ОСОБЕННОСТИ КЛИНИЧЕСКОЙ КАРТИНЫ И ДИАГНОСТИКИ МУКОВИСЦИДОЗА

  • Ю.М. Баканова Санкт-Петербургский государственный педиатрический медицинский университет. 194100, Российская Федерация, г. Санкт-Петербург, ул. Литовская, д. 2
  • К.В. Гульмамедова Санкт-Петербургский государственный педиатрический медицинский университет. 194100, Российская Федерация, г. Санкт-Петербург, ул. Литовская, д. 2
  • А.Ю. Трапезникова Санкт-Петербургский государственный педиатрический медицинский университет. 194100, Российская Федерация, г. Санкт-Петербург, ул. Литовская, д. 2
Ключевые слова: муковисцидоз, диагностика

Аннотация

Муковисцидоз, или кистозный фиброз, — распространенное наследственное заболевание, обусловленное мутацией гена CFTR, ответственного за синтез, сохранение структуры и функции белка CFTR. Муковисцидоз проявляется, в первую очередь, патологией со стороны желудочно-кишечного тракта и дыхательной системы. Недостаток функции белка при данной патологии приводит к повышению вязкости секрета экзокринных желез, обтурации органов и нарушению их функций, как следствие возникают стеаторея, мальабсорбция, сахарный диабет, нарушение метаболизма, задержка физического развития и хронический бронхолегочный процесс. В данной статье будут рассмотрены основные аспекты особенностей клинического течения и диагностики данного заболевания.

Литература

Кондратьева E.И., Каширская Н.Ю., Рославце- ва Е.А. Обзор национального консенсуса «Муковисцидоз: определение, диагностические критерии, терапия» для диетологов и гастроэнтерологов. Вопросы детской диетологии. 2018; 16(1). С. 58–74.

López-Valdez J.A., Aguilar-Alonso L.A., Gándara- Quezada V. et al. Cystic fibrosis: current concepts. Bol Med Hosp Infant Mex. 2021;78(6). Р. 584-596. DOI: 10.24875/BMHIM.20000372.

Регистр пациентов с муковисцидозом в Рос- сийской Федерации. 2020 год. / Под редакцией Е.И. Кондратьевой, С.А. Красовского, М.А. Стари- новой и др. М.: МЕДПРАКТИКА-М; 2022. С. 68.

De Boeck K. Cystic fibrosis in the year 2020: disease with a new face. Acta Paediatr. 2020;109(5). Р. 893– 899. DOI: https://doi.org/10.1111/apa.15155.

Lopes-Pacheco M. CFTR modulators: Shedding light on precision medicine for cystic fibrosis. Front Pharmacol. 2016;7. Р.275. DOI: https://doi. org/10.3389/fphar.2016.00275.

Капранов Н.И., Каширская Н.Ю. Муковисцидоз. М.: МЕДПРАКТИКА-М; 2014. С. 672.

Mogayzel P.J., Naureckas E.T., Robinson K.A. Cystic Fibrosis Pulmonary Guidelines. Am J Respir Crit Care Med. 2013;187(7):680–689. DOI: https://doi. org/10.1164/rccm.201207-1160oe.

Национальный консенсус «Муковисцидоз: опре- деление, диагностические критерии, терапия» / под ред. Е.И. Кондратьевой, Н.Ю. Каширской, Н.И. Капранова. М.: ООО «Компания БОРГЕС»; 2016. С. 205.

Demco C.A., Stern R.C., Doershuk C.F. Stenotrophomonas maltophilia in cystic fibrosis: incidence and prevalence. Pediatr Pulmonol. 1998;25(5):304–308. DOI: https://doi.org/10.1002/ (sici)1099-0496(199805)25:53.0.co;2-i.

Denning D.W., Cadranel J., Beigelman-Aubry C. et al. Chronic pulmonary aspergillosis: rationale and clinical guidelines for 188 diagnosis and management. Eur Respir J. 2016;47(1):45–68. DOI: https://doi.org/10.1183/13993003.00583-2015.

Kosmidis C., Denning D.W. The clinical spectrum of pulmonaryaspergillosis. Thorax. 2015;70(3):270–277. DOI: https://doi.org/10.1136/thoraxjnl-2014-206291.

