Кафедра внутрішніх та професійних хвороб
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Browsing Кафедра внутрішніх та професійних хвороб by Subject "diabetes mellitus"
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Item Combined influence of diabetes mellitus and obesity on left ventricle remodeling in hypertensive patients(2021-01) Shelest, Borys; Kovalova, Yuliia; Shelest, Oliksii; Rodionova, Yuliia; Hilova, YaroslavaThe aim of the study was to evaluate the effect of type 2 diabetes mellitus (T2DM) and obesity influence on the left ventricular (LV) remodeling peculiarities in hypertensive patients. Materials and methods. In total, 327 patients, aged 38–74 years, were comprehensively examined. The enrolled patients were divided into 4 groups in dependence of the presence of associated disease: the 1st group – n = 87 hypertensive patients with T2DM combined with obesity, the 2nd group – n = 71 hypertensive patient with T2DM and the 3rd group – n = 65 hypertensive patients with obesity; the comparison group consisted of 74 patients with essential hypertension (EH) but without obesity or diabetes. Echocardiography was performed according to the standard method of H. Feigenbaum to estimate the LV parameters. HbA1c was determined by turbidimetric method. Serum glucose levels were determined by ELISA. Results. When comparing the three patient groups with those who had only EH, the most significant influence was found in combined influence of T2DM and obesity on the development of unfavorable type of LV remodeling with values of χ2 = 29.371 and Pearson’s contingency coefficient (C) ‒ 0.393 (P < 0.05). The presence of concomitant T2DM without obesity had a significant moderate relationship with the development of unfavorable LV geometry, χ2 = 11.029 and C ‒ 0.266 (P < 0.05), which indicates a much smaller impact on the process compared to the polymorbid effect of T2DM with obesity. Comparison of patients with a combination of EH and obesity with those who had only EH did not show a significant effect of concomitant obesity on the development of unfavorable types of LV geometry with values of χ2 and C: 0.529 and 0.062, respectively (P > 0.05). Conclusions. Essential hypertension with type 2 diabetes mellitus and obesity polymorbidity, but not in combination with type 2 diabetes mellitus or obesity alone, has the most significant association with hypertrophic types of LV remodeling. The co-existence of type 2 diabetes mellitus and obesity in hypertensive patients leads to the development of predominantly LV concentric hypertrophy.Item Медіатори запалення та антропометричні параметри в прогресуванні АГ з коморбідною патологією(2018) Шелест, Борис ОлексійовичThe development of obesity in patients with arterial hypertension and their mortality remains high in all countries, despite advances in early diagnosis, the introduction of high-tech treatments and prevention of arterial hypertension. Obesity and diabetes significantly impair the prognosis, contribute to the progression of vascular changes, and accelerate the development of arterial hypertension. Thus, determining the impact of these diseases on a certain level of pathogenesis of inflammation is of great importance. The purpose of the study was to conduct an analysis of some clinical and inflammatory factors values in the progression of damage to target organs in arterial hypertension with diabetes and obesity. Material and methods. There were 48 patients with second stage arterial hypertension, 1-2 grade, and of high and very high cardiovascular risk score (22 men and 26 women) under observation. The average age of patients was 57.6 ± 4.7 years. The patients were divided into groups: the first group consisted of 23 patients with arterial hypertension with diabetes and obesity, which had no progression of the disease, the 2nd group included 25 patients with hypertension in combination with diabetes and obesity with progression of lesions of target organs. Results and discussion. The survey showed that the BMI ≤ 39.0 kg / m2 was relatively non-specific, as it was determined in almost all (97.7%) patients without progression of the disease and significantly exceeded the proportion of patients with progression of hypertension (77.6%, p ≤ 0.001). Normative and slightly exceeding the normative figures of the ratio of waist and thigh circumference were characteristic of patients without progression of the disease and were found in 65.2% of them. At the same time the proportion of such patients was 1.6 times lower and was 40, 8% (p ≤ 0.01) in the second group. The presence of inflammatory component in the body of patients with hypertension contributes to the progression of the disease. Regarding the level of anti-inflammatory cytokine IL-10, its significance did not reveal any significant differences in the groups (≥ 0.05). Significant increase in the content of chemerin (≥ 241 pg / ml) was 3.1 fold more (p ≤ 0.001) in the group with progression of the disease. The normative value of the indicator (≤ 200 pg / ml) was characteristic for the group without progression of hypertension. It was diagnosed by 2.7 times (р ≤ 0,001) more often in this group than in patients with progression of the disease. Conclusions. The direct reliable association with the progression of hypertension was determined by the weight of the patients’ body, the value of BMI, the ratio of the waist / thigh circumference, the thickness of the epicardial fat and the inverse correlation with the height of the patients. The presence of inflammatory component in the body of patients with hypertension, which is associated with obesity, contributes to the progression of the disease. The research leads to the continuation of studying the feasibility and the possibility of applying these criteria at all levels of treatment and prevention with the aim of stratifying the effectiveness of therapeutic tactics.