Medical Scientific Bulletin of Central Chernozemye (Naučno-medicinskij vestnik Centralʹnogo Černozemʹâ)

1990-472X

Федеральное государственное бюджетное образовательное учреждение высшего образования "Воронежский государственный медицинский университет имени Н.Н. Бурденко" Министерства здравоохранения Российской Федерации

9354

10.18499/1990-472X-2023-24-4-%p

PATHOGENETIC BASIS OF COMORBIDITY OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND ANEMIA

Budnevsky

Andrey V

budnev@list.ruGubanov

Dmitry S

dmitrij.gubanov@yandex.ruBavykina

Irina A

i-bavikina@yandex.ruМакеева

Анна V

a.makeeva@vrngmu.ruBudnevskaya

София A

Yuliyag36@gmail.comKotelnikova

Tatyana E

dkbfarm@yandex.ru

29122023

244

09022024

2023

<p>Attempts at pathogenetic treatment of anemia of chronic diseases are in preclinical trials. In clinical practice, the problem of the mutually aggravating course of COPD and anemia is acute. The article discusses the main pathogenetic mechanisms of comorbidity, provides statistics on the frequency of occurrence of a combination of pathologies and evaluates the significance of the effect of pro-inflammatory cytokines and erythropoiesis regulator hepsidin on erythrocytes in the pathogenesis of COPD. Reduction of hepcidin production, neutralization of hepcidin in plasma, and obstruction of ferroportin degradation and various ways of influencing the content of IL-6, antibodies to ferroportin and to hepcidin are considered as solution strategies. Hormonal imbalance, influence levels of vitamin D, angiotensin converting enzyme inhibitors and angiotensin II receptor blockers on the risk of anemia in COPD were analyzed according to current literature data. Experimental and clinical data on changes in the number and morphology of shaped blood elements in the presence of COPD are presented. All currently known mechanisms of comorbidity development are reflected, the study and refinement of which will contribute to the search for new diagnostic and clinical opportunities for pathogenetic therapy.</p>

Attempts at pathogenetic treatment of anemia of chronic diseases are in preclinical trials. In clinical practice, the problem of the mutually aggravating course of COPD and anemia is acute. The article discusses the main pathogenetic mechanisms of comorbidity, provides statistics on the frequency of occurrence of a combination of pathologies and evaluates the significance of the effect of pro-inflammatory cytokines and erythropoiesis regulator hepsidin on erythrocytes in the pathogenesis of COPD. Reduction of hepcidin production, neutralization of hepcidin in plasma, and obstruction of ferroportin degradation and various ways of influencing the content of IL-6, antibodies to ferroportin and to hepcidin are considered as solution strategies. Hormonal imbalance, influence levels of vitamin D, angiotensin converting enzyme inhibitors and angiotensin II receptor blockers on the risk of anemia in COPD were analyzed according to current literature data. Experimental and clinical data on changes in the number and morphology of shaped blood elements in the presence of COPD are presented. All currently known mechanisms of comorbidity development are reflected, the study and refinement of which will contribute to the search for new diagnostic and clinical opportunities for pathogenetic therapy.

интерлейкины, гепсидин, эритропоэз, анемия хронических заболеваний, гемоювелин.

1. Feinstein A. R. The pre-therapeutic classification of co-morbidity in chronic disease // Journal of Chronic Diseases. - 1970. -Vol. 23, №. 7.- P. 455– 468.

2. Головач И. Ю. Современные возможности дифференциальной диагностики анемий во врачебной практике // Фармакотерапия. - 2014. -№ 9 (185).- С. 22-26 [Golovach I. Yu. Modern possibilities of differential diagnosis of anemia in medical practice // Pharmacotherapy. - 2014. -№ 9 (185).- P. 22-26].

3. Бигаева Д.У., Даурова М.Д., Гатагонова Т.М., Болиева Л.З. Особенности некоторых структурно-функциональных показателей желудочков у больных хроническим обструктивным заболеванием легких в условиях коморбидности с гипертонической болезнью //Достижения клинической и экспериментальной медицины. 2018.- № 2.- С.56-67 [Bigaeva D.U., Daurova M.D., Gatagonova T.M., Bolieva L.Z. Features of some structural and functional parameters of ventricles in patients with chronic obstructive pulmonary disease in conditions of comorbidity with hypertension //Achievements of clinical and experimental medicine. 2018.- No. 2.- Р.56-67].

