avkАрхивъ внутренней медициныThe Russian Archives of Internal Medicine2226-67042411-6564“SINAPS” LLC10.20514/2226-6704-2019-9-1-44-51avk-882Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLEКЛИНИЧЕСКОЕ ЗНАЧЕНИЕ СУТОЧНОГО МОНИТОРИРОВАНИЯ ЭКГ ПО ХОЛТЕРУ ПРИ ХРОНИЧЕСКОМ ГЛОМЕРУЛОНЕФРИТЕ НА ДОДИАЛИЗНОЙ СТАДИИ ЗАБОЛЕВАНИЯTHE CLINICAL SIGNIFICANCE OF THE DAILY MONITORING OF HOLTER ECG IN CHRONIC GLOMERULONEPHRITIS AT THE PREDIALYSIS STAGE OF THE DISEASEМуркамиловИ. Т.MurkamilovI. T.

Бишкек

Bishkek

murkamilov.i@mail.ruСабировИ. С.SabirovI. S.

Бишкек

Bishkek

ФоминВ. В.FominV. V.

Москва

Moscow

МуркамиловаЖ. А.MurkamilovaZh. A.

Бишкек

Bishkek

СабироваА. И.SabirovaA. I.

Бишкек

Bishkek

АйтбаевК. А.AitbaevK. A.

Бишкек

Bishkek

ИмановБ. Ж.ImanovB. Zh.

Бишкек

Bishkek

РеджаповаН. А.RedzhapovaN. A.

Ош

Osh

ЮсуповФ. А.YusupovF. A.

Ош

Osh

Кыргызская государственная медицинская академия имени И.К. Ахунбаева; Кыргызско-Российский Славянский университет имени первого Президента России Б.Н. ЕльцинаКыргызстанKyrgyz State Medical Academy named after I.K. Akhunbaev; Kyrgyz Russian Slavic University named after the First President of Russia B.N. YeltsinKyrgyzstanКыргызско-Российский Славянский университет имени первого Президента России Б.Н. ЕльцинаКыргызстанKyrgyz Russian Slavic University named after the First President of Russia B.N. YeltsinKyrgyzstanФГАОУ ВО Первый Московский государственный медицинский университет имени И.М. СеченоваРоссияFSAEI HE First Moscow State Medical University named after I.M. SechenovRussian FederationЦентр семейной медицины № 7КыргызстанFamily Medicine Center № 7KyrgyzstanНаучно-исследовательский институт молекулярной биологии и медициныКыргызстанScientific and r esearch Institute of molecular biology and medicineKyrgyzstanНациональный Центр кардиологии и терапии имени академика Мирсаида МиррахимоваКыргызстанNational Cardiology and Therapy Center named after academician Mirsaid MirrahimovKyrgyzstanОшский государственный университетКыргызстанOsh State UniversityKyrgyzstan201912022019914451Copyright © Муркамилов И.Т., Сабиров И.С., Фомин В.В., Муркамилова Ж.А., Сабирова А.И., Айтбаев К.А., Иманов Б.Ж., Реджапова Н.А., Юсупов Ф.А., 20192019Муркамилов И.Т., Сабиров И.С., Фомин В.В., Муркамилова Ж.А., Сабирова А.И., Айтбаев К.А., Иманов Б.Ж., Реджапова Н.А., Юсупов Ф.А.Murkamilov I.T., Sabirov I.S., Fomin V.V., Murkamilova Z.A., Sabirova A.I., Aitbaev K.A., Imanov B.Z., Redzhapova N.A., Yusupov F.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/882

В статье представлены результаты собственных исследований: комплексные клинико-лабораторные обследования, в том числе данные суточного холтеровского мониторирования электрокардиограммы у 169 пациентов с хроническим гломерулонефритом на преддиализной стадии заболевания. По данным суточного холтеровского мониторирования электрокардиограммы у 60,3% обследованных нами лиц были выявлены эпизоды наджелудочковой групповой экстрасистолии, желудочковые групповые экстрасистолы — у 28,9%. Кроме того, у 11,2% лиц регистрировались предсердно-желудочковые блокады (неполные/частичные), у 8,8% — фибрилляция предсердий и безболевая ишемия в количестве от 1 до 3 эпизодов в сутки у — 14,7%. В зависимости от средней частоты сердечных сокращений по данным суточного холтеровского мониторирования электрокардиограммы пациенты с хроническим гломерулонефритом были разделены на две подгруппы. В подгруппу «А» были включены 38 пациентов с уровнем частоты сердечных сокращений ≤ 70 уд/мин, в подгруппу «Б» — 131 больные с частотой сердечных сокращений более 70 уд/мин. При равных значениях мочевой кислоты, общего ХС, ХС ЛПВП, ТГ, креатинина плазмы и фибриногена крови в подгруппе «Б» отмечалось статистически значимое увеличение концентрации ХС ЛПНП (3,58 (2,74;5,54) ммоль/л против 2,82 (2,30;3,86) ммоль/л; р<0,05) и снижение расчетной СКФ (70,4 (48,8;96,3) мл/мин против 85,7 (31,5;103,1) мл/мин; р<0,05) по сравнению с подгруппой «А». В подгруппе «Б» регистрировалась тенденция к увеличению степени суточной экскреции белка с мочой. Полученные нами данные подтверждают тот факт, что проведение суточного холтеровского мониторирования электрокардиограммы с анализом частоты сердечных сокращений имеет важное клиническое значение для диагностики сердечно-сосудистых нарушений и предупреждения кардиоваскулярных осложнений при хроническом гломерулонефрите на преддиализной стадии заболевания.

This article presents the results of our own research: comprehensive clinical and laboratory examinations, including data from the daily Holter monitoring of the electrocardiogram (DMEKG) in 169 patients with chronic glomerulonephritis at the predialysis stage of the disease. According to the DMEKG, 60.3% of the persons examined by us had episodes of supraventricular group extrasystoles, and ventricular group extrasystoles in 28.9%. In addition, 11.2% of patients had atrial ventricular blockade (incomplete / partial), 8.8% had atrial fibrillation and painless ischemia in an amount of from 1 to 3 episodes per day in 14.7%. Depending on the average heart rate (HR) according to the DMEKG, patients with chronic glomerulonephritis were divided into two subgroups. Subgroup “A” included 38 patients with heart rate less than or equal to 70 beats / min, in subgroup “B” — 131 patients with a heart rate of more than 70 beats / min. With equal values of uric acid, total cholesterol cholesterol, HDL cholesterolcholesterol, TG, plasma creatinine and blood fibrinogen in subgroup “B” there was a statistically significant increase in LDL cholesterol concentration(3.58 (2.74; 5.54) mmol / l vs. 2, 82 (2.30; 3.86) mmol / l; p <0.05) and a decrease in the calculated GFR (70.4 (48.8; 96.3) ml / min vs. 85.7 (31.5; 103,1) ml / min; p <0.05) compared with subgroup “A”. In the subgroup “B” a tendency was observed to increase the degree of daily excretion of protein with urine. The data obtained confirm the fact that the conduct of the DMEKG with the analysis of heart rate is of significant clinical importance for the diagnosis of cardiovascular disorders and the p revention of cardiovascular complications in chronic glomerulonephritis at the predialysis stage of the disease.

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