Легочная гипертензия и метаболические нарушения

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.

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