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Адипокины и кардиореспираторная система у молодых пациентов с сахарным диабетом 1-го типа
© ООО «КОНСИЛИУМ МЕДИКУМ», 2022 г.
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Vengrzhinovskaya OI, Bondarenko IZ, Shatskaya OA, Nikankina LV, Kalashnikov VIu, Shestakova MV, Mokrysheva NG. Adipokines and the cardiorespiratory system in young patients with type 1 diabetes mellitus. Terapevticheskii Arkhiv (Ter. Arkh.). 2022;94(10):1143–1148. DOI: 10.26442/00403660.2022.10.201889
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Цель. Оценить прогностическую ценность адипокинов в отношении персонифицированного подхода к углубленному обследованию молодых пациентов с СД 1.
Материалы и методы. В исследование включили 98 пациентов без ССЗ: 70 с СД 1 (средний возраст – 26,4±8,1 года) и 28 без СД (средний возраст – 27±9 лет). Всем участникам провели общеклиническое обследование, эргоспирометрию, эхокардиографию, биоимпедансометрию, у всех определили уровни адипокинов.
Результаты. Выявлены изменения в кардиореспираторной системе у пациентов с СД 1 в сравнении с лицами без такового: анаэробный порог достигался быстрее (р=0,001), максимальное потребление кислорода было ниже (р=0,048), метаболический эквивалент снижен (р=0,0001). Обнаружены признаки ремоделирования миокарда при СД 1: отмечалось увеличение относительной толщины стенок (р=0,001), задней стенки левого желудочка (р=0,001), индекса массы миокарда (р=0,049) – в сравнении с лицами без СД 1. Выявлены изменения в системе адипокинов: более высокие уровни резистина (р=0,002) и висфатина (р=0,001), более низкий уровень адипонектина (р=0,040) при СД 1. Обнаружена положительная взаимосвязь задней стенки левого желудочка с висфатином (р=0,014) и отрицательная – адипонектина с относительной толщиной стенок (р=0,018) при СД 1.
Заключение. При СД 1 даже в молодом возрасте наблюдаются многофакторные изменения со стороны сердечно-сосудистой системы, которые можно выявить еще на доклиническом этапе. Полученные данные могут быть использованы для выделения групп пациентов высокого риска развития ССЗ при СД 1, что может лечь в основу определения сроков начала превентивной терапии.
Ключевые слова: сахарный диабет 1-го типа, спироэргометрия, кардиореспираторная система, висфатин, резистин, адипонектин, эхокардиография, биоимпедансометрия
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Early screening of complications of diabetes mellitus (DM) is one of the priorities for public health. Most patients with type 1 diabetes mellitus (T1DM) are patients of working age. New strategies for the primary prevention of cardiovascular disease (CVD) are needed to prevent their early disability.
Aim. To assess the predictive value of adipokines in relation to a personalized approach to the need for an in-depth examination of young patients with T1DM.
Materials and methods. The study included 98 patients without CVD: 70 patients with T1DM (mean age 26.4±8.1 years) and 28 patients without DM (mean age 27±9 years). All patients underwent a general clinical examination, the levels of adipokines were determined, ergospirometry, echocardiography, and bioimpedancemetry were performed.
Results. Changes in the cardiorespiratory system in patients with T1DM were revealed, in comparison with persons without T1DM: anaerobic threshold was reached faster (p=0.001), maximum oxygen consumption was lower (p=0.048), metabolic equivalent was reduced (p=0.0001). Signs of myocardial remodeling were found in the T1DM group: there was an increase in the relative wall thickness (p=0.001), the posterior wall of the left ventricle (p=0.001), myocardial mass index (p=0.049), in comparison with persons without T1DM. Changes in the adipokines system were revealed: higher levels of resistin (p=0.002) and visfatin (p=0.001), lower level of adiponectin (p=0.040) in T1DM. A positive correlation was found between posterior wall of the left ventricle and visfatin (p=0.014) and a negative relationship between adiponectin and relative wall thickness (p=0.018) in T1DM.
