Тромбоэмболия легочной артерии и диффузное альвеолярное кровотечение: варианты сочетания и особенности терапии
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Tret’yakov AYu, Radenska-Lopovok SG, Novikov PI, Tret’yakova VA, Zakharchenko SP. Terapevticheskii Arkhiv (Ter. Arkh.). 2021; 93 (3): 311–319. DOI: 10.26442/00403660.2021.03.200657
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Ключевые слова: диффузное альвеолярное кровотечение, тромбоэмболия легочной артерии, гранулематоз с полиангиитом, капиллярит, лейкоцитоклазис, рекрутирование нейтрофилов, иммуносупрессивная терапия, обменное переливание плазмы, плазмаферез, рекомбинантный VII фактор свертывания
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The analysis of the mechanisms of the formation of a rare clinical combination of pulmonary embolism (PE) and diffuse alveolar hemorrhage (DAH), which are complications of systemic vasculitis associated with antibodies to the cytoplasm of neutrophils (primarily granulomatosis with polyangiitis), systemic lupus erythematosus and secondary antiphlogistic syndrome – primary antiphospholipid syndrome and Goodpasture’s syndrome. Taking into account the chronological sequence of the occurrence of PE and DAH, 3 variants of the onset of these potentially fatal additions to the underlying disease were considered: the anticipatory DAH development of PE, delayed from DAH PE and joint (within 24 hours) formation of PE and DAH. A review of single descriptions of such a combination of complications of granulomatosis with polyangiitis is carried out, criteria are indicated, a working classification of severity is given and, taking this into account, a modern program of therapy for DAH as an independent event and in combination with PE.
Keywords: diffuse alveolar bleeding, pulmonary embolism, granulomatosis with polyangiitis, capillaritis, leukocytoclasis, neutrophil recruitment, immunosuppressive therapy, exchange plasma transfusion, plasmapheresis, recombinant coagulation factor VII
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3. Ahlehoff O, Wu JJ, Raunsø J. Cutaneous lupus erythematosus and the risk of deep venous thrombosis and pulmonary embolism: A Danish nationwide cohort study. Lupus. 2017;26(13):1435-9. doi: 10.1177/0961203317716306
4. Isshiki Т, Sugino K, Gocho K, et al. Primary Antiphospholipid Syndrome Associated with Diffuse Alveolar Hemorrhage and Pulmonary Thromboembolism. Intern Med. 2015;54(16):2029-33. doi: 10.2169/internalmedicine.54.4058
5. Moreno-Gonzalez G, Corral-Ansa L, Sabater-Riera J, et al. Pulmonary Thromboembolism and Diffuse Alveolar Hemorrhage in Granulomatosis With Polyangiitis Vasculitis. Respiratory Care. 2014;59(12):206-9.doi: 10.4187/respcare.03162
6. Kazzaz NM, Coit P, Lewis EE, Knight JS. Systemic lupus erythematosus complicated by diffuse alveolar haemorrhage: risk factors, therapy and survival. Lupus Sci Med. 2015;2(1):000117. doi: 10.1136/lupus-2015-000117
7. Bazzan M, Vaccarino A, Marletto F. Systemic lupus erythematosus and thrombosis. Thrombosis J. 2015;13:16. doi: 10.1186/s12959-015-0043-3
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9. Thickett DR, Richter AG, Nathani N, et al. Pulmonary manifestations of anti-neutrophil cytoplasmic antibody (ANCA)-positive vasculitis. Rheumatology. 2006;45(3):261-8. doi: 10.1093/rheumatology/kei217
10. Stassen PM, Derks RP, Kallenberg CG. Venous thromboembolism in ANCA-associated vasculitis-incidence and risk factors. Rheumatology. 2008;47(4):530-4. doi: 10.1093/rheumatology/ken035
