Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.
Возможность применения ингибиторов ангиотензинпревращающего фермента (фозиноприла) у пациентов с коморбидной кардиореспираторной патологией
Возможность применения ингибиторов ангиотензинпревращающего фермента (фозиноприла) у пациентов с коморбидной кардиореспираторной патологией
Кароли Н.А., Ребров А.П. Возможность применения ингибиторов ангиотензинпревращающего фермента (фозиноприла) у пациентов с коморбидной кардиореспираторной патологией. Consilium Medicum. 2016; 18 (1): 73–78. DOI: 10.26442/2075-1753_2016.1.73-78
________________________________________________
Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.
Аннотация
В настоящем обзоре освещаются вопросы блокады ренин-ангиотензин-альдостероновой системы (РААС) как потенциальной терапевтической стратегии при хронической обструктивной болезни легких (ХОБЛ) и, в частности, роль ингибиторов ангиотензинпревращающего фермента (ИАПФ) в лечении коморбидной сердечно-сосудистой патологии при ХОБЛ.
Существуют данные о том, что повышение активности РААС может вносить вклад в патогенез и прогрессирование ХОБЛ. Имеются данные, что прием ИАПФ ассоциируется со снижением смертности пожилых пациентов с ХОБЛ, госпитализированных по поводу обострения. Также появляются доказательства того, что ИАПФ могут оказывать благоприятное воздействие на функцию скелетных мышц и сердечно-сосудистую заболеваемость у больных ХОБЛ.
В обзоре показано, что ИАПФ, в частности фозиноприл, сохраняют свою значимость при лечении пациентов с сочетанной кардиореспираторной патологией. Действие фозиноприла многогранно и определяется не только влиянием на артериальное давление, симптомы систолической и диастолической дисфункции левого желудочка как причины хронической сердечной недостаточности, но и нормализацией функционирования РААС, органопротективным эффектом. Фозиноприл имеет благоприятный метаболический профиль и низкую частоту побочных эффектов.
Ключевые слова: ингибиторы ангиотензинпревращающего фермента, ренин-ангиотензин-альдостероновая система, хроническая обструктивная болезнь легких, фозиноприл.
The review shows that ACE inhibitors, particularly fosinopril, remain their clinical relevance in treating patients with cardiorespiratory pathology. Fosinopril action is multiplex and is determined not only by the effect on blood pressure, left ventricular systolic and diastolic dysfunction (the cause of chronic heart failure), but also by the normalization of the RAAS functioning and organoprotective effect. Fosinopril is a drug with favorable metabolic profile and low incidence of adverse events.
Key words: angiotensin-converting enzyme inhibitors, renin-angiotensin-aldosterone system, chronic obstructive pulmonary disease, fosinopril.
Существуют данные о том, что повышение активности РААС может вносить вклад в патогенез и прогрессирование ХОБЛ. Имеются данные, что прием ИАПФ ассоциируется со снижением смертности пожилых пациентов с ХОБЛ, госпитализированных по поводу обострения. Также появляются доказательства того, что ИАПФ могут оказывать благоприятное воздействие на функцию скелетных мышц и сердечно-сосудистую заболеваемость у больных ХОБЛ.
В обзоре показано, что ИАПФ, в частности фозиноприл, сохраняют свою значимость при лечении пациентов с сочетанной кардиореспираторной патологией. Действие фозиноприла многогранно и определяется не только влиянием на артериальное давление, симптомы систолической и диастолической дисфункции левого желудочка как причины хронической сердечной недостаточности, но и нормализацией функционирования РААС, органопротективным эффектом. Фозиноприл имеет благоприятный метаболический профиль и низкую частоту побочных эффектов.
Ключевые слова: ингибиторы ангиотензинпревращающего фермента, ренин-ангиотензин-альдостероновая система, хроническая обструктивная болезнь легких, фозиноприл.
________________________________________________
The review shows that ACE inhibitors, particularly fosinopril, remain their clinical relevance in treating patients with cardiorespiratory pathology. Fosinopril action is multiplex and is determined not only by the effect on blood pressure, left ventricular systolic and diastolic dysfunction (the cause of chronic heart failure), but also by the normalization of the RAAS functioning and organoprotective effect. Fosinopril is a drug with favorable metabolic profile and low incidence of adverse events.
Key words: angiotensin-converting enzyme inhibitors, renin-angiotensin-aldosterone system, chronic obstructive pulmonary disease, fosinopril.
Полный текст
Список литературы
1. Sin DD, Anthonisen NR, Soriano JB, Agusti AG. Mortality in COPD: role of comorbidities. Eur Respir J 2006: 28; 1245–57.
2. Lopez AD, Shibuya K, Rao C et al. Chronic obstructive pulmonary disease: current burden and future projections. Eur Respir J 2006; 27: 397–412.
3. Burt VL, Cutler JA, Higgins M et al. Trends in the Prevalence, Awareness, Treatment, and Control of Hypertension in the Adult US Population. Hypertension 1995; 26: 60–9.
4. Chandy D, Aronow WS, Banach M. Current perspectives on treatment of hypertensive patients with chronic obstructive pulmonary disease. Integr Blood Press Control 2013; 6: 101–9.
5. Кароли Н.А., Ребров А.П. Артериальная гипертензия у пациентов с бронхиальной астмой и хронической обструктивной болезнью легких. Клиницист. 2011; 2: 20–30. / Karoli N.A., Rebrov A.P. Arterial'naia gipertenziia u patsientov s bronkhial'noi astmoi i khronicheskoi obstruktivnoi bolezn'iu legkikh. Klinitsist. 2011; 2: 20–30. [in Russian]
6. Ольбинская Л.И., Белов А.А. Динамика суточного профиля артериального давления при хронических обструктивных заболеваниях легких в сочетании с артериальной гипертонией на фоне лечения эналаприлом. Тер. арх. 2002; 3: 59–62. / Ol'binskaia L.I., Belov A.A. Dinamika sutochnogo profilia arterial'nogo davleniia pri khronicheskikh obstruktivnykh zabolevaniiakh legkikh v sochetanii s arterial'noi gipertoniei na fone lecheniia enalaprilom. Ter. arkh. 2002; 3: 59–62. [in Russian]
7. Incalzi AR, Fuso L, De Rosa M et al. Co-morbidity contributes to predict mortality of patients with chronic obstructive pulmonary disease. Eur Respir J 1997; 10: 2794–800.
