Влияние терапии постоянным положительным давлением на показатели углеводного и липидного обменов у больных с синдромом Z

Цель. Оценить влияние терапии постоянным положительным давлением (СРАР-терапии) на показатели углеводного и липидного обменов у больных с метаболическим синдромом (МС) в сочетании с синдромом обструктивного апноэ сна (СОАС).
Материал и методы. В исследование были включены 62 пациента c МС, 20 женщин и 42 мужчины в возрасте 39-66 лет (средний возраст – 52,4±7,6). 15 пациентов без СОАС составили контрольную группу, у 47 (основная группа) был диагностирован СОАС различной степени тяжести. 11 пациентов основной группы в течение 12 недель находились на СРАР-терапии. До начала исследования и через 12 недель использования СРАР-терапии у пациентов проводили антропометрическое обследование: рост, массы тела (МТ), объема талии (ОТ) и бедер (ОБ), определение индекса МТ (ИМТ); биохимическое исследование крови: общий холестерин (ОХС), ХС липопротеидов высокой плотности (ХС ЛВП), триглицериды (ТГ), глюкоза, пероральный тест толерантности к глюкозе; определяли уровень лептина, резистина и адипонектина; использовали суточное мониторирование артериального давления.
Результаты. Показатели МТ, ИМТ, ОТ, ОТ/ОБ, ОХС снизились, но недостоверно. Уровень ХС ЛВП повысился с 0,99±0,2 ммоль/л до 1,12±0,1 ммоль/л (р<0,05). Концентрация ТГ уменьшилась с 4,18±3,3 ммоль/л до 2,31±1,2 ммоль/л (р<0,05). Содержание глюкозы натощак снизилось с 5,8±0,8 ммоль/л до 5,3±0,3 ммоль/л (р<0,05) и после нагрузки с 8,3±1,8 ммоль/л до 6,5±1,9 ммоль/л (р<0,05). Уровни адипоцитокинов достоверно улучшались: концентрация лептина снизилась с 15,14±4,6 до 11,17±5,2 нг/мл (р<0,05); резистин уменьшился с 3,02±0,87 до 2,5±0,51 нг/мл (p<0,05); уровень адипонектина повысился с 2,44±0,6 до 3,34±0,9 нг/мл (p<0,05).
Заключение. Эффективная СРАР-терапия достоверно улучшает метаболические показатели у больных МС с СОАС.

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