Нужна ли спирометрия при сердечно-сосудистых заболеваниях?

Нужна ли спирометрия при сердечно-сосудистых заболеваниях?

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Аннотация

В последние десятилетия происходит неуклонный рост распространенности сердечно-сосудистых (ССЗ) и бронхообструктивных заболеваний во всем мире, что привело к высокой частоте встречаемости пациентов с сочетанной патологией, в первую очередь артериальной гипертонией и хронической обструктивной болезнью легких (ХОБЛ) и/или бронхиальной астмой (БА). Рост числа пациентов с этой патологией обусловлен как повышением заболеваемости артериальной гипертонией, ХОБЛ и БА, так и увеличением гериатрической популяции больных, у которых эти заболевания весьма распространены. В эпидемиологических исследованиях показано, что ухудшение функции легких является столь же сильным предиктором сердечно-сосудистой летальности, как и основные сердечно-сосудистые факторы риска. Однако спирометрия у пациентов с ССЗ проводится недостаточно. Недостаточная диагностика ХОБЛ и БА, особенно у пациентов с ССЗ, отрицательно влияет на клиническое течение обоих заболеваний, приводит к неадекватному лечению и ухудшению прогноза для пациента. Необходимость широкого скринингового проведения спирометрии всем пациентам с ССЗ пока не доказана. Отсутствуют референсные значения спирометрических показателей у пациентов с ССЗ, что делает практически невозможным их использование при стратификации сердечно-сосудистого риска. Это диктует необходимость проведения дальнейших исследований, позволяющих уточнить взаимосвязь между тяжестью, особенностями течения разных ССЗ и различными спирометрическими показателями.

Ключевые слова: спирометрия, сердечно-сосудистые заболевания, хроническая обструктивная болезнь легких, бронхиальная астма.

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In recent decades cardiovascular (CVD) and COPD diseases are widespread around the world, leading to a high prevalence of patients with comorbidity, especially arterial hypertension (AH) and chronic obstructive pulmonary disease (COPD) and/or bronchial asthma (BA). The growing number of patients with this comorbidity is due to increased hypertension, COPD, and asthma comorbidities, with the increase of the geriatric population of patients with these pathologies. Epidemiological studies have shown that the deterioration of lung function is as strong a predictor of cardiovascular mortality, as well as major cardiovascular risk factors. However, spirometry in patients with CVD is carried out infrequently. Inadequate spirometric diagnostics of COPD and asthma, especially in patients with cardiovascular disease, affects the clinical course of both diseases, leading to inappropriate treatment and poor prognosis for the patient. The need for extensive screening spirometry in all patients with CVD is not proven. Thera are no spirometry reference values in patients with CVD, which makes it almost impossible to use these parameters in stratification of CV risk. This dictates the need for further research to clarify the relationship between the severity and characteristics of the various CVD and spirometric parameters.

Key words: spirometry, cardiovascular disease, chronic obstructive pulmonary disease, bronchial asthma.

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Список литературы

1. Lopez AD, Mathers CD, Ezzatim et al. Global burden of disease and risk factors. Washington (DC): World Bank, 2006. Chapter 1.
2. MacKay J, Mensah G. The atlas of heart disease and stroke. Geneva, Switzerland: World Health Organization, 2004.
3. Murray CJL, Lopez AD. The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020. Cambridge, MA, Harvard School of Public Health on behalf on the World Health Organization and the World Bank (Global Burden of Disease and Injury Series, Vol. I).
4. Mathers CD, Lopez A, Stein P et al. Deaths and disease burden by cause: global burden of disease estimates for 2001 by World Bank country groups. Washington. The World Health Organization (WHO), the World Bank, and the Fogarty International Center, US National Institutes of Health (NIH), 2003. DCPP Working papers series No. 18. Second project on disease control priorities in developing countries (DCPP). Retrieved October 2005.
5. Жуковский Г.С., Константинов В.В., Варламова Т.А., Капустина А.В. Артериальная гипертония: эпидемиологическая ситуация в России и других странах. РМЖ. 1997; 9 (5): 551–8.
6. Kannel WB. Blood pressure as a cardiovascular risk factor: prevention and treatment. JAMA 1996; 275 (24): 1571–6.
7. Behar S, Panosh A, Reicher-Reiss H et al. Prevalence and prognosis of chronic obstructive pulmonary disease among 5,839 consecutive patients with acute myocardial infarction. SPRINT Study Group. Am J Med 1992; 93 (6): 637–41.
8. Диагностика и лечение артериальной гипертензии. Российские рекомендации (четвертый пересмотр). Системные гипертензии. 2010; 3: 3–25.
9. Шальнова С., Кукушкин С., Маношкина Е., Тимофеева Т. Артериальная гипертензия и приверженность терапии. Врач. 2009; 12: 39–42.
10. Шальнова С.А., Деев А.Д. Ишемическая болезнь сердца в России: распространенность и лечение (по данным клинико-эпидемиологических исследований). Тер. архив. 2011; 1: 7–11.
11. Агеев Ф.Т., Даниелян С.А., Мареев В.Ю. и др. Больные с хронической сердечной недостаточностью в российской амбулаторной практике: особенности контингента, диагностики и лечения (по материалам исследования ЭПОХА-О-ХСН). Сердеч. недостаточность. 2004; 5 (1): 4–7.
12. Респираторная медицина. Под ред. А.Г.Чучалина. М.: ГЭОТАР-Медиа, 2007.
13. American thoracic society. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1995; 152: S77–S120.
14. Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention. Update Dec 2011.
15. Masoli M, Fabian D, Holt S, Beasley R. Global Initiative for Asthma (GINA) Program. The global burden of asthma: executive summary of the GINA, Dissemination Committee report. Allergy 2004; 59 (5): 469–78.
16. Killian KJ, Leblanc P, Martin DH et al. Exercise capacity and ventilatory, circulatory, and symptom limitation inpatients with chronic airflow limitation. Am Rev Respir Dis 1992; 146: 935–40.
17. Higgins M. Epidemiology of obstructive pulmonary disease. In: R.Cassaburi, T.L.Petty eds. Principles and practice of pulmonary rehabilitation. W.B. Saunders, Philadelphia, 1993.
18. Бронхиальная астма. Руководство для врачей (формулярная система). Пульмонология. 2004; 206–41.
19. Sin DD, Wu L, Man SF. The relationship between reduced lung function and cardiovascular mortality: A population-based study and a systematic review of the literature. Chest 2005; 127 (6): 1952–9.
20. Кароли H.A., Ребров А.П. Эндотелиальная дисфункция у больных бронхиальной астмой с хроническим легочным сердцем. Рос. мед. журн. 2002; 4: 22–4.
21. Dogra S, Ardern C, Baker J. The relationship between age of asthma onset and cardiovascular disease in Canadians. J Asthma 2007; 44: 849–54.
22. Perera PN, Armstrong EP, Sherrill DL, Skrepnek GH. Acute exacerbations of COPD in the United States: inpatient burden and predictors of costs and mortality. COPD 2012; 9 (2): 131–41.
23. Mannino DM, Thorn D, Swensen A, Holguin F. Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD. Eur Respir J 2008; 32: 962–9.
24. Кароли Н.А., Ребров А.П. Коморбидность у больных хронической обструктивной болезнью легких: место кардиоваскулярной патологии. Рацион. фармакотерапия в кардиологии. 2009; 4: 9-16.
25. Anthonisen NR, Connett JE, Enright PL, Manfreda J. Lung health study research group. Hospitalizations and mortality in the Lung Health Study. Am J Respir Crit Care Med 2002; 166: 333–9.
26. Miravitlles M, Calle M, Soler-Cataluña J. Clinical phenotypes of COPD: identification, definition and implications for guidelines. Arch Bronconeumol 2012; 48 (3): 86–98.
27. Thomas M, Taylor R. Assessing inflammatory phenotypes and improving the cost-effectiveness of asthma and COPD care in the community. Prim Care Respir J 2011; 20 (4): 349–50.
28. Buch P, Friberg J, Scharling H et al. Reduced lung function and risk of atrial fibrillation in the Copenhagen City Heart Study. Eur Respir J 2003; 21 (6): 1012–6.
29. Kleiger RE, Senior RM. Longterm electrocardiographic monitoring of ambulatory patients with chronic airway obstruction. Chest 1974; 65 (5): 483–7.
30. Boezen HM, Rijcken B, Schouten JP, Postma DS. Breathlessness in elderly individuals is related to low lung function and reversibility of airway obstruction. Eur Respir J 1998; 12: 805–10.