8. Anthonisen NR, Connet JE, Enright PL, Manfreda J. Hospitalizations and mortality in the Lung Health Study. Am J Respir Crit Care Med 2002; 166: 333–9.
9. Huiart L, Ernst P, Ranouli X, Suissa S. Low-dose inhaled corticosteroids and the risk of acute myocardial infarction in COPD. Eur Respir J 2005; 25: 634–9.
10. Кароли Н.А., Ребров А.П. Смертность при хронической обструктивной болезни легких: роль коморбидности. Клин. медицина. 2008; 3: 18–21. / Karoli N.A., Rebrov A.P. Smertnost' pri khronicheskoi obstruktivnoi bolezni legkikh: rol' komorbidnosti. Klin. meditsina. 2008; 3: 18–21. [in Russian]
11. Almagro P, Calbo E, Echagilen AO et al. Mortality after hospitalization for COPD. Chest 2002; 121: 1441–8.
12. Hansell AL, Walk JA, Soriano JB. What do chronic obstructive pulmonary disease patients die from? A multiple case coding analysis. Eur Respir J 2003; 22: 809–14.
13. Sin DD, Man SFP. Chronic obstructive pulmonary disease as a risk factor for cardiovascular morbidity and mortality. Proc Am Thorac Soc 2005; 2: 8–11.
14. Barnes PJ. Chronic obstructive pulmonary disease. N Engl J Med 2000; 343: 269–80.
15. Jessup M, Brozena S. Medical progress: heart failure. N Engl J Med 2003; 348: 2007–18.
16. Национальные рекомендации ОССН, РКО и РНМОТ по диагностике и лечению ХСН (четвертый пересмотр). Сердечная недостаточность. 2013; 81: 1–94. / Natsional'nye rekomendatsii OSSN, RKO i RNMOT po diagnostike i lecheniiu KhSN (chetvertyi peresmotr). Serdechnaia nedostatochnost'. 2013; 81: 1–94. [in Russian]
17. Кароли Н.А., Ребров А.П. Хроническая обструктивная болезнь легких и кардиоваскулярная патология. Клиницист. 2007; 1: 13–9. / Karoli N.A., Rebrov A.P. Khronicheskaia obstruktivnaia bolezn' legkikh i kardiovaskuliarnaia patologiia. Klinitsist. 2007; 1: 13–9. [in Russian]
18. Глобальная стратегия диагностики, лечения и профилактики хронической обструктивной болезни легких (пересмотр 2011 г.). Пер. с англ. под ред. А.С.Белевского. М.: Российское респираторное общество, 2012. / Global'naia strategiia diagnostiki, lecheniia i profilaktiki khronicheskoi obstruktivnoi bolezni legkikh (peresmotr 2011 g.). Per. s angl. pod red. A.S.Belevskogo. M.: Rossiiskoe respiratornoe obshchestvo, 2012. [in Russian]
19. Бова А.А., Лапицкий Д.В. Современные подходы к диагностике и лечению ишемической болезни сердца у больных хронической обструктивной болезнью легких. Мед. новости. 2007; 9: 7–14. / Bova A.A., Lapitskii D.V. Sovremennye podkhody k diagnostike i lecheniiu ishemicheskoi bolezni serdtsa u bol'nykh khronicheskoi obstruktivnoi bolezn'iu legkikh. Med. novosti. 2007; 9: 7–14. [in Russian]
20. Стрюк Р.И. Эффективность и безопасность фозиноприла в клинической практике. Consilium Medicum. 2015; 17 (1): 18–21. / Striuk R.I. Efficacy and safety in clinical practice fosinopril. http://con-med.ru/magazines/consilium_medicum/consilium_medicum-01-2015/effektivnost_i_bezopasnost_f... Consilium Medicum. 2015; 17 (1): 18–21. [in Russian]
21. Болотова Е.В., Дудникова А.В. Особенности факторов риска хронической болезни почек у пациентов с хронической обструктивной болезнью легких. Нефрология. 2015; 5: 28–33. / Bolotova E.V., Dudnikova A.V. Osobennosti faktorov riska khronicheskoi bolezni pochek u patsientov s khronicheskoi obstruktivnoi bolezn'iu legkikh. Nefrologiia. 2015; 5: 28–33. [in Russian]
22. Стаценко М.Е., Иванова Д.А., Спорова О.Е., Фабрицкая С.В. Особенности клиники, качества жизни и кардиоренальных взаимоотношений у пациентов с хронической сердечной недостаточностью и хронической обструктивной болезнью легких. Волгоградский науч.-мед. журн. 2012; 4 (36): 22–7. / Statsenko M.E., Ivanova D.A., Sporova O.E., Fabritskaia S.V. Osobennosti kliniki, kachestva zhizni i kardiorenal'nykh vzaimootnoshenii u patsientov s khronicheskoi serdechnoi nedostatochnost'iu i khronicheskoi obstruktivnoi bolezn'iu legkikh. Volgogradskii nauch.-med. zhurn. 2012; 4 (36): 22–7. [in Russian]
23. Shrikrishna D, Astin R, Kemp PR, Hopkinson NS. Renin-angiotensin system blockade: a novel therapeutic approach in chronic obstructive pulmonary disease. Clin Sci (Lond) 2012; 123 (8): 487–98.
24. Stockley RA. Progression of chronic obstructive pulmonary disease: impact of inflammation, comorbidities and therapeutic intervention. Curr Med Res Opin 2009; 25: 1235–45.
25. Marshall RP. The pulmonary renin-angiotensin system. Curr Pharm Des 2003; 9: 715–22.
26. Hanif K, Bid HK, Konwar R. Reinventing the ACE inhibitors: some old and new implications of ACE inhibition. Hypertens Res 2010; 33: 11–21.
27. Kaparianos A, Argyropoulou E. Local renin-angiotensin II systems, angiotensin-converting enzyme and its homologue ACE2: their potential role in the pathogenesis of chronic obstructive pulmonary diseases, pulmonary hypertension and acute respiratory distress syndrome. Curr Med Chem 2011; 18: 3506–15.
28. Wong MH, Chapin OC, Johnson MD. LPS-stimulated cytokine production in type I cells is modulated by the renin-angiotensin system. Am J Respir Cell Mol Biol 2011; 46: 641–50.
