cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLCcardiovascular-2175Research ArticleМЕТАБОЛИЧЕСКИЙ СИНДРОМ И САХАРНЫЙ ДИАБЕТMETABOLIC SYNDROME AND DIABETES MELLITUSВклад отдельных составляющих метаболического синдрома в процесс ремоделирования сердца у женщинRole of the individual metabolic syndrome components and heart remodelling progression in womenХурсЕ. М.KhursE. M.

доцент кафедры внутренних болезней № 1, начмед МЦ Шанс

lmk@olympus.ruДмитриевА. Н.DmitrievA. N.

доцент кафедры внутренних болезней, эндокринологии и клинической фармакологии

ПоддубнаяА. В.PoddubnayaA. V.

ассистент кафедры внутренних болезней, эндокринологии и клинической фармакологии

ФутерманЕ. М.FutermanE. M.

ассистент кафедры внутренних болезней, эндокринологии и клинической фармакологии

ГОУ ВПО Уральская государственная медицинская академия Росздрава. ЕкатеринбургUral State Medical Academy. Yekaterinburg201001011970981722Copyright © Хурс Е.М., Дмитриев А.Н., Поддубная А.В., Футерман Е.М., 19701970Хурс Е.М., Дмитриев А.Н., Поддубная А.В., Футерман Е.М.Khurs E.M., Dmitriev A.N., Poddubnaya A.V., Futerman E.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/2175

Цель. Проанализировать изменения структурных и функциональных параметров сердца у женщин в зависимости от составляющих компонентов метаболического синдрома (МС). Материал и методы. Обследованы 245 женщин, сравнимых по возрасту и уровню АД: с АГ без дислипидемии (ДЛП) и ожирения (Ож) (n=100) — контрольная группа (гр.) (ГК); АГ + ДЛП без Ож (n=37) — гр. 1; АГ + ДЛП + абдоминальное Ож (АО) — окружность талии (ОТ)=104,84±15,92 см, без нарушений углеводного обмена (n=93) — гр. 2; АГ + ДЛП + АО и нарушение толерантности к глюкозе (НТГ) (n=15) — гр. 3; АГ + ДЛП + АО и впервые выявленный сахарный диабет (СД) 2 типа (n=22) — гр. 4. Всем выполнены ЭхоКГ с расчетом индексов ремоделирования ЛЖ, пероральный глюкозотолерантный тест и исследование липидного спектра сыворотки крови. Результаты. ДЛП не вносит самостоятельного вклада в структурно-функциональную перестройку сердца. У пациенток с МС и нарушением углеводного обмена (НТГ или СД) процессы ремоделирования носят дезадаптивный характер. Повышение индекса массы тела (ИМТ) и гипергликемия ассоциированы с ухудшением систолической функции сердца: нарастание МСс, снижение ФВ и более раннее развитие сердечной недостаточности у пациенток с МС и нарушениями углеводного обмена. Заключение. У женщин с различными комбинациями составляющих МС нарушения структуры и функции сердца разнородны. Инсулинорезистентность провоцирует нарастание МСс и снижение ФВ. Повышение ИМТ, уровня глюкозы сыворотки крови и гликозилированного гемоглобина ассоциировано с ухудшением систолической функции сердца и более ранним развитием сердечной недостаточности у женщин с МС.

Aim. To analyze the dynamics of heart structure, geometry, and function in women, in accordance with present components of metabolic syndrome (MS). Material and methods. In total, 245 women, comparable by age and blood pressure (BP) levels, were examined: with arterial hypertension (AH), but without dyslipidemia (DL) or obesity (O) (control group, CG; n=100); with AH and DL, but without O (Group 1; n=37); with AH, DL, abdominal O (mean waist circumference, WC, 104,84±15,92 cm), but without carbohydrate metabolism disturbances (Group 2; n=93); with AH, DL, abdominal O and impaired glucose tolerance, IGT (Group 3; n=15); with AH, DL, abdominal O and new-onset Type 2 diabetes mellitus (DM-2) (Group 4; n=22). All participants underwent echocardiography, with the assessment of left ventricular (LV) remodelling indices, oral glucose tolerance test, and serum lipid profile assessment. Results. DL did not demonstrate an independent role in heart structural and functional changes. In women with MS and impaired carbohydrate metabolism (IGT or DM), remodelling was a manifestation of disadaptation. In these patients, increased body mass index (BMI) and plasma glucose levels were associated with impaired systolic function (increased systolic myocardial stress, reduced ejection fraction, and earlier development of heart failure). Conclusion. In women with various combinations of MS components, heart structure and function changes are different. Insulin resistance facilitates the progression of systolic myocardial stress and myocardial contractility reduction. Increased levels of BMI, serum glucose and glycated hemoglobin were associated with impaired systolic function and earlier development of heart failure in women with MS.

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The authors declare that there are no conflicts of interest present.