11. Faurschou M, Obel N, Baslund B. High Risk of Pulmonary Embolism and Deep Venous Thrombosis but Not of Stroke in Granulomatosis With Polyangiitis (Wegener’s). Arthr Care Res. 2014;66(12):1910-4. doi: 10.1002/acr.22423
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14. Sousa ED, Smith R, Chaudhry A, et al. Venous thromboembolism with concurrent pulmonary haemorrhage in systemic vasculitis. Nephrol Dialys Transplant. 2012;27(12):4357-61. doi: 10.1093/ndt/gfs099
15. Hilhorst M, Winckers K, Wilde B, et al. Patients with Antineutrophil Cytoplasmic Antibodies Associated Vasculitis in Remission Are Hypercoagulable. J Rheumatol. 2013;40(12):2012-46. doi: 10.3899/jrheum.130200
16. Berden A, Nolan S, Morris H, et al. Anti-plasminogen antibodies compromise fibrinolysis and associate with renal histology in ANCA-associated vasculitis. J Am Soc Nephrol. 2010;21(12):2169-79. doi: 10.1681/asn.2010030274
17. Nachman PH, Henderson AG. Pathogenesis of lung vasculitis. Seminars Respir Crit Care Med. 2011;32(3):245-53. doi: 10.1055/s-0031-1279822
18. Hidalgo A, Chang J, Jang JE. Heterotypic interactions enabled by polarized neutrophil microdomains mediate thromboinflammatory injury. Nat Med. 2009;15(4):384-91. doi: 10.1038/nm.1939
19. Angelillo-Scherrer A. Leukocyte-Derived Microparticles in Vascular Homeostasis. Circul Res. 2012;110(2):356-69. doi: 10.1161/circresaha.110.233403
20. Huang Y-M, Wang H, Wang C, et al. Promotion of hypercoagulability in antineutrophil cytoplasmic antibody-associated vasculitis by C5a-induced tissue factor-expressing microparticles and neutrophil extracellular traps. Arthrit Rheumatol. 2015;67(10):2780-90. doi: 10.1002/art.39239
21. Lara AR, Schwarz MI. Diffuse Alveolar Hemorrhage. Chest. 2010;137(5):1164-71. doi: 10.1378/chest.08-2084
22. Fishbein G, Fishbein M. Lung Vasculitis and Alveolar Hemorrhage: Pathology. Seminars Respir Crit Care Med. 2011;32(3):254-63. doi: 10.1055/s-0031-1279823
23. Franks TJ, Koss MN. Pulmonary capillaritis. Curr Opin Pulmon Med. 2000;6(5):430-5. doi: 10.1097/00063198-200009000-00008
24. Wood J, Ellery P, Maroney S, et al. Biology of tissue factor pathway inhibitor. Blood. 2014;123(19):2934-43. doi: 10.1182/blood-2013-11-512764
25. Heslet J, Nielsen J, Levi M, Johansson P. Successful pulmonary administration of activated recombinant factor VII in diffuse alveolar hemorrhage. Crit Care. 2006;10(6):177. doi: 10.1186/cc5132
26. Cartin-Ceba R, Diaz-Caballero L, Al-Qadi MO, et al. Diffuse Alveolar Hemorrhage Secondary to Antineutrophil Cytoplasmic Antibody-Associated Vasculitis. Predictors of Respiratory Failure and Clinical Outcomes. Arthrit Rheumatol. 2016;68(6):1467-76. doi: 10.1002/art.39562
27. Rolla G. Exhaled NO in diffuse alveolar haemorrhage. Thorax. 2005;60(7):614-5. doi: 10.1136/thx.2005.040287
28. Brezina B, Jayne D. Plasma exchange and glucocorticoid dosing in anti-neutrophil cytoplasm antibody associated vasculitis: a randomized controlled trial. PEXIVAS. La Presse Médicale. 2013;42(4):772. doi: 10.1016/j.lpm.2013.02.285
29. De Prost N, Parrot A, Cuquemelle E. Diffuse alveolar hemorrhage in immunocompetent patients: Etiologies and prognosis revisited. Respir Med. 2012;106(7):1021-32. doi: 10.1016/j.rmed.2012.03.015
30. Ioachimescu OC, Stoller JK. Diffuse alveolar hemorrhage: diagnosing it and finding the cause. Cleveland Clin J Med. 2008;75(4):258-80.
doi: 10.3949/ccjm.75.4.258
31. Afonso M, Alfaro TM, Fernandes V, Cemlyn-Jones J. Diffuse alveolar hemorrhage – review of an interstitial lung disease clinic. Eur Respir J. 2017;50(61).
