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Управление гипергликемией при остром коронарном синдроме. Проблемы и решения

https://doi.org/10.21518/2079-701X-2016-3-98-105

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Аннотация

Роль гипергликемии как независимого предиктора неблагоприятного течения и прогноза острого коронарного синдрома (ОКС) у лиц с сахарным диабетом (СД) и без него [1] сложно переоценить. Данная взаимосвязь широко освещена в литературе [2-13], и дискуссии на этот предмет не теряют актуальности. Заболеваемость и смертность от ИБС у пациентов с СД превышает ожидаемые уровни при простом суммировании рисков, указывая на непосредственное влияние гипергликемии на атеро-склеротический процесс [14-16]. При этом стоит отметить, что у пациентов без СД гипергликемия ассоциирована с худшими клиническими исходами и более высокой смертностью от всех причин по сравнению с пациентами, страдающими сахарным диабетом [17-21]. Повышение сахара крови на момент поступления, как правило, воспринимается как реакция на стресс при остром состоянии, однако в ряде случаев может служить маркером уже существующего, но еще не диагностированного сахарного диабета 2-го типа или нарушения толерантности к глюкозе (НТГ) [22]. По данным обсервационных исследований, гипергликемия встречается у 32-38% пациентов в стационаре [23, 24], у 41% тяжелых пациентов с острым коронарным синдромом [25], у 44% пациентов с сердечной недостаточностью [25] и у 80% пациентов после хирургического вмешательства на коронарных артериях [26, 27].

Об авторах

А. С. Аметов
Российская медицинская академия последипломного образования
Россия


Я. В. Пуговкина
Российская медицинская академия последипломного образования
Россия


Н. А. Черникова
Российская медицинская академия последипломного образования
Россия


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