Conclusion. In T1DM, even at a young age, there are multifactorial changes in the heart, which can be detected even at the preclinical stage. The data obtained can be used to identify groups of patients at high risk of developing dangerous CVD in T1DM, which can form the basis for determining the timing of the start of preventive therapy.
Keywords: diabetes mellitus type 1, spiroergometry, cardiorespiratory system, visfatin, resistin, adiponectin, echocardiography, bioimpedancemetry
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1. Laukkanen JA, Kurl S, Lakka TA, et al. Exercise-induced silent myocardial ischemia and coronary morbidity and mortality in middle-aged men. J Am Coll Cardiol. 2001;38(1):72-9. DOI:10.1016/s0735-1097(01)01311-0
2. Dedov II, Shestakova MV, Vikulova OK. Epidemiology of diabetes mellitus in Russian Federation: clinical and statistical report according to the federal diabetes registry. Diabetes Mellitus. 2017;20(1):13-41 (in Russian). DOI:10.14341/DM8664
3. Balady GJ, Arena R, Sietsema K, et al; American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee of the Council on Clinical Cardiology; Council on Epidemiology and Prevention; Council on Peripheral Vascular Disease; Interdisciplinary Council on Quality of Care and Outcomes Research. Clinician's Guide to cardiopulmonary exercise testing in adults: a scientific statement from the American Heart Association. Circulation. 2010;122(2):191-225. DOI:10.1161/CIR.0b013e3181e52e69
4. Russian Scientific Society of Cardiologists. Prediction and Prevention of Cardiac Complications of Noncardiac Surgical Interventions. National Clinical Guidelines. Kardiovaskulyarnaya terapiya i profilaktika. 2011;10(6, prilozhenie 3):1-28 (in Russian).
5. Rudski LG, Lai WW, Afilalo J, еt al. Guidelines for the Echocardiographic Assessment of the Right Heart in Adults: A Report from the American Society of Echocardiography Endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010;23(7):685-713. DOI:10.1016/j.echo.2010.05.010
6. Parfenovа NS, Tanyanskiy DA. Adiponectin: beneficial effects on metabolic and cardiovascular dysfunctions. Arterialnaya Gipertenziya (Arterial Hypertension). 2013;19(1):84-96 (in Russian). DOI:10.18705/1607-419X-2013-19-1-84-96
7. Vavilova TP, Pleten' AP, Mikheev RK. Biological role of adipokines and their association with morbid conditions. Voprosy pitaniia. 2017;86(2):5-13 (in Russian). DOI:10.1073/pnas.1920004117
8. Bailey SD, Loredo-Osti JC, Lepage P, et al. Common polymorphisms in the promoter of the visfatin gene (PBEF1) influence plasma insulin levels in a French-Canadian population. Diabetes. 2006;55(10):2896-902. DOI:10.2337/db06-0189
9. Gaivoronsky IV, Nichiporuk GI, Gaivoronsky IN, Nichiporuk NG. Bioimpedansometry As A Method For Assessing The Component Composition Of The Human Body (Literature Review). Vestnik of Saint Petersburg University. Medicine. 2017;12(4):365-84 (in Russian). DOI:10.21638/11701/spbu11.2017.406
10. Cho YH, Craig ME, Davis EA, et al; Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial. Cardiac autonomic dysfunction is associated with high-risk albumin-to-creatinine ratio in young adolescents with type 1 diabetes in AdDIT (adolescent type 1 diabetes cardio-renal interventional trial). Diabetes Care. 2015;38(4):676-81. DOI:10.2337/dc14-1848
