ДГПЖ. Доброкачественная гиперплазия предстательнойжелезыКодирование по Международной статистической классификации болезней и проблем, связанных со здоровьем N40
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3.3 Иное лечение Среди медикаментозных препаратов применяемых для лечения пациентов с гиперплазией простаты в Российской Федерации также существует две группы лекарственных средств, разработанных российскими учёными, не попадающие в вышеприведенные группы фармакологического классификатора. Одним из таких препаратов является созданный на основе технологически обработанных (сверхвысокие разведения) аффинно очищенных антител к NOS – синтазе оксида азота и простатическому специфическому антигену (ПСА). Антитела к ПСА модифицируют функциональную активность эндогенного ПСА, измененную при доброкачественной гиперплазии предстательной железы, что сопровождается усилением регуляторного влияния данного антигена на функциональные и метаболические процессы в ткани предстательной желез, оказывая профилактическое и лечебное действие. Антитела к эндотелиальной NO- синтазе способствуют увеличению скорости кровотока в сосудах полового члена и предстательной железы; оказывают протективное действие по отношению к эндотелию (способствуют снижению реактивности сосудов, уменьшению сосудистого спазма и улучшению периферической микроциркуляции). В недавно опубликованном мультицентровом, плацебо- контролированном, двойном слепом, рандомизированном исследовании, которое продолжалось 12 месяцев, была показана достоверная эффективность по сравнению с плацебо в улучшении выраженности симптомов нарушенного мочеиспускания и уменьшении объема простаты. [144] Вторая группа – биорегуляторные пептиды – биологически активный экстракт предстательных желез бычков. Наиболее полный анализ отечественных фундаментальных и клинических исследований представлен в мета-анализе И.А. Корнеева [145]. Проанализировав результаты 9 исследований, проведенных российскими урологами, было сделано заключение, что полученные данные подтверждают эффективность применения препарата на основе предстательных желез бычков при лечения пациентов с умеренно выраженными СНМП и инфравезикальной обструкцией, обусловленной ДГПЖ, с целью снижения степени дизурии, повышения качества жизни и нормализации уродинамических показателей. Однако, эти исследования объединили лишь 380 пациентов и ни одно из них не было плацебо- контролированным. Требуется проведение дальнейших длительных, рандомизированных, плацебоконтролируемых исследований [145]. Разработки Российских ученых и создание новых групп лекарственных препаратов для лечения пациентов с гиперплазией простаты требуют проведения дальнейших исследований, которые позволят подтвердить их эффективность и определить те категории пациентов, которым данная терапия наиболее целесообразна. 4. Реабилитация Медицинская реабилитация не предусмотрена. 5. Профилактика Рекомендуется диспансерное наблюдение пациента с ДГПЖ у врача-уролога с различной периодичностью (1 раз в 6–12 мес) в соответствии с избранным методом лечения и включает следующие обследования: ультразвуковое исследование мочевого пузыря с определением остаточной мочи, урофлоуметрию, заполнение дневника мочеиспускания для предотвращения прогрессирования заболевания и развития осложнений [2, 4]. Уровень убедительности рекомендаций С (уровень достоверности доказательств– 5) Для наблюдения за динамикой симптоматики у пациентов с ДГПЖ рекомендуется использовать шкалу международного индекса этого заболевания (IPSS) и качества жизни вследствие расстройства мочеиспускания (QoL) [2, 4]. Уровень убедительности рекомендаций С (уровень достоверности доказательств– 5) Для своевременного выявления РПЖ рекомендуется выполнять ПРИ и контролировать уровень ПСА в сыворотке крови каждые 12 мес всем мужчинам старше 50 лет (при наличии семейного анамнеза рака простаты [2, 4, 5]. Уровень убедительности рекомендаций С (уровень достоверности доказательств– 5) Комментарии: Определение ПСА у пациентов с ожидаемой продолжительности жизни менее 10-15 лет имеет умеренную прогностическую значимость и не оказывает существенного влияния на продолжительность их жизни [2, 4]. Для контроля наличия инфекции мочевых путей (ИМП) и функции почек рекомендуется раз в год выполнять общий анализ мочи, определять концентрацию креатинина в сыворотке крови [2, 4]. Уровень убедительности рекомендаций С (уровень достоверности доказательств– 5) Для своевременного выявления побочных эффектов медикаментозной терапии рекомендуется при каждом посещении пациентом врача выяснять переносимость назначенных лекарственных препаратов [2, 4]. Уровень убедительности рекомендаций С (уровень достоверности доказательств– 5) Организация оказания медицинской помощи Показания для плановой госпитализации в медицинскую организацию: Наличие показаний для оперативного вмешательства Показания для экстренной госпитализации: 1. Острая задержка мочи 2. Макрогематурия Показания к выписке пациента из стационара 1. Восстановление уродинамики; 2. Отсутствие признаков системного воспаления; 3. Отсутствие риска осложнений. 6. Дополнительная информация, влияющая на течение и исход заболевания Нет. Критерии оценки качества медицинской помощи № Критерии качества Оценка выполнения 1 Выполнено ультразвуковое исследование мочевого пузыря с определением остаточной мочи, ультразвуковое исследование предстательной железы трансректальное Да/Нет 2 Выполнено исследование уровня общего простатоспецифического антигена в крови Да/Нет 3 Выполнена урофлоуметрия Да/Нет 4 Выполнено хирургическое вмешательство, при наличии показаний и отсутствии противопоказаний Да/Нет Список литературы 1. Jacobsen SJ, Girman CJ, Lieber MM. Natural history of benign prostatic hyperplasia. Urology. 2001;58(6 Suppl 1):5–16. 2. Пушкарь Д.Ю., Раснер П.И. Симптомы нижних мочевыводящих путей и доброкачественная гиперплазия предстательной железы. // Урология 2006; № 3 (приложение): с. 4-18. 3. Emberton M, Fitzpatrick JM, Garcia-Losa M, Qizilbash N, Djavan B. Progression of benign prostatic hyperplasia: systematic review of the placebo arms of clinical trials. BJU Int. 2008;102:981–6. 4. 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