31. Rosengren A, Wilhelmsen L. Respiratory symptoms and long-term risk of death from cardiovascular disease, cancer and other causes in Swedish men. Int J Epidemiol 1998; 27: 962–9.
32. Nishimura K, Izumi T, Tsukino M, Oga T. Dyspnea is a better predictor of 5-year survival than airway obstruction in patients with COPD. Chest 2002; 121: 1434–40.
33. Carpenter L, Beral V, Strachan D et al. Respiratory symptoms as predictors of 27 year mortality in a representative sample of British adults. BMJ 1989; 299: 357–61.
34. Frostad A, Soyseth V, Andersen A, Gulsvik A. Respiratory symptoms as predictors of all-cause mortality in an urban community: a 30-year follow-up. J Intern Med 2006; 259: 520–9.
35. Frostad A, Soyseth V, Haldorsen T et al. Respiratory symptoms and long-term cardiovascular mortality. Respir Med 2007; 101: 2289–96.
36. Huijnen B, Horst F, Amelsvoort L et al. Dyspnea in elderly family practice patients. Occurrence, severity, quality of life and mortality over an 8-year period. Fam Pract 2006; 23: 34–9.
37. Stavem K, Sandvik L, Erikssen J. Breathlessness, phlegm and mortality: 26 years of follow-up in healthy middle-aged Norwegian men. J Intern Med 2006; 260: 332–42.
38. Tessier JF, Nejjari C, Letenneur L et al. Dyspnea and 8-year mortality among elderly men and women: the PAQUID cohort study. Eur J Epidemiol 2001; 17: 223–9.
39. Ebi-Kryston KL. Respiratory symptoms and pulmonary function as predictors of 10-year mortality from respiratory disease, cardiovascular disease, and all causes in the Whitehall study. J Clin Epidemiol 1988; 41: 251–60.
40. Celli B.R. Pulmonary rehabilitation in patients with COPD. Am J Respir Crit Care Med 1995; 152: 861–4.
41. Mannino DM, Ford ES, Redd SC. Obstructive and restrictive lung disease and markers of inflammation: data from the Third National Health and Nutrition Examination. Am J Med 2003; 114: 758–62.
42. Camilli AE, Robbins DR, Lebowitz MD. Death certificate reporting of confirmed airways obstructive disease. Am J Epidemiol 1991; 133: 795–800.
43. Sin DD, Man SF. Why are patients with chronic obstructive pulmonary disease at increased risk of cardiovascular diseases? The potential role of systemic inflammation in chronic obstructive pulmonary disease. Circulation 2003; 107: 1514–9.
44. Eid AA, Ionescu AA, Nixon LS et al. Inflammatory response and body composition in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2001; 164: 1414–8.
45. Takabatake N, Nakamura H, Abe S et al. The relationship between chronic hypoxemia and activation of the tumor necrosis factor-ct system in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2000; 161: 1179–84.
46. Wouters EF, Creutzberg EC, Schols AM. Systemic effects in COPD. Chest 2002; 121 (Suppl.): 127S–130S.
47. Yamanouchi H, Fujita J, Yoshinouchi T et al. Measurement of hepatocyte growth factor in serum and bronchoalveolar lavage fluid in patients with pulmonary fibrosis. Respir Med 1998; 92: 273–8.
48. Zureik M, Benetos A, Neukirch C et al. Reduced pulmonary function is associated with central arterial stiffness in men. Am J Respir Crit Care Med 2001; 164: 2181–5.
49. Beaty TH, Newill CA, Cohen BH et al. Effects of pulmonary function on mortality. J Chronic Dis 1985; 38: 703–10.
50. Higgins MW, Keller JB. Predictors of mortality in the adult population of Tecumseh. Arch. Environ. Hlth 1970; 21: 418–24.
51. Speizer FE, Fay ME, Dockery DW, Ferris BG. Chronic obstructive pulmonary disease mortality in six U.S. cities. Am Rev Respir Dis 1989; 140: S49–S55.
52. Engstrom G, Wollmer P, Hedblad B et al. Occurrence and prognostic significance of ventricular arrhythmia is related to pulmonary function: a study from men born in 1914, Malmo, Sweden. Circulation 2001; 103: 3086–91.
53. GOLD Spirometry Guide. Spirometry for health care providers. Update June 2010.
54. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (GOLD). Update Dec 2011.
55. Buffels J, Degryse J, Heyrman J, Decramer M. Office spirometry significantly improves early detection of COPD in general practice: the DIDASCO study (Randomized Controlled Trial). Chest 2004; 125 (4): 1394–9.
56. Price DB, Tinkelman DG, Halbert RJ et al. Symptom based questionnaire for identifying COPD in smokers. Respiration 2006; 73 (3): 277–8.
57. Van Schayck CP, Loozen JM, Wagena E et al. Detecting patients at a high risk of developing chronic obstructive pulmonary disease in general practice: cross sectional case finding study. Br Med J 2002; 324: 1370–5.
58. Levy ML, Quanjer PH, Booker R et al. Diagnostic spirometry in primary care: proposed standards for general practice compliant with American Thoracic Society and European Respiratory Society recommendations. Primary Care Respiratory J 2009; 18 (3): 130–47.

Авторы

Б.М.Назаров1, К.А.Зыков2, Л.Г.Ратова1, О.Ю.Агапова2, Ю.А.Долгушева1, И.Е.Чазова1

1 ИКК им. А.Л.Мясникова ФГБУ РКНПК Минздрава РФ, Москва;
2 ГБОУ ВПО МГМСУ им. А.И.Евдокимова Минздрава РФ

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B.M.Nazarov, К.А.Zykov, L.G.Ratova, O.Yu.Agapova, Yu.A.Dolgusheva, I.E.Chazova

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