medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2020-19-78-88medsovet-5922Research ArticleРЕВМАТОЛОГИЯRHEUMATOLOGYСовременная парадигма лечения гиперурикемии и подагры у коморбидных пациентов с развитием кардиоваскулярной патологииModern paradigm of treatment of hyperuricemia and gout in comorbid patients with the development of cardio-vascular pathologyhttps://orcid.org/0000-0002-0797-2051МазуровВ. И.MazurovV. I.

Мазуров Вадим Иванович - академик РАН, доктор медицинских наук, профессор, заслуженный деятель науки РФ, главный научный консультант, заведующий кафедрой терапии, ревматологии, экспертизы временной нетрудоспособности и качества медицинской помощи имени Э.Э. Эйхвальда.

191015, Санкт-Петербург, ул. Кирочная, д. 41; SPIN-код: 6823-5482

Vadim I. Mazurov - Academician of RAS, Dr. of Sci. (Med.), Professor, Honored worker of science of Russia, Principal scientific advisor, Head of the Department of therapy, rheumatology, examination of temporary disability and quality of medical care named after E.E. Eichwald.

41, Kirochnaya St., St Petersburg, 191015, Russia; е-mail: maz.nwgmu@yandex.ru

maz.nwgmu@yandex.ruhttps://orcid.org/0000-0002-7981-6349БеляеваИ. Б.BelyaevaI. B.

Беляева Ирина Борисовна - доктор медицинских наук, профессор кафедры терапии, ревматологии, экспертизы временной нетрудоспособности и качества медицинской помощи имени Э.Э. Эйхвальда.

Irina B. Belyaeva - Dr. of Sci. (Med.), Professor of the Department of therapy, rheumatology, examination of temporary disability and quality of medical care named after E.E. Eichwald.

41, Kirochnaya St., St Petersburg, 191015

belib@mail.ruhttps://orcid.org/0000-0001-5261-6614ПетроваМ. С.PetrovaM. S.

Петрова Марианна Семеновна - кандидат медицинских наук, доцент кафедры терапии, ревматологии, экспертизы временной нетрудоспособности и качества медицинской помощи имени Э.Э. Эйхвальда.

191015, Санкт-Петербург, ул. Кирочная, д. 41

Marianna S. Petrova - Cand. of Sci. (Med.), Assistant Professor of the Department of therapy, rheumatology, examination of temporary disability and quality of medical care named after E.E. Eichwald.

podagra@bk.ruhttps://orcid.org/0000-0001-9344-1304БашкиновР. А.BashkinovR. A.

Башкинов Роман Андреевич - аспирант кафедры терапии, ревматологии, экспертизы временной нетрудоспособности и качества медицинской помощи имени Э.Э. Эйхвальда.

Roman A. Bashkinov - Postgraduate of the Department of therapy, rheumatology, examination of temporary disability and quality of medical care named after E.E. Eichwald.

bashkinov-roman@mail.ruСеверо-Западный государственный медицинский университет им. И.И. МечниковаРоссияNorth-West State Medical University named after I.I. MechnikovRussian Federation2020101220200197888Copyright © Мазуров В.И., Беляева И.Б., Петрова М.С., Башкинов Р.А., 20202020Мазуров В.И., Беляева И.Б., Петрова М.С., Башкинов Р.А.Mazurov V.I., Belyaeva I.B., Petrova M.S., Bashkinov R.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/5922

В статье рассматривается проблема гиперурикемии (ГУ) и подагры в современной медицине, актуальность которой обусловлена высокой распространенностью заболевания и его социально-экономическими последствиями, связанными с развитием у данных пациентов более раннего и тяжелого течения атеросклероза, ишемической болезни сердца, хронической болезни почек (ХБП) и, соответственно, увеличением риска смерти. Рассмотрены патогенетические механизмы влияния ГУ на сердечно-сосудистую систему, которые характеризуются формированием эндотелиальной дисфункции, усилением адгезии и агрегации тромбоцитов, нарушением реологии крови, увеличением уровня воспалительных маркеров, нарушением функции почек. Подчеркнуто, что при артериальной гипертензии (АГ) возможным механизмом повышения концентрации мочевой кислоты (МК) является нарушение ее почечной экскреции из-за уменьшения канальцевой секреции. Представлены данные исследований, свидетельствующие о том, что у больных с сахарным диабетом 2-го типа увеличение концентрации МК ассоциируется с возрастанием риска фатального и нефатального инсульта. Освещены современные рекомендации коррекции ГУ, утвержденные в Российской Федерации, в которых отмечена целесообразность терапии коморбидных состояний, коррекции пищевого рациона и образа жизни. Представлены консенсус Европейского общества кардиологов и Российского кардиологического общества (РКО) по ведению пациентов с ГУ с высоким сердечно-сосудистым риском (ССР) и Клинические рекомендации РКО по АГ. На основании данных документов всем больным с АГ рекомендовано оценивать уровень МК в сыворотке крови и считать высоким уровень более 360 мкмоль/л, рекомендуется проводить уратснижающую терапию пациентам с высоким ССР, с целевым уровнем ниже 300 мкмоль/л. Представлены современные возможности патогенетической терапии подагры. Отмечено, что применение фебуксостата демонстрирует не только более высокую эффективность в снижении и поддержании уровня МК, но и лучшую переносимость по сравнению с аллопуринолом. Подчеркнуто, что у лиц пожилого возраста не требуется коррекции дозы фебуксостата, его могут применять пациенты с ХБП.

The article presents the actuality of the problem of hyperuricemia (HU) and gout in modern medicine, caused by the high prevalence and socio-economic consequences associated with the development in patients with these pathologies of earlier and more severe course of atherosclerosis, coronary heart disease, chronic kidney disease (CKD) and increased mortality. Illustrated pathogenetic mechanisms of HU influence on the cardiovascular system, which are characterized by the formation of endothelial dysfunction, increased adhesion and aggregation of thrombocytes, blood rheology disorders, increased levels of inflammatory markers, renal function disorders. It is highlighted that in arterial hypertension (AH) a possible mechanism for increasing the concentration of uric acid (UA) is a violation of renal excretion due to reduced tubal secretion. The data of the studies are presented, showing that in patients with type 2 diabetes mellitus and higher UA concentration is associated with increased risk of fatal and non-fatal stroke. Modern recommendations of HU correction, approved in the Russian Federation, are highlighted, where the expediency ofcomorbid condition therapy, correction of diet and lifestyle are noted. The consensus of the European Society of Cardiology and the Russian Society of Cardiology (RSC) on the management of patients with HU with high cardiovascular risk (CVR) and the RSC Clinical Practice Guidelines for AH are presented. Based on these documents, all patients with AH are recommended to evaluate the level of UA in serum and consider it high - more than 360 pmol/l, it is recommended to perform urate-lowering therapy for patients with high CVR, with the target level below 300 pmol/l. Modern possibilities of pathogenetic therapy of gout are presented. It is noted that the use of febuxostat demonstrates not only higher efficiency in reducing and maintaining the level of UA, but also better tolerance, in comparison with allopurinol. It is emphasized that elderly people do not need to correct the dose of febuxostat, it can be used by patients with CKD.

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