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ɍȾɄ 616.12-008.331.1:616.13-053.81
ɗ.Ʌ. Ʉɨɥɟɫɧɢɤ
ɍɉɊɍȽɈ-ɗɅȺɋɌɂɑȿɋɄɂȿ ɋȼɈɃɋɌȼȺ
ɋɈɋɍȾɂɋɌɈɃ ɋɌȿɇɄɂ ɍ ȻɈɅɖɇɕɏ
ȺɊɌȿɊɂȺɅɖɇɈɃ ȽɂɉȿɊɌȿɇɁɂȿɃ
ȼ ɆɈɅɈȾɈɆ ȼɈɁɊȺɋɌȿ
Ƚɍ «Ⱦɧɟɩɪɨɩɟɬɪɨɜɫɤɚɹ ɦɟɞɢɰɢɧɫɤɚɹ ɚɤɚɞɟɦɢɹ» ɆɁ ɍɤɪɚɢɧɵ
ɤɚɮɟɞɪɚ ɝɨɫɩɢɬɚɥɶɧɨɣ ɬɟɪɚɩɢɢ ʋ 2
(ɡɚɜ. – ɚɤɚɞɟɦɢɤ ɇȺɆɇ ɍɤɪɚɢɧɵ, ɞ. ɦɟɞ. ɧ., ɩɪɨɮ. Ƚ.ȼ. Ⱦɡɹɤ)
ɭɥ. Ⱦɡɟɪɠɢɧɫɤɨɝɨ, 9, Ⱦɧɟɩɪɨɩɟɬɪɨɜɫɤ, 49000, ɍɤɪɚɢɧɚ
SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine»
Department of Hospital Therapy N 2
Dzerzhinskiy str., 9, Dnipropetrovsk, 49000, Ukraine
e-mail: [email protected]
Ʉɥɸɱɟɜɵɟ ɫɥɨɜɚ: ɫɤɨɪɨɫɬɶ ɪɚɫɩɪɨɫɬɪɚɧɟɧɢɹ ɩɭɥɶɫɨɜɨɣ ɜɨɥɧɵ, ɰɟɧɬɪɚɥɶɧɨɟ ɚɨɪɬɚɥɶɧɨɟ ɞɚɜɥɟɧɢɟ, ɢɧɞɟɤɫ
ɚɭɝɦɟɧɬɚɰɢɢ, ɚɪɬɟɪɢɚɥɶɧɚɹ ɝɢɩɟɪɬɟɧɡɢɹ, ɫɭɬɨɱɧɨɟ ɦɨɧɢɬɨɪɢɪɨɜɚɧɢɟ ɚɪɬɟɪɢɚɥɶɧɨɝɨ ɞɚɜɥɟɧɢɹ
Key words: pulse wave velocity, central aortic pressure, augmentation index, ambulatory blood pressure monitoring,
arterial hypertension
Ɋɟɮɟɪɚɬ. ɉɪɭɠɧɨ-ɟɥɚɫɬɢɱɧɿ ɜɥɚɫɬɢɜɨɫɬɿ ɫɭɞɢɧɧɨʀ ɫɬɿɧɤɢ ɭ ɯɜɨɪɢɯ ɧɚ ɚɪɬɟɪɿɚɥɶɧɭ ɝɿɩɟɪɬɟɧɡɿɸ ɭ ɦɨɥɨɞɨɦɭ
ɜɿɰɿ. Ʉɨɥɟɫɧɢɤ ȿ.Ʌ. Ɇɟɬɨɸ ɞɨɫɥɿɞɠɟɧɧɹ ɛɭɥɨ ɜɢɜɱɢɬɢ ɨɫɨɛɥɢɜɨɫɬɿ ɩɪɭɠɧɨ-ɟɥɚɫɬɢɱɧɢɯ ɜɥɚɫɬɢɜɨɫɬɟɣ ɫɭɞɢɧɧɨʀ ɫɬɿɧɤɢ ɭ ɯɜɨɪɢɯ ɧɚ ɚɪɬɟɪɿɚɥɶɧɭ ɝɿɩɟɪɬɟɧɡɿɸ (ȺȽ) ɭ ɦɨɥɨɞɨɦɭ ɜɿɰɿ ɣ ɨɰɿɧɢɬɢ ɜɡɚɽɦɨɡɜ'ɹɡɨɤ ɿɡ ɫɭɛɤɥɿɧɿɱɧɢɦ
ɭɪɚɠɟɧɧɹɦ ɨɪɝɚɧɿɜ-ɦɿɲɟɧɟɣ ɬɚ ɩɨɤɚɡɧɢɤɚɦɢ ɞɨɛɨɜɨɝɨ ɦɨɧɿɬɨɪɭɜɚɧɧɹ ɚɪɬɟɪɿɚɥɶɧɨɝɨ ɬɢɫɤɭ (ȾɆȺɌ).
Ɉɛɫɬɟɠɟɧɨ 30 ɱɨɥɨɜɿɤɿɜ ɜɿɤɨɦ 18 - 35 ɪɨɤɿɜ, ɹɤɿ ɫɬɪɚɠɞɚɸɬɶ ɧɚ ɝɿɩɟɪɬɨɧɿɱɧɭ ɯɜɨɪɨɛɭ I ɿ II ɫɬɚɞɿʀ, ȺȽ 1-ɝɨ ɬɚ
2-ɝɨ ɫɬɭɩɟɧɹ. Ɉɛɫɬɟɠɟɧɧɹ ɯɜɨɪɢɯ ɜɤɥɸɱɚɥɨ ɜ ɫɟɛɟ ɡɚɝɚɥɶɧɨɤɥɿɧɿɱɧɿ ɦɟɬɨɞɢ, ɟɯɨɤɚɪɞɿɨɝɪɚɮɿɸ, ȾɆȺɌ ɬɚ ɫɭɩɪɚɫɢɫɬɨɥɿɱɧɭ ɫɮɿɝɦɨɝɪɚɮɿɸ. Ȼɭɥɨ ɜɫɬɚɧɨɜɥɟɧɨ, ɳɨ ɲɜɢɞɤɿɫɬɶ ɪɨɡɩɨɜɫɸɞɠɟɧɧɹ ɩɭɥɶɫɨɜɨʀ ɯɜɢɥɿ (ɒɊɉɏ) (r=0,557
p<0,01), ɰɟɧɬɪɚɥɶɧɢɣ ɚɨɪɬɚɥɶɧɢɣ ɬɢɫɤ (SBPao) (r=0,492 p<0,01) ɬɚ ɿɧɞɟɤɫ ɚɭɝɦɟɧɬɚɰɿʀ (AIxao) (r=0,489
p<0,01) ɞɨɫɬɨɜɿɪɧɨ ɩɿɞɜɢɳɭɜɚɥɢɫɶ ɡ ɜɿɤɨɦ ɩɚɰɿɽɧɬɿɜ. ɇɚ ɩɪɢɫɤɨɪɟɧɧɹ ɒɊɉɏ ɜɩɥɢɜɚɥɢ ɈɌ (r=0,566 p<0,01) ɬɚ
ɿɧɞɟɤɫ ɦɚɫɢ ɬɿɥɚ (r=0,599 p<0,01). Ɂɛɿɥɶɲɟɧɧɹ ɿɧɞɟɤɫɭ ɦɚɫɢ ɦɿɨɤɚɪɞɚ ɥɿɜɨɝɨ ɲɥɭɧɨɱɤɚ (ȱɆɆɅɒ) ɜɢɫɨɤɨ
ɚɫɨɰɿɣɨɜɚɧɨ ɡ ɩɿɞɜɢɳɟɧɧɹɦ SBPao (r=0,506 p<0,05) ɬɚ ɒɊɉɏ (r=0,434 p<0,05). Ɂɚ ɞɚɧɢɦɢ ȾɆȺɌ ɧɚɣɛɿɥɶɲ
ɡɧɚɱɧɢɣ ɡɜ’ɹɡɨɤ ɿɡ ɩɨɤɚɡɧɢɤɚɦɢ ɠɨɪɫɬɤɨɫɬɿ ɫɭɞɢɧɧɨʀ ɫɬɿɧɤɢ ɩɪɨɞɟɦɨɧɫɬɪɭɜɚɜ ɪɿɜɟɧɶ ɞɿɚɫɬɨɥɿɱɧɨɝɨ ɚɪɬɟɪɿɚɥɶɧɨɝɨ ɬɢɫɤɭ (ȾȺɌ) ɬɚ ɱɚɫ ɝɿɩɟɪɬɟɧɡɿʀ ɩɨ ȾȺɌ ɡɚ ɞɟɧɶ – ɿɡ AIxao (r=0,418 p<0,01), ɿɡ ɒɉɊɏ (r=0,699 p<0,01 ɬɚ
r=0,714 p<0,01) ɬɚ ɡ SBPao ȾȺȾɞɟɧɶ (r=0,695 p<0,01), Ɍɚɤɢɦ ɱɢɧɨɦ, ɜɿɤ, ɧɚɞɦɿɪɧɚ ɜɚɝɚ ɬɿɥɚ ɬɚ ɨɠɢɪɿɧɧɹ ɫɥɿɞ
ɪɨɡɝɥɹɞɚɬɢ ɹɤ ɧɟɫɩɪɢɹɬɥɢɜɿ ɱɢɧɧɢɤɢ, ɳɨ ɩɨɝɿɪɲɭɸɬɶ ɩɪɭɠɧɨ-ɟɥɚɫɬɢɱɧɿ ɜɥɚɫɬɢɜɨɫɬɿ ɫɭɞɢɧɧɨʀ ɫɬɿɧɤɢ ɭ
ɩɚɰɿɽɧɬɿɜ ɡ ȺȽ ɜɠɟ ɭ ɜɿɰɿ ɞɨ 35 ɪɨɤɿɜ. Ɇɚɤɫɢɦɚɥɶɧɨ ɧɟɝɚɬɢɜɧɢɣ ɜɩɥɢɜ ɧɚ ɩɚɪɚɦɟɬɪɢ ɩɪɭɠɧɨ-ɟɥɚɫɬɢɱɧɢɯ
ɜɥɚɫɬɢɜɨɫɬɟɣ ɫɭɞɢɧɧɨʀ ɫɬɿɧɤɢ ɡɚ ɞɚɧɢɦɢ ȾɆȺɌ ɱɢɧɢɥɢ ɪɿɜɟɧɶ ɩɿɞɜɢɳɟɧɧɹ ȾȺɌ ɿ ɱɚɫ ɝɿɩɟɪɬɟɧɡɿʀ ɩɨ ȾȺɌ,
ɨɫɨɛɥɢɜɨ ɜɞɟɧɶ. ɉɿɞɜɢɳɟɧɧɹ ɪɿɜɧɹ ɰɟɧɬɪɚɥɶɧɨɝɨ ɚɨɪɬɚɥɶɧɨɝɨ ɬɢɫɤɭ ɿ ɲɜɢɞɤɨɫɬɿ ɪɨɡɩɨɜɫɸɞɠɟɧɧɹ ɩɭɥɶɫɨɜɨʀ
ɯɜɢɥɿ ɭ ɩɚɰɿɽɧɬɿɜ ɡ ȺȽ ɜɠɟ ɭ ɦɨɥɨɞɨɦɭ ɜɿɰɿ ɚɫɨɰɿɣɨɜɚɧɟ ɡɿ ɡɛɿɥɶɲɟɧɧɹɦ ɿɧɞɟɤɫɭ ɦɚɫɢ ɦɿɨɤɚɪɞɚ ɥɿɜɨɝɨ ɲɥɭɧɨɱɤɚ.
Abstract. Arterial wall stiffness in patients with essential hypertension at young age. Kolesnik E.L. Research
objective was investigating arterial wall stiffness in patients with hypertension at young age and assessing the
relationship between subclinical target organs damage and ambulatory blood pressure monitoring (ABPM)
parameters. 30 male patients aged 18-35 years with essential hypertension stage I and II, hypertension 1 and 2nd grade
were surveyed. The examination included general clinical methods, echocardiography, ABPM and suprasystolic
sfigmography. It was found that the pulse wave velocity (PWVao) (r = 0,557 p <0,01), central aortic blood pressure
(SBPao) (r = 0,492 p <0,01) and augmentation index (AIxao) (r = 0,489 p <0.01) significantly increased with the patients’ age. Abdominal obesity (r = 0,566 p <0,01) and BMI (r = 0,599 p <0,01) impacted on the PWVao acceleration.
Increasing of the left ventricular mass index (LVMI) is highly associated with SBPao (r = 0,506 p <0,05) and PWVao (r
= 0,434 p <0,05). According to ABPM the most significant correlation with arterial wall stiffness parameters demonstrated diastolic blood pressure (DBP) daytime level (AIxao (r = 0,418 p <0,01), with PWVao (r = 0,699 p <0.01) and
SBPao (r = 0,695 p <0,01)). Thus, age, excessive body weight and obesity should be considered as unfavorable factors
that worsen arterial wall stiffness in patients with hypertension at the age before 35 years. Increase of DBP levels
especially during the day causes maximum negative impact on the arterial wall stiffness parameters according to
ABPM. Increased SBPao and PWVao in patients with hypertension at a young age are associated with increased left
ventricular mass index.
