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С-реактивный белок в диагностике внебольничной пневмонии
Ершов А.В. С-реактивный белок в диагностике внебольничной пневмонии. Consilium Medicum. 2019; 21 (3): 15–19. DOI: 10.26442/20751753.2019.3.190259
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Ershov A.V. С-reactive protein in the diagnostics of communicative pneumonia. Consilium Medicum. 2019; 21 (3): 15–19. DOI: 10.26442/20751753.2019.3.190259
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Аннотация
В статье приводится анализ актуальной информации о диагностической ценности С-реактивного белка (СРБ) в терапии и пульмонологии в разрезе дифференциального поиска патологии органов дыхательной системы, а также нозологических форм, имеющих общие элементы клинической симптоматики, характерной для внебольничной пневмонии (ВБП). Отражены история открытия, основные эффекты, биологическое значение и особенности лабораторной диагностики содержания СРБ в крови. Критически раскрыты результаты исследований по использованию концентрации СРБ в качестве биологического маркера возникновения ВБП, ее осложнений и тяжести течения, а также адекватности выбранной антибактериальной терапии.
Ключевые слова: внебольничная пневмония, С-реактивный белок, лабораторная диагностика.
Ключевые слова: внебольничная пневмония, С-реактивный белок, лабораторная диагностика.
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The article provides an analysis of current information about the diagnostic value of the C-reactive protein in therapy and pulmonology in the context of the differential search for pathology of the respiratory system organs, as well as nosological forms that have common elements of clinical symptoms characteristic of community-acquired pneumonia. The history of discovery, main effects, biological significance and features of laboratory diagnosis of C-reactive protein content in blood are reflected. The results of studies on the use of C-reactive protein concentration as a biological marker of the occurrence of community-acquired pneumonia, its complications and severity, as well as the adequacy of the selected antibacterial therapy are critically disclosed.
Key words: community-acquired pneumonia, C-reactive protein, laboratory diagnostics.
Key words: community-acquired pneumonia, C-reactive protein, laboratory diagnostics.
Полный текст
Список литературы
1. Титова О.Н., Кузубова Н.А., Лебедева Е.С. Биомаркеры прогноза тяжести течения и исхода внебольничной пневмонии. Мед. альянс. 2018; 2: 55–60.
[Titova O.N., Kuzubova N.A., Lebedeva E.S. Biomarkery prognoza tiazhesti techeniia i iskhoda vnebol'nichnoi pnevmonii. Med. al'ians. 2018; 2: 55–60 (in Russian).]
2. Бородулин Б.Е., Черногаева Г.Ю., Бородулина Е.А. и др. Летальность от внебольничной пневмонии в условиях многопрофильной больницы за 10 лет. Мед. альманах. 2012; 2 (21): 34–6.
[Borodulin B.E., Chernogaeva G.Iu., Borodulina E.A. et al. Letal'nost' ot vnebol'nichnoi pnevmonii v usloviiakh mnogoprofil'noi bol'nitsy za 10 let. Med. al'manakh. 2012; 2 (21): 34–6 (in Russian).]
3. Бородулина Е.А., Бородулин Б.Е., Поваляева Л.В. и др. Предикторы летальности от внебольничной пневмонии в современных условиях работы пульмонологического центра. Вестн. современ. клин. медицины. 2015; 8 (4): 19–22.
[Borodulina E.A., Borodulin B.E., Povaliaeva L.V. et al. Prediktory letal'nosti ot vnebol'nichnoi pnevmonii v sovremennykh usloviiakh raboty pul'monologicheskogo tsentra. Vestn. sovremen. klin. meditsiny. 2015; 8 (4): 19–22 (in Russian).]
4. Чучалин А.Г., Синопальников А.И., Козлов Р.С. и др. Внебольничная пневмония у взрослых: практические рекомендации по диагностике, лечению и профилактике. М.: МАКМАХ, 2010.
[Chuchalin A.G., Sinopal'nikov A.I., Kozlov R.S. et al. Vnebol'nichnaia pnevmoniia u vzroslykh: prakticheskie rekomendatsii po diagnostike, lecheniiu i profilaktike. Moscow: MAKMAKh, 2010 (in Russian).]
5. Muller B, Harbarth S, Stolz D et al. Diagnostic and prognostic accuracy of clinical and laboratory parameters in community-acquired pneumonia. BMC Infect Dis 2007; 7: 10.
