THE ASSESSMENT OF COMORBID PATHOLOGY IN CLEAN-UP WORKERS OF THE ACCIDENT CONSEQUENCES AT THE CHORNOBYL NPP HAVING CARDIOVASCULAR DISEASES

Autor: Kursina N, O Bazyka, Bilaya Vv, Z Gabulavichene, O. Kovaliov, Sydorenko Gv, David Belyi, O Nastina
Rok vydání: 2020
Předmět:
Zdroj: Problemy radiatsiinoi medytsyny ta radiobiolohii. 25
ISSN: 2313-4607
Popis: Analysis of comorbid pathology based on the use of methods for its quantitative assessment in personswho were exposed to radiation because of the Chornobyl accident.Comorbid pathology was studied in 608 men, including 420 clean-up workers (CW) of theaccident consequences at the Chornobyl NPP (main group) and 188 non-irradiated persons (control group - CG). Allpatients had cardiovascular diseases as their main pathology and were examined in the cardiology department ofthe NRCRM hospital during 2011-2019. The groups did not differ by age, either at the beginning of the accident orat the time of their last examination. Patients of both groups before the accident were practically healthy peopleand were not registered at the dispensary. The Cumulative Illness Rating Scale (CIRS) was used to quantify comorbid pathology.Comorbid pathology was detected in 418 CW (99.5 %) and 183 patients of CG (99.3 %). The total score inCW (10.3 ± 2.9) units significantly (р = 0.000) exceeded the same index in non-irradiated patients (8.8 ± 3.0) units,as well as the mean number of CIRS categories, whose level severity was 1 point (3.3 ± 1.7 vs. 2.6 ± 1.5, р = 0.000),2 points (1.8 ± 1.0 vs. 1.6 ± 1.0, p = 0.032) and 3-4 points (1.2 ± 0.8 vs. 1.0 ± 0.9, р = 0.062). In contrast, the meanvalue of the categories with zero score, i.e. without diseases, was more common in CG (7.8 ± 1.8 vs. 8.8 ± 1.7,р = 0.000). The most common pathology in CW and CG were heart (98.3 % vs. 94.7 %, р0.05) and vascular diseases(92.9 % vs. 87.8 %, р0.05), followed by diseases of nervous system (79.0 % vs. 57.4 %, р0.001), musculoskeletal system and skin (69.8 % vs. 56.9 %, р0.01), endocrine (56.0 % vs. 49,5 %, р0.05) and the respiratory system (53.8 % vs. 53.7 %, р0.05) and liver (51.2 % vs. 36.2 %, р0.001), which were detected more than in halfpatients of the main group. Diseases of the kidneys (3.3 % vs. 4.8 %, р0.05) and lower gastrointestinal tract(3.3 % vs. 0.5 %, р0.01) were quite rare. The incidence of the other four CIRS categories was 18.6-34 %. The totalscore in subgroups with different ages varied in descending order of mean values as follows: CW65 years (10.5 ± 2.9)units, CW65 years (9.9 ± 2.8) units, CG65 years (9.5 ± 2.8) units and CG65 years (7.8 ± 2.9) units with significant differences both between age subgroups in each of the groups and between CW and CG older subgroups.Quantitative assessment of comorbidity by CIRS showed that in persons irradiated during their emergency work due to the Chornobyl accident, the incidence of combined pathology of such organ systems as cardiovascular, nervous, endocrine, hematopoietic, urogenital, musculoskeletal, gastrointestinal, liver and kidneys wassignificantly higher than in non-irradiated patients. In irradiated patients, the course of comorbid pathology wasmore severe for each system and in general, reflecting higher values of the total CIRS score. Both among CW andnon-irradiated controls, higher values of the total comorbidity score were observed in patients 65 years and older,compared with younger individuals. In both age subgroups of CW the total score was higher than in patients of thecontrol group.Meta: provedennia analizu komorbidnoï patologiï na