Abstract:
:Chronic thromboembolic pulmonary hypertension (CTEPH) is precapillary pulmonary hypertension, in which chronic obstruction of large and middle branches of pulmonary arteries (PAs) and secondary changes in the lung microcirculatory bed result in a progressive increase in pulmonary vascular resistance and PA pressure with the development of severe right cardiac dysfunction and heart failure. CTEPH is a unique form of pulmonary hypertension since it is potentially curable by surgical treatment. The diagnostic criteria for CTEPH are a mean PA pressure of ≥25 mm Hg, as evidenced by right heart catheterization; a PA wedge pressure of ≤15 mm Hg; a pulmonary vascular resistance of >2 Wood units; the presence of chronic/organized thrombi/emboli in the elastic PAs (pulmonary trunk, lobular, segmental, subsegmental PAs); effective anticoagulant therapy at therapeutic dosages over at least 3 months. Up to now, our country has had no guidelines for the diagnosis and treatment of this rare severe disease that, when appropriately untreated, has an extremely poor prognosis. The main task in the preparation of this document was to generalize and analyze the data of current registries, multicenter randomized clinical trials, national and international guidelines, and consensus documents recently published on this problem in order to optimize a diagnostic process and treatment in this category of patients. Part 1 gives a definition of CTEPH, its place in the clinical classification, epidemiology and prognosis, risk factors, pathogenesis and morphology, diagnostic approaches and determination of operability in patients, and specific features of differential diagnosis. :Хроническая тромбоэмболическая легочная гипертензия (ХТЭЛГ) - прекапиллярная форма легочной гипертензии, при которой хроническая обструкция крупных и средних ветвей легочных артерий (ЛА), а также вторичные изменения микроциркуляторного русла легких приводят к прогрессирующему повышению легочного сосудистого сопротивления и давления в ЛА с развитием тяжелой дисфункции правых отделов сердца и сердечной недостаточности. ХТЭЛГ является уникальной формой легочной гипертензии, поскольку она потенциально излечима с помощью хирургического лечения. Диагностическими критериями ХТЭЛГ служат среднее давление в ЛА ≥25 мм рт.ст. по данным катетеризации правых отделов сердца; давление заклинивания в ЛА ≤15 мм рт.ст.; легочное сосудистое сопротивление >2 ед. Вуда; наличие хронических/организованных тромбов/эмболов в ЛА эластического типа (легочный ствол, долевые, сегментарные, субсегментарные легочные артерии); эффективная антикоагулянтная терапия на протяжении не менее 3 мес в лечебных дозировках. До настоящего времени в нашей стране отсутствовали рекомендации по диагностике и лечению этого редкого тяжелого заболевания, которое без необходимого лечения имеет крайне неблагоприятный прогноз. Основной задачей при подготовке данного документа явились обобщение и анализ данных современных регистров, многоцентровых рандомизированных клинических исследований, национальных и международных руководств и согласительных документов, опубликованных за последние годы по этой проблеме с целью оптимизации диагностического процесса и лечения данной категории больных. В I части представлены определение ХТЭЛГ, место в клинической классификации, эпидемиология и прогноз, факторы риска, патогенез и морфология, подходы к диагностике и определение операбельности больных, особенности дифференциального диагноза. :Аннотация Хроническая тромбоэмболическая легочная гипертензия (ХТЭЛГ) — прекапиллярная форма легочной гипертензии, при которой хроническая обструкция крупных и средних ветвей легочных артерий (ЛА), а также вторичные изменения микроциркуляторного русла легких приводят к прогрессирующему повышению легочного сосудистого сопротивления и давления в ЛА с развитием тяжелой дисфункции правых отделов сердца и сердечной недостаточности. ХТЭЛГ является уникальной формой легочной гипертензии, поскольку она потенциально излечима с помощью хирургического лечения. Диагностическими критериями ХТЭЛГ служат среднее давление в ЛА ≥25 мм рт.ст. по данным катетеризации правых отделов сердца; давление заклинивания в ЛА ≤15 мм рт.ст.; легочное сосудистое сопротивление >2 ед. Вуда; наличие хронических/организованных тромбов/эмболов в ЛА эластического типа (легочный ствол, долевые, сегментарные, субсегментарные легочные артерии); эффективная антикоагулянтная терапия на протяжении не менее 3 мес в лечебных дозировках. До настоящего времени в нашей стране отсутствовали рекомендации по диагностике и лечению этого редкого тяжелого заболевания, которое без необходимого лечения имеет крайне неблагоприятный прогноз. Основной задачей при подготовке данного документа явились обобщение и анализ данных современных регистров, многоцентровых рандомизированных клинических исследований, национальных и международных руководств и согласительных документов, опубликованных за последние годы по этой проблеме с целью оптимизации диагностического процесса и лечения данной категории больных. В I части представлены определение ХТЭЛГ, место в клинической классификации, эпидемиология и прогноз, факторы риска, патогенез и морфология, подходы к диагностике и определение операбельности больных, особенности дифференциального диагноза.
