nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical Universitynefr-7Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИ. КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯORIGINAL ARTICLES. CLINICAL INVESTIGATIONSМикроальбуминурия при метаболических нарушениях у женщин в перименопаузеMicroalbuminuria and metabolic disorders in perimenopausal womenШишкинА. Н.ShishkinA. N.noemail@neicon.ruХудяковаН. В.HudiakovaN. V.uhs83@mail.ruТемнаяН. В.TemnajaN. V.noemail@neicon.ruСанкт-Петербургский государственный университетRussian FederationГородская поликлиника № 97Russian Federation2014010120141816267Copyright © Шишкин А.Н., Худякова Н.В., Темная Н.В., 20142014Шишкин А.Н., Худякова Н.В., Темная Н.В.Shishkin A.N., Hudiakova N.V., Temnaja N.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/7

ЦЕЛЬ ИССЛЕДОВАНИЯ. Изучить структурно-функциональные параметры сердечно-сосудистой системы в зависимости от уровня суточной альбуминурии у женщин с метаболическим синдромом (МС) в перименопаузе. ПАЦИЕНТЫ И МЕТОДЫ. В исследование было включено 67 женщин в перименопаузе с МС. Рассматривались две группы: основная - пациентки с МС и МАУ (n=34) и группа сравнения - с МС и нормоальбуминурией (НАУ) (n=33). Всем больным кроме определения суточной экскреции альбумина с мочой и расчета индекса массы тела (ИМТ) были проведены следующие исследования: суточное мониторирование артериального давления, определение толщины интима-медиа общей сонной артерии (ТИМОСА), проба с реактивной гиперемией, эхокардиография. РЕЗУЛЬТАТЫ. Ремоделирование миокарда у женщин с менопаузальным МС и МАУ наблюдалось в 88,2% случаев, преимущественно по типу концентрической гипертрофии (50% случаев). Средние значения массы миокарда левого желудочка (ММЛЖср.) и индекса массы миокарда (ИММср.) были выше в основной группе по сравнению с группой с МС и НАУ: 242,10±18,70 и 162,80±7,50 г (р<0,01); 121,60±7,70 и 95,20±3,40 г/м2 (р<0,01) соответственно. Нарушение эндотелийзависимой вазодилатации у женщин с МС и МАУ выявлялось в 76,5% случаев. У пациенток основной группы ТИМОСА была достоверно больше по сравнению с женщинами с МС и НАУ: 0,89±0,05 и 0,72±0,05 мм (р<0,05) соответственно. Влияние систолического и диастолического артериального давления на МАУ подтверждается данными линейного регрессионного анализа. ЗАКЛЮЧЕНИЕ. МАУ при МС в перименопаузе ассоциирована с концентрической ГЛЖ, дисфункцией эндотелия и увеличенными значениями ТИМОСА.

THE AIM. To study structural and functional features of cardio-vascular system depending on the level of daily albuminuria in women with metabolic syndrome (MS) at perimenopause. PATIENTS AND METHODS. A total of 67 women in perimenopause with MS were selected and divided into two groups: general - patients with MS and MA (n=34) and control group - with MS and normoalbuminuria (NA) (n=33). All patients were performed evaluation of daily albumin excretion by urinary way and calculation of body mass index (BMI). Also they were performed following examinations: arterial pressure daily monitoring, common carotid artery intima-media thickness test (CCAIMT), test with reactive hyperemia, echocardiography. RESULTS. Cardiac remodeling was observed in menopausal women with MS and MA in 88,2% cases, mainly by concentric hypertrophy type (50% cases). Mean left ventricular mass and left ventricular mass index were significantly higher in general group as compared to MS and NA group (242,10±18,70g and 162,80±7,50g; (р<0,01). 121,58±7,70g/m2vs 95,16±3,40g/m2; P=0,002 respectively). Endothelial dependent vasodilation disorder inwomen with MS and MA was revealed in 76,5% cases. In patients of general group CCAIMT was accurately higher than in women with MS and MA: 0,89±0,05mm and 0,72±0,05mm (р<0,05) respectively. The effect of systolic and diastolic arterial pressure on MA is verified by linear regression analyses data. CONCLUSION. MA at MS in perimenopause is associated with concentric LVH., endothelial dysfunction and increased values of CCAIMT.

