medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2024-405medsovet-8611Research ArticleДИСЛИПИДЕМИЯDYSLIPIDEMIAНарушения коагуляционного гемостаза и повышенный уровень липопротеина (а) у пациентов с артериальной гипертензией и мультифокальным атеросклерозомCoagulation hemostasis disorders and elevated lipoprotein (a) levels in patients with arterial hypertension and multifocal atherosclerosishttps://orcid.org/0000-0001-5219-9216ВеденскаяС. С.VedenskayaS. S.

Веденская Светлана Сергеевна, к.м.н., доцент кафедры факультетской терапии, эндокринологии, аллергологии и иммунологии

620028, Екатеринбург, ул. Репина, д. 3

Svetlana S. Vedenskaya, Cand. Sci. (Med.), Associate Professor of the Department of Faculty Therapy, Endocrinology, Allergology and Immunology

3, Repin St., Ekaterinburg, 620028

ssveden@yandex.ruhttps://orcid.org/0000-0002-0705-6651СмоленскаяО. Г.SmolenskayaO. G.

Смоленская Ольга Георгиевна, д.м.н., профессор, заведующая кафедрой факультетской терапии, эндокринологии, аллергологии и иммунологии

620028, Екатеринбург, ул. Репина, д. 3

Olga G. Smolenskaya, Dr. Sci. (Med.), Professor, Head of the Department of Faculty Therapy, Endocrinology, Allergology and Immunology

3, Repin St., Ekaterinburg, 620028

o.smolenskaya@mail.ruhttps://orcid.org/0000-0003-2485-2243БельтюковЕ. К.BeltyukovE. K.

Бельтюков Евгений Кронидович, чл.корр. РАН, д.м.н., профессор, профессор кафедры факультетской терапии, эндокринологии, аллергологии и иммунологии

620028, Екатеринбург, ул. Репина, д. 3

 

Evgeny K. Beltyukov, Corr. Member RAS, Dr. Sci. (Med.), Professor of the Department of Faculty Therapy, Endocrinology, Allergology and Immunology

3, Repin St., Ekaterinburg, 620028

asthma@mail.ruhttps://orcid.org/0000-0001-9397-4063ГрачевВ. Г.GrachevV. G.

Грачев Вадим Геннадьевич, к.м.н., доцент кафедры факультетской терапии, эндокринологии, аллергологии и иммунологии

620028, Екатеринбург, ул. Репина, д. 3

Vadim G. Grachev, Cand. Sci. (Med.), Associate Professor of the Department of Faculty Therapy, Endocrinology, Allergology and Immunology

3, Repin St., Ekaterinburg, 620028

grach_vad@mail.ruhttps://orcid.org/0000-0001-5063-5571КлячинаЕ. С.KlyachinaE. S.

Клячина Екатерина Сергеевна, к.м.н., ассистент кафедры факультетской терапии, эндокринологии, аллергологии и иммунологии

620028, Екатеринбург, ул. Репина, д. 3

Ekaterina S. Klyachina, Cand. Sci. (Med.), Assistant of the Department of Faculty Therapy, Endocrinology, Allergology and Immunology

3, Repin St., Ekaterinburg, 620028

katrina.s.sharm@gmail.comhttps://orcid.org/0009-0007-4068-0388КовалеваА. Д.KovalevaA. D.

Ковалева Аделина Дмитриевна, студент

620028, Екатеринбург, ул. Репина, д. 3

Adelina D. Kovaleva, Student

3, Repin St., Ekaterinburg, 620028

adelinababak0301@gmail.comУральский государственный медицинский университетРоссияUral State Medical UniversityRussian Federation2024301020240164652Copyright © Веденская С.С., Смоленская О.Г., Бельтюков Е.К., Грачев В.Г., Клячина Е.С., Ковалева А.Д., 20242024Веденская С.С., Смоленская О.Г., Бельтюков Е.К., Грачев В.Г., Клячина Е.С., Ковалева А.Д.Vedenskaya S.S., Smolenskaya O.G., Beltyukov E.K., Grachev V.G., Klyachina E.S., Kovaleva A.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/8611Введение

Введение. Нарушения гемостаза могут выступать в качестве дополнительных факторов риска у пациентов с артериальной гипертензией (АГ) и мультифокальным атеросклеротическим поражением (МФАП). Повышенный уровень липопротеина (а) (Лп(а)) может усугублять прокоагулянтные сдвиги.

