pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2014-0-5-32-38pulmo-464Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL STUDIESОжирение и метаболические нарушения у больных хронической обструктивной болезнью легких: возможности фенотипированияObesity and metabolic disorders in COPD patients: opportunities for phenotypingСамулееваЮ. В.SamuleevaYu. V.

ст. лаборант кафедры терапии и семейной медицины ГБОУ ВПО "МГМСУ им. А.И.Евдокимова" Минздрава России; тел.: (916) 5500410

panda82@yandex.ruЗадионченкоВ. С.ZadionchenkoV. S.

д. м. н., профессор, зав. кафедрой терапии и семейной медицины ГБОУ ВПО "МГМСУ им. А.И.Евдокимова" Минздрава России; тел.: (985) 7617451

z7vladimir@bk.ruЛиВ. В.LiV. V.

к. м. н., доцент кафедры терапии и семейной медицины ГБОУ ВПО "МГМСУ им. А.И.Евдокимова" Минздрава России; тел.: (916) 5098663

vera0212@yandex.ruАдашеваТ. В.AdashevaT. V.

д. м. н., профессор кафедры терапии и семейной медицины ГБОУ ВПО "МГМСУ им. А.И.Евдокимова" Минздрава России; тел.: (903) 6294607

adashtv@mail.ruСаморуковаЕ. И.SamorukovaE. I.

аспирант кафедры терапии и семейной медицины ГБОУ ВПО "МГМСУ им. А.И.Евдокимова" Минздрава России; тел.: (985) 1359172

wlrad@bk.ruПихлакА. Э.PikhlakA. E.

к. м. н., доцент; зав. кафедрой ревматологии ФПДО ГБОУ ВПО "МГМСУ им. А.И.Евдокимова" Минздрава России; тел.: (495) 5074112

joints_spine@yahoo.comЛогачевВ. А.LogachevV. A.

ассистент кафедры ревматологии ФПДО ГБОУ ВПО "МГМСУ им. А.И.Евдокимова" Минздрава России; тел.: (926) 2112643

vladimir.logachev@gmail.comСоколоваЛ. Б.SokolovaL. B.

к. м. н., врачпульмонолог высшей категории, зав. пульмонологическим отделением № 7 ГБУЗ ГКБ № 11 ДЗг. Москвы; тел.: (903) 7687543;

sokolova@11gkb.ruГБОУ ВПО "Московский государственный медико+стоматологический университет им. А.И.Евдокимова" Минздрава России: 127473, Москва, ул. Делегатская, 20 / 1РоссияA.I.Evdokimov Moscow State University of Medicine and Dentistry, Healthcare Ministry of Russia; Moscow, RussiaRussian FederationГБУЗ "Городская клиническая больница № 11" Департамента здравоохранения г. Москвы: 127018, Москва, ул. Двинцев, 6РоссияCity Clinical Hospital № 11, Moscow Healthcare Department; Moscow, RussiaRussian Federation201428102014053238Copyright © Самулеева Ю.В., Задионченко В.С., Ли В.В., Адашева Т.В., Саморукова Е.И., Пихлак А.Э., Логачев В.А., Соколова Л.Б., 20142014Самулеева Ю.В., Задионченко В.С., Ли В.В., Адашева Т.В., Саморукова Е.И., Пихлак А.Э., Логачев В.А., Соколова Л.Б.Samuleeva Y.V., Zadionchenko V.S., Li V.V., Adasheva T.V., Samorukova E.I., Pikhlak A.E., Logachev V.A., Sokolova L.B.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/464

Целью исследования явилось изучение клиникофункциональных параметров и качества жизни (КЖ) больных хронической обструктивной болезнью легких (ХОБЛ) c сопутствующим ожирением и метаболическими нарушениями с оценкой возможности их фенотипирования. На основании кластерного анализа, проведенного по методу kсредних МакКуина, выделены 4 группы пациентов с отличительными особенностями течения ХОБЛ. Установлено, что наличие сопутствующего ожирения у больных ХОБЛ ассоциировано со значительным снижением легочной функции, переносимости физической нагрузки, показателей КЖ и выживаемости, частыми обострениями, развитием инсулинорезистентности и активацией системных воспалительных реакций. Предполагается, что клинический вариант ХОБЛ с сопутствующим ожирением целесообразно рассматривать в качестве отдельного фенотипа заболевания, характеризующегося тяжелым течением.