Ⱥɪɬɟɪɢɚɥɶɧɨɣ ɝɢɩɟɪɬɟɧɡɢɟɣ (ȺȽ) ɜ ɦɢɪɟ, ɩɨ
ɞɚɧɧɵɦ ɪɚɡɥɢɱɧɵɯ ɚɜɬɨɪɨɜ, ɫɬɪɚɞɚɸɬ ɛɨɥɟɟ 30-
14/ Ɍɨɦ XIX / 4
45% ɨɬ ɨɛɳɟɝɨ ɱɢɫɥɚ ɧɚɫɟɥɟɧɢɹ, ɩɪɢ ɷɬɨɦ ɧɚɛɥɸɞɚɟɬɫɹ ɪɟɡɤɨɟ ɭɜɟɥɢɱɟɧɢɟ ɤɨɥɢɱɟɫɬɜɚ ɫɥɭɱɚɟɜ
25
ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ
ɡɚɛɨɥɟɜɚɧɢɹ ɫ ɜɨɡɪɚɫɬɨɦ [10]. ɉɨɫɥɟɞɧɟɟ ɞɟɫɹɬɢɥɟɬɢɟ ɨɫɨɛɨɟ ɜɧɢɦɚɧɢɟ ɜ ɤɚɪɞɢɨɥɨɝɢɢ ɩɪɢɤɨɜɚɧɨ ɧɟ ɬɨɥɶɤɨ ɤ ɭɪɨɜɧɸ ɚɪɬɟɪɢɚɥɶɧɨɝɨ ɞɚɜɥɟɧɢɹ (ȺȾ), ɢɡɦɟɪɹɟɦɨɝɨ ɧɚ ɩɥɟɱɟɜɨɣ ɚɪɬɟɪɢɢ ɩɨ
ɦɟɬɨɞɭ ɇ.ɋ. Ʉɨɪɨɬɤɨɜɚ ɢɥɢ ɨɫɰɢɥɥɨɦɟɬɪɢɱɟɫɤɢɦ
ɦɟɬɨɞɨɦ, ɧɨ ɢ ɤ ɩɨɤɚɡɚɬɟɥɹɦ ɰɟɧɬɪɚɥɶɧɨɣ ɝɟɦɨɞɢɧɚɦɢɤɢ ɢ ɭɩɪɭɝɨ-ɷɥɚɫɬɢɱɟɫɤɢɦ ɫɜɨɣɫɬɜɚɦ
ɚɪɬɟɪɢɚɥɶɧɨɣ ɫɬɟɧɤɢ.
ɋ ɪɚɫɲɢɪɟɧɢɟɦ ɬɟɯɧɢɱɟɫɤɢɯ ɜɨɡɦɨɠɧɨɫɬɟɣ ɢ
ɫɨɡɞɚɧɢɟɦ ɰɟɥɨɝɨ ɪɹɞɚ ɧɟɢɧɜɚɡɢɜɧɵɯ ɫɢɫɬɟɦ ɞɥɹ
ɚɧɚɥɢɡɚ ɢ ɨɰɟɧɤɢ ɩɭɥɶɫɨɜɨɣ ɜɨɥɧɵ ɧɚ ɪɚɡɥɢɱɧɵɯ
ɭɱɚɫɬɤɚɯ ɚɪɬɟɪɢɚɥɶɧɨɝɨ ɞɟɪɟɜɚ ɩɟɪɟɞ ɤɚɪɞɢɨɥɨɝɚɦɢ ɨɬɤɪɵɥɢɫɶ ɧɨɜɵɟ ɞɢɚɝɧɨɫɬɢɱɟɫɤɢɟ ɢ ɥɟɱɟɛɧɵɟ ɜɨɡɦɨɠɧɨɫɬɢ ɩɪɢ ɜɟɞɟɧɢɢ ɛɨɥɶɧɵɯ ɫ ȺȽ.
ɉɚɪɚɦɟɬɪɚɦɢ, ɤɨɬɨɪɵɟ ɨɬɪɚɠɚɸɬ ɭɩɪɭɝɨ-ɷɥɚɫɬɢɱɟɫɤɢɟ ɫɜɨɣɫɬɜɚ, ɹɜɥɹɸɬɫɹ ɫɤɨɪɨɫɬɶ ɪɚɫɩɪɨɫɬɪɚɧɟɧɢɹ ɩɭɥɶɫɨɜɨɣ ɜɨɥɧɵ (ɋɊɉȼ), ɢɧɞɟɤɫ
ɚɭɝɦɟɧɬɚɰɢɢ (AIxao) ɢ ɰɟɧɬɪɚɥɶɧɨɟ ɚɨɪɬɚɥɶɧɨɟ
ɞɚɜɥɟɧɢɟ (ɐȺȾ, SBPao).
ɂɧɬɟɪɟɫ ɤ ɚɧɚɥɢɡɭ ɤɨɧɬɭɪɚ ɩɭɥɶɫɨɜɨɣ ɜɨɥɧɵ ɢ
ɨɩɪɟɞɟɥɟɧɢɸ ɐȺȾ ɩɨɥɭɱɢɥ ɪɚɫɩɪɨɫɬɪɚɧɟɧɢɟ
ɛɥɚɝɨɞɚɪɹ ɪɟɡɭɥɶɬɚɬɚɦ ɢɫɫɥɟɞɨɜɚɧɢɣ REASON
[13] ɢ ASCOT-CAFÉ [9], ɤɨɬɨɪɵɟ ɩɨɡɜɨɥɢɥɢ
ɩɪɟɞɩɨɥɨɠɢɬɶ, ɱɬɨ ɐȺȾ, ɢɡɦɟɪɟɧɧɨɟ ɧɟɢɧɜɚɡɢɜɧɵɦ ɩɭɬɟɦ, ɜ ɛɨɥɶɲɟɣ ɫɬɟɩɟɧɢ, ɱɟɦ ɩɟɪɢɮɟɪɢɱɟɫɤɨɟ ȺȾ, ɫɜɹɡɚɧɨ ɫ ɪɟɝɪɟɫɫɨɦ ɝɢɩɟɪɬɪɨɮɢɢ
ɥɟɜɨɝɨ ɠɟɥɭɞɨɱɤɚ, ɚ ɬɚɤɠɟ ɹɜɥɹɟɬɫɹ ɧɚɢɛɨɥɟɟ
ɱɭɜɫɬɜɢɬɟɥɶɧɵɦ ɢɧɞɢɤɚɬɨɪɨɦ ɩɨɜɪɟɠɞɟɧɢɹ ɨɪɝɚɧɨɜ-ɦɢɲɟɧɟɣ ɢ ɪɢɫɤɚ ɪɚɡɜɢɬɢɹ ɫɟɪɞɟɱɧɨ-ɫɨɫɭɞɢɫɬɵɯ ɡɚɛɨɥɟɜɚɧɢɣ ɧɟ ɬɨɥɶɤɨ ɭ ɩɚɰɢɟɧɬɨɜ ɫ
ɚɬɟɪɨɫɤɥɟɪɨɡɨɦ [5], ɧɨ ɢ ɭ ɡɞɨɪɨɜɵɯ ɥɢɰ [4].
«Ɂɨɥɨɬɵɦ ɫɬɚɧɞɚɪɬɨɦ», ɨɬɪɚɠɚɸɳɢɦ ɭɩɪɭɝɨɷɥɚɫɬɢɱɟɫɤɢɟ ɫɜɨɣɫɬɜɚ ɫɨɫɭɞɢɫɬɨɣ ɫɬɟɧɤɢ, ɹɜɥɹɟɬɫɹ ɋɊɉȼ ɜ ɚɨɪɬɟ. ɉɨ ɦɧɟɧɢɸ ɷɤɫɩɟɪɬɨɜ ȿɜɪɨɩɟɣɫɤɨɝɨ ɨɛɳɟɫɬɜɚ ɤɚɪɞɢɨɥɨɝɨɜ ɢ ȿɜɪɨɩɟɣɫɤɨɝɨ
ɨɛɳɟɫɬɜɚ ɩɨ ɥɟɱɟɧɢɸ ɚɪɬɟɪɢɚɥɶɧɨɣ ɝɢɩɟɪɬɟɧɡɢɢ,
ɜ 2007 ɝɨɞɭ ɋɊɉȼ ɜɧɟɫɟɧɚ ɜ ɫɩɢɫɨɤ ɨɛɹɡɚɬɟɥɶɧɨ
ɬɟɫɬɢɪɭɟɦɵɯ ɩɚɪɚɦɟɬɪɨɜ ɫɭɛɤɥɢɧɢɱɟɫɤɨɝɨ ɩɨɪɚɠɟɧɢɹ ɨɪɝɚɧɨɜ-ɦɢɲɟɧɟɣ ɞɥɹ ɫɬɪɚɬɢɮɢɤɚɰɢɢ ɫɟɪɞɟɱɧɨ-ɫɨɫɭɞɢɫɬɨɝɨ ɪɢɫɤɚ ɭ ɩɚɰɢɟɧɬɨɜ ɫ ȺȽ [12].
ɍɜɟɥɢɱɟɧɢɟ ɋɊɉȼ ɜɫɟɝɨ ɧɚ 1ɦ/ɫ ɭɜɟɥɢɱɢɜɚɟɬ
ɪɢɫɤ ɫɦɟɪɬɢ ɧɚ 10%, ɜ ɫɜɹɡɢ ɫ ɱɟɦ ɋɊɉȼ ɜɵɫɬɭɩɚɟɬ ɧɟɡɚɜɢɫɢɦɵɦ ɩɪɟɞɢɤɬɨɪɨɦ ɪɚɡɜɢɬɢɹ ɤɚɪɞɢɨɜɚɫɤɭɥɹɪɧɵɯ ɡɚɛɨɥɟɜɚɧɢɣ ɢ ɨɛɳɟɣ ɫɟɪɞɟɱɧɨɫɨɫɭɞɢɫɬɨɣ ɫɦɟɪɬɧɨɫɬɢ [19].
ɋɧɢɠɟɧɢɟ ɭɩɪɭɝɨ-ɷɥɚɫɬɢɱɟɫɤɢɯ ɫɜɨɣɫɬɜ ɚɪɬɟɪɢɚɥɶɧɨɣ ɫɬɟɧɤɢ ɩɪɢɜɨɞɢɬ ɤ ɭɜɟɥɢɱɟɧɢɸ ɫɤɨɪɨɫɬɢ ɪɚɫɩɪɨɫɬɪɚɧɟɧɢɹ ɭɞɚɪɧɨɣ ɩɭɥɶɫɨɜɨɣ ɜɨɥɧɵ ɢ ɛɨɥɟɟ ɪɚɧɧɟɦɭ ɟɟ ɨɬɪɚɠɟɧɢɸ ɨɬ ɦɧɨɝɨɱɢɫɥɟɧɧɵɯ ɛɢɮɭɪɤɚɰɢɣ ɚɪɬɟɪɢɚɥɶɧɨɝɨ ɪɭɫɥɚ. ȼ
ɪɟɡɭɥɶɬɚɬɟ ɷɬɨɝɨ ɨɬɪɚɠɟɧɧɚɹ ɜɨɥɧɚ ɜɨɡɜɪɚɳɚɟɬɫɹ
ɤ ɫɟɪɞɰɭ ɜ ɩɨɡɞɧɸɸ ɫɢɫɬɨɥɭ, ɚ ɧɟ ɞɢɚɫɬɨɥɭ, ɱɬɨ
ɜɥɟɱɟɬ ɡɚ ɫɨɛɨɣ ɩɨɜɵɲɟɧɢɟ ɞɚɜɥɟɧɢɹ ɜ ɚɨɪɬɟ.
Ʉɨɥɢɱɟɫɬɜɟɧɧɨ ɷɬɨ ɭɜɟɥɢɱɟɧɢɟ ɯɚɪɚɤɬɟɪɢɡɭɟɬɫɹ
ɢɧɞɟɤɫɨɦ ɚɭɝɦɟɧɬɚɰɢɢ (ɢɧɞɟɤɫ ɩɪɢɪɨɫɬɚ, ɚɭɝ-
26
ɦɟɧɬɚɰɢɨɧɧɵɣ ɢɧɞɟɤɫ) [11, 14]. ɉɨ ɞɚɧɧɵɦ
McEniery (2011), ɞɥɹ ɥɸɞɟɣ ɦɨɥɨɞɨɝɨ ɜɨɡɪɚɫɬɚ
ɛɨɥɟɟ ɱɭɜɫɬɜɢɬɟɥɶɧɵɦ ɦɚɪɤɟɪɨɦ ɫɬɚɪɟɧɢɹ ɫɨɫɭɞɨɜ ɹɜɥɹɟɬɫɹ AIxao, ɜ ɬɨ ɜɪɟɦɹ ɤɚɤ ɞɥɹ ɥɢɰ
ɫɬɚɪɲɟɝɨ ɜɨɡɪɚɫɬɚ – ɋɊɉȼ ɜ ɚɨɪɬɟ. ɉɨɷɬɨɦɭ ɞɥɹ
ɬɨɝɨ, ɱɬɨɛɵ ɩɨɥɧɨɫɬɶɸ ɨɰɟɧɢɬɶ ɜɥɢɹɧɢɟ ɜɨɡɪɚɫɬɚ
ɧɚ ɭɩɪɭɝɨ-ɷɥɚɫɬɢɱɟɫɤɢɟ ɫɜɨɣɫɬɜɚ, ɧɟɨɛɯɨɞɢɦɨ
ɨɰɟɧɢɜɚɬɶ ɨɛɚ ɩɨɤɚɡɚɬɟɥɹ ɜ ɪɚɜɧɨɣ ɦɟɪɟ [15].
