Сравнительный анализ динамики клинико-функциональных особенностей метаболического синдрома у больных ХОБЛ, перенесших новую коронавирусную инфекцию

Abstract

Introduction. To date, it has been established that risk factors for the development of a novel coronavirus infection (NCI), in addition to advanced age and chronic obstructive pulmonary disease (COPD), are metabolic diseases such as obesity, diabetes mellitus, arterial hypertension (AH), non-alcoholic fatty liver disease (NAFLD), united by the notion of “metabolic syndrome” (MS). At the same time, NCI contributes to the onset and aggravation of the clinical manifestations of MS. Similar to the restoration of respiratory function in subjects who had NCI, it seems relevant to analyze the disorders of carbohydrate and lipid metabolism in the long-term period after acute NCI in COPD patients. Aim. To study in a comparative aspect the dynamics of clinical and functional characteristics of the metabolic syndrome in COPD patients who had NCI. Materials and methods. We observed for 12 months in the Therapeutic Department of the City Health Centre No. 9, Barnaul, 385 COPD patients, which were divided into 2 groups: group I – 55 patients without MS, group II – 330 patients with MS. When assessing the distribution of patients by sex, the majority were men. The mean age of patients in group I was 65.2 ± 11.1 years; in group II – 63.7 ± 9.8 years (рI–II > 0.05). Group III (comparison) consisted of 120 patients with MS without COPD, comparable in age and gender. Complaints, anamnestic data of all patients were collected. Physical examination, laboratory (assessment of carbohydrate, lipid metabolism, liver and kidney function) and clinical (electrocardiography, echocardiography) examinations were carried out. Demographic indicators, smoking habit, duration of COPD, presence of complications and comorbidities were assessed. Results. NCI was detected in 15 (27.3%) patients of group I, in 169 (51.2%) patients of group II (рI–II < 0.05). In the comparison group, NCI was diagnosed in 52 (43.3%) patients (pII–III > 0.05). Post-COVID syndrome (NICE, 2020) was diagnosed in 6.7% of patients in group I, in 34.3% of patients in group II (p < 0.05), and in 18.4% of patients in group III (p > 0.05). A direct strong correlation was found between the occurrence of post-COVID syndrome and the severity of carbohydrate metabolism disorders according to the values of the visceral adiposity index (VAI) and the insulin resistance index (HOMA-IR) (r = 0.74 and 0.72, respectively; p < 0.05). For most clinical and laboratory indicators, the negative dynamics persisted until the 6th month with improvement by the 12th month: the levels of high-density lipoprotein cholesterol and glucose decreased, the fat free mass index (FFMI) increased (p < 0.05), however, the number of patients with high normal blood pressure and AH increased statistically significantly by the 12th month after NCI, reaching 92.4% in group II (p < 0.05). Conclusion. NCI is more often diagnosed in patients with MS in combination wih COPD, in the presence of risk factors: advanced age, COPD, obesity, AH. Post-COVID syndrome was detected in every third patient with MS and COPD with the positive dynamics of carbohydrate and lipid metabolism disorders by the 12th month of the follow-up. AH with the development of complications (diastolic dysfunction, abdominal obesity, and associated NAFLD) was characterized by an unfavorable, progredient course in patients with MS in combination with COPD in the long-term period after NCI, which necessitates early initiation of therapy for comorbidities.