6. Watkins RR, Lemonovich TL. Diagnosis and management of community-acquired pneumonia in adult. Am Fam Physician 2011; 83 (11): 1299–306.
7. Woodhead M et al. ERS/ESCMID Joint Task Force. Clin Microbiol Infect 2011; 17 (6): 1.
8. Бобылев А.А., Рачина С.А., Авдеев С.Н., Дехнич Н.Н. Клиническое значение определения С-реактивного белка в диагностике внебольничной пневмонии. Клин. фармакология и терапия. 2016; 25 (2): 32–42.
[Bobylev A.A., Rachina S.A., Avdeev S.N., Dekhnich N.N. Klinicheskoe znachenie opredeleniia S-reaktivnogo belka v diagnostike vnebol'nichnoi pnevmonii. Klin. farmakologiia i terapiia. 2016; 25 (2): 32–42 (in Russian).]
9. Бобылев А.А., Рачина С.А., Авдеев С.Н., Младов В.В. Перспективы применения биомаркеров для диагностики внебольничной пневмонии на фоне хронической сердечной недостаточности. Клин. фармакология и терапия. 2018; 27 (3): 16–25.
[Bobylev A.A., Rachina S.A., Avdeev S.N., Mladov V.V. Perspektivy primeneniia biomarkerov dlia diagnostiki vnebol'nichnoi pnevmonii na fone khronicheskoi serdechnoi nedostatochnosti. Klin. farmakologiia i terapiia. 2018; 27 (3): 16–25 (in Russian).]
10. Tillet W, Francis T. Serological reaction in pneumonia with a non-protein somatic fraction of Pneumococcus. J Exp Med 1930; 52: 561–71.
11. Ghose T. Oswald Avery: the professor, DNA, and the Nobel Prize that eluded him. Can Bull Med Hist 2004; 21 (1): 135–44.
12. Bottazzi B, Doni A, Garlanda C, Mantovani A. An integrated view of humoral innate immunity: pentraxins as a paradigm. Ann Rev Immunol 2010; 28: 157–83.
13. MacLeod CM, Avery OT. The occurrence during acute infections of a protein not normally present in the blood: II. Isolation and properties of the reactive protein. J Exp Med 1941; 73 (2): 183–90.
14. Singh PP, Voleti B, Agrawal A. A novel RBP-J kappa-dependent switch from C/EBP beta to C/EBP zeta at the C/EBP binding site on the C-reactive protein promoter. J Immunol 2007; 178 (11): 7302–9.
15. Thompson D, Pepys MB, Wood SP. The physiological structure of human Creactive protein and its complex with phosphocholine. Structure 1999; 7 (2): 169–77.
16. Рыдловская А.В., Симбирцев А.С. Функциональный полиморфизм гена TNF-a и патология. Цитокины и воспаление. 2005; 4 (3): 4–10.
[Rydlovskaia A.V., Simbirtsev A.S. Funktsional'nyi polimorfizm gena TNF-a i patologiia. Tsitokiny i vospalenie. 2005; 4 (3): 4–10 (in Russian).]
17. Shaddock E.J. How and when to use common biomarkers in community-acquired pneumonia. Pneumonia (Nathan) 2016; 8: 17.
18. Young B, Greeson M, Gripps AW et al. C-reactive protein: a critical review. Pathology 1991; 23: 118–24.
19. Зайцев А.А., Кондратьева Т.В., Маджанова Е.Р. Диагностические и прогностические возможности количественного определения С-реактивного белка при внебольничной пневмонии. Воен.-мед. журн. 2013; 11: 35–40.
[Zaitsev A.A., Kondrat'eva T.V., Madzhanova E.R. Diagnosticheskie i prognosticheskie vozmozhnosti kolichestvennogo opredeleniia S-reaktivnogo belka pri vnebol'nichnoi pnevmonii. Voen.-med. zhurn. 2013; 11: 35–40 (in Russian).]
20. Pepys MB, Hirschfield GM. C-reactive protein: a critical update. J Clin Invest 2003; 111: 1805–12.
21. Yuste J et al. Serum amyloid P aids complement-mediated immunity to Streptococcus pneumonia. PLoS Pathog 2007; 3 (9): 1208–19.
22. Brown JS et al. The classical pathway is the dominant complement pathway required for innate immunity to Streptococcus pneumoniae infection in mice. Proc Natl Acad Sci U S A 2002; 99 (26): 16969–74.
