clinmedКлиническая медицинаClinical Medicine (Russian Journal)0023-21492412-1339ООО «Медицинское информационное агентство»10.34651/0023-2149-2020-98-1-61-67clinmed-12Research ArticleВ ПОМОЩЬ ПРАКТИЧЕСКОМУ ВРАЧУGUIDELINES FOR PRACTITIONERSИндивидуализированная медицина в клинической практикеIndividualized medicine in clinical practiceБеляловФ. И.BelialovF. I.

Белялов Фарид Исмагильевич — проф. кафедры геронтологии и гериатрии

664049, Иркутск

fbelyalov@mail.ruГБОУ ДПО «Иркутская государственная медицинская академия последипломного образования»РоссияIrkutsk State Medical Academy of Postgraduate EducationRussian Federation2020140720209816167Copyright © Белялов Ф.И., 20202020Белялов Ф.И.Belialov F.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.clinmedjournal.com/jour/article/view/12

В статье обсуждаются вопросы применения медицинских решений, основанных на учете индивидуальных особенностей пациента и направленных на преодоление недостатков популяционного подхода. Тестирование генетических вариаций не позволяет существенно повысить эффективность лечения большинства заболеваний. Рассмотрены важность учета интересов и позиции пациента, достижения оптимального уровня физиологических показателей, дифференцированного лечения симптомов в зависимости от механизма, коморбидных соматических и психических заболеваний, роли факторов внешней среды, временны́ х аспектов болезней, прогнозных оценок для выбора оптимальной лечебной программы.

Individualized medicine is developing conception of modern medicine which aimed for overcoming of weakness of evidencebased medicine. Genetic tests weren’t able to improve outcomes of overwhelming majority of diseases. The role of patient’s interests and position, optimal physiological parameters, physiology of symptoms, comorbidity, psychosomatics, environment, chronomedicine, and prognosis in optimal treatment of patient are discussed in the article.