32. Seror R, Pagnoux C, Ruivard M, et al. French Vasculitis Study Group. Treatment strategies and outcome of induction-refractory Wegener’s granulomatosis or microscopic polyangiitis: analysis of 32 patients with first-line induction-refractory disease in the WEGENT trial. Ann Rheumat Dis. 2010;69(12):2125-30. doi: 10.1136/ard.2010.131953
33. Casian A, Jayne D. Management of Alveolar Hemorrhage in Lung Vasculitides. Seminars Respirat Crit Care Med. 2011;32(3):335-45. doi: 10.1055/s-0031-1279830
34. Dreyer G, Fan S. Therapeutic Implications of Coexisting Severe Pulmonary Hemorrhage and Pulmonary Emboli in a Case of Wegener Granulomatosis. Am J Kidney Dis. 2009;53(5):e5-8. doi: 10.1053/j.ajkd.2008.12.022
35. Tseng S-T, Tseng M-H, Huang J-L. Concurrent pulmonary hemorrhage and deep vein thrombosis in a child with ANCA-associated vasculitis: case report and review of literature. Pediatr Rheumatol. 2015;13(1):20. doi: 10.1186/s12969-015-0015-y
36. Travis WD, Hoffman GS, Leavitt RY, et al. Surgical pathology of the lung in wegener’s granulomatosis. Review of 87 open lung biopsies from 67 patients. Am J Surg Pathol. 1991;15(4):315-33. doi: 10.1097/00000478-199104000-00001
37. Mark EJ, Matsubara O, Tan-Liu NS, Fienberg R. The pulmonary biopsy in the early diagnosis of wegener’s (pathergic) granulomatosis: A study based on 35 open lung biopsies. Human Pathol. 1988;19(9):1065-71. doi: 10.1016/s0046-8177(88)80088-1
38. Krause ML, Cartin-Ceba R, Specks U, Peikert T. Update on Diffuse Alveolar Hemorrhage and Pulmonary Vasculitis. Immunol Allergy Clin North Am. 2012;32(4):587–600. doi: 10.1016/j.iac.2012.08.001
39. Zagorski J, Debelak J, Gellar M, et al. Chemokines Accumulate in the Lungs of Rats with Severe Pulmonary Embolism Induced by Polystyrene Microspheres. J Immunol. 2003;171(10):5529-36. doi: 10.4049/jimmunol.171.10.5529
40. Kinoshita Y, Sakamoto A, Koga T, Midaka K. Diffuse alveolar damage associated with pulmonary thromboembolism. Respir Med Case Rep. 2013;8:25-7. doi: 10.1016/j.rmcr.2012.12.005
41. Stone JH, Merkel PA, Spiera R, Seo P. Rituximab versus Cyclophosphamide for ANCA-Associated Vasculitis. N Eng J Med. 2010;363(3):221-32. doi: 10.1056/nejmoa0909905
42. Yates M, Watts RA, Bjema IM, et al. EULAR/ERA-EDTA recommendations for the management of ANCA-associated vasculitis. Ann Rheumat Dis. 2016;75(9):583-94. doi: 10.1136/annrheumdis-2016-209133
43. Pusey C, Hamour S, Salama AD. Management of ANCA-associated vasculitis: Current trends and future prospects. Therap Clin Risk Manag. 2010;6:253-64. doi: 10.2147/tcrm.s6112
44. Miloslavsky EM, Specks U, Merkel PA, et al. Rituximab for the Treatment of Relapses in ANCA-associated Vasculitis. Arthrit Rheumatol. 2014;66(11):3151-9. doi: 10.1002/art.38788
45. Frausová D, Hrušková Z, Lánská V, Lachmanova J. Long-term outcome of patients with ANCA-associated vasculitis treated with plasma exchange: a retrospective, single-centre study. Arthrit Res Ther. 2016;18(1):168. doi: 10.1186/s13075-016-1055-5
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1. Allenbach Y, Seror R, Pagnoux C, et al. High frequency of venous thromboembolic events in Churg-Strauss syndrome, Wegener’s granulomatosis and microscopic polyangiitis but not polyarteritis nodosa: a systematic retrospective study on 1130 patients. Ann Rheum Dis. 2009;68(4):564-7. doi: 10.1136/ard.2008.099051
2. Hammoudeh F, Perwaiz MK, Patolia S, et al. Diffuse Alveolar Haemorrhage with ANCA associated vaculitis – review of literature. Br J Med Practition. 2011;4(1):16-9.
