Aim. To study the relationship between parameters of cardiointervalometry and ergoreflex, and 6-minute walk test data in patients with chronic obstructive pulmonary disease (COPD). Materials and Methods. The study included 103 men, of them 63 patients with COPD, 40 patients of the control group. Functional assessment of external respiration and a 6-minute walk test were performed using Spiropalm 6MWT equipment (Cosmed, Italy). The autonomic status and the influence of the ergoreflex on it were assessed by the method of cardiointervalometry before, during and after the test with external peripheral vascular occlusion using Varicard hardware and software complex (LLC Ramena, Ryazan, Russia). Results. When performing a 6-minute walk test, significant differences were obtained between the groups of patients with COPD and of the control group in the majority of the studied parameters (p0.01). In 18 of 63 patients with COPD, the level of SpO2 in 6-minute walk test decreased by 4% (p0.01). The obtained result is of considerable importance for assessment of exercise tolerance in patients with COPD. In tests with external peripheral vascular occlusion in patients with COPD and of the control group, the index of activity of regulatory systems (IARS) increased in both groups. However, after completion of the test, the index in patients with COPD decreased below the initial values (p0.05), and in patients of the control group the changes were even more pronounced (p0.01). Patients with COPD were divided into groups depending on the distance covered in 6-minute walk test. Analysis of the data revealed a moderate positive correlation between the covered distance and the forced expiratory volume in the 1st second (FEV1, R=0.45, p0.01).The maximum level of the total effect of the autonomic regulation of blood circulation was recorded in patients who covered the minimum distance (227.7748.13 m) in 6-minute walk test. Besides, a moderate negative correlation between IARS and the results of 6-minute test was recorded (R=-0.34, p0.01). Conclusions. 1. For assessment of the functional status of patients in 6-minute walk test it is important to take measurement of saturation throughout the whole test. 2. The change in IARS values in the test with external peripheral vascular occlusion can be regarded as a reduction of the influence of reflex from the lower limb ergoreceptors on the functional condition of patients. 3. Patients with COPD showed a marked autonomic imbalance. IARS showed a moderate negative correlation with the distance covered in 6-minute walk test. 4. Maximum value of IARS was obtained in patients with the minimal distance covered in 6-minute walk test.

Aim. To evaluate changes in the cardiointervalogram (CIG) in the test with external peripheral vascular occlusion in patients with chronic obstructive pulmonary disease (COPD) and in individuals without diseases of the respiratory system. Materials and Methods. The study included 105 men, of them 64 patients with COPD (age 64.988.67) and 41 volunteers without diseases of the respiratory system (age 61.689.21). The autonomic status was examined and alterations in CIG in the test with occlusion were evaluated on Varicard hardware and software complex (OOO Ramena, Russia). Results. The obtained data showed the autonomic imbalance with predomination of the activity of sympathetic division of the autonomic nervous system (ANS) in patients with COPD as compared to the control group (p0.05). A study of ergoreflex by analysis of changes in CIG showed reduction of the activity of sympathetic division of the ANS in the test with external peripheral vascular occlusion in individuals without diseases of the respiratory system. In patients with COPD, changes in CIG in the test were less expressed and not always achieved statistically significant level (p0.05). Conclusions. Differences in the results of the test with external peripheral vascular occlusion in patients with COPD and volunteers without diseases of the respiratory system are attributed to hyperactivation of ergofeflex in patents with COPD.