osnovi vykorystannia metodiv ïï kil'kisnoï otsinky v osib, iakizaznaly radiatsiĭnogo vplyvu vnaslidok avariï na Chornobyl's'kiĭ AES.Materialy ta metody. Doslidzhennia komorbidnoï patologiï provodyly u 608 cholovikiv, iz nykh 420 uchasnykylikvidatsiï naslidkiv avariï (ULNA) na Chornobyl's'kiĭ AES (osnovna grupa) i 188 neoprominenykh osib – kontrol'na grupa (KG). Vsi patsiienty prokhodyly obstezhennia v kardiologichnomu viddilenni kliniky NNTsRM vprodovzh2011–2019 rr. z pryvodu sertsevo-sudynnykh zakhvoriuvan', iaki buly osnovnoiu patologiieiu. Grupy ne rozriznialys'za vikom, iak na pochatok avariï, tak i na moment ostann'ogo obstezhennia. Patsiienty obokh grup do avariï buly praktychno zdorovymy liud'my ta ne perebuvaly na dyspansernomu obliku. Dlia kil'kisnogo analizu komorbidnoï patologiï vykorystovuvaly shkalu otsinky sukupnoï zakhvoriuvanosti (Cumulative Illness Rating Scale – CIRS).Rezul'taty. Komorbidna patologiia vyiavlena u 418 ULNA (99,5 %) i 183 khvorykh KG (99,3 %). Zagal'na suma balivv ULNA (10,3 ± 2,9) od. dostovirno (r = 0,000) perevyshchuvala analogichnyĭ pokaznyk u neoprominenykh patsiientiv(8,8 ± 3,0) od., a takozh i serednie chyslo system CIRS, tiazhkist' patologichnykh staniv iakykh stanovyla 1 bal (3,3 ± 1,7 proty 2,6 ± 1,5, r = 0,000), 2 baly (1,8 ± 1,0 proty 1,6 ± 1,0, r = 0,032) ta 3–4 baly (1,2 ± 0,8 proty 1,0 ± 0,9, r = 0,062).Navpaky, serednie znachennia system z nul'ovym balom, tobto bez zakhvoriuvan', chastishe zustrichalosia v KG (7,8 ± 1,8proty 8,8 ± 1,7, r = 0,000). Naĭbil'sh poshyrenoiu patologiieiu v ULNA i KG buly khvoroby sertsia (98,3 % proty94,7 %, r0,05) ta sudyn (92,9 % proty 87,8 %, r0,05), potim ĭshly zakhvoriuvannia nervovoï systemy (79,0 %proty 57,4 %, r0,001), oporno-rukhovogo aparatu ta shkiry (69,8 % proty 56,9 %, r0,01), endokrynnoï (56,0 %proty 49,5 %, r0,05) i dykhal'noï system (53,8 % proty 53,7 %, r0,05) ta pechinky (51,2 % proty 36,2 %,r0,001), iaki vyiavleni bil'sh nizh u polovyny patsiientiv osnovnoï grupy. Dosyt' ridko zustrichalys' zakhvoriuvannia nyrok (3,3 % proty 4,8 %, r0,05) i nyzhnikh viddiliv shlunkovo-kyshkovogo traktu (3,3 % proty 0,5 %, r0,01).Chastota zustrichal'nosti zakhvoriuvan' inshykh chotyr'okh system CIRS stanovyla 18,6–34 %. Zagal'na bal'na otsinkav pidgrupakh riznogo viku zminiuvalas' v poriadku zmenshennia serednikh znachen' nastupnym chynom: ULNA65 rokiv –(10,5 ± 2,9) od., ULNA65 rokiv – (9,9 ± 2,8) od., KG65 rokiv – (9,5 ± 2,8) od. i KG65 rokiv – (7,8 ± 2,9) od.pry vysokiĭ dostovirnosti vidminnosteĭ iak mizh vikovymy pidgrupamy v kozhniĭ z grup, tak i mizh bil'sh starshoiupidgrupoiu sered ULNA i KG.Vysnovky. Kil'kisna otsinka komorbidnosti za shkaloiu CIRS pokazala, shcho v osib, oprominenykh pid chas robit polikvidatsiï naslidkiv Chornobyl's'koï avariï, chastota zustrichal'nosti poiednanoï patologiï takykh organiv i systemorganizmu, iak sertsevo-sudynna, nervova, endokrynna, krovotvorna, urogenital'na, oporno-rukhova, shlunkovokyshkova, pechinka i nyrky, bula dostovirno vyshcha, nizh u neoprominenykh patsiientiv. V oprominenykh patsiientiv perebig komorbidnoï patologiï buv vazhchym za kozhnoiu systemoiu i v tsilomu, shcho vidobrazhaly bil'sh vysoki znachennia sumarnogo balu CIRS. Iak sered ULNA, tak i neoprominenogo kontroliu bil'sh vysoki znachennia sumarnogo balukomorbidnosti vidznacheni u patsiientiv 65 rokiv i starshe, v porivnianni z osobamy menshogo viku. V obokh vikovykhpidgrupakh ULNA sumarnyĭ bal buv vyshche, nizh u patsiientiv kontrol'noï grupy.
Databáze: OpenAIRE
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