ɍɫɬɚɧɨɜɥɟɧɨ, ɱɬɨ ɜɨɡɪɚɫɬ ɩɚɰɢɟɧɬɚ ɢ ɧɚɥɢɱɢɟ
ȺȽ ɨɤɚɡɵɜɚɸɬ ɧɚɢɛɨɥɶɲɟɟ ɜɥɢɹɧɢɟ ɧɚ ɩɨɜɵɲɟɧɢɟ ɐȺȾ ɢ ɠɟɫɬɤɨɫɬɢ ɫɨɫɭɞɢɫɬɨɣ ɫɬɟɧɤɢ. Ɋɚɡɧɢɰɚ ɦɟɠɞɭ ɐȺȾ ɜ ɚɨɪɬɟ ɢ ȺȾ ɧɚ ɩɥɟɱɟɜɨɣ
ɚɪɬɟɪɢɢ ɜ ɦɨɥɨɞɨɦ ɜɨɡɪɚɫɬɟ ɦɨɠɟɬ ɞɨɫɬɢɝɚɬɶ 20
ɦɦ ɪɬ.ɫɬ. ɋ ɭɜɟɥɢɱɟɧɢɟɦ ɜɨɡɪɚɫɬɚ, ɚ ɬɚɤɠɟ ɩɪɢ
ȺȽ ɷɥɚɫɬɢɱɧɨɫɬɶ ɫɬɟɧɤɢ ɚɨɪɬɵ ɭɦɟɧɶɲɚɟɬɫɹ, ɱɬɨ
ɩɪɢɜɨɞɢɬ ɤ ɩɨɜɵɲɟɧɢɸ ɭɪɨɜɧɹ ɐȺȾ ɢ ɭɦɟɧɶɲɟɧɢɸ ɮɢɡɢɨɥɨɝɢɱɟɫɤɨɣ ɪɚɡɧɢɰɵ ɦɟɠɞɭ ɚɨɪɬɚɥɶɧɵɦ ɞɚɜɥɟɧɢɟɦ ɢ ɋȺȾ, ɢɡɦɟɪɟɧɧɵɦ ɧɚ
ɩɥɟɱɟɜɨɣ ɚɪɬɟɪɢɢ [17].
ɐɟɥɶɸ ɞɚɧɧɨɝɨ ɢɫɫɥɟɞɨɜɚɧɢɹ ɛɵɥɨ ɢɡɭɱɢɬɶ
ɨɫɨɛɟɧɧɨɫɬɢ ɭɩɪɭɝɨ-ɷɥɚɫɬɢɱɟɫɤɢɯ ɫɜɨɣɫɬɜ ɫɨɫɭɞɢɫɬɨɣ ɫɬɟɧɤɢ ɭ ɛɨɥɶɧɵɯ ɫ ȺȽ ɜ ɦɨɥɨɞɨɦ
ɜɨɡɪɚɫɬɟ ɢ ɨɰɟɧɢɬɶ ɢɯ ɜɡɚɢɦɨɫɜɹɡɶ ɫ ɫɭɛɤɥɢɧɢɱɟɫɤɢɦ ɩɨɪɚɠɟɧɢɟɦ ɨɪɝɚɧɨɜ-ɦɢɲɟɧɟɣ ɢ ɩɨɤɚɡɚɬɟɥɹɦɢ ɫɭɬɨɱɧɨɝɨ ɦɨɧɢɬɨɪɢɪɨɜɚɧɢɹ ȺȾ (ɋɆȺȾ).
ɆȺɌȿɊɂȺɅɕ ɂ ɆȿɌɈȾɕ ɂɋɋɅȿȾɈȼȺɇɂɃ
ȼ ɢɫɫɥɟɞɨɜɚɧɢɟ ɛɵɥɢ ɜɤɥɸɱɟɧɵ 30 ɦɭɠɱɢɧ ɜ
ɜɨɡɪɚɫɬɟ 18-35 ɥɟɬ, ɫɬɪɚɞɚɸɳɢɯ ɝɢɩɟɪɬɨɧɢɱɟɫɤɨɣ ɛɨɥɟɡɧɶɸ I ɫɬɚɞɢɢ (73,33%) ɢ II ɫɬɚɞɢɢ
(26,67%). ɉɨ ɫɬɟɩɟɧɢ ɩɨɜɵɲɟɧɢɹ ȺȾ ȺȽ 1-ɣ
ɫɬɟɩɟɧɢ ɛɵɥɚ ɭɫɬɚɧɨɜɥɟɧɚ ɭ 27 (90%) ɢ ȺȽ 2-ɣ
ɫɬɟɩɟɧɢ – ɭ 3 (10%) ɛɨɥɶɧɵɯ. ɋɪɟɞɧɢɣ ɜɨɡɪɚɫɬ ɜ
ɝɪɭɩɩɟ ɫɨɫɬɚɜɢɥ 27,63r4,92 ɝɨɞɚ, ɞɥɢɬɟɥɶɧɨɫɬɶ
ɡɚɛɨɥɟɜɚɧɢɹ – 4,3r1,2 ɝɨɞɚ. Ɉɬɹɝɨɳɟɧɧɚɹ ɧɚɫɥɟɞɫɬɜɟɧɧɨɫɬɶ ɩɨ ȺȽ ɨɬɦɟɱɟɧɚ ɭ 25 (83,3%) ɩɚɰɢɟɧɬɨɜ. ɂɧɞɟɤɫ ɦɚɫɫɵ ɬɟɥɚ ɫɨɫɬɚɜɢɥ 27,38r4,37 ɤɝ/ɦ2,
ɱɬɨ ɫɨɨɬɜɟɬɫɬɜɭɟɬ ɢɡɛɵɬɨɱɧɨɣ ɦɚɫɫɟ ɬɟɥɚ, ɢ ɨɤɪɭɠɧɨɫɬɶ ɬɚɥɢɢ - 98,74r13,61 ɫɦ. ɍɪɨɜɟɧɶ ɨɛɳɟɝɨ
ɯɨɥɟɫɬɟɪɢɧɚ ɜ ɝɪɭɩɩɟ ɫɨɫɬɚɜɢɥ 5,14r1,45 ɦɦɨɥɶ/ɥ,
ɝɥɸɤɨɡɚ ɤɪɨɜɢ – 4,64r0,62 ɦɦɨɥɶ/ɥ.
Ʉɪɢɬɟɪɢɹɦɢ ɢɫɤɥɸɱɟɧɢɹ ɹɜɥɹɥɢɫɶ ɜɨɡɪɚɫɬ
ɫɬɚɪɲɟ 35 ɥɟɬ, ɫɢɦɩɬɨɦɚɬɢɱɟɫɤɢɟ ɮɨɪɦɵ ȺȽ,
ɧɚɥɢɱɢɟ ɤɥɢɧɢɱɟɫɤɢɯ ɩɪɢɡɧɚɤɨɜ ɢɲɟɦɢɱɟɫɤɨɣ
ɛɨɥɟɡɧɢ ɫɟɪɞɰɚ, ɧɚɪɭɲɟɧɢɣ ɫɟɪɞɟɱɧɨɝɨ ɪɢɬɦɚ,
ɩɪɢɡɧɚɤɨɜ ɫɟɪɞɟɱɧɨɣ ɧɟɞɨɫɬɚɬɨɱɧɨɫɬɢ, ɜɪɨɠɞɟɧɧɵɟ ɢ ɩɪɢɨɛɪɟɬɟɧɧɵɟ ɩɨɪɨɤɢ ɫɟɪɞɰɚ, ɫɚɯɚɪɧɵɣ
ɞɢɚɛɟɬ, ɩɚɬɨɥɨɝɢɹ ɛɪɨɧɯɨ-ɥɟɝɨɱɧɨɣ ɫɢɫɬɟɦɵ.
Ɉɛɫɥɟɞɨɜɚɧɢɟ ɩɚɰɢɟɧɬɨɜ ɩɪɨɜɨɞɢɥɨɫɶ ɫɨɝɥɚɫɧɨ ɇɚɰɢɨɧɚɥɶɧɵɦ ɪɟɤɨɦɟɧɞɚɰɢɹɦ ɢ ɤɥɢɧɢɱɟɫɤɨɦɭ ɩɪɨɬɨɤɨɥɭ ɩɨ ɨɤɚɡɚɧɢɸ ɦɟɞɢɰɢɧɫɤɨɣ
ɩɨɦɨɳɢ «Ⱥɪɬɟɪɢɚɥɶɧɚɹ ɝɢɩɟɪɬɟɧɡɢɹ» (2012ɝ.) [2]
ɢ ɜɤɥɸɱɚɥɨ ɨɛɳɟɤɥɢɧɢɱɟɫɤɢɟ ɦɟɬɨɞɵ, ɢɡɦɟɪɟɧɢɟ ɨɮɢɫɧɨɝɨ ɛɪɚɯɢɚɥɶɧɨɝɨ ȺȾ ɩɨ ɦɟɬɨɞɭ Ʉɨɪɨɬɤɨɜɚ, ɷɯɨɤɚɪɞɢɨɝɪɚɮɢɸ (ɗɯɨɄȽ), ɞɨɩɩɥɟɪɨɝɪɚɮɢɸ
ɢɧɬɪɚ- ɢ ɷɤɫɬɪɚɤɪɚɧɢɚɥɶɧɵɯ ɚɪɬɟɪɢɣ, ɋɆȺȾ, ɚ
ɆȿȾɂɑɇȱ ɉȿɊɋɉȿɄɌɂȼɂ
ɬɚɤɠɟ ɢɡɦɟɪɟɧɢɟ ɩɨɤɚɡɚɬɟɥɟɣ ɐȺȾ ɢ ɠɟɫɬɤɨɫɬɢ
ɫɨɫɭɞɢɫɬɨɣ ɫɬɟɧɤɢ ɫ ɩɨɦɨɳɶɸ ɫɭɩɪɚɫɢɫɬɨɥɢɱɟɫɤɨɣ ɫɮɢɝɦɨɝɪɚɮɢɢ. Ɇɚɫɫɭ ɦɢɨɤɚɪɞɚ ɥɟɜɨɝɨ ɠɟɥɭɞɨɱɤɚ (ɆɆɅɀ) ɨɰɟɧɢɜɚɥɢ ɩɨ ɞɚɧɧɵɦ ɗɯɨɄȽ ɜ
ɫɨɨɬɜɟɬɫɬɜɢɢ ɫ ɪɟɤɨɦɟɧɞɚɰɢɹɦɢ Penn Convention,
ɩɨ ɮɨɪɦɭɥɟ R.B. Devereux ɢ N. Reitchek (1977).
ɂɧɞɟɤɫ ɆɆɅɀ (ɂɆɆɅɀ) ɨɩɪɟɞɟɥɹɥɢ ɤɚɤ ɨɬɧɨɲɟɧɢɟ ɆɆɅɀ ɤ ɩɥɨɳɚɞɢ ɩɨɜɟɪɯɧɨɫɬɢ ɬɟɥɚ
(ɝ/ɦ2).
ɋɭɬɨɱɧɨɟ ɦɨɧɢɬɨɪɢɪɨɜɚɧɢɟ ȺȾ ɩɪɨɜɨɞɢɥɢ ɜ
ɚɦɛɭɥɚɬɨɪɧɵɯ ɭɫɥɨɜɢɹɯ ɫ ɩɨɦɨɳɶɸ ɦɨɧɢɬɨɪɨɜ
ABPM*04 ɢ CardioTens («Meditech Ltd», ȼɟɧɝɪɢɹ).
