Клинико-генетические особенности течения хронической обструктивной болезни легких с остеопорозом

Abstract

Pulmonogenic osteopenia, which can be detected by blood markers of bone tissue resorption (C-terminal collagen-1 telopeptide), markers of bone tissue formation (osteocalcin, alkaline phosphatase), regulators of osteoclastogenesis (osteoprotegerin), and parathyroid hormone, develops in patients with COPD, especially comorbid metabolic syndrome (MS). They are formed as a result of systemic inflammation, which is characterized by hyperproduction of adipokines (resistin) and indicators of systemic inflammation (TNF-α, IL-4, IL-6, IL-18). Among such patients, a special category consists of individuals with polymorphisms of candidate genes that determine bone mineral density. Accordingly, the combination of the above-mentioned modifiable and unmodifiable risk factors leads to an increase in the incidence of fractures of both vertebrogenic and non-vertebrogenic localization, which enhances the medical and social significance of this pathology. 110 people were examined: 20 of them made up the control group, 45 were included in the COPD group and 45 in the group of COPD combined with metabolic syndrome (COPD + MS). In patients of the studied groups, a genetic study was conducted to identify polymorphism of the calcitonin receptor gene CALCR, to determine indicators of systemic inflammation of tumor necrosis factor alpha (TNF-α), interleukin 4 (IL-4), interleukin-6 (IL-4), interleukin-18 (IL-18), markers of bone metabolism: beta- terminal C-telopeptide of collagen-1 (β-CTx), osteocalcin (OC), alkaline phosphatase (ALP), osteoprotegerin (OP), parathyroid hormone (PTH). In patients with COPD combined with metabolic syndrome, a high frequency of occurrence of pathological alleles Leu/Leu- calcitonin receptor gene (CALCR) was revealed. The levels of markers of systemic inflammation and bone metabolism were significantly higher in the group of patients with COPD+MS. Significant relationships were revealed between the indicators of FEV1, T-criterion, TNF-α, IL-6, VAS, β- STx, PTH and functional defective alleles of Leu/Leu in patients with COPD+MS.