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Биомаркеры поражения сердца и сосудов в рамках минерально-костных нарушений при хронической болезни почек, воз можности коррекции

https://doi.org/10.30629/0023-2149-2021-99-4-245-258

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Аннотация

Сердечно-сосудистые заболевания (ССЗ) часто встречаются у больных хронической болезнью почек (ХБП), при этом риск смерти от ССЗ на ранних и умеренных стадиях ХБП намного превышает риск прогрессирования ХБП до терминальной стадии почечной недостаточности (ТПН) с необходимостью диализа. В последние годы накапливается все больше данных, что наличие минеральных и костных нарушений (МКН), ХБП ассоциировано с сердечно-сосудистыми событиями и смертностью. Среди сердечно-сосудистых осложнений (ССО) при ХБП ведущую роль играют прогрессирующее ремоделирование сердца и кальцификация сосудов, в совокупности приводя к чрезвычайно высокой смертности от ССЗ у пациентов с ХБП. Уточнение механизмов прогрессирования ХБП и возможных ранних маркеров ССЗ вызвало интерес к изучению выявленных в последние годы факторов, таких как фактор роста фибробластов-23 (FGF-23), Klotho и склеростин. Результаты исследований показывают, что нарушения в системе FGF-23–Klotho– sclerostin коррелируют с частотой и тяжестью гипертонии, ремоделирования сердца, кальцификации сосудов, анемии, белково-энергетической недостаточности, воспаления и существенно усугубляют сердечно-сосудистый риск при ХБП. В данном обзоре представлен анализ имеющихся литературных данных об ассоциации ССО, связанных с ХБП, с известными — «старыми» (паратиреоидный гормон — ПТГ, фосфат, дефицит витамина D) и более новыми (FGF-23, Klotho, sclerostin) биомаркерами МКН-ХБП, а также возможностях коррекции их нарушений. Показано, что ренопротективная терапия, включая блокаторы ренин-ангиотензина, низкобелковую диету с добавлением незаменимых аминокислот/кетокислот, фосфатсвязывающие средства, стимуляторы эритропоэза, метаболиты витамина D, используемые для достижения целевых уровней артериального давления, фосфора в сыворотке крови, гемоглобина, ПТГ, может влиять на уровень биомаркеров МКН-ХБП и модулировать риск сердечно-сосудистых событий у пациентов с ХБП.

Об авторах

Л. Ю. Милованова
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет)
Россия

Милованова Людмила Юрьевна — д-р мед. наук, проф. кафедры внутренних, профессиональных болезней и ревматологии

119991, Москва



В. Д. Бекетов
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет)
Россия

119991, Москва



С. Ю. Милованова
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет)
Россия

119991, Москва



М. В. Таранова
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет)
Россия

119991, Москва



А. А. Филиппова
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет)
Россия

 

119991, Москва



А. И. Пасечник
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет)
Россия

 

119991, Москва



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Для цитирования:


Милованова Л.Ю., Бекетов В.Д., Милованова С.Ю., Таранова М.В., Филиппова А.А., Пасечник А.И. Биомаркеры поражения сердца и сосудов в рамках минерально-костных нарушений при хронической болезни почек, воз можности коррекции. Клиническая медицина. 2021;99(4):245-258. https://doi.org/10.30629/0023-2149-2021-99-4-245-258

For citation:


Milovanova L.Yu., Beketov V.D., Milovanova S.Yu., Taranova M.V., Filippova A.A., Pasechnik A.I. Biomarkers of heart and vascular lesions in the framework of mineral and bone disorders in chronic kidney disease, correction possibilities. Clinical Medicine (Russian Journal). 2021;99(4):245-258. (In Russ.) https://doi.org/10.30629/0023-2149-2021-99-4-245-258

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