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Іванова Л.М., Луговськов Є.О. Спільні фактори ризику у хворих на хронічний некалькульозний холецистит у поєднанні з ішемічною хворобою серця
31.07.2014, 16:38

Резюме
Іванова Л.М., Луговськов Є.О. Спільні фактори ризику у хворих на хронічний некалькульозний холецистит у поєднанні з ішемічною хворобою серця та ожирінням.
В статі наведені спільні фактори виникнення та прогресування поєднаної патології: обтяжена спадковість, нераціональне харчування, гіподінамія, паління.
Ключові слова: хронічний некалькульозний холецистит, ішемічна хвороба серця, ожиріння, фактори ризику.
Резюме
Иванова Л.Н., Луговсков Е.А. Общие факторы риска у больных с хроническим некалькулезным холециститом в сочетании с ишемической болезнью сердца и ожирением.
В статье приведены общие факторы развития и прогрессирования сочетанной патологии: отягощенная наследственность, нерациональное питание, гиподинамия, курение.
Ключевые слова: хронический некалькулезный холецистит, ишемическая болезнь сердца, ожирение, факторы риска.
Summary
Ivanova L.M., Lugovskov E.A. Common risk factors for patients with non-calculous cholecystitis combined with ischemic heart disease and obesity.
In the article authors showed common risk factors of development and progression of combined pathology: burdened heredity, irrational feeding, hypodynamia and smoking.
Key words: non-calculous cholecystitis, ischemic heart disease, obesity, risk factors.

Рецензент: д.мед.н., проф. Ю.Г. Бурмак

УДК 616.366-002+616.12-008.331.1] - 092-07-037

ДЗ «Луганський державний медичний університет»

ГЗ «Луганский государственный медицинский университет»

State Establishment "Lugansk State Medical University"

propedevtika2011@yandex.ua

evg-lugovskov@yandex.ua

Introduction. At the present times the pathology of the biliary system is one of the leading diseases of internal organs [1 , 3, 5 , 9]. The incidence of chronic non-calculous cholecystitis (CNC) in Ukraine increased by 35.3 % for the last 10 years, [2, 4, 5, 8]. Thus gallbladder pathology is increasingly combined with cardiovascular diseases, including coronary heart disease (CHD) , which remains a major cause of morbidity and mortality [6, 7]. In the same time, an amount people with obesity is increasing, which is in the nature of a pandemic , and observed nearly 80% in the presence of hepatobiliary pathology and cardiovascular systems [ 10].
Relationship of academic programs, plans , themes : work performed with the basic plan of the scientific research "Lugansk State Medical University" and this is a fragment of the theme of research on the topic : " Rehabilitation patients with combined therapeutic pathology "(№ state registration 0106U0010837).
The aim of the study is to establish common risk factors for comorbidity in chronic non-calculous cholecystitis form, ischemic heart disease and obesity.
Materials and methods
We observed 57 patients with NCC combined with coronary artery disease and obesity, women - 69.7 %, males - 30.3 %.
CNC)  and CHD were classified according to clinical protocols and guidelines ( MOH of Ukraine of 13.06.2005 № 271, MOH of Ukraine of 03.07.2006 № 436 , Recommendation Ukrainian Heart Association , 2011). We used classification criteria of the WHO definition of body mass index (BMI) for diagnosis of obesity and determination of its extent.

Age of the patients was in the range of 23 to 59 years. Age groups were defined according to WHO classification: 18-29 years old - young age, 30-44 - mature, 45-59 - average. Dominated middle-aged person 28 (49.3 %) patients with mature age were less - 22 ( 38.2 %) and the smallest was amount of the young age of 7 (12.5 %), which could explain probability of change lipid metabolism with increasing age, decreasing physical activity, presence of pregnancy in history.
On the social status of the patients were distributed as follows : workers - 23 ( 39.6%) , employees - 30 ( 51.7 %) and pensioners - 3 ( 6.1%) , unemployed - 1 (1.6% ), the vast majority ( 92.3 %) were patients who were active employment .
Duration of dual pathology have 13 ( 22.9 %) patients - from 1 to 4 years , and 33 ( 57.6 %) - 5 to 9 years , and 11 ( 19.5 %) - 10 to 12 years. Perhaps, patients with a disease duration of 10 years and more were less due to the fact that with an increase in the duration of CNC increased gallstone formation and part of such patients receive surgery.
Clinical examination of patients included careful collection medical history: the duration and the manifestation of symptoms of various combined diseases , the conditions of their emergence and dynamics.
Obtained results and discussion
While questioning patients identified the following risk factors and progression of comorbidity : 50 (87.1 %) has the presence of social risk factors, including night shifts, violations of labor and leisure, alcohol abuse , prolong smoking  46 (81, 4%) has  the nature of the violation and diet (long intervals between meals , eating just dry food , hasty eating , eating large amounts of food with preservatives , stabilizers , dyes) , the imbalance of the main ingredients (the predominance of carbohydrates). 38 (67.5%) patients had consumed excessive amounts of foods high in saturated fats, lack of exercise had 35 (61.9%) patients.
39 (68.9 %) patients had a family first-line chronic gastroduodenal diseases . Hereditary predisposition to coronary heart disease was observed in 40 ( 70.4 %) patiens, 46 patients ( 81.3%) had obesity.
However, an important factor in the risk of CHD and CNC  was  psycho-emotional state : a history  48 ( 84.0 %) patients had a pathology defined by chronic stress , conflict at work or in the family, continued hard work .
The combination of two risk factors had 33 (57.7 %) patients, three  factors had 19 ( 33.1 % ) patients, more than three factors  5 ( 8.2% ) patients. Attention is drawn to the fact that among of the examined patients with a BMI 30-34,9 kg/m2 dominated by males (60.7 %) with a BMI 35-39,9 kg/m2 - female (79.3 %) who led a sedentary lifestyle.
Aggravation of CNC patients was associated with stressful situations (14 patients - 23.8 %), and errors in diet (28 patients - 48.9 %), irregular eating, lack of breakfast, quick snack , main meal in the evening (33 patients - 58.4 %), dominated in the diet of biscuits , chocolate, sandwiches , spicy and fatty foods (15 patients - 27.1 %), alcohol abuse (10 patients - 17.8 %), smoking (22 patients - 38.3 %).
In this case, men were more characteristic of alcohol abuse , smoking, and women - stress. Common to both sexes were irregular meals, abuse oily, fried and spicy foods.
Conclusions
1 Patients with chronic non-calculous cholecystitis in combination with coronary heart disease and obesity principal risk factors and progression of dual pathology were social factors, heredity, increased body mass index , stress , disturbance of nature and diet, unbalanced main ingredients , including excessive consumption of foods high in carbohydrates and saturated fats, lack of exercise , prolonged smoking.
2. In the future we plan to examine the state kinetics of gallbladder and biliary tract for the patients with comorbidity.

Література

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Категорія: 4 (118) | Додав: siderman | Теги: ischemic heart disease, risk factors, non-calculous cholecystitis, obesity
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