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Международный журнал прикладных и фундаментальных исследований

ISSN 1996-3955

ИФ РИНЦ = 0,593

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Гуртовая М.Н. 1 Прокопьев Н.Я. 1 Колунин Е.Т. 1 Губин Д.Г. 1 Дуров А.М. 1

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1 Тюменский государственный университет

В статье приводится обзор 220 источников иностранной литературы, отражающий современные взгляды на общее и различие аллергического ринита и бронхиальной астмы. Рассматривается частота заболеваний в различных странах мира. Анализируются методы лечения и качество жизни.

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аллергический ринит

бронхиальная астма

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Аллергический ринит (АР) и бронхиальная астма (БА) – два наиболее часто встречающихся хронических аллергических заболеваний у детей и взрослых [20]. За истекшие 10 лет распространенность этих заболеваний увеличилась практически вдвое.

В настоящее время АР страдает до 40 % населения земного шара [27, 52], причем независимо от региона проживания [2, 5, 7, 8, 15, 17, 24, 35, 36, 37, 38, 43, 55, 62, 71, 72, 73, 83, 95, 102, 104, 112, 115, 118, 122, 123, 128, 134, 142, 151, 165, 174, 176, 180, 182, 183, 189, 194, 198, 199, 208, 219, 220]. Проблема увеличивающегося распространения аллергических заболеваний и АР в частности и бронхиальной астмы (БА) настолько масштабна, что было создано ряд обществ по их изучению: Международное Исследование Астмы и Аллергии у детей (ISAAC), Европейское Сообщество Обследование состояния здоровья (CCASHH), Международное Общество по изучению Зуда (International Forum for the Study of Itch), Всемирная Организация по Аллергии (WAO), Американская Академия Аллергии, Астмы и Иммунологии (AAAAI). Кроме того, была предложена классификации ARIA (аллергический ринит и его влияния на астму – Allergic Rhinitis and its Impact on Asthma).

Большую тревогу вызывает увеличение заболевания бронхиальной астмой у детей различных стран мира. Бронхиальная астма – хроническое заболевание, в основе которого лежит аллергическое воспаление трахеобронхиального дерева. Так, в частности, только в США более 15 миллионов человек, включая 5 миллионов детей, имеют эту опасную для жизни болезнь. Каждый год на больных астмой приходится почти 2 миллиона чрезвычайных посещений кабинетов врачей, 500 000 госпитализаций и более 5000 смертных случаев. Ежегодно экономические потери только на лечение БА обходится американскому обществу примерно в 4,5 миллиарда долларов.

Следует отметить, что, несмотря на огромный прорыв в изучении аллергии, на сегодняшний день нет достоверных сведений о частоте АР у больных БА (таблица).

Процентное отношение ринита к бронхиальной астме

Клиницисты отмечают, что АР и БА часто являются сопутствующими друг другу заболеваниями, что связано с их физиологическими, гистологическими и иммунопатологическими сходствами дыхательных путей [41].

Достаточно трудно отличить АР от неаллергического ринита, так как они имеют сходные симптомы и даже могут сочетаться у одного и того же пациента [31, 32, 33]. Японскими авторами сообщалось, что 44–68 % пациентов с БА страдают и АР [77, 143].

Существует также хронологическая связь АР и БА, что было многократно подтверждено в крупных исследованиях. Данные BAMSE когорты (Швеция, 2012) показали, что в детском возрасте астма часто сочетается с атопическим дерматитом (АД) и АР, в то время как ринит и АД чаще бывают изолированными [202]. Коморбидность возрастает с возрастом ребенка, так в возрасте 1 года астма сочеталась с ринитом и/или АД в 38 % случаев и показатель возрос до 67 % случаев к 12 годам. Развитие АД, АР и БА – это динамический процесс [14, 96, 140].

В этиологии АР придается большое значение домашней пыли и клещам [25, 177, 191], домашним животным [22, 119, 120, 121, 161, 162, 203, 209, 216], пыльце трав [58, 124], профессиональным вредностям [56, 87, 109, 136, 195, 197, 205, 206, 207], курению [6, 154],

продуктам питания [23, 126, 127], бытовому газу [215], керосину как топливу в домашних условиях [200], загрязнениям внутреннего и наружного воздуха окружающей среды [69, 78, 79, 219].

По данным журнала Electromagnetic Biology and Medicine миру грозит эпидемия техногенного недуга – электрогиперчувствительности и к 2017 году ею будет страдать каждый второй человек планеты.

Продолжается накопление и анализ клинической оценки тяжести клинических симптомов АР [2, 42, 76, 85, 108, 113, 116, 184, 192] и факторов риска развития БА [34, 101, 117].

