ФГБОУ ВО Амурская ГМА Минздрава России г. Благовещенск В настоящее время хроническая обструк-тивная болезнь легких (ХОБЛ) -широко рас-пространенное заболевание, которым страда-ет 4-6% взрослого населения старше 45 лет с неуклонно прогрессирующим ростом смертно-сти [8]. Наличие внелегочных эффектов ХОБЛ, среди которых наибольшую актуальность име-ет развитие сердечно-сосудистой патологии, позволяет определять ХОБЛ как системное заболевание [2, 3]. Одним из потенциальных системных проявлений ХОБЛ является повре-ждение и активация сосудистого эндотелия с развитием эндотелиальной дисфункции (ЭД), которая является предиктором риска разви-тия сердечно-сосудистых катастроф [5, 7].Под ЭД понимают нарушение паритета между продукцией вазодилатирующих, анги-опротективных, антипролиферативных факто-ров, с одной стороны, и вазоконстрикторных, протромботических, пролиферативных про-дуцентов эндотелия -с другой. По мнению не-которых авторов, выделяют гемостатический, вазомоторный, адгезиогенный, ангиогенный типы ЭД [4]. Как правило, в конкретной клини-ческой ситуации могут сочетаться несколько вариантов нарушения функциональной актив-ности сосудистого эндотелия, поэтому в крови происходит изменение содержания различных факторов ДЭ. Самыми изученными биохими-ческими маркерами ЭД являются эндотелин-1РЕЗЮМЕ У 69 человек в возрасте 56,8±2,5 лет, страдающих хронической обструктивной болезнью лег-ких (ХОБЛ) тяжелого течения, категорий высокого риска в период обострения изучено плазмен-ное содержание фактора Виллебранда (фВ) и проанализирована его взаимосвязь с некоторыми параметрами системного воспаления и биомаркерами эндотелиальной дисфункции (ЭД). При ХОБЛ уровень фВ выше, чем у здоровых добровольцев в 1,2 раза (р<0,05), что свидетельствует о наличии у пациентов ХОБЛ ЭД. Обнаружена прямая коррелляционная зависимость содержания фВ от высокочувствительного С-реактивного белка (r=+0,54; р<0,05), фактора некроза опухоли-альфа (r=+0,47; р<0,05), эндотелина-1(ЭТ-1) (r=+0,58; р<0,05) и общего гомоцистеина (r=+0,55; р<0,05).Ключевые слова: хроническая обструктивная болезнь легких, дисфункция эндотелия, фак-тор Виллебранда, системное воспаление. DOI Важным маркером, отражающим состоя-ние эндотелиальных клеток, является и фактор Виллебранда (фВ). Это самый большой суль-фитированный гликопротеид плазмы крови с молекулярным весом от 540 до нескольких тысяч кДа, участвующий как в сосудисто-тром-боцитарном (первичном), так и в коагуляцион-ном (вторичном) гемостазе. фВ имеет два пути секреции: непосредственная секреция после синтеза и полимеризации, которая создает определенный уровень фВ в крови, и регуля-торная секреция из пулов хранения, которыми являются эндотелиальные клетки, в ответ на различную стимуляцию. В случае поврежде-ния клетки эндотелия освобождение фВ уве-личивается, что дает основание некоторым ав-торам предлагать использовать его в качестве индикатора эндотелиальной и эндокардиаль-ной дисфункции [6].Несмотря на имеющиеся достижения в из-учении функционального состояния сосуди-стого эндотелия, остается открытым ряд вопро-сов, в ...
