zurniimtpeМедицина труда и промышленная экологияRussian Journal of Occupational Health and Industrial Ecology1026-94282618-8945FSBSI “Izmerov Research Institute of Occupational Health”10.31089/1026-9428-2024-64-6-408-419onddwazurniimtpe-3508Research ArticleОБЗОРЫ ЛИТЕРАТУРЫLITERATURE REVIEWSГиперчувствительный пневмонит: современное состояние проблемыHypersensitivity pneumonitis: the current state of the problemhttps://orcid.org/0000-0001-9661-7213СувороваОльга АлександровнаSuvorovaOlga A.

Ассистент кафедры пульмонологии Института клинической медицины имени Н.В. Склифосовского ФГАОУ ВО «Первый Московский государственный медицинский университет имени И.М. Сеченова» Минздрава России (Сеченовский Университет)

e-mail: Olga.a.suvorova@mail.ru

Assistant, Pulmonology Department, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University)

e-mail: Olga.a.suvorova@mail.ru

Olga.a.suvorova@mail.ruhttps://orcid.org/0000-0002-0685-4133ТрушенкоНаталья ВладимировнаTrushenkoNatalia V.

Ассистент кафедры пульмонологии Института клинической медицины имени Н.В. Склифосовского ФГАОУ ВО «Первый Московский государственный медицинский университет имени И.М. Сеченова» Минздрава России (Сеченовский Университет), научный сотрудник научно-методического центра мониторинга и контроля болезней органов дыхания ФГБУ «Научно-исследовательский институт пульмонологии» ФМБА России, канд. мед. наук

e-mail: trushenko.natalia@yandex.ru

Assistant, Department of Pulmonology, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University); Researcher, Scientific and Methodological Center for Monitoring and Control of Respiratory Diseases, Pulmonology Scientific Research Institute, Cand. of Sci. (Med.)

e-mail: trushenko.natalia@yandex.ru

trushenko.natalia@yandex.ruhttps://orcid.org/0000-0001-8170-1260СамсоноваМария ВикторовнаSamsonovaMaria V.

Зав. лабораторией патологической анатомии и иммунологии ФГБУ «Научно-исследовательский институт пульмонологии» ФМБА России, ст. науч. сотр. лаборатории инновационной патоморфологии ГБУЗ «Московский клинический научно-практический центр имени А.С. Логинова» Департамента здравоохранения города Москвы, д-р мед. наук

e-mail: samary@mail.ru

Head of Laboratory of Pathological Anatomy and Immunology, Pulmonology Scientific Research Institute, Senior Researcher, Laboratory of Innovative Pathomorphology, Moscow Clinical Scientific Center named after Loginov, Dr. of Sci. (Med.)

e-mail: samary@mail.ru

samary@mail.ruhttps://orcid.org/0000-0003-0973-9250ЧерняевАндрей ЛьвовичCherniaevAndrey L.

Зав. отделом фундаментальной пульмонологии ФГБУ «Научно-исследовательский институт пульмонологии» ФМБА России; профессор кафедры патологической анатомии и клинической патологической анатомии лечебного факультета ФГБОУ ВО «Российский национальный исследовательский медицинский университет имени Н.И. Пирогова» Минздрава России; вед. науч. сотр. лаборатории клинической морфологии Научно-исследовательский институт морфологии человека имени академика А.П. Авцына ФГБНУ «Российский научный центр хирургии им. акад. Б.В. Петровского»; д-р мед. наук, проф.

e-mail: cheral12@gmail.com

Head of the Department of Fundamental Pulmonology, Pulmonology Scientific Research Institute; Professor of the Department of Pathological Anatomy and Clinical Pathological Anatomy, Faculty of N.I. Pirogov Russian National Research Medical University; Leading Researcher, Laboratory of Clinical Morphology, Avtsyn Research Institute оf Human Morphology оf Petrovsky National Research Centre оf Surgery, Dr. of Sci. (Med.), Professor

e-mail: cheral12@gmail.com

cheral12@gmail.comhttps://orcid.org/0000-0003-4781-4645ГордееваАнастасия АлексеевнаGordeevaAnastasia A.

Студентка VI курса ФГАОУ ВО «Первый Московский государственный медицинский университет имени И.М. Сеченова» Минздрава России (Сеченовский Университет)

e-mail: gordeeva.anast.aleks@gmail.com

6th year Student, I.M. Sechenov First Moscow State Medical University (Sechenov University)

e-mail: gordeeva.anast.aleks@gmail.com

gordeeva.anast.aleks@gmail.comhttps://orcid.org/0009-0003-0970-7934ПанинаУльяна ВалерьевнаPaninaUl’yana V.

