sibmedСибирский научный медицинский журналСибирский научный медицинский журнал2410-25122410-2520ИЦиГ СО РАН10.15372/SSMJ20200116sibmed-346Research ArticleКЛИНИЧЕСКАЯ МЕДИЦИНАCLINICAL MEDICINEСОСТОЯНИЕ НУТРИТИВНОГО СТАТУСА И ФАКТОРЫ РИСКА РАЗВИТИЯ СЕРДЕЧНО-СОСУДИСТЫХ ЗАБОЛЕВАНИЙ У БОЛЬНЫХ НА ПРОГРАММНОМ ГЕМОДИАЛИЗЕTHE STATE OF NUTRITIONAL STATUS AND ITS IMPACT ON THE LEVEL OF COMORBIDITY IN PATIENTS ON HEMODIALYSISКоролеваИ. Е.KorolevaI. Ye.

630087, г. Новосибирск, ул. Немировича-Данченко, 130

630087, Novosibirsk, Nemirovich-Danchenko str., 130

inna.koroleva.1986@inbox.ruАбрамоваЕ. Э.AbramovaYe. E.

к.м.н., 

630091, г. Новосибирск, Красный просп., 52

630091, Novosibirsk, Krasny av., 52 

eamed1974@mail.ruТовН. Л.TovN. L.

д.м.н., проф.,

 630091, г. Новосибирск, Красный просп., 52

630091, Novosibirsk, Krasny av., 52 

nikita.tov@gmail.ruМовчанЕ. А.MovchanYe. A.

д.м.н., 

 630091, г. Новосибирск, Красный просп., 52

630091, Novosibirsk, Krasny av., 52 

emovchan@gmail.ruОвечкинаЮ. В.OvechkinaYu. V.

к.м.н., 

630091, г. Новосибирск, Красный просп., 52

630091, Novosibirsk, Krasny av., 52 

jbaboshkina@mail.ruЛогиноваА. Б.LoginovaA. B.

630091, г. Новосибирск, Красный просп., 52

Anastasiavinci@ngs.ruГосударственная Новосибирская областная клиническая больницаРоссияNovosibirsk State Regional Clinical HospitalRussian FederationНовосибирский государственный медицинский университет Минздрава РоссииРоссияNovosibirsk State Medical University of Minzdrav of RussiaRussian Federation202008032020401115123Copyright © Королева И.Е., Абрамова Е.Э., Тов Н.Л., Мовчан Е.А., Овечкина Ю.В., Логинова А.Б., 20202020Королева И.Е., Абрамова Е.Э., Тов Н.Л., Мовчан Е.А., Овечкина Ю.В., Логинова А.Б.Koroleva I.Y., Abramova Y.E., Tov N.L., Movchan Y.A., Ovechkina Y.V., Loginova A.B.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://sibmed.elpub.ru/jour/article/view/346

Цель исследования – изучить состояние нутритивного статуса и выявить факторы риска развития сердечнососудистых заболеваний у больных на гемодиализе.

Материал и методы

Материал и методы. Обследовано 144 пациента на программном гемодиализе. Всем больным проводили общеклиническое и лабораторное обследование, исследовали липидный профиль, рассчитывали индекс массы тела, измеряли окружность талии (ОТ) и бедер (ОБ), определяли индекс ОТ/ОБ, выполняли интегральную многочастотную биоимпедансометрию, мультиспиральную компьютерную томографию брюшной полости.

Результаты

Результаты. У больных на программном гемодиализе выявлены гендерные особенности распределения абдоминальной жировой ткани и дислипидемии. У женщин происходит преимущественное накопление висцеральной жировой ткани, в то время как для мужчин характерно пропорциональное распределение подкожной и висцеральной жировой клетчатки в абдоминальной области. Женщины по сравнению с мужчинами имеют наиболее высокие показатели атерогенных фракций липопротеинов, уровень которых тесно связан с объемом висцеральной жировой ткани. Среди сопутствующей патологии у обследованных больных преобладают заболевания сердечно-сосудистой системы. В результате регрессионного анализа выявлено, что наиболее значимыми факторами риска для развития ИБС являются повышение содержания липопротеинов низкой плотности, для хронической сердечной недостаточности – увеличение окружности талии.

Заключение

Заключение. Полученные данные свидетельствуют о необходимости контроля за состоянием нутритивного статуса у больных на гемодиализе для выявления и коррекции факторов риска развития сердечно-сосудистой патологии.  

The aim of the study was to investigate the nutritive status and identify risk factors for cardiovascular disease in patients on hemodialysis.

Material and methods

Material and methods. 144 patients on program hemodialysis were examined. All patients underwent general clinical and laboratory examination, lipid profile was examined, body mass index was calculated, waist and hip circumference was measured, ratio of waist circumference to the circumference of hip was determined, abdominal integral multi-frequency bioimpedansometry and multispiral computed tomography were performed.

Results

Results. Gender features of distribution of abdominal adipose tissue and dyslipidemia in patients on program hemodialysis were revealed. Women have a predominant accumulation of visceral adipose tissue, while men are characterized by a proportional distribution of subcutaneous and visceral adipose tissue in the abdominal area. Women compared to men have higher rates of atherogenic lipoprotein fractions, which level is closely related to the volume of visceral adipose tissue. Among the comorbidities in the examined patients, diseases of the cardiovascular system predominate. The regression analysis revealed that the most significant risk factor for the development of coronary artery disease is an increase in lowdensity lipoproteins, for chronic heart failure – an increase in waist circumference.

Conclusions

Conclusions. The data obtained indicate the need to monitor the nutritional status of patients on hemodialysis to identify and correct risk factors for cardiovascular disease.

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