метаболический синдромперименопаузасердечно-сосудистая системамикроальбуминурияmetabolic syndromeperimenopausecardiovascular systemmicroalbuminuriaReferencesFord E.S. The metabolic syndrome and mortality from cardiovascular disease and all-causes: Findings from the National Health and Nutrition Examination Survey II Mortality Study. Ath erosclerosis 2004 (173): 309-314Ford E.S. The metabolic syndrome and mortality from cardiovascular disease and all-causes: Findings from the National Health and Nutrition Examination Survey II Mortality Study. Ath erosclerosis 2004 (173): 309-314Wang. Z., Wang F.F., Zhu X.J. et al. Metabolic syndrome and microalbuminuria accompanied with hyperglycemia in community subjects. Zhonghua Yi Xue Za Zhi 2012 Sep 25; 92(36): 2526-2529Wang. Z., Wang F.F., Zhu X.J. et al. Metabolic syndrome and microalbuminuria accompanied with hyperglycemia in community subjects. Zhonghua Yi Xue Za Zhi 2012 Sep 25; 92(36): 2526-2529El Azeem H.A., Khalek el-S.A., El-Akabawy H. et al. Association between nonalcoholic fatty liver disease and the incidence of cardiovascular and renal events. J. Saudi Heart Assoc 2013 Oct; 25 (4): 239-246El Azeem H.A., Khalek el-S.A., El-Akabawy H. et al. Association between nonalcoholic fatty liver disease and the incidence of cardiovascular and renal events. J. Saudi Heart Assoc 2013 Oct; 25 (4): 239-246Michalakis K., Mintziori G., Kaprara A. et al. The complex interaction between obesity, metabolic syndrome and reproductive axis: a narrative review. Metabolism 2013 Apr; 62 (4): 457-478Michalakis K., Mintziori G., Kaprara A. et al. The complex interaction between obesity, metabolic syndrome and reproductive axis: a narrative review. Metabolism 2013 Apr; 62 (4): 457-478Иванов Н.В., Сильницкий П.А., Ворохобина Н.В. Нарушения репродуктивной функции у мужчин с метаболическим синдромом. Балтийский журнал современной эндокринологии 2011; (2): 98-105Иванов Н.В., Сильницкий П.А., Ворохобина Н.В. Нарушения репродуктивной функции у мужчин с метаболическим синдромом. Балтийский журнал современной эндокринологии 2011; (2): 98-105Singh A.K., Kari J.A. Metabolic syndrome and chronic kidney disease. Curr Opin Nephrol Hypertens 2013 Mar; 22(2): 198-203Singh A.K., Kari J.A. Metabolic syndrome and chronic kidney disease. Curr Opin Nephrol Hypertens 2013 Mar; 22(2): 198-203Chen J., Muntner P., Hamm L.L. et al. The metabolic syndrome and chronic kidney disease in U. S. adults. Ann Intern Med 2004; 140 (3): 167-174Chen J., Muntner P., Hamm L.L. et al. The metabolic syndrome and chronic kidney disease in U. S. adults. Ann Intern Med 2004; 140 (3): 167-174Ryu S., Chang X., Woo H.Y. et al. Time-dependent association between metabolic syndrome and risk of CKD in Korean men without hypertension or diabetes. Am J. Kidney Dis 2009; 53(1): 59-69Ryu S., Chang X., Woo H.Y. et al. Time-dependent association between metabolic syndrome and risk of CKD in Korean men without hypertension or diabetes. Am J. Kidney Dis 2009; 53(1): 59-69Yang T., Chu C.H., Hsu C.H. et al. Impact of metabolic syndrome on the incidence of chronic kidney disease: a Chinese cohort study. Nephrology (Carlton) 2012; 17(6): 532-538Yang T., Chu C.H., Hsu C.H. et al. Impact of metabolic syndrome on the incidence of chronic kidney disease: a Chinese cohort study. Nephrology (Carlton) 2012; 17(6): 532-538Пчелин И.Ю., Шишкин А.Н., Лаптева О.