3. Ahlehoff O, Wu JJ, Raunsø J. Cutaneous lupus erythematosus and the risk of deep venous thrombosis and pulmonary embolism: A Danish nationwide cohort study. Lupus. 2017;26(13):1435-9. doi: 10.1177/0961203317716306
4. Isshiki Т, Sugino K, Gocho K, et al. Primary Antiphospholipid Syndrome Associated with Diffuse Alveolar Hemorrhage and Pulmonary Thromboembolism. Intern Med. 2015;54(16):2029-33. doi: 10.2169/internalmedicine.54.4058
5. Moreno-Gonzalez G, Corral-Ansa L, Sabater-Riera J, et al. Pulmonary Thromboembolism and Diffuse Alveolar Hemorrhage in Granulomatosis With Polyangiitis Vasculitis. Respiratory Care. 2014;59(12):206-9.doi: 10.4187/respcare.03162
6. Kazzaz NM, Coit P, Lewis EE, Knight JS. Systemic lupus erythematosus complicated by diffuse alveolar haemorrhage: risk factors, therapy and survival. Lupus Sci Med. 2015;2(1):000117. doi: 10.1136/lupus-2015-000117
7. Bazzan M, Vaccarino A, Marletto F. Systemic lupus erythematosus and thrombosis. Thrombosis J. 2015;13:16. doi: 10.1186/s12959-015-0043-3
8. Mykhin NA, Semencova EN, Krivosheev OG, Novikov PI. Use of rituximab for severe ANCA-associated systemic vasculitis. Klinicheskaya nefrologiya. 2010;2:40-5 (In Russ.)
9. Thickett DR, Richter AG, Nathani N, et al. Pulmonary manifestations of anti-neutrophil cytoplasmic antibody (ANCA)-positive vasculitis. Rheumatology. 2006;45(3):261-8. doi: 10.1093/rheumatology/kei217
10. Stassen PM, Derks RP, Kallenberg CG. Venous thromboembolism in ANCA-associated vasculitis-incidence and risk factors. Rheumatology. 2008;47(4):530-4. doi: 10.1093/rheumatology/ken035
11. Faurschou M, Obel N, Baslund B. High Risk of Pulmonary Embolism and Deep Venous Thrombosis but Not of Stroke in Granulomatosis With Polyangiitis (Wegener’s). Arthr Care Res. 2014;66(12):1910-4. doi: 10.1002/acr.22423
12. Emmi G, Silvestri E, Squatrito D, et al. Thrombosis in vasculitis: from pathogenesis to treatment. Thrombosis J. 2015;13(1). doi: 10.1186/s12959-015-0047-z
13. Makarov EA, Novikov PI, Shevtsova TP, et al. Venous thromboembolic complications in ANCA-associated vasculitis. Klinicheskaya farmakologiya i terapiya. 2017;26(3):37-42 (In Russ.)