индивидуализированная медицинаперсонализированная медицинаточная медициналичностно-ориентированная медицинаindividualized medicinepersonalized medicineperson-centered medicineprecision medicineReferencesPersonalized Medicine Coalition. The Personalized Medicine Report. 2017.Personalized Medicine Coalition. The Personalized Medicine Report. 2017.Белялов Ф.И. Есть ли будущее у персонифицированной медицины? Клиническая медицина. 2014;6:7 3– 4.Belialov F. Has personalized medicine the future?. Klinicheskaya Meditsina. 2014;73–4. (in Russian)Mortensen M.B., Nordestgaard B.G. Comparison of Five Major Guidelines for Statin Use in Primary Prevention in a Contemporary General Population. Ann. Intern. Med. 2018;168:85–92.Mortensen M.B., Nordestgaard B.G. Comparison of Five Major Guidelines for Statin Use in Primary Prevention in a Contemporary General Population. Ann. Intern. Med. 2018;168:85–92.ACCF 2012 health policy statement on patient-centered care in cardiovascular medicine: a report of the American College of Cardiology Foundation Clinical Quality Committee. J. Am. Coll. Car diol. 2012;59(23):2125–43.ACCF 2012 health policy statement on patient-centered care in cardiovascular medicine: a report of the American College of Cardiology Foundation Clinical Quality Committee. J. Am. Coll. Cardiol. 2012;59(23):2125-43.Kirchhof P., Sipido K.R., Cowie M.R. et al. The continuum of personalized cardiovascular medicine: a position paper of the European Society of Cardiology. Eur. Heart J. 2014;35:3250–3257.Kirchhof P., Sipido K.R., Cowie M.R. et al. The continuum of personalized cardiovascular medicine: a position paper of the European Society of Cardiology. Eur. Heart J. 2014;35:3250–3257.Person-Centered Care: A Definition and Essential Elements. J. Am. Geriatr. Soc. 2016;64(1):15–8.Person-Centered Care: A Definition and Essential Elements. J. Am. Geriatr. Soc. 2016;64(1):15–8.Hood L., Heath J.R., Phelps M.E. et al. Systems biology and new technologies enable predictive and preventative medicine. Science. 2004;306(5696):640–3.Hood L., Heath J.R., Phelps M.E. et al. Systems biology and new technologies enable predictive and preventative medicine. Science. 2004;306(5696):640–3.Flores M., Glusman G., Brogaard K., Price N.D., Hood L. P4 me dicine: how systems medicine will transform the healthcare sector and society. Personalized medicine. 2013;10(6):565–76.Flores M., Glusman G., Brogaard K., Price N.D., Hood L. P4 medicine: how systems medicine will transform the healthcare sector and society. Personalized Med. 2013;10(6):565–76.Mills K.T., Obst K.M., Shen W. et al. Comparative effectiveness of implementation strategies for blood pressure control in hypertensive patients: A systematic review and meta-analysis. Ann. Int. Med. 2018;168(2):110–20.Mills K.T., Obst K.M., Shen W. et al. Comparative effectiveness of implementation strategies for blood pressure control in hypertensive patients: A systematic review and meta-analysis. Ann. Int. Med. 2018;168(2):110–20.Fors A., Swedberg K., Ulin K., Wolf A., Ekman I. Effects of person-centred care after an event of acute coronary syndrome: Two-year follow-up of a randomised controlled trial. Int. J. Card. 2017;249(Supplement C):42–7.Fors A., Swedberg K., Ulin K., Wolf A., Ekman I. Effects of person-centred care after an event of acute coronary syndrome: Two-year follow-up of a randomised controlled trial. Int. J. Card. 2017;249(Supplement C):42–7.Levine D., Landon B.E., Linder J. Trends in patient-perceived shared decision making among adults in the United States, 2002-2014. Ann. Fam. Med. 2017;15(6):552–556.Levine D., Landon B.E., Linder J. Trends in patient-perceived shared decision making among adults in the United States, 2002-2014. Ann. Fam. Med. 2017;15(6):552–6.B ardy G .H., Lee K.L., Mark D.B., et al. Amiodarone or an Implantable Cardioverter–Defibrillator for Congestive Heart Failure. N. Engl. J. Med. 2005;352:225–37.Bardy G.H., Lee K.L., Mark D.B., et al. Amiodarone or an Implantable Cardioverter–Defibrillator for Congestive Heart Failure. N. Engl. J. Med. 2005;352:225–37.A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N. Engl. J. Med. 2015;373:2103–6.A Randomized trial of intensive versus standard blood-pressure control. N. Engl. J. Med. 2015;373:2103–6.The ACCORD Study Group. Effects of intensive bloodpressure control in type 2 diabetes mellitus. New Engl. J. Med. 2010;362(17):1575– 85.The ACCORD Study Group. Effects of intensive bloodpressure control in type 2 diabetes Mellitus. N. Engl. J. Med. 2010;362(17):1575–85.Kalkman D.N., Brouwer T.F., Vehmeijer J.T. et al. J Curve in patients randomly assigned to different systolic blood pressure targets. Circulation. 2017;136(23):2220.Kalkman D.N., Brouwer T.F., Vehmeijer J.T. et al. J curve in patients randomly assigned to different systolic blood pressure targets. Circulation. 2017;136(23):2220.Magriço R., Bigotte Vieira M., Viegas Dias C., Leitão L., Neves J.S. BP reduction, kidney function decline, and cardiovascular events in patients without CKD. CJASN. 2018;13(1):73–80.Magriço R., Bigotte Vieira M., Viegas Dias C., Leitão L., Neves J.S. BP Reduction, Kidney Function Decline, and Cardiovascular Events in Patients without CKD. CJASN. 2018;13(1):73–80.Rhee S.Y. Hypoglycemia and Dementia. Endocrinol. Metabol. 2017;32(2):195–9.Rhee S.Y. Hypoglycemia and Dementia. Endocrinol. Metabol. 2017;32(2):195–9.Lim A.Y., Park T.K., Cho S.W. et al. Clinical implications of lowdose aspirin on vasospastic angina patients without significant coronary artery stenosis; a propensity score-matched analysis. Int. J. Cardiol. 2016;221:161–6.Lim A.Y., Park T.K., Cho S.W., et al. Clinical implications of lowdose aspirin on vasospastic angina patients without significant coronary artery stenosis; a propensity score-matched analysis. Inter. J. Cardiol. 