А. Роль системного и локального воспаления в развитии диабетической нефропатии. Нефрология 2011; 15 (4): 21-26Пчелин И.Ю., Шишкин А.Н., Лаптева О.А. Роль системного и локального воспаления в развитии диабетической нефропатии. Нефрология 2011; 15 (4): 21-26Alberti K.G.,, Zimmet P.Z. Definition, diagnosis and classification of diabetes mellitus and its complications, part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 1998; (15): 539-553Alberti K.G.,, Zimmet P.Z. Definition, diagnosis and classification of diabetes mellitus and its complications, part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 1998; (15): 539-553Scott M., Grundy M.D., Becker D. et al. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of Hight Blood Cholesterolin Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of hight blood cholesterol in adults (Adult Treatment Panel III) final report. Circulation 2002 (106): 3143-3421Scott M., Grundy M.D., Becker D. et al. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of Hight Blood Cholesterolin Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of hight blood cholesterol in adults (Adult Treatment Panel III) final report. Circulation 2002 (106): 3143-3421Jarraya F., Lakhdar R., Kammoun K. et al. Microalbuminuria A Useful Marker of Cardiovascular Disease. Iranian Journal of Kidney Diseases 2013 May; 7 (3): 178-186Jarraya F., Lakhdar R., Kammoun K. et al. Microalbuminuria A Useful Marker of Cardiovascular Disease. Iranian Journal of Kidney Diseases 2013 May; 7 (3): 178-186Aaron R. Folsom. Classical and Novel Biomarkers for Cardiovascular Risk Prediction in the United States. J. Epidemiol 2013; 23(3): 158-162.Aaron R. Folsom. Classical and Novel Biomarkers for Cardiovascular Risk Prediction in the United States. J. Epidemiol 2013; 23(3): 158-162.Добронравов В.А., Смирнов А.В., Каюков И.Г. Многогранная микроальбуминурия: аспекты клинического значения. Нефрология 2009; 13 (3); 33-38Добронравов В.А., Смирнов А.В., Каюков И.Г. Многогранная микроальбуминурия: аспекты клинического значения. Нефрология 2009; 13 (3); 33-38Шишкин А.Н., Худякова Н.В., Смирнов В.В. Менопаузальный метаболический синдром. Современные представления. Вестн. С.-Петерб ун-та 2013; 11 (2): 17-27Шишкин А.Н., Худякова Н.В., Смирнов В.В. Менопаузальный метаболический синдром. Современные представления. Вестн. С.-Петерб ун-та 2013; 11 (2): 17-27Spenser C.P., Godsland I.F., Stevenson C. Is there a menopause metabolic syndrome? Gynecol Endocrinol 1997; (11): 341345Spenser C.P., Godsland I.F., Stevenson C. Is there a menopause metabolic syndrome? Gynecol Endocrinol 1997; (11): 341345Скибицкий В.В., Шухардина Е.Л., Медведева Ю.Н., Кармазина В.В. Взаимосвязь ремоделирования левого желудочка с гемодинамическими и метаболическими факторами у женщин с артериальной гипертонией в ранней постменопаузе. Южно -Российский медицинский журн. 2004; (3): 16-19Скибицкий В.В., Шухардина Е.Л., Медведева Ю.Н., Кармазина В.В. Взаимосвязь ремоделирования левого желудочка с гемодинамическими и метаболическими факторами у женщин с артериальной гипертонией в ранней постменопаузе. Южно -Российский медицинский журн. 2004; (3): 16-19Troy B.L., Pombo J., Rackley C.E. Measurement of left ventricular wall thickness and mass by echocardiography. Circulation 1972; 45: 602-11Troy B.L., Pombo J., Rackley C.E. Measurement of left ventricular wall thickness and mass by echocardiography. Circulation 1972; 45: 602-11Lang R.M., Bierig M., Devereux R.B., Flachskampf F.A. et al. Recommendations for chamber quantification: A report from the American Society of echocardiography’s Guidelines and Standards committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of echocardiography, a branch of the European Society of cardiology. J. Am Soc Echocardiogr 2005; 18: 1440-1463Lang R.M., Bierig M., Devereux R.B., Flachskampf F.A. et al. Recommendations for chamber quantification: A report from the American Society of echocardiography’s Guidelines and Standards committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of echocardiography, a branch of the European Society of cardiology. J. Am Soc Echocardiogr 2005; 18: 1440-1463DuBois D., DuBois E.F. A formula to estimate the approximate surface area if height and weight be known. Arch Intern Med 1916; 17: 863-871DuBois D., DuBois E.F. A formula to estimate the approximate surface area if height and weight be known. Arch Intern Med 1916; 17: 863-871Genau A., Devereux R.B., Roman M.J. Pattern left ventricular hypertrophy and geometric remodeling in essential hypertension. J. Amer Coll Cardiol 1992; 19Е: 1550-1558Genau A., Devereux R.B., Roman M.J. Pattern left ventricular hypertrophy and geometric remodeling in essential hypertension. J. Amer Coll Cardiol 1992; 19Е: 1550-1558Alberti K.G., Eckel R.H., Grundy S.M. et al. Harmonizing the metabolic syndrome. Circulation 2009; 120 (16): 1640-1645Alberti K.G., Eckel R.H., Grundy S.M. et al. Harmonizing the metabolic syndrome. Circulation 2009; 120 (16): 1640-1645Eiamthanasinchai S., Laowahutanont N., Yamwong P., Teerapornlertratt T. Prevalence and factors associated with microalbuminuria and abnormal renal function in Thai obese adults. J. Med Assoc Thai 2013; 96 (2): 9-16Eiamthanasinchai S., Laowahutanont N., Yamwong P., Teerapornlertratt T. Prevalence and factors associated with microalbuminuria and abnormal renal function in Thai obese adults. J. Med Assoc Thai 2013; 96 (2): 9-16Dutta D., Choudhuri S., Mondal S.A. et al. Urinary albumincreatinine ratio predicts prediabetes progression to diabetes and reversal to normoglycemia: Role of associated insulin resistance, inflammatory cytokines and low vitamin-D. J. Diabetes 2013 20. doi: 10.1111/1753-0407.12112. [Epub ahead of print]Dutta D., Choudhuri S., Mondal S.A. et al. Urinary albumincreatinine ratio predicts prediabetes progression to diabetes and reversal to normoglycemia: Role of associated insulin resistance, inflammatory cytokines and low vitamin-D. J. Diabetes 2013 20. doi: 10.1111/1753-0407.12112. [Epub ahead of print]Navarro-Gonzâlez J.F., Mora C., Muros M. et al. Association of tumor necrosis factor-alpha with early target organ damage in newly diagnosed patients with essential hypertension. J. Hypertens 2008; 26(11): 2168-2175Navarro-Gonzâlez J.F., Mora C., Muros M. et al. Association of tumor necrosis factor-alpha with early target organ damage in newly diagnosed patients with essential hypertension. J. Hypertens 2008; 26(11): 2168-2175Chen F., Wang J., Liu X. et al. Levels of Inflammatory Cytokines in Type 2 Diabetes Patients with Different Urinary Albumin Excretion Rates and Their Correlation with Clinical Variables. Journal of Diabetes Research 2013 Oct: 1-6Chen F., Wang J., Liu X. et al. Levels of Inflammatory Cytokines in Type 2 Diabetes Patients with Different Urinary Albumin Excretion Rates and Their Correlation with Clinical Variables. Journal of Diabetes Research 2013 Oct: 1-6Moura R.S.S.S., Vasconcelos D.F., Freitas E. et al. Cystatin C., C.R.P., Log TG/HDLc and Metabolic Syndrome are Associated with Microalbuminuria in Hypertension. Arq Bras Cardiol 2013; [online]. ahead print: 0-0Moura R.S.S.S., Vasconcelos D.F., Freitas E. et al. Cystatin C., C.R.P., Log TG/HDLc and Metabolic Syndrome are Associated with Microalbuminuria in Hypertension. Arq Bras Cardiol 2013; [online]. ahead print: 0-0Rodilla E., Costa J.A., Martin J. et al. Impact of abdominal obesity and ambulatory blood pressure in the diagnosis of left ventricular hypertrophy in never treated hypertensives. Med Clin (Barc).2 013 Oct (16) [online].ahead print: 0-0Rodilla E., Costa J.A., Martin J. et al. Impact of abdominal obesity and ambulatory blood pressure in the diagnosis of left ventricular hypertrophy in never treated hypertensives. Med Clin (Barc).2 013 Oct (16) [online].ahead print: 0-0Naidoo D.P. The link between microalbuminuria, endothelial dysfunction and cardiovascular disease in diabetes. Cardiovasc J. S. Afr 2002 Jul-Aug; 13(4): 194-199Naidoo D.P. The link between microalbuminuria, endothelial dysfunction and cardiovascular disease in diabetes. Cardiovasc J. S. Afr 2002 Jul-Aug; 13(4): 194-199Sjöblom P., Nystrom F.H., Länne T. et al. Microalbuminuria, but not reduced eGFR., is associated with cardiovascular subclinical organ damage in type 2diabetes. J. Diabetes Metab 2013 Nov 4. (13)[online].ahead print: 0-0Sjöblom P., Nystrom F.H., Länne T. et al. Microalbuminuria, but not reduced eGFR., is associated with cardiovascular subclinical organ damage in type 2diabetes. J. Diabetes Metab 2013 Nov 4. (13)[online].ahead print: 0-0Wolfgang L., Bjoern M., Stritzke J. et al. Association of low-grade urinary albumin excretion with left ventricular hypertrophy in the general population: The MONICA/KORA Augsburg Echocardiographic Substudy. NDT 2006; 21 (10): 2780-2787Wolfgang L., Bjoern M., Stritzke J. et al. Association of low-grade urinary albumin excretion with left ventricular hypertrophy in the general population: The MONICA/KORA Augsburg Echocardiographic Substudy. NDT 2006; 21 (10): 2780-2787Нечесова Т.А., Коробко И.Ю., Кузнецова Н.И. Ремоделирование левого желудочка: патогенез и методы оценки. Медицинские новости 2008; (11): 7-13Нечесова Т.А., Коробко И.Ю., Кузнецова Н.И. Ремоделирование левого желудочка: патогенез и методы оценки. Медицинские новости 2008; (11): 7-13Cuspidi C., Giudici V., Negri F. et al. Left ventricular geometry, ambulatory blood pressure and extra-cardiac organ damage in untreated essential hypertension. Blood Press Monit 2010 Jun; 15(3): 124-131Cuspidi C., Giudici V., Negri F. et al. Left ventricular geometry, ambulatory blood pressure and extra-cardiac organ damage in untreated essential hypertension. Blood Press Monit 2010 Jun; 15(3): 124-131Mattu H.S., Randeva H.S. Role of adipokines in cardiovascular disease. Journal of endocrinology 2013 (216): 17-36Mattu H.S., Randeva H.S. Role of adipokines in cardiovascular disease. Journal of endocrinology 2013 (216): 17-36Kong X.L., Jia X.Y., Wei Y. et al. Association between microalbuminuria and subclinical atherosclerosis evaluated by carotid artery intima-media in elderly patients