29. Bradford C, Ely D, Raizada M. Targeting the vasoprotective axis of the renin-angiotensin system: a novel strategic approach to pulmonary hypertensive therapy. Curr Hypertens Rep 2010; 12: 212–9.
30. Cuttica MJ, Kalhan R, Shlobin OA et al. Categorization and impact of pulmonary hypertension in patients with advanced COPD. Respir Med 2010; 104: 1877–82.
31. Ferreira AJ, Shenoy V, Yamazato Y et al. Evidence for angiotensin-converting enzyme 2 as a therapeutic target for the prevention of pulmonary hypertension. Am J Respir Crit Care Med 2009; 179: 1048–54.
32. Некрасов А.А., Кузнецов А.Н., Мельниченко О.В. Активация нейрогормональных систем как независимый механизм ремоделирования сердца у больных хронической обструктивной болезнью легких. Клин. медицина. 2014; 5: 50–4. / Nekrasov A.A., Kuznetsov A.N., Mel'nichenko O.V. Aktivatsiia neirogormonal'nykh sistem kak nezavisimyi mekhanizm remodelirovaniia serdtsa u bol'nykh khronicheskoi obstruktivnoi bolezn'iu legkikh. Klin. meditsina. 2014; 5: 50–4. [in Russian]
33. Busquets X., MacFarlane NG, Heine-Suner D et al. Angiotensin-converting-enzyme gene polymorphisms, smoking and chronic obstructive pulmonary disease. Int J Chronic Obstruct Pulm Dis 2007; 2: 329–34.
34. Brice EA, Friedlander W, Bateman ED, Kirsch RE. Serum angiotensin-converting enzyme activity, concentration, and specific activity in granulomatous interstitial lung disease, tuberculosis, and COPD. Chest 1995; 107: 706–10.
35. Ucar G, Yildirim Z, Ataol E et al. Serum angiotensin converting enzyme activity in pulmonary diseases: correlation with lung function parameters. Life Sci 1997; 61: 1075–82.
36. Kanazawa H, Okamoto T, Hirata K, Yoshikawa J. Deletion polymorphisms in the angiotensin converting enzyme gene are associated with pulmonary hypertension evoked by exercise challenge in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2000; 162: 1235–8.
37 Tkacova R, Joppa P. Angiotensin-converting enzyme genotype and C-reactive protein in patients with COPD. Eur Respir J 2007; 29: 816–7.
38. Mortensen EM, Copeland LA, Pugh MJV et al. Impact of statins and ACE inhibitors on mortality after COPD exacerbations. Respir Res 2009; 10: 45.
39. Mancini GB, Etminan M, Zhang B et al. Reduction of morbidity and mortality by statins, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers in patients with chronic obstructive pulmonary disease. J Am Coll Cardiol 2006; 47 (12): 2554–60.
40. Kanazawa H, Hirata K, Yoshikawa J. Effects of captopril administration on pulmonary haemodynamics and tissue oxygenation during exercise in ACE gene subtypes in patients with COPD: a preliminary study. Thorax 2003; 58: 629–31.
41. Mortensen EM, Copeland LA, Pugh MJ et al. Impact of statins and ACE inhibitors on mortality after COPD exacerbations. Respir Res 2009; 10: 45.
42. Попова М.А., Терентьева Н.Н. Сравнительная эффективность ингибиторов ангиотензин-превращающего фермента спираприла, фозиноприла и эналаприла в комплексной терапии больных с сочетанием ишемической болезни сердца, хронических обструктивных болезней легких и артериальной гипертензии. Кардиоваск. терапия и профилактика. 2006; 3: 32–8. / Popova M.A., Terent'eva N.N. Sravnitel'naia effektivnost' ingibitorov angiotenzin-prevrashchaiushchego fermenta spiraprila, fozinoprila i enalaprila v kompleksnoi terapii bol'nykh s sochetaniem ishemicheskoi bolezni serdtsa, khronicheskikh obstruktivnykh boleznei legkikh i arterial'noi gipertenzii. Kardiovask. terapiia i profilaktika. 2006; 3: 32–8. [in Russian]
43. Хохлов А.Л., Воронина Е.А., Мельникова Ю.Е. Возможности применения ингибитора ангиотензинпревращающего фермента фозиноприла в клинической практике (обзор литературы). Справ. поликлин. врача. 2014; 4: 35–9. / Khokhlov A.L., Voronina E.A., Mel'nikova Iu.E. Vozmozhnosti primeneniia ingibitora angiotenzinprevrashchaiushchego fermenta fozinoprila v klinicheskoi praktike (obzor literatury). Sprav. poliklin. vracha. 2014; 4: 35–9. [in Russian]
2. Lopez AD, Shibuya K, Rao C et al. Chronic obstructive pulmonary disease: current burden and future projections. Eur Respir J 2006; 27: 397–412.
3. Burt VL, Cutler JA, Higgins M et al. Trends in the Prevalence, Awareness, Treatment, and Control of Hypertension in the Adult US Population. Hypertension 1995; 26: 60–9.
4. Chandy D, Aronow WS, Banach M. Current perspectives on treatment of hypertensive patients with chronic obstructive pulmonary disease. Integr Blood Press Control 2013; 6: 101–9.
5. Karoli N.A., Rebrov A.P. Arterial'naia gipertenziia u patsientov s bronkhial'noi astmoi i khronicheskoi obstruktivnoi bolezn'iu legkikh. Klinitsist. 2011; 2: 20–30. [in Russian]
6. Ol'binskaia L.I., Belov A.A. Dinamika sutochnogo profilia arterial'nogo davleniia pri khronicheskikh obstruktivnykh zabolevaniiakh legkikh v sochetanii s arterial'noi gipertoniei na fone lecheniia enalaprilom. Ter. arkh. 2002; 3: 59–62. [in Russian]
7. Incalzi AR, Fuso L, De Rosa M et al. Co-morbidity contributes to predict mortality of patients with chronic obstructive pulmonary disease. Eur Respir J 1997; 10: 2794–800.
8. Anthonisen NR, Connet JE, Enright PL, Manfreda J. Hospitalizations and mortality in the Lung Health Study. Am J Respir Crit Care Med 2002; 166: 333–9.
9. Huiart L, Ernst P, Ranouli X, Suissa S. Low-dose inhaled corticosteroids and the risk of acute myocardial infarction in COPD. Eur Respir J 2005; 25: 634–9.