23. Kerr AR et al. Innate immune defense against pneumococcal pneumonia requires pulmonary complement component C3. Infect Immun 2005; 73 (7): 4245–52.
24. Li YP, Mold C, Du Clos TW. Sublytic complement attack exposes C-reactive protein binding sites on cell membranes. J Immunol 1994; 152 (6): 2995–3005.
25. Bauer S, Lamy O. Role of C-reactive protein in the diagnosis, prognosis and follow-up of community-acquired pneumonia. Rev Med Suisse 2010; 6 (269): 2068–70.
26. Van der Meer V, Neven A, Van den Broek P, Assendelft W. Diagnostic value of C reactive protein in infections of the lower respiratory tract: systematic review. BMJ 2005; 331 (7507): 26.
27. Flanders SA, Stein J, Shochat G et al. Performance of a bedside C-reactive protein test in the diagnosis of community-acquired pneumonia in adults with acute cough. Am J Med 2004; 116: 529–35.
28. Kang YA, Kwon SY, Yoon HI et al. Role of C-reactive protein and procalcitonin in differentiation of tuberculosis from bacterial community acquired pneumonia. Korean J Intern Med 2009; 24 (4): 337–42.
29. Steurer J, Held U, Spaar A et al. A decision aid to rule out pneumonia and reduce unnecessary prescriptions of antibiotics inprimary care patients with cough and fever. BMC Med 2011; 9: 56.
30. Almirall J, Bolipar I, Vidal J et al. Contribution of C-reactive protein to the diagnosis and assessment of severity of community-acquired pneumonia. Chest 2004; 125: 1335–42.
31. Bafadhel M, Clark TW, Reid C et al. Procalcitonin and C-reactive protein in hospitalized adult patients with communityacquired pneumonia or exacerbation of asthma or COPD. Chest 2011; 139 (6): 1410–8.
32. Авдеев С.Н., Баймаканова Г.Е., Зубаирова П.А. Возможности С-реактивного белка в диагностике бактериальной инфекции и пневмонии у больных с обострением хронической обструктивной болезни легких. Уральский мед. журн. 2008; 13: 19–24.
[Avdeev S.N., Baimakanova G.E., Zubairova P.A. Vozmozhnosti S-reaktivnogo belka v diagnostike bakterial'noi infektsii i pnevmonii u bol'nykh s obostreniem khronicheskoi obstruktivnoi bolezni legkikh. Ural'skii med. zhurn. 2008; 13: 19–24 (in Russian).]
33. Garcia Vazquez E, Martines JA, Menza J et al. C-reactive protein levels in community-acquired pneumonia. Eur Respir J 2003; 21: 702–5.
34. Hohenthal U, Hurme S, Helenius H et al. Utility of C-reactive protein in assessing the disease severity and complications of community-acquired pneumonia. Clin Microbiol Infect 2009; 15 (11): 1026–32.
35. Chalmers JD, Singanayagam A, Scally C et al. Risk Factors for complicated parapneumonic effusion and empyema on presentation to hospital with community-acquired pneumonia. Thorax 2009; 64: 592-597.
36. Menendez R, Martinez R, Reyes S et al. Stability in community-acquired pneumonia: one step forward with markers? Thorax 2009; 64: 987–92.
37. Smith RP. C-reactive protein in simple community-acquired pneumonia. Chest 1995; 107: 1028–31.
38. Bruns AH, Oosterheert JJ, Hak E, Hoepelman AI. Usefulness of consecutive C-reactive protein measurements in follow-up of severe community-acquired pneumonia. Eur Respir J 2008; 32: 726–32.
39. Seligman R, Ramos-Lima LF, Oliveira VA et al. Biomarkers in community-acquired pneumonia: A state-of-the-art review. Clinics 2012; 67 (11): 1321–5.
40. Castro-Guardiola A, Armengou-Arxe A, Viedjo-Rodriguez A et al. Differential diagnosis between community-acquired pneumonia and non-pneumonia diseases of the chest in the emergency ward. Eur J Intern Med 2000; 11: 334–9.
41. Вахитов Х.М., Пикуза О.И., Вахитова Л.Ф. и др. Значение определения С-реактивного белка для дифференциальной диагностики бронхита и пневмонии у детей. Практ. медицина. 2012; 7 (63): 23.
[Vakhitov Kh.M., Pikuza O.I., Vakhitova L.F. et al. Znachenie opredeleniia S-reaktivnogo belka dlia differentsial'noi diagnostiki bronkhita i pnevmonii u detei. Prakt. meditsina. 2012; 7 (63): 23 (in Russian).]