11. Barstow TJ, Molé PA. Linear and nonlinear characteristics of oxygen uptake kinetics during heavy exercise. J Appl Physiol (1985). 1991;71(6):2099-106. DOI:10.1152/jappl.1991.71.6.2099
12. Agostoni P, Cattadori G, Bussotti M, Apostolo A. Cardiopulmonary interaction in heart failure. Pulm Pharmacol Ther. 2007;20(2)130-4. DOI:10.1016/j.pupt.2006.03.001
13. Alway SE, Mohamed JS, Myers MJ. Mitochondria Initiate and Regulate Sarcopenia. Exerc Sport Sci Rev. 2017;45(2):58-69. DOI:10.1249/JES.0000000000000101
14. Mukha NV, Govorin AV, Zaitsev DN, Filev AP. Structural and functional myocardial disorders and arrhythmias in patients with type 1 diabetes mellitus complicated by ketoacidosis. Russian Journal of Cardiology. 2020;25(7):3891. (in Russian). DOI:10.15829/1560-4071-2020-3891
15. Acar G, Akcay A, Sokmen A, et al. Assessment of atrial electromechanical delay, diastolic functions, and left atrial mechanical functions in patients with type 1 diabetes mellitus. J Am Soc Echocardiogr. 2009;22(6):732-8. DOI:10.1016/j.echo.2009.03.028
16. Tsvetkova MV, Khirmanov VN, Zybina NN. The role of nonesterified fatty acids in pathogenesis of cardiovascular disease. Arterial Hypertension. 2010;16(1):93-103 (in Russian). DOI:10.18705/1607-419X-2010-16-1-93-103
17. Bando YK, Murohara T. Diabetes-related heart failure. Circ J. 2014;78(3):576-83. DOI:10.1253/circj.cj-13-1564
18. Ouchi N, Ohishi M, Kihara S, et al. Fssociation of hypoadiponectinemia with impaired vasoreactivity. Hypertension. 2003;42:231-4. DOI:10.1161/01.hyp.0000083488.67550.b8
19. Iwashima Y, Katsuya T, Ishikawa K, et al. Hypoadiponectinemia is an Independent Risk Factor for Hypertension. Hypertension. 2004;43:1318-23. DOI:10.1161/01.hyp.0000129281.03801.4b
20. Verbovoy AF, Tsanava IA, Verbovaya NI. Adipokines and metabolie patients with type 2 diabetes mellitus in combination with gout. Ozhirenie i metabolism. 2016;13(1):20-4 (in Russian). DOI:10.14341/omet2016120-24
21. Schnabel R, Messow CM, Lubos E, et al. Association of adiponectin with adverse outcome in coronary artery disease patients: results from the AtheroGene study. Eur Heart J. 2008;29(5):649-57. DOI:10.1093/eurheartj/ehn009
22. Calabro P, Samudio I, Willerson JT, Yeh ET. Resistin Promotes Smooth Muscle Cell Proliferation Through Activation of Extracellular Signal-Regulated Kinase 1/2 and Phosphatidylinositol 3-Kinase Pathways. Circulation. 2004;110(21):3335-40. DOI:10.1161/01.CIR.0000147825.97879.E7
23. Teryaeva NB. Adiponectin: regulation of energymetabolism and the pathogenesis of cardiovascular diseases. Creative Cardiology. 2007;12:20-5 (in Russian).
24. Frankel DS, Vasan RS, D'Agostino RB, et al. Resistin, Adiponectin, and Risk of Heart Failure. J Am Coll Cardiol. 2009;53(9):754-62. DOI:10.1016/j.jacc.2008.07.073
ФГБУ «Национальный медицинский исследовательский центр эндокринологии» Минздрава России, Москва, Россия
*vengrzhinovskay@gmail.com
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Oksana I. Vengrzhinovskaya*, Irina Z. Bondarenko, Olga A. Shatskaya, Larisa V. Nikankina, Victor Iu. Kalashnikov, Marina V. Shestakova, Natalia G. Mokrysheva
National Medical Research Center for Endocrinology, Moscow, Russia
*vengrzhinovskay@gmail.com