microcirculationРегионарное кровообращение и микроциркуляцияRegional blood circulation and microcirculation1682-66552712-9756Academician I.P. Pavlov First St. Petersburg State Medical University10.24884/1682-6655-2022-21-3-4-11microcirculation-1095Research ArticleОБЗОРЫREVIEWSЭндотелиальная дисфункция у больных с ожирениемEndothelial dysfunction in patients with obesityШишкинА. Н.ShishkinA. N.

Шишкин Александр Николаевич – д-р мед. наук, профессор, зав. кафедрой факультетской терапии Медицинского факультета

199034, Санкт-Петербург, Университетская наб., д. 7/9

Shishkin Aleksandr N. – MD, Professor, Head of Department of Faculty Therapy, Medical Faculty

7/9, University embankment, Saint Petersburg, 199034

alexshishkin@bk.ruКнязеваА. И.KniazevaA. I.

Князева Алена Игоревна – аспирант кафедры факультетской терапии Медицинского факультета

199034, Санкт-Петербург, Университетская наб., д. 7/9

Kniazeva Alena I. – Postgraduate Student, Department of Faculty Therapy, Medical Faculty

7/9, University embankment, Saint Petersburg, 199034

st030951@student.spbu.ruФедеральное государственное бюджетное учреждение высшего образования «Санкт-Петербургский государственный университет»РоссияSaint-Petersburg State UniversityRussian Federation202211102022213411Copyright © Шишкин А.Н., Князева А.И., 20222022Шишкин А.Н., Князева А.И.Shishkin A.N., Kniazeva A.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.microcirc.ru/jour/article/view/1095

Эндотелиальная дисфункция рассматривается как патогенетическое звено при ожирении, которое широко распространено в популяции. Целью обзора является предоставление обновленной информации о патогенетических особенностях и маркерах эндотелиальной дисфункции у пациентов c ожирением. Важным аспектом эндотелиальной дисфункции являются системные нарушения при ожирении, такие как оксидативный стресс, повышение провоспалительных цитокинов – фактора некроза опухоли альфа, интерлейкина-6, активности аргиназы. Обсуждена роль в развитии эндотелиальной дисфункции инсулинорезистентности, а также продукта метаболизма жировой ткани – белка-хемоаттрактанта моноцитов-1. Рассмотрено участие периваскулярной жировой ткани и гипероксии жировой ткани в регуляции воспаления, влияние атерогенных концентраций окисленных липопротеинов низкой плотности, уровня эндогенного асимметричного диметил-L-аргинина на функцию эндотелия при ожирении. Проанализировано изменение лабораторных параметров – эндотелина-1, микроальбуминурии, гомоцистеина и мочевой кислоты. Описаны цитологические (циркулирующие сосудообразующие клетки, эндотелиальные микрочастицы) и инструментальные (эндотелийзависимая вазодилатация, периферическая артериальная тонометрия, толщина комплекса интима-медиа общей сонной артерии, ультразвуковое исследование почек с дуплексным сканированием почечных артерий) методы оценки функции эндотелия. Представлены данные о факторах, влияющих на риск сердечно-сосудистых осложнений – артериальной гипертензии и артериальной жесткости, высокого уровня липопротеинов низкой плотности и триглицеридов, снижения физической активности. В настоящее время определение функции эндотелия у больных с ожирением является важным для прогнозирования патологии сердечно-сосудистой системы. Информация об оценке маркеров эндотелиальной дисфункции у таких пациентов расширит возможности ранней диагностики и профилактики сердечно-сосудистых осложнений.

Endothelial dysfunction has been considered in the pathogenesis of obesity widespread in the population. The purpose of this review was to provide updated information about pathogenetic features and markers of endothelial dysfunction in obese patients. We mentioned systemic disorders in obesity, such as oxidative stress, an increase in pro-inflammatory cytokines – tumor necrosis factor alpha, interleukin-6, and arginase activity. We also discussed the role of insulin resistance in the development of endothelial dysfunction, as well as the product of adipose tissue metabolism – monocyte chemoattractant protein-1. The participation of perivascular adipose tissue, hyperoxia of adipose tissue in the regulation of inflammation was considered. We illustrated the influence of atherogenic concentrations of oxidized low-density lipoproteins, the asymmetric dimethyl-L-arginine level on endothelial function. Changes in laboratory parameters were analyzed: endothelin-1, levels of microalbuminuria, homocysteine and uric acid. We also described cytological (circulating vascular cells, endothelial microparticles) and instrumental (endothelium-dependent vasodilation, peripheral arterial tonometry, intima-media complex thickness of the common carotid artery, ultrasound kidneys examination with duplex scanning of the renal arteries) methods for assessing endothelial function. Factors that influence the risk of cardiovascular complications were arterial hypertension and arterial stiffness, high levels of low-density lipoprotein and triglycerides, reduced physical activity. The determination of endothelial function in patients with obesity can be important for predicting the pathology of the cardiovascular system. Information on the assessment of markers of endothelial dysfunction in such patients may expand the possibilities of early diagnosis and prevention of cardiovascular complications.

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