nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.24884/1561-6274-2008-12-3-18-23nefr-1115Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИ. КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯORIGINAL ARTICLES. CLINICAL INVESTIGATIONSДИСФУНКЦИИ МИОКАРДА, ОЦЕНИВАЕМЫЕ МЕТОДОМ ТКАНЕВОЙ ДОППЛЕРОГРАФИИ И ФОСФОРНО-КАЛЬЦИЕВЫЙ БАЛАНС У ПАЦИЕНТОВ НА ХРОНИЧЕСКОМ ГЕМОДИАЛИЗЕTHE MYOCARDIAL DYSFUNCTION, EVALUATED BY MEANS OF TISSUE DOPPLEROGRAPHY AND PHOSPHORUS-CALCIUM BALANCE IN PATIENTS ON CHRONIC HEMODIALYSISВолковМ. М.VolkovM. M.

кафедра пропедевтики внутренних болезней

197022 Санкт-Петербург, ул. Л.Толстого 17, «Нефрокорпус»,

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vmm58@mail.ruСмирновА. В.SmirnovA. V.

кафедра пропедевтики внутренних болезней

 

ДегтереваО. А.DegterevaO. A.

кафедра пропедевтики внутренних болезней

 

ШевяковаЕ. В.SheviakovaE. V.

кафедра пропедевтики внутренних болезней

 

Санкт-Петербургский государственный медицинский университет им. акад. И.П. ПавловаRussian Federation2008100320081231823Copyright © Волков М.М., Смирнов А.В., Дегтерева О.А., Шевякова Е.В., 20082008Волков М.М., Смирнов А.В., Дегтерева О.А., Шевякова Е.В.Volkov M.M., Smirnov A.V., Degtereva O.A., Sheviakova E.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/1115

ЦЕЛЬ ИССЛЕДОВАНИЯ. Определить характер связи между функцией левого желудочка, оцениваемой при тканевом допплерографическом исследовании (ТДИ) и показателями фосфорно-кальциевого баланса у пациентов на хроническом гемодиализе (ГД). ПАЦИЕНТЫ И МЕТОДЫ. Обследовано 53 пациентов (29 мужчин, 24 женщины), в возрасте 51,6±12,9 лет, находящихся на ГД 73,7±68,6 мес., не страдающих ревматизмом, инфекционным эндокардитом, кардиомиопатиями с выполненным эхокардиографическим исследованием (ЭхоКГ), дополненным ТДИ. Пациентам определили уровни интактного паратгормона (ПТГ), щелочной фосфатазы (ЩФ), маркеров синтеза (остеокальцин) и резорбции (С-телопептиды коллагена 1 типа) костей, фибриноген и С-реактивный белок (СРБ). Выраженность костно-суставных болей оценивали в баллах. Для определения минеральной плотности костей (МПК) 25 пациентам выполнена денситометрия трех отделов скелета. Рентгенологически оценивали толщину кортикальных слоев 2-й пястной кости и выраженность кальциноза брюшной аорты. РЕЗУЛЬТАТЫ. Систолическая дисфункция по данным различных методов ЭхоКГ выявлена у 13,3–49,1% пациентов. У всех пациентов обнаружена систолическая дисфункция хотя бы одного сегмента. Диастолическая дисфункция диагностирована у 58,5–94,3% больных. Диастолическая функция по E/A сегм была хуже у пациентов с более низкими значениями МПК предплечья, c более выраженным кальцинозом брюшной аорты. Диастолическая функция по E/A (ФК МК) была хуже у пациентов с низкой МПК предплечья, меньшей толщиной кортикального слоя рентгенологически, большей выраженностью кальцификации брюшной аорты, более высоким уровнем СРБ. Скорость распространения ранней диастолической волны была выше у пациентов с более высокими значениями МПК предплечья, более низкими уровнями С-телопептидов коллагена 1 типа и остеокальцина. Систолическая функция по Vs ФК МК была ниже у пациентов с более низкой МПК предплечья, более высокими уровнями ПТГ, С-телопептидов коллагена 1 типа, СРБ, большей выраженностью костно-суставных болей. ЗАКЛЮЧЕНИЕ. ТДИ является более чувствительным методом в оценке сердечной функции по сравнению с рутинными методами ЭхоКГ у больных на ГД. Впервые обнаружено, что при снижении МПК и выраженном кальцинозе аорты были хуже систолическая и диастолическая функции ЛЖ по данным ТДИ.

THE AIM. To determine the character of the connections between the left ventricular function, evaluated during the tissue dopplerography investigation (TDI) and the parameters of phosphorus-calcium balance in hemodialysis patients (HD). PATIENTS AND METHODS. 53 patients were evaluated (29 men, 24 women), in the mean age of 51,6 ± 12,9 years, who were on HD during 73,7 ± 68,6 month, not suffering from rheumatism, infectious endocarditis, cardiomiopathias, with echocardiographic examination performed (EchoCG), with additional TDI. The levels of intact parathormone (PTH), alkaline phosphatase (AP), bone markers of synthesis (osteocalcin) and reabsorbtion (C-telopeptides of type 1 collagen), fibrinogen and C-reactive protein (CRP) were evaluated. The extend of bone-joint pain was evaluated in points. For the evaluation of mineral bone density (MBD) densitometry of the three parts on the skeleton was performed in 25 patients. By means of X-ray the thickness of the cortical layer of the 2 nd middle metacarpal bone and the extend of the calcification of abdominal aorta was evaluated. RESULTS. The systolic dysfunction by means of various methods of EchoCG was discovered in 13,3-49,1% of the patients. In all patients was discovered at least one segment systolic dysfunction. Diastolic dysfunction was diagnosed in 58,5-94,3% of the patients. Diastolic function by E/A segment was worse in patients with lower values of MBD of forearm, with more expressed calcification of abdominal aorta. Diastolic function by E/A (FC MC) was worse in patents with lower MBD of forearm, lower thickness of cortical layer by X-ray, higher calcification of abdominal aorta, higher level of CRP. The speed of diffusion of early diastolic wave was higher in patients with higher values of MBD of forearm, lower level of C-telopeptides of type 1 collagen and osteocalcin. The systolic function by Vs ФК МК was lower in patients with lower MBD of forearm, higher levels of PTH, C-telopeptides of type 1 collagen, CRP, higher extend of bone-joint pain. CONCLUSION. TDI is a more sensitive method of evaluation of cardiac function in comparison with standard methods of EchoCG in patients on HD. For the first time was detected that with the decrease of MBD and extensive calcification of aorta, the systolic and diastolic function of left ventricular was worse by the TDI data.

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