journal_name
Ter Arkhjournal_title
Terapevticheskii arkhivauthors
Chazova IE,Martynyuk TVdoi
10.17116/terarkh201688990-101subject
Has Abstractpub_date
2016-01-01 00:00:00pages
90-101issue
9eissn
0040-3660issn
2309-5342journal_volume
88pub_type
杂志文章,实务指引abstract::Neurological complications were examined in 30 patients with multiple myeloma. The neurological syndromes which play the key role in the clinical picture of the disease were distinguished. The pathogenetic mechanisms of the development of the individual symptoms and the methods for their treatment are discussed. ...
journal_title:Terapevticheskii arkhiv
pub_type: 杂志文章
doi:
更新日期:1986-01-01 00:00:00
abstract::To assess the effect of partusisten (fenoterol) on excretory function of the kidneys, the drug was administered per os in a dose of 10 mg/day for 7-10 days in 17 chronic glomerulonephritis patients with initial forms (stages I-IIA) of renal failure. A dramatic increase of glomerular filtration, a certain rise of tubul...
journal_title:Terapevticheskii arkhiv
pub_type: 杂志文章
doi:
更新日期:1991-01-01 00:00:00
abstract::At present, compelling evidence has been obtained that combined therapy of pulmonary arterial hypertension (PAH) with specific drugs can significantly slow progression of PAH. Therefore, in current guidelines combination therapy is already considered as standard treatment for a significant proportion of patients with ...
journal_title:Terapevticheskii arkhiv
pub_type: 杂志文章,评审
doi:10.26442/terarkh201890372-80
更新日期:2018-04-19 00:00:00
abstract::The authors assessed the time course of the S-T segment in 12 standard and monitor ECG leads and the time course of MB CPK fraction activity and Mg blood concentration in 34 patients with acute myocardial infarction. After the detection of thrombotic occlusion of the coronary artery they received thrombolytic therapy ...
journal_title:Terapevticheskii arkhiv
pub_type: 杂志文章
doi:
更新日期:1987-01-01 00:00:00
abstract:AIM:To determine the nature of changes in fibroblast growth factor 23 (FGF-23) and other bone mineral metabolism parameters detectable in the blood of patients with end-stage chronic renal failure (CRF) and to analyze their links to the development of cardiovascular events in uremic intoxication. SUBJECTS AND METHODS:...
journal_title:Terapevticheskii arkhiv
pub_type: 杂志文章
doi:10.17116/terarkh2016881251-56
更新日期:2016-01-01 00:00:00
abstract::Multifactorial prophylaxis on the individual basis was conducted for 5 years among the population of 2047 males aged 40-59 years with ischemic heart disease (IHD) or its risk factors. Compared to the comparison group of 2101 subjects, in the study group the investigators achieved a 37% reduction in the mean population...
journal_title:Terapevticheskii arkhiv
pub_type: 杂志文章
doi:
更新日期:1997-01-01 00:00:00
abstract::A study was made of the rate of HLA system antigens in 75 patients with different clinical versions and immuno-pathological manifestations of systemic lupus erythematosus (SLE). A total of 350 normal subjects comprised the control group. During SLE, a high rate of DNW3, B8 and AI antigens was revealed. Associative rel...
journal_title:Terapevticheskii arkhiv
pub_type: 杂志文章
doi:
更新日期:1984-01-01 00:00:00
abstract::During examination of the adult population of two rural communities: 1558 inhabitants of a settlement of Salantai and 1713 inhabitants of a settlement of Merkine their arterial pressure was measured and they were interviewed. A high prevalence of risk factors of chronic noncommunicable diseases was established. Arteri...
journal_title:Terapevticheskii arkhiv
pub_type: 杂志文章
doi:
更新日期:1986-01-01 00:00:00
abstract::Overall 16 patients with chronic renal failure on regular hemodialysis were examined. Of these, 8 received recombinant human erythropoietin (rhERP). A study was made of platelet aggregation and the level of some prostanoids in the blood of these patients. As the time of the treatment with rhERP was increased, the hemo...
