ssmuБюллетень сибирской медициныBulletin of Siberian Medicine1682-03631819-3684Siberian State Medical University, the Ministry of Healthcare of the Russian Federation10.20538/1682-0363-2015-5-10-14ssmu-181Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL PAPERSМЕТАБОЛИЧЕСКИЕ НАРУШЕНИЯ И ТРОМБОЭМБОЛИЯ ЛЕГОЧНОЙ АРТЕРИИMETABOLIC DISORDERS AND PULMONARY EMBOLISMВасильцеваО. Я.VasiltsevaO. Ya.vas_oy@sibmail.comВорожцоваИ. Н.VorozhtsovaI. N.vas_oy@sibmail.comЛавровА. Г.LavrovA. G.vas_oy@sibmail.comКарповР. С.KarpovR. S.

Karpov Rostislav S.

vas_oy@sibmail.comНИИ кардиологии, ТомскРоссияResearch Institute for Cardiology, TomskRussian FederationНИИ кардиологии, Томск; Сибирский государственный медицинский университет, ТомскРоссияResearch Institute for Cardiology, Tomsk; Siberian State Medical University, TomskRussian FederationСибирский государственный медицинский университет, ТомскРоссияSiberian State Medical University, TomskRussian Federation2015281020151451014Copyright © Васильцева О.Я., Ворожцова И.Н., Лавров А.Г., Карпов Р.С., 20152015Васильцева О.Я., Ворожцова И.Н., Лавров А.Г., Карпов Р.С.Vasiltseva O.Y., Vorozhtsova I.N., Lavrov A.G., Karpov R.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://bulletin.ssmu.ru/jour/article/view/181

Цель исследования – на основании данных Регистра новых случаев госпитальной тромбоэмболии легочной артерии (ТЭЛА) в стационарах г. Томска (2003–2012 гг.) изучить вклад сахарного диабета (СД) и ожирения в развитие легочной эмболии.

Материал и методы

Материал и методы. Исследованию были подвергнуты истории болезни и протоколы вскрытий пациентов, лечившихся в стационарах г. Томска в 2003–2012 гг., у которых при патологоанантомическом и (или) инструментальном исследовании выявлена ТЭЛА. Учитывая сроки создания Регистра (2003–2012 гг.), в нашей работе использовалась классификация СД, предложенная ВОЗ в 1999 г. с соответствующими критериями. Степень ожирения оценивали согласно критериям ВОЗ (1997).

The purpose of the study. To examine the contribution of diabetes and obesity in the development of pulmonary embolism on the based data of the Register of new hospital of pulmonary embolism (PE) in hospitals inTomsk(2003–2012). Material and Methods. The medical history and records of autopsies of patients treated in hospitals in the city ofTomsk, 2003–2012, and anatomopathological and/or instrumental examination revealed pulmonary embolism have been subjected to studies. We used the classification of diabetes mellitus proposed by the WHO in1999 inour work, because the register including data (2003–2012). The degree of obesity was assessed according to WHO classification (1997). Statistical analysis of the results was carried out with the help of software for computer Statistica for Windows, version 8.0. The Shapiro–Wilk and Kolmogorov–Smirnov tests was used to determine the nature of the distribution of the data. The ho mogeneity of the population variance was assessed using Fisher's exact test andLeuventest. The Mann– Whitney test was used when comparing two independent samples to determine the significance of differences. The analysis was conducted by means of qualitative characteristics contingency tables using Pearson χ 2 . The odds ratio was calculated to assess the association between a specific outcome and the risk. Data are presented as M ± SD factor. The significance level of p for all procedures used by the statistical analysis was taken to be 0.05. It was considered statistically significant level of p < 0.05. The results of the study. In intermediate urbanized city ofWestern Siberia,Tomsk, established register of hospital pulmonary embolism (2003–2012). The register included 751patients whose in vivo and / or postmortem revealed pulmonary embolism (PE). The data histories and autopsy reports was analyze. The type 2diabetes was diagnosed in 205 patients. The type 2 diabetes moderate had 29%. Diabetes severe suffer 82 patients (40%). In the group body mass index (BMI) was (29.24 ± 7.87) kg/m2 . Obesity diagnosed in 157patients (20.9%). It occurs in24.7% of cases for women andin 15.2% of cases for men. If a patient had obesity grade 3 was found to increase the risk of a massive thromboembolism in 3.27 times (OR = 3.27; 95% confidence interval [1.60–6.69]; p = 0.001) and an increase in the risk of fatal thromboembolism 3.56 times(OR = 3.56; 95% CI [1.73–7.43]; p = 0.001). It does not detect the influence of obesity 1 and 2 degrees on the development of a massive pulmonary embolism, or PE, which would cause the patient's death. Significant effect of type 2 diabetes was found on the development of the heavy flow of fatal pulmonary embolism. 