ɂɡɦɟɪɟɧɢɹ ɩɪɨɜɨɞɢɥɢ ɤɚɠɞɵɟ 15 ɦɢɧɭɬ ɜ ɩɟɪɢɨɞ
ɞɧɟɜɧɨɣ ɚɤɬɢɜɧɨɫɬɢ ɢ ɤɚɠɞɵɟ 30 ɦɢɧɭɬ ɜɨ ɜɪɟɦɹ
ɧɨɱɧɨɝɨ ɫɧɚ. ɉɚɪɚɥɥɟɥɶɧɨ ɦɨɧɢɬɨɪɢɪɨɜɚɧɢɸ ɩɚɰɢɟɧɬɵ ɜɟɥɢ ɞɧɟɜɧɢɤ ɚɤɬɢɜɧɨɫɬɢ, ɫɨɝɥɚɫɧɨ ɤɨɬɨɪɨɦɭ ɢɧɞɢɜɢɞɭɚɥɶɧɨ ɜɵɫɬɚɜɥɹɥɢɫɶ ɜɪɟɦɟɧɧɵɟ
ɢɧɬɟɪɜɚɥɵ ɞɧɟɜɧɨɝɨ ɢ ɧɨɱɧɨɝɨ ɩɟɪɢɨɞɨɜ, ɜ
ɡɚɜɢɫɢɦɨɫɬɢ ɨɬ ɪɟɠɢɦɚ ɤɚɠɞɨɝɨ ɩɚɰɢɟɧɬɚ. Ⱥɧɚɥɢɡ ɩɨɥɭɱɟɧɧɵɯ ɪɟɡɭɥɶɬɚɬɨɜ ɋɆȺȾ ɩɪɨɜɨɞɢɥɢ ɫ
ɩɨɦɨɳɶɸ ɨɪɢɝɢɧɚɥɶɧɨɣ ɤɨɦɩɶɸɬɟɪɧɨɣ ɩɪɨɝɪɚɦɦɵ Medibase 1.42. Ⱥɧɚɥɢɡɢɪɨɜɚɥɢ ɫɥɟɞɭɸɳɢɟ
ɩɚɪɚɦɟɬɪɵ: ɫɪɟɞɧɟɫɭɬɨɱɧɵɟ, ɫɪɟɞɧɟɞɧɟɜɧɵɟ,
ɫɪɟɞɧɟɧɨɱɧɵɟ ɢ ɜ ɫɩɟɰɢɚɥɶɧɵɣ ɩɟɪɢɨɞ (ɫ 4 ɞɨ 10
ɱɚɫɨɜ ɭɬɪɚ) ɡɧɚɱɟɧɢɹ ɋȺȾ (ɋȺȾ24, ɋȺȾɞɟɧɶ,
ɋȺȾɧɨɱɶ, ɋȺȾɫɩɟɰ), ȾȺȾ (ȾȺȾ24, ȾȺȾɞɟɧɶ,
ȾȺȾɧɨɱɶ, ȾȺȾɫɩɟɰ), ɩɭɥɶɫɨɜɨɝɨ ȺȾ (ɉȺȾ24,
ɉȺȾɞɟɧɶ, ɉȺȾɧɨɱɶ, ɉȺȾɫɩɟɰ); ɩɨɤɚɡɚɬɟɥɢ «ɧɚɝɪɭɡɤɢ ɞɚɜɥɟɧɢɟɦ» – ɢɧɞɟɤɫɵ ɜɪɟɦɟɧɢ (ɂȼ) ɢ
ɩɥɨɳɚɞɢ (ɂɉ) ɝɢɩɟɪɬɟɧɡɢɢ; ɫɬɟɩɟɧɶ ɧɨɱɧɨɝɨ
ɫɧɢɠɟɧɢɹ ȺȾ (ɋɇɋ ɋȺȾ ɢ ɋɇɋ ȾȺȾ ɫɨɨɬɜɟɬɫɬɜɟɧɧɨ), ɚ ɬɚɤɠɟ ɜɚɪɢɚɛɟɥɶɧɨɫɬɶ ɞɧɟɦ ɢ ɜ
ɩɟɪɢɨɞ ɧɨɱɧɨɝɨ ɫɧɚ ɩɨ ɋȺȾ (ȼȺɊ ɋȺȾɞɟɧɶ, ȼȺɊ
ɋȺȾɧɨɱɶ) ɢ ȾȺȾ (ȼȺɊ ȾȺȾɞɟɧɶ, ȼȺɊ ȾȺȾɧɨɱɶ).
ɉɪɢ ɩɪɨɜɟɞɟɧɢɢ ɢɫɫɥɟɞɨɜɚɧɢɹ ɩɨɥɶɡɨɜɚɥɢɫɶ
ɧɨɪɦɚɬɢɜɧɵɦɢ ɡɧɚɱɟɧɢɹɦɢ ȺȾ, ɪɟɤɨɦɟɧɞɨɜɚɧɧɵɦɢ ȿɜɪɨɩɟɣɫɤɢɦ ɨɛɳɟɫɬɜɨɦ ɤɚɪɞɢɨɥɨɝɨɜ ɜ
2013 ɝɨɞɭ [10] ɢ Ⱥɫɫɨɰɢɚɰɢɟɣ ɤɚɪɞɢɨɥɨɝɨɜ ɍɤɪɚɢɧɵ ɜ 2012 ɝɨɞɭ [2]. ɇɨɪɦɚɥɶɧɵɦ ɫɱɢɬɚɥɢ
ɫɪɟɞɧɟɫɭɬɨɱɧɵɣ ɭɪɨɜɟɧɶ ȺȾ < 130/80 ɦɦ ɪɬ. ɫɬ.,
ɫɪɟɞɧɢɣ ɭɪɨɜɟɧɶ ȺȾ ɞɧɟɦ – < 135/85 ɦɦ ɪɬ. ɫɬ. ɢ
ɧɨɱɶɸ – < 120/70 ɦɦ ɪɬ. ɫɬ. Ⱦɥɹ ɞɢɚɝɧɨɫɬɢɤɢ ȺȽ
ɩɨɪɨɝɨɜɵɦ ɭɪɨɜɧɟɦ ɞɥɹ ɫɪɟɞɧɟɫɭɬɨɱɧɨɝɨ ɋȺȾ ɢ
ȾȺȾ ɫɥɭɠɢɥɢ ɡɧɚɱɟɧɢɹ • 130/80 ɦɦ ɪɬ. ɫɬ.
ɇɨɪɦɚɬɢɜɵ ɞɥɹ ɩɭɥɶɫɨɜɨɝɨ ȺȾ (ɉȺȾ) ɩɨ ɞɚɧɧɵɦ
ɋɆȺȾ ɜ ɧɚɫɬɨɹɳɟɟ ɜɪɟɦɹ ɨɤɨɧɱɚɬɟɥɶɧɨ ɧɟ
ɨɩɪɟɞɟɥɟɧɵ, ɩɨɷɬɨɦɭ ɜ ɪɚɛɨɬɟ ɛɵɥ ɢɫɩɨɥɶɡɨɜɚɧ
ɨɪɢɟɧɬɢɪɨɜɨɱɧɵɣ ɨɩɬɢɦɚɥɶɧɵɣ ɭɪɨɜɟɧɶ ɞɥɹ
ɫɪɟɞɧɟɫɭɬɨɱɧɨɝɨ ɉȺȾ – < 45 ɦɦ ɪɬ. ɫɬ., ɩɪɟɞɥɨɠɟɧɧɵɣ P.Verdecchia ɜ 1994 ɝɨɞɭ [3].
ɍɩɪɭɝɨ-ɷɥɚɫɬɢɱɟɫɤɢɟ ɫɜɨɣɫɬɜɚ ɫɨɫɭɞɢɫɬɨɣ
ɫɬɟɧɤɢ ɨɩɪɟɞɟɥɹɥɢ ɫ ɢɫɩɨɥɶɡɨɜɚɧɢɟɦ ɚɪɬɟɪɢɨɝɪɚɮɚ Tensioclinic (Tensiomed, ȼɟɧɝɪɢɹ), ɨɫɰɢɥɥɨɦɟɬɪɢɱɟɫɤɨɝɨ ɩɪɢɛɨɪɚ, ɩɪɢɧɰɢɩ ɞɟɣɫɬɜɢɹ
ɤɨɬɨɪɨɝɨ ɨɫɧɨɜɚɧ ɧɚ ɫɭɩɪɚɫɢɫɬɨɥɢɱɟɫɤɨɦ ɦɟɬɨɞɟ
14/ Ɍɨɦ XIX / 4
ɪɟɝɢɫɬɪɚɰɢɢ ɫɮɢɝɦɨɝɪɚɦɦ. Ⱥɧɚɥɢɡ ɩɭɥɶɫɨɜɨɣ
ɜɨɥɧɵ ɜɵɩɨɥɧɹɥɢ ɫ ɩɨɦɨɳɶɸ ɨɪɢɝɢɧɚɥɶɧɨɣ
ɤɨɦɩɶɸɬɟɪɧɨɣ ɩɪɨɝɪɚɦɦɵ Tensiomed. ɇɚ ɛɪɚɯɢɚɥɶɧɨɣ ɚɪɬɟɪɢɢ ɢɡɦɟɪɹɥɢ ɋȺȾ, ȾȺȾ ɢ ɉȺȾ,
ɱɢɫɥɨ ɫɟɪɞɟɱɧɵɯ ɫɨɤɪɚɳɟɧɢɣ (ɑɋɋ), ɨɰɟɧɢɜɚɥɢ
ɰɟɧɬɪɚɥɶɧɨɟ ɚɨɪɬɚɥɶɧɨɟ ɫɢɫɬɨɥɢɱɟɫɤɨɟ ȺȾ
(SBPao), ɰɟɧɬɪɚɥɶɧɨɟ ɚɨɪɬɚɥɶɧɨɟ ɩɭɥɶɫɨɜɨɟ ȺȾ
(ɊɊao), AIxao, ɋɊɉȼ.
ɉɨɥɭɱɟɧɧɵɟ ɪɟɡɭɥɶɬɚɬɵ ɨɛɪɚɛɚɬɵɜɚɥɢ ɦɟɬɨɞɚɦɢ ɜɚɪɢɚɰɢɨɧɧɨɣ ɢ ɧɟɩɚɪɚɦɟɬɪɢɱɟɫɤɨɣ ɫɬɚɬɢɫɬɢɤɢ ɦɟɞɢɤɨ-ɛɢɨɥɨɝɢɱɟɫɤɨɝɨ ɩɪɨɮɢɥɹ ɫ ɩɨɦɨɳɶɸ
ɩɚɤɟɬɚ ɨɪɢɝɢɧɚɥɶɧɵɯ ɩɪɢɤɥɚɞɧɵɯ ɫɬɚɬɢɫɬɢɱɟɫɤɢɯ
ɩɪɨɝɪɚɦɦ “Microsoft Excel” ɢ “SPSS”. Ɋɚɫɫɱɢɬɵɜɚɥɢ ɫɥɟɞɭɸɳɢɟ ɩɚɪɚɦɟɬɪɵ: ɫɪɟɞɧɢɟ ɚɪɢɮɦɟɬɢɱɟɫɤɢɟ ɡɧɚɱɟɧɢɹ (Ɇ), ɫɪɟɞɧɢɟ ɤɜɚɞɪɚɬɢɱɧɵɟ ɨɬɤɥɨɧɟɧɢɹ (V), ɫɬɚɧɞɚɪɬɧɵɟ ɨɲɢɛɤɢ ɫɪɟɞɧɢɯ (m). Ⱦɥɹ
ɨɩɪɟɞɟɥɟɧɢɹ ɜɡɚɢɦɨɫɜɹɡɢ ɦɟɠɞɭ ɨɩɪɟɞɟɥɹɟɦɵɦɢ
ɩɚɪɚɦɟɬɪɚɦɢ ɢɫɩɨɥɶɡɨɜɚɥɢ ɦɟɬɨɞ ɪɚɧɝɨɜɨɣ ɤɨɪɪɟɥɹɰɢɢ ɉɢɪɫɨɧɚ. Ɋɚɡɥɢɱɢɹ ɦɟɠɞɭ ɩɨɤɚɡɚɬɟɥɹɦɢ
ɫɱɢɬɚɥɢ ɞɨɫɬɨɜɟɪɧɵɦɢ ɩɪɢ ɪ<0,05 [1].
ɊȿɁɍɅɖɌȺɌɕ ɂ ɂɏ ɈȻɋɍɀȾȿɇɂȿ
ɉɪɢ ɨɛɫɥɟɞɨɜɚɧɢɢ ɭɪɨɜɟɧɶ ɨɮɢɫɧɨɝɨ ɋȺȾ,
ȾȺȾ ɢ ɉȺȾ ɧɚ ɛɪɚɯɢɚɥɶɧɨɣ ɚɪɬɟɪɢɢ ɫɨɫɬɚɜɢɥ
141,33±2,67, 83,33±2,35 ɢ 58±1,52 ɦɦ ɪɬ. ɫɬ.
ɫɨɨɬɜɟɬɫɬɜɟɧɧɨ. ɑɚɫɬɨɬɚ ɫɟɪɞɟɱɧɵɯ ɫɨɤɪɚɳɟɧɢɣ
ɡɚɪɟɝɢɫɬɪɢɪɨɜɚɧɚ
ɜ
ɩɪɟɞɟɥɚɯ
ɧɨɪɦɵ
–
69,15±2,32 ɭɞ./ɦɢɧ.
ɋɨɝɥɚɫɧɨ ɩɨɥɭɱɟɧɧɵɦ ɪɟɡɭɥɶɬɚɬɚɦ ɋɆȺȾ
(ɬɚɛɥ.1) ɛɵɥɨ ɭɫɬɚɧɨɜɥɟɧɨ ɩɨɜɵɲɟɧɢɟ ɭɪɨɜɧɹ
ȺȾ ɡɚ ɜɫɟ ɚɧɚɥɢɡɢɪɭɟɦɵɟ ɜɪɟɦɟɧɧɵɟ ɢɧɬɟɪɜɚɥɵ
ɫɭɬɨɤ. ɉɨɤɚɡɚɬɟɥɢ «ɧɚɝɪɭɡɤɢ ɞɚɜɥɟɧɢɟɦ» - ɂȼ ɢ
ɂɉ ɛɵɥɢ ɩɨɜɵɲɟɧɵ ɜ ɬɟɱɟɧɢɟ ɜɫɟɝɨ ɩɟɪɢɨɞɚ
ɢɡɦɟɪɟɧɢɣ. ɂɧɞɟɤɫ ɜɪɟɦɟɧɢ ɩɨ ɋȺȾ ɞɧɟɦ ɢ
ɧɨɱɶɸ ɩɪɟɜɵɲɚɥ 50%, ɱɬɨ ɫɜɢɞɟɬɟɥɶɫɬɜɭɟɬ ɨ
ɫɬɚɛɢɥɶɧɨɦ ɩɨɜɵɲɟɧɢɢ ɋȺȾ.
