pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2016-26-1-38-45pulmo-670Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL STUDIESХроническая сердечная недостаточность различного генеза у больных хронической обструктивной болезнью легкихDifferent origins of chronic heart failure in patients with chronic obstructive pulmonary diseaseКаролиН. А.KaroliN. A.

д. м. н. профессор кафедры госпитальной терапии лечебного факультета ГБОУ ВПО «Саратовский государственный медицинский университет им. В.И.Разумовского» Минздрава России; тел.: (917) 213-69-86

MD, Professsor at Department of Hospital Internal Medicine, Medical Faculty, V.I.Razumovskiy Saratov State Medical University, Healthcare Ministry of Russia; tel.: (917) 213-69-86;

andreyrebrov@yandex.ruБородкинА. В.BorodkinA. V.

аспирант кафедры госпитальной терапии лечебного факультета ГБОУ ВПО «Саратовский государственный медицинский университет им. В.И.Разумовского» Минздрава России; тел.: (917) 981-32-70;

PhD student at Department of Hospital Internal Medicine, Medical Faculty, V.I.Razumovskiy Saratov State Medical University, Healthcare Ministry of Russia; tel.: тел.: (917) 981-32-70;

andreyrebrov@yandex.ruРебровА. П.RebrovA. P.

д. м. н. заведующий кафедрой госпитальной терапии лечебного факультета ГБОУ ВПО «Саратовский государственный медицинский университет им. В.И.Разумовского» Минздрава России; тел.: (845) 249-14-37

MD, Professor, Head of Department of Hospital Internal Medicine, Medical Faculty, V.I.Razumovskiy Saratov State Medical University, Healthcare Ministry of Russia; tel.: (845) 249-14-37;

andreyrebrov@yandex.ruГБОУ ВПО «Саратовский государственный медицинский университет им. В.И.Разумовского» Минздрава России: 410012, Саратов, ул. Большая Казачья, 112РоссияV.I.Razumovskiy Saratov State Medical University, Healthcare Ministry of Russia: 112, Bol. Kazach'ya str., Saratov, 410012, RussiaRussian Federation2016190420162613845Copyright © Кароли Н.А., Бородкин А.В., Ребров А.П., 20162016Кароли Н.А., Бородкин А.В., Ребров А.П.Karoli N.A., Borodkin A.V., Rebrov A.P.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/670

Цель. Изучена частота встречаемости и клинические особенности хронической сердечной недостаточности (ХСН) различного генеза у пациентов с хронической обструктивной болезнью легких (ХОБЛ). Материалы и методы. Среди обследованных пациентов с ХОБЛ у 112 (36,2 %) отмечены признаки недостаточности кровообращения. Пациенты с сочетанной патологией оказались старше, имели больший индекс массы тела, курили дольше и интенсивнее. Длительность одышки как одного из основных симптомов ХОБЛ также была несколько выше у пациентов с ХОБЛ и ХСН. Результаты и обсуждение. Выявлена взаимосвязь между выраженностью бронхообструкции и развитием ХСН. Различий между пациентами с различным генезом ХСН не отмечено. Артериальная гипертензия (АГ) встречалась одинаково часто у больных ХОБЛ при наличии и отсутствии ХСН. Длительность АГ была почти в 2 раза дольше у больных с недостаточностью кровообращения. Заключение. У пациентов с ХОБЛ и ХСН фракция выброса левого желудочка (ЛЖ) достоверно ниже этого показателя у больных ХОБЛ без ХСН. У пациентов с ХСН ишемического генеза фракция выброса ЛЖ была достоверно ниже, чем у больных с ХСН неишемического генеза. Установлены снижение физической работоспособности (6-минутный шаговый тест) и более выраженная гипоксемия у пациентов с ХСН по сравнению с больными без таковой.

The aim of this study was to analyze prevalence, clinical course and pathogenesis of chronic heart failure (CHF) in patients with chronic obstructive pulmonary disease (COPD). Methods. The study involved 309 patients with COPD who underwent spirometry and Doppler echocardiography. Natriuretic peptide level was measured in blood. Results.One hundred and twelve (36.2%) patients had CHF. Patients with comorbidity were older, had higher body mass index, longer and more severe smoking history. Dyspnea as one of the main COPD symptoms existed for longer period in patients with COPD and CHF. CHF was related to severity of the airflow limitation. There was no difference between patients with different origin of CHF. The rate of hypertension was similar in COPD patients with and without CHF, but the duration of hypertension was almost twice as higher in patients with CHF. The left ventricular ejection fraction (LV EF) was significantly lower in COPD patients with CHF compared to those without CHF and was significantly lower in patients with ischaemic CHF compared to CHF of another origin. Also, COPD patients with CHF had significantly lower physical tolerance measured by 6-min walk test and more severe hypoxemia. Conclusion. Prevalence of CHF in COPD patients is quite high. CHF is caused both by concomitant cardiovascular disease (coronary heart disease, hypertension, etc.) and actually by progressive chronic cor pulmonale. Unaffected LV EF is seen more often in COPD patients; however, decreased LV EF is associated with coronary heart disease. Development of CHF in COPD patients is also associated with such risk factors as smoking, severe bronchial obstruction, hypoxemia, and tachycardia.

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