ometendoОжирение и метаболизмObesity and metabolism2071-87132306-5524Endocrinology Research Centre10.14341/omet2014433-40ometendo-6789Research ArticleНаучные исследованияOriginal studiesГормон роста и инсулиноподобный фактор роста - 1 в прогнозе течения ИБС у пациентов с ожирениемGrowth hormone and insulin-like growth factor-1 in prognosis coronary artery disease in patients with obesityШпагинаОльга ВикторовнаShpaginaOlga Viktorovna

клинический аспирант

MD postgraduate student

shpagina_olga@mail.ruБондаренкоИрина ЗиятовнаBondarenkoIrina Ziyatovna

д.м.н., главный научный сотрудник

MD, PhD, Chief Researcher

iz_bondarenko@mail.ruКуклинаМария ДмитриевнаKuklinaMaria Dmitrievna

PhD

m_kuklina@mail.ruМанченкоОксана ВладимировнаManchenkoOksana Vladimirovna

PhD

xana03@mail.ruКолесниковаГалина СергеевнаKolesnikovaGalina Sergeevna

Sc.D., Chief Researcher

shpagina_olga@mail.ruГончаровНиколай ПетровичGoncharovNikolay Petrovich

MD, PhD, professor, Chief Researcher

shpagina_olga@mail.ruФГБУ «Эндокринологический научный центр» Минздрава России, МоскваРоссияEndocrinology Research Centre, MoscowRussian FederationEndocrinology Research Centre, MoscowRussian Federation2014261020141143340Copyright © Шпагина О.В., Бондаренко И.З., Куклина М.Д., Манченко О.В., Колесникова Г.С., Гончаров Н.П., 20142014Шпагина О.В., Бондаренко И.З., Куклина М.Д., Манченко О.В., Колесникова Г.С., Гончаров Н.П.Shpagina O.V., Bondarenko I.Z., Kuklina M.D., Manchenko O.V., Kolesnikova G.S., Goncharov N.P.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.omet-endojournals.ru/jour/article/view/6789Введение

Введение. У пациентов с ожирением коронарный атеросклероз и хроническая недостаточность кровообращения (ХСН) прогрессируют быстрее и имеют более неблагоприятный отдаленный прогноз, чем у лиц с нормальным весом.

Цель

Цель. Изучить прогностическую значимость гормона роста (ГР) и инсулиноподобного фактора роста-1 (ИФР-1) в оценке сердечно-сосудистого риска у пациентов с избыточным весом и ожирением.

Материалы и методы

Материалы и методы. В исследование включено 75 мужчин (средний возраст 55,31±6,32 лет) с избыточной массой тела или ожирением 1-й степени (ИМТ 28,69±3,6 кг/м2), не имеющих сахарный диабет. В 1-ю группу вошли 45 пациентов с сохраненной систолической функцией левого желудочка (ЛЖ), которым была выполнена коронароангиография и подтверждена ишемическая болезнь сердца (ИБС) 2-3 ФК по NYHA (возраст пациентов составил 56,4±6,29 лет, ИМТ 28,69±3,69 кг/м2, АД 124±10,18/ 80±4,59 мм рт. ст.). Во 2-ю группу вошли 30 пациентов (возраст 53,6±6,1, ИМТ 28,68±3,52 кг/м2, АД 128±9/83±6,81 мм рт. ст.), у которых ИБС исключалась с помощью тредмил-теста. В этой группе также определялся индекс коронарного кальция. Всем участникам исследования проводился глюкозотолерантный тест (НТГ), оценивались показатели ЭхоКГ, общего холестерина (ХС), ХСЛНП, ХСЛВП, триглицериды (ТГ), ГР, ИФР-1.

Результаты

Результаты. Пациенты обеих групп не различались по возрасту, ИМТ, уровню АД. Средний уровень ИФР-1 в 1-й группе не отличался по сравнению со 2-й группой. Однако в 1-й группе чаще наблюдалось превышение референсных значений ИФР-1 по сравнению со 2-й группой (р=0,018). Превышение нормы ИФР-1 ассоциировалось с наличием АГ (р=0,002), ожирением (р=0,033), курением (р=0,049), КДР ЛЖ (р=0,045). Средний уровень ГР у пациентов с ИБС был достоверно ниже (р=0,046). Гормон роста отрицательно коррелировал с индексом коронарного кальция (р=0,005) и диаметром ЛП (р=0,025), положительно – с ФВ ЛЖ (р=0,023) и Е/А (р=0,043).

Выводы

Выводы: 1. У пациентов с ожирением относительный дефицит ГР достоверно чаще ассоциируется с гемодинамически значимым поражением коронарных артерий сердца. 2. Уровень ИФР-1 может быть полезным индивидуальным индикатором в оценке прогноза ИБС и ХСН у пациентов с ожирением.

Introduction

Introduction. In patients with obesity coronary atherosclerosis and chronic heart failure (CHF) progress rapidly and have a worse long-term prognosis than those with normal weight.

Objective

Objective: To investigate the prognostic significance of GH and IGF-1 in the evaluation of cardiovascular risk in patients with obesity.

Materials and Methods

Materials and Methods. The study included 75 men (mean age 55.31±6.32 years), which are overweight or have mild obesity (body mass index (BMI) 28.69±3.6 kg/m2). Group 1 included 45 patients (age 56.4±6.29 years, BMI 28.69±3.69 kg/m2, blood pressure 124±10.18/80±4.59 mm Hg) who underwent coronary angiography. Group 2 included 30 patients (mean age 53.6 ± 6.1 years, BMI 28.68±3.52 kg/m2, blood pressure 128±9/83±6.81 mm Hg), CAD who are excluded by treadmill test. The coronary artery calcium score was assessed in group 2. All participants were evaluated impaired glucose tolerance (IGT), triglycerides (TG), IGF-1 and GH, LPHD, LPLD, geometry of the heart chambers was assessed by echocardiography.

Results

Results. Patients in both groups did not differ in age, BMI, blood pressure. IGF-1 levels were not significantly different among the study groups. High circulating IGF-1 levels were frequently observed in group 1 (р=0.018). A statistically significant association of high IGF-1 observed with obesity (p=0.033), smoking (p=0.049), hypertension (p=0.002), end-diastolic dimension (p=0.045). GH was lower in group 1 compared with group 2 (p=0.046). Serum levels of GH are positively associated with EF (p=0.023) and E/A (p=0.043) and negatively associated with left atrial wall thickness (p=0.025) and coronary artery calcium score (p=0.005).

Conclusion

Conclusion: 1. IGF-1 may be a useful indicator to assess the prognosis of CAD and CHF in patients with obesity. 2. Relative GH deficiency was more often associated with severe CAD in patients with obesity.

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