therapeuticЮжно-Российский журнал терапевтической практикиSouth Russian Journal of Therapeutic Practice2712-8156РостГМУ10.21886/2712-8156-2022-3-3-60-67therapeutic-263Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL RESEARCHНапряжение сдвига на эндотелии стенки сонной артерии и кальциноз коронарных артерий у пациентов с гипертонической болезньюFluid shear stress on the endothelium of the carotid artery wall and coronary artery calcinosis in patients with arterial hypertensionhttps://orcid.org/0000-0001-8960-1272ЛобановаН. Ю.LobanovaN. Iu.

Лобанова Надежда Юрьевна, врач-терапевт, УЗД

Киров

Nadezhda Iu. Lobanova, GP, ultrasonic medical investigation specialist, clinic

Kirov

nadya.uar@narod.ruЧичеринаЕ. Н.ChicherinaE. N.

Чичерина Елена Николаевна, доктор медицинских наук, проф., заведующая кафедрой внутренних болезней

Киров

Elena N. Chicherina, D. Sc. (Medicine), professor, head of department of internal medicine

Kirov

e-chicherina@bk.ruhttps://orcid.org/0000-0002-2209-9457МальчиковаС. В.MalchikovaS. V.

Мальчикова Светлана Владимировна, доктор медицинских наук, профессор кафедры госпитальной терапии

Киров

Svetlana V. Malchikova, D. Sc. (Medicine), professor of hospital therapy department

Kirov

malchikova@list.ruМаксимчук-КолобоваН. С.Maksimchuk-KolobovaN. S.

Максимчук-Колобова Надежда Сергеевна, кандидат медицинских наук, доцент кафедры семейной медицины и поликлинической терапии

Киров

Nadezhda S. Maksimchuk-Kolobova, Cand. Sc. (Medicine), associate professor of family medicine and outpatient treatment department

Kirov

n.maksimchuk@mail.ruФГБОУ ВО «Кировский государственный медицинский университет» Минздрава РоссииРоссияKirov State Medical UniversityRussian Federation202201092022336067Copyright © Лобанова Н.Ю., Чичерина Е.Н., Мальчикова С.В., Максимчук-Колобова Н.С., 20222022Лобанова Н.Ю., Чичерина Е.Н., Мальчикова С.В., Максимчук-Колобова Н.С.Lobanova N.I., Chicherina E.N., Malchikova S.V., Maksimchuk-Kolobova N.S.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therapeutic-j.ru/jour/article/view/263Цель

Цель: изучить взаимообусловленность изменений скорости сдвига на эндотелии (ССЭ) стенки интактного от атеросклероза участка общей сонной артерии (ОСА) с величиной индекса коронарной кальцификации (КИ) среди пациентов с гипертонической болезнью (ГБ).

Материалы и методы

Материалы и методы: в исследование включили 99 пациентов с ГБ, у 52 из которых выявлено атеросклеротическое поражение брахиоцефальных артерий (БЦА). Всем пациентам проведено ультразвуковое исследование сонных артерий с определением ССЭ на интактном участке ОСА, мультиспиральная компьютерная томография коронарных артерий с определением КИ.

Результаты

Результаты: распространённость атеросклеротического поражения БЦА в исследуемой выборке составила 53 %. Средние значения ССЭ для пациентов с ГБ и атеросклерозом БЦА (первая группа) составили 660,7 (185,6) с-1, для пациентов с ГБ без него (вторая группа) — 735,8 (149,8) с-1, р = 0,009. Параметры липидного спектра у пациентов обеих групп оказались сопоставимы. Медианные значения КИ у пациентов с атеросклеротическим поражением БЦА статистически значимо выше (15,00 (0,00;178, 00)) по сравнению с пациентами второй группы (0,00 (0,00;171,00), при р = 0,001. Шансы выявления кальциноза коронарных артерий среди пациентов первой группы в 2 раза выше (ОШ = 2,25, 95 % ДИ: 1,58–8,33), чем среди пациентов второй группы. Низкие значения ССЭ коррелировали с мужским полом (rs = 0,40 (95 % ДИ: 0,22;0,55) р<0,001) и увеличением КИ (rs = -0,23 (95 % ДИ: -0,41–0,04), р = 0,022).

Заключение

Заключение: среди пациентов с ГБ без симптомных заболеваний, обусловленных атеросклерозом в анамнезе, распространённость атеросклеротического поражения БЦА составила 53 %. В группе пациентов с ГБ и атеросклеротическим поражением БЦА медианные значения КИ были значимо выше, а поражение коронарных артерий выявлялось достоверно чаще (ОШ = 2,25, 95 % ДИ: 1,58–8,33), чем среди пациентов с ГБ и интактными БЦА. Средние значения ССЭ для пациентов с ГБ и атеросклерозом БЦА статистически значимо ниже, чем для пациентов с ГБ без него и составили 660,7 (185,6) с-1 и 735,8 (149,8) с-1 соответственно, р = 0,009. Низкие значения ССЭ коррелировали с мужским полом и увеличением КИ.

Objective

Objective: to study the interconditionality of changes in the fluid shear stress on the endothelium (FSE) of the common carotid artery (CCA) wall which is intact from atherosclerosis with the value of the Cardiac Calcium Score (CCS) among patients with e arterial hypertension (AH).

Materials and methods

Materials and methods: the study included 99 patients with AH, 52 of them had atherosclerotic lesions of the brachiocephalic arteries (BCA). The ultrasound investigation of the carotid arteries with the determination of FSE in the intact area of the CCA, multispiral computed tomography of the coronary arteries with the determination of CCS were performed to all patients.

Results

Results: the prevalence of BCA atherosclerotic lesion in the study was 53%. The mean value of FSE for patients with AH and BCA atherosclerosis (group 1) were 660.7 (185.6) c-1, for patients with AH without its (group 2) — 735.8 (149.8) c-1, p = 0.009. The parameters of the lipid spectrum in patients of both groups were comparable. Мedian value of CCS in patients with atherosclerotic lesions of the BCA were statistically significantly higher (15.00 (0.00; 178.00),) compared with patients of the group 2 (0.00 (0.00; 171.00), at p = 0.001. The chances of detecting coronary artery calcification among patients of group 1 are in 2 times higher (OR = 2.25, 95% CI: 1.58-8.33) than among patients of group 2. Low FSE values correlated with male gender (rs = 0.40 (95% CI: 0.22; 0.55) p <0.001) and increasing of CCS (rs = -0.23 (95% CI: -0.41; -0.04) p = 0.022).

Conclusions

Conclusions: the prevalence of atherosclerotic lesions of the BCA among patients with AH without a history of symptomatic diseases associated with atherosclerosis was 53%. In the group of patients with AH and atherosclerotic lesions of the BCA, median values of CCS were significantly higher, and coronary artery lesions were detected significantly more often (OR = 2.25, 95% CI: 1.58-8.33) than among patients with AH and intact BCA. The mean value of FSE for patients with AH and BCA atherosclerosis were statistically significantly lower than for patients with AH without it and amounted to 660.7 (185.6) c-1 and 735.8 (149.8) c-1, respectively, p = 0.009. Low FSE values correlated with male gender and increasing of CCS 

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