin

A. V.

д.м.н., доцент, профессор кафедры медицинской микробиологии и иммунологии, директор научно-образовательного профессионального центра генетических и лабораторных технологий

PhD, MD (Medicine), Associate Professor; Professor of the Department of Medical Microbiology and Immunology; Director of the Professional Center for Education and Research in Genetic and Laboratory Technologies

a.v.lyamin@samsmu.ru

ФГБОУ ВО «Самарский государственный медицинский университет» Министерства здравоохранения РФ, Самара, РоссияРоссияSamara State Medical University, Samara, Russian FederationRussian Federation

2019

11082026

Online First

3399

2019

Золотов М.О., Мигачёва Н.Б., Лямин А.В.

Zolotov M.O., Migacheva N.B., Lyamin A.V.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://www.mimmun.ru/mimmun/article/view/3399

Внебольничная пневмония – одно из самых распространенных инфекционных заболеваний. По данным Всемирной организации здравоохранения инфекции нижних дыхательных путей являются одной из лидирующих причин смерти. Для практической медицины большой интерес представляет выявление предикторов тяжелого течения и летального исхода пневмонии. Прогнозирование течения заболевания позволяет определить тактику ведения пациента и своевременно госпитализировать больного. Цель исследования – провести анализ научной литературы для определения предикторов тяжелого течения и летального исхода пневмонии. Для подбора литературы были использованы базы Elibrary, Cyberleninca, Pubmed, Google Scholar. Определение количества лейкоцитов и их популяций в крови является наиболее доступным методом обследования, который отражает иммунные реакции, происходящие в организме. Установлена связь между снижением уровня эозинофилов в крови и тяжелым течением воспалительных заболеваний легких. По данным исследователей повышение относительного числа нейтрофилов и соотношение нейтрофилов и лимфоцитов могут быть использованы для прогнозирования исхода пневмонии, а снижение абсолютного числа лимфоцитов ниже 0,724*10^9/л является независимым предиктором 30-дневной летальности. Определение биохимических маркеров позволяет комплексно оценить состояние больного. Так, уровень альбумина в крови позволяет определить нутритивный статус пациента, кроме того, он обладает иммуномодулирующей активностью и участвует в борьбе с патогенами. У тяжелых больных наблюдается не только гипоальбуминемия, но и повышение уровней креатинина и азота мочевины. В клинических исследованиях также была продемонстрирована связь между уровнем мозговых пептидов и летальностью у пациентов с сопутствующей сердечно-сосудистой патологией. С-реактивный белок является одним из основных показателей степени тяжести внебольничной пневмонии, используемых в клинической практике, наравне с прокальцитонином. В зарубежной литературе большое внимание уделяется пентраксину-3 как показателю тяжелого течения и предиктору наступления летального исхода. В регуляции иммунного ответа на патогены важную роль играют цитокины, уровни которых меняются в ответ на развитие воспалительной реакции. Однако для комплексной оценки состояния пациента необходимо использование прогностических шкал. Наличие большого количества существующих и вновь предлагаемых шкал является отражением текущего состояния проблемы, заключающейся в отсутствии в настоящее время методики, полностью удовлетворяющей требования практической медицины. Для полной оценки в прогностических шкалах требуется учитывать иммунологические показатели.

Community-acquired pneumonia is one of the most common infectious diseases. According to the World Health Organization, lower respiratory tract infections are a leading cause of death. Identifying predictors of severe pneumonia and its fatal outcome is of great interest to practical medicine. Predicting the course of the disease allows us to develop an appropriate treatment strategy for the patient and ensure timely hospitalization. The aim of this study was to analyze the scientific literature to identify predictors of severe pneumonia and its fatal outcome. The following databases were used: Elibrary, Cyberleninca, Pubmed, and Google Scholar. Determining the number of leukocytes and their populations in the blood is the most accessible diagnostic method, reflecting immune responses. A link has been established between eosinopenia and the severity of inflammatory lung diseases. According to researchers, an increase in the relative neutrophil count and the neutrophil-to-lymphocyte ratio can be used to predict the outcome of pneumonia, while a decrease in the absolute lymphocyte count below 0.724*10^9/L is an independent predictor of 30-day mortality. Determining biochemical markers allows for a comprehensive assessment of the patient's condition. For example, blood albumin levels help determine the patient's nutritional status; it also has immunomodulatory activity and is involved in the fight against pathogens. In severely ill patients, hypoalbuminemia is observed, as well as elevated creatinine and blood urea nitrogen levels. Clinical studies have also demonstrated a link between brain peptide levels and mortality in patients with concomitant cardiovascular disease. C-reactive protein, along with procalcitonin, is one of the main indicators of community-acquired pneumonia severity used in clinical practice. Pentraxin-3 has received considerable attention as an indicator of severe progression and a predictor of mortality. Cytokines, whose levels change in response to the development of an inflammatory reaction, play a key role in regulating the immune response to pathogens. However, a comprehensive assessment of a patient's condition requires the use of prognostic scales. The large number of existing and newly proposed scales reflects the lack of a methodology that would fully meet the requirements of practical medicine. A complete assessment in prognostic scales requires consideration of immunological parameters.

тяжелая пневмонияС-реактивный белокпрокальцитонинальбуминмочевинапнетраксин-3прогностические шкалы.

severe pneumoniaC-reactive proteinprocalcitoninalbuminureapnetraxin-3prognostic scales.

Нет

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The authors declare that there are no conflicts of interest present.