Budnevsky A V, Ovsyannikov E S, Labzhania N B
N.N. Burdenko Voronezh State Medical University, Ministry of Health of Russia, Voronezh, Russia.
Ter Arkh. 2017;89(1):123-127. doi: 10.17116/terarkh2017891123-127.
Chronic obstructive pulmonary disease (COPD) still remains a serious public health problem, which is a common cause of disability and death in the able-bodied population. Furthermore, the number of patients with metabolic syndrome (MS) is steadily increasing worldwide. Recently, there is also an increase in the number of patients with COPD concurrent with MS, which is a mutually confounding risk factor for concomitant cardiovascular disease and adversely affects prognosis in these patients. Systemic subclinical inflammation is a common link between COPD and the components of MS. Systemic inflammation in patients with comorbidity is complemented by an inflammatory process in the abdominal visceral adipose tissue that serves as a source of proinflammatory adipokines (leptin, resistin, and tumor necrosis factor-α). Patients with COPD in the presence of MS components have in general higher ventilation needs, more obvious clinical manifestations of bronchopulmonary diseases, and more frequent COPD exacerbations and frequently require higher doses of inhaled glucocorticosteroids. As compared with normal-weight patients with COPD, obese patients with this condition have more limited physical activity and much more exercise intolerance. There are currently no practical recommendations for the management of patients with comorbidity; patients with COPD concurrent with MS need an individual therapeutic approach. It is important to elaborate a package of preventive measures to improve quality of life in patients, to reduce the incidence of systemic complications, and to achieve symptomatic improvements. Thus, to develop and implement practical guidelines for physicians and patients are an urgent issue.
慢性阻塞性肺疾病（COPD）仍然是一个严重的公共卫生问题，是健全人群中致残和死亡的常见原因。此外，全球代谢综合征（MS）患者数量正在稳步增加。最近，COPD合并MS的患者数量也在增加，这是并发心血管疾病的相互混杂的危险因素，并对这些患者的预后产生不利影响。全身亚临床炎症是COPD与MS各组成部分之间的共同联系。合并症患者的全身炎症由腹部内脏脂肪组织中的炎症过程补充，腹部内脏脂肪组织是促炎脂肪因子（瘦素、抵抗素和肿瘤坏死因子-α）的来源。存在MS组分的COPD患者通常通气需求更高，支气管肺疾病的临床表现更明显，COPD急性加重更频繁，并且经常需要更高剂量的吸入糖皮质激素。与体重正常的COPD患者相比，肥胖的COPD患者身体活动更受限，运动不耐受性更强。目前对于合并症患者的管理没有实用的建议；COPD合并MS的患者需要个体化的治疗方法。制定一套预防措施以改善患者生活质量、降低全身并发症的发生率并实现症状改善非常重要。因此，为医生和患者制定并实施实用指南是一个紧迫的问题。
