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Buyeverov A.O., Bogomolov P.O.
Non-alcoholic fatty liver disease: substantiation of pathogenic therapy The aim. To present up-to-date views on pathogenesis of non-alcoholic fatty liver disease (NAFLD), that prove management tactics.
Original statements of the review. The NAFLD is divided in two stages: fatty dystrophy (steatosis) of the liver and non-alcoholic steatohepatitis (NASH). NAFLD development is based on insulin resistance phenomenon with decrease sensitivity of tissue receptors to endogenous insulin, that is produced in normal or even increased amount. In pathogenesis of NASH important role is played by oxydative stress, induced by active forms of oxygen. According to pathogenic mechanisms, basic treatment of NAFLD and NASH includes diet low in calories, dynamic physical exercises, insulin-sensitizers (metformin, glitazones). According to the key pathogenic mechanisms application of metabolic agents is justified as well.
Conclusions. NAFLD requires further studying. Its multifactor origin requires complex treatment. Zhdanov K.V., Gusev D.A., Chirsky V.S., Kozlov K.V., Shkuro A.V., Lavrov A.V.
Characteristic of iron metabolism in patients with chronic hepatitis C Aim of investigation. Studying of iron metabolism at patients with chronic hepatitis C (CH С).
Methods. In 111 patients (84 men and 27 women, mean age – 33±1,5 year) serum concentrations of iron, transferrin, ferritin, ceruloplasmin, haptoglobin and total serum iron-binding capacity (TIBC) were investigated. The iron transferrin saturation ratio (TFS) was calculated. Liver biopsy was carried out. Liver biopsy samples were stained by Perls method. Genetic tests for carriage of mutant alleles of hereditary hemochromatosis (HH) gene C282Y and H63D were done.
Results. The level of serum iron was increased in 45,2% of men and 59,3% of women, and serum ferritin – at 60,7 and 51,8% respectively. