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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">ssmu</journal-id><journal-title-group><journal-title xml:lang="ru">Бюллетень сибирской медицины</journal-title><trans-title-group xml:lang="en"><trans-title>Bulletin of Siberian Medicine</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">1682-0363</issn><issn pub-type="epub">1819-3684</issn><publisher><publisher-name>Siberian State Medical University, the Ministry of Healthcare of the Russian Federation</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.20538/1682-0363-2017-1-162-178</article-id><article-id custom-type="elpub" pub-id-type="custom">ssmu-787</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ОБЗОРЫ И ЛЕКЦИИ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>REVIEW AND LECTURES</subject></subj-group></article-categories><title-group><article-title>Патология периферического кровообращения при хронической сердечной недостаточности</article-title><trans-title-group xml:lang="en"><trans-title>Pathology of the peripheral circulation in chronic heart failure</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-0721-0038</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Тепляков</surname><given-names>А. Т.</given-names></name><name name-style="western" xml:lang="en"><surname>Teplyakov</surname><given-names>A. T.</given-names></name></name-alternatives><bio xml:lang="ru"><p>д-р мед. наук, профессор, руководитель отделения сердечной недостаточности, НИИ кардиологии, </p><p>634012, г. Томск, ул. Киевская, 111а</p></bio><bio xml:lang="en"><p>DM, Professor, Head of the Department of Heart Failure, Cardiology Research Institute,</p><p>111а, Kievskaya Str., Tomsk, 634012</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-9640-2028</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Калюжин</surname><given-names>В. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Kalyuzhin</surname><given-names>V. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>д-р мед. наук, профессор, и.о. зав. кафедрой госпитальной терапии с курсом физической реабилитации и спортивной медицины,</p><p>634050, г. Томск, Московский тракт, 2</p></bio><bio xml:lang="en"><p>DM, Professor, Head of the Department of Hospital Therapy with a Сourse of Physical Rehabilitation and Sports Medicine,</p><p>2, Moscow Trakt, Tomsk, 634050</p></bio><email xlink:type="simple">kalyuzhinvv@mail.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-7978-5327</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Калюжина</surname><given-names>Е. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Kalyuzhina</surname><given-names>E. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>д-р мед. наук, профессор кафедры госпитальной терапии с курсом физической реаби- литации и спортивной медицины, </p><p>634050, г. Томск, Московский тракт, 2</p></bio><bio xml:lang="en"><p>DM, Professor of the Department of Hospital Therapy with a Сourse of Physical Rehabilitation and Sports Medicine,</p><p>2, Moscow Trakt, Tomsk, 634050</p></bio><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-5780-6660</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Черногорюк</surname><given-names>Г. Э.</given-names></name><name name-style="western" xml:lang="en"><surname>Chernogoryuk</surname><given-names>G. E.</given-names></name></name-alternatives><bio xml:lang="ru"><p>д-р мед. наук, профессор, кафедра госпитальной терапии с курсом физической реабилитации и спортивной медицины,</p><p>634050, г. Томск, Московский тракт, 2</p></bio><bio xml:lang="en"><p>DM, Professor of the Department of Hospital Therapy with a Сourse of Physical Rehabilitation and Sports Medicine,</p><p>2, Moscow Trakt, Tomsk, 634050</p></bio><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-1977-9443</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Рачковский</surname><given-names>М. И.</given-names></name><name name-style="western" xml:lang="en"><surname>Rachkovsky</surname><given-names>M. I.</given-names></name></name-alternatives><bio xml:lang="ru"><p>д-р мед. наук, профессор кафедры госпитальной терапии с курсом физической реабилитации и спортивной медицины, </p><p>634050, г. Томск, Московский тракт, 2</p></bio><bio xml:lang="en"><p>DM, Professor of the Department of Hospital Therapy with a Сourse of Physical Rehabilitation and Sports Medicine,</p><p>2, Moscow Trakt, Tomsk, 634050</p></bio><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-4513-6329</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Беспалова</surname><given-names>И. Д.