cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLC10.15829/1728-8800-2023-3706TWOHHCcardiovascular-3706Research ArticleЭНДОВАСКУЛЯРНЫЕ ВМЕШАТЕЛЬСТВАENDOVASCULAR INTERVENTIONSОтдаленные результаты применения ренальной денервации в лечении коморбидных пациентов с артериальной гипертензией, сахарным диабетом и атеросклерозом коронарных артерийLong-term outcomes of renal denervation in the treatment of comorbid patients with hypertension, diabetes and coronary atherosclerosishttps://orcid.org/0000-0002-7294-7274АраблинскийН. А.ArablinskyN. A.

Никита Александрович Араблинский — врач-кардиолог, аспирант отдела инновационных эндоваскулярных методов профилактики и лечения сердечно-сосудистых заболеваний

Москва

Moscow

nekit1868@yandex.ruhttps://orcid.org/0000-0003-3851-4544ФещенкоД. А.FeshchenkoD. A.

Дарья Анатольевна Фещенко — младший научный сотрудник отдела инновационных эндоваскулярных методов профилактики и лечения сердечно-сосудистых заболеваний, врач рентгенэндоваскулярных методов диагностики и лечения, зав. операционным блоком

Москва

Moscow

nekit1868@yandex.ruhttps://orcid.org/0000-0003-0346-9069РуденкоБ. А.RudenkoB. A.

Борис Александрович Руденко — доктор медицинских наук, врач рентгенэндоваскулярных методов диагностики и лечения, руководитель отдела инновационных эндоваскулярных методов профилактики и лечения сердечно-сосудистых заболеваний

Москва

Moscow

nekit1868@yandex.ruhttps://orcid.org/0000-0001-7307-1502ШукуровФ. Б.ShukurovF. B.

Фирдавс Баходурович Шукуров — кандидат медицинских наук, старший научный сотрудник отдела инновационных эндоваскулярных методов профилактики  и лечения сердечно-сосудистых заболеваний, врач рентгенэндоваскулярных методов диагностики и лечения

Москва

Moscow

nekit1868@yandex.ruhttps://orcid.org/0000-0003-2602-5006ВасильевД. К.VasilievD. K.

Дмитрий Константинович Васильев — кандидат медицинских наук, научный сотрудник отдела инновационных эндоваскулярных методов профилактики и лечения сердечно-сосудистых заболеваний, врач рентгенэндоваскулярных методов диагностики и лечения

Москва

Moscow

nekit1868@yandex.ruhttps://orcid.org/0000-0002-4453-8430ДрапкинаО. М.DrapkinaO. M.

Оксана Михайловна Драпкина — доктор медицинских наук, профессор, академик РАН, директор

Москва

Moscow

nekit1868@yandex.ruФГБУ "Национальный медицинский исследовательский центр терапии и профилактической медицины" Минздрава РоссииNational Medical Research Center for Therapy and Preventive Medicine20230610202322937063706Copyright © Араблинский Н.А., Фещенко Д.А., Руденко Б.А., Шукуров Ф.Б., Васильев Д.К., Драпкина О.М., 20232023Араблинский Н.А., Фещенко Д.А., Руденко Б.А., Шукуров Ф.Б., Васильев Д.К., Драпкина О.М.Arablinsky N.A., Feshchenko D.A., Rudenko B.A., Shukurov F.B., Vasiliev D.K., Drapkina O.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/3706Цель

Цель. Изучить клинические эффекты и отдаленные результаты катетерной денервации почек (РДН) у пациентов с сердечно-сосудистой патологией и сахарным диабетом (СД).

Материалы и методы

Материалы и методы. В одноцентровое проспективное рандомизированное исследование были включены 60 пациентов с неконтролируемой артериальной гипертензией, СД 2 типа и ишемической болезнью сердца (ИБС) после полной эндоваскулярной реваскуляризации. Пациенты были рандомизированы по 30 человек в группу РДН и контрольную группу. РДН проводилась феморальным доступом катетером Spyral (Medtronic, USA). Первичной конечной точкой являлась оценка динамики уровня гликемии через 12 месяцев.

Результаты

Результаты. В группе РДН выявлено достоверное снижение уровня базальной гликемии с 9,3 (7,67-10,12) до 6,05 (5,2-8,3),  гликированного гемоглобина с 7,6 (6,9-8,4) до 6,6 (6,2-7,2) ммоль/л, степени инсулинорезистентности (индекс HOMA-IR) с 6,6 (3,73-11,2) до 4,76 (2,73-7,1) – при отсутствии значимых изменений в контрольной группе. Также выявлено значимое снижение среднего уровня офисного систолического (-14 (-24; -10) мм рт.ст., р = 0,0002) и диастолического артериального давления (-10 (-10; -6) мм рт.ст., р = 0,0007) – при отсутствии значимой динамики в контрольной группе. Поздняя потеря просвета статистически не различалась и составила 21,8% (17,3-28,8) в группе РДН против 26,3% (19,5-34,0) в группе контроля – p = 0,09.

Заключение

Заключение. Выявлено положительное влияние РДН на показатели углеводного обмена у пациентов с СД 2 типа, АГ и ИБС, а также подтверждена гипотеза о плейотропных эффектах РДН.  

Aim

Aim. To study the clinical effects and long-term outcomes of catheterbased renal denervation (CRD) in patients with cardiovascular disease and diabetes.

Material and methods

Material and methods. This single-center prospective observational study included 60 patients with uncontrolled hypertension, type 2 diabetes, and coronary artery disease after complete endovascular revascularization. Patients were divided into 30 groups into the CRD group and the control group. CRD was performed via femoral access using a Spyral catheter (Medtronic, USA). The primary endpoint was the change in glycemic levels after 12 months.

Results

Results. In the CRD group, a significant decrease in basal glycemia level from 9,3 (7,67-10,12) to 6,05 (5,2-8,3) mmol/l, glycated hemoglobin from 7,6 (6,98,4) to 6,6 (6,2-7,2)%, Homeostasis Model Assessment Insulin Resistance (HOMA-IR) from 6,6 (3,73-11,2) to 4,76 (2,73-7,1) — in the absence of significant changes in the control group. A significant decrease in the average level of office systolic (-14 (-24; -10) mm Hg, p=0,0002) and diastolic blood pressure (-10 (-10; -6) mm Hg, p=0,0002), p=0,0007) was also revealed — in the absence of significant changes in the control group. There were no significant differences in late lumen loss between the groups: 21,8% (17,3-28,8) in the CRD group vs 26,3% (19,5-34,0) in the control group (p=0,09).

Conclusion

Conclusion. A positive effect of CRD on carbohydrate metabolism in patients with type 2 diabetes, hypertension and coronary artery disease was revealed. The hypothesis of the pleiotropic effects of CRD was confirmed.

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