Резюме
Тесленко Ю.В. Зміни показників якості життя у пацієнтів з стабільною стенокардією напруження під впливом комбінованої терапії остеоартрозу та ожиріння.
Проведення оцінки якості життя (ЯЖ) у пацієнтів з коморбідними захворюваннями має важливе значення, так як обумовлює не лише визначення стану пацієнтів, а й вибір тактики лікування, спрямованої на покращення прогнозу.Метою дослідження було вивчення особливостей показників ЯЖ у пацієнтів з стабільною стенокардією напруження (ССН) протягом лікування на фоні комбінованої терапії остеоартрозу (ОА) та ожиріння. Предметом дослідження було 74 хворих з ССН, поєднаною з ОА та ожирінням. Оцінка ЯЖ проводилась згідно показників неспецифічного опитувальника для оцінки ЯЖ «SF - 36 Health Status Survey». В результаті проведеного дослідження встановлено що, взаємообтяжуючий перебіг коморбідних захворювань має негативний вплив на рівень ЯЖ у пацієнтів з ССН, поєднаною з ОА та ожирінням. Враховуючи статистично достовірне підвищення показників ЯЖ у пацієнтів ДГ порівняно з КГ, можна стверджувати про позитивний вплив комбінованої терапії ОА та ожиріння у пацієнтів з ССН на рівень ЯЖ.
Ключові слова: стабільна стенокардія напруження, остеоартроз, ожиріння, якість життя.
Резюме
Тесленко Ю.В. Изменения показателей качества жизни у пациентов с стабильной стенокардией напряжения под влиянием комбинированной терапии остеоартроза и ожирения.
Проведение оценки качества жизни (КЖ) у пациентов с коморбидными заболеваниями имеет важное значение, так как обуславливает не только определение состояния пациентов, но и выбор тактики лечения, направленной на улучшение прогноза. Целью исследования было изучение особенностей показателей КЖ у пациентов с стабильной стенокардией напряжения (ССН) при лечении на фоне комбинированной терапии остеоартроза (ОА) и ожирения. Предметом исследования было 74 больных с ССН, сочетанной с ОА и ожирением. Оценка КЖ проводилась согласно показателей неспецифичного опросника для оценки КЖ «SF - 36 Health Status Survey». В результате проведенного исследования установлено, что взаимоотягощающее течение коморбидных заболеваний имеет негативное влияние на уровень КЖ у пациентов с ССН, сочетанной с ОА и ожирением. Учитывая статистически достоверное повышение показателей КЖ у пациентов ИГ в сравнении с КГ, можно утверждать о позитивном влиянии комбинированной терапии ОА и ожирения у пациентов с ССН на уровень КЖ.
Ключевые слова: стабильная стенокардия напряжения, остеоартроз, ожирение, качество жизни.
Summary
Teslenko J.V. Changes of life quality in patients with stable angina pectoris under combined therapy of obesity and osteoarthritis.
Assessment of quality of life (QoL) in patients with comorbid diseases is important because not only determine the causes of the patients, but treatment selection aiming at improving prediction. The aim of the study was to investigate the indicators of QoL in patients with stable angina pectoris (SAP) for the treatment, of the background combined therapy of osteoarthritis (OA) and obesity. The subject of the study was 74 patients with SAP, combined with OA and obesity. QoL assessment was performed by non-specific indicators to measure QoL questionnaire «SF - 36 Health Status Survey». As a result, the study found that worsening course of comorbid disease has a negative impact on QoL in patients with SAP, combined with OA and obesity. Given the statistically significant increase of the QoL in patients from IG in comparison with KG can be said about the positive effects of combination therapy of OA and obesity in patients with SAP on the level of QoL.
Key words: stable angina pectoris, osteoarthritis, obesity, quality of life.
Рецензент: д.мед.н., проф. Л.М. Іванова

УДК 616.12-009.72:616.72-002]-056.5-08

Вищий державний навчальний заклад «Українська медична стоматологічна академія» (Полтава)

Высшее государственное учебное заведение "Украинская медицинская стоматологическая академия" (Полтава)

Higher state educational institution of Ukraine "Ukrainian Medical Stomatological Academy" (Poltava)

JuraDocHard1981@mail.ru

Introduction. In medicine, quality of life (QoL) is defined as "quality of life related to health" (in English literature «health - related quality of life»). It is believed that this - the level of well-being and satisfaction of those aspects of life that are affected by the disease or its treatment [3]. The current patient is special in terms of the presence in it of various nature and course of pathological states, competing for their prognostic significance and impact on QoL [1].

Cardiovascular disease (CVD), including stable angina pectoris (SAP) as the most common form of coronary heart disease (CHD) and osteoarthritis (OA) - the leading diseases that cause functional failure and disability in the adult population [2,4,7]. In his turn obesity is the primary risk factor for the development and progression of both CVD and OA [5,6].

Given the above, it can be argued that the assessment of QoL in patients with comorbid diseases is important because not only determine the causes of the patients, but treatment selection aiming at improving prediction.

The work is a piece of scientific research carried out by the Chair of Internal Medicine with nursing and general practice (family medicine) "The role of inflammation in the pathogenesis of coronary and noncoronary heart disease and development methods of pathogenetic therapy», state registration № 0107U004808

The aim of the study. Study of indicators of QoL in patients with SAP for treatment on a background of combined therapy of OA and obesity.

