perinatologyРоссийский вестник перинатологии и педиатрииRossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics)1027-40652500-2228Ltd. “The National Academy of Pediatric Science and Innovation”10.21508/1027-4065-2024-69-2-86-91perinatology-1975Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESОбратимость бронхиальной обструкции у пациентов с первичной цилиарной дискинезией в обоснование коррекции ингаляционной терапииReversibility of bronchial obstruction in patients with primary ciliary dyskinesia to justify correction of inhalation therapyhttps://orcid.org/0000-0002-0740-1718МизерницкийЮ. Л.MizernitskiyYu. L.

Мизерницкий Юрий Леонидович - д.м.н., проф., зав. отделом хронических воспалительных и аллергических болезней легких, проф. кафедры инновационной педиатрии и детской хирургии, засл. работник здравоохранения РФ

127412 Москва, ул. Талдомская, д. 2

Moscow

yulmiz@mail.ruhttps://orcid.org/0000-0001-9398-2215НовакА. А.NovakA. A.

Новак Андрей Александрович - науч. сотр. отдела хронических воспалительных и аллергических болезней легких

127412 Москва, ул. Талдомская, д. 2

Moscow

https://orcid.org/0009-0007-5811-7710ПронькинТ. Н.PronkinaT. N.

Пронькина Тамара Николаевна - врач-ординатор

127412 Москва, ул. Талдомская, д. 2

Moscow

https://orcid.org/0000-0002-8612-2126РынгаченкоЕ. С.RyngachenkoE. S.

Рынгаченко Елизавета Сергеевна - мл. науч. сотр. отдела хронических воспалительных и аллергических болезней легких

127412 Москва, ул. Талдомская, д. 2

Moscow

https://orcid.org/0000-0002-2376-0518СоколоваЛ. В.SokolovaL. V.

Соколова Людмила Вильевна - к.м.н., зав. клиническим отделениемпульмонологии

127412 Москва, ул. Талдомская, д. 2

Moscow

https://orcid.org/0000-0002-3445-4903ДьяковаС. Э.DiakovaS. E.

Дьякова Светлана Эвальдовна - к.м.н., врач отделения пульмонологии

127412 Москва, ул. Талдомская, д. 2

Moscow

ЗоринаИ. Е.ZorinaI. E.

Зорина Ирина Евгеньевна - врач отделения пульмонологии

127412 Москва, ул. Талдомская, д. 2

Moscow

https://orcid.org/0000-0002-2324-2454ШатохаП. А.ShatokhaP. A.

Шатоха Полина Александровна - науч. сотр. отдела хронических воспалительных и аллергических болезней легких

127412 Москва, ул. Талдомская, д. 2

Moscow

https://orcid.org/0000-0002-6956-1418ШудуеваА. Р.ShuduevaA. R.

Шудуева Амина Руслановна - мл. науч. сотр. отдела хронических воспалительных и аллергических болезней легких

127412 Москва, ул. Талдомская, д. 2

Moscow

ОСП «Научно-исследовательский клинический институт педиатрии и детской хирургии им. академика Ю.Е. Вельтищева» (Институт Вельтищева) ФГАОУ ВО РНИМУ им. Н.И. Пирогова Минздрава РоссииРоссияVeltischev Research and Clinical Institute for Pediatrics and Pediatric Surgery of the Pirogov Russian National Research Medical UniversityRussian Federation2024100520246928691Copyright © Ltd. “The National Academy of Pediatric Science and Innovation”, 20242024Ltd. “The National Academy of Pediatric Science and Innovation”Ltd. “The National Academy of Pediatric Science and Innovation”https://www.ped-perinatology.ru/jour/about/submissions#copyrightNoticehttps://www.ped-perinatology.ru/jour/article/view/1975