journal_title:Terapevticheskii arkhiv
pub_type: 杂志文章
doi:
更新日期:1991-01-01 00:00:00
abstract::The article deals with current studies on the role of uric acid (UA) in development of cardiovascular diseases. The results of large prospective trials are presented which have revealed a pathogenetic role of UA in development of essential hypertension. Clinical trials demonstrated elevated concentrations of UA in hyp...
journal_title:Terapevticheskii arkhiv
pub_type: 杂志文章,评审
doi:
更新日期:2011-01-01 00:00:00
abstract::As compared with normal persons, in 46 patients with diabetes mellitus there was a significant decrease in spontaneous leukocyte migration, a reduction in the absolute count of T-, B- and O-lymphocytes, and a rise in the relative count of D-lymphocytes. The disorders of cell-mediated immunity are formed during the fir...
journal_title:Terapevticheskii arkhiv
pub_type: 杂志文章
doi:
更新日期:1986-01-01 00:00:00
abstract::The paper provides current views on the structure and functional activity of bacterial toxins, clinical use of bacterial lipopolysaccharides and their derivatives as immunostimulators, review investigations on the introduction of the botulinic toxin A in ophthalmological and neurological practice, on production of imm...
journal_title:Terapevticheskii arkhiv
pub_type: 杂志文章,评审
doi:
更新日期:1994-01-01 00:00:00
abstract:AIM:To study the impact of the genes of donor killer cell immunoglobulin-like receptors (KIR) and HLA-KIR ligands on overall (OS) and event-free survival (EFS) rates in patients with myeloid leukemia after transplantation with allogeneic hematopoietic stem cells (allo-HSCT) from HLA-identical related and HLA-compatible...
journal_title:Terapevticheskii arkhiv
pub_type: 杂志文章
doi:10.17116/terarkh2015871168-77
更新日期:2015-01-01 00:00:00
abstract::As many as 132 patients with bronchial asthma were examined for the clinical, functional and laboratory parameters before and during alpine climatotherapy at a height of 3200 m above the sea level (the Tyuya-Ashu pass, the northern Tien Shan). In addition to the improvement of the general status, the patients manifest...
journal_title:Terapevticheskii arkhiv
pub_type: 杂志文章
doi:
更新日期:1991-01-01 00:00:00
abstract::The paper treats the results of a comparative 6-year study of arterial blood pressure, body weight, motor activity, and tobacco-smoking prevalence with respect to two representative samples of schoolchildren aged 11 and 14 years living in one of the districts of Moscow. A total of 1999 and 1219 persons were examined. ...
journal_title:Terapevticheskii arkhiv
pub_type: 杂志文章
doi:
更新日期:1989-01-01 00:00:00
abstract::The authors describe the results of a study into antioxidants (superoxide dismutase and catalase) and production of the active forms of oxygen (superoxide anion radical, hydrogen peroxide, hydroxyl radical, and singlet oxygen) by blood and bone marrow leukocytes from patients with Fanconi's anemia. The generation of t...
journal_title:Terapevticheskii arkhiv
pub_type: 杂志文章
doi:
更新日期:1989-01-01 00:00:00
abstract::Overall 75 references concerning the etiology, pathogenesis and the clinical picture of eosinophilic lesions of the lungs were analyzed. Sixteen patients with drug-induced disease were placed under the author's observation. Of these, 8 patients fell ill due to penicillin, 3 to tetracycline, 3 to sulfanilamide intake a...
journal_title:Terapevticheskii arkhiv
pub_type: 杂志文章,评审
doi:
更新日期:1991-01-01 00:00:00
abstract:AIM:The aim of the study was to analyze the severity of the difference in these values in real clinical practice in patients suffering from arterial hypertension (AH) on the basis of an open multicenter register to monitor the effectiveness of therapy in patients with hypertension "HYPERION", conducted by the Eurasian ...
journal_title:Terapevticheskii arkhiv
pub_type: 杂志文章
doi:10.26442/terarkh201890421-28
更新日期:2018-04-19 00:00:00
abstract:AIM:To evaluate a combination of the effects of non-drug measures and rozuvastatin on the lipid spectrum and blood pressure (BP) in patients with treated arterial hypertension (AH) concurrent with dyslipidemia. MATERIALS AND METHODS:The multicenter open-labeled prospective program included 299 patients from 19 cities ...
journal_title:Terapevticheskii arkhiv
pub_type: 临床试验,杂志文章,多中心研究
doi:
更新日期:2007-01-01 00:00:00
abstract:AIM:To characterize the spectrum, incidence rate and features of pulmonary pathology in HIV-infected inpatients with reference to a fall in the count of CD4-lymphocytes. MATERIAL AND METHODS:A total of 2370 patients with HIV infection admitted to Moscow infectious hospital N 2 were examined. The protocol of examinatio...
