SURUNKALI OBSTRUKTIV O'PKA KASALLIGI XURUJLARINING CHASTOTASI VA OG'IRLIGINI BELGILOVCHI MODIFIKATSIYALANUVCHI HAMDA O'ZGARMAS XATAR OMILLARINING KO'P O'LCHOVLI TAHLILI
Ключевые слова:
Surunkali obstruktiv o'pka kasalligi, O'tkir xurujlar, FEV1 pasayishi, Eozinofil yallig'lanish, Farmakoterapiyaga moslashuvchanlikАннотация
Surunkali obstruktiv o'pka kasalligi (SO'K) xurujlari o'pka funksiyasining pasayish dinamikasini tezlashtiradi, bemorlarning hayot sifatini keskin yomonlashtiradi va global miqyosda kattalar o'rtasidagi umumiy o'lim ko'rsatkichlarini sezilarli darajada oshiradi. Nafas yo'llaridagi yallig'lanish jarayonlarining geterogen tabiati, tizimli komorbid holatlar hamda turli tashqi ekologik qo'zg'atuvchilarning mavjudligi sababli klinik qaytalanishlarni oldindan prognoz qilish o'ta murakkab vazifa bo'lib qolmoqda. Ushbu tadqiqot birlamchi tibbiy-sanitariya yordami muassasalariga murojaat qilgan turli xil klinik fenotipga ega bemorlar guruhida fiziologik, klinik va biomarkerlarga asoslangan xatar omillarining SO'K xurujlari chastotasiga sinergik ta'sirini o'rganadi. Tadqiqotda 18 oylik davomiy kuzatuv davri davomida o'rtacha va og'ir darajadagi SO'K tashxisi qo'yilgan 214 nafar shaxs ishtirokida prospektiv kuzatuv dizayni qo'llanildi. Dastlabki demografik ma'lumotlar, spirometrik ko'rsatkichlar (FEV1, FVC), qondagi eozinofillar miqdori, chekish indeksi va farmakoterapiyaga moslashuvchanlik darajasi tizimli ravishda qayd etildi. Ko'p o'lchovli Koks (Cox) proporsional xavf regressiya modellaridan foydalangan holda, birinchi xurujgacha bo'lgan vaqt va yillik klinik qaytalanish ko'rsatkichlari kuzatildi. Natijalar shuni ko'rsatdiki, oldingi yil davomida ikki yoki undanortiq xuruj kuzatilganligi kelgusi holatlarning eng kuchli mustaqil predikativ omili hisoblanadi (Xavf nisbati 2.85, 95% CI 2.10-3.95). Periferik qondagi eozinofillar sonining bir mikrolitrda 300 hujayradan oshishi og'ir, steroidlarga sezgir o'tkir holatlar bilan uzviy bog'liqligi aniqlandi. Ingalatordan noto'g'ri foydalanish va umumiy davolanish tartibiga rioya qilmaslik asosiy terapiya samaradorligining 42% ga pasayishiga olib keldi. Atrof-muhit o'zgaruvchilari, xususan, havo haroratining mavsumiy pasayishi va mahalliy havo sifati indeksining o'zgarishi shoshilinch shifoxonaga yotqizish holatlari bilan kechiktirilgan, ammo statistik jihatdan ahamiyatli korrelyatsiyani namoyish etdi. Tadqiqot natijasida yuqori xavfli bemorlar fenotiplarini aniq stratifikatsiya qilish uchun tizimli yallig'lanish markerlarini ijtimoiy-xulq-atvor ko'rsatkichlari bilan birlashtiruvchi prognostik matritsa ishlab chiqildi. Ushbu ko'p o'lchovli xavf-stratifikatsiya tizimini ambulator sharoitda joriy etish maqsadli profilaktik choralarni optimallashtiradi hamda qaytalanadigan nafas yo'llari obstruksiyasining iqtisodiy va fiziologik yukini keskin kamaytiradi
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