avkАрхивъ внутренней медициныThe Russian Archives of Internal Medicine2226-67042411-6564“SINAPS” LLC10.20514/2226-6704-2016-6-4-14-20avk-548Research ArticleОБЗОРНЫЕ СТАТЬИREVIEW ARTICLESСЛОЖНОСТИ ПРОГНОЗИРОВАНИЯ ТЕЧЕНИЯ ХОБЛ КАК ВЫЗОВ СОВРЕМЕННОЙ КЛИНИЧЕСКОЙ ПУЛЬМОНОЛОГИИDIFFICULTY OF COPD PREDICTING AS A CHALLENGE TO MODERN CLINICAL PULMONOLOGYКарнаушкинаМ. А.KarnaushkinaM. A.kar3745@yandex.ruФедосенкоС. В.FedosenkoS. V.СазоновА. Э.SazonovA. E.ПетровВ. А.PetrovV. A.ВаколюкР. М.VakoluykR. M.ДворецкийЛ. И.DvoretckiyL. I.ОгородоваЛ. М.OgorodovaL. M.ГБОУ ВПО Первый МГМУ им. И.М. Сеченова Минздрава России, Москва, РоссияРоссияI.M. Sechenov First Moscow State Medical University, Moscow, RussiaRussian FederationГБОУ ВПО СибГМУ Минздрава России, Томск, РоссияРоссияSiberian State Medical University, Tomsk, RussiaRussian FederationГБОУ ВПО Московский государственный университет им. М.В. Ломоносова Минобразования России, Москва, РоссияРоссияM.V. Lomonosov Moscow State University, Moscow, RussiaRussian Federation201631082016641420Copyright © Карнаушкина М.А., Федосенко С.В., Сазонов А.Э., Петров В.А., Ваколюк Р.М., Дворецкий Л.И., Огородова Л.М., 20162016Карнаушкина М.А., Федосенко С.В., Сазонов А.Э., Петров В.А., Ваколюк Р.М., Дворецкий Л.И., Огородова Л.М.Karnaushkina M.A., Fedosenko S.V., Sazonov A.E., Petrov V.A., Vakoluyk R.M., Dvoretckiy L.I., Ogorodova L.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.medarhive.ru/jour/article/view/548

В последние годы современное медицинское сообщество пришло к выводу, что применяемые в настоящее время прогностические критерии течения ХОБЛ не позволяют с высокой достоверностью предсказать дальнейшее развитие заболевания, его осложнения и исходы. Наиболее востребованным прогностическим критерием в клинической практике по-прежнему остается определение уровня ОФВ1. Однако накоплена достаточная доказательная база, делающая необходимым расширение списка критериев для определения более точного прогноза течения и клинического исхода заболевания. Ведущей задачей современной пульмонологии, становится поиск прогностических маркеров, комплекса нескольких параметров, способных обеспечить прогноз и своевременный выбор терапии. Одними из них могут стать наличие у больных ХОБЛ коморбидных заболеваний и высокой частоты обострений.

