Патогенетичне значення порушень вуглеводного обміну у прогресуванні хронічної серцевої недостатності у хворих з постінфарктним кардіосклерозом, цукровим діабетом 2 типу та ожирінням

Abstract

В статье проводилось определение патогенетического значения нарушений углеводного обмена в прогрессировании хронической сердечной недостаточности у больных с постинфарктным кардиосклерозом, сахарным диабетом 2 типа и ожирением путем обследования 295 больных. Установлено, что полиморбидность постинфарктного кардиосклероза, сахарного диабета 2 типа и ожирения приводит к более значимым нарушениям углеводного обмена. Нарушение углеводного обмена у больных с постинфарктным кардиосклерозом, сахарным диабетом 2 типа и ожирением происходит на фоне нарастания функционального класса хронической сердечной недостаточности путем увеличения уровня глюкозы крови, гликозилированного гемоглобина и инсулина. The chronic heart failure problem is magnified in individuals with diabetes and obesity, in whom incidence rates are two to five times greater than those in the general population. The aim of our study was determined the pathogenic role of disorders of carbohydrate metabolism in the progression of chronic heart failure in patients with postinfarction cardiosclerosis, type 2 diabetes and obesity. There were examined 295 patients, which were divided into four groups. The first group included patients with postinfarction cardiosclerosis and type 2 diabetes (n=68), the second – patients with postinfarction cardiosclerosis and obesity (n=76), the third – patients with postinfarction cardiosclerosis, type 2 diabetes and obesity (n=71) the fourth – patients with postinfarction cardiosclerosis (n=80) and control group consisted of practically healthy people (n=35). All patients were determined following carbohydrate metabolism. Determination of glycated hemoglobin content (HbA1с) in whole blood was performed by photometric method according to response to thiobarbituric acid with the use of commercial test system developed by «Reagent» company (Ukraine) in conformity with the enclosed instruction. The level of glucose was determined by glucose oxidation method in capillary blood, taken in the fasted state. The concentration of insulin were determined in the serum of patients by ELISA («Monobind», USA). There were definition insulin resistance by formula: the concentration of insulin × the level of glucose in the blood /22,5. The statistical processing of results was performed with the help of software package «Statistika» (StaSoftInc, USA). The values calculated: the average (M), dispersion, standard deviation, the median (m), accuracy and level of significance (p). The standard programme of correlation analysis with calculation of average arithmetic means was used: M+m, σ, and level of accuracy (p). Pearson correlation coefficient was applied to evaluate the interaction stage between the samples (r). The level of glucose, insulin, HbA1s and insulin resistance were significantly increases in patients with postinfarction cardiosclerosis, type 2 diabetes and obesity. The study showed that in patients with postinfarction cardiosclerosis, type 2 diabetes and obesity the disorders of carbohydrate metabolism were associated with functional class of chronic heart failure. The pathogenic role of disorders of carbohydrate metabolism in patients with postinfarction cardiosclerosis, type 2 diabetes and obesity was determined in the progression of chronic heart failure.