avkАрхивъ внутренней медициныThe Russian Archives of Internal Medicine2226-67042411-6564“SINAPS” LLC10.20514/2226-6704-2017-7-5-340-349avk-695Research ArticleОБЗОРНЫЕ СТАТЬИREVIEW ARTICLESЛЕЧЕНИЕ ПЕРИПАРТАЛЬНОЙ КАРДИОМИОПАТИИ (ОБЗОР ЛИТЕРАТУРЫ)TREATMENT OF PERIPARTUM CARDIOMYOPATHY (REVIEW)ВатутинН. Т.VatutinN. T.

Донецк, Украина

Donetsk, Ukraine

ТарадинГ. Г.TaradinG. G.

Donetsk, Ukraine

taradin@inbox.ruПопелнухинаЛ. Г.PopelnukhinaL. G.

Донецк, Украина

ГриценкоЮ. П.GritzenkoY. P.

Донецк, Украина

Donetsk, Ukraine

СидоренкоИ. А.SidorenkoI. A.Институт неотложной и восстановительной хирургии им. В.К. Гусака; Кафедра госпитальной терапии, Донецкий национальный медицинский университет им. М. ГорькогоУкраинаDepartment of Hospital Therapy, Donetsk National Medical University named after M. Gorky ; Department of Emergency Cardiac Care and Cardiosurgery, Institute of Urgent and Reconstructive Surgery named after V.K. GusakUkraineИнститут неотложной и восстановительной хирургии им. В.К. ГусакаУкраинаDepartment of Hospital Therapy, Donetsk National Medical University named after M. GorkyUkraineКафедра клинической фармакологии, Донецкий национальный медицинский университет им. М. ГорькогоУкраинаDepartment of Clinical Pharmacology, Donetsk National Medical University named after M. GorkyUkraine20172909201775340349Copyright © Ватутин Н.Т., Тарадин Г.Г., Попелнухина Л.Г., Гриценко Ю.П., Сидоренко И.А., 20172017Ватутин Н.Т., Тарадин Г.Г., Попелнухина Л.Г., Гриценко Ю.П., Сидоренко И.А.Vatutin N.T., Taradin G.G., Popelnukhina L.G., Gritzenko Y.P., Sidorenko I.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.medarhive.ru/jour/article/view/695

Обзор посвящен обсуждению современных представлений о лечении перипартальной кардиомиопатии. В начале обзора приводится определение перипартальной кардиомиопатии, затрагиваются общие вопросы диагностики и патогенеза заболевания. В частности, обсуждается роль системы «пролактин — катепсин D — пролактин 16 кDa» в развитии кардиомиопатии. Освещаются общие подходы ведения больных. Приводятся детальные сведения о показаниях, осложнениях и клиническом опыте основных фармакологических препаратов, применяемых в лечении перипартальной кардиомиопатии с учетом их возможного неблагоприятного влияния на плод и лактацию. Дано подробное описание диуретиков, включая петлевые, тиазидового ряда и калийсберегающие препараты. Отмечена относительная безопасность и эффективность нитратов и гидралазина в условиях ограниченного выбора из группы вазодилататоров и, особенно, противопоказанных при беременности ингибиторов ангиотензин-превращающего фермента и блокаторов рецепторов к ангиотензину-II. Отдельное внимание уделено группе инотропных препаратов: левосимендану, милринону и сердечным гликозидам. Описана роль β-адреноблокаторов и ивабрадина в лечении сердечной недостаточности при перипартальной кардиомиопатии. Подробно представлены антикоагулянты, назначение которых оправдано при выраженной дилатации полостей сердца, снижении фракции выброса и наличии интракардиального тромбоза. В статье обсуждается место антиаритмиче- ских препаратов, применяемых при развитии разнообразных нарушений ритма сердца. Данные приведены с учетом потенциального влияния на плод при антенатальной перипартальной кардиомиопатии, при которой преимущественно назначаются лидокаин и соталол, с осторожностью — аденозин, хинидин и флекаинид и полностью противопоказаны амиодарон и дронедарон. С учетом предложенных патогенетических механизмов, представлена также информация о лекарственных средствах, направленных на коррекцию возможных звеньев механизма развития этой патологии. В частности на основе проанализированных данных обсуждается обоснованность, показания и побочные эффекты иммуносупрессивной терапии, иммуноглобулина, пентоксифиллина, блокаторов секреции пролактина — бромокриптина и каберголина. Приведен опыт трансплантации сердца у больных с рефрактерной ПКМП, а также затронуты вопросы родоразрешения при этом заболевании.

 

The presented review concerns discussion about current insights into treatment of peripartum cardiomyopathy. The definition of peripartum cardiomyopathy and general issues about diagnosis and pathogenesis of the disorder are provided at the head of the review. Particularly, the role of the system «prolactin — cathepsin D — prolactin 16 kDa» in cardiomyopathy development is disclosed. The general approaches to management of the patients are highlighted. The review provides detailed data about indications, adverse effects and derived clinical experience concerning the main pharmacological drugs which had been used in peripartum cardiomyopathy treatment given their possible unfavorable influence on fetus maturation and maternal lactation. The detailed description is provided on diuretics including loop, thiazide and potassium-sparing drugs. It was noted relative safety and efficiency of nitrates and hydralazine in conditions of limited choice from vasodilator group and, particularly, angiotensinconverting-enzyme inhibitors and angiotensin-II receptor blockers which are contraindicated in pregnancy. A special attention is paid to the group of inotropic drugs: levosimendan, milrinone, and cardiac glycosides. The role of β-blockers and ivabradine is disclosed in heart failure treatment of peripartum cardiomyopathy. Anticoagulants were presented in details given that these drugs are justified in severe cardiac chambers dilation, decrease in ejection fraction, and in presence of intracardiac thrombosis. The place of antiarrhythmic drugs administrating in various cardiac rhythm disorders is discussed in the review. The data is given with account of potential influence on fetus in antenatal peripartum cardiomyopathy in which lidocaine and sotalol are the most preferable drugs; adenosine, quinidine, and flecainide are useful with caution, but amiodarone and dronedarone are absolutely contraindicated. Taking into account proposed pathogenic mechanisms of this cardiomyopathy, the information about pharmacological drugs directed to correction of possible links of development mechanism of this pathology is introduced. On the basis of analyzed data authors discuss relevance, indications and side effects of immunosuppressive therapy, immunoglobulin, pentoxifylline, and prolactin secretion inhibitors — bromocriptine and cabergoline. The experience of cardiac transplantation is specified in patients with refractory peripartum cardiomyopathy, and issues of delivery are highlighted in women suffering from this disease.

 

 

 

 

 

 

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