Динамика параметров качества жизни и депрессивных расстройств при лечении больных с анемическим синдромом на фоне хронической сердечной недостаточности ишемического генеза

Abstract

Изучена динамика параметров качества жизни и депрессии у пациентов с анемией на фоне хронической сердечной недостаточности под влиянием стандартной терапии с добавлением перорального препарата железа (III) и его комбинации с флуоксетином. Установлено положительное влияние обеих схем терапии на качество жизни за счет параметров физической активности (PWB, FWB, FACT-G), а также нивелирования соматического компонента депрессии у анемичных больных с хронической сердечной недостаточностью (p<0,05). Добавление флуоксетина и перорального препарата железа (III) к стандартной терапии имеет более выраженный положительный эффект на параметры качества жизни, связанный с редукцией когнитивно-аффективного и соматического компонентов депрессорных расстройств, что ассоциируется с улучшением физического состояния и активным социальным функционированием. According to numerous multi-center trial anemia is an independent risk factor for adverse course of chronic heart failure. In modern medicine, much attention is paid to the personality of the patient, his position to the disease, a proper understanding of the role and impact of the disease on life functioning, emotional state and social relations, that is, the quality of life of patients. The dynamics of quality of life parameters and depression in anemic patients with chronic heart failure were investigated during standard treatment with the addition of oral preparation of iron (III) and its combination with fluoxetine. The study involved 68 patients with chronic heart failure II-IV functional class due to ischemic heart disease. In all patients with chronic heart failure revealed mild anemia. For adequate assessment of quality of life in anemic patients with chronic heart failure was used FACT-An questionnaire. The questionnaire includes 47 questions by category: PWB - physical condition, SWB - social/family relationships, EWB - emotional well-being, FWB - well-being in everyday life, AnS - additional indicators that reflect the scale of anemia, FACT-G - the total scale of weakness, FACT-An total - total scale of weakness and anemia. The total score is from 0 to 180. The greatest number of points reflects a higher quality of life. To assess the presence and nature of depressive disorders was used a Beck scale (Beck Depression Inventory). This questionnaire consists of 21 groups of statements. Paragraphs 1-13 describe the cognitive-affective subscale, 14-21 - subscale of somatic symptoms of depression. Sum results equal to 10 points or more indicates a depression. Anemic patients with chronic heart failure were divided into two groups. The first group (n = 32) received oral preparation Fe (III) hydroxide polymaltose complex on a background of standard heart failure therapy. The second group (n = 36) - a combination of oral Fe (III) and fluoxetine on a background of standard heart failure therapy. The duration of therapy was 3 months. In anemic patients with chronic heart failure treated with standard therapy and oral Fe (III), there was an increase values of the parameters PWB, SWB, EWB, FWB, AnS, FACT-G and FACT-An total (р<0,001). In the group of patients who took oral Fe (III) and fluoxetine on a background of standard therapy also increased the value of PWB, SWB, EWB, FWB, AnS, FACT-G and FACT-An total (р<0,001). Comparative evaluation of the dynamics of quality of life parameters under the influence of two treatment schemes showed significantly more positive effect in patients treated with a combination of standard therapy with the oral Fe (III) and fluoxetine. In patients of 1 group observed a significant decrease in the scale of depression by 14% (p<0.001), subscale of somatic symptoms by 17% (p<0.001). As a result of the therapy subscale level of affective disorders has changed slightly. 2 groups of patients significantly improved depression scale scores by 53.9%, subscale somatic symptoms by 53.9%, and the cognitive subscale of 61.3% (p<0.001). The positive effect of both schemes of treatment on quality of life through physical activity settings (PWB, FWB, FACT-G), and leveling the somatic component of depression in anemic patients with chronic heart failure were shown (p <0,05). Addition of fluoxetine and oral Fe (III) to standard therapy has a clear positive impact on the parameters of quality of life associated with the reduction of cognitive-affective and somatic components of depression that are associated with improved physical condition and active social functioning.