Patients with rheumatoid arthritis associate arterial hypertension with a poor prognosis and early development of cardiovascular complications. One of the leading aspects of the pathogenesis of both rheumatoid arthritis and arterial hypertension is oxidative stress, an imbalance between the production of derivatives of free radical oxidation and lipid peroxidation and the ability to neutralize these highly reactive substances. A high level of lipid peroxidation contributes to cardiomyocyte apoptosis and plays an important role in myocardial remodeling, manifestation of diastolic dysfunction. The purpose of the study was to determine the features of lipid peroxidation and the relationship of oxidative stress indicators with left ventricular diastolic function in patients with arterial hypertension in combination with rheumatoid arthritis. Material and methods. We examined 93 patients with arterial hypertension of II stage (grades 1 and 2) with rheumatoid arthritis, mean age 56 (51; 61) years, activity on the DAS 28 scale 4.64 (4.24; 4.88) points, and 45 patients with arterial hypertension of II stage (grades 1 and 2), mean age 54 (51; 58) years. Сardiac ultrasound examination was performed for all patients in standard M and B mode. The levels of isolated double bonds, diene conjugates, diene ketones, schiff bases, malonic aldehyde in the serum were determined in all patients. Statistical processing was performed using the PSPP program package (version 0.10.2, GNU Project, 1998-2016) and Apache Open Office (version 4.1, GNU GPL license). The data is presented in the form of a median and interquartile range Me (Q25; Q75). Results and discussion. There was no significant difference between the left ventricular diastolic function in patients with arterial hypertension and patients with arterial hypertension in combination with rheumatoid arthritis (p >0.05). The medians of indicators of isolated double bonds, diene conjugates, dieth ketones, schiff bases, malonic aldehyde in patients with arterial hypertension in combination with rheumatoid arthritis were significantly higher by 26.72 %, 31.58 %, 31.25 %, 17.65 % and 28.33 %, respectively, compared with patients with arterial hypertension (p <0.05). Indicators of isolated double bonds, diene conjugates, diene ketones, schiff bases, malonic aldehyde subgroups of patients with normal diastolic function were significantly lower by 20.2 %, 19.9 %, 17 %, 12.5 % and 17.6 %, respectively, compared with patients with diastolic dysfunction impaired left ventricular relaxation, and by 34.2 %, 37.6 %, 33.9 %, 33.3 %, and 38.8 % against the indicators of patients with pseudonormal type of transmitral flow velosity (p <0.001). Conclusions. The largest area under the ROC curve was AUC 0.809, the sensitivity was 81.01% and the specificity was 71.43% respectively. The violation of left ventricular diastolic function in patients with arterial hypertension in combination with rheumatoid arthritis was found in the index of isolated double bonds (95% CI 0.715 to 0.883) at an optimal distribution point of> 21.3 cu / ml.
Keywords: arterial hypertension, rheumatoid arthritis, diastolic left ventricular dysfunction, oxidative stress
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