4. Ступницкая Г.И., Власик Л., Сухолотюк А. Особенности организации первичной медико-санитарной помощи больным, страдающим хронической обструктивной болезнью легких совместно с ишемической болезнью сердца. Wiadomosci lekarskie. - 2017. -№. 70. -P. 466-469 [Stupnitskaya G.I., Vlasik L., Sukholotyuk A. Features of the organization of primary health care for patients suffering from chronic obstructive pulmonary disease together with coronary heart disease. Wiadomosci lekarskie. - 2017. -№. 70. -P. 466-469].

5. Brinchault G. et al. Le Comorbidités Dans La BPCO // Revue De Pneumologie Clinique. - 2015.-Vol. 71, №. 6. -P. 342–349

10.

11.

6. Nesterovska O., Stupnytska G., Fediv O., Stupnytska A. Effectiveness of long-term treatment with erythromycin in patients with Asthma-COPD overlap syndrome European Respiratory Journal Sep – 2019. -№54 (suppl 63).- PA4234;

12.

13.

7. Pertseva T., Konopkina L., Babenko A. A new perspective on bronchial asthma and chronicobstructive pulmonary disease overlap: potential diagnostic criteria. Wiadomości Lekarskie. - 2020. -Vol. 73, №. 7.- P. 1480–1483.

14.

15.

8. Tassiopoulos S. et al. Erythropoietic response to hypoxaemia in diffuse idiopathic pulmonary fibrosis, as opposed to chronic obstructive pulmonary disease // Respiratory Medicine. - 2001. -Vol. 95, № 6.- P. 471–475.

16.

17.

9. John M. et al. Anemia and inflammation in COPD // Chest. - 2005. -Vol. 127, № 3.- P. 825–829.

18.

19.

10. Chambellan A. et al. Prognostic value of the hematocrit in patients with severe COPD receiving long-term oxygen therapy // Chest. - 2005. -Vol. 128, № 3. -P. 1201–1208.

20.

21.

11. Cote C. et al. Haemoglobin level and its clinical impact in a cohort of patients with COPD // European Respiratory Journal. - 2007. -Vol. 29, № 5.- P. 923–929.

22.

23.

12. Parveen S, Rangreze I, Ahmad SN, Mufti SA, et al. Prevalence of anemia in patients with COPD and its potential impact on morbidity of COPD patients //Int J Clin Med. - 2014, -№ 5. -Р. 452‑8.

24.

25.

13. Romaniuk A, Lyndin M, Lуndіna Y, Sikora V. еt al. / Changes in the Hematopoietic System and Blood Under the Influence of Heavy Metal Salts Can Be Reduced with Vitamin E. // Turk Patoloji Derg. – 2018.- №34(1). -Р. 73-81.

26.

27.

14. Smiyan O. I. et al. Macro- and microelements determination in children with rotavirus infection // Zaporozhye Medical Journal. – 2018.- № 20 (3).- Р. 371–374.

28.

29.

15. Tarantino G., Brilli E., Giordano G.,Torelli A. Innovative oral iron supplement (sucrosomial iron) is able to downregulate hepsidin release during inflammation: in vitro study // Blood – 2015.- №126.- Р. 4563–5.

30.

31.

16. Kautz L, Jung G, Valore EV, Rivella S, et al. Identification of erythroferrone as an erythroid regulator of iron metabolism // Nat Genet.-2014. - № 46. - Р. 678-684.

32.

33.

17. Park S., Jung C. W., Kim K. et al. Iron deficient erythropoiesis might play key role in development of anemia in cancer patients // Oncotarget. – 2015. - № 6(40). - Р. 42803–12.

34.

35.

18. Мостовой Ю. М., Слепченко Н. С. Хроническое обструктивное заболевания легких и сердце: достижения и вопросы сегодняшнего дня // Пульмонологический журнал. – 2018.- № 4.- С. 56-61.

36.

37.

19. Andreas S, Anker SD, Scanlon PD, Somers VK. Neurohumoral activation as a link to systemic manifestations of chronic lung disease // Chest. – 2005.- №28(5). -Р. 3618-24.

38.

39.

20. Тодорико Л. Д. Формирование системных проявлений и определении предикторов прогрессирования при хроническом обструктивном заболевании легких по результатам факторного анализа // Пульмонологический журнал. – 2019.- № 1.- С. 49-54 [Todoriko L. D. Formation of systemic manifestations and determination of predictors of progression in chronic obstructive pulmonary disease based on the results of factor analysis // Pulmonological Journal. – 2019. - No. 1.- P. 49-54].

40.

41.

21. Barba R. et al Anemia in chronic obstructive pulmonary disease: a readmission prognosis factor // Current Medical Research and Opinion. – 2012. -Vol. 28., №4 P. -617–622

42.

43.