Aim of studies: evaluate the action of complex therapy with rophlumilast on clinical course in the patients with COPD of C, D types during a year.Materials and methods 69 patients with COPD of high risk (GOLD, 2011) at the age of 42-75 years treated in the specialized pulmonary department from 2012 to 2015 were included. COPD was diagnosed on the ground of clinic instrumental methods of examination taking into account international and federal documents. The patients were divided in to 2 groups by the simple blind method in the dependence on the volume of administered therapy. The males (82,5%) were predominated. Diagnostics of COPD were performed on the ground of clinical instrumental methods of examination taking into account the international and federal documents. The patients of the irst group (n=38) took the preparations of the irst choice recommended GOLD (2013), in the treatment of the second group (n=31) the drug rophlumilast ("Daxas") was added at the dosage 500vkg once a day in the evenings daily during a year. The groups were equal to the sex, duration of COPD and case history of smoking, basic therapy. Complex clinical instrumental examinations of the patients were made in the period of randomization: initial data, in 6 and 12 months of studies.The examination program included estimation of respiratory complaints (cough, sputum) according to the scale: 0-no symptom, 1-slight manifestation of the symptom, 2-moderate manifestation of the symptom, 3-severe manifestation of the symptom. Rate of dyspnea manifestation was evaluated due to the well-known scale mMRC (0-4 points) illed in by the patients independently.Also a number of occurred attacks in patients in comparison with frequency ones in last year was evaluated. Control and treatment correction were performed once a month at the out-patient department.The data obtained were processed due to program Statistica 6.1 (Statsoft). Descriptive statics presented by 95% veriied interval to the mean data. Taking into consideration asymmetric distribution of signs non parametric methods of variable statistics were used: comparison of dependence choices was made with criteria by Vilcockson; comparison of independence choices was performed with U-criteria by Mann-Whitney. Critical level of signiicance was equal to 0,05.
Aim. To analyze indicators of the vascular endothelium function in patients with chronic obstructive pulmonary disease (COPD) depending on the COVID-19 history.Materials and methods. 98 patients with stable COPD who had COVID-19, regardless of the severity of the infection, were examined 4-8 weeks after discharge from the infectious disease hospital (Group 1). The comparison group included 50 patients with stable COPD without a history of COVID-19 (Group 2). To assess the vascular endothelium function, in all patients the following were determined: endothelin-1 (ET-1, fmol/L), total homocysteine (Hcy, µmol/L), antigen to von Willebrand factor (vWF, fmol/L), C-reactive protein (CRP, mg/L). The following parameters of arterial stiffness (AS) were recorded using sphygmomanometry (Vasera-1000, Japan): pulse wave velocity (PWV, m/s), right/left cardio-ankle vascular index (R/L-CAVI, units), augmentation index on the right shoulder (R-AI, units), augmentation index on the common carotid artery (C-AI, units).Results. The concentration of biomarkers Hcy, ET-1, vWF in the 1st group was significantly higher than in the 2nd group (p<0.01, p<0.05 and p<0.05, respectively). The studied parameters of AS in patients with COPD were significantly higher than the reference values, regardless of the presence of a COVID-19 history. In patients of the 1st group, the indices R-AI and CAI (p<0.05) were significantly higher than in patients of the 2nd group. Correlation analysis showed relationships between R-CAVI and CRP (r=0.513, p<0.001) and CRP and ET-1 (r=0.485, p<0.01).Conclusion. In patients with COPD, the past COVID-19 leads to more significant shifts in the functional activity of the vascular endothelium than in isolated COPD of a stable course and is associated with active systemic inflammation.
Introduction. According to current data, the COPD phenotype without frequent exacerbations is frequently encountered and requires close attention. However, in the course of a literary search, it was possible to find only isolated scientific works with a generalized description of the features of this phenotype. Aim. The aim of the study is to compile a typical clinical portrait of a patient with the COPD phenotype without frequent exacerbations based on the analysis of clinical, laboratory and functional parameters. Material and methods. The study included 45 patients aged 57.2±1.1 years with a diagnosis of COPD without frequent exacerbations in age. In all patients, the concentration of proinflammatory cytokines, C-reactive protein in blood serum was determined by immunoferment analysis. Results and discussion. Males (93.3%) with a smoker index of 33.7± 2.5 packs/years and a disease duration of more than 10 years dominated the studied cohort. The average score on the CAT test was 10.32±0.05 points, on the mMRC scale more than two points. The post - bronchodilation value of FEV1 corresponded to the average severity of obstructive disorders in 91.1% of individuals. Among the examined patients, persons with bronchitic type of COPD predominated (53.3%). The concentration of inflammatory biomarkers determined in the blood serum significantly exceeded the levels of the reference values. Also, patients with COPD with the studied phenotype was found to have low adherence to treatment and dispensary observation and late visit to the doctor. Conclusions. The obtained results of the study made it possible to draw up a clinical portrait of the patient with the COPD phenotype without frequent exacerbations.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.