Шагинян И.А., Капранов Н.И., Чернуха М.Ю. и др. Микробный пейзаж нижних дыхательных путей у различных возрастных групп детей, больных муковисцидозом. Журнал микробиологии, эпидемиологии и иммунобиологии. 2010. № 1. С. 15– 20.

Burke M.S., Ragi J.M., Karamanoukian H.L. et al. New strategies in thenon-operative management of meconium ileus. J Pediat Surg. 2002;37(5):760– 764. DOI: https://doi.org/10.1053/jpsu.2002.32272.

Кондратьева Е.И., Шерман В.Д., Амелина Е.Л. и др. Клинико-генетическая характеристика и исходы мекониевого илеуса при муковисцидозе. Российский вестник перинаталогии и педиатрии. 2016. Т. 61. № 6. С. 77–81. DOI: https://doi. org/10.21508/1027-4065-2016-6-77-81.

Debray D., Narkewicz M.R., Bodewes F.A. et al. Cystic Fibrosis-related Liver Disease: Research Challenges and Future Perspectives. J Pediatr Gastroenterol Nutr. 2017;65(4):443–448. DOI: https://doi. org/10.1097/MPG.0000000000001676.

Ciucă I.M., Pop L., Tămaş L. et al. Cystic fibrosis liver disease-from diagnosis to risk factors. Rom J Morphol Embryol. 2014;55(1). Р. 91–95.

Klotter V., Gunchick C., Siemers E. et al. Assessment of pathologic increase in liver stiffness enables earlier diagnosis of CFLD: Results from a prospective longitudinal cohort study. PloS One. 2017;12(6):e0178784. DOI: https://doi.org/10.1371/ journal.pone.0178784.

Terliesner N., Vogel M., Steighardt A. et al. Cystic- fibrosis related-diabetes (CFRD) is preceded by and associated with growth failure and deteriorating lung function. J Pediatr Endocrinol Metab. 2017;30(8):815– 821. DOI: https://doi.org/10.1515/ jpem-2017-0005.

Edenborough FP. Women with cystic fibrosis and their potential for reproduction. Thorax. 2001;56(8):649–655. DOI: https://doi.org/10.1136/ thorax.56.8.649.

Амелина Е.Л., Красовский С.А., Шугинин И.О. Муковисцидоз и беременность: клинико-генетические, функциональные и микробиологические характеристики пациенток. Педиатрия. Журнал им. Г.Н. Сперанского. 2014. Т. 93. № 4. С. 38–43.

Aris R.M., Merkel P.A., Bachrach L.K. et al. Consensus statement: Guide to bone health and disease in cystic fibrosis. J Clin Endocrinol Metab. 2005;90(3):1888–1896. DOI: https://doi.org/10.1210/ jc.2004-1629.

Климко Н.Н. Микозы: диагностика и лечение: ру- ководство для врачей. 3-е изд., перераб. и доп. М.: Фармтек; 2017. С. 272.

Орлов А. В., Симонова О. И., Рославцева Е. А., Шадрин Д.И. Муковисцидоз (клиническая картина, диагностика, лечение, реабилитация, диспансеризация): учебное пособие для врачей. СПб.: Изд-во СЗГМУ им. И. И. Мечникова, 2014. С. 160.

Castellani C., Duff A.J.A., Bell S.C. et al. ECFS best practice guidelines: the 2018 revision. J Cyst Fibros. 2018;17(2).Р.153–178. DOI: https://doi.org/10.1016/j. jcf.2018.02.006.

Stevens D.A., Moss R.B., Kurup V.P. et al. Allergic bronchopulmonary aspergillosis in cystic fibrosis — state of the art: Cystic Fibrosis Foundation Consensus Conference. Clin Infect Dis. 2003;37(Suppl 3). Р.S225–S264. DOI: https://doi. org/10.1086/376525.

Liu J.C., Modha D.E., Gaillard E.A. What is the clinical significance of filamentous fungi positive sputum cultures in patients with cystic fibrosis? J Cyst Fibros. 2013;12(3). Р.187–193. DOI: https://doi.org/10.1016/j. jcf.2013.02.003.

Geller D.E., Kaplowitz H., Light M.J., Colin A.A. Allergic bronchopulmonary aspergillosis in cystic fibrosis: reported prevalence, regional distribution, and patient characteristics. Scientific Advisory Group, Investigators, and Coordinators of the Epidemiologic Study of Cystic Fibrosis. Chest. 1999;116(3). Р.639–646. DOI: https://doi.org/10.1378/ chest.116.3.639.