The aim of the study was to compare clinical and functional features and healthrelated quality of life (HRQoL) in patients with chronic obstructive pulmonary disease (COPD) regarding to comorbid obesity as a phenotypic sign.

Methods

Methods. Patient classification was performed using Kmeans clustering analysis (MacQueen). It resulted in the classification of subjects into four clinical groups with marked differences in COPD symptoms.

Results

Results. Subjects with obesity had severe airflow limitation and dyspnoea, frequent exacerbations, severely impaired HRQoL, poor survival, decreased physical activity, insulin resistance and increased systemic inflammation.

Conclusion

Conclusion. Thus, COPD with comorbid obesity could be considered as a distinct phenotype of COPD with severe symptoms.

хроническая обструктивная болезнь легкихожирениеинсулинорезистентностьфенотиптяжелое течениекластерный анализ.chronic obstructive pulmonary diseaseobesityinsulin resistancephenotypeseveritycluster analysisReferencesHan M.K., Agusti A., Calverley P.M. et al. COPD phenotypes: The future of COPD. Am. J .Respir. Crit. Care Med. 2010; 182: 598–604.Han M.K., Agusti A., Calverley P.M. et al. COPD phenotypes: The future of COPD. Am. J .Respir. Crit. Care Med. 2010; 182: 598–604.Авдеев С.Н. Фенотипы хронической обструктивной болезни легких: особенности терапии. Consilium medicum. 2010; 1: 23–28. / Avdeev S.N. Chronic obstructive pulmonary disease phenotypes: therapy distinctions. Consilium medicum. 2010; 1: 23–28 (in Russian).Авдеев С.Н. Фенотипы хронической обструктивной болезни легких: особенности терапии. Consilium medicum. 2010; 1: 23–28. / Avdeev S.N. Chronic obstructive pulmonary disease phenotypes: therapy distinctions. Consilium medicum. 2010; 1: 23–28 (in Russian).Eisner M.D., Blanc P.D., Sidney S. et al. Body composition and functional limitation in COPD. Respir. Res. 2007; 8: 7.Eisner M.D., Blanc P.D., Sidney S. et al. Body composition and functional limitation in COPD. Respir. Res. 2007; 8: 7.Vozoris N.T., O'Donnell D.E. Prevalence, risk factors, activity limitation and health care utilization of an obesepopulationbased sample with chronic obstructive pulmonary disease. Can. Respir. J. 2012; 19: e18–e24.Vozoris N.T., O'Donnell D.E. Prevalence, risk factors, activity limitation and health care utilization of an obesepopulationbased sample with chronic obstructive pulmonary disease. Can. Respir. J. 2012; 19: e18–e24.Lam KB.H., Jordan R.E., Jiang C.Q. et al. Airflow obstruction and metabolic syndrome: the Guangzhou Biobank Cohort Study. Eur. Respir. J. 2010; 35: 317–323.Lam KB.H., Jordan R.E., Jiang C.Q. et al. Airflow obstruction and metabolic syndrome: the Guangzhou Biobank Cohort Study. Eur. Respir. J. 2010; 35: 317–323.Oganov R.G., ed. National guidelines on diagnosis and treatment of metabolic syndrome. 3rd ed. Moscow: "Solitseya–Poligra"; 2010. 278–316 (in Russian).Oganov R.G., ed. National guidelines on diagnosis and treatment of metabolic syndrome. 3rd ed. Moscow: "Solitseya–Poligra"; 2010. 278–316 (in Russian).Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Revised 2007.Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Revised 2007.Yashina L.A. Overweight, obesity and pulmonary disease: a pulmonologist's point of view. Zdorov'ya Ukraini. 2011; 2 (14): 14–15 (in Russian).Yashina L.A. Overweight, obesity and pulmonary disease: a pulmonologist's point of view. Zdorov'ya Ukraini. 2011; 2 (14): 14–15 (in Russian).Celli B.R., Cote C.G., Marin J.M. et al. The body mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N. Engl. J. Med. 2004; 350: 1005–1012.Celli B.R., Cote C.G., Marin J.M. et al. The body mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N. Engl. J. Med. 2004; 350: 1005–1012.Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Revised 2013. www.goldcopd.orgGlobal Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Revised 2013. www.goldcopd.orgSava F., Maltais F., Poirier P. The Impact of Obesity and Metabolic Syndrome in COPD. Bronchitis. 2011. http://www.intechopen.com/books/bronchitis/theimpactofobesityandmetabolicsyndromeincopdSava F., Maltais F., Poirier P. The Impact of Obesity and Metabolic Syndrome in COPD. Bronchitis. 2011. http://www.intechopen.com/books/bronchitis/theimpactofobesityandmetabolicsyndromeincopdEagan T.M.L., Aukrust P., Ueland T. et al. Body composition and plasma levels of inflammatory biomarkers in COPD. Eur. Respir. J. 2010; 36: 1027–1033.Eagan T.M.L., Aukrust P., Ueland T. et al. Body composition and plasma levels of inflammatory biomarkers in COPD. Eur. Respir. J. 2010; 36: 1027–1033.Leone N., Courbon D., Thomas F. Lung function impairment and metabolic syndrome. The critical role of abdominal obesity. Am. J. Respir. Crit. Care Med. 2009; 179: 509–516.Leone N., Courbon D., Thomas F. Lung function impairment and metabolic syndrome. The critical role of abdominal obesity. Am. J. Respir. Crit. Care Med. 2009; 179: 509–516.Ora J., Laveneziana P., Ofir D. et al. Combined effects of obesity and COPD on dyspnea and exercise tolerance. Am. J. Respir. Crit. Care Med. 2009; 180: 964–971.Ora J., Laveneziana P., Ofir D. et al. Combined effects of obesity and COPD on dyspnea and exercise tolerance. Am. J. Respir. Crit. Care Med. 2009; 180: 964–971.Tkacova R. Systemic Inflammation in chronic obstructive pulmonary disease: May adipose tissue play a role? Review of the literature and future perspectives. Hindawi Publishing Corporation. Mediators of Inflammation. 2010; 1–11.Tkacova R. Systemic Inflammation in chronic obstructive pulmonary disease: May adipose tissue play a role? Review of the literature and future perspectives. Hindawi Publishing Corporation. Mediators of Inflammation. 2010; 1–11.Kershaw E.E., Flier J.S. Adipose tissue as an endocrine organ. J. Clin. Endocrinol. Metabol. 2004; 89 (6): 2548–2556.Kershaw E.E., Flier J.S. Adipose tissue as an endocrine organ. J. Clin. Endocrinol. Metabol. 2004; 89 (6): 2548–2556.Fontana L., Eagon J.C., Trujillo M.E. et al. Visceral fat adipokine secretion is associated with systemic inflamma tion in obese humans. Diabetes. 2007; 56 (4): 1010–1013.Fontana L., Eagon J.C., Trujillo M.E. et al. Visceral fat adipokine secretion is associated with systemic inflamma tion in obese humans. Diabetes. 2007; 56 (4): 1010–1013.Antipina A.N. Clinical and laboratory features of chronic obstructive pulmonary disease in obese patients: Diss. Tyumen'; 2011 (in Russian).Antipina A.N. Clinical and laboratory features of chronic obstructive pulmonary disease in obese patients: Diss. Tyumen'; 2011 (in Russian).Danilova L.I. Insulin resistance in clinical practice: pathogenetic mechanisms and treatment approach. Lechebnoe delo. 2009; 2 (6): 29–40 (in Russian).Danilova L.I. Insulin resistance in clinical practice: pathogenetic mechanisms and treatment approach. Lechebnoe delo. 2009; 2 (6): 29–40 (in Russian).Regazzetti С., Peraldi P., Grémeaux T. et al. Hypoxia decreases insulin signaling pathways in adipocytes. Diabetes. 2009; 58 (1): 95–103.Regazzetti С., Peraldi P., Grémeaux T. et al. Hypoxia decreases insulin signaling pathways in adipocytes. Diabetes. 2009; 58 (1): 95–103.

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