medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2023-405medsovet-7895Research ArticleРАЦИОНАЛЬНАЯ ФАРМАКОТЕРАПИЯRATIONAL PHARMACOTHERAPYИнгаляционный оксид азота: известные и новые показанияInhaled nitric oxide: well-known and new therapeutic indicationshttps://orcid.org/0000-0002-5999-2150АвдеевС. Н.AvdeevS. N.

Авдеев Сергей Николаевич, академик РАН, доктор медицинских наук, профессор, заведующий кафедрой пульмонологии, Первый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет); руководитель клинического отдела, Научно-исследовательский институт пульмонологии Федерального медико-биологического агентства

119991, Москва, ул. Трубецкая, д. 8, стр. 2,

115682, Москва, Ореховый бульвар, д. 28

Sergey N. Avdeev, Acad. RAS, Dr. Sci. (Med.), Professor, Head of the Department of Pulmonology, Sechenov First Moscow State Medical University (Sechenov University); Head of the Clinical Department, Research Institute for Pulmonology of the Federal Medical Biological Agency

8, Bldg. 2, Trubetskaya St., Moscow, 119991,

8, Orekhovy Boulevard, Moscow, 115682

serg_avdeev@list.ruhttps://orcid.org/0000-0001-9357-4924ЦареваН. А.TsarevaN. A.

Царева Наталья Анатольевна, кандидат медицинских наук, доцент кафедры пульмонологии, Первый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет); научный сотрудник лаборатории интенсивной терапии и дыхательной недостаточности, Научно-исследовательский институт пульмонологии Федерального медико-биологического агентства

119991, Москва, ул. Трубецкая, д. 8, стр. 2,

115682, Москва, Ореховый бульвар, д. 28

Natalya A. Tsareva, Cand. Sci. (Med.), Associate Professor of the Department of Pulmonology, Sechenov First Moscow State Medical University (Sechenov University); Researcher of the Laboratory of Intensive Therapy and Respiratory Failure, Research Institute for Pulmonology of the Federal Medical Biological Agency

8, Bldg. 2, Trubetskaya St., Moscow, 119991,

8, Orekhovy Boulevard, Moscow, 115682

n_tsareva@mail.ruhttps://orcid.org/0000-0002-9509-0867НеклюдоваГ. В.NekludovaG. V.

Неклюдова Галина Васильевна, доктор медицинских наук, профессор кафедры пульмонологии, Первый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет); ведущий научный сотрудник лаборатории функциональных и ультразвуковых методов исследования, Научно-исследовательский институт пульмонологии Федерального медикобиологического агентства

119991, Москва, ул. Трубецкая, д. 8, стр. 2,

115682, Москва, Ореховый бульвар, д. 28

Galina V. Nekludova, Dr. Sci. (Med.), Professor, Professor of the Department of Pulmonology, Sechenov First Moscow State Medical University (Sechenov University); Leading Researcher of the Laboratory of Functional and Ultrasound Research Methods, Research Institute for Pulmonology of the Federal Medical Biological Agency

8, Bldg. 2, Trubetskaya St., Moscow, 119991,

8, Orekhovy Boulevard, Moscow, 115682

nekludova_gala@mail.ruhttps://orcid.org/0000-0002-4726-4906НуралиеваГ. С.NuralievaG. S.

Нуралиева Галиа Сериковна, кандидат медицинских наук, доцент кафедры пульмонологии, Первый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет); научный сотрудник лаборатории интенсивной терапии и дыхательной недостаточности, Научно-исследовательский институт пульмонологии Федерального медико-биологического агентства

119991, Москва, ул. Трубецкая, д. 8, стр. 2,

115682, Москва, Ореховый бульвар, д. 28

Galiya S. Nuralieva, Cand. Sci. (Med.), Associate Professor of the Department of Pulmonology, Sechenov First Moscow State Medical University (Sechenov University); Researcher at the Laboratory of Intensive Therapy and Respiratory Failure, Research Institute for Pulmonology of the Federal Medical Biological Agency

8, Bldg. 2, Trubetskaya St., Moscow, 119991,

8, Orekhovy Boulevard, Moscow, 115682

galia32@yandex.ruhttps://orcid.org/0000-0002-3174-5000МержоеваЗ. М.MerzhoevaZ. M.