ȼɚɪɢɚɛɟɥɶɧɨɫɬɶ ɜ ɞɧɟɜɧɵɟ ɱɚɫɵ ɩɨ ɋȺȾ
(11,2±0,67 ɦɦ ɪɬ. ɫɬ.) ɢ ȾȺȾ (10,15±0,51 ɦɦ ɪɬ. ɫɬ.)
ɢ ɜ ɩɟɪɢɨɞ ɫɧɚ (9,12±0,56 ɢ 7,4±0,39 ɦɦ ɪɬ. ɫɬ.
ɫɨɨɬɜɟɬɫɬɜɟɧɧɨ) ɧɟ ɩɪɟɜɵɲɚɥɚ ɧɨɪɦɚɬɢɜɧɵɯ ɡɧɚɱɟɧɢɣ [3]. ɋɬɟɩɟɧɶ ɧɨɱɧɨɝɨ ɫɧɢɠɟɧɢɹ ɋȺȾ
(13,5±0,85%) ɢ ȾȺȾ (19,91±1,19%) ɛɵɥɚ ɜ ɧɨɪɦɟ
ɢ ɫɜɢɞɟɬɟɥɶɫɬɜɨɜɚɥɚ ɨ ɫɨɯɪɚɧɟɧɢɢ ɮɢɡɢɨɥɨɝɢɱɟɫɤɨɝɨ ɞɜɭɯɮɚɡɧɨɝɨ ɰɢɪɤɚɞɧɨɝɨ ɪɢɬɦɚ ȺȾ. ɉɨɥɭɱɟɧɧɵɟ ɞɚɧɧɵɟ ɬɪɚɤɬɨɜɚɥɢ ɤɚɤ 1-ɸ ɫɬɟɩɟɧɶ ȺȽ
ɫ ɩɪɟɢɦɭɳɟɫɬɜɟɧɧɵɦ ɩɨɜɵɲɟɧɢɟɦ ɋȺȾ.
ɉɪɢ ɨɰɟɧɤɟ ɫɭɛɤɥɢɧɢɱɟɫɤɨɝɨ ɩɨɪɚɠɟɧɢɹ ɨɪɝɚɧɨɜ-ɦɢɲɟɧɟɣ ɛɵɥɨ ɭɫɬɚɧɨɜɥɟɧɨ (ɬɚɛɥ. 2), ɱɬɨ ɜɟɥɢɱɢɧɚ ɂɆɆɅɀ ɜ ɫɪɟɞɧɟɦ ɩɨ ɝɪɭɩɩɟ ɧɟ ɩɪɟɜɵɲɚɥɚ ɧɨɪɦɚɬɢɜɧɵɯ ɡɧɚɱɟɧɢɣ (113,52r23,85 ɝɪ/ɦ2)
ɫɨɝɥɚɫɧɨ ɪɟɤɨɦɟɧɞɚɰɢɹɦ ɩɨ ɥɟɱɟɧɢɸ ɚɪɬɟɪɢɚɥɶɧɨɣ ɝɢɩɟɪɬɟɧɡɢɢ, ɩɪɢɧɹɬɵɦ ɜ 2013 ɝɨɞɭ ȿɜɪɨɩɟɣɫɤɢɦ ɨɛɳɟɫɬɜɨɦ ɤɚɪɞɢɨɥɨɝɨɜ ɢ ȿɜɪɨɩɟɣɫɤɢɦ
ɨɛɳɟɫɬɜɨɦ ɩɨ ɥɟɱɟɧɢɸ ɚɪɬɟɪɢɚɥɶɧɨɣ ɝɢɩɟɪɬɟɧɡɢɢ
[10]. ȼ ɬɨ ɠɟ ɜɪɟɦɹ ɞɢɚɩɚɡɨɧ ɤɨɥɟɛɚɧɢɣ ɂɆɆɅɀ ɜ
ɝɪɭɩɩɟ ɫɨɫɬɚɜɢɥ ɨɬ 87,6 ɞɨ 178,8 ɝɪ/ɦ2.
27
ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ
Ɍɚɛɥɢɰɚ 1
ɉɨɤɚɡɚɬɟɥɢ ɫɭɬɨɱɧɨɝɨ ɦɨɧɢɬɨɪɢɪɨɜɚɧɢɹ ɚɪɬɟɪɢɚɥɶɧɨɝɨ ɞɚɜɥɟɧɢɹ
ɭ ɛɨɥɶɧɵɯ ȺȽ ɜ ɦɨɥɨɞɨɦ ɜɨɡɪɚɫɬɟ (M±m)
ɉɨɤɚɡɚɬɟɥɢ
Ƚɪɭɩɩɚ ɢɫɫɥɟɞɨɜɚɧɢɹ (n=30)
ɋɭɬɤɢ
ɋȺȾ24, ɦɦ ɪɬ.ɫɬ.
133,54 ± 1,38
ȾȺȾ24, ɦɦ ɪɬ.ɫɬ.
76,74 ± 1,55
ɉȺȾ24, ɦɦ ɪɬ.ɫɬ.
56,79 ± 1,06
ɑɋɋ24, ɭɞ./ɦɢɧ
72,72 ± 1,80
ɂȼɋȺȾ24, %
57,88 ± 3,8
ɂȼȾȺȾ24, %
37,54 ± 4,8
ɂɉɋȺȾ24, %
166,26 ± 23,33
ɂɉȾȺȾ24, %
80,27 ± 15,99
ɋɇɋ ɋȺȾ, %
13,5±0,85
ɋɇɋ ȾȺȾ, %
19,91±1,19
Ⱦɟɧɶ
ɋȺȾɞɟɧɶ, ɦɦ ɪɬ.ɫɬ.
139,95 ± 1,39
ȾȺȾɞɟɧɶ, ɦɦ ɪɬ.ɫɬ.
82,31 ± 1,58
ɉȺȾɞɟɧɶ, ɦɦ ɪɬ.ɫɬ.
57,65 ± 1,16
ɑɋɋɞɟɧɶ, ɭɞ./ɦɢɧ
79,33 ± 2,12
ɂȼɋȺȾɞɟɧɶ, %
61,96 ± 4,05
ɂȼȾȺȾɞɟɧɶ, %
41,02 ± 4,82
ɂɉɋȺȾɞɟɧɶ, %
192,28 ± 26,47
ɂɉȾȺȾɞɟɧɶ, %
92,92 ± 17,96
ȼȺɊ ɋȺȾɞɟɧɶ, ɦɦ ɪɬ.ɫɬ.
11,2±0,67
ȼȺɊ ȾȺȾɞɟɧɶ, ɦɦ ɪɬ.ɫɬ.
10,15±0,51
ɇɨɱɶ
ɋȺȾɧɨɱɶ, ɦɦ ɪɬ.ɫɬ.
120,99 ± 1,51
ȾȺȾɧɨɱɶ, ɦɦ ɪɬ.ɫɬ.
65,98 ± 1,55
ɉȺȾɧɨɱɶ, ɦɦ ɪɬ.ɫɬ.
55,01 ± 1,17
ɑɋɋɧɨɱɶ, ɭɞ./ɦɢɧ
59,39 ± 1,21
ɂȼɋȺȾɧɨɱɶ, %
51,42 ± 5,48
ɂȼȾȺȾɧɨɱɶ, %
33,41 ± 6,13
ɂɉɋȺȾɧɨɱɶ, %
122,67 ± 23,79
ɂɉȾȺȾɧɨɱɶ, %
59,69 ± 14,77
ȼȺɊ ɋȺȾɧɨɱɶ, ɦɦ ɪɬ.ɫɬ.
9,12±0,56
ȼȺɊ ȾȺȾɧɨɱɶ, ɦɦ ɪɬ.ɫɬ.
7,4±0,39
ɋɩɟɰɢɚɥɶɧɵɣ ɩɟɪɢɨɞ (ɪɚɧɧɢɟ ɭɬɪɟɧɧɢɟ ɱɚɫɵ)
28
ɋȺȾɫɩɟɰ, ɦɦ ɪɬ.ɫɬ.
127,93 ± 1,85
ȾȺȾɫɩɟɰ, ɦɦ ɪɬ.ɫɬ.
73,51 ± 1,99
ɉȺȾɫɩɟɰ, ɦɦ ɪɬ.ɫɬ.
54,41 ± 1,0
ɑɋɋɫɩɟɰ, ɭɞ./ɦɢɧ
68,32 ± 1,93
ɂȼɋȺȾɫɩɟɰ, %
67,84 ± 4,43
ɂȼȾȺȾɫɩɟɰ, %
31,34 ± 4,46
ɂɉɋȺȾɫɩɟɰ, %
259,28 ± 34,05
ɂɉȾȺȾɫɩɟɰ, %
81,49 ± 19,87
ɆȿȾɂɑɇȱ ɉȿɊɋɉȿɄɌɂȼɂ
Ɍɨɥɳɢɧɚ ɄɂɆ ɛɵɥɚ ɜ ɩɪɟɞɟɥɚɯ ɧɨɪɦɵ
(0,64r0,12 ɦɦ), ɨɞɧɚɤɨ ɭ 1 ɩɚɰɢɟɧɬɚ ɜɵɹɜɥɟɧɵ
ɩɪɢɡɧɚɤɢ ɧɟɫɬɟɧɨɡɢɪɭɸɳɟɝɨ ɚɬɟɪɨɫɤɥɟɪɨɡɚ ɛɪɚɯɢɨɰɟɮɚɥɶɧɵɯ ɚɪɬɟɪɢɣ.
ɉɪɢɡɧɚɤɨɜ ɩɨɪɚɠɟɧɢɹ ɩɨɱɟɤ ɭ ɨɛɫɥɟɞɨɜɚɧɧɵɯ
ɛɨɥɶɧɵɯ ɫɨɝɥɚɫɧɨ ɜɟɥɢɱɢɧɟ ɋɄɎ ɧɟ ɜɵɹɜɥɟɧɨ.
Ɍɚɛɥɢɰɚ 2
ɉɨɤɚɡɚɬɟɥɢ ɫɭɛɤɥɢɧɢɱɟɫɤɨɝɨ ɩɨɪɚɠɟɧɢɹ
ɨɪɝɚɧɨɜ-ɦɢɲɟɧɟɣ (M±m)
ɉɨɤɚɡɚɬɟɥɢ
ɂɆɆɅɀ, ɝɪ/ɦ2
ɄɂɆ, ɦɦ
ɋɤɨɪɨɫɬɶ ɤɥɭɛɨɱɤɨɜɨɣ ɮɢɥɶɬɪɚɰɢɢ*,
ɦɥ/ɦɢɧ/1,73ɦ2
Ƚɪɭɩɩɚ (n=30)
113,52 r 23,85
0,64 r 0,12
104,14 r 19,05
ɉ ɪ ɢ ɦ ɟ ɱ ɚ ɧ ɢ ɹ : ɂɆɆɅɀ – ɢɧɞɟɤɫ ɦɚɫɫɵ ɦɢɨɤɚɪɞɚ ɥɟɜɨɝɨ
ɠɟɥɭɞɨɱɤɚ, ɄɂɆ – ɤɨɦɩɥɟɤɫ ɢɧɬɢɦɚ-ɦɟɞɢɚ, • ɩɨ Chronic Kidney
Disease Epidemiology Collaboration (CKD EPI).
ɉɨ ɞɚɧɧɵɦ ɫɭɩɪɚɫɢɫɬɨɥɢɱɟɫɤɨɣ ɚɪɬɟɪɢɨɝɪɚɮɢɢ ɭɪɨɜɟɧɶ ɰɟɧɬɪɚɥɶɧɨɝɨ ɚɨɪɬɚɥɶɧɨɝɨ ɢ ɩɭɥɶɫɨɜɨɝɨ ɞɚɜɥɟɧɢɹ ɜ ɝɪɭɩɩɟ ɧɚɛɥɸɞɟɧɢɹ (ɬɚɛɥ. 3) ɧɟ
ɛɵɥ ɩɨɜɵɲɟɧ (125,86±2,76 ɢ 42,52±1,03 ɦɦ ɪɬ. ɫɬ.
