Динаміка копептину у хворих з гострим інфарктом міокарда залежно від ступеню ожиріння

Abstract

Копептин - новый биомаркер в области сердечно-сосудистых заболеваний (ССЗ), с помощью которого можно оптимизировать диагностику острого инфаркта миокарда (ОИМ) у пациентов с сопутствующим ожирением (ОЖ). Целью исследования было определить динамику копептина, а также оценить наличие и характер связей копептина с антропометрическими показателями (объем шеи (ОШ), объем талии (ОТ), объем талии /объем бедер (ОТ/ОБ)). У больных с ОИМ и ОЖ наблюдалось достоверное повышение уровня копептина в сравнении с пациентами без ОЖ. У пациентов с ОИМ рост степени ОЖ ассоциировался с ростом уровня копептина, что особенно отчетливо определялось при наличии абдоминального типа ОЖ. ОШ обладает высокими предикторными свойствами, что позволяет использовать его в составе регрессионного уравнения для прогноза уровня копептина у больных с ОИМ и ОЖ в учреждениях здравоохранения Cardiovascular diseases (CVD) took first place in the overall structure of chronic diseases and are the cause of premature death of Ukraine's population of more than 60% of cases. Every year in Ukraine there are nearly 25 million patients with cardiovascular disease, of which approximately 8.5 million – have coronary heart disease (CHD). CHD is one of the most important problems of modern cardiology. Special drama in the development of coronary artery disease becomes acute myocardial infarction (AMI), which arises as a result of destabilization CHD. At the present stage the attention of researchers aimed at identifying the effect of obesity as a risk factor for CVD, and as a factor that contributes to the progression of coronary artery disease. In recent years, obesity has become one of the most common adverse events and the growth rate is becoming rampant. In the pathogenesis of AMI neurohumoral system’s activation plays an important role. Most neurohormonal changes mediated by an imbalance of vasoconstrictor and vasodilator work reactions. And that is why the discovery and development of new biomarkers in the field of CVD is a promising area of work of scientists. The purpose of research - to optimize the diagnosis of AMI in patients with concomitant obesity on the basis of determining the dynamics of copeptyn, and to assess the presence and nature of the changes copeptin’s relations with anthropometric measurements (neck’s volume, waist circumference, waist circumference / hips ratio). The study includes 80 patients with AMI, among which 30 people have normal body index, 50 patients - increased body index. Obesity I stage diagnosed in 25 people and obesity II stage was found in 25 people. These patients were treated at the department of intensive care of the Kharkiv City Clinical Hospital №27. Exclusion criteria were acute and chronic inflammations, diffuse connective tissue diseases, cancer, concomitant thyroid disease, the presence of symptomatic hypertension. To conduct the study we applied subjective (complaints, medical history and life’s history), objective methods (inspection, palpation, percussion, auscultation, blood pressure measurement), laboratory, and instrumental methods of examination. The presence of obesity was adjusted according to the definition body mass index which is determined by the formula by Kettler: BMI (kg / m2) = body weight / (height) 2 Copeptin determined by ELISA using a reagent kit «Human Copeptin» (Biological Technology, Shanghai). Statistical data processing was carried out using the statistical software package «Microsoft Excel». Data are presented as mean values and the average error. Statistical significance was determined by a variety of criterion Fisher. Analysis of the relationship is performed using Spearman correlation (r). In patients with AMI and obesity there was a significant increase copeptin’s level compared with patients without obesity. In patients with AMI obesity’s level increasing was associated with an increased copeptin’s level of that most clearly defined in the presence of abdominal type of adipose tissue distribution. Neck’s volume has a high predictor properties, it can be used as a part of the regression equation for the forecast of copeptin in patients with AMI and obesity in health care