Индивидуализированная медицина в клинической практике
Аннотация
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.
Об авторе
Ф. И. Белялов
ГБОУ ДПО «Иркутская государственная медицинская академия последипломного образования»
Россия
Россия
Белялов Фарид Исмагильевич — проф. кафедры геронтологии и гериатрии
664049, Иркутск
Список литературы
1. Personalized Medicine Coalition. The Personalized Medicine Report. 2017.
2. Белялов Ф.И. Есть ли будущее у персонифицированной медицины? Клиническая медицина. 2014;6:7 3– 4.
3. 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.
4. 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.
5. 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.
6. Person-Centered Care: A Definition and Essential Elements. J. Am. Geriatr. Soc. 2016;64(1):15–8.
7. 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.
8. 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.
9. 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.
10. 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.
11. 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.
12. 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.
13. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N. Engl. J. Med. 2015;373:2103–6.
14. The ACCORD Study Group. Effects of intensive bloodpressure control in type 2 diabetes mellitus. New Engl. J. Med. 2010;362(17):1575– 85.
15. 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.
16. 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.
17. Rhee S.Y. Hypoglycemia and Dementia. Endocrinol. Metabol. 2017;32(2):195–9.
18. 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.
19. 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.
20. Белялов Ф.И. Лечение болезней в условиях коморбидности. 10-е изд. Москва: ГЭОТАР-Медиа, 2016.
21. Белялов Ф.И. Психосоматика. 7-е изд. Москва: ГЭОТАР-Медиа, 2018.
22. 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.
23. 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.
24. 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.
25. 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.
26. 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.
27. 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.
28. 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.
29. 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.
30. 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.
31. 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.
32. 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.
33. 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.
34. Белялов Ф.И. Прогнозирование и шкалы в кардиологии. 2-е изд. Москва: МЕДпресс-информ, 2019.
Для цитирования:
Белялов Ф.И. Индивидуализированная медицина в клинической практике. Клиническая медицина. 2020;98(1):61-67. https://doi.org/10.34651/0023-2149-2020-98-1-61-67
For citation:
Belialov F.I. Individualized medicine in clinical practice. Clinical Medicine (Russian Journal). 2020;98(1):61-67. (In Russ.) https://doi.org/10.34651/0023-2149-2020-98-1-61-67
Просмотров: 75
Послать статью по эл. почте 
