mvjrМедицинский вестник Юга РоссииMedical Herald of the South of Russia2219-80752618-7876The Rostov State Medical University10.21886/2219-8075-2017-8-4-23-27mvjr-563Research ArticleОБЗОРЫREVIEWТактика хирургического лечения ишемической болезни сердца у пациентов с сахарным диабетомSurgical treatment of ischemic heart disease in patients with diabetesСидоровР. В.SidorovRoman V.

д.м.н., доцент кафедры хирургических болезней №2

PhD, associate Professor of the surgical diseases chair №2

romas-64@mail.ruТалалаевЕ. П.TalalaevEgor P.

Аспирант кафедры хирургических болезней №2

post-graduate student of the surgical diseases chair №2

talalaev.egor@list.ruЩеткоВ. Н.ShchetkoVitaly N.

Аспирант кафедры хирургических болезней №2

post-graduate student of the surgical diseases chair №2

vit-rnd@yandex.ruШлыкИ. Ф.ShlykIrina F.

к.м.н.

PhD

sushkinaif@mail.ruЕрошенкоО. Л.EroshenkoOlga L.

к.м.н., доцент, кафедра ультразвуковой диагностики факультета повышения квалификации и профессиональной переподготовки специалистов

PhD, assistent professor, Department of Ultrasound Diagnostics of the Faculty of Training and Retraining of Specialists

uzikafedra@rambler.ruРостовский государственный медицинский университетРоссияRostov State Medical UniversityRussian FederationРостовская областная клиническая больницаRussian FederationRostov regional clinical hospitalRussian Federation201730122017842327Copyright © Сидоров Р.В., Талалаев Е.П., Щетко В.Н., Шлык И.Ф., Ерошенко О.Л., 20172017Сидоров Р.В., Талалаев Е.П., Щетко В.Н., Шлык И.Ф., Ерошенко О.Л.Sidorov R.V., Talalaev E.P., Shchetko V.N., Shlyk I.F., Eroshenko O.L.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.medicalherald.ru/jour/article/view/563

Известно, что коронарный атеросклероз имеет более тяжелые последствия при наличии у больного сахарным диабетом (СД), так как сочетание этих двух факторов существенно увеличивает риск развития проявлений ишемических болезней сердца (ИБС), часто сочетающихся с пролонгированными атеросклеротическими бляшками в коронарных артериях, многососудистым поражением, поражением левой коронарной артерии. В связи с этим все большее число больных становятся кандидатами на проведение реваскуляризации миокарда. Несмотря на значительные достижения в эндоваскулярной хирургии, результаты коронарного стентирования у больных СД остаются хуже, чем у больных ИБС без диабета. Результаты крупномасштабных исследований свидетельствуют о несомненных преимуществах проведения аортокоронарного шунтирования (АКШ) у больных СД при характерном для них многососудистом поражении коронарных артерий.

It is known that coronary atherosclerosis has more severe consequences if there is a patient of diabetes, as the combination of these two factors signifi cantly increases the risk of manifestations of CHD, oft en combined with prolonged atherosclerotic plaques in the coronary artery, multivessel coronary artery disease, lesions of the left coronary artery. In this regard, an increasing number of patients are becoming candidates for a revascularization of a myocardium. Despite signifi cant advances in endovascular surgery, the results of coronary stenting in diabetic patients remain worse than in CHD patients without diabetes. Th e results of large-scale studies testify to the undoubted benefi ts of carrying out coronary artery bypass graft ing (CABG) in diabetic patients, with their characteristic multi-vessel lesion of coronary arteries

