asurgeryАмбулаторная хирургияAmbulatornaya khirurgiya = Ambulatory Surgery (Russia)2712-87412782-2591ООО «ГРУППА РЕМЕДИУМ»10.21518/akh2024-014asurgery-425Research ArticleФЛЕБОЛОГИЯPHLEBOLOGYХронические заболевания вен и ожирение: патогенетически обоснованные возможности лечения и профилактикиChronic venous diseases and obesity: pathogenetically based treatment and prevention optionshttps://orcid.org/0000-0002-3940-0787БогачевВ. Ю.BoldinB. V.

Богачев Вадим Юрьевич - д.м.н., профессор кафедры факультетской хирургии №2 лечебного факультета, Российский национальный исследовательский медицинский университет имени Н.И. Пирогова; научный руководитель, Первый флебологический центр,

117997, Москва, ул. Островитянова, д. 1; 117447, Москва, ул. Дмитрия Ульянова, д. 31

Vadim Yu. Bogachev - Dr. Sci. (Med.), Professor of the Department of Faculty Surgery No. 2, Pirogov RNRMUy; Scientific Supervisor, FPC.

1, Ostrovityanov St., Moscow, 117997; 31, Dmitry Ulyanov St., Moscow, 117447

vadim.bogachev63@gmail.comhttps://orcid.org/0000-0003-4488-9123БолдинБ. В.BoldinB. V.

Болдин Борис Валентинович - д.м.н., профессор, заведующий кафедрой факультетской хирургии №2 лечебного факультета.

117997, Москва, ул. Островитянова, д. 1

Boris V. Boldin - Dr. Sci. (Med.), Professor, Head of the Department of Faculty Surgery No. 2.

1, Ostrovityanov St., Moscow, 117997

bvb195411@mail.ruhttps://orcid.org/0000-0002-3574-6190ВаричГ. А.VarichG. A.

Варич Георгий Александрович - к.м.н., доцент кафедры факультетской хирургии.

117997, Москва, ул. Островитянова, д. 1

Georgiy A. Varich - Cand. Sci. (Med.), Associate Professor of the Department of Faculty Surgery No. 2.

1, Ostrovityanov St., Moscow, 117997

geravarich@mail.ruhttps://orcid.org/0000-0003-3811-5156ДженинаО. В.DzheninaO. V.

Дженина Ольга Вадимовна - к.м.н., врач-флеболог.

117447, Москва, ул. Дмитрия Ульянова, д. 31

Olga V. Dzhenina - Cand. Sci. (Med.), Phlebologist.

31, Dmitry Ulyanov St., Moscow, 117447

helgelman@mail.ruhttps://orcid.org/0009-0009-1230-1269АбдошР.AbdoshR.

Абдош Робеар - аспирант кафедры факультетской хирургии №2 лечебного факультета.

117997, Москва, ул. Островитянова, д. 1

Robear Abdosh - Postgraduate Student of the Department of Faculty Surgery No. 2.

1, Ostrovityanov St., Moscow, 117997

robear532@gmail.comРоссийский национальный исследовательский медицинский университет имени Н.И. Пирогова; Первый флебологический центрРоссияPirogov Russian National Research Medical UniversityRussian FederationРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian FederationПервый флебологический центрРоссияFirst Phlebological CenterRussian Federation2024170520242116473Copyright © Богачев В.Ю., Болдин Б.В., Варич Г.А., Дженина О.В., Абдош Р., 20242024Богачев В.Ю., Болдин Б.В., Варич Г.А., Дженина О.В., Абдош Р.Boldin B.V., Boldin B.V., Varich G.A., Dzhenina O.V., Abdosh R.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.a-surgeon.ru/jour/article/view/425