Студентка VI курса ФГАОУ ВО «Первый Московский государственный медицинский университет имени И.М. Сеченова» Минздрава России (Сеченовский Университет)

e-mail: ulya00panina@mail.ru

6th year Student, I.M. Sechenov First Moscow State Medical University

e-mail: ulya00panina@mail.ru

ulya00panina@mail.ruhttps://orcid.org/0009-0002-4563-4499БабаянФеня ЗахаровнаBabayanFenya Z.

Студентка VI курса ФГАОУ ВО «Первый Московский государственный медицинский университет имени И.М. Сеченова» Минздрава России (Сеченовский Университет)

e-mail: fen0993@icloud.com

6th year Student, I.M. Sechenov First Moscow State Medical University (Sechenov University)

e-mail: fen0993@icloud.com

fen0993@icloud.comhttps://orcid.org/0000-0002-5999-2150АвдеевСергей НиколаевичAvdeevSergey N.

Заведующий кафедрой пульмонологии Института клинической медицины имени Н.В. Склифосовского ФГАОУ ВО «Первый Московский государственный медицинский университет имени И.М. Сеченова» Минздрава России (Сеченовский Университет), руководитель клинического отдела ФГБУ «Научно-исследовательский институт пульмонологии» ФМБА России; главный внештатный специалист-пульмонолог Минздрава России; директор Национального медицинского исследовательского центра по профилю «Пульмонология»; д-р мед. наук, проф., академик РАН

e-mail: serg_avdeev@list.ru

Head of the Department of Pulmonology, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Head of Clinical Department, Federal Pulmonology Research Institute; Chief Freelance Pulmonologist of the Ministry of Health of the Russian Federation; Director of the National Medical Research Center for Pulmonology, Dr. of Sci. (Med.), Professor Academician of RAS

e-mail: serg_avdeev@list.ru

serg_avdeev@list.ruФГАОУ ВО «Первый Московский государственный медицинский университет имени И.М. Сеченова» Минздрава России (Сеченовский Университет)РоссияI.M. Sechenov First Moscow State Medical University (Sechenov University)Russian FederationФГАОУ ВО «Первый Московский государственный медицинский университет имени И.М. Сеченова» Минздрава России (Сеченовский Университет); ФГБУ «Научно-исследовательский институт пульмонологии» Федерального медико-биологического агентства РоссииРоссияI.M. Sechenov First Moscow State Medical University (Sechenov University); Federal Pulmonology Research Institute of the Federal Medical and Biological Agency of RussiaRussian FederationФГБУ «Научно-исследовательский институт пульмонологии» Федерального медико-биологического агентства России; ГБУЗ «Московский клинический научно-практический центр имени А.С. Логинова» Департамента здравоохранения города МосквыРоссияFederal Pulmonology Research Institute of the Federal Medical and Biological Agency of Russia; Loginov Moscow State Clinical and Research CenterRussian FederationФГБУ «Научно-исследовательский институт пульмонологии» Федерального медико-биологического агентства России; ФГБОУ ВО «Российский национальный исследовательский медицинский университет имени Н.И. Пирогова» Минздрава России; Научно-исследовательский институт морфологии человека имени академика А.П. Авцына ФГБНУ «Российский научный центр хирургии им. акад. Б.В. Петровского»РоссияFederal Pulmonology Research Institute of the Federal Medical and Biological Agency of Russia; Pirogov Russian National Research Medical University (Pirogov Medical University); Avtsyn Research Institute of Human Morphology of Petrovsky National Research Centre of SurgeryRussian Federation202402082024636408419Copyright © Суворова О.А., Трушенко Н.В., Самсонова М.В., Черняев А.Л., Гордеева А.А., Панина У.В., Бабаян Ф.З., Авдеев С.Н., 20242024Суворова О.А., Трушенко Н.В., Самсонова М.В., Черняев А.Л., Гордеева А.А., Панина У.В., Бабаян Ф.З., Авдеев С.Н.Suvorova O.A., Trushenko N.V., Samsonova M.V., Cherniaev A.L., Gordeeva A.A., Panina U.V., Babayan F.Z., Avdeev S.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.journal-irioh.ru/jour/article/view/3508

Гиперчувствительный пневмонит (ГП) является воспалительным интерстициальным заболеванием лёгких (ИЗЛ), которое возникает у предрасположенных лиц в ответ на повторные воздействия различных аэрозольных антигенов. В последних клинических рекомендациях 2020 и 2021 г. внесены изменения в классификацию ГП, выделены фибротический и нефибротический типы ГП, при этом фибротический тип ассоциирован с прогрессированием заболеванием и худшим прогнозом.