22. Silverberg D. S. et al. Anemia and iron deficiency in COPD patients: prevalence and the effects of correction of the anemia with erythropoiesis stimulating agents and intravenous iron // BMC Pulmonary Medicine. – 2014.- Vol. 14, № 1.- Р. 24.

44.

45.

23. Ступницкая Г.И., Власик Л., Сухолотюк А. Особенности организации первичной медико-санитарной помощи больным, страдающим хронической обструктивной болезнью легких совместно с ишемической болезнью сердца. Wiad Lek. – 2017. № 70. -P. 466-469 [Stupnitskaya G.I., Vlasik L., Sukholotyuk A. Features of the organization of primary health care for patients suffering from chronic obstructive pulmonary disease together with coronary heart disease. Wiad Lek. – 2017. № 70. -P. 466-469].

46.

47.

24. Rodríguez-Mañero M, López-Pardo E, Cordero A, Ruano-Ravina A, et al. A prospective study of the clinical outcomes and prognosis associated with comorbid COPD in the atrial fibrillation population // International journal of chronic obstructive pulmonary disease. – 2019. №14. -Р. 371–80.

48.

49.

25. Najafinobar N, Venkatesan S, von Sydow L, Klarqvist M, et al. ToF-SIMS mediated analysis of human lung tissue reveals increased iron deposition in COPD (GOLD IV) patients // Sci Rep. – 2019. -№9(1). -Р.10060.

50.

51.

26. Xiong W, Xu M, Pudasaini B, Guo X, Liu J. The influence of anemia on one-year exacerbation rate of patients with COPD-PH // BMC Pulm Med. – 2018. -№18.- Р.143.

52.

53.

27. Hillas G, Perlikos F, Tsiligianni I, Tzanakis N: Managing comorbidities in COPD // Int J Chron Obstruct Pulmon Dis. – 2015. -№ 10. -Р. 95-109.

54.

55.

28. Guo J, Zheng C, Xiao Q, et al.: Impact of anaemia on lung function and exercise capacity in patients with stable severe chronic obstructive pulmonary disease // BMJ Open. – 2015.- № 5(10).- Р. e008295

56.

57.

29. Alvarez-Hernández X., Felstein M.V., Brock J. H. The relationship between iron release, ferritin synthesis and intracellular iron distribution in mouse peritoneal macrophages. Evidence for a reduced level of metabolically available iron in elicited macrophages // Biochimica Et Biophysica Acta 155(BBA) – Molecular Cell Research.- 1986. - Vol. 886, № 2. - P. 214–222.

58.

59.

30. Tilg H., Herbert T., Hanno U., Arthur K., et al. Role of IL-10 for induction of anemia during inflammation // The Journal of Immunology. - 2012. -Vol. 169, №4.- P. 2204–2209.

60.

61.

31. Aeberli I., Hurrell R. F., Zimmermann M. B. Overweight children have higher circulating hepcidin concentrations and lower iron status but have dietary iron intakes and bioavailability comparable with normal weight children // International Journal of Obesity. – 2009. - Vol. 33, №10. - P. 1111–1117.

62.

63.

32. Ковчун А. В., Кмита В. В., Приступа Л. Н. Клинико-функциональная характеристика больных хроническим обструктивным заболеванием легких в зависимости от показателей красного ростка крови и содержания растворимых трансферриновых рецепторов // Львовский клинический вестник. – 2018. - № 4 (24).- С.33-38 [Kovchun A.V., Kmita V. V., Paroxysm L. N. Clinical and functional characteristics of patients with chronic obstructive pulmonary disease depending on the indicators of red blood germ and the content of soluble transferrin receptors // Lviv Clinical Bulletin. – 2018. - № 4 (24).- P.33-38].

64.

65.

33. Ergаn B, Ergün R. Impаct of аnemiа on short-term survivаl in severe COPD exаcerbаtions: а cohort study // Int J Chron Obstruct Pulmon Dis. - 2016. -№ 11. - Р. 1775-83.

66.

67.

34. Boutou А, Kаrrаr S, Hopkinson N, et аl. Аnemiа аnd survivаl in chronic obstructive pulmonаry diseаse: а dichotomous rаther thаn а continuous predictor // Respirаtion. – 2013. - № 85. - Р. 126–131.

68.

69.

35. Гендерные аспекты клиники и лечения больных хронической обструктивной болезнью легких и анемией : автореферат дис. ... кандидата медицинских наук : 14.01.04 / Ульянова Марина Ильинична;. - Воронеж, 2016. - 23 с. [Gender aspects of the clinic and treatment of patients with chronic obstructive pulmonary disease and anemia : abstract of the dissertation of the Candidate of Medical Sciences : 14.01.04 / Ulyanova Marina Ilyinichna;. - Voronezh, 2016. - 23 р.].