Мержоева Замира Магомедовна, кандидат медицинских наук, доцент кафедры пульмонологии, заведующая отделением пульмонологии Университетской клинической больницы №4

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Zamira M. Merzhoeva, Cand. Sci. (Med.), Assistant of the Department of Pulmonology, Head of the Department of Pulmonology, University Clinical Hospital No. 4

8, Bldg. 2, Trubetskaya St., Moscow, 119991

zamira.merzhoeva@bk.ruhttps://orcid.org/0000-0002-0685-4133ТрушенкоН. В.TrushenkoN. V.

Трушенко Наталья Владимировна, кандидат медицинских наук, доцент кафедры пульмонологии Первый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет); научный сотрудник клинической лаборатории, Научно-исследовательский институт пульмонологии Федерального медико-биологического агентства

119991, Москва, ул. Трубецкая, д. 8, стр. 2,

115682, Москва, Ореховый бульвар, д. 28

Natalia V. Trushenko, Cand. Sci. (Med.), Assistant of the Department of Pulmonology, Sechenov First Moscow State Medical University (Sechenov University); Researcher of the Clinical Laboratory, Research Institute for Pulmonology of the Federal Medical Biological Agency

8, Bldg. 2, Trubetskaya St., Moscow, 119991,

8, Orekhovy Boulevard, Moscow, 115682

trushenko.natalia@yandex.ruhttps://orcid.org/0000-0002-1314-0091ШмидтА. Е.ShmidtA. E.

Шмидт Анна Евгеньевна, ассистент кафедры пульмонологии

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Anna E. Shmidt, Assistant of the Department of Pulmonology

8, Bldg. 2, Trubetskaya St., Moscow, 119991

 

a_e_schmidt@mail.ruhttps://orcid.org/0000-0001-9661-7213СувороваО. А.SuvorovaO. A.

Суворова Ольга Александровна, ассистент кафедры пульмонологии

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Olga A. Suvorova, Assistant of the Department of Pulmonology

8, Bldg. 2, Trubetskaya St., Moscow, 119991

 

Olga.a.suvorova@mail.ruhttps://orcid.org/0000-0003-0249-4238АтаманК. С.AtamanK. S.

Атаман Кирилл Сергеевич, ассистент кафедры пульмонологии

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Kirill S. Ataman, Assistant of the Department of Pulmonology

8, Bldg. 2, Trubetskaya St., Moscow, 119991

 

kiataman@yandex.ruhttps://orcid.org/0000-0001-7616-1239КуркиеваФ. Т.KurkievaF. T.

Куркиева Фатима Тамерлановна, ординатор 1 года кафедры пульмонологии

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Fatima T. Kurkieva, 1st year Resident at the Department of Pulmonology

8, Bldg. 2, Trubetskaya St., Moscow, 119991

 

Kurkievafatima-1999@yandex.ruhttps://orcid.org/0009-0000-2444-6523ГорошковА. В.GoroshkovA. V.

Горошков Александр Валерьевич, ординатор 1 года кафедры пульмонологии

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Aleksandr V. Goroshkov, 1st year Resident at the Department of Pulmonology

8, Bldg. 2, Trubetskaya St., Moscow, 119991

Etozhalex@gmail.comhttps://orcid.org/0000-0001-7606-6565ХачатуровМ. В.KhachaturovM. V.

Хачатуров Михаил Викторович, студент

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Mikhail V. Khachaturov, Student

8, Bldg. 2, Trubetskaya St., Moscow, 119991

khachaturov.michael@gmail.comhttps://orcid.org/0000-0002-2070-3497АвдеевИ. С.AvdeevI. S.

Авдеев Иван Сергеевич, студент

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Ivan S. Avdeev, Student

8, Bldg. 2, Trubetskaya St., Moscow, 119991

ivan.avdeev@list.ruhttps://orcid.org/0000-0002-1484-092XЯрошецкийА. И.YaroshetskiyA. I.