10. Karoli N.A., Rebrov A.P. Smertnost' pri khronicheskoi obstruktivnoi bolezni legkikh: rol' komorbidnosti. Klin. meditsina. 2008; 3: 18–21. [in Russian]
11. Almagro P, Calbo E, Echagilen AO et al. Mortality after hospitalization for COPD. Chest 2002; 121: 1441–8.
12. Hansell AL, Walk JA, Soriano JB. What do chronic obstructive pulmonary disease patients die from? A multiple case coding analysis. Eur Respir J 2003; 22: 809–14.
13. Sin DD, Man SFP. Chronic obstructive pulmonary disease as a risk factor for cardiovascular morbidity and mortality. Proc Am Thorac Soc 2005; 2: 8–11.
14. Barnes PJ. Chronic obstructive pulmonary disease. N Engl J Med 2000; 343: 269–80.
15. Jessup M, Brozena S. Medical progress: heart failure. N Engl J Med 2003; 348: 2007–18.
16. Natsional'nye rekomendatsii OSSN, RKO i RNMOT po diagnostike i lecheniiu KhSN (chetvertyi peresmotr). Serdechnaia nedostatochnost'. 2013; 81: 1–94. [in Russian]
17. Karoli N.A., Rebrov A.P. Khronicheskaia obstruktivnaia bolezn' legkikh i kardiovaskuliarnaia patologiia. Klinitsist. 2007; 1: 13–9. [in Russian]
18. Global'naia strategiia diagnostiki, lecheniia i profilaktiki khronicheskoi obstruktivnoi bolezni legkikh (peresmotr 2011 g.). Per. s angl. pod red. A.S.Belevskogo. M.: Rossiiskoe respiratornoe obshchestvo, 2012. [in Russian]
19. Bova A.A., Lapitskii D.V. Sovremennye podkhody k diagnostike i lecheniiu ishemicheskoi bolezni serdtsa u bol'nykh khronicheskoi obstruktivnoi bolezn'iu legkikh. Med. novosti. 2007; 9: 7–14. [in Russian]
20. Striuk R.I. Efficacy and safety in clinical practice fosinopril. http://con-med.ru/magazines/consilium_medicum/consilium_medicum-01-2015/effektivnost_i_bezopasnost_f... Consilium Medicum. 2015; 17 (1): 18–21. [in Russian]
21. Bolotova E.V., Dudnikova A.V. Osobennosti faktorov riska khronicheskoi bolezni pochek u patsientov s khronicheskoi obstruktivnoi bolezn'iu legkikh. Nefrologiia. 2015; 5: 28–33. [in Russian]
22. Statsenko M.E., Ivanova D.A., Sporova O.E., Fabritskaia S.V. Osobennosti kliniki, kachestva zhizni i kardiorenal'nykh vzaimootnoshenii u patsientov s khronicheskoi serdechnoi nedostatochnost'iu i khronicheskoi obstruktivnoi bolezn'iu legkikh. Volgogradskii nauch.-med. zhurn. 2012; 4 (36): 22–7. [in Russian]
23. Shrikrishna D, Astin R, Kemp PR, Hopkinson NS. Renin-angiotensin system blockade: a novel therapeutic approach in chronic obstructive pulmonary disease. Clin Sci (Lond) 2012; 123 (8): 487–98.
24. Stockley RA. Progression of chronic obstructive pulmonary disease: impact of inflammation, comorbidities and therapeutic intervention. Curr Med Res Opin 2009; 25: 1235–45.
25. Marshall RP. The pulmonary renin-angiotensin system. Curr Pharm Des 2003; 9: 715–22.
26. Hanif K, Bid HK, Konwar R. Reinventing the ACE inhibitors: some old and new implications of ACE inhibition. Hypertens Res 2010; 33: 11–21.
27. Kaparianos A, Argyropoulou E. Local renin-angiotensin II systems, angiotensin-converting enzyme and its homologue ACE2: their potential role in the pathogenesis of chronic obstructive pulmonary diseases, pulmonary hypertension and acute respiratory distress syndrome. Curr Med Chem 2011; 18: 3506–15.
28. Wong MH, Chapin OC, Johnson MD. LPS-stimulated cytokine production in type I cells is modulated by the renin-angiotensin system. Am J Respir Cell Mol Biol 2011; 46: 641–50.
29. Bradford C, Ely D, Raizada M. Targeting the vasoprotective axis of the renin-angiotensin system: a novel strategic approach to pulmonary hypertensive therapy. Curr Hypertens Rep 2010; 12: 212–9.
30. Cuttica MJ, Kalhan R, Shlobin OA et al. Categorization and impact of pulmonary hypertension in patients with advanced COPD. Respir Med 2010; 104: 1877–82.
31. Ferreira AJ, Shenoy V, Yamazato Y et al. Evidence for angiotensin-converting enzyme 2 as a therapeutic target for the prevention of pulmonary hypertension. Am J Respir Crit Care Med 2009; 179: 1048–54.
32. Nekrasov A.A., Kuznetsov A.N., Mel'nichenko O.V. Aktivatsiia neirogormonal'nykh sistem kak nezavisimyi mekhanizm remodelirovaniia serdtsa u bol'nykh khronicheskoi obstruktivnoi bolezn'iu legkikh. Klin. meditsina. 2014; 5: 50–4. [in Russian]
33. Busquets X., MacFarlane NG, Heine-Suner D et al. Angiotensin-converting-enzyme gene polymorphisms, smoking and chronic obstructive pulmonary disease. Int J Chronic Obstruct Pulm Dis 2007; 2: 329–34.
34. Brice EA, Friedlander W, Bateman ED, Kirsch RE. Serum angiotensin-converting enzyme activity, concentration, and specific activity in granulomatous interstitial lung disease, tuberculosis, and COPD. Chest 1995; 107: 706–10.
35. Ucar G, Yildirim Z, Ataol E et al. Serum angiotensin converting enzyme activity in pulmonary diseases: correlation with lung function parameters. Life Sci 1997; 61: 1075–82.
36. Kanazawa H, Okamoto T, Hirata K, Yoshikawa J. Deletion polymorphisms in the angiotensin converting enzyme gene are associated with pulmonary hypertension evoked by exercise challenge in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2000; 162: 1235–8.