Zolin A., Orenti A., van Rens J. et al. ECFS Patient Registry. Annual Data Report (2017 data). Version 1.2019. Available online: https://www.ecfs.eu/ sites/default/files/general- content- images/ workinggroups/ecfs-patient-registry/ECFSPR_ Report2017_v1.3.pdf. Accessed on April 17, 2022.

Leung D.H., Narkewicz M.R. Cystic Fibrosis-related cirrhosis. J Cyst Fibros. 2017;16(Suppl 2). Р.50–S61. DOI: https://doi.org/10.1016/j.jcf.2017.07.002.

Pseudo-Bartter’s syndrome. In: Clinical Guidelines: Care of Children with Cystic Fibrosis. Royal Brompton Hospital; 2020. Vol. 8. P. 173–174.

Akata D., Akhan O. Liver manifestations of cystic fibrosis. Eur J Radiol. 2007;61(1).Р.11–17. DOI: https:// doi.org/10.1016/j.ejrad.2006.11.008.

Williams S.M., Goodman R., Thomson A. et al. Ultrasound evaluation of liver disease in cystic fibrosis as part of an annual assessment clinic: a 9-year review. Clin Radiol. 2002;57(5).Р.365–370. DOI: https://doi.org/10.1053/crad.2001.0861.

Mueller-Abt P.R., Frawley K.J., Greer R.M. et al. Comparison of ultrasound and biopsy findings in children with cystic fibrosis related liver disease. J Cyst Fibros. 2008;7(3).Р.215–221. DOI: https://doi. org/10.1016/j.jcf.2007.08.001.

Durand F., Valla D. Assessment of the prognosis of cirrhosis: Child-Pugh versus MELD. J Hepatol. 2005;42(Suppl 1).Р.100–S107. DOI: https://doi. org/10.1016/j.jhep.2004.11.015.

Moran A., Brunzell C., Cohen R.C. Clinical care guidelines for cystic fibrosis-related diabetes: a position statement of the American Diabetes Association and a clinical practice guideline of the Cystic Fibrosis Foundation, endorsed by the Pediatric Endocrine Society. Diabetes Care. 2010;33(12). Р.2697–2708. DOI: https://doi.org/10.2337/dc10-1768.

Gordon C.M., Leonard M.B., Zemel B.S. 2013 Pediatric Position Development Conference: Executive Summary and Reflections. J Clin Densitom. 2014;17(2).Р.219–224. DOI: https://doi. org/10.1016/j.jocd.2014.01.007.

Richards S., Aziz N., Bale S. et al. Rehm, the ACMG Laboratory Quality Assurance Committee Standardsand guidelines for the interpretation of sequence variants: a joint consensus recommendation of the American College of Medical Genetics and Genomics and the Association for Molecular Pathology. Genet Med. 2015;17(5).Р.405–424. DOI: http://doi.org/10.1038/gim.2015.30.

Turck D., Braegger C.P., Colombo C. et al. ESPEN- ESPGHANECFS guidelines on nutrition care for infants, children, and adults with cystic fibrosis. Clin Nutr. 2016;35(3).Р.557–577. DOI: http://doi. org/10.1016/j.clnu.2016.03.004.

Leifke E., Friemert M., Heilmann M. et al. Sex steroid sand body composition in men with cystic fibrosis. Eur J Endocrinol. 2003;148(5).Р.551–557. DOI: https:// doi.org/10.1530/eje.0.1480551.

Blackman S.M., Tangpricha V. Endocrine Disordersin Cystic Fibrosis. Pediatr Clin North Am. 2016;63(4).Р.699–708. DOI: https://doi.org/10.1016/j. pcl.2016.04.009.

Kang S.H., Dalcin P.T.R., Piltcher O.B, Migliavacca R.O. Chronic rhinosinusitis and nasal polyposis in cystic fibrosis: update on diagnosis and treatment. J Bras Pneumol. 2015;41(1).Р.65–76. DOI: https://doi. org/10.1590/S1806-37132015000100009.

Исаков Ю.Ф., Дронова А.Ф. Детская хирургия: национальное руководство. М.: ГЭОТАР-Медиа; 2009. С. 328–331.

