rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.14412/1995-4484-2019-545-552rsp-2789Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL RESEARCHФакторы риска сердечно-сосудистых заболеваний у пациентов с болезнью депонирования кристаллов пирофосфата кальцияCardiovascular risk factors in patients with calcium pyrophosphate crystal deposition diseaseЕлисеевМ. С.EliseevM. S.

Елисеев Максим Сергеевич.

115522, Москва, Каширское шоссе, 34А.

Maksim Eliseev.

34A, Kashirskoe Shosse, Moscow 115522.

elicmax@rambler.ruЖелябинаО. В.ZhelyabinaO. V.

115522, Москва, Каширское шоссе, 34А.

34A, Kashirskoe Shosse, Moscow 115522.

ЧикинаМ. Н.ChikinaM. N.

115522, Москва, Каширское шоссе, 34А.

34A, Kashirskoe Shosse, Moscow 115522.

НовиковаА. М.NovikovaA. M.

115522, Москва, Каширское шоссе, 34А.

34A, Kashirskoe Shosse, Moscow 115522.

Научно-исследовательский институт ревматологии им. В.А. НасоновойРоссияV.A. Nasonova Research Institute of RheumatologyRussian Federation201916112019575545552Copyright © Елисеев М.С., Желябина О.В., Чикина М.Н., Новикова А.М., 20192019Елисеев М.С., Желябина О.В., Чикина М.Н., Новикова А.М.Eliseev M.S., Zhelyabina O.V., Chikina M.N., Novikova A.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/2789

Болезнь депонирования кристаллов  пирофосфата кальция  (БДПК) входит в число самых распространенных воспалительных ревматических заболеваний, однако исследования по изучению рисков сердечно-сосудистых заболеваний (ССЗ)  при БДПК  не проводились.

Цель исследования – стратификация риска ССЗ у пациентов с БДПК  на основе алгоритма систематической оценки  коронарного риска (SCORE), позволяющего определить  индивидуальный 10-летний  риск смерти от ССЗ.

Материал и методы

Материал и методы. В одномоментное одноцентровое исследование по изучению риска ССЗ включено 118 пациентов с БДПК  (43 мужчины и 75 женщин). Лабораторные исследования включали определение натощак  сывороточного уровня глюкозы,  общего холестерина,  мочевой  кислоты, магния,  фосфора, общего кальция.  Уровень С-реактивного белка (СРБ)  измеряли  высокочувствительным методом,  за высокий был принят  уровень >5 мг/л,  паратгормон определялся хемилюминесцентным иммуноаналитическим методом. Всем больным  с помощью  таблицы  SCORE  проводилась  оценка  суммарного  сердечно-сосудистого риска.

Результаты и обсуждение

Результаты и обсуждение. Средний  возраст пациентов составил 60,7±12,4  года. У 59 (50%) больных выявлен очень высокий, у 6 (5%) – высокий  риск смерти от ССЗ по шкале SCORE,  только в 10% случаев данный риск был связан исключительно с возрастом (>65 лет); 60 из 118 пациентов (50,8%) не имели предшествующих сердечно-сосудистых событий или факторов  риска атеросклероза. Ишемическая болезнь сердца была выявлена  у 28,8% из 118 пациентов, артериальная гипертензия (АГ) – у 64%, сахарный диабет (СД) – почти у 15%. Средние значения SCORE  у мужчин и женщин  достоверно  не различались. Уровень СРБ у мужчин был выше, чем у женщин  (8,6±4,6 и 7,3±3,5  мг/дл соответственно; р=0,04).  Скорость  клубочковой фильтрации (СКФ) <60 мл/мин выявлена  у 11 пациентов с очень высоким  риском  ССЗ,  обусловленным наличием ХБП, у двоих из них также диагностирован СД, у двоих – хроническая сердечная  недостаточность и в анамнезе  у одного – перенесенный инсульт,  у одного – инфаркт  миокарда.  У пациентов с СКФ <100 мл/мин чаще встречался  высокий  риск по шкале SCORE,  чем при СКФ  >100 мл/мин: у 60 из 98 (61%) и у 5 из 20 (25%) пациентов, соответственно (р=0,003). Гиперпаратиреоз (ГПТ) выявлен  у 12 (10%) пациентов, и 7 из них имели очень высокий  риск по шкале SCORE,  однако гиперкальциемия определялась  только в трех случаях. Результаты стратификации SCORE  общей группы показали, что у 64 из 118 (54,2%) пациен тов с БДПК  был очень высокий  или высокий  риск, причем ровно в половине  случаев (у 59 пациентов) он был очень высоким.