Materials and methods. To address this goal on a background of standard therapy according to the " Protocols of care for patients with coronary artery disease: stable angina pectoris I-II, III-IV FC " and the recommendations of the European Society of Cardiology , which included the appointment of antithrombotic therapy ( aspirin with a daily dose of 75 - 100 mg), lipid-lowering drugs ( HMG -Co -A reductase inhibitors : atorvastatin daily dose of 20-40 mg), antianginal drugs ( isosorbide dinitrate moderately long-acting ), beta-blockers, angiotensin-converting enzyme, performed combined, concomitant therapy of OA and obesity, which included non-steroidal anti-inflammatory drugs (NSAIDs) selective inhibitors of cyclooxygenase-2 (COX-2): meloxicam administered parenterally at the beginning of treatment (1.5 ml of 1% solution to 5 days), oral (7,5-15 mg / day for 2-3 weeks and during exacerbations) hondroprotektyve drugs (HPD): parenterally hondroityn sulfate 2 ml ( 0.2 g) 1 time per day intramuscularly № 25-30 (“Mukosat”) followed by taking the combined HPP (562.5 mg of glucosamine sulfate and chondroitin sulfate 350 mg ) orally 1 tablet 3 times her day for the first 3 weeks  and 1 tablet 2 times per day followed by ("Osteal") of biguanide antidiabetic medication (metformin daily dose of 1.5-3 g in control of blood glucose and urine) , a drug that affects the centers of hunger and reduces appetite in patients with obesity "Tsefamadar" (active ingredient trituration Madar D4 250 mg) 1 tablet 3 times per day , as well as reduced energy value of the diet number 8 and its variants: 8a ( obese patients with I- II degree ) 8b ( obese Class III).

The subject of the study was 74 patients with SAP, combined with OA and obesity. In order to assess QoL and effectiveness of the proposed method of treatment according to the principles of evidence-based medicine and prospective study involved two groups of equal number of patients were homogeneous at the beginning of treatment. The control group (CG) consisted of 37 patients who received standard therapy of coronary artery disease. Age of the patients was from 42 to 72 years. The average age was 58,14 ± 1,47 years. In CG included 13 men and 24 women. According to BMI, the ratio of body weight (kg) and height (m2) in 20 patients was stage II obesity (BMI = 35-40 kg/m2) in 17 patients - stage III obesity (BMI ≥ 40 kg/m2). Research group consisted of 37 patients on a background of standard therapy of coronary artery disease receiving combination, concomitant therapy of OA and obesity on the proposed methodology. Age of the patients was from 42 to 72 years. The average age - 60,7 ± 1,54 years. The studied group comprised 12 men and 25 women. According to BMI in 20 patients was obesity of II degree, in 17 patients – obesity of III degree.

QoL assessment was performed by questionnaire of indicators to assess QoL «SF - 36 Health Status Survey». In assessing the results of the questionnaire used instruction prepared by "Preferense." The results were evaluated as a ratings in scores by 8 scales generated so that a higher score indicated a higher level of QoL. Assessment of performance held at the beginning of treatment, after 6 and 12 months.

In the statistical analysis results of the study used the parametric Student's t criteria. Mathematical processing of the data was performed using the program STATISTICA Version 6.0 and application package of Microsoft Office (Word, Exel).

Results and discussion. As a result, the study found a statistically significant (p ˂ 0,01) increase in average values of QoL according to the scales of the questionnaire SF - 36 in patients in the experimental group (n = 37) compared with patients with CG (n = 37) after 6 months and at the end of treatment (Table 1), indicating the effectiveness of concurrent, combination therapy of OA and obesity in patients with SAP.

TABLE 1.

The average value of the scales of the questionnaire SF - 36 in patients of the control group and the experimental group before and after treatment, M ± m.

Notes: test t - Student indicated for average values between CG and EG performance after treatment. * - р < 0,01; *** - p > 0,05.

It should be noted that at significant increase in performance of the scales “physical functioning” (Physical Functioning - PF), “intensity of pain” (Bodily pain - BP) (Figure 1) and the scales “Social functioning” (Social Functioning - SF) and "Role functioning due to emotional state» (Role-Emotional - RE) (Figure 2) in EG patients during treatment, was noted decrease of these parameters  in the CG. These changes demonstrate the feasibility and efficacy of concomitant therapy designed OA and obesity.

         Figure. 1. The physical health component by the scales SF - 36 in patients of CG and EG during treatment.

        Figure. 2. Psychological health component by the scales SF - 36 in patients of CG and EG during treatment.

At insignificant increase in average in patients of CG  indication of scale "General health» (General Health - GH), -  physical health component (Figure 3), and the scale parameters «vitality» (Vitality - VT), and the scale “Mental Health” (Mental Health - MH). - mental health component (Figure 4), observed a significant increase in these parameters in the EG.

         Figure. 3. The physical component of health by the scale GH SF - 36 in patients of CG and EG during treatment.

        Figure. 4. Psychological health component by the scales SF - 36 in patients of CG and EG during treatment.

According to scale "Role functioning due to physical state» (Role-Physical Functioning - RP), - physical health component, the average difference after treatment between CG and EG was not statistically significant, though with a slight decrease in CG levels, in the EG did not change.

Summarizing above, it should be noted a statistically significant increase in overall physical performance (PH) and psychological (MH) components of health by SF - 36 in EG patients compared with the CG (Figure 5).

 Figure. 5. General characteristics of physical and mental health components according to SF - 36 in patients of CG and EG during treatment.

Conclusions:

1. Aggravating course of comorbid disease has a negative impact on QoL in patients with SAP, combined with OA and obesity.
2. Considering statistically significant increasing of the QoL in patients of EG compared to CG can be said about positive influence of combination, concomitant treatment of OA and obesity in patients with SAP on the level of QoL.

Література

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