37 Tkacova R, Joppa P. Angiotensin-converting enzyme genotype and C-reactive protein in patients with COPD. Eur Respir J 2007; 29: 816–7.
38. Mortensen EM, Copeland LA, Pugh MJV et al. Impact of statins and ACE inhibitors on mortality after COPD exacerbations. Respir Res 2009; 10: 45.
39. Mancini GB, Etminan M, Zhang B et al. Reduction of morbidity and mortality by statins, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers in patients with chronic obstructive pulmonary disease. J Am Coll Cardiol 2006; 47 (12): 2554–60.
40. Kanazawa H, Hirata K, Yoshikawa J. Effects of captopril administration on pulmonary haemodynamics and tissue oxygenation during exercise in ACE gene subtypes in patients with COPD: a preliminary study. Thorax 2003; 58: 629–31.
41. Mortensen EM, Copeland LA, Pugh MJ et al. Impact of statins and ACE inhibitors on mortality after COPD exacerbations. Respir Res 2009; 10: 45.
42. Popova M.A., Terent'eva N.N. Sravnitel'naia effektivnost' ingibitorov angiotenzin-prevrashchaiushchego fermenta spiraprila, fozinoprila i enalaprila v kompleksnoi terapii bol'nykh s sochetaniem ishemicheskoi bolezni serdtsa, khronicheskikh obstruktivnykh boleznei legkikh i arterial'noi gipertenzii. Kardiovask. terapiia i profilaktika. 2006; 3: 32–8. [in Russian]
43. Khokhlov A.L., Voronina E.A., Mel'nikova Iu.E. Vozmozhnosti primeneniia ingibitora angiotenzinprevrashchaiushchego fermenta fozinoprila v klinicheskoi praktike (obzor literatury). Sprav. poliklin. vracha. 2014; 4: 35–9. [in Russian]
2. Lopez AD, Shibuya K, Rao C et al. Chronic obstructive pulmonary disease: current burden and future projections. Eur Respir J 2006; 27: 397–412.
3. Burt VL, Cutler JA, Higgins M et al. Trends in the Prevalence, Awareness, Treatment, and Control of Hypertension in the Adult US Population. Hypertension 1995; 26: 60–9.
4. Chandy D, Aronow WS, Banach M. Current perspectives on treatment of hypertensive patients with chronic obstructive pulmonary disease. Integr Blood Press Control 2013; 6: 101–9.
5. Кароли Н.А., Ребров А.П. Артериальная гипертензия у пациентов с бронхиальной астмой и хронической обструктивной болезнью легких. Клиницист. 2011; 2: 20–30. / Karoli N.A., Rebrov A.P. Arterial'naia gipertenziia u patsientov s bronkhial'noi astmoi i khronicheskoi obstruktivnoi bolezn'iu legkikh. Klinitsist. 2011; 2: 20–30. [in Russian]
6. Ольбинская Л.И., Белов А.А. Динамика суточного профиля артериального давления при хронических обструктивных заболеваниях легких в сочетании с артериальной гипертонией на фоне лечения эналаприлом. Тер. арх. 2002; 3: 59–62. / Ol'binskaia L.I., Belov A.A. Dinamika sutochnogo profilia arterial'nogo davleniia pri khronicheskikh obstruktivnykh zabolevaniiakh legkikh v sochetanii s arterial'noi gipertoniei na fone lecheniia enalaprilom. Ter. arkh. 2002; 3: 59–62. [in Russian]
7. Incalzi AR, Fuso L, De Rosa M et al. Co-morbidity contributes to predict mortality of patients with chronic obstructive pulmonary disease. Eur Respir J 1997; 10: 2794–800.
8. Anthonisen NR, Connet JE, Enright PL, Manfreda J. Hospitalizations and mortality in the Lung Health Study. Am J Respir Crit Care Med 2002; 166: 333–9.
9. Huiart L, Ernst P, Ranouli X, Suissa S. Low-dose inhaled corticosteroids and the risk of acute myocardial infarction in COPD. Eur Respir J 2005; 25: 634–9.
10. Кароли Н.А., Ребров А.П. Смертность при хронической обструктивной болезни легких: роль коморбидности. Клин. медицина. 2008; 3: 18–21. / Karoli N.A., Rebrov A.P. Smertnost' pri khronicheskoi obstruktivnoi bolezni legkikh: rol' komorbidnosti. Klin. meditsina. 2008; 3: 18–21. [in Russian]
11. Almagro P, Calbo E, Echagilen AO et al. Mortality after hospitalization for COPD. Chest 2002; 121: 1441–8.
12. Hansell AL, Walk JA, Soriano JB. What do chronic obstructive pulmonary disease patients die from? A multiple case coding analysis. Eur Respir J 2003; 22: 809–14.
13. Sin DD, Man SFP. Chronic obstructive pulmonary disease as a risk factor for cardiovascular morbidity and mortality. Proc Am Thorac Soc 2005; 2: 8–11.