Цель

Цель. Выявить нарушения в коагуляционном звене гемостаза у пациентов с АГ и МФАП в зависимости от уровня Лп(а).

Материалы и методы

Материалы и методы. В исследование были включены 219 пациентов с АГ и МФАП, медиана возраста 59 (53; 66) лет, из них 110 пациентов с контролируемой АГ I–II стадии (1-я группа) и 109 пациентов с контролируемой АГ III стадии с ишемическим инсультом в анамнезе. В зависимости от уровня Лп(а) пациенты каждой группы были распределены на 2 подгруппы: с уровнем Лп(а) ≤50 мг/дл и с уровнем Лп(а) выше 50 мг/дл. Пациенты обеих групп получали антигипертензивную, липидснижающую, антиагрегантную терапию и имели сопоставимые значения артериального давления и липидного спектра.

Результаты

Результаты. У пациентов группы 2 достоверно чаще регистрировались прокоагулянтные сдвиги, несмотря на постоянный прием антиагрегантной терапии. Нарушения показателей гемостаза в зависимости от уровня Лп(а) наблюдались в подгруппах 1b и 2b. По результатам множественных апостериорных сравнений наиболее существенные гиперкоагуляционные изменения наблюдались у пациентов с перенесенным инсультом, а также с уровнем Лп(а) > 50 мг/дл.

Заключение

Заключение. Таким образом, у части пациентов с АГ и МФАП, несмотря на прием антигипертензивной, гиполипидемической и антиагрегантной терапии могут иметь место нарушения коагуляционного гемостаза. Повышенный уровень Лп(а) сочетается с более выраженными нарушениями гемостаза, особенно при наличии предшествующего инсульта. Интенсификация антитромботической терапии может быть рассмотрена у таких пациентов для предотвращения сердечно-сосудистых осложнений.

Introduction

Introduction. Hemostatic disorders may act as additional risk factors in patients with arterial hypertension (AH) and multifocal atherosclerotic lesion (MFAL). Elevated lipoprotein (a) (Lp(a)) levels may exacerbate procoagulant shifts.

Aim

Aim. To identify disorders in the coagulation link of hemostasis in patients with AH and MFAL, depending on the level of Lp(a).

Materials and methods

Materials and methods. The study included 219 patients with hypertension and MFAL, median age 59 (53; 66) years, of which 110 patients with stage I–II controlled hypertension (group 1) and 109 patients with stage III controlled hypertension with a history of ischemic stroke. Depending on the level of Lp(a), patients in each group were divided into 2 subgroups with Lp(a) levels < 50 mg/dl and with Lp(a) levels above 50 mg/dl. Patients of both groups received antihypertensive, lipid-lowering, antiplatelet therapy and had comparable values of blood pressure and lipid spectrum.

Results

Results. In group 2 patients, procoagulant shifts were significantly more often recorded, despite the constant use of antiplatelet therapy. Violations of hemostasis parameters depending on the level of Lp(a) were observed in subgroups 1b and 2b. According to the results of multiple a posteriori comparisons, the most significant hypercoagulation changes were observed in patients with stroke, as well as with Lp(a) levels > 50 mg/dl.

Conclusions

Conclusions. Thus, in some patients with hypertension and MFAL, despite taking antihypertensive, lipid-lowering and antiplatelet therapy, coagulation hemostasis disorders may occur. Elevated Lp(a) levels are combined with more pronounced hemostatic disorders, especially in the presence of a previous stroke. Intensification of antithrombotic therapy may be considered in such patients to prevent cardiovascular complications.

 

 

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