REFERENCES

Kondrat'eva E.I., Kashirskaya N.Yu., Roslavtseva E.A. Obzor natsional'nogo konsensusa «Mukovistsidoz: opredelenie, diagnosticheskie kriterii, terapiya» dlya dietologov i gastroenterologov [Review of national consensus "Mukovistsidoz: definition, dia- gnostic criteria, therapy" for nutritionists and gastroenterologists]. Voprosy detskoy dietologii. 2018; 16(1). S. 58–74. (in Russian).

López-Valdez J.A., Aguilar-Alonso L.A., Gándara-Quezada V. et al. Cystic fibrosis: current concepts. Bol Med Hosp Infant Mex. 2021;78(6). R. 584-596. DOI: 10.24875/BMHIM.20000372.

Registr patsientov s mukovistsidozom v Rossiyskoy Federatsii [Register of cystic fibrosis patients in the Russian Federation]. 2020 god. /Pod redaktsiey E.I. Kondrat'evoy, S.A. Krasovskogo, M.A. Starinovoy i dr. M.: MEDPRAKTIKA-M, 2022, S. 68. (in Russian).

De Boeck K. Cystic fibrosis in the year 2020: disease with a new face. Acta Paediatr. 2020;109(5). P. 893– 899. DOI: https://doi.org/10.1111/apa.15155.

Lopes-Pacheco M. CFTR modulators: Shedding light on precision medicine for cystic fibrosis. Front Phar- macol. 2016;7. S. 275. DOI: https://doi.org/10.3389/ fphar.2016.00275.

Kapranov N.I., Kashirskaya N.Yu. Mukovistsidoz [Cystic fibrosis]. M.: MEDPRAKTIKA-M; 2014. S. 672. (in Russian).

Mogayzel P.J., Naureckas E.T., Robinson K.A. Cyst- ic Fibrosis Pulmonary Guidelines. Am J Respir Crit Care Med. 2013;187(7):680–689. DOI: https://doi. org/10.1164/rccm.201207-1160oe.

Natsional'nyy konsensus «Mukovistsidoz: opre- delenie, diagnosticheskie kriterii, terapiya» [Natio- nal Consensus Cystic Fibrosis: Definition, Diagnos- tic Criteria, Therapy] / pod red. E.I. Kondrat'evoy, N.Yu. Kashirskoy, N.I. Kapranova. M.: OOO «Kom- paniya BORGES»; 2016. S. 205. (in Russian).

Demco C.A., Stern R.C., Doershuk C.F. Stenotro- phomonas maltophilia in cystic fibrosis: incidence and prevalence. Pediatr Pulmonol. 1998;25(5):304– 308. DOI: https://doi.org/10.1002/ (sici)1099- 0496(199805)25:53.0.co;2-i.

Denning D.W., Cadranel J., Beigelman-Aubry C. et al. Chronic pulmonary aspergillosis: rationale and clinical guidelines for 188 diagnosis and management. Eur Respir J. 2016;47(1):45–68. DOI: https://doi.org/10.1183/13993003.00583-2015.

Kosmidis C., Denning D.W. The clinical spectrum of pulmonary aspergillosis. Thorax. 2015;70(3):270–277. DOI: https://doi.org/10.1136/thorax- jnl-2014-206291.

Shaginyan I.A., Kapranov N.I., Chernukha M.Yu. i dr. Mikrobnyy peyzazh nizhnikh dykhatel'nykh putey u razlichnykh vozrastnykh grupp detey, bol'nykh mukovistsidozom [Microbic landscape of the lower airways at various age groups of children, patients mukovistsidozy]. Zhurnal mikrobiologii, epide- miologii i immunobiologii. 2010. № 1. S. 15–20. (in Russian).

Burke M.S., Ragi J.M., Karamanoukian H.L. et al. New strategies in thenon-operative management of meconium ileus. J Pediat Surg. 2002;37(5):760– 764. DOI: https://doi.org/10.1053/jpsu.2002.32272.

Kondrat'eva E.I., Sherman V.D., Amelina E.L. i dr. Kliniko-geneticheskaya kharakteristika i iskhody mekonievogo ileusa pri mukovistsidoze [Clinical genetic characteristics and outcomes of meconium ileus in cystic fibrosis]. Rossiyskiy vestnik peri- natalogii i pediatrii. 2016. T. 61. № 6. S. 77–81. DOI: https://doi.org/10.21508/1027-4065-2016-6-77-81. (in Russian).