Заключение

Заключение. Половина пациентов с БДПК  имеют очень высокий  сердечно-сосудистый риск. Помимо  высокой частоты выявления традиционных факторов  сердечно-сосудистого риска (АГ, курение,  гиперхолестеринемия и СД), при определении риска ССЗ у пациентов с БДПК  следует учитывать наличие  хронического микрокристаллического воспаления, сопутствующие  обменные  нарушения и заболевания (гиперурикемия, ГПТ, снижение  функции почек).

Calcium pyrophosphate  crystal deposition disease (CPCDD) is among the most common  inflammatory rheumatic diseases; however, studies of cardiovascular risks in CPCDD have not been conducted.

Objective

Objective: to stratify a cardiovascular risk in patients with CPCDD according to the systematic coronary risk evaluation (SCORE)  algorithm that allows determination of an individual 10-year risk of cardiovascular death.

Subjects and methods

Subjects and methods. The one-stage,  single-center  study of a cardiovascular risk enrolled 118 patients (43 men and 75 women) with CPCDD. Laboratory studies included determination of fasting serum glucose, total cholesterol, uric acid, magnesium,  phosphorus,  and total calcium. The level of C-reactive  protein (CRP)  was measured by a highly sensitive method;  CRP >5 mg/L was taken as a high level; parathyroid  hormone  was determined  by chemiluminescence immunoassay.  The SCORE  table was used to assess the total cardiovascular risk in all the patients.

Results and discussion

Results and discussion. The patients' mean age was 60.7±12.4 years. According to the SCORE scale, very high and high risks of cardiovascular death were found in 59 (50%) and 6 (5%) patients, respectively; only in 10% of cases this risk was associated exclusively with age (> 65 years); 60 (50.8%) of the 118 patients did not have previous cardiovascular events or atherosclerosis risk factors. Coronary heart disease was detected in 28.8% of the 118 patients; hypertension was identified in 64%; diabetes mellitus (DM)  was found in almost 15%. The mean SCORE values did not significantly differ in men and women. The level of CRP was higher in men than that in women (8.6±4.6 and 7.3±3.5 mg/dL,  respectively; p = 0.04). Glomerular  filtration rate (GFR) <60 ml/min was detected in 11 patients at a very high cardiovascular risk due to the presence of chronic kidney disease; two of them were also diagnosed with DM; two had chronic heart failure, one patient had a history of stroke and another  had that of myocardial infarction.  The patients with GFR  <100 ml/min were more frequently found to be at high risk by the SCORE scale than those with GFR >100 ml/min: 61% (60/98) and 25% (5/20) of patients, respectively (p = 0.003). Hyperparathyroidism (HPT)  was detected in 12 (10%) patients, and 7 of them were at a very high risk by the SCORE scale; however, hypercalcemia was diagnosed in only three cases. The results of the SCORE stratification of the whole group showed that 64 (54.2%) of the 118 patients with CPCDD were at a very high or high risk, the latter was very high in exactly half of the cases (n = 59.

Conclusion

Conclusion. One-half of patients with CPCDD have a very high cardiovascular risk. In addition to the high detection  rate of traditional  cardiovascular risk factors (hypertension, smoking, hypercholesterolemia, and DM),  the presence of chronic microcrystalline  inflammation, concomitant metabolic disorders and diseases (hyperuricemia, HPT,  decreased renal function)  should be taken into account when determining the cardiovascular risk in patients with CPCDD.

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