Журнал "Медицинский совет. В поликлинике" № 20, 2017
Б. С. Белов, доктор медицинских наук, Научно-исследовательский институт ревматологии им. В.А. Насоновой, Москва
Г. М. Тарасова, кандидат медицинских наук, Научно-исследовательский институт ревматологии им. В.А. Насоновой, Москва
Д. С. Буханова, Научно-исследовательский институт ревматологии им. В.А. Насоновой, Москва
В современных условиях иммуносупрессивная терапия системных ревматических заболеваний (РЗ) получает все большее распространение. В то же время активное применение иммуносупрессоров, в т. ч. генно-инженерных биологических препаратов, сопровождается нарастанием оппортунистических инфекций. К числу последних относится пневмоцистная пневмония (ППн), которая представляет собой серьезное осложнение со значимой летальностью у больных РЗ. Однако, учитывая неоднородные данные о рисках, касающихся конкретных РЗ и той или иной иммуносупрессивной терапии, создание основанного на доказательных принципах всеобъемлющего руководства по профилактике ППн в ревматологии в настоящее время не представляется возможным. Определенными ориентирами для практических врачей могут служить опубликованные разными авторскими коллективами алгоритмы профилактики ППн, которые, несомненно, подлежат дальнейшей доработке (или переработке) по мере накопления новых данных в рамках рассматриваемой проблемы.
Ключевые слова: пневмоцистная пневмония, ревматические заболевания, глюкокортикоиды, цитостатики, ко-тримоксазол, профилактика
B.S. Belov, MD, G.M. Tarasova, PhD in medicine, D.S. Bukhanova, Nasonova Research Institute of Reumatology, Moscow
Pneumocystic pneumonia in rheumatic diseases: current issues in prophylaxis
In the current context, immunosuppressive therapy of systemic rheumatic diseases (RD) is becoming more widespread. At the same time, the active use of immunosuppressors including genetically engineered biological preparations is accompanied by an increase in opportunistic infections. The latter include pneumocystic pneumonia (PPn), which is a serious complication with significant mortality in patients with RD. However, given the heterogeneous data on the risks of specific RH and some or other immunosuppressive therapy, the development of a evidence-based comprehensive guide on the prevention of PPn in rheumatology is currently not possible. Specific guidelines for practical physicians can serve as algorithms of PPn prevention published by different authors, which are sure to be further followed-up (or processed) as new data are accumulated within the framework of the problem under consideration. Keywords: pneumocystis pneumonia, rheumatic diseases, glucocorticoids, cytostatics, co-trimoxazole, prophylaxis
Keywords: pneumocystis pneumonia, rheumatic diseases, glucocorticoids, cytostatics, co-trimoxazole, prophylaxis
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