ХОБЛпрогностические критерииОФВ1обострениякоморбидные заболеванияCOPDprognostic criteriaFEV1exacerbationcomorbid diseasesReferencesАвдеев С.А. Хроническая обструктивная болезнь легких: обострения. Пульмонология. 2013; 3: 5-18. Avdeev S.N. Acute exacerbation of chronic obstructive pulmonary disease. Pulmonology. 2013; (3): 5-18 (in Russian).Авдеев С.А. Хроническая обструктивная болезнь легких: обострения. Пульмонология. 2013; 3: 5-18. Avdeev S.N. Acute exacerbation of chronic obstructive pulmonary disease. Pulmonology. 2013; (3): 5-18.Дворецкий Л.И. Остеопороз у больных ХОБЛ: коморбидность или системное проявление? Consilium Medicum. 2007; 9(12): 42-48. Dvoretsky L.I., Chistyakova E.M. Оsteoporosis in patients with chronic obstructive pulmonary disease: is it comorbidity or a systemic manifestation? Consilium Medicum. 2007; 9(12): 42-48 (in Russian).Дворецкий Л.И. Остеопороз у больных ХОБЛ: коморбидность или системное проявление? Consilium Medicum. 2007; 9(12): 42-48. Dvoretsky L.I., Chistyakova E.M. Оsteoporosis in patients with chronic obstructive pulmonary disease: is it comorbidity or a systemic manifestation? Consilium Medicum. 2007; 9(12): 42-48Agustí A., Edwards L.D., Rennard S.I. et al. 2012. Persistent systemic inflammation is associated with poor clinical outcomes in COPD: A novel phenotype. PLoS ONE 7(5): e37483. http://dx.doi. org/10.1371/journal.pone.0037483.Agustí A., Edwards L.D., Rennard S.I. et al. 2012. Persistent systemic inflammation is associated with poor clinical outcomes in COPD: A novel phenotype. PLoS ONE 7(5): e37483. http://dx.doi.org/10.1371/journal.pone.0037483.Agustí A., Faner R. Systemic Inflammation and Comorbidities in Chronic Obstructive Pulmonary Disease. Proceedings of the American Thoracic Society. 2012; 9(2): 43-46.Agustí A., Faner R. Systemic Inflammation and Comorbidities in Chronic Obstructive Pulmonary Disease. Proceedings of the American Thoracic Society. 2012; 9(2): 43-46.Agusti A, Vestbo J. Current controversies and future perspectives in chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 2011; 184: 507–513.Agusti A, Vestbo J. Current controversies and future perspectives in chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 2011; 184: 507–513.Bakakos P., Kostikas K., Loukides S. COPD and comorbidities. 2010, 23(1): 24-27.Bakakos P., Kostikas K., Loukides S. COPD and comorbidities. 2010, 23(1): 24-27.Barnes P.J., Celli B.R. Systemic manifestations and comorbidities of COPD Eur. Respir. J. 2009; 33: 1165–1185.Barnes P.J., Celli B.R. Systemic manifestations and comorbidities of COPD Eur. Respir. J. 2009; 33: 1165–1185.Calverley P.M.A., Anderson J.A., Celli B. et al. Cardiovascular events in patients with COPD: TORCH Study results. Thorax. 2010; 65: 719-725.Calverley P.M.A., Anderson J.A., Celli B. et al. Cardiovascular events in patients with COPD: TORCH Study results. Thorax. 2010; 65: 719-725.Caram L.M., Ferrari R., Naves C.R. Association between left ventricular diastolic dysfunction and severity of chronic obstructive pulmonary disease. Clinics (Sao Paulo). 2013; 6: 772-776.Caram L.M., Ferrari R., Naves C.R. Association between left ventricular diastolic dysfunction and severity of chronic obstructive pulmonary disease. Clinics (Sao Paulo). 2013; 6: 772-776.Celli B.R., Cote C.G., Lareau S.C. et al. Predictors of Survival in COPD: More than Just the FEV1. Respir. Med. 2008; 102(Supplement 1): 27–35.Celli B.R., Cote C.G., Lareau S.C. et al. Predictors of Survival in COPD: More than Just the FEV1. Respir. Med. 2008; 102(Supplement 1): 27–35.Cote C.G., Pinto-Plata V.M., Marin J.M. et al. The modified BODE index: validation with mortality in COPD. Eur. Respir. J. 2008; 32: 1269–1274.Cote C.G., Pinto-Plata V.M., Marin J.M. et al. The modified BODE index: validation with mortality in COPD. Eur. Respir. J. 2008; 32: 1269–1274.Drummond M., Hansel N., Connett J. et al . Spirometric predictors of lung function decline and mortality in early chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 2012; 185: 1301–1306.Drummond M., Hansel N., Connett J. et al . Spirometric predictors of lung function decline and mortality in early chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 2012; 185: 1301–1306.Footitt J., Mallia P., Durham A.L. et al. Oxidative and Nitrosative Stress and Histone Deacetylase-2 Activity in Exacerbations of COPD. Chest. 