[Titova O.N., Kuzubova N.A., Lebedeva E.S. Biomarkery prognoza tiazhesti techeniia i iskhoda vnebol'nichnoi pnevmonii. Med. al'ians. 2018; 2: 55–60 (in Russian).]
2. Бородулин Б.Е., Черногаева Г.Ю., Бородулина Е.А. и др. Летальность от внебольничной пневмонии в условиях многопрофильной больницы за 10 лет. Мед. альманах. 2012; 2 (21): 34–6.
[Borodulin B.E., Chernogaeva G.Iu., Borodulina E.A. et al. Letal'nost' ot vnebol'nichnoi pnevmonii v usloviiakh mnogoprofil'noi bol'nitsy za 10 let. Med. al'manakh. 2012; 2 (21): 34–6 (in Russian).]
3. Бородулина Е.А., Бородулин Б.Е., Поваляева Л.В. и др. Предикторы летальности от внебольничной пневмонии в современных условиях работы пульмонологического центра. Вестн. современ. клин. медицины. 2015; 8 (4): 19–22.
[Borodulina E.A., Borodulin B.E., Povaliaeva L.V. et al. Prediktory letal'nosti ot vnebol'nichnoi pnevmonii v sovremennykh usloviiakh raboty pul'monologicheskogo tsentra. Vestn. sovremen. klin. meditsiny. 2015; 8 (4): 19–22 (in Russian).]
4. Чучалин А.Г., Синопальников А.И., Козлов Р.С. и др. Внебольничная пневмония у взрослых: практические рекомендации по диагностике, лечению и профилактике. М.: МАКМАХ, 2010.
[Chuchalin A.G., Sinopal'nikov A.I., Kozlov R.S. et al. Vnebol'nichnaia pnevmoniia u vzroslykh: prakticheskie rekomendatsii po diagnostike, lecheniiu i profilaktike. Moscow: MAKMAKh, 2010 (in Russian).]
5. Muller B, Harbarth S, Stolz D et al. Diagnostic and prognostic accuracy of clinical and laboratory parameters in community-acquired pneumonia. BMC Infect Dis 2007; 7: 10.
6. Watkins RR, Lemonovich TL. Diagnosis and management of community-acquired pneumonia in adult. Am Fam Physician 2011; 83 (11): 1299–306.
7. Woodhead M et al. ERS/ESCMID Joint Task Force. Clin Microbiol Infect 2011; 17 (6): 1.
8. Бобылев А.А., Рачина С.А., Авдеев С.Н., Дехнич Н.Н. Клиническое значение определения С-реактивного белка в диагностике внебольничной пневмонии. Клин. фармакология и терапия. 2016; 25 (2): 32–42.
[Bobylev A.A., Rachina S.A., Avdeev S.N., Dekhnich N.N. Klinicheskoe znachenie opredeleniia S-reaktivnogo belka v diagnostike vnebol'nichnoi pnevmonii. Klin. farmakologiia i terapiia. 2016; 25 (2): 32–42 (in Russian).]
9. Бобылев А.А., Рачина С.А., Авдеев С.Н., Младов В.В. Перспективы применения биомаркеров для диагностики внебольничной пневмонии на фоне хронической сердечной недостаточности. Клин. фармакология и терапия. 2018; 27 (3): 16–25.
[Bobylev A.A., Rachina S.A., Avdeev S.N., Mladov V.V. Perspektivy primeneniia biomarkerov dlia diagnostiki vnebol'nichnoi pnevmonii na fone khronicheskoi serdechnoi nedostatochnosti. Klin. farmakologiia i terapiia. 2018; 27 (3): 16–25 (in Russian).]
10. Tillet W, Francis T. Serological reaction in pneumonia with a non-protein somatic fraction of Pneumococcus. J Exp Med 1930; 52: 561–71.
11. Ghose T. Oswald Avery: the professor, DNA, and the Nobel Prize that eluded him. Can Bull Med Hist 2004; 21 (1): 135–44.
12. Bottazzi B, Doni A, Garlanda C, Mantovani A. An integrated view of humoral innate immunity: pentraxins as a paradigm. Ann Rev Immunol 2010; 28: 157–83.
13. MacLeod CM, Avery OT. The occurrence during acute infections of a protein not normally present in the blood: II. Isolation and properties of the reactive protein. J Exp Med 1941; 73 (2): 183–90.