Цель исследования. Оценка обратимости бронхиальной обструкции у пациентов с первичной цилиарной дискинезией в группах с сопутствующим аллергическим воспалением и без него, а также определение целесообразности использования ингаляционных бронхолитических препаратов у пациентов с первичной цилиарной дискинезией.Материалы и методы. Ретроспективный анализ результатов оценки объема форсированного выдоха за 1-ю секунду (ОФВ1) до и после ингаляции бронхолитика и исследование зависимости обратимости обструкции от наличия маркеров атопии.Результаты. Из 100 пациентов у 63 (63%) выявлены маркеры атопии, у 37 (37%) эти маркеры не обнаружены (р≤0,05). При сравнении ОФВ1 у детей с аллергической отягощенностью (n=63) и в отсутствие таковой (n=37) выявлено, что у пациентов с маркерами атопии обструктивные изменения, определяемые при спирометрии, встречались на 14,2% чаще (р≤0,05). Обратимость бронхиальной обструкции зарегистрирована у 24 (24%) пациентов, из которых у 21 (87,5%) выявлены маркеры атопии (р≤0,05). У детей с сопутствующей аллергической отягощенностью и снижением ОФВ1 обратимость обструкции обнаружена в 15 (48,4%) случаях (р≤0,05). Выявлено, что у пациентов с наличием маркеров атопии и ОФВ1 ≤80% обратимость обструкции встречается на 42,8% чаще, чем в группе пациентов с нормальным ОФВ1 (р≤0,05).Заключение. Большинство пациентов с первичной цилиарной дискинезией (n=63) имеют маркеры атопии, преимущественно за счет изолированного повышения уровня общего IgE в сыворотке крови (р≤0,05). Снижение ОФВ1 ≤80% у детей с аллергической отягощенностью определялось на 14,2% чаще, чем в группе детей в отсутствие таковой (р≤0,05). У большинства пациентов с аллергическим фенотипом зарегистрирована обратимость обструкции после пробы с бронхолитиком. Таким образом, всем пациентам с первичной цилиарной дискинезией и наличием маркеров атопии рекомендовано проведение пробы с бронхолитиком, а при выявлении обратимости обструкции целесообразно добавление в терапию бронхолитического препарата.

Purpose. To assess the reversibility of bronchial obstruction in patients with primary ciliary dyskinesia in groups with and without concomitant allergic inflammation, with the aim of a differentiated approach to inhalation therapy and the validity of prescribing bronchodilators.Material and methods. Retrospective analysis of the results of FEV1 before and after inhalation of a bronchodilator and study of the dependence of the reversibility of obstruction on the presence of atopy markers.Results. Of 100 patients, 63% (n=63) had atopy markers; 37% (n=37) did not have these markers (p≤0.05). When comparing the FEV1 indicator in children with the presence of allergic burden (n=63) and in the absence of it (n=37), it was found that in patients with markers of atopy, obstructive changes identified during spirometry were 14.2% more common ( p≤0.05). Reversibility of bronchial obstruction was recorded in 24% (n=24), of which 87.5% (n=21) of patients had markers of atopy (p≤0.05). In children with concomitant allergic burden and a decrease in FEV1, reversibility of obstruction was detected in 48.4% (n=15) of cases (p≤0.05). It was revealed that in patients with the presence of atopy markers and a decrease in FEV1≤80%, reversibility of obstruction occurs 42.8% more often compared to the group of patients with a normal level of FEV1 (p≤0.05).Conclusions. The vast majority of patients with primary ciliary dyskinesia (n=63) have markers of atopy, mainly due to an isolated increase in total IgE in the blood serum (p≤0.05). A decrease in FEV1≤80% in children with allergies was detected 14.2% more often compared to the group of children without it (p≤0.05). In the vast majority of patients with an allergic phenotype, reversibility of obstruction was observed after a test with a bronchodilator. Thus, all patients with primary ciliary dyskinesia and the presence of atopy markers are recommended to undergo a test with a bronchodilator, and if reversibility of obstruction is detected, it is advisable to add a bronchodilator drug to therapy.

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