Вивчення факторів ризику хронічного обструктивного захворювання легень на фоні метаболічного синдрому

Abstract

Встановлено, що надмірна вага тіла, куріння відіграє ключову роль у формуванні патологічного процесу як при хронічному обструктивному захворюванні легень (ХОЗЛ), так і при метаболічному синдромі (МС). Приєднання МС у хворих на ХОЗЛ, особливо в поєднанні з гіпертонічною хворобою, ішемічною хворобою серця, цукровим діабетом значно ускладнює клінічний перебіг захворювання, дозволяє прогнозувати високий ризик серцево-судинних ускладнень у цих пацієнтів, погіршує його прогноз; Установлено, что избыточный вес тела, курение играет ключевую роль в формировании патологического процесса как при хроническом обструктивном заболевании легких (ХОЗЛ) , так и при метаболическом синдроме ( МС). Присоединение МС у больных ХОЗЛ, особенно в сочетании с гипертонической болезнью, ишемической болезнью сердца, сахарным диабетом значительно усложняет клиническое течение заболевания, позволяет прогнозировать высокий риск сердечно-сосудистых осложнений у этих пациентов, ухудшает его прогноз; Today, chronic obstructive pulmonary disease (COPD), along with arterial hypertension (AH), coronary heart disease (CHD) and diabetes mellitus (DM) are leading a group of chronic diseases, which accounted for over 30% of all other forms of human pathology. Due to the aging population and increasing prevalence of risk factors for COPD, especially smoking, we are seeing a steady increase in the number of patients with this disease. In our country, 58% of men and 14% of women consider themselves smokers. Striking prevalence of smoking among adolescents 13-16 years - it has reached 50%. According to British research firm ERC Ukraine ranks second in the world in the number of cigarettes smoked per year per person. On average Ukrainian smokes cigarettes per year in 2500, or seven units per day. According to studies of COPD is the fourth largest in the structure of total mortality and characterized by persistent tendency to increase, by 2020 it could take 3rd place among the leading causes of death for man. The most common comorbidities in COPD are cardiovascular, including: coronary heart disease (CHD), hypertension (AH), atrial fibrillation (AF) and heart failure (HF). Note the clinical course of myocardial infarction in patients with COPD, such as less pain syndrome and more pronounced shortness of breath, which often leads to delays in seeking medical help as a patient condition evaluates as exacerbation of COPD. The problem of COPD complicated by the fact that the disease is diagnosed at fairly advanced stages. A lack of awareness not only about the symptoms and effects of COPD, but also the very existence of such pathology leads to the fact that even patients in the later stages unaware at the presence of the disease. Cough with sputum production, which is characteristic of the early stages of COPD, is regarded as a normal smoker's cough. This is due to many reasons: the attitude of the patient to the health, medical support to the imperfections of employees associated with substandard periodic medical examinations, insufficient provision of modern diagnostic equipment, poor training of doctors. Age - a frequent risk factor for COPD. To date, it remains unclear whether an independent risk factor for age or age only reflects the cumulative impact of external factors over a lifetime. With regard to gender, according to numerous studies, the incidence of and mortality from COPD is higher among men, but in developing countries practically neutralized the difference is likely due to widespread smoking. As for low birth weight - a risk factor for COPD is, the proof of associative links between birth weight and FEV1 in childhood; Some studies support the role of bronchopulmonary infections transferred in early childhood. According to WHO to date, the prevalence of metabolic syndrome (MS) has become a pandemic. One of the classic signs of a patient suffering from COPD was always reduced weight due to muscular dystrophy, which is caused by disorder of metabolism under the influence of systemic inflammation, hypoxia and prolonged use of β2-agonists. However, in recent decades formed COPD combination with MS, what a significant role overweight, smoking, which are the main risk factors for overall morbidity and mortality . They are associated with the development of insulin resistance, oxidative stress and increased content of cytokines, leading to endothelial dysfunction. Smoking leads to the development of hyperinsulinemia, dyslipidemia. Diagnosis of metabolic syndrome at this stage does not present much difficulty. It is necessary to point out the importance of prevention of this syndrome, as it is a "disease" of modern lifestyle payback for urbanization (lack of exercise, poor nutrition, and lack of physical activity). All of the above ultimately causes a number of diseases such as diabetes, heart attack, stroke and others. The leading role in the detection of COPD in the background MS should belong to primary care - family doctors, because they apply to patients with COPD and the first signs of MS. Careful attention to the patients, a detailed medical history with the discovery of major risk factors, functional study of patients with stage treatment in the outpatient department could facilitate earlier diagnosis of COPD and MS and reduce the cost of further treatment and rehabilitation of patients.