with normal renal function. BMC Nephrology 2012; http://www.biomedcentral.com/14712369/13/37Kong X.L., Jia X.Y., Wei Y. et al. Association between microalbuminuria and subclinical atherosclerosis evaluated by carotid artery intima-media in elderly patients with normal renal function. BMC Nephrology 2012; http://www.biomedcentral.com/14712369/13/37Olefsky J.M., Glass C.K. Macrophages, inflammation, and insulin resistance. Annu Rev Physiol 2010 (72): 219-246Olefsky J.M., Glass C.K. Macrophages, inflammation, and insulin resistance. Annu Rev Physiol 2010 (72): 219-246López-Andrés N., Rousseau A., Akhtar R. et al. Cardiotrophin 1 Is Involved in Cardiac, Vascular, and Renal Fibrosis and Dysfunction. Hypertension 2012; (60): 563-573López-Andrés N., Rousseau A., Akhtar R. et al. Cardiotrophin 1 Is Involved in Cardiac, Vascular, and Renal Fibrosis and Dysfunction. Hypertension 2012; (60): 563-573Piya M.K., McTernan P.G., Kumar S. Adipokine inflammation and insulin resistance: the role of glucose, lipids and endotoxin. J. of endocrinology 2013; (216): 1-15Piya M.K., McTernan P.G., Kumar S. Adipokine inflammation and insulin resistance: the role of glucose, lipids and endotoxin. J. of endocrinology 2013; (216): 1-15Elseweidy M.M., Elswefy S.E., Younis N.N. et al. Pyridoxamine, an inhibitor of protein glycation, in relation to microalbuminuria and proinflammatory cytokines in experimental diabetic nephropathy. Exp Biol Med (Maywood) 2013 Aug 1; 238(8): 881-888Elseweidy M.M., Elswefy S.E., Younis N.N. et al. Pyridoxamine, an inhibitor of protein glycation, in relation to microalbuminuria and proinflammatory cytokines in experimental diabetic nephropathy. Exp Biol Med (Maywood) 2013 Aug 1; 238(8): 881-888Tsioufis C., Dimitriadis K., Taxiarchou E. et al. Diverse associations of microalbuminuria with C-reactive protein, interleukin-18 and soluble CD 40 ligand in male essential hypertensivDimitriadis K. Chatzis D. et al. Relation of microalbuminuria to adiponectin and augmented C-reactive protein levels in men with essential hypertension. Am J. Cardiol 2005 Oct 1; 96 e subjects. Am J. Hypertens 2006; 19 (5): 462- 466Tsioufis C., Dimitriadis K., Taxiarchou E. et al. Diverse associations of microalbuminuria with C-reactive protein, interleukin-18 and soluble CD 40 ligand in male essential hypertensivDimitriadis K. Chatzis D. et al. Relation of microalbuminuria to adiponectin and augmented C-reactive protein levels in men with essential hypertension. Am J. Cardiol 2005 Oct 1; 96 e subjects. Am J. Hypertens 2006; 19 (5): 462- 466Tsioufis C., Dimitriadis K. Chatzis D. et al. Relation of microalbuminuria to adiponectin and augmented C-reactive protein levels in men with essential hypertension. Am J. Cardiol 2005; 96 (7): 946-951Tsioufis C., Dimitriadis K. Chatzis D. et al. Relation of microalbuminuria to adiponectin and augmented C-reactive protein levels in men with essential hypertension. Am J. Cardiol 2005; 96 (7): 946-951Юренев А.П., Рязанов А.С., Жукова Н.В., Аракелянц А.А. Микроальбуминурия: клиническое и прогностическое значение при артериальной гипертонии. Терапевтический архив 2003; (12): 81-83Юренев А.П., Рязанов А.С., Жукова Н.В., Аракелянц А.А. Микроальбуминурия: клиническое и прогностическое значение при артериальной гипертонии. Терапевтический архив 2003; (12): 81-83

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