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4УДК 616.1:616.12-008.313.2 КОМОРБИДНАЯ ПАТОЛОГИЯ В КАРДИОЛОГИЧЕСКОЙ ПРАКТИКЕ
Юлдашев Рафикжан Нуманович Касимова Нурхон Джураевна Абдурахманов Мухиддин Ганиевич Турсунова Мархабохан Абдулмажит цизи Ганиева Зулайхо Вохидовна
Андижанский государственный медицинский институт
На протяжении последних десятилетий зарубежными исследователями делались многочисленные попытки количественной оценки клинической и прогностической значимости, имеющейся у пациентов коморбидной патологии. С этой целью были разработаны ряд индексов и систем.
Необходимость создания первых отечественных Клинических Рекомендаций по коморбидной патологии связана с рядом актуальных тенденций в современном отечественном здравоохранении.
Ключевые слова: коморбидност, практика, кардиологических больных.
КАРДИОЛОГИЯ АМАЛИЁТИДА КОМОРБИД Х.ОЛАТЛАР
Сунгги ун йилликлар ичида хорижий тадцицотчилар беморларда коморбид патологиянинг клиник ва прогностик ах,амиятини мицдорий бах,олашга куплаб уринишлар цилдилар. Шу мацсадда бир цатор индекслар ва тизимлар ишлаб чицилган.
Коморбидликда патология буйича биринчи мах,аллий Клиник цулланмани яратиш зарурати замонавий мах,аллий соглицни сацлашнинг бир цатор замонавий тенденциялари билан боглиц.
Калит сузлар: коморбидлик, амалиёт, юрак касалликлари.
COMORBIDAL PATHOLOGY IN CARDIOLOGICAL PRACTICE
Over the past decades, foreign researchers have made numerous attempts to quantitatively assess the clinical and prognostic significance of comorbid pathology in patients. For this purpose, a number of indices and systems have been developed.
The need to create the first domestic Clinical Guidelines for comorbid pathology is associated with a number of current trends in modern domestic health care.
Key words: comorbidity, practice, cardiac patients.
Relevance. The phenomenon of comorbidity is the simultaneous existence of two or more diseases in a patient, interrelated by the mechanisms of pathogenesis, occurring at the same time or being a complication of the course of the underlying disease or its treatment[2].
The problem of the prevalence of comorbid pathology among patients is currently becoming increasingly relevant. This is due to the fact that in conditions of comorbidity, many diseases acquire an atypical course, the risk of complications increases; the problem of polypragmasia worsens, and patients' adherence to treatment decreases[6].
Ultimately, this leads to difficulties in the process of diagnosis and management of such patients. This problem is of particular importance in the primary health care sector due to the predominance of elderly people among patients. Geriatric patients, as a rule, have a
particularly high level of comorbidity [1,2]. Within the framework of comorbidity, type 2 diabetes mellitus (DM) is one of the most important non-communicable diseases, due to the wide variety of comorbid pathology in such patients, a very high frequency of occurrence, and a steady increase in the number of patients [4].
This is due to an increase in the age of the population, an increase in the process of urbanization, an increase in the prevalence of physical inactivity, malnutrition and other risk factors among the population. Thus, the prevalence of metabolic syndrome (MS) according to modern data is 2 times higher than the prevalence of diabetes, and in the next 25 years it is expected to increase its growth rate by 50% [5].
The presence of metabolic syndrome in patients leads to pronounced changes in metabolism, which can subsequently affect the development of type 2 diabetes mellitus, hypertension, vascular atherosclerosis and other diseases [6]. All this determines the prerequisites for the occurrence of a high level of comorbid pathology in these patients.
The study of the structure of comorbid pathology in patients with type 2 diabetes is of great importance. Awareness of the prevalence of pathology of a certain system and individual nosological forms in patients of different genders and ages can contribute to the improvement of diagnosis, rational choice of therapy.
The use of systems for calculating comorbidity indices (IC) in patients with type 2 diabetes makes it easier to assess the level of comorbidity among sex and age groups, to assess the prognostic indicators of the risk of death and ten-year survival of patients and, taking them into account, if necessary, to change treatment tactics [3].
The purpose of the study. The aim of the study was to study the features of comorbid pathology in patients with comorbid pathology.