2016; 149: 62-73.Footitt J., Mallia P., Durham A.L. et al. Oxidative and Nitrosative Stress and Histone Deacetylase-2 Activity in Exacerbations of COPD. Chest. 2016; 149: 62-73.Gan W.Q., Man S.F., Senthilselvan A., Sin D.D. Association between chronic obstructive pulmonary disease and systemic inflammation: a systematic review and a metaanalysis. Thorax. 2004; 59: 574– 580.Gan W.Q., Man S.F., Senthilselvan A., Sin D.D. Association between chronic obstructive pulmonary disease and systemic inflammation: a systematic review and a metaanalysis. Thorax. 2004; 59: 574– 580.Garcia-Aymerich J., Lange P., Benet M., Schnohr P. et al. Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: a population based cohort study. Thorax. 2006; 61(9): 772-778.Garcia-Aymerich J., Lange P., Benet M., Schnohr P. et al. Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: a population based cohort study. Thorax. 2006; 61(9): 772-778.McGarvey L.P., Magder S., Burkhart D. et al. Cause-specific mortality adjudication in the UPLIFT® COPD trial: Findings and recommendations. Respiratory Medicine. 2012; 106(4): 515–521.McGarvey L.P., Magder S., Burkhart D. et al. Cause-specific mortality adjudication in the UPLIFT® COPD trial: Findings and recommendations. Respiratory Medicine. 2012; 106(4): 515–521.Gaur S.N., Goel N. Systemic Manifestations of COPD. Medicine Update. 2012; 22: 386-389.Gaur S.N., Goel N. Systemic Manifestations of COPD. Medicine Update. 2012; 22: 386-389.Global Initiative for Chronic Obstructive Lung Disease (GOLD). http://www.goldcopd.org/uploads/users/files/GOLD_Report_2011_ Feb21.pdf. Revised 2011Global Initiative for Chronic Obstructive Lung Disease (GOLD). http://www.goldcopd.org/uploads/users/files/GOLD_Report_2011_Feb21.pdf. Revised 2011L. Graat-Verboom, Wouters E.F.M., Smeenk F.W.J.M., van den Borne B.E.E.M., Lunde R., Spruit M.A.. Current status of research on osteoporosis in COPD: a systematic review. Eur. Respir. J. 2009; 34: 209–218.L. Graat-Verboom, Wouters E.F.M., Smeenk F.W.J.M., van den Borne B.E.E.M., Lunde R., Spruit M.A.. Current status of research on osteoporosis in COPD: a systematic review. Eur. Respir. J. 2009; 34: 209–218.Graat-Verbooma L., Smeenka F.W.J.M., van den Bornea B.E.E.M. et al. Progression of osteoporosis in patients with COPD: A 3-year follow up study. Respiratory Medicine. 2012; 106(60: 861–870.Graat-Verbooma L., Smeenka F.W.J.M., van den Bornea B.E.E.M. et al. Progression of osteoporosis in patients with COPD: A 3-year follow up study. Respiratory Medicine. 2012; 106(60: 861–870.Halpin D.M., Decramer M., Celli B., Kesten S., Liu D. Exacerbation frequency and course of COPD. Int. J. Chron. Obstruct. Pulmon. Dis. 2012; 7: 653–661.Halpin D.M., Decramer M., Celli B., Kesten S., Liu D. Exacerbation frequency and course of COPD. Int. J. Chron. Obstruct. Pulmon. Dis. 2012; 7: 653–661.Huang Y.S., Feng Y.C., Zhang J. Impact of chronic obstructive pulmonary diseases on left ventricular diastolic function in hospitalized elderly patients. Clin. Interv. Aging. 2014; 10: 81-87.Huang Y.S., Feng Y.C., Zhang J. Impact of chronic obstructive pulmonary diseases on left ventricular diastolic function in hospitalized elderly patients. Clin. Interv. Aging. 