14. Singh PP, Voleti B, Agrawal A. A novel RBP-J kappa-dependent switch from C/EBP beta to C/EBP zeta at the C/EBP binding site on the C-reactive protein promoter. J Immunol 2007; 178 (11): 7302–9.
15. Thompson D, Pepys MB, Wood SP. The physiological structure of human Creactive protein and its complex with phosphocholine. Structure 1999; 7 (2): 169–77.
16. Рыдловская А.В., Симбирцев А.С. Функциональный полиморфизм гена TNF-a и патология. Цитокины и воспаление. 2005; 4 (3): 4–10.
[Rydlovskaia A.V., Simbirtsev A.S. Funktsional'nyi polimorfizm gena TNF-a i patologiia. Tsitokiny i vospalenie. 2005; 4 (3): 4–10 (in Russian).]
17. Shaddock E.J. How and when to use common biomarkers in community-acquired pneumonia. Pneumonia (Nathan) 2016; 8: 17.
18. Young B, Greeson M, Gripps AW et al. C-reactive protein: a critical review. Pathology 1991; 23: 118–24.
19. Зайцев А.А., Кондратьева Т.В., Маджанова Е.Р. Диагностические и прогностические возможности количественного определения С-реактивного белка при внебольничной пневмонии. Воен.-мед. журн. 2013; 11: 35–40.
[Zaitsev A.A., Kondrat'eva T.V., Madzhanova E.R. Diagnosticheskie i prognosticheskie vozmozhnosti kolichestvennogo opredeleniia S-reaktivnogo belka pri vnebol'nichnoi pnevmonii. Voen.-med. zhurn. 2013; 11: 35–40 (in Russian).]
20. Pepys MB, Hirschfield GM. C-reactive protein: a critical update. J Clin Invest 2003; 111: 1805–12.
21. Yuste J et al. Serum amyloid P aids complement-mediated immunity to Streptococcus pneumonia. PLoS Pathog 2007; 3 (9): 1208–19.
22. Brown JS et al. The classical pathway is the dominant complement pathway required for innate immunity to Streptococcus pneumoniae infection in mice. Proc Natl Acad Sci U S A 2002; 99 (26): 16969–74.
23. Kerr AR et al. Innate immune defense against pneumococcal pneumonia requires pulmonary complement component C3. Infect Immun 2005; 73 (7): 4245–52.
24. Li YP, Mold C, Du Clos TW. Sublytic complement attack exposes C-reactive protein binding sites on cell membranes. J Immunol 1994; 152 (6): 2995–3005.
25. Bauer S, Lamy O. Role of C-reactive protein in the diagnosis, prognosis and follow-up of community-acquired pneumonia. Rev Med Suisse 2010; 6 (269): 2068–70.
26. Van der Meer V, Neven A, Van den Broek P, Assendelft W. Diagnostic value of C reactive protein in infections of the lower respiratory tract: systematic review. BMJ 2005; 331 (7507): 26.
27. Flanders SA, Stein J, Shochat G et al. Performance of a bedside C-reactive protein test in the diagnosis of community-acquired pneumonia in adults with acute cough. Am J Med 2004; 116: 529–35.
28. Kang YA, Kwon SY, Yoon HI et al. Role of C-reactive protein and procalcitonin in differentiation of tuberculosis from bacterial community acquired pneumonia. Korean J Intern Med 2009; 24 (4): 337–42.
29. Steurer J, Held U, Spaar A et al. A decision aid to rule out pneumonia and reduce unnecessary prescriptions of antibiotics inprimary care patients with cough and fever. BMC Med 2011; 9: 56.
30. Almirall J, Bolipar I, Vidal J et al. Contribution of C-reactive protein to the diagnosis and assessment of severity of community-acquired pneumonia. Chest 2004; 125: 1335–42.
31. Bafadhel M, Clark TW, Reid C et al. Procalcitonin and C-reactive protein in hospitalized adult patients with communityacquired pneumonia or exacerbation of asthma or COPD. Chest 2011; 139 (6): 1410–8.
32. Авдеев С.Н., Баймаканова Г.Е., Зубаирова П.А. Возможности С-реактивного белка в диагностике бактериальной инфекции и пневмонии у больных с обострением хронической обструктивной болезни легких. Уральский мед. журн. 2008; 13: 19–24.