Диагностика ГП и разделение его на типы основывается на сочетании клинико-анамнестических данных, картине компьютерной томографии высокого разрешения (КТВР), результатах цитологического исследования бронхоальвеолярного лаважа (БАЛ) и биопсии лёгкого. Используются также функциональные лёгочные тесты для определения прогрессирования заболевания. Ключевым методом диагностики является КТВР, на которой выделяют признаки патологии лёгочной ткани («матовое стекло», мозаичная плотность) и признаки поражения мелких дыхательных путей (центрилобулярные очаги, воздушные ловушки). При фибротическом ГП выявляются признаки фиброза: тракционные бронхоэктазы, ретикулярные изменения, снижение объёма лёгких, возможно формирование «сотового лёгкого». Для БАЛ характерен лимфоцитарный тип цитограммы (более 30% от общего числа клеток) при нефибротическом типе ГП, в то время как при фибротическом ГП лимфоцитоз встречается реже. Биопсия лёгких часто используется для дифференциальной диагностики с другими ИЗЛ. При нефибротическом ГП оцениваются признаки вовлечения в воспалительный процесс бронхиол и прилежащих альвеол, характер воспалительного инфильтрата, наличие гранулём. При фиброзном ГП определяются бронхиолоцентричный фиброз, хроническая интерстициальная пневмония, перибронхиолярная метаплазия и другие признаки.

Терапия ГП включает в себя устранение контакта с антигеном, назначение глюкокортикостероидов и/или иммуносупрессантов, а также антифибротической терапии при наличии прогрессирующего варианта фибротического ГП.

Участие авторов

Участие авторов:Суворова О.А. — концепция и дизайн исследования, сбор и обработка данных, написание текста, редактирование;Трушенко Н.В. — концепция и дизайн исследования, сбор и обработка данных, написание текста, редактирование;Самсонова М.В. — написание текста;Черняев А.Л. — написание текста;Гордеева А.А. — сбор и обработка данных, написание текста;Панина У.В. — сбор и обработка данных, написание текста;Бабаян Ф.З. — сбор и обработка данных, написание текста;Авдеев С.Н. — концепция и дизайн исследования, редактирование.

Финансирование

Финансирование. Исследование не имело спонсорской поддержки.

Конфликт интересов

Конфликт интересов. Автор заявляет об отсутствии конфликта интересов.

Дата поступления

Дата поступления: 06.02.2024 / Дата принятия к печати: 09.06.2024 / Дата публикации: 31.07.2024

Hypersensitive pneumonitis (HP) is an inflammatory interstitial lung disease (ILD) that occurs in predisposed individuals in response to repeated exposure to various aerosol antigens. In 2020 and 2021, specialists made changes to the latest clinical recommendations, to the classification of HP, allowing to distinguish between fibrous and non-fibrous types of HP. The fibrous type is associated with the progression of the disease and an unfavorable prognosis. The diagnosis of HP and its division into types are based on a combination of clinical and anamnestic data, a high-resolution computed tomography (HRCT) picture, the results of cytological examination of bronchoalveolar lavage (BAL) and lung biopsy. Specialists also use lung function tests to determine the progression of the disease. The key diagnostic method is high-resolution computed tomography, which reveals signs of lung tissue pathology («frosted glass», mosaic density) and signs of damage to the small respiratory tract (centrilobular foci, air traps). In fibrotic HP, experts have identified signs of fibrosis: traction bronchiectasis, reticular changes, decreased lung volume, and the formation of a «cellular lung» is possible. Non-fibrotic HP is characterized by: lymphocytic cytogram type (more than 30% of the total number of cells), while in fibrotic HP lymphocytosis is less common. Experts often use lung biopsies for differential diagnosis with other diseases. In nonfibrotic HP, scientists evaluate the signs of involvement of bronchioles and adjacent alveoli in the inflammatory process, the nature of inflammatory infiltration and the presence of granulomas. Fibrotic HP has bronchiolocentric fibrosis, chronic interstitial pneumonia, peribronchiolar metaplasia and other signs. HP therapy includes the elimination of contact with the antigen, the administration of glucocorticosteroids and/or immunosuppressants, as well as antifibrotic therapy in the presence of a progressive variant of fibrous HP.

Contribution

Contribution:Suvorova O.A. — research concept and design, data collection and processing, writing the text, editing;Trushenko N.V. — research concept and design, data collection and processing, writing the text, editing;Samsonova M.V. — writing the text;Chernyaev A.L. — writing the text;Gordeeva A.A. — data collection and processing, writing the text;Panina U.V. — data collection and processing, writing the text;Babayan F.Z. — data collection and processing, writing the text;Avdeev S.N. — research concept and design, editing.

Funding

Funding. The study had no funding.

Conflict of interests

Conflict of interests. The authors declare no conflict of interests.

Received

Received: 06.02.2024 / Accepted: 09.06.2024 / Published: 31.07.2024

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