2016;221:161–6.N estelberger T. et al. Effect of Definition on Incidence and Prognosis of Type 2 Myocardial Infarction. J. Am. Coll. Card. 2017;70(13):1558.Nestelberger T. et al. Effect of Definition on Incidence and Prognosis of Type 2 Myocardial Infarction. J. Am. Coll. Card. 2017;70(13):1558.Белялов Ф.И. Лечение болезней в условиях коморбидности. 10-е изд. Москва: ГЭОТАР-Медиа, 2016.Belialov F. Treatment of diseases in comorbidity. 10th ed. M: GEOTAR-media, 2016. (in Russian)Белялов Ф.И. Психосоматика. 7-е изд. Москва: ГЭОТАР-Медиа, 2018.Belialov F. Psychosomatics. 7th ed. M: GEOTAR-media, 2018. (in Russian)Al-Lamee R., Thompson D., Dehbi H-M. et al. Percutaneous coronary intervention in stable angina (ORBITA): a double-blind, randomised controlled trial. Lancet. 2018;391(10115):31–40.Al-Lamee R., Thompson D., Dehbi H-M. et al. Percutaneous coronary intervention in stable angina (ORBITA): a double-blind, randomised controlled trial. Lancet. 2018;391(10115):31–40.Krintus M., Kozinski M., Boudry P. et al. Defining normality in a European multinational cohort: Critical factors influencing the 99th percentile upper reference limit for high sensitivity cardiac troponin I. Int. J. Card. 2015;187:256–63.Krintus M, Kozinski M, Boudry P, et al. Defining normality in a European multinational cohort: Critical factors influencing the 99th percentile upper reference limit for high sensitivity cardiac troponin I. Int. J. Card. 2015;187:256–63.Gore M.O., Seliger S.L., Defilippi C.R. et al. Age- and sex-dependent upper reference limits for the high-sensitivity cardiac troponin T assay. J. Am. Coll. Cardiol. 2014;63(14):1441–8.Gore M.O., Seliger S.L., Defilippi C.R. et al. Age- and sex-dependent upper reference limits for the high-sensitivity cardiac troponin T assay. J. Am. Coll. Cardiol. 2014;63(14):1441–8.Jose P.O., Frank A.H., Kapphahn K.I. et al. Cardiovascular disease mortality in asian americans. J. Am. Coll. Cardiol. 2014;64(23):2486– 94.Jose P.O., Frank A.H., Kapphahn K.I. et al. Cardiovascular disease mortality in asian americans. J. Am. Coll. Cardiol. 2014;64(23):2486– 94.Goto S., Zhu J., Liu L. et al. Efficacy and safety of apixaban compared with warfarin for stroke prevention in patients with atrial fibrillation from East Asia. Am. Heart J. 2014;168:303–309.Goto S., Zhu J., Liu L. et al. Efficacy and safety of apixaban compared with warfarin for stroke prevention in patients with atrial fibrillation from East Asia. Am. Heart J. 2014;168:303–9.Liu T., Hui J., Hou Y. et al. Meta-Analysis of Efficacy and Safety of Low-Intensity Warfarin Therapy for East Asian Patients With Nonvalvular Atrial Fibrillation. Am. J. Card. 2017;120(9):1562–7.Liu T., Hui J., Hou Y. et al. Meta-Analysis of efficacy and safety of low-intensity warfarin therapy for east asian patients with nonvalvular atrial fibrillation. Am. J. Card. 2017;120(9):1562–7.Choi K-N., Jin H-Y., Shin H-C. et al. Comparison of the Antiplatelet Effects of Once and Twice Daily Low-Dose Ticagrelor and Clopidogrel After Percutaneous Coronary Intervention. Am. J. Card. 2017;120(2):201–6.Choi K-N., Jin H-Y., Shin H-C. et al. Comparison of the antiplatelet effects of once and twice daily low-dose ticagrelor and clopidogrel after percutaneous coronary intervention. Am. J. Card. 2017;120(2):201–6.Cesaroni G., Forastiere F., Stafoggia M. et al. Long term exposure to ambient air pollution and incidence of acute coronary events: prospective cohort study and meta-analysis in 11 European cohorts from the ESCAPE Project. BMJ 2014;348:f7412.Cesaroni G., Forastiere F., Stafoggia M. et al. Long term exposure to ambient air pollution and incidence of acute coronary events: prospective cohort study and meta-analysis in 11 European cohorts from the ESCAPE Project. BMJ. 2014;348:f7412.Schwartz B.G., Qualls C. Kloner R.A., Laskey W.K. Relation of total and cardiovascular death rates to climate system, temperature, barometric pressure, and respiratory infection. Am. J. Cardiol. 2015;116:1290–7.Schwartz B.G., Qualls C., Kloner R.A., Laskey W.K. Relation of total and cardiovascular death rates to climate system, temperature, barometric pressure, and respiratory infection. Am. J. Cardiol. 2015;116:1290–7.Hensel M., Stuhr M., Geppert D. et al. Relationship between ambient temperature and frequency and severity of cardiovascular emergencies: A prospective observational study based on out-ofhospital care data. Int. J. Card. 2017;228:55.Hensel M., Stuhr M., Geppert D. et al. Relationship between ambient temperature and frequency and severity of cardiovascular emergencies: A prospective observational study based on out-ofhospital care data. Int. J. Card. 2017;228:55.Mazzanti A., Maragna R., Faragli A. et al. Gene-specific therapy with mexiletine reduces arrhythmic events in patients with long QT syndrome type 3. J. Am. Coll. Cardiol. 2016;67:1053–8.Mazzanti A., Maragna R., Faragli A. et al. Gene-specific therapy with mexiletine reduces arrhythmic events in patients with long QT syndrome type 3. J. Am. Coll. Cardiol. 2016;67:1053–8.Chorin E., Hu D., Antzelevitch C. et al. Ranolazine for congenital long-QT syndrome type III: experimental and long-term clinical data. Circ. Arrhythm. Electrophysiol. 2016;9:e004370.Chorin E., Hu D., Antzelevitch C. et al. Ranolazine for congenital long-QT syndrome type III: experimental and long-term clinical data. Circ. Arrhythm. Electrophysiol. 2016;9:e004370.Белялов Ф.И. Прогнозирование и шкалы в кардиологии. 2-е изд. Москва: МЕДпресс-информ, 2019.Belialov F. Prognosis and scores in cardiology. M: MEDpressinform, 2019. (in Russian)

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