rmtОбщая реаниматологияGeneral Reanimatology1813-97792411-7110FSBI "SRIGR" RAMS10.15360/1813-9779-2022-4-45-54rmt-2253Research ArticleОБЗОРЫ И КРАТКИЕ СООБЩЕНИЯREVIEWS & SHORT COMMUNICATIONSПерсонализированная медицина критических состояний (обзор)Personalized Critical Care Medicine (Review)ГолубевА. М.GolubevA. M.

Аркадий Михайлович Голубев

107031, г. Москва, ул. Петровка, д. 25, стр. 2

 Arkady M. Golubev 

 25 Petrovka Str., Bldg. 2, 107031 Moscow 

arkadygolubev@mail.ruНИИ общей реаниматологии им. В. А. Неговского ФНКЦ РРРоссияV. A. Negovsky Research Institute of General Reanimatology, Federal Research and Clinical Center of Intensive Care Medicine and RehabilitologyRussian Federation2022250820221844554Copyright © Голубев А.М., 20222022Голубев А.М.Golubev A.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.reanimatology.com/rmt/article/view/2253

Персонализированная медицина (ПМ) является главным вектором развития здравоохранения в XXI веке и включает направления, касающиеся факторов риска развития заболевания (предикативность), мероприятия по предотвращению заболевания (профилактика), индивидуализацию диагностики и лечения (персонализация), информирование пациента по вопросам профилактики и лечения заболевания (партисипативность). В последние годы ведется активная исследовательская работа, направленная на внедрение принципов ПМ в процесс оказания помощи пациентам, находящимся в критических состояниях. Это касается выделения групп пациентов на основе исследования генома, разработки диагностических тестов с использованием молекулярных маркеров, создания нового класса лекарств с учетом индивидуальных характеристик пациентов.

Цель обзора — обобщить имеющиеся данные о внедрении принципов ПМ в практику работы медицинских учреждений, обеспечивающих лечение пациентов, находящихся в критическом состоянии.

Провели анализ более 300 источников литературы международных баз данных Pubmed, Scopus и РИНЦ. Из общего массива отобрали 85 источников, которые в наибольшей степени соответствуют цели обзора.

В обзоре представили сведения об организации и результатах внедрения принципов и передовых технологий ПМ, таких как банк образцов неотложной медицины — EMSB, в работу клиник, оказывающих неотложную помощь при критических состояниях. Рассмотрели формирование представлений о ПМ, в том числе признаки новой концепции, ориентированной на лечение пациентов в критическом состоянии. Изложили сведения о специфике развития конкретных критических состояний (острых нарушений мозгового кровообращения, острого респираторного дистресс-синдрома, черепно-мозговой травмы, шока, инфаркта миокарда, нарушений ритма и проводимости), а также об эффективности применения лекарственных препаратов, в зависимости от индивидуальных генетических особенностей пациентов.

Ограничений исследований по вопросам темы не выявили.

Заключение. Анализ данных литературы свидетельствует о позитивных результатах внедрения принципов ПМ в профилактику, диагностику и лечение больных в критических состояниях. Создание биобанков, разработка учебных программ и нормативной документации, активизация научных исследований, внедрение новых методов диагностики и лечения способствуют реализации принципов ПМ в практическом здравоохранении.

Personalized medicine (PM) is a major trend in health care development in the 21st century. This area includes studying risk factors for disease development (prediction), interventions for preventing diseases (prophylaxis), individualization of diagnosis and treatment (personalization), informing the patient on disease prevention and treatment (participation). In the recent years, an intense research to introduce the personalized medicine principles into the management of critically ill patients, has been under way. This includes identification of patient groups based on genomic research, development of diagnostic tests using molecular markers, creation of novel classes of drugs based on individual patient characteristics.

The aim of the review is to summarize the available data on the implementation of the principles of PM in the routine practice of critical care institutions.

We analyzed more than 300 sources of literature from the Pubmed and Scopus databases, as well as the RSCI database. Eighty five most relevant sources were selected for the review. The paper reports data on the organization and results of implementation of PM principles and advanced technologies, such as Emergency Medicine Sample Bank (EMSB), in the daily activity of clinics providing emergency critical care. The formation of the novel PM concept focused on the treatment of critically ill patients has been discussed. The review contains detailed data on the patterns of development of specific critical illnesses such as acute cerebrovascular events, acute respiratory distress syndrome, traumatic brain injury, shock, myocardial infarction, cardiac rhythm and conduction disturbances. Medication efficacy in view of individual genetic patient characteristics has also been highlighted. No research limitations on the subject were identified.

Conclusion. The analysis of literature has demonstrated positive results of implementing PM principles in prevention, diagnosis and treatment of critically ill patients. Creation of Biobanks, development of training programs and regulatory documentation, advancing the scientific research, introduction of new methods of diagnosis and treatment will contribute to the implementation of PM principles in practical healthcare.

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The authors declare that there are no conflicts of interest present.