2014; 10: 81-87.Hurst J., Vestbo J., Anzueto A. et al . Susceptibility to exacerbation in chronic obstructive pulmonary disease. N. Engl. J. Med. 2010; 363: 1128–1138.Hurst J., Vestbo J., Anzueto A. et al . Susceptibility to exacerbation in chronic obstructive pulmonary disease. N. Engl. J. Med. 2010; 363: 1128–1138.Jenkins C.R., Celli B., Anderson J.A., Ferguson G.T., Jones P.W. Seasonality and determinants of moderate and severe COPD exacerbations in the TORCH study. Eur. Respir. J. 2012, 39: 38–45.Jenkins C.R., Celli B., Anderson J.A., Ferguson G.T., Jones P.W. Seasonality and determinants of moderate and severe COPD exacerbations in the TORCH study. Eur. Respir. J. 2012, 39: 38–45.Johns D.P., Walters J.A., Walters E.H. Diagnosis and early detection of COPD using spirometry. J. Thorac. Dis. 2014; 6: 1557–1569.Johns D.P., Walters J.A., Walters E.H. Diagnosis and early detection of COPD using spirometry. J. Thorac. Dis. 2014; 6: 1557–1569.Jones P.W., Chen W.H., Wilcox T.K., Sethi S., Leidy N.K. Characterizing and quantifying the symptomatic features of COPD exacerbations. Chest. 2011; 139: 1388–1394.Jones P.W., Chen W.H., Wilcox T.K., Sethi S., Leidy N.K. Characterizing and quantifying the symptomatic features of COPD exacerbations. Chest. 2011; 139: 1388–1394.Lankeit M., Held M. Incidence of venous thromboembolism in COPD: linking inflammation and thrombosis? Eur. Respir. J. 2016; 47: 369–373.Lankeit M., Held M. Incidence of venous thromboembolism in COPD: linking inflammation and thrombosis? Eur. Respir. J. 2016; 47: 369–373.Mannino D.M., Make B.J. Is it time to move beyond the “O” in early COPD? Eur. Respir. J. 2015; 46: 1535–1537.Mannino D.M., Make B.J. Is it time to move beyond the “O” in early COPD? Eur. Respir. J. 2015; 46: 1535–1537.Mannino D.M., Thorn D., Swensen A., Holguin F. Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD. Eur. Respir. J. 2008; 32: 962–969.Mannino D.M., Thorn D., Swensen A., Holguin F. Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD. Eur. Respir. J. 2008; 32: 962–969.Martinez F.J., Raczek A.E., Seifer F.D. qt al. COPD-PS Clinician Working Group. Development and initial validation of a self-scored COPD Population Screener Questionnaire (COPD-PS). COPD. 2008; 5(2): 85-95.Martinez F.J., Raczek A.E., Seifer F.D. qt al. COPD-PS Clinician Working Group. Development and initial validation of a self-scored COPD Population Screener Questionnaire (COPD-PS). COPD. 2008; 5(2): 85-95.Miller A., Raskin J.M. The natural history of COPD: confirming and going beyond Fletcher and Peto. Eur. Respir. J. 2014; 44: 280–283.Miller A., Raskin J.M. The natural history of COPD: confirming and going beyond Fletcher and Peto. Eur. Respir. J. 2014; 44: 280–283.Miravitlles M., Calle M., Soler-Cataluña J. Clinical phenotypes of COPD: identification, definition and implications for guidelines. Arch. Bronconeumol. 2012; 48: 86–98.Miravitlles M., Calle M., Soler-Cataluña J. Clinical phenotypes of COPD: identification, definition and implications for guidelines. Arch. Bronconeumol. 2012; 48: 86–98.Sinden N.J., Stockley R.A. Chronic obstructive pulmonary disease: an update of treatment related to frequently associated comorbidities. Ther. Adv. Chronic. Dis. 2010; 1(2): 43–57.Sinden N.J., Stockley R.A. Chronic obstructive pulmonary disease: an update of treatment related to frequently associated comorbidities. Ther. Adv. Chronic. Dis. 2010; 1(2): 43–57.Nishimura M., Makita H., Nagai K. et al . Annual change in pulmonary function and clinical phenotype in chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care. Med. 2012; 185: 44–52.Nishimura M., Makita H., Nagai K. et al . Annual change in pulmonary function and clinical phenotype in chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care. Med. 2012; 185: 44–52.Nussbaumer-Ochsner Y., Rabe K.F. Systemic manifestations of COPD. Chest. 2011; 139(1): 165-173.Nussbaumer-Ochsner Y., Rabe K.F. Systemic manifestations of COPD. Chest. 