[Avdeev S.N., Baimakanova G.E., Zubairova P.A. Vozmozhnosti S-reaktivnogo belka v diagnostike bakterial'noi infektsii i pnevmonii u bol'nykh s obostreniem khronicheskoi obstruktivnoi bolezni legkikh. Ural'skii med. zhurn. 2008; 13: 19–24 (in Russian).]
33. Garcia Vazquez E, Martines JA, Menza J et al. C-reactive protein levels in community-acquired pneumonia. Eur Respir J 2003; 21: 702–5.
34. Hohenthal U, Hurme S, Helenius H et al. Utility of C-reactive protein in assessing the disease severity and complications of community-acquired pneumonia. Clin Microbiol Infect 2009; 15 (11): 1026–32.
35. Chalmers JD, Singanayagam A, Scally C et al. Risk Factors for complicated parapneumonic effusion and empyema on presentation to hospital with community-acquired pneumonia. Thorax 2009; 64: 592-597.
36. Menendez R, Martinez R, Reyes S et al. Stability in community-acquired pneumonia: one step forward with markers? Thorax 2009; 64: 987–92.
37. Smith RP. C-reactive protein in simple community-acquired pneumonia. Chest 1995; 107: 1028–31.
38. Bruns AH, Oosterheert JJ, Hak E, Hoepelman AI. Usefulness of consecutive C-reactive protein measurements in follow-up of severe community-acquired pneumonia. Eur Respir J 2008; 32: 726–32.
39. Seligman R, Ramos-Lima LF, Oliveira VA et al. Biomarkers in community-acquired pneumonia: A state-of-the-art review. Clinics 2012; 67 (11): 1321–5.
40. Castro-Guardiola A, Armengou-Arxe A, Viedjo-Rodriguez A et al. Differential diagnosis between community-acquired pneumonia and non-pneumonia diseases of the chest in the emergency ward. Eur J Intern Med 2000; 11: 334–9.
41. Вахитов Х.М., Пикуза О.И., Вахитова Л.Ф. и др. Значение определения С-реактивного белка для дифференциальной диагностики бронхита и пневмонии у детей. Практ. медицина. 2012; 7 (63): 23.
[Vakhitov Kh.M., Pikuza O.I., Vakhitova L.F. et al. Znachenie opredeleniia S-reaktivnogo belka dlia differentsial'noi diagnostiki bronkhita i pnevmonii u detei. Prakt. meditsina. 2012; 7 (63): 23 (in Russian).]
________________________________________________
1. Titova O.N., Kuzubova N.A., Lebedeva E.S. Biomarkery prognoza tiazhesti techeniia i iskhoda vnebol'nichnoi pnevmonii. Med. al'ians. 2018; 2: 55–60 (in Russian).
2. Borodulin B.E., Chernogaeva G.Iu., Borodulina E.A. et al. Letal'nost' ot vnebol'nichnoi pnevmonii v usloviiakh mnogoprofil'noi bol'nitsy za 10 let. Med. al'manakh. 2012; 2 (21): 34–6 (in Russian).
3. Borodulina E.A., Borodulin B.E., Povaliaeva L.V. et al. Prediktory letal'nosti ot vnebol'nichnoi pnevmonii v sovremennykh usloviiakh raboty pul'monologicheskogo tsentra. Vestn. sovremen. klin. meditsiny. 2015; 8 (4): 19–22 (in Russian).
4. Chuchalin A.G., Sinopal'nikov A.I., Kozlov R.S. et al. Vnebol'nichnaia pnevmoniia u vzroslykh: prakticheskie rekomendatsii po diagnostike, lecheniiu i profilaktike. Moscow: MAKMAKh, 2010 (in Russian).
5. Muller B, Harbarth S, Stolz D et al. Diagnostic and prognostic accuracy of clinical and laboratory parameters in community-acquired pneumonia. BMC Infect Dis 2007; 7: 10.
6. Watkins RR, Lemonovich TL. Diagnosis and management of community-acquired pneumonia in adult. Am Fam Physician 2011; 83 (11): 1299–306.
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Авторы
А.В.Ершов
1 ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М.Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия;
1 ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М.Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия;
2 ФГБНУ «Федеральный научно-клинический центр реаниматологии и реабилитологии», Москва, Россия
________________________________________________
Anton V. Ershov
1 I.M.Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia;
1 I.M.Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia;
2 Federal Research and Clinical Center for Resuscitation and Rehabilitation, Moscow, Russia
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