vestimИзвестия Национальной академии наук Беларуси. Серия медицинских наукProceedings of the National Academy of Sciences of Belarus, Medical series1814-60232524-2350The Republican Unitary Enterprise Publishing House "Belaruskaya Navuka"10.29235/1814-6023-2020-17-2-237-247vestim-679Research ArticleКЛИНИЧЕСКАЯ И ЭКСПЕРИМЕНТАЛЬНАЯ МЕДИЦИНАCLINICAL AND EXPERIMENTAL MEDICINEПроспективная характеристика факторов кардиоваскулярного риска у реципиентов трансплантата почкиProspective characteristic of cardiovascular risk factors in renal transplant recipientsСмоляковаМ. В.SmaliakovaM. V.

Смолякова Мария Васильевна – аспирант, врачнефролог

пр. Дзержинского, 83, 220116, г. Минск

Maria V. Smaliakova – Postgraduate student, nephrologist

83, Dzerzhynskii Ave., 220116, Minsk

m.smaliakova@gmail.comМитьковскаяН. П.MitkovskayaN. P.

Митьковская Наталья Павловна – д-р мед. наук, профессор, заведующий кафедрой

пр. Дзержинского, 83, 220116, г. Минск

Natalya P. Mitkovskaya – D. Sc. (Med.), Professor, Head of the Department

83, Dzerzhynskii Ave., 220116, Minsk

mitkovskaya1@mail.ruКалачикО. В.KalachikA. V.

Калачик Олег Валентинович – д-р мед. наук, профессор, заместитель директора

ул. Семашко, 8, 220116, г. Минск

Aleh V. Kalachik – D. Sc. (Med.), Professor, Deputy Director

8, Semashko Str., 220116, Minsk

oleg_kalachik@hotmail.comГригоренкоЕ. А.GrigorenkoE. A.

Григоренко Елена Александровна – канд. мед. наук, доцент, профессор

пр. Дзержинского, 83, 220116, г. Минск

Elena A. Grigorenko – Ph. D. (Med.), Assistant Professor, Professor

83, Dzerzhynskii Ave., 220116, Minsk

alegri@tut.byБелорусский государственный медицинский университетBelarusian State Medical UniversityМинский научно-практический центр хирургии, трансплантологии и гематологииMinsk Scientific and Practical Center of Surgery, Transplantation and Hematology202006062020172237247Copyright © Смолякова М.В., Митьковская Н.П., Калачик О.В., Григоренко Е.А., 20202020Смолякова М.В., Митьковская Н.П., Калачик О.В., Григоренко Е.А.Smaliakova M.V., Mitkovskaya N.P., Kalachik A.V., Grigorenko E.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestimed.belnauka.by/jour/article/view/679

Цель исследования – оценить динамику лабораторных и инструментальных показателей, являющихся факторами кардиоваскулярного риска, у пациентов с хроническими заболеваниями почек в предоперационном периоде и после выполнения трансплантации донорской почки.

Проведено одноцентровое проспективное когортное исследование, включавшее 43 реципиента трансплантата почки. Клинический осмотр, лабораторные и инструментальные исследования у пациентов проводили в предоперационном периоде, через 6 мес. и через 5 лет после трансплантации. Лабораторные исследования включали в себя общий анализ крови, коагулограмму, биохимический и иммуноферментный анализы крови. Для оценки динамики структурно-функциональных показателей сердца в предоперационном периоде и в отдаленные сроки после трансплантации почки использовали метод эхокардиографии.

Установлено, что после трансплантации почки у пациентов наблюдается снижение артериального давления и пульса, частоты выявления эпизодов гипотензии по сравнению с аналогичными показателями в предоперационном периоде. Гиперальдостеронемия в предоперационном периоде встречалась чаще, чем после трансплантации. В отдаленном послеоперационном периоде в крови реципиентов наблюдалось снижение уровней общего холестерина, триглицеридов, интерлейкина-6, фактора некроза опухолей-α, С-реактивного белка по сравнению с показателями предоперационного периода. Частота выявления гипергликемии значимо снизилась к концу периода наблюдения. Повышенный уровень NT-proBNP, отмечаемый у всех реципиентов в предоперационном периоде, в послеоперационном периоде снизился до нормальных значений у 37,2 % (n = 16) обследованных. В послеоперационном периоде у реципиентов трансплантата почки наблюдалось увеличение таких показателей, как количество эритроцитов в крови и концентрация гемоглобина, и снижение частоты встречаемости гиперэритропоэтинемии. При оценке адекватности функционирования трансплантата установлено, что скорость клубочковой фильтрации через 6 мес. после трансплантации была ниже, чем через 5 лет.

The aim of the study is assess the dynamics of laboratory and instrumental parameters (these are cardiovascular risk factors) in patients with chronic kidney disease in the preoperative period and after renal transplantation.

A single-center prospective cohort study included 43 kidney transplant recipients. Clinical examination, laboratory and instrumental studies were carried out in the preoperative period, in six months and in five years after transplantation. Laboratory tests included a complete blood count, coagulation, biochemical blood test and enzyme-linked immunosorbent assays. The dynamics of structural and functional heart parameters was studied by echocardiography in the preoperative period and in five years.

It was found that the blood pressure, pulse rate, and hypotension episodes decreased after renal transplantation. Hyperaldosterone in the preoperative period was more common than after transplantation. It was observed that the blood level of total cholesterol, triglycerides, interleukin-6, tumor necrosis factor-α, and C-reactive protein decreased in the postoperative period. The hyperglycemia incidence significantly decreased by the end of the observation period. It was detected that the NT-proBNP level increased in all recipients in the preoperative period and decreased to normal values in 37.2 % (n = 16) recipients in the postoperative period. The number of red blood cells and the hemoglobin concentration increased and the hyperethropoietinemia incidence decreased in the postoperative period. The glomerular filtration rate was lower in six months after transplantation than in five years.

реципиенты трансплантата почкианемияэритроцитоздислипидемиягипергликемиясистемное воспалениеrenal transplant recipientsanemiaerythrocytosisdyslipidemiahyperglycemiasystemic inflammationИсследование выполнено в рамках научно-исследовательской работы «Предикторы кардиоваскулярного риска у пациентов с кардиоренальным континуумом», проводимой при участии Белорусского республиканского фонда фундаментальных исследований 2016–2018 гг., а также гранта Президента Республики Беларусь на 2020 г. на разработку и внедрение в практическое здравоохранение новых организационных форм работы, направленных на улучшение диспансерного наблюдения за реципиентами трансплантатов печени и почек с целью повышения эффективности первичной и вторичной профилактики сердечно-сосудистых осложнений у данной категории пациентов.The study was carried out as part of the research project “Predictors of cardiovascular risk in patients with cardiorenal continuum” conducted with participation of the Belarusian Republican Foundation for Fundamental Research in 2016–2018 and supported by a grant from the President of the Republic of Belarus for 2020 to develop and implement new organizational forms of work in practical health care aimed at improving dispensary monitoring of recipients of liver and kidney transplants in order to increase the effectiveness of primary and secondary prevention of cardiovascular complications in this category of patients.ReferencesEarly detection of acute kidney injury in the perioperative period of liver transplant with neutrophil gelatinaseassociated lipocalin / C. 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The authors declare that there are no conflicts of interest present.