DOI: https://doi.org/10.14739/2310-1210.2020.5.214729

Диагностическая ценность определения мозгового натрийуретического пептида при коморбидном течении гипертонической болезни и сахарного диабета 2 типа у мужчин

Ya. O. Antoniuk, A. F. Humeniuk, Yu. P. Pashkova, O. O. Sakovych, V. M. Zhebel

Аннотация


 

Цель работы – исследовать диагностическую информативность мозгового натрийуретического пептида (МНУП) при диастолической дисфункции левого желудочка (ДД ЛЖ) и начальных стадиях хронической сердечной недостаточности (ХСН) при коморбидном течении гипертонической болезни II стадии (ГБ II) и сахарного диабета 2 типа (СД 2) у мужчин.

Материалы и методы. Обследовали 211 мужчин: 79 человек без признаков сердечно-сосудистых заболеваний составили группу контроля; 62 человека с ГБ II и ХСН не выше І ФК по NYHA вошли в первую основную группу; 70 мужчин с ГБ II в сочетании с СД 2 и ХСН I–II ФК – во вторую основную группу исследования. Концентрацию МНУП в плазме крови определяли методом ИФА. Обследование включало определение HbA1с, липидного профиля крови, ЭхоКГ. Математическую обработку выполнили с использованием стандартного статистического пакета Statistica 6.1.

Результаты. Плазменные уровни МНУП при коморбидном течении ГБ II и СД 2 достоверно выше (102,18 ± 4,18 пг/мл), чем у больных с ГБ без СД (77,40 ± 2,85 пг/мл) и у пациентов без сердечно-сосудистых заболеваний (21,74 ± 0,59 пг/мл) (р < 0,00001). Согласно регрессионного анализа, у пациентов с ГБ II уровень МНУП связан с изменениями параметров внутрисердечной гемодинамики, а у коморбидных больных с ГБ II и СД 2 – еще и с показателями системной гемодинамики и величиной массы тела. МНУП как маркер ХСН при рекомендуемом пограничном уровне (35 пг/мл) у больных с ГБ II и СД 2 характеризуется чувствительностью 98,57 % и специфичностью 55,32 %. Определены граничные уровни МНУП, имеющие более высокую специфичность для ранней диагностики ХСН в условиях коморбидности ГБ II с СД 2 и ожирением.

Выводы. МНУП как ранний маркер ДД ЛЖ и начальных стадий ХСН при рекомендуемом пограничном уровне в условиях коморбидности ГБ II и СД 2 у мужчин имеет недостаточно высокую специфичность. При указанных патологических состояниях определенные пограничные уровни МНУП могут быть использованы как ориентировочные суррогатные маркеры ранней диагностики ХСН при проведении скрининговых обследований для определения пациентов, нуждающихся в ЭхоКГ дообследовании, и в случаях невозможности осуществления ЭхоКГ.

 


Ключевые слова


мозговой натрийуретический пептид; гипертоническая болезнь; сахарный диабет 2 типа; хроническая сердечная недостаточность

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Литература


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