обзоришемическая болезнь сердцасахарный диабеткоронарное стентированиекоронарное шунтированиеcoronary artery diseasediabetescoronary stentingcoronary artery bypass surgeryReferencesАкчурин Р.С., Власова Э.Е., Мершин К.В. Сахарный диабет и хирургическое лечение ишемической болезни сердца // Вестник РАМН. – 2012. – №1. – С.14-19.Akchurin RS, Vlasova EE, Mershin KV. Diabetus mellitus and surgical treatment of coronary heart disease. Vestnik RAMN. 2012;(1):14-19. (In Russ).Silva J.A., Escobar A., Collins T.J., Ramee S.R., White C.J. Unstable angina: a comparison of angioscopic fi ndings between diabetic and non-diabetic patients. // Circulation. – 1995. – V.92 (7). – P.1731–36.Silva JA, Escobar A, Collins TJ, Ramee SR, White CJ. Unstable angina: a comparison of angioscopic fi ndings between diabetic and non-diabetic patients. Circulation. 1995;92(7):1731–36.Rask-Madsen C., King G.L. Mechanisms of disease: endothelial dysfunction in insulin resistance and diabetes. // Nat. Clin. Pract. Endocrinol. Metab. – 2007. – V.3(1). – P.46–56. doi: 10.1038/ncpendmet0366Rask-Madsen C, King GL. Mechanisms of disease: endothelial dysfunction in insulin resistance and diabetes. Nat. Clin. Pract. Endocrinol. Metab. 2007;3(1):46–56. doi: 10.1038/ncpendmet0366Сидоров Р.В., Петяев А.А., Петяев А.М., Поспелов Д.Ю., Долтмурзиева Н.С., Щетко В.Н. Временное внутрикоронарное шунтирование при реваскуляризации миокарда в условиях параллельного искусственного кровообращения // Медицинский вестник юга России. – 2016. – №1. – С.72-76.Sidorov RV, Petyaev AA, Petyaev AM, Pospelov DY, Doltmurzieva NS, Shchetko VN. Temporary interluminal shunting under conditions of a parallel cardiopulmonary bypass. Meditsinskii vestnik yuga Rossii. 2016;(1):72-76. (in Russ.)BARI Investigators. Th e fi nal 10-year follow-up results from the BARI randomized trial. // J. Am. Coll. Cardiol. – 2007. – V.49(15). – P. 1600–6. doi: 10.1016/j.jacc.2006.11.048BARI Investigators. Th e fi nal 10-year follow-up results from the BARI randomized trial. J. Am. Coll. Cardiol. 2007;49(15):1600–6. doi: 10.1016/j.jacc.2006.11.048Kip K.E., Faxon D.P., Detre K.M., Yeh W., Kelsey S.F., Currier J.W. Coronary angioplasty in diabetic patients. Th e National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry. // Circulation. – 1996. – V.94 (8). – P. 1818–25.Kip KE, Faxon DP, Detre KM, Yeh W, Kelsey SF, Currier JW. Coronary angioplasty in diabetic patients. Th e National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry. Circulation. 1996;94(8):1818–25.Brooks М.М., Jones R.Н, Bach R.G., Chaitman B.R., Kern M.J., Orszulak T.A. et al. Predictors of mortality and mortality from cardiac causes in the Bypass Angioplasty Revascularization Investigation (BARI) Randomized Trial and Registry // Circulation. – 2000. – Vоl.101, № 23. – Р. 2682–2689.Brooks ММ, Jones RН, Bach RG, Chaitman BR, Kern MJ, Orszulak TA, et al. Predictors of mortality and mortality from cardiac causes in the Bypass Angioplasty Revascularization Investigation (BARI) Randomized Trial and Registry. Circulation. 2000;101(23):2682–2689.Feher М.D., Elkeles R.S. Lipid modifi cation and coronary heart disease in type 2 diabetes: diff erent the general population // Heart. – 1999. – Vol. 81. – P. 10–11..Feher МD, Elkeles RS. Lipid modifi cation and соronary heart disease in type 2 diabetes: diff erent the general population. Heart.1999;81:10–11.King H., Aubert R.E., Herman W.H. Global burden of diabetes, 1995–2025: prevalence, numerical estimates, and projections // Diabetes Care. – 1998. – Vol. 21. – P. 1414–1431.King H, Aubert RE, Herman WH. Global burden of diabetes, 1995–2025: prevalence, numerical estimates, and projections. Diabetes Care. 1998;21:1414–1431.Weintraub W.S., Stein B., Kosinski А., Douglas J.S. Jr., Ghazzal Z.M., Jones E.L., et al. Outcome of coronary bypass surgery versus соronarу angioplasty in diabetic patients with multivessel coronary artery disease. // JACC. – 1998. – Vоl. 31. – Р. 10–19.Weintraub