14. Sousa ED, Smith R, Chaudhry A, et al. Venous thromboembolism with concurrent pulmonary haemorrhage in systemic vasculitis. Nephrol Dialys Transplant. 2012;27(12):4357-61. doi: 10.1093/ndt/gfs099
15. Hilhorst M, Winckers K, Wilde B, et al. Patients with Antineutrophil Cytoplasmic Antibodies Associated Vasculitis in Remission Are Hypercoagulable. J Rheumatol. 2013;40(12):2012-46. doi: 10.3899/jrheum.130200
16. Berden A, Nolan S, Morris H, et al. Anti-plasminogen antibodies compromise fibrinolysis and associate with renal histology in ANCA-associated vasculitis. J Am Soc Nephrol. 2010;21(12):2169-79. doi: 10.1681/asn.2010030274
17. Nachman PH, Henderson AG. Pathogenesis of lung vasculitis. Seminars Respir Crit Care Med. 2011;32(3):245-53. doi: 10.1055/s-0031-1279822
18. Hidalgo A, Chang J, Jang JE. Heterotypic interactions enabled by polarized neutrophil microdomains mediate thromboinflammatory injury. Nat Med. 2009;15(4):384-91. doi: 10.1038/nm.1939
19. Angelillo-Scherrer A. Leukocyte-Derived Microparticles in Vascular Homeostasis. Circul Res. 2012;110(2):356-69. doi: 10.1161/circresaha.110.233403
20. Huang Y-M, Wang H, Wang C, et al. Promotion of hypercoagulability in antineutrophil cytoplasmic antibody-associated vasculitis by C5a-induced tissue factor-expressing microparticles and neutrophil extracellular traps. Arthrit Rheumatol. 2015;67(10):2780-90. doi: 10.1002/art.39239
21. Lara AR, Schwarz MI. Diffuse Alveolar Hemorrhage. Chest. 2010;137(5):1164-71. doi: 10.1378/chest.08-2084
22. Fishbein G, Fishbein M. Lung Vasculitis and Alveolar Hemorrhage: Pathology. Seminars Respir Crit Care Med. 2011;32(3):254-63. doi: 10.1055/s-0031-1279823
23. Franks TJ, Koss MN. Pulmonary capillaritis. Curr Opin Pulmon Med. 2000;6(5):430-5. doi: 10.1097/00063198-200009000-00008
24. Wood J, Ellery P, Maroney S, et al. Biology of tissue factor pathway inhibitor. Blood. 2014;123(19):2934-43. doi: 10.1182/blood-2013-11-512764
25. Heslet J, Nielsen J, Levi M, Johansson P. Successful pulmonary administration of activated recombinant factor VII in diffuse alveolar hemorrhage. Crit Care. 2006;10(6):177. doi: 10.1186/cc5132
26. Cartin-Ceba R, Diaz-Caballero L, Al-Qadi MO, et al. Diffuse Alveolar Hemorrhage Secondary to Antineutrophil Cytoplasmic Antibody-Associated Vasculitis. Predictors of Respiratory Failure and Clinical Outcomes. Arthrit Rheumatol. 2016;68(6):1467-76. doi: 10.1002/art.39562
27. Rolla G. Exhaled NO in diffuse alveolar haemorrhage. Thorax. 2005;60(7):614-5. doi: 10.1136/thx.2005.040287
28. Brezina B, Jayne D. Plasma exchange and glucocorticoid dosing in anti-neutrophil cytoplasm antibody associated vasculitis: a randomized controlled trial. PEXIVAS. La Presse Médicale. 2013;42(4):772. doi: 10.1016/j.lpm.2013.02.285
29. De Prost N, Parrot A, Cuquemelle E. Diffuse alveolar hemorrhage in immunocompetent patients: Etiologies and prognosis revisited. Respir Med. 2012;106(7):1021-32. doi: 10.1016/j.rmed.2012.03.015
30. Ioachimescu OC, Stoller JK. Diffuse alveolar hemorrhage: diagnosing it and finding the cause. Cleveland Clin J Med. 2008;75(4):258-80.
doi: 10.3949/ccjm.75.4.258
31. Afonso M, Alfaro TM, Fernandes V, Cemlyn-Jones J. Diffuse alveolar hemorrhage – review of an interstitial lung disease clinic. Eur Respir J. 2017;50(61).
