systhiperСистемные гипертензииSystemic Hypertension2075-082X2542-2189LLC «ИнтерМедсервис»systhiper-516Research ArticleСТАТЬИARTICLESКлинические и генетические факторы, определяющие поражения органов-мишеней у пациентов с артериальной гипертензией среди населения Горной ШорииClinical and genetic factors determining target lesions of patients with arterial hypertension among Mountain Shoria populationМулероваТ. А.MulerovaT. A.mulerova-77@mail.ruФГБНУ НИИ КПССЗ, ГБОУ ДПО НГИУВРоссияNovokuznetsk State Institute for Postgraduate Training of Physicians of the Ministry of Health of the Russian Federation; Research Institute for Complex Issues of Cardiovascular DiseasesRussian Federation2017231220221434250Copyright © Мулерова Т.А., 20222022Мулерова Т.А.Mulerova T.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.syst-hypertension.ru/jour/article/view/516

Цель исследования - установить ассоциации клинических и генетических факторов риска с поражениями органов-мишеней (сердце, сосуды, почки) у пациентов с артериальной гипертензией (АГ) населения Горной Шории в зависимости от этнической принадлежности. Материалы и методы. Проведено клинико-эпидемиологическое исследование компактно проживающего населения в труднодоступных районах Горной Шории. Данный регион среднегорья расположен на юге Западной Сибири. Обследованы 1409 человек: 901 - представители коренной национальности (шорцы), 508 - представители некоренной национальности (90% из них европеоиды). Диагноз АГ выставлялся в соответствии с рекомендациями Всероссийского научного общества кардиологов и Российского медицинского общества по артериальной гипертонии (2010 г.). Оценка структурно-функционального состояния миокарда и дуплексное сканирование брахицефальных артерий пациентам с АГ проведены методом эхокардиографии. Фотометрическим методом исследовали уровень альбумина мочи. Полиморфизмы генов ACE (I/D, rs4340), АGT (c.803T>C, rs699), AGTR1 (А1166С, rs5186), ADRB1 (с.145A>G, Ser49Gly, rs1801252), ADRA2B (I/D, rs28365031), MTHFR (c.677С>Т, Ala222Val, rs1801133) и NOS3 (VNTR, 4b/4a) тестировали с помощью полимеразной цепной реакции. Результаты. В коренной этнической группе гипертрофия миокарда левого желудочка (ГЛЖ) ассоциировалась с особенностями течения самой АГ (ее степени и длительности), курением, генотипами I/D гена АСЕ среди мужчин и Т/Т и С/Т гена MTHFR; увеличенная толщина комплекса интима-медиа (ТКИМ) - с особенностями течения самой АГ (ее длительности), мужским полом, возрастом, генотипами Т/С гена АGT и С/T гена MTHFR; повышенный уровень альбуминурии - с особенностями течения самой АГ (ее степени и длительности), нарушениями липидного обмена (гипоальфахолестеринемия, гипертриглицеридемия, гипербетахолестеринемия), генотипами D/D и I/D гена АСЕ, D/D гена ADRA2B и С/Т гена MTHFR среди лиц возрастной группы 18-64 лет. Протективные эффекты оказывали генотип Т/С гена AGT в отношении ГЛЖ, генотипы G/G и А/G гена ADRB1 в отношении увеличения ТКИМ и альбуминурии. В некоренной этнической группе ГЛЖ взаимосвязана с особенностями течения самой АГ (ее длительности), гипертриглицеридемией, абдоминальным ожирением, генотипами D/D гена АСЕ и 4b/4а и 4а/4а гена NOS3; увеличенная ТКИМ - с особенностями течения самой АГ (ее длительности), возрастом и генотипами Т/С и С/С гена АGT; повышенный уровень альбуминурии - с особенностями течения самой АГ (ее степени и длительности), ожирением, включая абдоминальное, генотипами С/С гена AGTR1, D/D гена ADRA2B и Т/Т гена MTHFR. Протективный эффект оказывал генотип I/D гена ADRA2B в отношении увеличения ТКИМ. Заключение. Данное исследование продемонстрировало актуальность проблемы этногенетических механизмов развития мультифакториальной патологии, что требует проведения дальнейших исследований и выделения лиц с АГ и поражением органов-мишеней для последующего контроля при проведении профилактических осмотров и диспансеризации населения

Objective. To establish associations between clinical and genetic risk factors and target lesions (heart, blood vessels, kidneys) of patients with arterial hypertension (AH) among the population of Mountain Shoria, depending on ethnicity. Matherials and methods. A clinical and epidemiological study of compactly living population in the remote areas of the Mountain Shoria was carried out. This middle altitude region is located in the south of Western Siberia. 1409 people were examined (901 representatives of the indigenous ethnic group - the Shors, 508 representatives of the non-indigenous ethnic group - 90% of them being Caucasian). The diagnosis of AH was set in accordance with the recommendations of the Society of Cardiology of the Russian Federation / Medical Society of the Russian Federation on the Problem of Arterial Hypertension, 2010. Assessment of the structural and functional state of the cardiac muscle and duplex scanning of brachiocephalic arteries among the patients with AH was made by echocardiography. A photometric method was used to examine the urinary albumin concentration level. The polymorphisms of the genes ACE (I/D, rs4340), АGT (c.803T>C, rs699), AGTR1 (А1166С, rs5186), ADRB1 (с.145A>G, Ser49Gly, rs1801252), ADRA2B (I/D, rs28365031), MTHFR (c.677С>Т, Ala222Val, rs1801133) and NOS3 (VNTR, 4b/4a) were tested by the PCR method. Results. Among the members of the indigenous ethnic group left ventricle hypertrophy (LVH) correlated with the AG progression features (extent and duration), smoking, genotypes I/D of the ACE gene among men and T/T and C/T of the MTHFR gene; increased intima-media complex thickness (IMT) correlated with the AG progression features (duration), male sex, age, genotypes T/C of the AGT gene and C/T of the MTHFR gene; high level of albuminuria (AU) correlated with the AG progression features (extent and duration), lipid disorders (hypoalphacholesterolemia, hypertriglyceridemia, hyperbetacholesterolemia), genotypes D/D and I/D of the ACE gene, D/D of the ADRA2B gene and the C/T of the MTHFR gene among 18-64-year-olds. Genotype T/C of the AGT gene had a protective effect on LVH, genotypes G/G and A/G of the ADRB1 gene had protective effects on IMT and AU levels. In the nonindigenous ethnic group LVH correlated with the AG progression features (duration), hypertriglyceridemia, abdominal obesity, genotypes D/D of the ACE gene, 4b/4a and 4a/4a of the NOS3 gene; increased IMT correlated with the AG progression features (duration), age and genotypes T/C and C/C of the AGT gene; AU high level correlated with the AG progression features (extent and duration), obesity, abdominal including, genotypes C/C of the AGTR1 gene, D/D of the ADRA2B gene and T/T of the MTHFR gene. Genotype I/D of the ADRA2B gene had protective effect on IMT. Conclusion. The study demonstrated the importance of the ethnogenetic mechanisms in the multifactorial pathology development. The problem requires further research, also identification of people with AH and target lesions is needed for monitoring during the prophylactic medical examination of the population.

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