ɫɨɨɬɜɟɬɫɬɜɟɧɧɨ). ɋɨɝɥɚɫɧɨ ɩɨɥɭɱɟɧɧɵɦ ɪɟɡɭɥɶɬɚɬɚɦ ɭɪɨɜɧɢ SBPao ɢ PPao ɧɟ ɩɪɟɜɵɲɚɥɢ ɨɮɢɫɧɵɟ
ɩɨɤɚɡɚɬɟɥɢ ɋȺȾ ɢ ɉȺȾ ɧɚ ɛɪɚɯɢɚɥɶɧɨɣ ɚɪɬɟɪɢɢ,
ɱɬɨ ɫɜɢɞɟɬɟɥɶɫɬɜɭɟɬ ɨɛ ɨɬɫɭɬɫɬɜɢɢ ɧɚɪɭɲɟɧɢɹ
ɮɢɡɢɨɥɨɝɢɱɟɫɤɨɝɨ ɫɨɨɬɧɨɲɟɧɢɹ ɦɟɠɞɭ ȺȾ ɜ
ɰɟɧɬɪɚɥɶɧɵɯ ɫɨɫɭɞɚɯ ɢ ɧɚ ɩɟɪɢɮɟɪɢɢ. ɇɚ
ɫɟɝɨɞɧɹɲɧɢɣ ɞɟɧɶ ɭɫɬɚɧɨɜɥɟɧɨ, ɱɬɨ ɭɜɟɥɢɱɟɧɢɟ
ɰɟɧɬɪɚɥɶɧɨɝɨ ɉȺȾ ɨɬɪɢɰɚɬɟɥɶɧɨ ɜɥɢɹɟɬ ɧɚ
ɩɪɨɝɧɨɡ ɠɢɡɧɢ ɩɚɰɢɟɧɬɚ, ɚ ɬɚɤɠɟ ɪɢɫɤ ɪɚɡɜɢɬɢɹ
ɫɟɪɞɟɱɧɨ-ɫɨɫɭɞɢɫɬɵɯ ɨɫɥɨɠɧɟɧɢɣ. Ɉɬɦɟɱɟɧɨ,
ɱɬɨ ɢɦɟɧɧɨ ɰɟɧɬɪɚɥɶɧɨɟ ɉȺȾ ɹɜɥɹɟɬɫɹ ɥɭɱɲɢɦ
ɩɪɟɞɢɤɬɨɪɨɦ ɫɟɪɞɟɱɧɨ-ɫɨɫɭɞɢɫɬɨɝɨ ɪɢɫɤɚ, ɱɟɦ
ɉȺȾ, ɢɡɦɟɪɟɧɧɨɟ ɧɚ a. brachialis [6-8, 18].
ɉɪɢ ɚɧɚɥɢɡɟ ɨɫɨɛɟɧɧɨɫɬɟɣ ɩɭɥɶɫɨɜɨɣ ɜɨɥɧɵ ɭ
ɢɫɫɥɟɞɭɟɦɵɯ ɩɚɰɢɟɧɬɨɜ ɧɟ ɛɵɥɨ ɜɵɹɜɥɟɧɨ
ɩɨɜɵɲɟɧɢɹ Ⱥȱɯao (8,70±1,48%) ɢ ɋɊɉȼ
(7,89±0,35 ɦ/ɫ), ɱɬɨ ɫɜɢɞɟɬɟɥɶɫɬɜɭɟɬ ɨɛ ɨɬɫɭɬɫɬɜɢɢ ɫɭɛɤɥɢɧɢɱɟɫɤɨɝɨ ɩɨɪɚɠɟɧɢɹ ɫɨɫɭɞɢɫɬɨɣ
ɫɬɟɧɤɢ ɤɚɤ ɨɪɝɚɧɚ-ɦɢɲɟɧɢ ɭ ɦɨɥɨɞɵɯ ɩɚɰɢɟɧɬɨɜ
ɫ ȺȽ.
ȼ ɬɨ ɠɟ ɜɪɟɦɹ ɤɨɪɪɟɥɹɰɢɨɧɧɵɣ ɚɧɚɥɢɡ ɦɟɠɞɭ
ɮɚɤɬɨɪɚɦɢ ɪɢɫɤɚ ɪɚɡɜɢɬɢɹ ɫɟɪɞɟɱɧɨ-ɫɨɫɭɞɢɫɬɵɯ
ɨɫɥɨɠɧɟɧɢɣ ɢ ɪɟɡɭɥɶɬɚɬɚɦɢ ɚɪɬɟɪɢɨɝɪɚɮɢɢ ɭ
ɩɚɰɢɟɧɬɨɜ ɫ ȺȽ ɩɨɤɚɡɚɥ, ɱɬɨ ɫ ɭɜɟɥɢɱɟɧɢɟɦ ɜɨɡɪɚɫɬɚ ɧɚɛɥɸɞɚɟɬɫɹ ɭɯɭɞɲɟɧɢɟ ɭɩɪɭɝɨ-ɷɥɚɫɬɢɱɟɫɤɢɯ ɫɜɨɣɫɬɜ ɫɨɫɭɞɢɫɬɨɣ ɫɬɟɧɤɢ. Ɍɚɤ, ɋɊɉȼ
(r=0,557 p<0,01), SBPao (r=0,492 p<0,01) ɢ AIxao
14/ Ɍɨɦ XIX / 4
(r=0,489 p<0,01) ɞɨɫɬɨɜɟɪɧɨ ɭɜɟɥɢɱɢɜɚɥɢɫɶ ɫ
ɜɨɡɪɚɫɬɨɦ ɩɚɰɢɟɧɬɨɜ.
ɉɪɢ ɞɚɥɶɧɟɣɲɟɦ ɚɧɚɥɢɡɟ ɜɥɢɹɧɢɹ ɦɨɞɢɮɢɰɢɪɭɟɦɵɯ ɎɊ ɋɋɁ, ɬɚɤɢɯ ɤɚɤ ɝɥɸɤɨɡɚ ɩɥɚɡɦɵ
ɤɪɨɜɢ, Ɉɏ, ɈɌ ɢ ɂɆɌ, ɧɚ ɩɨɤɚɡɚɬɟɥɢ ɰɟɧɬɪɚɥɶɧɨɣ ɝɟɦɨɞɢɧɚɦɢɤɢ ɢ ɩɨɤɚɡɚɬɟɥɢ ɠɟɫɬɤɨɫɬɢ ɫɨɫɭɞɢɫɬɨɣ ɫɬɟɧɤɢ ɛɵɥɨ ɜɵɹɜɥɟɧɨ, ɱɬɨ ɭɜɟɥɢɱɟɧɢɟ
ɈɌ (r=0,382 p<0,05) ɢ ɭɪɨɜɧɹ Ɉɏ (r=0,5 p<0,01)
ɛɵɥɨ ɚɫɫɨɰɢɢɪɨɜɚɧɨ ɫ ɪɨɫɬɨɦ SBPao. ɇɚ ɭɫɤɨɪɟɧɢɟ ɋɊɉȼ ɜ ɚɨɪɬɟ ɨɤɚɡɵɜɚɥɢ ɜɥɢɹɧɢɟ ɈɌ
(r=0,566 p<0,01) ɢ ɂɆɌ (r=0,599 p<0,01). Ɍɚɤɢɦ
ɨɛɪɚɡɨɦ, ɢɡɛɵɬɨɱɧɵɣ ɜɟɫ ɢ ɨɠɢɪɟɧɢɟ ɫɥɟɞɭɟɬ
ɪɚɫɫɦɚɬɪɢɜɚɬɶ ɤɚɤ ɧɟɛɥɚɝɨɩɪɢɹɬɧɵɟ ɮɚɤɬɨɪɵ,
ɭɯɭɞɲɚɸɳɢɟ ɭɩɪɭɝɨ-ɷɥɚɫɬɢɱɟɫɤɢɟ ɫɜɨɣɫɬɜɚ
ɫɨɫɭɞɢɫɬɨɣ ɫɬɟɧɤɢ ɭ ɦɨɥɨɞɵɯ ɩɚɰɢɟɧɬɨɜ, ɱɬɨ
ɩɨɥɧɨɫɬɶɸ ɫɨɝɥɚɫɭɟɬɫɹ ɫ ɩɨɥɭɱɟɧɧɵɦɢ ɪɚɧɟɟ
ɞɚɧɧɵɦɢ [16, 20].
Ʉɨɪɪɟɥɹɰɢɨɧɧɵɣ ɚɧɚɥɢɡ ɦɟɠɞɭ ɯɚɪɚɤɬɟɪɢɫɬɢɤɚɦɢ ɛɟɫɫɢɦɩɬɨɦɧɨɝɨ ɩɨɪɚɠɟɧɢɹ ɨɪɝɚɧɨɜ-ɦɢɲɟɧɟɣ ɭ ɨɛɫɥɟɞɨɜɚɧɧɵɯ ɦɨɥɨɞɵɯ ɩɚɰɢɟɧɬɨɜ ɫ
ȺȽ ɢ ɩɨɤɚɡɚɬɟɥɹɦɢ ɚɪɬɟɪɢɨɝɪɚɮɢɢ ɩɨɤɚɡɚɥ, ɱɬɨ
ɭɜɟɥɢɱɟɧɢɟ ɂɆɆɅɀ ɜɵɫɨɤɨ ɚɫɫɨɰɢɢɪɨɜɚɧɨ ɫ
ɩɨɜɵɲɟɧɢɟɦ SBPao (r=0,506 p<0,05) ɢ ɋɊɉȼ
(r=0,434 p<0,05). ȼ ɬɨ ɠɟ ɜɪɟɦɹ ɜɟɥɢɱɢɧɚ ɋɄɎ ɢ
ɬɨɥɳɢɧɚ ɄɂɆ ɧɟ ɨɤɚɡɵɜɚɥɢ ɡɧɚɱɢɦɨɝɨ ɜɥɢɹɧɢɹ
ɧɚ ɢɡɦɟɧɟɧɢɟ ɭɩɪɭɝɨ-ɷɥɚɫɬɢɱɟɫɤɢɯ ɫɜɨɣɫɬɜ ɫɨɫɭɞɢɫɬɨɣ ɫɬɟɧɤɢ ɭ ɩɚɰɢɟɧɬɨɜ ɫ ȺȽ ɢɡ ɝɪɭɩɩɵ
ɢɫɫɥɟɞɨɜɚɧɢɹ.
Ɍɚɛɥɢɰɚ 3
ɉɨɤɚɡɚɬɟɥɢ ɭɩɪɭɝɨ-ɷɥɚɫɬɢɱɟɫɤɢɯ ɫɜɨɣɫɬɜ
ɚɪɬɟɪɢɚɥɶɧɨɣ ɫɬɟɧɤɢ ɭ ɛɨɥɶɧɵɯ ȺȽ
ɜ ɦɨɥɨɞɨɦ ɜɨɡɪɚɫɬɟ (M±m)
ɉɨɤɚɡɚɬɟɥɢ
Ƚɪɭɩɩɚ ɢɫɫɥɟɞɨɜɚɧɢɹ (n=30)
SBPao, ɦɦ ɪɬ.ɫɬ.
125,86±2,76
PPao, ɦɦ ɪɬ.ɫɬ.
42,52±1,03
AIx ɚɨ, %
8,70±1,48
ɋɊɉȼ, ɦ/ɫ
7,89±0,35
ɉɪɢ ɚɧɚɥɢɡɟ ɜɡɚɢɦɨɫɜɹɡɢ ɨɮɢɫɧɵɯ ɢɡɦɟɪɟɧɢɣ
ȺȾ, ɞɚɧɧɵɯ ɋɆȺȾ ɢ ɩɨɤɚɡɚɬɟɥɟɣ ɚɪɬɟɪɢɨɝɪɚɮɢɢ
ɭ ɛɨɥɶɧɵɯ ȺȽ ɜ ɦɨɥɨɞɨɦ ɜɨɡɪɚɫɬɟ ɛɵɥɨ ɜɵɹɜɥɟɧɨ, ɱɬɨ ɭɯɭɞɲɟɧɢɟ ɭɩɪɭɝɨ-ɷɥɚɫɬɢɱɟɫɤɢɯ
ɫɜɨɣɫɬɜ ɫɨɫɭɞɢɫɬɨɣ ɫɬɟɧɤɢ ɚɫɫɨɰɢɢɪɨɜɚɧɨ ɫ
ɩɨɜɵɲɟɧɢɟɦ ɭɪɨɜɧɹ ȾȺȾ ɜ ɬɟɱɟɧɢɟ ɜɫɟɯ ɜɪɟɦɟɧɧɵɯ ɩɟɪɢɨɞɨɜ. Ɍɚɤ, ɩɨɞɴɟɦ AIxao ɧɚɢɛɨɥɟɟ ɜɵɪɚɠɟɧɨ ɤɨɪɪɟɥɢɪɨɜɚɥ ɫ ɪɨɫɬɨɦ ɨɮɢɫɧɨɝɨ ȾȺȾ
(r=0,479 p<0,05) ɢ ȾȺȾɞɟɧɶ (r=0,418 p<0,01)
(ɪɢɫ. 1).
29
ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ
Ɋɢɫ. 1. Ʉɨɪɪɟɥɹɰɢɨɧɧɵɟ ɜɡɚɢɦɨɫɜɹɡɢ ɢɧɞɟɤɫɚ ɚɭɝɦɟɧɬɚɰɢɢ ɢ ɩɨɤɚɡɚɬɟɥɟɣ ɋɆȺȾ
ɇɚ ɭɫɤɨɪɟɧɢɟ ɋɊɉȼ ɦɚɤɫɢɦɚɥɶɧɨɟ ɜɥɢɹɧɢɟ
ɨɤɚɡɵɜɚɥɨ ɩɨɜɵɲɟɧɢɟ ɨɮɢɫɧɨɝɨ ȾȺȾ (r=0,704
p<0,01) ɢ ȾȺȾɞɟɧɶ (r=0,699 p<0,01), ɚ ɬɚɤɠɟ ɩɨɤɚɡɚɬɟɥɢ “ɧɚɝɪɭɡɤɢ ɞɚɜɥɟɧɢɟɦ” – ɂȼ (r=0,714
p<0,01) ɢ ɂɉ ȾȺȾɞɟɧɶ (r=0,729 p<0,01) (ɪɢɫ. 2).