</given-names></name><name name-style="western" xml:lang="en"><surname>Bespalova</surname><given-names>I. D.</given-names></name></name-alternatives><bio xml:lang="ru"><p>д-р. мед. наук, зав. кафедрой социальной работы, социальной и клинической психологии,</p><p>634050, г. Томск, Московский тракт, 2</p></bio><bio xml:lang="en"><p>DM, Head of the Department of Social Work, Social and Clinical Psychology,</p><p>2, Moscow Trakt, Tomsk, 634050</p></bio><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-0462-3526</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Терентьева</surname><given-names>Н. Н.</given-names></name><name name-style="western" xml:lang="en"><surname>Terentyeva</surname><given-names>N. N.</given-names></name></name-alternatives><bio xml:lang="ru"><p>канд. мед. наук, доцент кафедры госпитальной терапии,</p><p>628412, г. Сургут, пр. Ленина, 1</p></bio><bio xml:lang="en"><p>PhD, Associate Professor of the Department of Hospital Therapy,</p><p>1, Lenina Av., Surgut, 628412</p></bio><xref ref-type="aff" rid="aff-3"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-2357-6910</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Лившиц</surname><given-names>И. К.</given-names></name><name name-style="western" xml:lang="en"><surname>Livshits</surname><given-names>I. K.</given-names></name></name-alternatives><bio xml:lang="ru"><p>канд. мед. наук, доцент кафедры госпитальной терапии с курсом физической реабилитации и спортивной медицины,</p><p>634050, г. Томск, Московский тракт, 2</p></bio><bio xml:lang="en"><p>PhD, Associate Professor of the Department of Hospital Therapy with a Сourse of Physical Rehabilitation and Sports Medicine,</p><p>2, Moscow Trakt, Tomsk, 634050</p></bio><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Соловцов</surname><given-names>М. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Solovtsov</surname><given-names>M. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>врач отделения ультразвуковой диагностики,</p><p>634063, г. Томск, ул. И. Черных, 96</p></bio><bio xml:lang="en"><p>Doctor of the Department of Ultrasonic Diagnostics,</p><p>96/I, Chernuh Str., Tomsk, 634063</p></bio><xref ref-type="aff" rid="aff-4"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-0105-2307</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Чернявская</surname><given-names>Г. М.</given-names></name><name name-style="western" xml:lang="en"><surname>Chernjavskaja</surname><given-names>G. M.</given-names></name></name-alternatives><bio xml:lang="ru"><p>д-р мед. наук, профессор, кафедра госпитальной терапии с курсом физической реабилитации и спортивной медицины,</p><p>634050, г. Томск, Московский тракт, 2</p></bio><bio xml:lang="en"><p>DM, Professor of the Department of Hospital Therapy with a Сourse of Physical Rehabilitation and Sports Medicine,</p><p>2, Moscow Trakt, Tomsk, 634050</p></bio><xref ref-type="aff" rid="aff-2"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>НИИ кардиологии, Томский национальный исследовательский медицинский центр (ТНИМЦ) Российской академии наук (РАН)</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Cardiology Research Institute, Tomsk National Research Medical Center (TNRMC), Russian Academy of Sciences (RAS)</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>Сибирский государственный медицинский университет (СибГМУ)</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Siberian State Medical University</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-3"><aff xml:lang="ru"><institution>Сургутский государственный университет (СурГУ)</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Surgut State University</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-4"><aff xml:lang="ru"><institution>Томская областная клиническая больница (ТОКБ)</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Regional Clinical Hospital</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2017</year></pub-date><pub-date pub-type="epub"><day>20</day><month>04</month><year>2017</year></pub-date><volume>16</volume><issue>1</issue><fpage>162</fpage><lpage>178</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Тепляков А.Т., Калюжин В.В., Калюжина Е.В., Черногорюк Г.Э., Рачковский М.И., Беспалова И.Д., Терентьева Н.Н., Лившиц И.К., Соловцов М.А., Чернявская Г.М., 2017</copyright-statement><copyright-year>2017</copyright-year><copyright-holder xml:lang="ru">Тепляков А.Т., Калюжин В.В., Калюжина Е.В., Черногорюк Г.Э., Рачковский М.И., Беспалова И.Д., Терентьева Н.Н., Лившиц И.К., Соловцов М.А., Чернявская Г.М.</copyright-holder><copyright-holder xml:lang="en">Teplyakov A.T., Kalyuzhin V.V., Kalyuzhina E.V., Chernogoryuk G.E., Rachkovsky M.I., Bespalova I.D., Terentyeva N.N., Livshits I.K., Solovtsov M.A., Chernjavskaja G.M.