факторы риска тромбоэмболии легочной артериисахарный диабет 2-го типаожирениеpulmonary embolism risk factorstype2 diabetesobesityReferencesGarcia Trade L.J., Creight L.J., Gaffney L.J. Diabetes melli-tus as an hypercoagulable state; its relationship with fibrin fragments and vascular damage // Thromb. Res. 1987. Р. 533–540.Carcia Trade L.J., Creight L.J., Gaffney L.J. Diabetes mellitus as an hypercoagulable state; its relationship with fibrin frag-ments and vascular damage. Thromb. Res., 1987, pp. 533–540.Космачева Е.Д., Петрик Г.Г. Сахарный диабет как протромбогенное состояние: пути профилактики // Кардиология. 2013. Т. 53, № 4. С. 80–87.Kosmachеva Ye.D., Petrik G.G. Sakharnyi diabet kak protrombogennoye sostoyaniye: puti profilaktiki [Diabetes Mellitus as Hypercoagulate State: Ways of Preventing]. Kardiologiya – Cardiology, 2013, vol. 53, no. 4, рр. 80–87 (in Russian).Konstantinides S.V., Torbicki A., Agnelli G. et al. Guidelines on the diagnosis and management of acute pulmonary embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC) Endorsed by the European Respiratory Society (ERS) // Eur. Heart J. 2014. V. 35 (43). Р. 3033–3073. doi: 10.1093/eurheartj/ehu393.Konstantinides S.V., Torbicki A., Agnelli G. et al. Guidelines on the diagnosis and management of acute pulmonary embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC) Endorsed by the European Respiratory Society (ERS). Eur. Heart J., 2014, vol. 35(43), pp. 3033–3073. doi: 10.1093/eurheartj/ehu393.Петрик Г.Г., Павлищук С.А. Показатели метаболизма и гемостаза у больных сахарным диабетом 2-го типа в зависимости от выраженности ангиопатий // Проблемы эндокринологии. 2010. № 2. С. 15–19.Petrik G.G., Pavlishchuk S.А. Pokazateli metabolizma i gemostaza u bol’nykh sakharnym diabetom 2 tipa v zavisimosti ot vyrazhennosti angiopatiy [Metabolic and he-mostatic characteristics of patients with type 2 diabetes mellitus differing in the severity of angiopathy]. Problemy endokrinologii – Problems of Endocrinology, 2010, no. 2, рр. 15–19 (in Russian).Российские клинические рекомендации по диагностике, лечению и профилактике венозных тромбоэмболических осложнений // Флебология. 2010. № 1. С. 2–37.Rossiyskiye klinicheskiye rekomendatsii po diagnostike, lecheniyu i profilaktike venoznyh tromboembolicheskih oslozhneniy [Russian clinical guidelinesdiagnosis, treatment and preventionvenous thromboembolic complications]. Flebologiya – Phlebology, 2010, no. 1, рр. 2–37 (in Russian).Арутюнов Г.П., Шавгулидзе К.Б., Былова Н.А. Роль жировой ткани в патогенезе хронической сердечной недостаточности // Сердечная недостаточность. 2008. Т. 9, № 3. С. 128–136.Аrutyunov G.P., Shavgulidze K.B., Bylova N.А. Rol’ zhirovoy tkani v patogeneze khronicheskoy serdechnoy nedostatochnosti [The role of adipose tissue in the pathogen-esis of congestive heart failure]. Serdechnaya nedostatochnost’ – Russian Heart Failure Journal, 2008, vol. 9, no. 3, рр. 128–136 (in Russian).Дедов И.И., Мельниченко Г.