ɍɜɟɥɢɱɟɧɢɟ SPBao ɧɚɛɥɸɞɚɥɨɫɶ ɩɪɢ ɩɨɜɵɲɟɧɢɢ ȾȺȾɞɟɧɶ(r=0,695 p<0,01), ɂȼ (r=0,651
p<0,05) ɢ ɂɉ ȾȺȾɞɟɧɶ (r=0,752 p<0,01) (ɪɢɫ. 3).
ɉɪɢ ɩɪɨɜɟɞɟɧɢɢ ɞɚɥɶɧɟɣɲɟɝɨ ɤɨɪɪɟɥɹɰɢɨɧɧɨɝɨ ɚɧɚɥɢɡɚ ɛɵɥɨ ɜɵɹɜɥɟɧɨ, ɱɬɨ ɭɜɟɥɢɱɟɧɢɟ
ɋɊɉȼ ɛɵɥɨ ɚɫɫɨɰɢɢɪɨɜɚɧɨ ɫ ɩɨɞɴɟɦɨɦ ɨɮɢɫɧɨɝɨ
ɋȺȾ (r=0,47 p<0,05), ɋȺȾɞɟɧɶ(r=0,444 p<0,01) ɢ
ɂɉ ɋȺȾɞɟɧɶ (r=0,452 p<0,05).ȼ ɬɨ ɠɟ ɜɪɟɦɹ ɧɚ
ɩɨɜɵɲɟɧɢɟ SBPao ɧɚɢɛɨɥɶɲɟɟ ɜɥɢɹɧɢɟ ɨɤɚɡɵɜɚɥɢ ɩɨɤɚɡɚɬɟɥɢ ɋȺȾ ɜ ɫɩɟɰɢɚɥɶɧɨɦ ɩɟɪɢɨɞɟ ɋȺȾɫɩɟɰ(r=0,529 p<0,01), ɂȼ (r=0,445 p<0,05) ɢ
ɂɉ ɋȺȾɫɩɟɰ (r=0,522 p<0,01). Ɉɞɧɚɤɨ ɫɥɟɞɭɟɬ
ɨɬɦɟɬɢɬɶ, ɱɬɨ ɫɬɟɩɟɧɶ ɜɵɪɚɠɟɧɧɨɫɬɢ ɭɫɬɚɧɨɜɥɟɧɧɵɯ ɚɫɫɨɰɢɚɰɢɣ ɦɟɠɞɭ ɋɊɉȼ ɢ ɋȺȾ ɦɟɧɶɲɟ,
ɱɟɦ ɫɬɟɩɟɧɶ ɚɫɫɨɰɢɚɰɢɢ ɫ ȾȺȾ.
Ɋɢɫ. 2. Ʉɨɪɪɟɥɹɰɢɨɧɧɵɟ ɜɡɚɢɦɨɫɜɹɡɢ ɫɤɨɪɨɫɬɢ ɪɚɫɩɪɨɫɬɪɚɧɟɧɢɹ ɩɭɥɶɫɨɜɨɣ ɜɨɥɧɵ ɢ ɩɨɤɚɡɚɬɟɥɟɣ ɋɆȺȾ
30
ɆȿȾɂɑɇȱ ɉȿɊɋɉȿɄɌɂȼɂ
Ɋɢɫ. 3. Ʉɨɪɪɟɥɹɰɢɨɧɧɵɟ ɜɡɚɢɦɨɫɜɹɡɢ ɰɟɧɬɪɚɥɶɧɨɝɨ ɚɨɪɬɚɥɶɧɨɝɨ ɞɚɜɥɟɧɢɹ ɢ ɩɨɤɚɡɚɬɟɥɟɣ ɋɆȺȾ
Ɍɚɤɠɟ ɧɟɥɶɡɹ ɧɟ ɨɬɦɟɬɢɬɶ ɜɵɪɚɠɟɧɧɭɸ ɡɚɜɢɫɢɦɨɫɬɶ ɩɨɜɵɲɟɧɢɹ ɋɊɉȼ ɩɪɢ ɭɜɟɥɢɱɟɧɢɢ
ɑɋɋ24 (r=0,581 p<0,01), ɞɧɟɦ (r=0,566 p<0,01), ɜ
ɪɚɧɧɢɟ ɭɬɪɟɧɧɢɟ ɱɚɫɵ (r=0,551 p<0,01), ɧɨ ɨɫɨɛɟɧɧɨ ɧɨɱɶɸ (r=0,636 p<0,01).
ȼɕȼɈȾɕ
1. ɉɨɥɭɱɟɧɧɵɟ ɞɚɧɧɵɟ ɩɨɡɜɨɥɹɸɬ ɫɞɟɥɚɬɶ ɜɵɜɨɞɵ ɨ ɬɨɦ, ɱɬɨ, ɩɨɦɢɦɨ ɜɨɡɪɚɫɬɚ, ɬɚɤɢɟ ɦɨɞɢɮɢɰɢɪɭɟɦɵɟ ɮɚɤɬɨɪɵ ɪɢɫɤɚ ɪɚɡɜɢɬɢɹ ɫɟɪɞɟɱɧɨ-ɫɨɫɭɞɢɫɬɵɯ ɡɚɛɨɥɟɜɚɧɢɣ, ɤɚɤ ɢɡɛɵɬɨɱɧɵɣ
ɜɟɫ, ɨɠɢɪɟɧɢɟ ɢ ɭɪɨɜɟɧɶ ɨɛɳɟɝɨ ɯɨɥɟɫɬɟɪɢɧɚ,
ɫɥɟɞɭɟɬ ɬɚɤɠɟ ɪɚɫɫɦɚɬɪɢɜɚɬɶ ɤɚɤ ɧɟɛɥɚɝɨɩɪɢɹɬɧɵɟ ɮɚɤɬɨɪɵ, ɭɯɭɞɲɚɸɳɢɟ ɭɩɪɭɝɨ-ɷɥɚɫɬɢɱɟɫɤɢɟ
ɫɜɨɣɫɬɜɚ ɫɨɫɭɞɢɫɬɨɣ ɫɬɟɧɤɢ ɭ ɩɚɰɢɟɧɬɨɜ ɫ ȺȽ
ɭɠɟ ɜɨɡɪɚɫɬɟ ɞɨ 35 ɥɟɬ.
2. Ɇɚɤɫɢɦɚɥɶɧɨ ɧɟɝɚɬɢɜɧɨɟ ɜɥɢɹɧɢɟ ɧɚ ɩɚɪɚɦɟɬɪɵ ɭɩɪɭɝɨ-ɷɥɚɫɬɢɱɟɫɤɢɯ ɫɜɨɣɫɬɜ ɫɨɫɭɞɢɫɬɨɣ ɫɬɟɧɤɢ ɩɨ ɞɚɧɧɵɦ ɋɆȺȾ ɨɤɚɡɵɜɚɥɢ
ɭɪɨɜɟɧɶ ɩɨɜɵɲɟɧɢɹ ȾȺȾ ɢ ɜɪɟɦɹ ɝɢɩɟɪɬɟɧɡɢɢ
ɩɨ ȾȺȾ ɨɫɨɛɟɧɧɨ ɞɧɟɦ; ɜɟɥɢɱɢɧɚ ɋȺȾ ɞɧɟɦ ɢ ɜ
ɪɚɧɧɢɟ ɭɬɪɟɧɧɢɟ ɱɚɫɵ; ɑɋɋ ɧɨɱɶɸ.
3. ɍ ɩɚɰɢɟɧɬɨɜ, ɫɬɪɚɞɚɸɳɢɯ ȺȽ ɜ ɦɨɥɨɞɨɦ
ɜɨɡɪɚɫɬɟ, ɩɨɜɵɲɟɧɢɟ ɭɪɨɜɧɹ ɐȺȾ ɢ ɋɊɉȼ ɚɫɫɨɰɢɢɪɭɟɬɫɹ ɫ ɭɜɟɥɢɱɟɧɢɟɦ ɂɆɆɅɀ, ɱɬɨ ɫɜɢɞɟɬɟɥɶɫɬɜɭɟɬ ɨ ɟɞɢɧɫɬɜɟ ɩɚɬɨɮɢɡɢɨɥɨɝɢɱɟɫɤɢɯ
ɦɟɯɚɧɢɡɦɨɜ ɮɨɪɦɢɪɨɜɚɧɢɹ ɫɭɛɤɥɢɧɢɱɟɫɤɨɝɨ ɩɨɪɚɠɟɧɢɹ ɫɟɪɞɰɚ ɢ ɫɨɫɭɞɢɫɬɨɣ ɫɬɟɧɤɢ ɩɪɢ ȺȽ.
ɋɉɂɋɈɄ ɅɂɌȿɊȺɌɍɊɕ
1. Ʌɚɧɝ Ɍ.Ⱥ. Ʉɚɤ ɨɩɢɫɵɜɚɬɶ ɫɬɚɬɢɫɬɢɤɭ ɜ ɦɟɞɢɰɢɧɟ. Ɋɭɤɨɜɨɞɫɬɜɨ ɞɥɹ ɚɜɬɨɪɨɜ, ɪɟɞɚɤɬɨɪɨɜ ɢ
ɪɟɰɟɧɡɟɧɬɨɜ / Ɍ.Ⱥ. Ʌɚɧɝ, Ɇ. ɋɟɫɢɤ [ɩɟɪ. ɫ ɚɧɝɥ. ] / ɩɨɞ
ɪɟɞ. ȼ.ɉ. Ʌɟɨɧɨɜɚ. — Ɇ.: ɉɪɚɤɬɢɱɟɫɤɚɹ ɦɟɞɢɰɢɧɚ,
2011. — 480 ɫ.
2. ɍɧɿɮɿɤɨɜɚɧɢɣ ɤɥɿɧɿɱɧɢɣ ɩɪɨɬɨɤɨɥ ɩɟɪɜɢɧɧɨʀ,
ɟɤɫɬɪɟɧɨʀ ɬɚ ɜɬɨɪɢɧɧɨʀ (ɫɩɟɰɿɚɥɿɡɨɜɚɧɨʀ) ɦɟɞɢɱɧɨʀ
ɞɨɩɨɦɨɝɢ “Aɪɬɟɪɿɚɥɶɧɚ ɝɿɩɟɪɬɟɧɡɿɹ” / ɆɈɁ ɍɤɪɚʀɧɢ. –
K., 2012. – 107 c.
3. Ambulatory blood pressure. An independent predictor of prognosis in essential hypertension / P. Verdecchia, C. Porcellati, G. Schillaci [et al.] // Hypertension.
— 1994. — Vol. 24, N 6. — P. 793–801.
4. Arterial stiffness and cardiovascular events the
Framingham heart study / G.F. Mitchell, S.-J. Hwang,
R.S. Vasan [et al.] // Circulation. — 2010. — Vol. 121,
N 4. — P. 505–511.
14/ Ɍɨɦ XIX / 4
5. Brachial-ankle pulse wave velocity as an index of
central arterial stiffness / S. Tsuchikura, T. Shoji, E.
Kimoto [et al.] // J. Atherosclerosis Thrombosis. — 2010.
— Vol. 17, N 6. — P. 658–665.
6. Brachial blood pressure but not carotid arterial
waveforms predict cardiovascular events in elderly female
hypertensives / A. M. Dart, C. D. Gatzka, B. A. Kingwell
[et al.] // Hypertension. — 2006. — Vol. 47, N 4. —
P. 785–790.
7. Central but not brachial blood pressure predicts
cardiovascular events in an unselected geriatric
population: the ICARe Dicomano Study / R. Pini,
M.C. Cavallini, V. Palmieri [et al.] // J. Am. College Cardiology. — 2008. — Vol. 51, N 25. — P. 2432–2439.
8. Central pressure more strongly relates to vascular
disease and outcome than does brachial pressure the
Strong Heart Study / M.J. Roman, R.B. Devereux,
31
ɄɅȱɇȱɑɇȺ ɆȿȾɂɐɂɇȺ
J.R. Kizer [et al.] // Hypertension. — 2007. — Vol. 50,
N 1. — P. 197–203.
9. Differential impact of blood pressure-lowering
drugs on central aortic pressure and clinical outcomes:
principal results of the Conduit Artery Function Evaluation (CAFE) Study / B. Williams, P. S. Lacy, S. M.
Thom [et al.] // Circulation. — 2006. — Vol. 113, N 9. —
P. 1213–1225.
10. ESH/ESC Guidelines for the management of
arterial hypertension the task force for the management of
arterial hypertension of the European society of hypertension (ESH) and of the European society of cardiology
(ESC) / G. Mancia, R. Fagard, K. Narkiewicz [et al.] //
Eur. Heart J. — 2013. — Vol. 34, N 28. — P. 2159–2219.
11. Expert consensus document on arterial stiffness:
methodological issues and clinical applications / S. Laurent, J. Cockcroft, L. V. Bortel [et al.] // Eur. Heart J. —
2006. — Vol. 27, N 21. — P. 2588–2605.
12. Guidelines for the management of arterial hypertension: the task force for the management of arterial
hypertension of the European society of hypertension
(ESH) and of the European society of cardiology (ESC) /
G. Mancia, G. De Backer, A. Dominiczak [et al.] // J. Hypertension. — 2007. — Vol. 25, N 6. — P. 1105–1187.
13. Mechanism(s) of selective systolic blood pressure
reduction after a low-dose combination of perindopril/indapamide in hypertensive subjects: comparison with atenolol
/ G.M. London, R.G. Asmar, M.F. O’Rourke [et al.] // J. Am.
