COMPARATIVE RISK-ORIENTED INTEGRATED ASSESSMENT OF LUNG HEALTH STATUS IN PREVENTIVE PLANNING OF REHABILITATION TREATMENT PROGRAMS IN A SANATORIUM

M. E.D., Mokina N.A.
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Abstract

Introduction. COPD is a heterogeneous disease, the variability and diversity of which depends on a combination of genetics and risk factors. At present, during the period of the deciphered human genome, an earlier assessment of the prognostic risk of the development of cochlea in young people is needed to understand the possibilities of establishing reversible lung lesions. Aim as a part of preventive phenotyping in young people; substantiate the importance of a comparative risk-oriented complex epigenetic and genetic assessment of the lung health status for predictive assessment of the risk of developing COPD. Materials and methods. In this cohort study, 293 young people (11-23 years old) took part, including 142 male and 151 female, who were divided into four groups. 1st group - 132 conditionally healthy non-smokers (51 male and 81 female), 2nd - 54 conditionally healthy smokers (39 male and 15 female), 3rd - 86 non-smokers, with chronic lung diseases (52 persons – chronical tracheobronchitis; 43 persons – bronchial asthma), 4th - 21 smokers with chronic lung diseases (HRTB - 12 persons, BA - 9 persons). To assess the differences in epigenetic and genetic criteria, methods such as spirometry, gas analysis, electronic auscultation, digital acoustic analysis of respiratory work, analysis of gene polymorphisms for the alpha1-antitrypsin-SERPINA-1 complex in venous blood serum were used. We have developed a computer program, taking into account the risk factors for the prognostic development of COPD in a cohort of smoking and non-smoking young people aged 11-23 years with or without a diagnosis of chronic lung disease. Results. Among the most reliable, informative, sensitive and specific phenotyping indicators in assessing the prognostic degree of COPD risk in adolescents: cough, sputum production, ARI frequency per year, smoking index, electronic auscultation data, FEV1%, FVC%, FEV1 / FVC%, CO, O2, AAT, SERPINA. These criteria made up the characteristics of risk phenotypes, which allows the subjects to be graded according to groups (phenotypes) of the prognostic risk of COPD - low, moderate, high or extremely high, depending on the scale of criterion values. In young people in the context of predictive preventive personalized medicine. This made it possible to draw up an algorithm for assessing risk groups and a computer program based on this algorithm, which makes it possible to determine the phenotypes of COPD risk in young people. Conclusion: Starting from adolescence, it is possible to record the initial functional disorders of the respiratory status in combination with genetic polymorphisms, which confirms the need for preventive screening for the primary identification of risk groups and the formation of preventive programs in young people. The developed algorithm and computer program make it possible to determine the prognostic risk of COPD in young people - from low to moderate, high and extremely high, in terms of the implementation of the concept of 3P (personalized, preventive, and predictive) medicine.
疗养院康复治疗方案预防性规划中肺健康状况的比较风险导向综合评估
介绍。慢性阻塞性肺病是一种异质性疾病,其可变性和多样性取决于遗传和危险因素的组合。目前,在破译人类基因组期间,需要对年轻人耳蜗发育的预后风险进行早期评估,以了解建立可逆性肺病变的可能性。目的:作为青少年预防性表型的一部分;证实以比较风险为导向的复杂表观遗传学和遗传学肺部健康状况评估对于预测COPD发生风险的重要性。材料和方法。在本队列研究中,共有293名11-23岁的年轻人参加,其中男性142人,女性151人,分为四组。第一组——132名有条件健康的非吸烟者(51名男性和81名女性),第二组——54名有条件健康的吸烟者(39名男性和15名女性),第三组——86名患有慢性肺病的非吸烟者(52人——慢性气管支气管炎;43人(支气管哮喘),4 - 21名患有慢性肺病的吸烟者(HRTB - 12人,BA - 9人)。采用肺活量测定、气体分析、电子听诊、呼吸功数字声学分析、静脉血α -1 -抗胰蛋白酶- serpina -1复合体基因多态性分析等方法评估表观遗传学和遗传标准的差异。我们开发了一个计算机程序,考虑了吸烟和非吸烟的11-23岁有或没有慢性肺部疾病诊断的年轻人COPD预后发展的危险因素。评估青少年COPD风险预后程度最可靠、信息最丰富、最敏感和最特异的表型指标包括:咳嗽、痰量、每年ARI频率、吸烟指数、电子听诊数据、FEV1%、FVC%、FEV1 / FVC%、CO、O2、AAT、SERPINA。这些标准构成了风险表型的特征,这使得受试者可以根据COPD预后风险的组(表型)进行分级——低、中、高或极高,具体取决于标准值的大小。在年轻人预测性预防个体化医疗的背景下。这使得制定评估风险群体的算法和基于该算法的计算机程序成为可能,这使得确定年轻人COPD风险的表型成为可能。结论:从青春期开始,结合遗传多态性记录呼吸状态的初始功能障碍是可能的,这证实了在青少年中进行预防性筛查以初步识别危险人群和形成预防方案的必要性。开发的算法和计算机程序使确定年轻人COPD的预后风险成为可能-从低到中度,高到极高,就3P(个性化,预防性和预测性)医学概念的实施而言。
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