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://bulletin.ssmu.ru/jour/article/view/787">https://bulletin.ssmu.ru/jour/article/view/787</self-uri><abstract><p>В механизмах развития хронической сердечной недостаточности (ХСН) ключевая роль традиционно отводится нарушению внутрисердечной гемоциркуляции. Так, в рекомендациях по оценке и лечению ХСН у взрослых эксперты Американской коллегии кардиологов и Американской ассоциации сердца (2001-2013 гг.) определяют ХСН как «сложный клинический синдром, который может быть вызван любым структурным или функциональным заболеванием сердца, нарушающим способность желудочка наполняться кровью или изгонять ее». Обычно справедливо полагают, что чем выраженнее инотропная и (или) люситропная несостоятельность соответствующего желудочка у пациента с ХСН, тем в целом ниже у него качество жизни и хуже прогноз. Вместе с тем степень выраженности клинических проявлений ХСН, с одной стороны, и снижение уровня удовлетворенности жизнью – с другой, далеко не всегда зависят только от состояния внутрисердечной гемодинамики. Авторы обзора анализируют работы, опубликованные по проблеме патологии периферического кровообращения при ХСН. Последовательно рассматривается роль ремоделирования периферических сосудов и увеличения жесткости артерий, дисфункции эндотелия крупных и резистивных артерий, а также патологии микроциркуляции.</p><p>Показано, что развитие и прогрессирование ХСН сопровождается ухудшением периферического кровообращения за счет ремоделирования артерий мышечно-эластического типа и вен со снижением сосудистого дилатационного резерва, повышения как регионального сосудистого сопротивления, так и венозного тонуса, нарушения тканевого транскапиллярного обмена кислорода и активации прокоагулянтных свойств крови. Обсуждается значение вазоконстрикторных эффектов нейрогуморальных систем и воспаления в механизмах нарушения периферического кровообращения у пациентов с ХСН, особенно ассоциированной с метаболическим синдромом. </p></abstract><trans-abstract xml:lang="en"><p>In the mechanisms of chronic heart failure (CHF) the key role traditionally given to a violation of intracardiac haemocirculation. Thus, in the guidelines for the evaluation and management of chronic heart failure in the adult, experts of the American College of Cardiology and the American Heart Association (2001-2013) define CHF as «a complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood». Usually rightly believe that than the expression of inotropic and/or lusitropic failure of the appropriate ventricle in patients with CHF, the generally lower of him quality of life and a worse prognosis. However, the severity of the clinical manifestations of heart failure, on the one hand, and reducing the level of satisfaction with life - on the other, is not always depends only on the state of intracardiac hemodynamics. The authors of the review have analyzed papers published on the problem of the pathology of the peripheral circulation in CHF. Consistently examines the role of peripheral vascular remodeling and increased arterial stiffness, endothelial dysfunction of major and resistance arteries, as well as pathology of microcirculation. It has been shown that the development and progression of heart failure is accompanied by a deterioration in the peripheral circulation due to the remodeling of arteries muscular-elastic type and veins with a reduction in vascular dilatation reserve, increase of regional vascular resistance and venous tone, disturbances of tissue transcapillary exchange of oxygen and activate of procoagulant properties of blood. The significance of the effects of vasoconstrictor neurohormonal systems and inflammation in mechanisms of disorders of peripheral circulation in patients with CHF, particularly associated with the metabolic syndrome, have discussed.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>хроническая сердечная недостаточность</kwd><kwd>периферическое кровообращение</kwd><kwd>ремоделирование сосудов</kwd><kwd>дисфункция эндотелия</kwd><kwd>воспаление</kwd><kwd>гиперкоагуляция</kwd><kwd>патология микроциркуляции</kwd></kwd-group><kwd-group xml:lang="en"><kwd>chronic heart failure</kwd><kwd>peripheral circulation</kwd><kwd>vascular remodeling</kwd><kwd>arterial stiffness</kwd><kwd>endothelial dysfunction</kwd><kwd>inflammation</kwd><kwd>hypercoagulation</kwd><kwd>pathology of microcirculation</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Tanai E., Frantz S. 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