diaendoСахарный диабетDiabetes mellitus2072-03512072-0378Endocrinology research centre10.14341/DM2015261-68diaendo-7084Research ArticleКардиологияCardiologyНарушения углеводного обмена и коллатеральный кровоток в миокарде у больных хронической ишемической болезнью сердцаCarbohydrate metabolism disorders and coronary collateral circulation in patients with chronic coronary artery diseaseСтаростинИван ВасильевичStarostinIvan Vasil'evich

MD, Junior research associate, Department for Novel Medical Information Technololgies

ivs_01@bk.ruТалицкийКонстантин АлександровичTalitskiyKonstantin Alexandrovich

MD, PhD, Research associate, Departemnt of Angiology

talitskiy@mail.ruБулкинаОльга СамуиловнаBulkinaOlga Samuilovna

MD, PhD, Senior research associate, Departemnt of Angiology

olgabulkina@mail.ruСамкоАнатолий НиколаевичSamkoAnatoly Nikolaevich

MD, PhD, Professor, Head of Department of Interventional Radiology

samkoan@mail.ruКарповЮрий АлександровичKarpovYury Alexandrovich

MD, PhD, Professor, Head of Departemnt of Angiology; Deputy Director for Science

krpv@cardio.ruФГБУ РКНПК МЗ РФ, МоскваРоссияCardiology Research Complex, MoscowRussian Federation2015010420151826168Copyright © Старостин И.В., Талицкий К.А., Булкина О.С., Самко А.Н., Карпов Ю.А., 20152015Старостин И.В., Талицкий К.А., Булкина О.С., Самко А.Н., Карпов Ю.А.Starostin I.V., Talitskiy K.A., Bulkina O.S., Samko A.N., Karpov Y.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.dia-endojournals.ru/jour/article/view/7084коллатеральный кровотокуглеводный обменишемическая болезнь сердцаcollateral circulationcarbohydrate metabolismcoronary artery diseaseотсутствуютАктуальностьЦельМатериалы и методыРезультаты
ПоказательЧисло наблюдений (n=603)Значение (% или среднее ± СО)
Возраст, лет60361,6±9,8
Мужчины:женщины443:16073,5:26,5
ИМТ, кг/м253529,2±4,5
Курение на момент исследования14123,4
АГ52987,7
Фракция выброса левого желудочка57957,5±8,5
Семейный анамнез ССС52331,5
Любое НУО28647,4
НГН172,8
СД161,0
НТГ213,5
СД214624,2
неуточненное НУО9515,8
Длительность ИБС, годы5905,1±6,0
ИМ в анамнезе36460,4
Стенокардия напряжения51785,7
ФК стенокардии  
I233,8
II22837,8
III13923,1
IV12620,9
Безболевая ишемия миокарда6611,0
Прием препаратов  
Ацетилсалициловая кислота37963,2
Клопидогрель15024,9
Бета-блокаторы37562,2
Нитраты26644,1
Статины32353,6
иАПФ28046,4
Антагонисты кальция13923,1
Диуретики10717,8
Инсулин345,6
Бигуаниды559,1
Препараты сульфонилмочевины386,3
ПараметрыБольные без НУО, N =317Больные с НУО, N=286Р между группами
Клинические
пол77% мужчин70% мужчин0,04*
ИМТ, кг/м228,2±4,330,4±4,50,00005**
Артериальная гипертония, %41,351,40,01*
Длительность ИБС, лет2 [0,8; 6]3,5 [1; 9]0,01***
Медикаментозные
Использование любых нитратов, %38,551,40,0005*
Использование иАПФ/БРА, %53,060,80,03*
Ангиографические
Максимальная выраженность стеноза, %91 [78; 100]97 [84; 100]0,0002***
Наличие стеноза >95%, %38.855,60,0005*
Число окклюзированных артерий, n0 [0; 1] (0,4±0,6)****0 [0; 1] (0,5±0,6)****0,001***
Лабораторные
Мочевина, ммоль/л5,7 [4,9; 6,9]6,3 [5,2; 7,4]0,0009***
Триглицериды, ммоль/л1,45 [1,14; 1,95]1,7 [1,3; 2,43]0,00005***
Моноциты, %7,8 [6,5; 9,0]7,1 [5,91; 8,6]0,002***
Группы больных ИБСБольные, принимавшие 2 ПССПБольные, принимавшие 1 ПССПБольные, не принимавшие ПССПР между группами
Общая группа2 [1; 3]2 [0; 3]1 [0; 2]р=0,05*
Стеноз ≤95%1 [1; 1,5]0 [0; 0]0 [0; 1]р=0,01*
Стеноз >95%2 [2; 3]3 [2; 3]2 [2; 3]НЗ*
ОбсуждениеВыводыReferencesMeier P, Hemingway H, Lansky AJ, et al. The impact of the coronary collateral circulation on mortality: a meta-analysis. European heart journal. 2012;33(5):614-621. doi: 10.1093/eurheartj/ehr308Meier P, Hemingway H, Lansky AJ, et al. The impact of the coronary collateral circulation on mortality: a meta-analysis. European heart journal. 2012;33(5):614-621. doi: 10.1093/eurheartj/ehr308Meier P, Gloekler S, Zbinden R, et al. Beneficial effect of recruitable collaterals: a 10-year follow-up study in patients with stable coronary artery disease undergoing quantitative collateral measurements. Circulation. 