Materials and methods of research. The medical histories of 80 cardiological patients aged 25 to 82 years (average age 56.3±4.5 years) who were treated at the ASMI clinic were analyzed.
The results of the study. At the first stage of the study, the general structure of comorbid pathology was determined among the selected patients (Figure 1). It was revealed that in the general structure of comorbidity, pathology of the central and peripheral nervous system (95%) occupies the first place in terms of prevalence, diseases of the cardiovascular system (86%) take the second place, and diseases of the genitourinary system (54%) take the third place.
When determining the structure of comorbid pathology, depending on gender, the following data were obtained: the pathology of the cardiovascular system is most common in men (97%), the pathology of the nervous system is in second place (88%), the pathology of the genitourinary system is in third place (56%).
Pathology of the nervous system prevails in women (100%), diseases of the cardiovascular system are in second place (80%), diseases of the genitourinary system and endocrine system are in third place (48%). A greater proportion of endocrine pathology in women may be associated with hormonal imbalance that occurs in the menopausal and postmenopausal period. The structure of comorbidity in the studied age groups is shown in Figures 2.3.
In the study of age groups, it was found that in the group of men under 60 years (56-60 years) cardiovascular pathology also prevails (89%), pathology of the nervous (81%) and genitourinary system (45%). In men over the age of 60 (60-75 years), cardiovascular diseases (100%) and diseases of the nervous system (100%) come to the fore. In the age groups among women (57-60 years and 60-74 years), pathology of the nervous system also prevails (100% in both groups), diseases of the cardiovascular system (63% and 85%, respectively, by group), genitourinary and endocrine systems (50% and 46%).
Among the pathology of the cardiovascular system in the studied patients, the following nosological forms were identified: hypertension (I11.0, I11.9) - in 95% of patients, coronary heart disease (I20.8, I25.1) - in 57%, rhythm disturbances (I48.0, I48.1, I48.2) in 21.4%, varicose veins of the lower extremities (I83.9) in 16.7% of men, compared with women, who had a more severe course, with a history of myocardial infarction (I25.2), acute cerebrovascular accident (I61.2, I63). Among the diseases of the nervous system, the leading place in men and women is occupied by diabetic polyneuropathy (G63.2 in 89.6% of patients, cerebrovascular disease (I67.9) - in 64.6%, osteochondrosis (M42.1) - in 39.6%.
In the pathology of the genitourinary system in the studied patients, there are: chronic pyelonephritis (N10) — 40%, chronic prostatitis (N41.1) and BPH (N40) — 36% and 32%, respectively, urolithiasis (N20, N21) - 20%, chronic cystitis (N30.1) -12%. Comorbid pathology of the endocrine system was detected only in women, and it is represented by mastopathy (N60.1) - in 80% of the subjects, thyroid diseases (E04.1, E04.2, E06.3) - in 53.3%.
Conclusion. Despite the variety of somatic pathology in the analyzed group of patients, there was a significant predominance of intracardial comorbidity.
Thus, the analysis of medical histories showed a high frequency of comorbid pathology and a large number of chronic diseases in cardiac patients in all age groups.
References:
1. Vertkin A.L., Skotnikov A.S., Rumyantsev M.A. Comorbidity. The attending physician. 2013; 6:
2. Oganov R.G., Denisov I.N., Simanenkov V.I. Comorbid pathology in clinical practice. Clinical recommendations. Cardiovascular therapy and prevention. 2017; 16(6): 5-10.
3. Yelsukova O.S., Nikitina E.A., Zhuravleva O.L. Study of comorbid pathology in patients with type 2 diabetes mellitus. Modern medicine: topical issues: collection of articles on Mater. XXXI International Scientific and Practical Conference 2014; 5(31): 27-36
4. International Diabetes Federation. The IDF Diabetes Atlas, 7th edition. 2015.
5. Ostroumova O.D., Zykova A.A. Metabolic syndrome in a doctor's practice: new possibilities of correction. EF. Endocrinology. 2011; 2: 18-22.
6. Recommendations of experts of the All-Russian Scientific Society of Cardiologists on diagnostics. Second edition. Cardiovascular therapy and prevention. 2009; 6 (2): 5-7.