32. Seror R, Pagnoux C, Ruivard M, et al. French Vasculitis Study Group. Treatment strategies and outcome of induction-refractory Wegener’s granulomatosis or microscopic polyangiitis: analysis of 32 patients with first-line induction-refractory disease in the WEGENT trial. Ann Rheumat Dis. 2010;69(12):2125-30. doi: 10.1136/ard.2010.131953
33. Casian A, Jayne D. Management of Alveolar Hemorrhage in Lung Vasculitides. Seminars Respirat Crit Care Med. 2011;32(3):335-45. doi: 10.1055/s-0031-1279830
34. Dreyer G, Fan S. Therapeutic Implications of Coexisting Severe Pulmonary Hemorrhage and Pulmonary Emboli in a Case of Wegener Granulomatosis. Am J Kidney Dis. 2009;53(5):e5-8. doi: 10.1053/j.ajkd.2008.12.022
35. Tseng S-T, Tseng M-H, Huang J-L. Concurrent pulmonary hemorrhage and deep vein thrombosis in a child with ANCA-associated vasculitis: case report and review of literature. Pediatr Rheumatol. 2015;13(1):20. doi: 10.1186/s12969-015-0015-y
36. Travis WD, Hoffman GS, Leavitt RY, et al. Surgical pathology of the lung in wegener’s granulomatosis. Review of 87 open lung biopsies from 67 patients. Am J Surg Pathol. 1991;15(4):315-33. doi: 10.1097/00000478-199104000-00001
37. Mark EJ, Matsubara O, Tan-Liu NS, Fienberg R. The pulmonary biopsy in the early diagnosis of wegener’s (pathergic) granulomatosis: A study based on 35 open lung biopsies. Human Pathol. 1988;19(9):1065-71. doi: 10.1016/s0046-8177(88)80088-1
38. Krause ML, Cartin-Ceba R, Specks U, Peikert T. Update on Diffuse Alveolar Hemorrhage and Pulmonary Vasculitis. Immunol Allergy Clin North Am. 2012;32(4):587–600. doi: 10.1016/j.iac.2012.08.001
39. Zagorski J, Debelak J, Gellar M, et al. Chemokines Accumulate in the Lungs of Rats with Severe Pulmonary Embolism Induced by Polystyrene Microspheres. J Immunol. 2003;171(10):5529-36. doi: 10.4049/jimmunol.171.10.5529
40. Kinoshita Y, Sakamoto A, Koga T, Midaka K. Diffuse alveolar damage associated with pulmonary thromboembolism. Respir Med Case Rep. 2013;8:25-7. doi: 10.1016/j.rmcr.2012.12.005
41. Stone JH, Merkel PA, Spiera R, Seo P. Rituximab versus Cyclophosphamide for ANCA-Associated Vasculitis. N Eng J Med. 2010;363(3):221-32. doi: 10.1056/nejmoa0909905
42. Yates M, Watts RA, Bjema IM, et al. EULAR/ERA-EDTA recommendations for the management of ANCA-associated vasculitis. Ann Rheumat Dis. 2016;75(9):583-94. doi: 10.1136/annrheumdis-2016-209133
43. Pusey C, Hamour S, Salama AD. Management of ANCA-associated vasculitis: Current trends and future prospects. Therap Clin Risk Manag. 2010;6:253-64. doi: 10.2147/tcrm.s6112
44. Miloslavsky EM, Specks U, Merkel PA, et al. Rituximab for the Treatment of Relapses in ANCA-associated Vasculitis. Arthrit Rheumatol. 2014;66(11):3151-9. doi: 10.1002/art.38788
45. Frausová D, Hrušková Z, Lánská V, Lachmanova J. Long-term outcome of patients with ANCA-associated vasculitis treated with plasma exchange: a retrospective, single-centre study. Arthrit Res Ther. 2016;18(1):168. doi: 10.1186/s13075-016-1055-5
46. Winters J. Plasma exchange: concepts, mechanisms, and an overview of the American Society for Apheresis guidelines. Hematology. 2012;2012:7-12.
47. Kaplan AA. A simple and accurate method for prescribing plasma exchange. ASAIO Trans. 1990;36:M597-9.
48. Szpir WM. Plasma exchange in antineutrophil cytoplasmic antibody-associated vasculitis – a 25-year perspective. Nephrol Dialys Transplant. 2015;30:i146-9. doi: 10.1093/ndt/gfv051
49. Heslet L, Nielsen J, Levi M, et al. Successful pulmonary administration of activated recombinant factor VII in diffuse alveolar hemorrhage. Crit Care. 2006;10(6):R177. doi: 10.1186/cc5132
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1 ФГАОУ ВПО «Белгородский государственный национальный исследовательский университет», Белгород, Россия;
2 ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия;
3 ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия;
4 ФГАОУ ВО «Российский университет дружбы народов», Москва, Россия
*opensource2007@yandex.ru
________________________________________________
Andrey Yu. Tret’yakov*1, Stefka G. Radenska-Lopovok2,3, Pavel I. Novikov2, Viktoriia A. Tret’yakova4, Svetlana P. Zakharchenko1
1 Belgorod National Research University, Belgorod, Russia;
2 Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia;
3 Russian Medical Academy of Continuous Professional Education, Moscow, Russia;
4 People’s Friendship University of Russia, Moscow, Russia
*opensource2007@yandex.ru