В обзоре проведен анализ литературы, посвященной связи ожирения и хронических заболеваний вен. Поиск литературных источников осуществлялся в базах данных Cochrane Library, PubMed, Medscape и Medline в соответствии с рекомендациями PRISMA. В обзор включены только публикации, имеющие особую актуальность для рассматриваемой проблемы и в которых по результатам статистической обработки разница «опыт – контроль» была значимой. Во всех включенных в анализ работах под ожирением подразумевался индекс массы тела 30,0 кг/м2 и более, а под избыточной массой тела – от 25 до 30 кг/м2 согласно критериям Всемирной организации здравоохранения. Результаты проанализированных публикаций доказывают, что избыточная масса тела и в особенности ожирение служат большим независимым фактором риска развития и прогрессирования как хронических заболеваний вен, так и их осложнений. Кроме того, наблюдается прямая причинно-следственная связь между массой тела и выраженностью хронической венозной недостаточности. Одной из ключевых особенностей патогенеза хронических заболеваний вен у пациентов с избыточной массой тела и ожирением выступает увеличение внутрибрюшного давления, связанного с отложением висцерального жира. В этой ситуации наиболее действенным методом улучшения флебологического статуса выступает бариатрическая хирургия, после которой потеря массы тела коррелирует со снижением клинического класса хронических заболеваний вен. Наряду с бариатрической хирургией рассматриваются возможности фармакотерапии у пациентов с хроническими заболеваниями вен на фоне избыточной массы тела и отягощенным коморбидным фоном. В связи с этим обсуждается роль комбинации гесперидина и диосмина, ранее зарекомендовавшей себя в качестве эффективного флеботропного препарата. Согласно исследованиям, проведенным в последние годы, гесперидин обладает самостоятельными плюрипотентными свойствами, среди которых интерес вызывают механизмы влияния данного вещества на метаболизм липидов со снижением массы тела испытуемых и уменьшением количества висцерального жира. Данный эффект гесперидина после проведения полноценных клинических исследований может быть реализован в различных лечебно-профилактических протоколах по ведению пациентов с хроническими заболеваниями вен на фоне избыточной массы тела и морбидного ожирения. Препарат Венарус® содержит два микронизированных компонента – гесперидин и диосмин в стандартизированных дозировках: 10% гесперидина и 90% диосмина, что может служить аргументом в пользу выбора данного лекарственного средства для терапии пациентов с хроническими заболеваниями вен на фоне ожирения или избыточной массы тела.

This literature review analyzes relationships and correlations between obesity and chronic venous diseases. The search of scien tific publications was carried out in the Cochrane Library, PubMed, Medscape and Medline databases in accordance with the PRISMA guidelines. The review includes only publications, which were particularly relevant to our focus of research and where a significance difference between “experience and control” groups was found based on the results of statistical analysis. All studies included in the analysis defined obesity as a body mass index of 30.0 kg/m2 or more, and overweight as a BMI from 25 to 30 kg/m2 according to the criteria of the World Health Organization. The findings of publication analysis show that excess body weight, and especially obesity, is a major independent risk factor for the development and progression of chronic venous diseases and their complications. In addition, a direct cause-and-effect relationship between body weight and the severity of chronic venous insufficiency was observed. Increased intra-abdominal pressure associated with the visceral fat deposition is one of the key features of the pathogenesis of chronic venous diseases in patients with overweight and obesity. In this context, bariatric surgery, after which weight loss correlates with falling into a lower clinical class of chronic venous diseases is the most effective method for improving phlebological status. Along with bariatric surgery, the pharmacotherapeutic options are considered in patients with chronic venous diseases with underlying overweight and burdened comorbidities anamnesis. In this regard, the role of hesperidin combined and diosmin that have been shown to be most effective phlebotropic drug is discussed. Recent studies demonstrate that hesperidin has independent pluripotent properties, among which the mechanisms of action of this substance on lipid metabolism accompanied by a decrease in subjects’ body weight and visceral fat volume are a matter of interest. After completion of full-fledged clinical studies this action of hesperidin can be implemented in various treatment-and-prophylactic protocols on the management of patients with chronic venous diseases, related to underlying overweight and morbid obesity. Venarus® contains two micronized components hesperidin and diosmin at standardized dosages: 10% hesperidin and 90% diosmin, which can be used as an argument in favour of choosing this drug to treat patients with chronic venous diseases, related to underlying obesity or overweight.

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The authors declare that there are no conflicts of interest present.