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Abstract
Abstract.
INFLUENCE OF HORMONAL DISORDERS ON ENDOTHELIAL DYSFUNCTION IN PATIENTS WITH ARTERIAL HYPERTENSION AND COMORBIDE ENDOCRINOPATHIES
Bilovol O.M., Nemtsova V.D., Ilchenko I.A., Zlatkina V.V.
Purpose: to investigate the effect of hormonal changes on endothelial dysfunction (ED) in patients with a comorbid course of hypertension (H), type 2 diabetes mellitus (T2DM) and subclinical hypothyroidism (SHT). Methods: 183 patients with H stage II were divided into 3 groups: Group 1 (n=50) - with isolated H (comparison group); Group 2 (n=63) - with a combined course of H and T2DM; Group 3 (n=70) - with comorbidity of H, T2DM and SHT. Blood pressure levels, carbohydrate, lipid and thyroid metabolism, plasma insulin concentration, insulin resistance (IR) the HOMA-IR index, vascular endothelial growth factor (VEGF-A) plasma levels were investigated. Results: Dyslipidemia was more pronounced in group 2 than in group 1. The addition of SHT was accompanied by a tendency to increase all the atherogenic lipids. IR was observed in all patients groups and was significantly higher than in control group (p<0.05). Significant increase of VEGF-A levels in all patients groups in comparison with the control (p<0.05) was found. In group 2 VEGF-A was lower than in group 1, which is probably due to the protective effect of metformin. Analysis of the influence of thyroid dysfunction degree on ED revealed significant increase of VEGF-A levels in TSH>6.0 μMU/ml subgroup (352.55±17.64 pg/ml vs 461.74±20.13 pg/ml (p<0.05)). Conclusion: Hormonal disorders contribute to aggravation of endothelial dysfunction in patients with hypertension and comorbid endocrinopathies - type 2 diabetes mellitus and subclinical hypothyroidism. Even minor decrease in thyroid function lead to the progression of endothelial dysfunction.
Key words: hypertension, type 2 diabetes mellitus, subclinical hypothyroidism, endothelial dysfunction
Резюме.
ВПЛИВ ГОРМОНАЛЬНИХ ПОРУШЕНЬ НА ЕНДОТЕЛІАЛЬНУ ДИСФУНКЦІЮ УПАЦІЄНТІВ З АРТЕРІАЛЬНОЮ ГІПЕРТЕНЗІЄЮ ТА КОМОРБІДНИМИ ЕНДОКРИНОПАТІЯМИ
Біловол О.М., Немцова В.Д., Ільченко І.А., Златкіна В.В.
Мета: дослідити вплив гормональних змін на ендотеліальну дисфункцію (ЕД) у пацієнтів з коморбідним перебігом артеріальної гіпертензії (АГ), цукрового діабету 2 типу (ЦД2Т) тасубклінічного гіпотиреозу (СГТ). Матеріали та методи: 183 пацієнта з АГ II стадії були розділені на 3 групи: 1-а група (n=50) - з ізольованою АГ (група порівняння); Група 2 (n=63) - з поєднаним перебігом АГ та ЦД2Т; Група 3 (n 70) – з комбінованим перебігом АГ, ЦД2Т і СГТ. Вивчали рівні артеріального тиску, показники вуглеводного, ліпідного і тиреоїдного обміну, концентрацію інсуліну в плазмі, індекс інсулінорезистентності (ІР) - HOMA-IR, рівні васкулоендотеліального фактора росту (VEGF-A) в плазмі. Результати. Ступінь дисліпідемії у 2-й групі була більш вираженою, ніж в 1-й. Приєднання СГТ супроводжувалося тенденцією до збільшення всіх атерогенних фракцій ліпідів. ІР спостерігалася у всіх групах пацієнтів і була достовірно більше, ніж у контрольній групі (р<0,05). Виявлено достовірне підвищення рівнів VEGF-A у всіх групах пацієнтів в порівнянні з контролем (р<0,05). В 2-й групі рівні VEGF-A були нижче, ніж в 1-й групі, що, ймовірно, пов'язано з протективним ефектом метформіну. Аналіз впливу ступеня гіпофункції щитовидної залози на ЕД виявив значне збільшення рівнів VEGF-A в підгрупі TSH> 6,0 мкМ / мл (352,55 ± 17,64 пг / мл і 461,74 ± 20,13 пг / мл відповідно, р <0,05). Висновки. Гормональні порушення сприяють погіршенню ендотеліальної дисфункції у пацієнтів з артеріальною гіпертензією та супутніми ендокринопатіями - цукровим діабетом 2 типу та субклінічним гіпотиреозом. Навіть незначне зниження функції щитовидної залози призводить до прогресування ендотеліальної дисфункції.
Ключові слова: гіпертензія, цукровий діабет 2 тип, субклінічний гіпотиреоз, ендотеліальна дисфункція
Резюме.
ВЛИЯНИЕ ГОРМОНАЛЬНЫХ НАРУШЕНИЙ НА ЭНДОТЕЛИАЛЬНУЮ ДИСФУНКЦИЮ У ПАЦИЕНТОВ С АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИЕЙ И КОМОРБИДНЫМИ ЭНДОКРИНОПАТИЯМИ
Беловол О.М., Немцова В.Д., Ильченко И.А., Златкина В.В.
Цель: исследовать влияние гормональных изменений на эндотелиальную дисфункцию (ЭД) у пациентов с коморбидным течением артериальной гипертензии (АГ), сахарного диабета 2 типа (СД2Т) и субклинического гипотиреоза (СГТ). Материалы и методы: 183 пациента с АГ IIстадии были разделены на 3 группы: 1-я группа (n = 50) - с изолированной АГ (группа сравнения); Группа 2 (n = 63) - с сочетанным течением АГ и СД2Т; Группа 3 (n = 70) - комбинированное течение АГ, СД2Т и СГТ. Изучали уровни артериального давления, показатели углеводного, липидного и тиреоидного обмена, концентрацию инсулина в плазме, индекс инсулинорезистентности (ИР)- HOMA-IR, уровни васкулоэндотелиального фактора роста(VEGF-A) в плазме. Результаты. Степень дислипидемии во 2-й группе была более выраженной, чем в 1-й. Присоединение СГТ сопровождалось тенденцией к увеличению всех атерогенных фракций липидов. ИР наблюдалась во всех группах пациентов и была достоверно больше, чем в контрольной группе (р<0,05). Выявлено достоверное повышение уровней VEGF-A во всех группах пациентов по сравнению с контролем (р <0,05). Во 2-й группе уровни VEGF-A были ниже, чем в 1-й группе, что, вероятно, связано с протективным эффектом метформина. Анализ влияния степени дисфункции щитовидной железы на ЭД выявил значительное увеличение уровней VEGF-A в подгруппе TSH> 6,0 мкМ/мл (352,55 ± 17,64 пг / мл и 461,74 ± 20,13 пг / мл соответственно, р<0,05). Заключение. Гормональные нарушения способствуют ухудшению эндотелиальной дисфункции у пациентов с артериальной гипертензией и сопутствующими эндокринопатиями - сахарным диабетом 2 типа и субклиническим гипотиреозом. Даже незначительное снижение функции щитовидной железы приводит к прогрессированию эндотелиальной дисфункции.
Ключевые слова: гипертензия, сахарный диабет 2 тип, субклинический гипотиреоз, эндотелиальная дисфункция
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