А., Бутрова С.А. Жировая ткань как эндокринный орган // Ожирение и метаболизм. 2006. № 1. С. 6–13.Dedov I.I., Mel’nichenko G.А., Butrova S.А. Zhirovaya tkan’ kak endokrinnyy organ [Adipose tissue as an endocrine organ]. Ozhireniye i metabolism – Obesity and Metabolism, 2006, no. 1, рр. 6–13 (in Russian).Драпкина О.М., Корнеева О.Н., Драпкина Ю.С. Эпикардиальный жир: нападающий или запасной? // Рациональная фармакотерапия в кардиологии. 2013. Т. 9, № 3. С. 287–291.Drapkina O.M., Korneyeva O.N., Drapkina Yu.S. Epikardial’nyy zhir: napadayushchiy ili zapasnoy? [ Epicardialfat: Forwardoremergency?]. Ratsional’naya farmakoterapiya v kardiologii – Rational Pharmacotherapy in Cardiology, 2013, vol. 9, no. 3, рр. 287–291 (in Russian).Фадеенко Г.Д., Масляева Л.В. Ожирение как проблема клинической медицины // Ліки України. 2009. Т. 132, № 6. С. 31–37.Fadeyenko G.D., Maslyayeva L.V. Ozhireniye kak problema klinicheskoy meditsiny [Obesity as a problem of clinical medicine]. Lіky Ukrainy, 2009, vol. 132, no. 6, рр. 31–37 (in Russian).Шишкова В.Н., Ременник А.Ю., Зотова Л.И. Развитие основных нарушений гемостаза у пациентов с ожирением // Кардиология. 2012. № 2. С. 59–65.Shishkova V.N., Remennik А.Yu., Zotova L.I. Razvitiye osnovnyh narusheniy gemostaza u patsiyentov s ozhireniyem [Development of basic hemostatic disorders in obese patients]. Kardiologiya – Cardiology, 2012, no. 2, рр. 59–65 (in Russian).Matsuzawa Y., Funahashi T., Kihara S., Shimomura I. Adiponectin and Metabolic Syndrome // Arterioscler. Thromb.Vasc. Biol. 2004. V. 24, № 3. P. 29–33.Matsuzawa Y., Funahashi T., Kihara S., Shimomura I. Adiponectin and Metabolic Syndrome. Arterioscler. Thromb. Vasc. Biol., 2004, vol. 24, no. 3, pp. 29–33.Okamoto Y., Arita Y., Nishida M. et al. An adipocyte-derived plasma protein, adiponectin, adheres to injures vascular walls // Horm. Metab. Res. 2000. V. 32. P. 47.Okamoto Y., Arita Y., Nishida M. et al. An adipocyte-derived plasma protein, adiponectin, adheres to injures vascular walls. Horm. Metab. Res., 2000, vol. 32, p. 47.Mertens I., Van Gaal L.F. Obesity, haemostasis and the fibrinolytic system // Obes. Rev. 2002. V. 3, № 2. P. 85–101.Mertens I., Van Gaal L.F. Obesity, haemostasis and the fibrinolytic system. Obes. Rev., 2002, vol. 3, no. 2, pp. 85–101.Previtali E., Bucciarelli P., Passamonti S.M., Martinelli I. Risk factors for venous and arterial thrombosis // Blood Transfus. 2011. V. 9. P. 120–138.Previtali E., Bucciarelli P., Passamonti S.M., Martinelli I. Risk factors for venous and arterial thrombosis. Blood Transfus., 2011, vol. 9, pp. 120–138.Дедов И.И., Шестакова М.В., Максимова М.А. Федеральная целевая программа «Сахарный диабет»: методические рекомендации. М., 2002. 87 с.Dedov I.I Shestakova M.V., Maksimova M.А. Federal’naya tselevaya programma “Sakharnyy diabet”: metodicheskiye rekomendatsii [The federal target program “Diabetes”: guidelines]. Moscow, 2002. 87 р. (in Russian).

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