14. Barnes PJ. Chronic obstructive pulmonary disease. N Engl J Med 2000; 343: 269–80.
15. Jessup M, Brozena S. Medical progress: heart failure. N Engl J Med 2003; 348: 2007–18.
16. Национальные рекомендации ОССН, РКО и РНМОТ по диагностике и лечению ХСН (четвертый пересмотр). Сердечная недостаточность. 2013; 81: 1–94. / Natsional'nye rekomendatsii OSSN, RKO i RNMOT po diagnostike i lecheniiu KhSN (chetvertyi peresmotr). Serdechnaia nedostatochnost'. 2013; 81: 1–94. [in Russian]
17. Кароли Н.А., Ребров А.П. Хроническая обструктивная болезнь легких и кардиоваскулярная патология. Клиницист. 2007; 1: 13–9. / Karoli N.A., Rebrov A.P. Khronicheskaia obstruktivnaia bolezn' legkikh i kardiovaskuliarnaia patologiia. Klinitsist. 2007; 1: 13–9. [in Russian]
18. Глобальная стратегия диагностики, лечения и профилактики хронической обструктивной болезни легких (пересмотр 2011 г.). Пер. с англ. под ред. А.С.Белевского. М.: Российское респираторное общество, 2012. / Global'naia strategiia diagnostiki, lecheniia i profilaktiki khronicheskoi obstruktivnoi bolezni legkikh (peresmotr 2011 g.). Per. s angl. pod red. A.S.Belevskogo. M.: Rossiiskoe respiratornoe obshchestvo, 2012. [in Russian]
19. Бова А.А., Лапицкий Д.В. Современные подходы к диагностике и лечению ишемической болезни сердца у больных хронической обструктивной болезнью легких. Мед. новости. 2007; 9: 7–14. / Bova A.A., Lapitskii D.V. Sovremennye podkhody k diagnostike i lecheniiu ishemicheskoi bolezni serdtsa u bol'nykh khronicheskoi obstruktivnoi bolezn'iu legkikh. Med. novosti. 2007; 9: 7–14. [in Russian]
20. Стрюк Р.И. Эффективность и безопасность фозиноприла в клинической практике. Consilium Medicum. 2015; 17 (1): 18–21. / Striuk R.I. Efficacy and safety in clinical practice fosinopril. http://con-med.ru/magazines/consilium_medicum/consilium_medicum-01-2015/effektivnost_i_bezopasnost_f... Consilium Medicum. 2015; 17 (1): 18–21. [in Russian]
21. Болотова Е.В., Дудникова А.В. Особенности факторов риска хронической болезни почек у пациентов с хронической обструктивной болезнью легких. Нефрология. 2015; 5: 28–33. / Bolotova E.V., Dudnikova A.V. Osobennosti faktorov riska khronicheskoi bolezni pochek u patsientov s khronicheskoi obstruktivnoi bolezn'iu legkikh. Nefrologiia. 2015; 5: 28–33. [in Russian]
22. Стаценко М.Е., Иванова Д.А., Спорова О.Е., Фабрицкая С.В. Особенности клиники, качества жизни и кардиоренальных взаимоотношений у пациентов с хронической сердечной недостаточностью и хронической обструктивной болезнью легких. Волгоградский науч.-мед. журн. 2012; 4 (36): 22–7. / Statsenko M.E., Ivanova D.A., Sporova O.E., Fabritskaia S.V. Osobennosti kliniki, kachestva zhizni i kardiorenal'nykh vzaimootnoshenii u patsientov s khronicheskoi serdechnoi nedostatochnost'iu i khronicheskoi obstruktivnoi bolezn'iu legkikh. Volgogradskii nauch.-med. zhurn. 2012; 4 (36): 22–7. [in Russian]
23. Shrikrishna D, Astin R, Kemp PR, Hopkinson NS. Renin-angiotensin system blockade: a novel therapeutic approach in chronic obstructive pulmonary disease. Clin Sci (Lond) 2012; 123 (8): 487–98.
24. Stockley RA. Progression of chronic obstructive pulmonary disease: impact of inflammation, comorbidities and therapeutic intervention. Curr Med Res Opin 2009; 25: 1235–45.
25. Marshall RP. The pulmonary renin-angiotensin system. Curr Pharm Des 2003; 9: 715–22.
26. Hanif K, Bid HK, Konwar R. Reinventing the ACE inhibitors: some old and new implications of ACE inhibition. Hypertens Res 2010; 33: 11–21.
27. Kaparianos A, Argyropoulou E. Local renin-angiotensin II systems, angiotensin-converting enzyme and its homologue ACE2: their potential role in the pathogenesis of chronic obstructive pulmonary diseases, pulmonary hypertension and acute respiratory distress syndrome. Curr Med Chem 2011; 18: 3506–15.
28. Wong MH, Chapin OC, Johnson MD. LPS-stimulated cytokine production in type I cells is modulated by the renin-angiotensin system. Am J Respir Cell Mol Biol 2011; 46: 641–50.
29. Bradford C, Ely D, Raizada M. Targeting the vasoprotective axis of the renin-angiotensin system: a novel strategic approach to pulmonary hypertensive therapy. Curr Hypertens Rep 2010; 12: 212–9.
30. Cuttica MJ, Kalhan R, Shlobin OA et al. Categorization and impact of pulmonary hypertension in patients with advanced COPD. Respir Med 2010; 104: 1877–82.
31. Ferreira AJ, Shenoy V, Yamazato Y et al. Evidence for angiotensin-converting enzyme 2 as a therapeutic target for the prevention of pulmonary hypertension. Am J Respir Crit Care Med 2009; 179: 1048–54.
32. Некрасов А.А., Кузнецов А.Н., Мельниченко О.В. Активация нейрогормональных систем как независимый механизм ремоделирования сердца у больных хронической обструктивной болезнью легких. Клин. медицина. 2014; 5: 50–4. / Nekrasov A.A., Kuznetsov A.N., Mel'nichenko O.V. Aktivatsiia neirogormonal'nykh sistem kak nezavisimyi mekhanizm remodelirovaniia serdtsa u bol'nykh khronicheskoi obstruktivnoi bolezn'iu legkikh. Klin. meditsina. 2014; 5: 50–4. [in Russian]
33. Busquets X., MacFarlane NG, Heine-Suner D et al. Angiotensin-converting-enzyme gene polymorphisms, smoking and chronic obstructive pulmonary disease. Int J Chronic Obstruct Pulm Dis 2007; 2: 329–34.
34. Brice EA, Friedlander W, Bateman ED, Kirsch RE. Serum angiotensin-converting enzyme activity, concentration, and specific activity in granulomatous interstitial lung disease, tuberculosis, and COPD. Chest 1995; 107: 706–10.
35. Ucar G, Yildirim Z, Ataol E et al. Serum angiotensin converting enzyme activity in pulmonary diseases: correlation with lung function parameters. Life Sci 1997; 61: 1075–82.
36. Kanazawa H, Okamoto T, Hirata K, Yoshikawa J. Deletion polymorphisms in the angiotensin converting enzyme gene are associated with pulmonary hypertension evoked by exercise challenge in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2000; 162: 1235–8.
37 Tkacova R, Joppa P. Angiotensin-converting enzyme genotype and C-reactive protein in patients with COPD. Eur Respir J 2007; 29: 816–7.
38. Mortensen EM, Copeland LA, Pugh MJV et al. Impact of statins and ACE inhibitors on mortality after COPD exacerbations. Respir Res 2009; 10: 45.
39. Mancini GB, Etminan M, Zhang B et al. Reduction of morbidity and mortality by statins, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers in patients with chronic obstructive pulmonary disease. J Am Coll Cardiol 2006; 47 (12): 2554–60.