Дискуссионным остается вопрос влияния АР на течение БА [27, 29, 30, 59, 100, 135, 155, 156, 186], в том числе на функциональные возможности бронхов и легких [16].

Изучается влияние климатических условий на распространенность симптомов астмы, АР и атопической экземы у детей [167, 210].

В некоторых исследованиях показано, что есть связь между наличием ринита и тяжестью протекания астмы [42, 163, 190].

Пациенты с БА с установленным диагнозом сопутствующего АР требуют больших затрат на лечение по сравнению с пациентами, которые имеют только астму [31, 158, 183]. Исследования E. Groot и соавт. [91] показали, что пациенты с БА в сочетании с АР имели достоверно более выраженный воспалительный процесс, чем пациенты без АР.

Систематически осуществляются публикации научных обзоров и крупномасштабных исследований, а также клинических рекомендаций по современным вопросам, связанных с изучением и лечением АР и астмы [10, 30, 50, 84, 89, 103, 110, 132,137, 149, 153, 166, 175, 178, 187, 213].

Предлагаются опросники по изучению АР и БА [12, 196]. Так, в частности, шведскими исследователями [93] разработана и апробирована на большом числе населения карта исследования больных с АР и БА.

Проведено обследование близнецов, братьев и сестер по изучению у них распространенности аллергических заболеваний [130].

В Швеции проведено когортное исследование по изучению индекса массы тела у призывников с аллергическим риноконьюнктивитом и БА [35, 36, 37].

Показано, что клинические проявления АР весьма разнообразны, ибо он может поражать глаза [44, 82, 107, 123, 147, 150].

Изучаются клинические особенности астматических больных и роль хронического гиперпластического риносинусита и полипоза носа [98].

Ведутся исследования о состоянии женщин, больных БА во время беременности [111] и влияние сезонного АР на менструальный цикл [188].

В последние годы разрабатываются научно-методологические подходы к проблемам оценки качества жизни человека в различных разделах сферы деятельности человека, в том числе и медицины. Всё большее внимание обращается на экономическое развитие общества и качество жизни больных АР и БА [3, 35, 57, 106, 114, 119, 120].

Исследования свидетельствуют о том [92, 93], что АР является независимым фактором риска для развития кашля помимо простуды среди взрослых. В этом направлении [179] проведено продольное исследование по изучению АР к появлению у человека рецидивирующего кашля и храпа во время сна.

Накапливаются сведения об изменении состава крови у больных с аллергическими заболеваниями [86, 168, 212], а также роль тучных и стволовых клеток на рецепторный аппарат слизистой оболочки носа [169].

Для уменьшения выраженности АР во время природного воздействия пыльцы растений и трав предлагается использовать специальные маски – «носовые фильтры» и очки [88, 146].

Даются рекомендации путешественникам по их поведению и методам защиты при природном воздействии аллергенов [4, 75].

Широко обсуждаются вопросы клинического применение и механизма действия различных лекарственных препаратов на больных, страдающих АР [1, 9, 11, 19, 45, 46, 47, 48, 49, 63, 64, 67, 97, 138, 144, 152, 160, 170, 185, 201, 211], в том числе применённых сублингвально [48, 66, 75, 99, 125, 141, 145, 159, 214] и специфической иммунотерапии АР и БА [21, 46, 47, 51, 54, 80, 81, 90, 133, 139, 204].

Значительная часть исследований проводится по изучению сезонной изменчивости бронхиальных клеток, верхних нижних дыхательных путей и мокроты у больных, как АР, так и БА [18, 26, 39, 40, 53, 60, 65, 68, 131, 156, 157, 171, 190].

Приводятся сведения о функциональном состоянии легких на фоне АР [61].

Рассматриваются причины наследственной расположенности к аллергическим заболеваниям [148].

Изучаются вопросы развития аллергии и астмы у младенцев и маленьких детей до возраста 7 лет с АД, причем наметились некоторые перспективы решений [94, 129].

Особого внимания заслуживают исследования роли уровней IgE человека с аллергическими заболеваниями [13, 29, 70, 105, 164, 172, 181, 217].

Не обойдено вниманием ученых изучение чисто экономических затрат на лечение аллергических заболеваний, в том числе АР и БА [173].

Таким образом, следует признать, что АР и БА, несмотря на несомненно достигнутые успехи в диагностике заболеваний, имеют весьма высокую тенденцию к распространению в различных странах мира, отличаются полиморфизмом клинических проявлений, высокой долей экономических потерь на лечение, смертностью и трудностью лечения.

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