Хронічне обструктивне захворювання легень у поєднанні з метаболічним синдромом

Abstract

В останні роки в клінічному перебігу хронічного обструктивного захворювання легень (ХОЗЛ) приділяють увагу розвитку метаболічного синдрому (МС). МС визначається як комплекс метаболічних, гормональних і клінічних порушень, в основі яких лежить інсулінорезистентність та компенсаторна гіперінсулінемія. Кількість публікацій і інтерес до МС значно виріс в останні роки, особливо у хворих на ХОЗЛ. Значний інтерес практичних лікарів обумовлений тим, що МС є чинником високого розвитку серцево-судинної патології, цукрового діабету. Це ускладнює клінічний перебіг бронхолегеневої патології та приводить до розвитку хронічного легеневого серця. Проведені дослідження мають важливі значення для розробки оптимальної терапії цих хворих; В последние годы в клиническом течении хронической обструктивной болезни легких (ХОБЛ) уделяют внимание развитию метаболического синдрома (МС). Метаболический синдром определяется как комплекс метаболических, гормональных и клинических нарушений, в основе которых лежит инсу-линорезистентность и компенсаторная гиперинсулинемия. Количество публикаций и интерес к МС в последние годы значительно вырос, особенно у больных на ХОБЛ. Значительный интерес практических врачей обусловлен тем, что МС является фактором высокого развития сердечно-сосудистой патологии, сахарного диабета. Это усложняет клиническое течение бронхолегочной патологии и приводит к развитию хронического легочного сердца. Проведенные исследования имеют важное значение для разработки оптимальной терапии этих больных; Now chronic obstructive pulmonary disease (COPD) incidence has increased significantly – male to 25 %, female to 61%. Its growth occurs mainly among the people who are over 40 years old. The occurrence of a grave course of this disease and of the constant disability increases. According to the prognosis of the World Public Health Organization experts COPD will take 3rd place among all the lethal causes by 2020. There are two phenotypes of COPD: emphysematous and cachectic. But in contrast to these clinical types, during last years scientists have distinguished a group of the patients with metabolic syndrome (MS), prevalence of which has pandemic character. The following is typical for this phenotype: high frequency of cardiovascular diseases (ischemic heart disease, arterial hypertension), insulin resistance, type II diabetes, which influence negatively significantly on a clinical course of these patients. The main cause of the death of the patients with documented COPD isn’t respiratory problems, but - cardiovascular ones. The main elements (factors) of MS are the following: arterial hypertension, increase level of triglycerides, obesity (central, mainly), low level of high-density lipoproteins cholesterol. The interest to MS, particularly in patients with COPD (and amount of the scientific works, accordingly), has increased during last years. An addition of MS causes the changes of a clinical course of COPD, the increase of cardiovascular complications in earlier age, an impairment of a prognosis for the disease. It is connected with the peculiarities of the interaction and mutual influence of links of pathogenesis of COPD and MS. The greatest place in the development of MS among the patients with COPD belongs to the smoking. The letter leads to hyperinsulinemia, dyslipidemia, decrease of respiratory function, bronchial obstruction. The prevalence of MS among the patients with MS takes from 21 to 53 % (its early stages and in combination with heart diseases, particularly). The study of its clinical picture and diagnostics is an important question. Clinical picture of MS consists of collective symptoms: obesity, arterial hypertension, gout, sleep apnea, dyslipidemia. О.С. Чабан, О.О. Хаустова (2008) consider MS as psychosomatic disorder, for development of which psychological traumas are important. They make much of anxiety-depressive and hypochondriac states, single life, stress. It is necessary to take the patient’s complaints both from bronchopulmonary system (COPD) and other organs and systems; pay your attention to heredity (in anamnesis), mark signs of central obesity (during inspection). The development of systemic subclinical inflammation is key link, which connects COPD and components of MS. In case of development of more intensive and elongated inflammatory answer - its physiological function is lost. It leads to tense work of endocrine system with release of great concentration of hormones, neuromediators into the blood, activation of cytokine mechanisms. It is manifested by increase of the lung failure, remodeling of myocardium with overload and hypertrophy of the right heart parts on the background of their dilatation. Addition of MS to the patients with COPD, in combination with hypertensive, ischemic heart disease peculiarly, complicates clinical prognosis of disease significantly. Increase of cardiovascular complications amount (worsening its prognosis) testifies about it. Presence of MS precipitates pneumosclerosis and pulmonary emphysema forming and causes formation of microtrombosis in the vessels of internal organs. Insulin resistance and dyslipidemia are in the basis of progressing of COPD on the background of MS and forming of cardiovascular complications. These pathogenic changes result to disorder of endothelial regulation of vascular tone, hemorheological disturbances. The latter potentiate development of chronic hypoxia, lung failure, fast forming of ischemic heart disease. Carried out studies have a great importance for development of the optimal therapy of these patients.