Coll. Cardiol. — 2004. — Vol. 43, N 1. — P. 92–99.
14. Nichols W.W. Arterial elastance and wave reflection augmentation of systolic blood pressure: deleterious
effects and implications for therapy / W.W. Nichols,
D.G. Edwards // J. Cardiovascular Pharmacology Therapeutics. — 2001. — Vol. 6, N 1. — P. 5–21.
15. Normal vascular aging: differential effects on
wave reflection and aortic pulse wave velocity the AngloCardiff Collaborative Trial (ACCT) / C.M. McEniery,
Yasmin, I.R. Hall [et al.] // J. Am. Coll. Cardiol. — 2005.
— Vol. 46, N 9. — P. 1753–1760.
16. Obesity and overweight associated with increased
carotid diameter and decreased arterial function in young
otherwise healthy men / R.M. Kappus, C.A. Fahs,
D. Smith [et al.] // Am. J. Hypertens. — 2014. — Vol. 27,
N 4. — P. 628–634.
17. Opposing effects of ageing on distal and proximal
large arteries in hypertensives / P. Boutouyrie, S. Laurent,
A. Benetos [et al.] // J. Hypertension. — 1992. —
Vol. 10, N 6. — P. S87–91.
18. Prediction of cardiovascular events and all-cause
mortality with central haemodynamics: a systematic
review and meta-analysis / C. Vlachopoulos, K. Aznaouridis, M. F. O’Rourke [et al.] // Eur. Heart J. — 2010. —
Vol. 31, N 15. — P. 1865–1871.
19. Prognostic value of aortic pulse wave velocity as
index of arterial stiffness in the general population /
T.W. Hansen, J.A. Staessen, C. Torp-Pedersen [et al.] //
Circulation. — 2006. — Vol. 113, N 5. — P. 664–670.
20. The impact of change in physical activity on
change in arterial stiffness in overweight or obese sedentary young adults / M. Hawkins, K.P. Gabriel, J. Cooper
[et al.] // Vascular Medicine. — 2014. — Vol. 19, N 4. —
P. 257–263.
REFERENCES
1. Thomas A Lang, Sesic M. [How To Report Statistics in Medicine. Annotated Guidelines for Authors,
Editors, and Reviewers]. M. Practicheskaya medicina,
2011;480. Russian.
2. Unɿfɿkovaniy klɿnɿchniy protokol pervinnoʀ,
ekstrenoʀ ta vtorinnoʀ (spetsɿalɿzovanoʀ) medichnoʀ dopomogi “arterɿal'na gɿpertenzɿya”. MOZ Ukraʀni. K.,
2012;107. Ukrainian.
3. Verdecchia P, Porcellati C, Schillaci G, Borgioni C,
Ciucci A, Battistelli M, et al. Ambulatory blood pressure. An
independent predictor of prognosis in essential hypertension.
Hypertension. 1994;1;24(6):793–801.
4. Mitchell GF, Hwang S-J, Vasan RS, Larson MG,
Pencina MJ, Hamburg NM, et al. Arterial Stiffness and
Cardiovascular Events The Framingham Heart Study.
Circulation. 2010 Feb 2;121(4):505–11.
5. Tsuchikura S, Shoji T, Kimoto E, Shinohara K,
Hatsuda S, Koyama H, et al. Brachial-ankle Pulse Wave
Velocity as an Index of Central Arterial Stiffness. J
Atheroscler Thromb. 2010;17(6):658–65.
6. Dart AM, Gatzka CD, Kingwell BA, Willson K,
Cameron JD, Liang Y-L, et al. Brachial Blood Pressure
But Not Carotid Arterial Waveforms Predict Cardiovascular Events in Elderly Female Hypertensives.
Hypertension. 2006 Apr 1;47(4):785–90.
32
7. Pini R, Cavallini MC, Palmieri V, Marchionni N,
Di Bari M, Devereux RB, et al. Central But Not Brachial
Blood Pressure Predicts Cardiovascular Events in an
Unselected Geriatric Population: The ICARe Dicomano
Study. J Am Coll Cardiol. 2008 Jun 24;51(25):2432–9.
8. Roman MJ, Devereux RB, Kizer JR, Lee ET,
Galloway JM, Ali T, et al. Central Pressure More Strongly Relates to Vascular Disease and Outcome Than Does
Brachial Pressure The Strong Heart Study. Hypertension.
2007 Jul 1;50(1):197–203.
9. Williams B, Lacy PS, Thom SM, Cruickshank K,
Stanton A, Collier D, et al. Differential impact of blood
pressure-lowering drugs on central aortic pressure and
clinical outcomes: principal results of the Conduit Artery
Function Evaluation (CAFE) study. Circulation. 2006
Mar 7;113(9):1213–25.
10. Mancia G, Fagard R, Narkiewicz K, Redon J,
Zanchetti A, Böhm M, et al. 2013 ESH/ESC Guidelines
for the management of arterial hypertension The Task
Force for the management of arterial hypertension of the
European Society of Hypertension (ESH) and of the
European Society of Cardiology (ESC). Eur Heart J. 2013
Jul 21;34(28):2159–219
11. Laurent S, Cockcroft J, Bortel LV, Boutouyrie P,
Giannattasio C, Hayoz D, et al. Expert consensus document
ɆȿȾɂɑɇȱ ɉȿɊɋɉȿɄɌɂȼɂ
on arterial stiffness: methodological issues and clinical
applications. Eur Heart J. 2006 Nov 1;27(21):2588–605.
12. Mancia G, De Backer G, Dominiczak A, Cifkova
R, Fagard R, Germano G, et al. 2007 Guidelines for the
Management of Arterial Hypertension: The Task Force
for the Management of Arterial Hypertension of the
European Society of Hypertension (ESH) and of the
European Society of Cardiology (ESC). J Hypertens.
2007 Jun;25(6):1105–87.
13. London GM, Asmar RG, O’Rourke MF, Safar
ME, REASON Project Investigators. Mechanism(s) of
selective systolic blood pressure reduction after a lowdose combination of perindopril/indapamide in hypertensive subjects: comparison with atenolol. J Am Coll
Cardiol. 2004 Jan 7;43(1):92–9.
14. Nichols WW, Edwards DG. Arterial elastance and
wave reflection augmentation of systolic blood pressure:
deleterious effects and implications for therapy. J Cardiovasc Pharmacol Ther. 2001 Jan;6(1):5–21.
15. McEniery CM, Yasmin, Hall IR, Qasem A, Wilkinson IB, Cockcroft JR. Normal Vascular Aging: Differential Effects on Wave Reflection and Aortic Pulse
Wave VelocityThe Anglo-Cardiff Collaborative Trial
(ACCT). J Am Coll Cardiol. 2005 Nov 1;46(9):1753–60.
16. Kappus RM, Fahs CA, Smith D, Horn GP,
Agiovlasitis S, Rossow L, et al. Obesity and overweight
associated with increased carotid diameter and decreased
arterial function in young otherwise healthy men. Am J
Hypertens. 2014 Apr;27(4):628–34.
17. Boutouyrie P, Laurent S, Benetos A, Girerd XJ,
Hoeks AP, Safar ME. Opposing effects of ageing on distal
and proximal large arteries in hypertensives. J Hypertens
Suppl Off J Int Soc Hypertens. 1992 Aug;10(6):S87–91.
18. Vlachopoulos C, Aznaouridis K, O’Rourke MF,
Safar ME, Baou K, Stefanadis C. Prediction of cardiovascular events and all-cause mortality with central haemodynamics: a systematic review and meta-analysis. Eur
Heart J. 2010 Aug 1;31(15):1865–71.
19. Hansen TW, Staessen JA, Torp-Pedersen C,
Rasmussen S, Thijs L, Ibsen H, et al. Prognostic Value of
Aortic Pulse Wave Velocity as Index of Arterial Stiffness
in the General Population. Circulation. 2006 Feb
7;113(5):664–70.
20. Hawkins M, Gabriel KP, Cooper J, Storti KL,
Sutton-Tyrrell K, Kriska A. The impact of change in
physical activity on change in arterial stiffness in overweight or obese sedentary young adults. Vasc Med. 2014
Aug 1;19(4):257–63.
ɋɬɚɬɬɹ ɧɚɞɿɣɲɥɚ ɞɨ ɪɟɞɚɤɰɿʀ
10.09.2014
ɍȾɄ 616.24-007.272-036.1-002.1-071.3:615.859
Ʉ.ɘ. Ƚɚɲɢɧɨɜɚ
ɁȺȽɈɋɌɊȿɇɇə ɏɈɁɅ: ȺɇɌɊɈɉɈɆȿɌɊɂɑɇȱ
ɏȺɊȺɄɌȿɊɂɋɌɂɄɂ ɏȼɈɊɂɏ ɌȺ ɑȺɋɌɈɌȺ
ȽɈɋɉȱɌȺɅȱɁȺɐȱɃ
ȾɁ «Ⱦɧɿɩɪɨɩɟɬɪɨɜɫɶɤɚ ɦɟɞɢɱɧɚ ɚɤɚɞɟɦɿɹ ɆɈɁ ɍɤɪɚʀɧɢ»
ɤɚɮɟɞɪɚ ɮɚɤɭɥɶɬɟɬɫɶɤɨʀ ɬɟɪɚɩɿʀ ɬɚ ɟɧɞɨɤɪɢɧɨɥɨɝɿʀ
(ɡɚɜ. – ɱɥɟɧ-ɤɨɪ. ɇȺɆɇ ɍɤɪɚʀɧɢ, ɞ. ɦɟɞ. ɧ., ɩɪɨɮ. Ɍ. Ɉ. ɉɟɪɰɟɜɚ)
ɜɭɥ. Ⱦɡɟɪɠɢɧɫɶɤɨɝɨ, 9, Ⱦɧɿɩɪɨɩɟɬɪɨɜcɶɤ, 49044, ɍɤɪɚʀɧɚ
SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine»
Department of faculty therapy and endocrinology
Dzerzhinsky str., 9, Dnepropetrovsk, 49044, Ukraine Dzerginsky
e-mail: [email protected]
Ʉɥɸɱɨɜɿ ɫɥɨɜɚ: ɏɈɁɅ, ɡɚɝɨɫɬɪɟɧɧɹ, ɚɧɬɪɨɩɨɦɟɬɪɢɱɧɿ ɩɨɤɚɡɧɢɤɢ
Key words: COPD, exacerbation, anthropometric parameters
Ɋɟɮɟɪɚɬ. Ɉɛɨɫɬɪɟɧɢɟ ɏɈȻɅ: ɚɧɬɪɨɩɨɦɟɬɪɢɱɟɫɤɢɟ ɯɚɪɚɤɬɟɪɢɫɬɢɤɢ ɛɨɥɶɧɵɯ ɢ ɱɚɫɬɨɬɚ ɝɨɫɩɢɬɚɥɢɡɚɰɢɣ.
Ƚɚɲɢɧɨɜɚ ȿ.ɘ. ɂɫɤɥɸɱɢɬɟɥɶɧɚɹ ɡɧɚɱɢɦɨɫɬɶ ɨɛɨɫɬɪɟɧɢɣ ɞɥɹ ɩɪɨɝɧɨɡɢɪɨɜɚɧɢɹ ɬɟɱɟɧɢɹ ɏɈȻɅ ɛɵɥɚ
ɨɬɪɚɠɟɧɚ ɜ ɪɟɞɚɤɰɢɢ GOLD, 2011, ɝɞɟ ɤɨɥɢɱɟɫɬɜɨ ɨɛɨɫɬɪɟɧɢɣ ɜ ɬɟɱɟɧɢɟ ɩɪɨɲɥɨɝɨ ɝɨɞɚ ɛɵɥɨ ɩɪɢɡɧɚɧɨ ɨɞɧɢɦ
ɢɡ ɝɥɚɜɧɵɯ ɤɪɢɬɟɪɢɟɜ ɛɭɞɭɳɢɯ ɪɢɫɤɨɜ ɞɥɹ ɩɚɰɢɟɧɬɨɜ. ɐɟɥɶɸ ɪɚɛɨɬɵ ɛɵɥɨ ɨɩɪɟɞɟɥɟɧɢɟ ɚɧɬɪɨɩɨɦɟɬɪɢɱɟɫɤɢɯ
ɩɨɤɚɡɚɬɟɥɟɣ, ɩɨɜɵɲɚɸɳɢɯ ɪɢɫɤ ɩɨɜɬɨɪɧɨɣ ɝɨɫɩɢɬɚɥɢɡɚɰɢɢ ɜ ɫɜɹɡɢ ɫ ɨɛɨɫɬɪɟɧɢɟɦ ɏɈȻɅ. ɉɪɨɜɟɞɟɧ ɪɟɬɪɨɫɩɟɤɬɢɜɧɵɣ ɚɧɚɥɢɡ ɢɫɬɨɪɢɣ ɛɨɥɟɡɧɟɣ ɫɬɚɰɢɨɧɚɪɧɵɯ ɛɨɥɶɧɵɯ, ɝɨɫɩɢɬɚɥɢɡɢɪɨɜɚɧɧɵɯ ɫ ɞɢɚɝɧɨɡɨɦ «ɨɛɨɫɬɪɟɧɢɟ
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