40. Kanazawa H, Hirata K, Yoshikawa J. Effects of captopril administration on pulmonary haemodynamics and tissue oxygenation during exercise in ACE gene subtypes in patients with COPD: a preliminary study. Thorax 2003; 58: 629–31.
41. Mortensen EM, Copeland LA, Pugh MJ et al. Impact of statins and ACE inhibitors on mortality after COPD exacerbations. Respir Res 2009; 10: 45.
42. Попова М.А., Терентьева Н.Н. Сравнительная эффективность ингибиторов ангиотензин-превращающего фермента спираприла, фозиноприла и эналаприла в комплексной терапии больных с сочетанием ишемической болезни сердца, хронических обструктивных болезней легких и артериальной гипертензии. Кардиоваск. терапия и профилактика. 2006; 3: 32–8. / Popova M.A., Terent'eva N.N. Sravnitel'naia effektivnost' ingibitorov angiotenzin-prevrashchaiushchego fermenta spiraprila, fozinoprila i enalaprila v kompleksnoi terapii bol'nykh s sochetaniem ishemicheskoi bolezni serdtsa, khronicheskikh obstruktivnykh boleznei legkikh i arterial'noi gipertenzii. Kardiovask. terapiia i profilaktika. 2006; 3: 32–8. [in Russian]
43. Хохлов А.Л., Воронина Е.А., Мельникова Ю.Е. Возможности применения ингибитора ангиотензинпревращающего фермента фозиноприла в клинической практике (обзор литературы). Справ. поликлин. врача. 2014; 4: 35–9. / Khokhlov A.L., Voronina E.A., Mel'nikova Iu.E. Vozmozhnosti primeneniia ingibitora angiotenzinprevrashchaiushchego fermenta fozinoprila v klinicheskoi praktike (obzor literatury). Sprav. poliklin. vracha. 2014; 4: 35–9. [in Russian]
________________________________________________
2. Lopez AD, Shibuya K, Rao C et al. Chronic obstructive pulmonary disease: current burden and future projections. Eur Respir J 2006; 27: 397–412.
3. Burt VL, Cutler JA, Higgins M et al. Trends in the Prevalence, Awareness, Treatment, and Control of Hypertension in the Adult US Population. Hypertension 1995; 26: 60–9.
4. Chandy D, Aronow WS, Banach M. Current perspectives on treatment of hypertensive patients with chronic obstructive pulmonary disease. Integr Blood Press Control 2013; 6: 101–9.
5. Karoli N.A., Rebrov A.P. Arterial'naia gipertenziia u patsientov s bronkhial'noi astmoi i khronicheskoi obstruktivnoi bolezn'iu legkikh. Klinitsist. 2011; 2: 20–30. [in Russian]
6. Ol'binskaia L.I., Belov A.A. Dinamika sutochnogo profilia arterial'nogo davleniia pri khronicheskikh obstruktivnykh zabolevaniiakh legkikh v sochetanii s arterial'noi gipertoniei na fone lecheniia enalaprilom. Ter. arkh. 2002; 3: 59–62. [in Russian]
7. Incalzi AR, Fuso L, De Rosa M et al. Co-morbidity contributes to predict mortality of patients with chronic obstructive pulmonary disease. Eur Respir J 1997; 10: 2794–800.
8. Anthonisen NR, Connet JE, Enright PL, Manfreda J. Hospitalizations and mortality in the Lung Health Study. Am J Respir Crit Care Med 2002; 166: 333–9.
9. Huiart L, Ernst P, Ranouli X, Suissa S. Low-dose inhaled corticosteroids and the risk of acute myocardial infarction in COPD. Eur Respir J 2005; 25: 634–9.
10. Karoli N.A., Rebrov A.P. Smertnost' pri khronicheskoi obstruktivnoi bolezni legkikh: rol' komorbidnosti. Klin. meditsina. 2008; 3: 18–21. [in Russian]
11. Almagro P, Calbo E, Echagilen AO et al. Mortality after hospitalization for COPD. Chest 2002; 121: 1441–8.
12. Hansell AL, Walk JA, Soriano JB. What do chronic obstructive pulmonary disease patients die from? A multiple case coding analysis. Eur Respir J 2003; 22: 809–14.
13. Sin DD, Man SFP. Chronic obstructive pulmonary disease as a risk factor for cardiovascular morbidity and mortality. Proc Am Thorac Soc 2005; 2: 8–11.
14. Barnes PJ. Chronic obstructive pulmonary disease. N Engl J Med 2000; 343: 269–80.
15. Jessup M, Brozena S. Medical progress: heart failure. N Engl J Med 2003; 348: 2007–18.
16. Natsional'nye rekomendatsii OSSN, RKO i RNMOT po diagnostike i lecheniiu KhSN (chetvertyi peresmotr). Serdechnaia nedostatochnost'. 2013; 81: 1–94. [in Russian]
17. Karoli N.A., Rebrov A.P. Khronicheskaia obstruktivnaia bolezn' legkikh i kardiovaskuliarnaia patologiia. Klinitsist. 2007; 1: 13–9. [in Russian]
18. Global'naia strategiia diagnostiki, lecheniia i profilaktiki khronicheskoi obstruktivnoi bolezni legkikh (peresmotr 2011 g.). Per. s angl. pod red. A.S.Belevskogo. M.: Rossiiskoe respiratornoe obshchestvo, 2012. [in Russian]
19. Bova A.A., Lapitskii D.V. Sovremennye podkhody k diagnostike i lecheniiu ishemicheskoi bolezni serdtsa u bol'nykh khronicheskoi obstruktivnoi bolezn'iu legkikh. Med. novosti. 2007; 9: 7–14. [in Russian]
20. Striuk R.I. Efficacy and safety in clinical practice fosinopril. http://con-med.ru/magazines/consilium_medicum/consilium_medicum-01-2015/effektivnost_i_bezopasnost_f... Consilium Medicum. 2015; 17 (1): 18–21. [in Russian]
21. Bolotova E.V., Dudnikova A.V. Osobennosti faktorov riska khronicheskoi bolezni pochek u patsientov s khronicheskoi obstruktivnoi bolezn'iu legkikh. Nefrologiia. 2015; 5: 28–33. [in Russian]
22. Statsenko M.E., Ivanova D.A., Sporova O.E., Fabritskaia S.V. Osobennosti kliniki, kachestva zhizni i kardiorenal'nykh vzaimootnoshenii u patsientov s khronicheskoi serdechnoi nedostatochnost'iu i khronicheskoi obstruktivnoi bolezn'iu legkikh. Volgogradskii nauch.-med. zhurn. 2012; 4 (36): 22–7. [in Russian]
23. Shrikrishna D, Astin R, Kemp PR, Hopkinson NS. Renin-angiotensin system blockade: a novel therapeutic approach in chronic obstructive pulmonary disease. Clin Sci (Lond) 2012; 123 (8): 487–98.