Рязанский государственный медицинский университет имени академика И.П. Павлова, Рязань, Российская Федерация _____________________________________________________________________________ Цель. Изучение функциональных показателей системы дыхания у больных хронической обструктивной болезнью легких (ХОБЛ) различной степени тяжести при выполнении 6минутного шагового теста (6МШТ). Материалы и методы. Настоящее исследование было выполнено на 64 пациентах с ХОБЛ разной степени тяжести при отсутствии обострений последние 6 недель. Критериями невключения пациентов в данное исследование были другие заболевания, которые влияют на пройденное расстояние при проведении 6МШТ. Во время ходьбы была выполнена динамическая пульсоксиметрия и оценка изменений вентиляторных параметров дыхания на оборудовании Spiropalm 6MWT (Cosmed, Италия). Результаты. У больных ХОБЛ различной степени тяжести (I-IV) при проведении 6МШТ установлена высокая частота (39%) встречаемости пациентов с десатурацией (SpO 2 ≥4%). При этом следует отметить, что в группе «десатураторов» имелся исходно более низкий показатель SpO 2. Также отмечено увеличение числа пациентов-«десатураторов» от I-II степени тяжести ХОБЛ (0%; 24%) к III и IV степени (40%; 36%). Разница между показателями сатурации (SpO 2) у «недесатураторов» и «десатураторов» статистически значима и составляет соответственно: уровень SpO 2 до выполнения 6МШТ-94,38±2,45% и 92,48±3,33% (p<0,01), средний уровень SpO 2 при выполнении 6МШТ-93,69±2,27% и 86,92±3,84% (p<0,001), минимальный уровень SpO 2 при выполнении 6МШТ-92,85±2,33% и 83,72±5,38% (p<0,001), уровень SpO 2 сразу после выполнения 6МШТ-94,1±2,26% и 86,4±4,72% (p<0,001). В 23,1% случаев самые низкие показатели SpO 2 отмечались сразу после выполнения 6МШТ, однако в 76,9% случаев были установлены в процессе выполнения 6МШТ. Важным является в группе «десатураторов» наличие соответствия падения сатурации при физической нагрузке нарастанию степени тяжести обструктивных нарушений (ОФВ 1). Выводы. У больных ХОБЛ II-IV степени тяжести в 39% случаях отмечается «скрытая» десатурация (SpO 2 ≥4%) при проведении 6МШТ. Установлено статистически значимое снижение ОФВ 1 (p<0,001) у больных имеющих снижение ≥4% показателя SpO 2. Оценка сатурации у больных ХОБЛ должна проводиться на протяжении всего времени выполнения теста и по его окончании для выявления наиболее низких показателей SpO 2. Ключевые слова: хроническая обструктивная болезнь легких; 6-минутный шаговый тест; пульсоксиметрия; десатурация; функциональные показатели.

BACKGROUND: Considering the economic costs of managing patients with chronic obstructive pulmonary disease (COPD), as well as the high mortality and disability rate, it is necessary to improve the diagnosis of the disease, to look for new approaches to assessing the functional status of patients. AIM: Is to study the functional status of patients with COPD. MATERIALS AND METHODS: A comprehensive approach was applied to assess the functional status of patients: the data of the 6-minute walk test (6MWT), heart rate variability (HRV) was studied, ergoreflex was assessed according to HRV data. 64 patients with COPD and 41 male volunteers without respiratory diseases older than 40 years were examined. Statistical processing of the obtained results was carried out using the licensed package of applied statistical programs Excel 2010 and Statistica 10. RESULTS: The group of patients with COPD and the respondents of the control group were comparable in terms of body mass index, heart rate, respiratory rate, index of indicators of activity of regulatory systems (p > 0.05). As expected, during the 6MWT, differences were obtained between the studied groups in terms of the distance covered (p < 0.01). Similarly, the results of the study of the function of external respiration showed a statistically significant difference in all the studied parameters (p < 0.01). The results obtained confirmed the presence of impaired respiratory function in the group of patients with COPD. Analysis of HRV values, when conducting a test with external peripheral vascular occlusion, confirmed ergoreflex hyperactivity in patients with COPD. CONCLUSION: The integration of methods for routine clinical diagnostics of patients condition (spirometry, 6-minute walk test, assessment of autonomic status) and the introduction of the study of ergoreflex activity made it possible to expand the understanding of the functional state of patients with COPD and is of great interest for further research.