???? :???? 15 ???? 2009 ?.


??????????? :??????????? “???????????, ??????? ????? ????????????? ? ??????, ????????????????? ?????????? ????????????? ???????????? ????????????, ??????? ????? ????????? ??????? ??????? ? ?????????? ?????????. ?? ???????? ???????????? ??????????????? ???????????? ???????? ?????????? ??????, ??????? ???????? ?? ?????????. ??????????? ?????????? ?????? ?????? ????????????? ? ??????? ? ?????????????? ?????????????? ??????? ?????? ?? ?????????? ??????? ? ????.” GOLD 2006. http://www.goldcopd.com


? 2020 ???? :? 2020 ???? ???? ?????? 3-? ???????? ?????????? ? 5-? ???????? ?????????? ? ??????????? ???????????? ??????? (?????? ? ????????? ?????????? ? ??? ???? ???????? 4-? ?????). ???? ? 1990 ? ?????????? ?? ???? ????????? 4% (> 2 ???), ?? ? 2020 ? ??? ?????????? ?? 7% (4-5 ???). Viegy G et al. Respiration, 2001; 68: 4-19


?????????????????? :?????????????????? >16 ??? ??????? ? ??? (??????? ?????????? ?????? ? 7 ???) 1.5 ??? - ? ???????, 3.0 ??? – ? ??????????????, 2.7 ??? – ? ????????, ?? 2.6 ??? – ? ?????? ? ???????, 14 ??? ? ??????. P. Stang et al. Chest 2000;117: Suppl. 2, 354S-359S (NHANES III)


Slide 5:? Barnes Immunology 2008; Vol 8: 183-192


???? ??? ????????? ? ??????? ??????????????????????? ????????? :???? ??? ????????? ? ??????? ??????????????????????? ????????? P. Barnes. N Engl Med J, 2000 a1-??????????? ??????????? ??????????????? ????????? ???????? ?????????? ???????????????? ????????????? ????????, ?????????? 3 ????????? ????????????????? (1,2,9,12)


?? vs ???? :?? vs ???? ? Barnes Immunology 2008; Vol 8: 183-192


Slide 8:? Barnes Immunology 2008; Vol 8: 183-192


??????????????? ????????? ? ??????? ???? :??????????????? ????????? ? ??????? ???? P. Barnes. N Engl Med J, 2000


??????????????? ????????? ? ??????? ???? :??????????????? ????????? ? ??????? ???? ????????????? ????? ???? ????? ???????????? ?????? ???? ????. ????????? ??????? ??????? ???? ??????? ????????? ?????? ????????????


Slide 11:O’Donnell DE Eur Respir Rev 2006; 15:37-41 ??????????? ????? EELV OE? ???????? ? ?????????? ????? ?????? ??? EELV ??? ???????? ? ?????????? ????? ?????? ??? ???? ??? ????? ??????????? ?????


????????????? :?????????????


????????? ??????????: IL-8, CRP, s-TNF R55, s-TNF-R75 :????????? ??????????: IL-8, CRP, s-TNF R55, s-TNF-R75 ????????, ?????? ??????? ????? ?? ???? ?????????, ???????? ????? ???? ????????? ?????: ??????? ????????, ??????? ?????????? ????????? ???????????? ??????


???? ? ????????-?????????? ??????? :???? ? ????????-?????????? ??????? ????? ? ???? ??????? ???? ??????? ????????-?????????? ????????? (??????-??????????? ???????) ???1 ??????????? ? ??????? ??????????? ?? ????????-?????????? ????????? ? ??????? ???? ???? ??????????? ???? ??????????? ?? ????????-?????????? ??????????? ? 3 ???? ?????????? ??????? ?????????? ??? ???? ?? 10% ??????????? ???? ?????????? ?? ????????-?????????? ????????? ?? 20% Sin; Chest 2005, 127, 1952-1959 Ricker et al. Circulation, 2001, 2003


???????????? ? ??????? ???? :???????????? ? ??????? ???? ?????? ????? ???????, ??? ? ??????? ? ?? - ????????? ??????????? ?? ?????? ?? ?????????? ??????????? ???????? ?????????? ????? ?????????????? ?? ?????? ?? ??????????????? ????????? ? ??????? ? ?????? ?? ????????? ???????????????? ??????????? ??????????? ?? ?????? ?? ????????????????? ????? ???????


Slide 16:O’Donnell DE Eur Respir Rev 2006; 15:37-41 ??????????? ????? EELV OE? ???????? ? ?????????? ????? ?????? ??? EELV ??? ???????? ? ?????????? ????? ?????? ??? ??? ????? ??????????? ????? ???????????


??? ? ??????? ???? :??? ? ??????? ???? ?? Peter J. Barnes, 1996


???????? ??????????? :???????? ??????????? Rabe KF et al. GOLD 2007. Am J Respir Crit Care Med 2007;176:532-555 ??????? >40 ??? ??????? >10 ?????-???


Fletcher C, Peto R. The natural history of chronic airflow obstruction. Br Med J 1977; 1: 1645–1648. :Fletcher C, Peto R. The natural history of chronic airflow obstruction. Br Med J 1977; 1: 1645–1648. ??????? ?? ??????????? ??????????, ??????????????????? ? ???? ??????? ? 65 ??? ??????? ? 45 ??? ????????? ??????? ??? «????????? ??????????» ????????????? ??????


???1 ? ???????? ??????????? :???1 ? ???????? ??????????? Sutherland ER and Cherniack RM. N Engl J Med 2004;350:2689-97. ???????????????? ??????????? ???????? ???1 100 50 20 ???????? ???


???? ? ???????? ????? :???? ? ???????? ????? Rutten-van Molken M et al. Chest 2006;130:1117-1128


????????????? ?? ??????? :????????????? ?? ??????? Rabe KF et al. GOLD 2007. Am J Respir Crit Care Med 2007;176:532-555 ???1 / ???? < 70%


?????????? ???? :?????????? ???? ?????? - ?????????? ??????????? ? ?????????????; ?????????????? ??????????? ?????? ?? ?????????; ????????? - ?????????? ??????????? ? ?????????????, ????????? ?????????????? ??????????? ?????? ? ???????????? ????????; ??????? – ????????? ??????????????; Roberto Rodriguez-Roisin, CHEST 2000; 117:398S–401S


????????? ?????????? ? ?????????? :????????? ?????????? ? ?????????? Soler-Cataluña JJ et al. Thorax 2005;64:925-31 ????? (??????) 0.0 0.2 0.4 0.6 0.8 1.0 0 10 20 30 40 50 60 ????????? ?????????? p<0.001 p=0.07 3-4 ?????????? 1-2 ?????????? ??? ?????????? ????????? ???????????? ????????????. n=304 ??????????, ????????? ??????????????


????: ??????????? ?????????? ? ?????????? :????: ??????????? ?????????? ? ?????????? 1Eriksen N, et al. Ugeskr Laeger 2003;165:3499–35022Groenewegen KH, et al. Chest 2003;124:459–4673Almagro P, et al. Chest 2002;121:1441–14484Connors AF, et al. Am J Respir Crit Care Med 1996;154:959–967