2007;116(9):975-983. doi: 10.1161/circulationaha.107.703959Meier P, Gloekler S, Zbinden R, et al. Beneficial effect of recruitable collaterals: a 10-year follow-up study in patients with stable coronary artery disease undergoing quantitative collateral measurements. Circulation. 2007;116(9):975-983. doi: 10.1161/circulationaha.107.703959Helfant RH, Vokonas P, S., Gorlin R. Functional importance of the human coronary collateral circulation. New England Journal of Medicine. 1971;284(23):1277-1281. doi: doi:10.1056/NEJM197106102842301Helfant RH, Vokonas P, S., Gorlin R. Functional importance of the human coronary collateral circulation. New England Journal of Medicine. 1971;284(23):1277-1281. doi: doi:10.1056/NEJM197106102842301Pohl T, Seiler C, Billinger M, et al. Frequency distribution of collateral flow and factors influencing collateral channel development: Functional collateral channel measurement in 450 patients with coronary artery disease. Journal of the American College of Cardiology. 2001;38(7):1872-1878. doi: 10.1016/S0735-1097(01)01675-8Pohl T, Seiler C, Billinger M, et al. Frequency distribution of collateral flow and factors influencing collateral channel development: Functional collateral channel measurement in 450 patients with coronary artery disease. Journal of the American College of Cardiology. 2001;38(7):1872-1878. doi: 10.1016/S0735-1097(01)01675-8Yilmaz MB, Caldir V, Guray Y, et al. Relation of coronary collateral vessel development in patients with a totally occluded right coronary artery to the metabolic syndrome. American Journal of Cardiology.97(5):636-639. doi: 10.1016/j.amjcard.2005.09.103Yilmaz MB, Caldir V, Guray Y, et al. Relation of coronary collateral vessel development in patients with a totally occluded right coronary artery to the metabolic syndrome. American Journal of Cardiology.97(5):636-639. doi: 10.1016/j.amjcard.2005.09.103Sasmaz H, Yilmaz MB. Coronary collaterals in obese patients: impact of metabolic syndrome. Angiology. 2009;60(2):164-168. doi: 10.1177/0003319708316007Sasmaz H, Yilmaz MB. Coronary collaterals in obese patients: impact of metabolic syndrome. Angiology. 2009;60(2):164-168. doi: 10.1177/0003319708316007Mouquet F, Cuilleret F, Susen S, et al. Metabolic syndrome and collateral vessel formation in patients with documented occluded coronary arteries: association with hyperglycaemia, insulin-resistance, adiponectin and plasminogen activator inhibitor-1. European heart journal. 2009;30(7):840-849. doi: 10.1093/eurheartj/ehn569Mouquet F, Cuilleret F, Susen S, et al. Metabolic syndrome and collateral vessel formation in patients with documented occluded coronary arteries: association with hyperglycaemia, insulin-resistance, adiponectin and plasminogen activator inhibitor-1. European heart journal. 2009;30(7):840-849. doi: 10.1093/eurheartj/ehn569Reed R, Kolz C, Potter B, et al. The mechanistic basis for the disparate effects of angiotensin ii on coronary collateral growth. Arteriosclerosis, thrombosis, and vascular biology. 2008;28(1):61-67. doi: 10.1161/atvbaha.107.154294Reed R, Kolz C, Potter B, et al. The mechanistic basis for the disparate effects of angiotensin ii on coronary collateral growth. Arteriosclerosis, thrombosis, and vascular biology. 2008;28(1):61-67. doi: 10.1161/atvbaha.107.154294Weihrauch D, Lohr NL, Mraovic B, et al. Chronic hyperglycemia attenuates coronary collateral development and impairs proliferative properties of myocardial interstitial fluid by production of angiostatin. Circulation. 2004;109(19):2343-2348. doi: 10.1161/01.cir.0000129225.67353.1fWeihrauch D, Lohr NL, Mraovic B, et al. Chronic hyperglycemia attenuates coronary collateral development and impairs proliferative properties of myocardial interstitial fluid by production of angiostatin. Circulation. 2004;109(19):2343-2348. doi: 10.1161/01.cir.0000129225.67353.1fLin TH, Wang CL, Su HM, et al. Functional vascular endothelial growth factor gene polymorphisms and diabetes: Effect on coronary collaterals in patients with significant coronary artery disease. Clin Chim Acta. 2010;411(21–22):1688-1693. doi: 10.1016/j.cca.2010.07.002Lin TH, Wang CL, Su HM, et al. Functional vascular endothelial growth factor gene polymorphisms and diabetes: Effect on coronary collaterals in patients with significant coronary artery disease. Clin Chim Acta. 2010;411(21–22):1688-1693. doi: 10.1016/j.cca.2010.07.002Hsu PC, Su HM, Lin TH. Association between coronary collaterals and serum uric acid level in chinese population with acute coronary syndrome. Angiology. 