fcmedicineФундаментальная и клиническая медицинаFundamental and Clinical Medicine2500-07642542-0941КемГМУ10.23946/2500-0764-2023-8-2-129-140fcmedicine-722Research ArticleОБЗОРНЫЕ СТАТЬИREVIEW ARTICLESК возможностям оценки клиренса респираторных отделов лёгких (аналитический обзор)Assessment of the alveolar clearance: a critical reviewhttps://orcid.org/0000-0002-1523-9669КобылянскийВ. И.KobylyanskyV. I.

Кобылянский Вячеслав Иванович, доктор медицинских наук, профессор образовательного центра

115682, Россия, г. Москва, Ореховый б-р, д. 28

Prof. Vyacheslav I. Kobylyanskiy, MD, DSc, Professor, Educational Centre

28, Orekhovyi Boulevard, Moscow, 115682

kobylyansky@mail.ruФГБОУ ВО «Омский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияResearch Institute of Pulmonology, Federal Medical-Biological Agency of RussiaRussian Federation20233006202382129140Copyright © Кобылянский В.И., 20232023Кобылянский В.И.Kobylyansky V.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://fcm.kemsmu.ru/jour/article/view/722

Гомеостаз органов дыхания обусловлен состоянием их разных защитных механизмов, находящихся в тесной функциональной взаимозависимости, нарушения которых играют принципиальную роль в развитии заболеваний лёгких. Это преимущественно физические, в проводящих дыхательных путях, происходящие благодаря процессам отложения ингалированных веществ и очищения от них лёгких или мукоцилиарному клиренсу, а также осуществляемые за счёт процессов абсорбции функции альвеолярной макрофагально-сурфактантной системы и других иммунологических механизмов, в респираторных отделах лёгких или альвеолярному клиренсу. Наиболее труднодоступным и, следовательно, наименее изученным является клиренс респираторных отделов лёгких или альвеолярный клиренс, что требует более детального рассмотрения возможностей его оценки для повышения точности диагностики и расширения возможностей лечения заболеваний лёгких. С этой целью проведен анализ соответствующей литературы с использованием баз данных биомедицинской научной информации, включая такие, как Index Medicus, PubMed, Embase, Cochrane реестр клинических исследований ClinicalTrials.gov и патентные базы. В результате оценены разные способы определения клиренса респираторных отделов лёгких, в разных аспектах отражены их достоинства и недостатки, установлены целесообразность и перспективы их использования. В заключении отмечается, что наиболее доступным и при этом информативным и недорогим методом, позволяющим оценивать состояние клиренса респираторных отделов лёгких, является бронхоальвеолярный лаваж (БАЛ) и исследование бронхоальвеолярной жидкости (БАЛЖ) разными способами. Метод конфокальной лазерной эндомикроскопии (КЛЭМС) в области практической пульмонологии пока не оправдал надежд, оставаясь прилагаемым в научной медицине. Весьма перспективным представляется неинвазивный радиоаэрозольный метод исследования альвеолярного клиренса in vivo, требующий адаптации к современным условиям.

Respiratory homeostasis is fine-tuned system largely dependent on the clearance of inhaled substances from both upper and lower airways. The least studied is alveolar clearance, which, however, is crucial for the proper lung function and requires a detailed examination in order to improve the accuracy of diagnosis and treatment of lung diseases. Here, I analysed relevant literature from publicly available databases (Index Medicus, PubMed, Embase, Cochrane Library, ClinicalTrials.gov, Google Patents) to compare various methods for determining alveolar clearance, their advantages and shortcomings, their applicability in routine clinical practice and prospects for their use. The most accessible, informative, and inexpensive method to assess the alveolar clearance is bronchoalveolar lavage and the study of bronchoalveolar lavage fluid. Confocal laser endomicroscopy, a new and powerful imaging modality, has not been widely implemented hitherto. A non-invasive inhalation of a radioaerosol tracer for studying alveolar clearance in vivo seems to be promising but still requires adaptation for the broad use.

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