systhiperСистемные гипертензииSystemic Hypertension2075-082X2542-2189LLC «ИнтерМедсервис»10.38109/2075-082X-2024-1-37-46systhiper-808Research ArticleОБЗОРНАЯ СТАТЬЯREVIEWЛегочная гипертензия и метаболические нарушенияPulmonary hypertension and metabolic disordershttps://orcid.org/0000-0002-9053-6030ЩелковаГ. В.SchelkovaG. V.

Щелкова Галина Владимировна, к.м.н., старший научный сотрудник, руководитель научно-экспертного отдела, Институт клинической кардиологии им. А.Л. Мясникова

ул. Академика Чазова, д. 15 а, г. Москва 121552

Galina V.  Schelkova, Cand. of Sci. (Med.), Scientific expert Department, A.L. Myasnikov Scientific research institute of clinical cardiology

St. Academician Chazova, 15 a, Moscow 121552

galina03@yandex.ruhttps://orcid.org/0000-0002-1982-3061ЯровойС. Ю.YarovoyS. Yu.

Яровой Сергей Юрьевич, к.м.н., младший научный сотрудник, отдел гипертонии, Институт клинической кардиологии им. А.Л. Мясникова

ул. Академика Чазова, д. 15 а, г. Москва 121552

Sergey Yu. Yarovoy, Cand. of Sci. (Med.), Hypertension Department, A.L. Myasnikov Scientific research institute of clinical cardiology

St. Academician Chazova, 15 a, Moscow 121552

doctoryarovoy@gmail.comhttps://orcid.org/0009-0004-1166-1215ДиневичЕ. О.DinevichE. O.

Диневич Екатерина Олеговна, лаборант-исследователь, научно-экспертный отдел, Институт клинической кардиологии им. А.Л. Мясникова

ул. Академика Чазова, д. 15 а, г. Москва 121552

Ekaterina O. Dinevich, research assistant, Scientific expert Department, A.L. Myasnikov Scientific research institute of clinical cardiology

St. Academician Chazova, 15 a, Moscow 121552

katya.seliverstova@gmail.comhttps://orcid.org/0000-0002-9822-4357ЧазоваИ. Е.ChazovaI. E.

Чазова Ирина Евгеньевна, академик РАН, д.м.н., профессор, заместитель генерального директора по научно-экспертной работе, руководитель отдела гипертонии, Институт клинической кардиологии им. А.Л. Мясникова

ул. Академика Чазова, д. 15 а, г. Москва 121552

Irina E. Chazova, Dr. of Sci. (Med.), Prof., Acad. Of RAS, A A.L. Myasnikov Scientific research institute of clinical cardiology

St. Academician Chazova, 15 a, Moscow 121552

c34h@yandex.ruФедеральное бюджетное государственное учреждение «Национальный медицинский исследовательский центр кардиологии имени академика Е.И. Чазова» Министерства здравоохранения Российской ФедерацииРоссияE.I. Chazov National Medical Research Center of cardiologyRussian Federation2024290320242113746Copyright © Щелкова Г.В., Яровой С.Ю., Диневич Е.О., Чазова И.Е., 20242024Щелкова Г.В., Яровой С.Ю., Диневич Е.О., Чазова И.Е.Schelkova G.V., Yarovoy S.Y., Dinevich E.O., Chazova I.E.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/808

Современная терапия легочной гипертензии (ЛГ) приводит к увеличению выживаемости пациентов, и все большее влияние на течение и прогноз заболевания начинает оказывать наличие сопутствующей патологии. Коморбидные заболевания могут вносить самостоятельный вклад в развитие ЛГ, а также влиять на назначение специфической терапии. Наиболее часто встречается сочетание с ЛГ компонентов метаболического синдрома.

В настоящем обзоре представлены актуальные данные, касающиеся взаимосвязи гиперурикемии, ожирения, сахарного диабета, нарушений липидного обмена и легочной артериальной гипертензии (ЛАГ), хронической тромбоэмболической легочной гипертензии (ХТЭЛГ). Гиперурикемия связана с более высоким риском развития и худшим прогнозом ЛАГ, большей тяжестью состояния пациентов. Ожирение приводит к развитию провоспалительных и вазоконстрикторных эффектов, гипоксии, что способствует прогрессированию ЛГ, однако выживаемость пациентов с ЛГ и избыточной массой тела или ожирением выше, чем при нормальной или сниженной массе тела. Сахарный диабет и сопутствующая ему инсулинорезистентность ассоциированы с высоким риском госпитализации по поводу правожелудочковой сердечной недостаточности и смертности. Наличие ЛАГ ассоциировано с более низкими значениями общего холестерина, холестерина липопротеидов низкой плотности (ХС ЛПНП), триглицеридов и, вероятно, холестерина липопротеидов высокой плотности (ХС ЛПВП). В то же время более высокие уровни ХС ЛПНП и ХС ЛПВП при ЛАГ и ХТЭЛГ определяют лучший прогноза заболевания.

Все рассмотренные метаболические нарушения имеют общие механизмы влияния на ЛГ. Дальнейшее изучение их патогенетической основы позволит выработать единые подходы к способам их коррекции у пациентов с различными вариантами легочной гипертензии.

This review presents current data regarding the relationship between hyperuricemia, obesity, diabetes mellitus, lipid disorders and pulmonary arterial hypertension (PAH), chronic thromboembolic pulmonary hypertension (CTEPH). Hyperuricemia is associated with a higher risk of developing of PAH, worse prognosis of PAH and greater severity of the patient's condition. Obesity leads to the development of pro-inflammatory and vasoconstrictor effects, hypoxia, which contributes to the progression of PH, however, the survival rate of patients with PH and overweight or obesity is higher than with normal or reduced body weight. Diabetes mellitus and concomitant insulin resistance are associated with a high risk of hospitalization for right ventricular heart failure and mortality. The presence of PAH is associated with lower values of total cholesterol, low-density lipoprotein cholesterol (LDL-C), triglycerides, and probably high-density lipoprotein cholesterol (HDL-C). At the same time, higher levels of LDL-С and HDL-С in PAH and CTEPH determine a better prognosis of the disease.

All metabolic disorders considered have common mechanisms of influence on PH. Further study of their pathogenetic basis will make it possible to develop unified approaches to methods of their correction in patients with various types of pulmonary hypertension.

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