pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2018-28-3-359-367pulmo-1006Research ArticleОБЗОРЫREVIEWВзаимосвязь хронической обструктивной болезни легких, ожирения и уровня мелатонинаA relationship between chronic obstructive pulmonary disease, obesity and melatonin levelБудневскийА. В.BudnevskiyA. V.

Будневский Андрей Валериевич – доктор медицинских наук, профессор, заведующий кафедрой факультетской терапии

394036, Воронеж, ул. Студенческая, 10

Andrey V. Budnevskiy, Doctor of Medicine, Professor, Head of Department of General Internal Medicine

ul. Studencheskaya 10, Voronezh, 394036

budnev@list.ruОвсянниковЕ. C.OvsyannikovЕ. S.

Овсянников Евгений Сергеевич – кандидат медицинских наук, доцент кафедры факультетской терапии

394036, Воронеж, ул. Студенческая, 10

Evgeniy S. Ovsyannikov, Candidate of Medicine, Associate Professor, Department of General Internal Medicine

ul. Studencheskaya 10, Voronezh, 394036

ШкатоваЯ. С.ShkatovaYa. S.

Шкатова Янина Сергеевна – ординатор кафедры факультетской терапии

394036, Воронеж, ул. Студенческая, 10

 

Yanina S. Shkatova, Resident Physician, Department of General Internal Medicine

ul. Studencheskaya 10, Voronezh, 394036

 

yankashkat@gmail.comФедеральное государственное бюджетное образовательное учреждение высшего образования «Воронежский государственный медицинский университет имени Н.Н.Бурденко» Министерства здравоохранения Российской ФедерацииРоссияN.N.Burdenko Voronezh State Medical University, Healthcare Ministry of RussiaRussian Federation201830072018283359367Copyright © Будневский А.В., Овсянников Е.C., Шкатова Я.С., 20182018Будневский А.В., Овсянников Е.C., Шкатова Я.С.Budnevskiy A.V., Ovsyannikov Е.S., Shkatova Y.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.pulmonology.ru/pulm/article/view/1006

Представлен обзор литературы, в котором приводятся результаты экспериментальных и клинических исследований, посвященных изучению влияния ожирения на клиническое течение хронической обструктивной болезни легких (ХОБЛ), патофизиологические механизмы этого влияния, а также взаимосвязи уровня мелатонина в крови и течения ХОБЛ. Рассматриваются данные исследований, в которых оцениваются наличие связи между степенью тяжести ХОБЛ, частотой обострений и уровнями в крови важнейших адипокинов – лептина и адипонектина, а также взаимное влияние уровней мелатонина и данных адипокинов. При изучении влияния ожирения на клиническое течение ХОБЛ получены противоречивые результаты: в ряде исследований выявлен т. н. парадокс ожирения, т. к. при наличии ожирения в ряде случаев снижается смертность у пациентов с ХОБЛ. В некоторых исследованиях также отмечалась менее сильная обструкция воздушного потока при наличии ожирения. Несмотря на наличие противоречивых результатов, при ожирении, вероятно, улучшается прогноз течения ХОБЛ за счет снижения системного воспаления на патофизиологическом уровне. При обострениях ХОБЛ отмечается повышение уровней лептина и адипонектина, которые затем возвращаются к исходному уровню. Помимо гормонов жировой ткани, немаловажное значение последние десятилетия придается и влиянию гормона шишковидной железы мелатонина на течение ХОБЛ, в первую очередь – за счет воздействия на системное воспаление и антиоксидантной активности. Согласно результатам ряда исследований, мелатонин оказывает влияние на уровни адипонектина и лептина в крови, что может опосредованно влиять на уровень системного воспаления при ХОБЛ. Требуются дальнейшие исследования в этой области, т. к. на данный момент результаты противоречивы.

This is a review of experimental and clinical studies investigated effects of obesity on clinical course of chronic obstructive pulmonary disease (COPD); pathophysiological mechanisms of this effect, and relationships between melatonin level and the course of COPD have been also discussed. Associations between severity of COPD, rate of exacerbations and blood levels of most important adipokines, such as leptin and adiponectin, and relationships between melatonin levels and those adipokines were published. Conflicting results were obtained in studies of effects of obesity on clinical course of COPD. The "obesity paradox", that is a reduction in mortality and milder bronchial obstruction in obese COPD patients, has been identified in several studies. Despite contradictory results, obesity is likely to improve prognosis of COPD due to decrease in the systemic inflammation. Levels of leptin and adiponectin increase in acute exacerbation of COPD and then decrease to the baseline. Moreover, melatonin is suggested to play a great role for COPD course, mostly due to antiinflammatory and antioxidant activities. According to results of several studies, melatonin could affect blood levels of adiponectin and lectin; this could indirectly influence on the systemic inflammation in COPD. Further studies are needed to elicit these relationships.

 

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