journal_title:Terapevticheskii arkhiv
pub_type: 杂志文章
doi:
更新日期:2007-01-01 00:00:00
abstract:AIM:To ascertain whether high arterial rigidity is obligatory in arterial hypertension (AH) and the presence of AH is obligatory in patients with rigid arteries. MATERIAL AND METHODS:Volume sphygmography (VS) was made in 153 patients aged 60-86 years: 96 patients with untreated AH of degree 1-3 (40 males aged 71.0 +/-...
journal_title:Terapevticheskii arkhiv
pub_type: 杂志文章
doi:
更新日期:2011-01-01 00:00:00
abstract::The most important condition for effective prophylactic medical examination is early detection of diseases. The efficacy of prophylactic medical examination of rheumatic fever patients rises considerably under the conditions of stage-by-stage therapy. Another important condition for early detection and diagnosis is ra...
journal_title:Terapevticheskii arkhiv
pub_type: 杂志文章
doi:
更新日期:1986-01-01 00:00:00
abstract:AIM:To study coronary-myocardial reserve in patients with a programmed pacemaker. MATERIALS AND METHODS:Stress-echocardiography was performed in 64 patients with coronary heart disease (CHD). The stress was induced by a gradual increase in the frequency of electrostimulation (ES) by 10 imp/min from initial 90 imp/min ...
journal_title:Terapevticheskii arkhiv
pub_type: 杂志文章
doi:
更新日期:2000-01-01 00:00:00
abstract::Basing on computer processing of 126 primary clinical and laboratory parameters obtained from 92 patients with myelodysplasia and using multifactorial regression analysis, the authors have developed prognostic models of life span and probability of transformation into acute leukemia. The model of life span enabled rec...
journal_title:Terapevticheskii arkhiv
pub_type: 杂志文章
doi:
更新日期:1996-01-01 00:00:00
abstract:AIM:To compare effectiveness of two long-acting calcium antagonists--amlodipin and diltiazem--in patients with ischemic heart disease (IHD) and stable angina of effort (SAE). MATERIAL AND METHODS:31 IHD patients with SAE entered the double blind randomized trial. The patients received either amlodipin (5-10 mg once a ...
journal_title:Terapevticheskii arkhiv
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:2001-01-01 00:00:00
abstract::Interrelationship of the peculiarities of the psychoemotional status, the activity of lipid peroxidation and the content of blood free fatty acids were studied in 64 CHD patients with arrhythmia. It was shown that prolonged and pronounced psychoemotional strain, high levels of the activity of free radical lipid oxidat...
journal_title:Terapevticheskii arkhiv
pub_type: 杂志文章
doi:
更新日期:1986-01-01 00:00:00
abstract:AIM:To study clinical features of typhoid fever (TF) in migrants (subjects in military service in Tadjikistan). MATERIAL AND METHODS:In chronic water epidemic TF symptoms were studied in 547 young soldiers and officers serving in Tadjikistan with incomplete biological and/or professional adaptation. RESULTS:In most c...
journal_title:Terapevticheskii arkhiv
pub_type: 杂志文章
doi:
更新日期:2001-01-01 00:00:00
abstract:AIM:To study time-dependent effects of altiazem PP-180 and its influence on circadian pattern of hemodynamics in patients with essential hypertension stage II in its administration in 8.00, 14.00 and 22.00. MATERIAL AND METHODS:30 patients with essential hypertension stage II (mean age 63.3 years) were divided into 3 ...
journal_title:Terapevticheskii arkhiv
pub_type: 杂志文章
doi:
更新日期:2000-01-01 00:00:00
abstract:AIM:To reveal the specific features of pancreatogenic diabetes mellitus (DM) and to discuss the principles of its medical therapy. SUBJECTS AND METHODS:Sixty-six patients (55 men and 11 women) aged 30 to 65 years with chronic pancreatitis (CP) were examined. The disease was accompanied with pancreatic calcification an...
journal_title:Terapevticheskii arkhiv
pub_type: 杂志文章
doi:
更新日期:2012-01-01 00:00:00
abstract:AIM:Epidemiological assessment of prevalence of blood hypertension (BH) in pregnant women. MATERIALS AND METHODS:Blood pressure and urinary protein were measured in 5160 gravidae observed in female consultations in 4 cities of Russia. RESULTS:BH was found in 1042(20.2%) examinees. Chronic BH was diagnosed in 306 pati...
journal_title:Terapevticheskii arkhiv
pub_type: 杂志文章
doi:
更新日期:1998-01-01 00:00:00