ФЕНОТИП ВИБРАЦИОННОЙ БОЛЕЗНИ В СОЧЕТАНИИ С АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИЕЙ: НОВЫЕ МИШЕНИ НУТРИТИВНО-МЕТАБОЛИЧЕСКИХ НАРУШЕНИЙ

Abstract

Introduction. Comorbidity in the modern world is a predictor of a more severe course of most diseases and has a significant impact on the characteristics, course and outcomes of the disease in the structure of occupational pathology. This is characterized by an increase in clinical syndromes, a deterioration in the quality of life and disability. Purpose of the study. Optimization of diagnostics in the form of studying clinical, functional and nutritional and metabolic parameters in professional patients on a model of comorbid pathology of vibration disease in combination with arterial hypertension. Materials and methods. In the course of a single-stage open, descriptive, comparative clinical study, 431 patients were examined in the conditions of the regional center of professional pathology in the city of Novosibirsk. Patients were divided into groups: patients with isolated vibration disease (n = 104), a group of comorbid WB+AH model (n = 101), a comparison group were patients with arterial hypertension (107 patients), a control group of conditionally healthy individuals (119 people) . The study duration was 4.9 ± 0.25 years. The indicators of the main analyzers, nutritional and metabolic status, nutritional adequacy, indicators of protein, lipid, carbohydrate metabolism, adipokine status, blood 25OH vitamin D, indicators of endothelial dysfunction, RAAS components, oxidative stress and systemic inflammation were evaluated. Results and its discussion. With VP+AH, the most unfavorable metabolic status was revealed. In this group, higher levels of insulin, glycated hemoglobin, HOMA-IR index, total cholesterol, LDL, triglycerides, atherogenic coefficient were determined in comparison with the isolated WB group and the control group, respectively. The phenotype of WB and AH shows the highest concentration of resistin, significantly higher than in the comparison and control groups, against the background of low levels of adiponectin, as well as an increase in the level of free leptin against the background of a decrease in the leptin-binding receptor. In the course of bioimpedancemetry, significant deviations were found in the group of the comorbid model of HF in combination with AH in the following indicators: an increase in fat mass normalized for growth and extracellular fluid with a decrease in the parameters of lean and active cell mass and phase angle. In the group of the comorbid model of WB and AH, changes were also detected in the following indicators of the molecular endotype: an increase in markers of oxidative stress (total antioxidant status of serum, Cu/ZnSOD, concentration of free radicals, lipid peroxides, protein oxidation products), the RAAS system, markers of endothelial dysfunction (endothelin 1, nitric oxide, tissue factor) and systemic inflammation (IL1 β, MCP-1, FGF 2, cardiotrophin, MMP 1, MMP 9, pentraxin 3, neutrophil elastase). Conclusions. A variant of the comorbid model is characterized by clinical-molecular and nutritional-metabolic features in professional patients, which are caused by a multifactorial pathomorphosis of a combination of vibration disease and arterial hypertension. In this variant, indicators of worse metabolic and adipokine status relative to the compared groups, pronounced processes of systemic inflammation, oxidative stress, and endothelial dysfunction were revealed.