外周动脉疾病患者保守治疗的现代可能性和前景

S. Katorkin, E. Krivoshchekov, E. Elshin, M. Y. Kushnarchuk
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摘要

外周动脉疾病最常见的临床表现是因患肢供血不足而导致间歇性跛行。本文对间歇性跛行患者保守治疗的最新成果进行了总结和系统的梳理。根据循证医学的要求,概述了俄罗斯和国外最新共识文件中提出的保守治疗的现代有前途的趋势。外周动脉疾病患者综合治疗的基础是:非药物治疗和药物治疗以缓解慢性缺血症状,药物治疗以二级预防心血管并发症,开放或血管内血运重建术以增加无痛行走距离。随着动脉粥样硬化的发展,内皮细胞的肽组成发生紊乱,从而降低血管壁抵抗炎症的能力和相关病理过程的触发。实验证明,在这种情况下,使用从健康和年轻动物的血管中获得的肽复合物可以恢复动脉的内皮功能,影响发病的主要环节。氧化应激的降低,动脉粥样硬化和血脂作用的降低,血管张力和血液凝固参数的正常化,微血管床的增加——这些都是证明动脉粥样硬化闭塞症患者应使用肽的机制。基于从血管中分离的多肽复合物的血管保护剂可以成为治疗下肢动脉闭塞性疾病患者的重要组成部分,提供复杂的发病作用。需要在多中心临床试验中进一步研究一种药物在一个疗程后较长时间内的治疗效果持续时间、对疾病长期结局的影响、重复疗程的可能性,以及根据Fontaine分类的下肢动脉慢性闭塞性疾病III-IV期,以及使用药物治疗各种动脉盆地的系统性动脉粥样硬化。
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Modern possibilities and prospects of conservative treatment of patients with peripheral arterial diseases
The most common clinical manifestation of peripheral arterial disease is intermittent claudication due to insufficient blood supply to the affected limb. The article summarizes and systematizes the latest achievements in the field of conservative treatment of patients with intermittent claudication. In accordance with the requirements of evidence-based medicine, an overview of modern promising trends in conservative therapy presented in the latest Russian and foreign consensus documents, is given. The basis of the complex treatment of patients with peripheral arterial diseases is: non-drug and drug treatment to relieve the symptoms of chronic ischemia, pharmacotherapy for the secondary prevention of cardiovascular complications, open or endovascular revascularization to increase the distance of painfree walking. With the development of atherosclerosis, disturbances in the peptide composition of the endothelium occur, which reduce the ability of the vascular wall to resist inflammation and the associated triggering of pathological processes. It has been experimentally proven that the use of a complex of peptides obtained from the vessels of healthy and young animals in this situation restores the endothelial function of the arteries, affecting the main links of pathogenesis. Decrease in oxidative stress, decrease in atherogenic and lipidemic action, normalization of vascular tone and blood coagulation parameters, increase in the microvascular bed – these are the mechanisms that justify the indication of peptides to patients with atherosclerosis obliterans. Angioprotector based on a complex of polypeptides isolated from blood vessels can become an important part of the treatment of patients with obliterating diseases of the arteries of the lower extremities, providing a complex pathogenetic effect. It is necessary to further study in multicenter clinical trials the duration of the therapeutic effect of a drug in a longer period after a course of treatment, its effect on long-term outcomes of the disease, the possibility of using repeated courses, in chronic obliterating diseases of the arteries of the lower extremities III-IV stages according to the Fontaine classification, as well as the use drug for the treatment of systemic atherosclerosis of various arterial basins.
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