24. Stockley RA. Progression of chronic obstructive pulmonary disease: impact of inflammation, comorbidities and therapeutic intervention. Curr Med Res Opin 2009; 25: 1235–45.
25. Marshall RP. The pulmonary renin-angiotensin system. Curr Pharm Des 2003; 9: 715–22.
26. Hanif K, Bid HK, Konwar R. Reinventing the ACE inhibitors: some old and new implications of ACE inhibition. Hypertens Res 2010; 33: 11–21.
27. Kaparianos A, Argyropoulou E. Local renin-angiotensin II systems, angiotensin-converting enzyme and its homologue ACE2: their potential role in the pathogenesis of chronic obstructive pulmonary diseases, pulmonary hypertension and acute respiratory distress syndrome. Curr Med Chem 2011; 18: 3506–15.
28. Wong MH, Chapin OC, Johnson MD. LPS-stimulated cytokine production in type I cells is modulated by the renin-angiotensin system. Am J Respir Cell Mol Biol 2011; 46: 641–50.
29. Bradford C, Ely D, Raizada M. Targeting the vasoprotective axis of the renin-angiotensin system: a novel strategic approach to pulmonary hypertensive therapy. Curr Hypertens Rep 2010; 12: 212–9.
30. Cuttica MJ, Kalhan R, Shlobin OA et al. Categorization and impact of pulmonary hypertension in patients with advanced COPD. Respir Med 2010; 104: 1877–82.
31. Ferreira AJ, Shenoy V, Yamazato Y et al. Evidence for angiotensin-converting enzyme 2 as a therapeutic target for the prevention of pulmonary hypertension. Am J Respir Crit Care Med 2009; 179: 1048–54.
32. Nekrasov A.A., Kuznetsov A.N., Mel'nichenko O.V. Aktivatsiia neirogormonal'nykh sistem kak nezavisimyi mekhanizm remodelirovaniia serdtsa u bol'nykh khronicheskoi obstruktivnoi bolezn'iu legkikh. Klin. meditsina. 2014; 5: 50–4. [in Russian]
33. Busquets X., MacFarlane NG, Heine-Suner D et al. Angiotensin-converting-enzyme gene polymorphisms, smoking and chronic obstructive pulmonary disease. Int J Chronic Obstruct Pulm Dis 2007; 2: 329–34.
34. Brice EA, Friedlander W, Bateman ED, Kirsch RE. Serum angiotensin-converting enzyme activity, concentration, and specific activity in granulomatous interstitial lung disease, tuberculosis, and COPD. Chest 1995; 107: 706–10.
35. Ucar G, Yildirim Z, Ataol E et al. Serum angiotensin converting enzyme activity in pulmonary diseases: correlation with lung function parameters. Life Sci 1997; 61: 1075–82.
36. Kanazawa H, Okamoto T, Hirata K, Yoshikawa J. Deletion polymorphisms in the angiotensin converting enzyme gene are associated with pulmonary hypertension evoked by exercise challenge in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2000; 162: 1235–8.
37 Tkacova R, Joppa P. Angiotensin-converting enzyme genotype and C-reactive protein in patients with COPD. Eur Respir J 2007; 29: 816–7.
38. Mortensen EM, Copeland LA, Pugh MJV et al. Impact of statins and ACE inhibitors on mortality after COPD exacerbations. Respir Res 2009; 10: 45.
39. Mancini GB, Etminan M, Zhang B et al. Reduction of morbidity and mortality by statins, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers in patients with chronic obstructive pulmonary disease. J Am Coll Cardiol 2006; 47 (12): 2554–60.
40. Kanazawa H, Hirata K, Yoshikawa J. Effects of captopril administration on pulmonary haemodynamics and tissue oxygenation during exercise in ACE gene subtypes in patients with COPD: a preliminary study. Thorax 2003; 58: 629–31.
41. Mortensen EM, Copeland LA, Pugh MJ et al. Impact of statins and ACE inhibitors on mortality after COPD exacerbations. Respir Res 2009; 10: 45.
42. Popova M.A., Terent'eva N.N. Sravnitel'naia effektivnost' ingibitorov angiotenzin-prevrashchaiushchego fermenta spiraprila, fozinoprila i enalaprila v kompleksnoi terapii bol'nykh s sochetaniem ishemicheskoi bolezni serdtsa, khronicheskikh obstruktivnykh boleznei legkikh i arterial'noi gipertenzii. Kardiovask. terapiia i profilaktika. 2006; 3: 32–8. [in Russian]
43. Khokhlov A.L., Voronina E.A., Mel'nikova Iu.E. Vozmozhnosti primeneniia ingibitora angiotenzinprevrashchaiushchego fermenta fozinoprila v klinicheskoi praktike (obzor literatury). Sprav. poliklin. vracha. 2014; 4: 35–9. [in Russian]
Авторы
Н.А.Кароли, А.П.Ребров*
ГБОУ ВПО Саратовский государственный медицинский университет им. В.И.Разумовского Минздрава России. 410012, Россия, Саратов, ул. Большая Казачья, д. 112
*andreyrebrov@yandex.ru
V.I.Razumovskii Saratov State Medical University of the Ministry of Health of the Russian Federation. 410012, Russian Federation, Saratov, ul. Bol'shaia Kazach'ia, d. 112
*andreyrebrov@yandex.ru
ГБОУ ВПО Саратовский государственный медицинский университет им. В.И.Разумовского Минздрава России. 410012, Россия, Саратов, ул. Большая Казачья, д. 112
*andreyrebrov@yandex.ru
________________________________________________
V.I.Razumovskii Saratov State Medical University of the Ministry of Health of the Russian Federation. 410012, Russian Federation, Saratov, ul. Bol'shaia Kazach'ia, d. 112
*andreyrebrov@yandex.ru
Цель портала OmniDoctor – предоставление профессиональной информации врачам, провизорам и фармацевтам.