2011; 139(1): 165-173.Papaioannou A.I., Loukides S., Gourgoulianis K.I., Kostikas K. Global assessment of the COPD patient: Time to look beyond FEV1? Respir. Med. 2009; 103: 650-660.Papaioannou A.I., Loukides S., Gourgoulianis K.I., Kostikas K. Global assessment of the COPD patient: Time to look beyond FEV1? Respir. Med. 2009; 103: 650-660.Quanjer P.H., Tammeling G.J., Cotes J.E. et al. Lung volumes and forced ventilatory flows. Report working party. Standardization of lung function tests. European Community for steel and coal. Official statement of the European Respiratory Society. Eur. Respir. J. 1993; 6: 5–40.Quanjer P.H., Tammeling G.J., Cotes J.E. et al. Lung volumes and forced ventilatory flows. Report working party. Standardization of lung function tests. European Community for steel and coal. Official statement of the European Respiratory Society. Eur. Respir. J. 1993; 6: 5–40.Quint J.K., Donaldson G.C., Hurst J.R. et al. Predictive accuracy of patient-reported exacerbation frequency in COPD. Eur. Respir. J. 2011; 37: 501–507.Quint J.K., Donaldson G.C., Hurst J.R. et al. Predictive accuracy of patient- reported exacerbation frequency in COPD. Eur. Respir. J. 2011; 37: 501–507.Rennard S.I., Drummond M.B. Early chronic obstructive pulmonary disease: definition, assessment, and prevention. Lancet. 2015; 385: 1778–1788.Rennard S.I., Drummond M.B. Early chronic obstructive pulmonary disease: definition, assessment, and prevention. Lancet. 2015; 385: 1778–1788.Sinden N.J., Stockley R.A. Systemic inflammation and comorbidity in COPD: a result of ‘overspill’ of inflammatory mediators from the lungs? Review of the evidence. Thorax. 2010; 65: 930-936.Sinden N.J., Stockley R.A. Systemic inflammation and comorbidity in COPD: a result of ‘overspill’ of inflammatory mediators from the lungs? Review of the evidence. Thorax. 2010; 65: 930-936.Valvi D., Mannino D.M., Muellerova H., Tal-Singer R. Fibrinogen, chronic obstructive pulmonary disease (COPD) and outcomes in two United States cohorts. International Journal of Chronic Obstructive Pulmonary Disease. 2012, 7: 173–182.Valvi D., Mannino D.M., Muellerova H., Tal-Singer R. Fibrinogen, chronic obstructive pulmonary disease (COPD) and outcomes in two United States cohorts. International Journal of Chronic Obstructive Pulmonary Disease. 2012, 7: 173–182.Vestbo J., Anderson W., Coxson H.O. et al. Evaluation of COPD Longitudinally to Identify Predictive Surrogate End point (ECLIPSE). Eur. Respir. J. 2008; 31: 869–873.Vestbo J., Anderson W., Coxson H.O. et al. Evaluation of COPD Longitudinally to Identify Predictive Surrogate End point (ECLIPSE). Eur. Respir. J. 2008; 31: 869–873.Vestbo J. The TORCH (TOwards a Revolution in COPD Health) survival study protocol. Eur. Respir. J. 2004; 24: 206–210.Vestbo J. The TORCH (TOwards a Revolution in COPD Health) survival study protocol. Eur. Respir. J. 2004; 24: 206–210.Vestbo J., Hurd S., Agusti A. et al . Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am. J. Respir. Crit. Care Med. 2013; 187: 347–365.Vestbo J., Hurd S., Agusti A. et al . Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am. J. Respir. Crit. Care Med. 2013; 187: 347–365.Vrieze A., de Greef M.H., Wijkstra P.J., Wempe J.B. Low bone mineral density in COPD patients related to worse lung function, low weight and decreased fat-free mass. Osteoporos. Int. 2007; 18: 1197–1202.Vrieze A., de Greef M.H., Wijkstra P.J., Wempe J.B. Low bone mineral density in COPD patients related to worse lung function, low weight and decreased fat-free mass. Osteoporos. Int. 2007; 18: 1197–1202.Wedzicha J.A., Brill S.E., Allinson J.P. Mechanisms and impact of the frequent exacerbator phenotype in chronic obstructive pulmonary disease. BMC Medicine. 2013, 11: 181.Wedzicha J.A., Brill S.E., Allinson J.P. Mechanisms and impact of the frequent exacerbator phenotype in chronic obstructive pulmonary disease. BMC Medicine. 2013, 11: 181.

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