Debray D., Narkewicz M.R., Bodewes F.A. et al. Cys- tic Fibrosis-related Liver Disease: Research Challenges and Future Perspectives. J Pediatr Gastro- enterol Nutr. 2017;65(4):443–448. DOI: https://doi. org/10.1097/MPG.0000000000001676.

Ciucă I.M., Pop L., Tămaş L. et al. Cystic fibrosis liver disease-from diagnosis to risk factors. Rom J Morphol Embryol. 2014;55(1). R.91–95.

Klotter V., Gunchick C., Siemers E. et al. Assess- ment of pathologic increase in liver stiffness enables earlier diagnosis of CFLD: Results from a prospective longitudinal cohort study. PloS One.2017;12(6):e0178784. DOI: https://doi.org/10.1371/ journal.pone.0178784.

Terliesner N., Vogel M., Steighardt A. et al. Cystic- fibrosis related-diabetes (CFRD) is preceded by and associated with growth failure and deterio- rating lung function. J Pediatr Endocrinol Metab. 2017;30(8):815– 821. DOI: https://doi.org/10.1515/ jpem-2017-0005.

Edenborough FP. Women with cystic fibrosis and their potential for reproduction. Thorax. 2001;56(8):649–655. DOI: https://doi.org/10.1136/ thorax.56.8.649.

Amelina E.L., Krasovskiy S.A., Shuginin I.O. Muko- vistsidoz i beremennost': kliniko-geneticheskie, funktsional'nye i mikrobiologicheskie kharakte- ristiki patsientok [Mukovistsidoz and pregnancy: kliniko-genetic, functional and microbiological characteristics of patients]. Pediatriya. Zhurnal im.G.N. Speranskogo. 2014. T. 93. № 4. S. 38–43. (in Russian).

Aris R.M., Merkel P.A., Bachrach L.K. et al. Consensus statement: Guide to bone health and disease in cystic fibrosis. J Clin Endocrinol Metab. 2005;90(3):1888–1896. DOI: https://doi.org/10.1210/ jc.2004-1629.

Klimko N.N. Mikozy: diagnostika i lechenie: rukovodstvo dlya vrachey [Mycoses: diagnostics and treatment: the management for doctors]. 3-e izd., pererab. i dop. M.: Farmtek; 2017. S.272. (in Russian).

Orlov A.V., Simonova O.I., Roslavtseva E.A., Shad- rin D.I. Mukovistsidoz (klinicheskaya kartina, diagnostika, lechenie, reabilitatsiya, dispanserizatsiya): uchebnoe posobie dlya vrachey [Mukovistsidoz (clinical picture, diagnostics, treatment, rehabili- tation, medical examination): manual for doctors]. SPb.: Izd-vo SZGMU im. I. I. Mechnikova, 2014. S.160. (in Russian).

Castellani C., Duff A.J.A., Bell S.C. et al. ECFS best practice guidelines: the 2018 revision. J Cyst Fibros. 2018;17(2). P. 153–178. DOI: https://doi.org/10.1016/j. jcf.2018.02.006.

Stevens D.A., Moss R.B., Kurup V.P. et al. Allergic bronchopulmonary aspergillosis in cystic fibrosis — state of the art: Cystic Fibrosis Foundation Consen- sus Conference. Clin Infect Dis. 2003;37(Suppl 3). R.S225–S264. DOI: https://doi.org/10.1086/376525.

Liu J.C., Modha D.E., Gaillard E.A. What is the cli- nical significance of filamentous fungi positive sputum cultures in patients with cystic fibrosis? J Cyst Fibros. 2013;12(3). P. 187–193. DOI: https://doi. org/10.1016/j.jcf.2013.02.003.

Geller D.E., Kaplowitz H., Light M.J., Colin A.A. Aller- gic bronchopulmonary aspergillosis in cystic fibrosis: reported prevalence, regional distribution, and patient characteristics. Scientific Advisory Group, In vestigators, and Coordinators of the Epidemiologic Study of Cystic Fibrosis. Chest. 1999;116(3). P. 639– 646. DOI: https://doi.org/10.1378/chest.116.3.639.

Zolin A., Orenti A., van Rens J. et al. ECFS Patient Registry. Annual Data Report (2017 data). Version 1.2019. Available online: https:// www.ecfs.eu/sites/ default/files/general-content-images/working- groups/ecfs-patient-registry/ECFSPR_Report2017_ v1.3.pdf. Accessed on April 17, 2022.

