Факторы риска и диагностические маркеры острого коронарного синдрома при хронической болезни почек

Введение. Острые формы ишемической болезни сердца признаны основной причиной смерти у пациентов с хро­нической болезнью почек (Хбп). Кроме того, Хбп сама инициирует развитие острого коронарного синдрома (ОКС), распространенность которого тем выше, чем более выражено нарушение функции почек и чем больше сопутству­ющих факторов риска у больного.

Цель исследования - изучение прогностической ценности различных лабораторных и инструментальных маркеров в выявлении риска развития ОКС у больных Хбп.

Материалы и методы. проведен поиск статей за последние 10 лет в базах PubMed, Medline, Google Scholar и eLIBRARY по ключевым словам на русском и английском языках в соответствии с целью исследования.

Результаты. ОКС манифестирует атипичной картиной у больных Хбп, а в 3 % случаев - вообще бессимптомно. Риск смерти от сердечно-сосудистых осложнений возрастает пропорционально снижению скорости клубочковой филь­трации (СКф). Данная прогрессия также увеличивает риск кальцификации коронарных артерий. при этом выявле­но, что цистатин С - более универсальный маркер снижения СКф, чем креатинин. Другими лабораторными марке­рами, указывающими на риск ОКС, выступают воспалительные маркеры, альбуминурия, натрийуретический пептид.

Заключение. Так как ОКС может протекать атипично, то в его прогнозировании в клинических условиях, помимо тропонинов и традиционных инструментальных методов диагностики, могут играть роль такие маркеры, как СКф, альбуминурия, увеличение в сыворотке крови уровня цистатина С, фосфата, фактора роста фибробластов-23, ин­терлейкина-6, фактора некроза опухолей альфа, общего паратгормона, фибриногена, натрийуретического пептида. 

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