Ярошецкий Андрей Игоревич, доктор медицинских наук, профессор кафедры пульмонологии

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Andrey I. Yaroshetskiy, Dr. Sci. (Med.), Professor of the Department of Pulmonology

8, Bldg. 2, Trubetskaya St., Moscow, 119991

dr.intensivist@gmail.comПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет); Научно-исследовательский институт пульмонологии Федерального медико-биологического агентстваРоссияSechenov First Moscow State Medical University (Sechenov University); Research Institute for Pulmonology of the Federal Medical Biological AgencyRussian FederationПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияSechenov First Moscow State Medical University (Sechenov University)Russian Federation202317112023020128137Copyright © Авдеев С.Н., Царева Н.А., Неклюдова Г.В., Нуралиева Г.С., Мержоева З.М., Трушенко Н.В., Шмидт А.Е., Суворова О.А., Атаман К.С., Куркиева Ф.Т., Горошков А.В., Хачатуров М.В., Авдеев И.С., Ярошецкий А.И., 20232023Авдеев С.Н., Царева Н.А., Неклюдова Г.В., Нуралиева Г.С., Мержоева З.М., Трушенко Н.В., Шмидт А.Е., Суворова О.А., Атаман К.С., Куркиева Ф.Т., Горошков А.В., Хачатуров М.В., Авдеев И.С., Ярошецкий А.И.Avdeev S.N., Tsareva N.A., Nekludova G.V., Nuralieva G.S., Merzhoeva Z.M., Trushenko N.V., Shmidt A.E., Suvorova O.A., Ataman K.S., Kurkieva F.T., Goroshkov A.V., Khachaturov M.V., Avdeev I.S., Yaroshetskiy A.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.med-sovet.pro/jour/article/view/7895

Применение оксида азота широко распространено в медицинской практике. Особенно интересно применение ингаляционной формы NO у пациентов c респираторными заболеваниями. В качестве ингаляционной терапии оксид азота достигает хорошо вентилируемых участков легких, оказывая незначительный системный эффект из-за своей быстрой инактивации в кровотоке. Давно известно, что ингаляционный NO улучшает оксигенацию при различных патологических состояниях. Низкие дозы ингаляционного оксида азота уже давно зарекомендовали себя в качестве сосудорасширяющего агента у пациентов с легочной гипертензией, его применение возможно даже у новорожденных с гипоксемической дыхательной недостаточностью и персистирующей легочной гипертензией. В свою очередь высокие дозы находят применение в терапии инфекционных заболеваний легких, к тому же очередной всплеск научного интереса к оксиду азота возник во время пандемии коронавирусной инфекции. Хотя антимикробный потенциал оксида азота широко известен, он мало используется в клинической практике. Эндогенная антимикробная активность в значительной степени опосредована высокими локальными концентрациями NO. Многочисленные доклинические исследования продемонстрировали, что NO обладает общей статической и бактерицидной активностью в отношении вирусов, бактерий, простейших и грибов/дрожжей in vitro. Ввиду дозозависимых положительных и отрицательных эффектов NO необходимы испытания безопасности и эффективности NO и его доноров для оценки их роли в профилактике и лечении инфекций. Данный обзор представляет информацию о химическом строении, особенностях метаболизма и доставке ингаляционного NO, а также уделяет особое внимание противомикробному эффекту при различных заболеваниях пульмонологического профиля.

The use of nitric oxide is widespread in medical practice. Inhaled form of NO in patients with respiratory disease is especially interesting. As an inhalation therapy, nitric oxide reaches well-ventilated areas of the lungs, having a negligible systemic effect due to its rapid inactivation in the bloodstream. It has long been known that inhaled NO improves oxygenation in various pathological conditions. Low doses of inhaled nitric oxide are known as a vasodilator in patients with pulmonary hypertension, its use is possible even in newborns with hypoxemic respiratory failure and persistent pulmonary hypertension. In turn, high doses are used in the treatment of infectious lung diseases, besides, another surge of scientific interest in nitric oxide arose during the coronavirus pandemic. Although the antimicrobial potential of nitric oxide is widely known, it is little used in clinical practice. Endogenous antimicrobial activity is largely mediated by high local concentrations of NO. Numerous preclinical studies have demonstrated that NO has general static and bactericidal activity against viruses, bacteria, protozoa and fungi/yeast in vitro. Due to the dose-dependent positive and negative effects of NO, safety and efficacy tests of NO and its donors are needed to assess their role in the prevention and treatment of infections. This review provides information on the chemical structure, features of metabolism and delivery of inhaled NO, and also pays special attention to the antimicrobial effect in various diseases of the pulmonological profile.

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