ÐÎËÜ ÃÅÍÅÒÈ×ÅÑÊÈÕ ÔÀÊÒÎÐΠ ÐÀÇÂÈÒÈÈ È ÏÀÒÎÃÅÍÅÇÅ ÏÅÐÂÈ×ÍÎÉ ÀÐÒÅÐÈÀËÜÍÎÉ ÃÈÏÅÐÒÅÍÇÈÈ Ó ÌÎËÎÄÛÕ ÌÓÆ×ÈÍ ÏÐÈÇÛÂÍÎÃÎ ÂÎÇÐÀÑÒÀ
Ëþñîâ Â.À.1, Åâñèêîâ Å.Ì.1, Ìàøóêîâà Þ.Ì.1, Êîòîâà Ò.Â.2, Êóãàåíêî Í.Î.2, Èâàõíåíêî Í.Å.2, Ñàëîâà Ò.Á.2
Ðîññèéñêèé ãîñóäàðñòâåííûé ìåäèöèíñêèé óíèâåðñèòåò, êàôåäðà ãîñïèòàëüíîé òåðàïèè ¹1 ëå÷åáíîãî ôàêóëüòåòà 1; 15-ÿ ãîðîäñêàÿ êëèíè÷åñêàÿ áîëüíèöà èì.Î.Ì.Ôèëàòîâà 2, ÌîñêâàÐåçþìå
Äëÿ óòî÷íåíèÿ ðîëè ñåðäå÷íî-ñîñóäèñòûõ ïîðàæåíèé, àíîìàëèé è çàáîëåâàíèé ïî÷åê, èõ ñîñóäîâ è ñòðóêòóð ìî÷åâûâîäÿùåé ñèñòåìû, íåéðîãåííûõ è ýíäîêðèííûõ çàáîëåâàíèé â ðàçâèòèè àðòåðèàëüíîé ãèïåðòåíçèè (ÀÃ) ó ìîëîäûõ ìóæ÷èí ïðèçûâíîãî âîçðàñòà, íàïðàâëåííûõ êîìèññèåé ÐÂÊ â ñòàöèîíàð äëÿ ïðîâåäåíèÿ îáñëåäîâàíèÿ è âåðèôèêàöèè äèàãíîçà ïåðâè÷íîé ãèïåðòåíçèè áûëî ïðîâåäåíî îáñëåäîâàíèå 60 ìóæ÷èí â âîçðàñòå îò 16 äî 26 ëåò. Ïîêàçàòåëè ãåìîäèíàìèêè îöåíèâàëè ïî ðåçóëüòàòàì îôèñíîãî è ìîíèòîðíîãî èçìåðåíèÿ ÀÄ, ýõîêàðäèîãðàôèè â Â-ðåæèìå. Ñòðóêòóðó è ôóíêöèþ îðãàíîâ ìî÷åâûâåäåíèÿ è ïî÷åê èçó÷àëè ïî äàííûì ñòàòè÷åñ-êîé è äèíàìè÷åñêîé ñöèíòèãðàôèè, ÓÇÈ ïî÷åê, ðåíî-ðàäèîãðàôèè, ýêñêðåòîðíîé óðîãðàôèè, öâåòíîé äîïïëåðîâñêîé àíãèîãðàôèè ïî÷å÷íûõ àðòåðèé, îöåíêå ìèêðîàëüáóìèíóðèè â óòðåííåé ìî÷å è ñêîðîñòè êëóáî÷êîâîé ôèëüòðàöèè ïî ýíäîãåííîìó êðåàòèíèíó. Èçó÷àëè óðîâåíü ìî÷åâîé êèñëîòû â ïëàçìå êðîâè, íàëè÷èå ýðèòðîöèòàðíûõ àíòèãåíîâ ÀÂÎ è ðåçóñ-ôàêòîð äëÿ èäåíòèôèêàöèè íàñëåäñòâåííîé îòÿãîùåííîñòè ïî ÀÃ.
Ïðîâåäåííîå èññëåäîâàíèå ïîçâîëèëî óñòàíîâèòü, ÷òî àðòåðèàëüíàÿ ãèïåðòåíçèÿ íå ÿâëÿåòñÿ èçîëèðîâàííûì çàáîëåâàíèåì, à ñî÷åòàåòñÿ ñ öåëûì ðÿäîì àíîìàëèé è ïîðàæåíèé ïî÷åê, èõ ñîñóäîâ, îðãàíîâ ìî÷åâûâîäÿùåé, ñåðäå÷íî-ñîñóäèñòîé è ýíäîêðèííîé ñèñòåìû, à òàêæå ñ ìåòàáîëè÷åñêèìè èçìåíåíèÿìè è îæèðåíèåì. Ó òàêèõ áîëüíûõ àíîìàëèè ðàçâèòèÿ ïî÷åê è èõ ñòðóêòóð, èìåþùèå â îñíîâå ãåíåòè÷åñêèå ïðè÷èíû èëè íàðóøåíèÿ âíóòðèýìáðèîíàëüíîãî ðàçâèòèÿ, ñîñòàâëÿþò áîëåå ïîëîâèíû âûÿâëåííûõ ñëó÷àåâ ïàòîëîãèè. Èç ïîëó÷åííûõ äàííûõ ñäåëàí âûâîä î áîëüøîé çíà÷èìîñòè ãåíåòè÷åñêèõ è âðîæäåííûõ àíîìàëèé ðàçâèòèÿ ïî÷åê è èõ ñòðóêòóð â ðàçâèòèè ñèíäðîìà õðîíè÷åñêîé àðòåðèàëüíîé ãèïåðòåíçèè ó ìîëîäûõ ìóæ÷èí ïðèçûâíîãî âîçðàñòà.Êëþ÷åâûå ñëîâà: àðòåðèàëüíàÿ ãèïåðòåíçèÿ, íàñëåäñòâåííàÿ îòÿãîùåííîñòü, ãåìîäèíàìèêà, ôóíêöèè ïî÷åê.
Abstract
To identify the role of cardiovascular pathology, renal, renovascular and renourinal anomalies, neurogenic and endocrine diseases in arterial hypertension (AH) pathogenesis among young, call-up-aged men hospitalized for examination and primary AH diagnosis verification, 60 men aged 16-26 years were included in the study. Hemodynamics was assessed by blood pressure (BP) office measurement and ambulatory monitoring, together with B-mode echocardiography data. Renal and renourinal structure and function was assessed by static and dynamic scintigraphy, renal ultrasound, renal radiography, excretory urography, color Doppler angiography of renal arteries, measurement of microalbuminuria in morning urine and glomerular filtration rate by endogenous creatinine. Plasma levels of uric acid, red blood cell ABO antigens, and Rhesus factor were also assessed to verify familial AH predisposition.
AH was not an isolated pathology, being combined with various anomalies and disorders of kidneys, renal vessels, renourinary, cardiovascular, endocrine systems, as well as with metabolic disturbances and obesity. In more than 50% of the cases, renal anomalies were explained by genetic or intrauterine factors. The results obtained point to the importance of genetic and inherited renal anomalies’ role in chronic AH syndrome development among young, call-up-aged men.Keywords: Arterial hypertension, complicated family anamnesis, hemodynamics, renal function.