WS, Stein B, Kosinski А, Douglas JS Jr, Ghazzal ZM, Jones EL, et al. Outcome of coronary bypass surgery versus соronarу angioplasty in diabetic patients with multivessel coronary artery disease. JACC. 1998;31:10–19.Timmis А.D. Diabetes. // Brit. Med. – 2001. – Vol. 59. – Р. 159–172.Timmis АD. Diabetes. Brit. Med. 2001;59:159–172.Legrand V.M., Serruys P.W., Unger F., van Hout B.A., Vrolix M.C., Fransen G.M., et al. Th ree-year outcome aft er coronary stenting versus bypass surgery for the treatment of multivessel disease. // Ibid. – 2004. – Vol. 109(9). – P. 1114–1120. doi: 10.1161/01.CIR.0000118504.61212.4BLegrand VM, Serruys PW, Unger F, van Hout BA, Vrolix MC, Fransen GM, et al. Th ree-year outcome aft er coronary stenting versus bypass surgery for the treatment of multivessel disease. Ibid. 2004;109(9):1114–1120. doi: 10.1161/01.CIR.0000118504.61212.4BSerruys P.W., Unger F., Sousa J.E., Jatene A., Bonnier H.J., Schönberger J.P., et al. Comparison of coronary artery bypass surgery and stenting for the treatment of multivessel disease. // N Engl J Med. – 2001. – V.344(15). – P.1117-24. doi: 10.1056/NEJM200104123441502Serruys PW, Unger F, Sousa JE, Jatene A, Bonnier HJ, Schönberger JP, et al. Comparison of coronary artery bypass surgery and stenting for the treatment of multivessel disease. N Engl J Med. 2001;344(15):1117-24. doi: 10.1056/NEJM200104123441502Weintraub W.S., Grau-Sepulveda M.V., Weiss J.M., O’Brien S.M., Peterson E.D., Kolm P., et al. Comparative eff ectiveness of revascularization strategies. // N. Engl. J. Med. – 2012. – V.366 (16). – P.1467–76. doi: 10.1056/NEJMoa1110717Weintraub WS, Grau-Sepulveda MV, Weiss JM, O’Brien SM, Peterson ED, Kolm P, et al. Comparative effectiveness of revascularization strategies. N. Engl. J. Med. 2012;366(16):1467–76. doi: 10.1056/NEJMoa1110717Kappetein P., Head S.J., Morice M.C., Banning A.P., Serruys P.W., Mohr F.W., et al. Treatment of complex coronary artery disease in patients with diabetes: 5-year results comparing outcomes of bypass surgery and percutaneous coronary intervention in the SYNTAX trial. // Eur. J. Cardiothorac. Surg. – 2013. – V.43 (5). – P. 1006–13. doi: 10.1093/ejcts/ezt017Kappetein P, Head SJ, Morice MC, Banning AP, Serruys PW, Mohr FW, et al. Treatment of complex coronary artery disease in patients with diabetes: 5-year results comparing outcomes of bypass surgery and percutaneous coronary intervention in the SYNTAX trial. Eur. J. Cardiothorac. Surg. 2013;43(5):1006–13. doi: 10.1093/ejcts/ezt017Banning A.P., Westaby S., Morice M.C., Kappetein A.P., Mohr F.W., Berti S., et al. Diabetic and nondiabetic patients with left main and/or 3-vessel coronary artery disease comparison of outcomes with cardiac surgery and paclitaxeleluting stents. // J. Am. Coll. Cardiol. – 2010. – V.55(11). – P.1067–75. doi: 10.1016/j.jacc.2009.09.057Banning AP, Westaby S, Morice MC, Kappetein AP, Mohr FW, Berti S, et al. Diabetic and nondiabetic patients with left main and/or 3-vessel coronary artery disease comparison of outcomes with cardiac surgery and paclitaxeleluting stents. J. Am. Coll. Cardiol. 2010;55(11):1067–75. doi: 10.1016/j.jacc.2009.09.057Conroy R.M., Pyorala K., Fitzgerald A.P., Sans S., Menotti A., De Backer G., et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. // Eur. Heart J. – 2003. – V.24. – P.987–1003.Conroy RM, Pyorala K, Fitzgerald AP, Sans S, Menotti A, De Backer G, et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur. Heart J. 2003;24:987–1003.Farkouh M.E., Domanski M., Sleeper L.A., Siami F.S., Dangas G., Mack M., et al. Strategies for multivessel revascularization in patients with diabetes. // N. Engl. J. Med. – 2012. – V.367(25). – P.2375–84. doi: 10.1056/NEJMoa1211585Farkouh ME, Domanski M, Sleeper LA, Siami FS, Dangas G, Mack M, et al. Strategies for multivessel revascularization in patients with diabetes. N. Engl. J. Med. 2012;367(25):2375–84. doi: 10.1056/NEJMoa1211585

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