Порівняльна характеристика функціональних показників ендотелію у хворих на хронічне обструктивне захворювання легень в умовах коморбідності

Abstract

Вивчались показники функції ендотелію у хворих на хронічне обструктивне захворювання легень (ХОЗЛ) в умовах коморбідності з ішемічною хворобою серця (ІХС) та метаболічним синдромом (МС). Встанов¬лено, що наявність коморбідної ІХС, а особливо в поєднанні з МС, супроводжується більш значним погіршен¬ням показників функціонального стану ендотелію. Свідченням тому є відповідні зміни як вазоконстрикторів (ЕТ-1) та вазодилататорів (метаболітів оксиду азота), так і показників морфометрії плечової артерії; Изучались показатели функции эндотелия у больных хронической обструктивной болезнью лег¬ких (ХОБЛ) в условиях коморбидности с ишемической болезнью сердца (ИБС) и метаболическим синдро¬мом (МС). Установлено, что наличие коморбидной ИБС, а особенно в сочетании с МС, сопровождается более значительным ухудшением показателей функционального состояния эндотелия. Свидетельством тому стали соответствующие изменения как вазоконстрикторов (эндотелина-1) и вазодилататоров (метаболитов оксида азота), так и показателей морфометрии плечевой артерии; Еstimation of endothelial function’s indices in the patients with chronic obstructive pulmonary disease (COPD) at conditions of comorbidity with coronary artery disease (CAD) and metabolic syndrome (MS) has been carried out. 45 outpatients with COPD of the second stage (male-30, female-15, mean age – 61,3±5,4) were examined. There were 15 patients with comorbid CAD (the 2nd group), 15-with comorbid CAD and MS (the 3nd group) among them. The 1st group included 15 patients with the isolated COPD. The patients’ status was medicamentous compensation. All the groups were of the same sex and age. The control group consisted of 10 practically healthy individuals of the same sex and age. It has been established that significant increase of endothelin-1(ET-1) occurs not only in patients of the 2nd and the 3rd group in comparison with the 1st group (accordingly, 1,41 times and 1,88 times as much as among the 1st group, р<0,001), but also in case of comparison of the 3rd and the 2 nd groups (1,33 times, р<0,001). Clear regularity also was observed during the analysis of content of the stable metabolites of nitrogen oxide (NOХ). Their concentration, on the contrary, was decreased in the patients of the 2nd and the 3rd groups in comparison with the 1st (accordingly, 1,43 times and 1,79 times as little as among the patients of the 1st group, р<0,001). Decrease of this index in the patients of the 3rd group (20,1±1,7 μmol/l) in comparison with the 2nd group (25,1±1,3 μmol/l) was also significant (р<0,05), but less than statistical difference of the preceding index. We have established the significant increase of the diameter of the right brachial artery (DRBA) only in the patients of the 2nd and the 3rd groups in comparison with the 1st (accordingly, 1,24 times and 1,31 times as much as among the patients of the 1st group, р<0,001). As for the comparison of this index between the 2nd and the 3rd groups, it is necessary to note that there is just an insignificant tendency to increase in case of combination of CAD and MS with COPD (the 2nd group – 5,2±0,2 mm; the 3rd group – 5,5±0,2 mm). The same result (but to the side of decrease) was obtained during the analysis of endothelium-dependent vasodilatation (EDVD) (the difference was significant only between the 2nd and the 1st, the 3rd and the 1st groups, р<0,001). As for endothelium-independent vasodilatation (EIVD), we have revealed not only significant differences between the 2nd and the 1st groups (р<0,001), the 3rd and the 1st groups (р<0,001) but also significant decrease of this index (1,30 times) in the patients of the 3rd group in comparison with the 2nd group (р<0,05). Such a decrease of the two last-mentioned indices can be connected with diminishing of smooth muscles cells’ sensitivity to nitrovasodilators (that can be observed in case of hypoxia, signs of the heart failure, metabolic imbalance) and with intensification of the vasoconstrictor factors. Difference of initial blood velocity in the patients with comorbid pathology was more significant (the 2nd group – 0,55±0,007 м/с, the 3rd group – 0,51±0,005 m/sec., (р<0,001), not to mention the more significant decrease of these indices in comparison with the 1st group. Analysis of hyperemia (percentage of increase of the blood velocity) has shown a significant decrease of this index in the patients of the 2nd group in comparison with the 1st (р<0,01), and especially in the patients of the 3rd group in comparison with the 1st (р<0,001). In our opinion, this result and the preceding data are the confirmation of the negative influence of comorbid pathology upon the functional state of endothelium. At the same time, its significant difference between patients of the 2nd and the 3rd groups wasn’t established in spite of decrease of this index in case of comorbidity of COPD with CAD and MS. Thus, the presence of comorbid CAD and, peculiarly, CAD combined with MS in the patients with COPD is accompanied by more significant worsening of the indices of the functional state of endothelium. The changes of both vasoconstrictors (ET-1), vasodilators (NOX) and indices of brachial artery’s morphometry are the evidence for it.