Leung D.H., Narkewicz M.R. Cystic Fibrosis-related cirrhosis. J Cyst Fibros. 2017;16(Suppl 2). P. 50–S61. DOI: https://doi.org/10.1016/j.jcf.2017.07.002.

Pseudo-Bartter’s syndrome. In: Clinical Guidelines: Care of Children with Cystic Fibrosis. Royal Brompton Hospital; 2020. Vol.8. P. 173–174.

Akata D., Akhan O. Liver manifestations of cystic fi- brosis. Eur J Radiol. 2007;61(1). P. 11–17. DOI: https:// doi.org/10.1016/j.ejrad.2006.11.008.

Williams S.M., Goodman R., Thomson A. et al. Ultra- sound evaluation of liver disease in cystic fibrosis as part of an annual assessment clinic: a 9-year review. Clin Radiol. 2002;57(5). P. 365–370. DOI: https://doi. org/10.1053/crad.2001.0861.

Mueller-Abt P.R., Frawley K.J., Greer R.M. et al. Comparison of ultrasound and biopsy findings in children with cystic fibrosis related liver disease. J Cyst Fibros. 2008;7(3). P. 215–221. DOI: https://doi. org/10.1016/j.jcf.2007.08.001.

Durand F., Valla D. Assessment of the prognosis of cirrhosis: Child-Pugh versus MELD. J Hepatol. 2005;42(Suppl 1). P. 100–S107. DOI: https://doi. org/10.1016/j.jhep.2004.11.015.

Moran A., Brunzell C., Cohen R.C. Clinical care guidelines for cystic fibrosis-related diabetes: a position statement of the American Diabetes Associ- ation and a clinical practice guideline of the Cystic Fibrosis Foundation, endorsed by the Pediatric Endocrine Society. Diabetes Care. 2010;33(12). P. 2697– 2708. DOI: https://doi.org/10.2337/dc10-1768.

Gordon C.M., Leonard M.B., Zemel B.S. 2013 Pedi- atric Position Development Conference: Executive Summary and Reflections. J Clin Densitom. 2014;17(2). P. 219–224. DOI: https://doi.org/10.1016/j. jocd.2014.01.007.

Richards S., Aziz N., Bale S. et al. Rehm, the ACMG Laboratory Quality Assurance Committee Stan dards and guidelines for the interpretation of se- quence variants: a joint consensus recommendation of the American College of Medical Genetics and Genomics and the Association for Molecular Pathology. Genet Med. 2015;17(5). P. 405–424. DOI: http://doi.org/10.1038/gim.2015.30.

Turck D., Braegger C.P., Colombo C. et al. ESPEN- ESPGHANECFS guidelines on nutrition care for infants, children, and adults with cystic fibrosis. Clin Nutr. 2016;35(3). P. 557–577. DOI: http://doi. org/10.1016/j.clnu.2016.03.004.

Leifke E., Friemert M., Heilmann M. et al. Sex steroid sand body composition in men with cystic fibro- sis. Eur J Endocrinol. 2003;148(5). P. 551–557. DOI: https://doi.org/10.1530/eje.0.1480551.

Blackman S.M., Tangpricha V. Endocrine Disor- dersin Cystic Fibrosis. Pediatr Clin North Am. 2016;63(4). P. 699–708. DOI: https://doi.org/10.1016/j. pcl.2016.04.009.

Kang S.H., Dalcin P.T.R., Piltcher O.B, Migliavacca R.O. Chronic rhinosinusitis and nasal polyposis in cystic fibrosis: update on diagnosis and treatment. J Bras Pneumol. 2015;41(1). P. 65–76. DOI: https://doi. org/10.1590/S1806-37132015000100009.

Isakov Yu.F., Dronova A.F. Detskaya khirurgiya: natsio- nal'noe rukovodstvo [Children's surgery: national lea- ders]. M.: GEOTAR-Media; 2009. S. 328–331. (in Russian).

Опубликован
2023-11-10
Как цитировать
Баканова, Ю., Гульмамедова, К., & Трапезникова, А. (2023). ОСОБЕННОСТИ КЛИНИЧЕСКОЙ КАРТИНЫ И ДИАГНОСТИКИ МУКОВИСЦИДОЗА. Детская медицина Северо-Запада, 11(3), 97-109. https://doi.org/10.56871/CmN-W.2023.34.39.007
Раздел
Статьи