2013;64(4):323-324. doi: 10.1177/0003319712463263Hsu PC, Su HM, Lin TH. Association between coronary collaterals and serum uric acid level in chinese population with acute coronary syndrome. Angiology. 2013;64(4):323-324. doi: 10.1177/0003319712463263Дедов И.И., Шестакова М.В., Александров А.А., и др. Алгоритмы специализированной помощи больным сахарным диабетом. // Сахарный диабет. - 2011. - №3 (приложение 1). – С.4-72. [Dedov II, Shestakova MV, Aleksandrov AA, et al. Algorithms of Specialized Medical Care for Diabetes Mellitus Patients. Diabetes mellitus. 2011;14(3s):2-72. ] doi: 10.14341/2072-0351-5612Дедов И.И., Шестакова М.В., Александров А.А., и др. Алгоритмы специализированной помощи больным сахарным диабетом. // Сахарный диабет. - 2011. - №3 (приложение 1). – С.4-72. [Dedov II, Shestakova MV, Aleksandrov AA, et al. Algorithms of Specialized Medical Care for Diabetes Mellitus Patients. Diabetes mellitus. 2011;14(3s):2-72. ] doi: 10.14341/2072-0351-5612Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia.1985;28(7):412-419.Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia.1985;28(7):412-419.Vittinghoff E, Glidden DV, Shiboski SC, et al. Regression Methodsin Biostatistics, 2nd ed.; Springer: USA; 2012. p.418-420.Vittinghoff E, Glidden DV, Shiboski SC, et al. Regression Methodsin Biostatistics, 2nd ed.; Springer: USA; 2012. p.418-420.StataCorp. Stata Statistical Software: Release 9. StataCorp LP, College Station, TX (2011).StataCorp. Stata Statistical Software: Release 9. StataCorp LP, College Station, TX (2011).Schmidt M, Johannesdottir SA, Lemeshow S, et al. Obesity in young men, and individual and combined risks of type 2 diabetes, cardiovascular morbidity and death before 55 years of age: a Danish 33-year follow-up study. BMJ Open. 2013;3(4):e002698. doi: 10.1136/bmjopen-2013-002698Schmidt M, Johannesdottir SA, Lemeshow S, et al. Obesity in young men, and individual and combined risks of type 2 diabetes, cardiovascular morbidity and death before 55 years of age: a Danish 33-year follow-up study. BMJ Open. 2013;3(4):e002698. doi: 10.1136/bmjopen-2013-002698Harjai KJ, Stone GW, Boura J, et al. Comparison of outcomes of diabetic and nondiabetic patients undergoing primary angioplasty for acute myocardial infarction. American Journal of Cardiology. 2003;91(9):1041-1045. doi: 10.1016/S0002-9149(03)00145-0Harjai KJ, Stone GW, Boura J, et al. Comparison of outcomes of diabetic and nondiabetic patients undergoing primary angioplasty for acute myocardial infarction. American Journal of Cardiology. 2003;91(9):1041-1045. doi: 10.1016/S0002-9149(03)00145-0Старостин И.В., Талицкий К.А., Булкина О.С., и др. Нарушения углеводного обмена и коллатеральный кровоток в миокарде. // Сахарный диабет. – 2013. - №1 – С.19-26. [Starostin IV, Talitskiy KA, Bulkina OS, et al. Glycemic disorders and coronary collateral circulation. Diabetes mellitus. 2013;16(1):19-26.] doi: 10.14341/2072-0351-3592Старостин И.В., Талицкий К.А., Булкина О.С., и др. Нарушения углеводного обмена и коллатеральный кровоток в миокарде. // Сахарный диабет. – 2013. - №1 – С.19-26. [Starostin IV, Talitskiy KA, Bulkina OS, et al. Glycemic disorders and coronary collateral circulation. Diabetes mellitus. 2013;16(1):19-26.] doi: 10.14341/2072-0351-3592Davis CA, Sherman AJ, Yaroshenko Y, et al. Coronary vascular responsiveness to adenosine is impaired additively by blockade of nitric oxide synthesis and a sulfonylurea. Journal of the American College of Cardiology. 1998;31(4):816-822. doi: http://dx.doi.org/10.1016/S0735-1097(97)00561-5Davis CA, Sherman AJ, Yaroshenko Y, et al. Coronary vascular responsiveness to adenosine is impaired additively by blockade of nitric oxide synthesis and a sulfonylurea. Journal of the American College of Cardiology. 1998;31(4):816-822. doi: http://dx.doi.org/10.1016/S0735-1097(97)00561-5

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