SummaryThis article contains clinical guidelines and current approaches to diagnosis and treatment of idiopathic pulmonary fibrosis (IPF). The aims of devel opment this guidelines were to improve early detection and efficacy of pharmacological and non pharmacological therapy of IPF. Achieving these goals indicates improvement in medical care quality for these patients. These guidelines are intended to pulmonologists, therapeutists and other medical specialists, healthcare managers and other healthcare providers.
Первый Санкт-Петербургский государственный медицинский университет им. акад. И. П. Павлова, Санкт-Петербург, Россия Цель. Оценить изменение лучевой и морфологической картины фиброзирующих болезней легких (ФБЛ) при их длительном наблюдении. Материалы и методы. Проанализированы данные 676 больных ФБЛ, возраст 53,3±15,2 года (ж/м-412/264). Выполнены ВРКТ, ОФЭКТ, КИФВД (с ДСЛ), эхокардиография. Результаты. ОИП у 142 больных (21,0%, ДСЛ менее 30% от Д) характеризовалась на КТ и ОФЭКТ нарастанием размеров и распространенности «сот», появлением новых субплевральных участков «матового стекла» и их трансформацией в «соты», выраженным снижением микроциркуляции в легких. НСИП у 439 пациентов (64,9%, ДСЛ-50% от Д) на КТ и ОФЭКТ проявлялась субплевральными ретикулярными изменениями и «матовым стеклом» без «сотового легкого», трансформировались в «соты». Обострение ФБЛ у 24 пациентов (3,5%) на КТ, ОФЭКТ и гистологически проявлялось ОсИП и КОП. У 11 больных привело к прогрессированию фиброза. Ранние признаки ФБЛ у 32 больных (4,7%, ДСЛ 70% от Д) на КТ, ОФЭКТ и морфологии проявлялись минимальными изменениями, трансформировались в картину ФБЛ у 21 пациента. Заключение. Накопление опыта клинико-лучевого обследования пациентов с ФБЛ обусловливает необходимость разработки новых подходов в диагностической и лечебной тактике. Ключевые слова: компьютерная томография, морфология, микроциркуляция, идиопатический легочный фиброз Контакт: Сперанская Александра Анатольевна,
The endothelium is a tissue most vulnerable to the SARS-CoV-2 virus. Systemic endothelial dysfunction leads to the development of endothelitis which causes the main manifestations of the disease and systemic disturbance of microcirculation in various organs. Pulmonary microcirculatory damage, the most striking clinical manifestation, was the reason to perform SPECT to detect microcirculation disorders.Aim. To assess microcirculatory changes in the lungs of patients who had no previous respiratory diseases and had a COVID-19 infection at different times from the onset of the disease.Methods. SPECT data were analyzed in 136 patients who had a proven coronavirus infection of varying severity from May 2020 to June 2021.Results. All patients showed changes in microcirculation in the lungs in the post-COVID period. The severity of microcirculation disorders had a significant correlation (rs = 0.76; p = 0.01) with the degree of damage to the pulmonary parenchyma and an average correlation (rs = 0.48; p = 0.05) with the timing of the post-COVID period and the degree of residual lesions on CT (rs = 0.49; p = 0.01). The examined patients with persistent clinical complaints had pulmonary microcirculatory lesions, which may indicate the development of vasculitis, at all stages of the post-COVID period. Despite regression of the lesions confirmed by CT in 3 to 6 months after the acute COVID-19 infection, specialists from Russian and other countries report that 30–36% of patients develop pulmonary fibrosis. Similar changes were identified in 19.1% of the examined patients in our study.Conclusion. Microcirculation disorders are detected in all patients in the post-COVID period, irrespective of the severity according to CT. Progressive decrease in microcirculation in the lower parts of the lungs, local zones of hypoperfusion with the critically low accumulation of radiopharmaceuticals, persistent areas of compaction of the lung tissue (so-called “ground glass”), reticular changes, and the development of traction bronchiectasis, a decrease in the diffusion capacity of the lungs and alveolar volume may indicate fibrotic lesions with subsequent development of virus-associated interstitial lung disease.
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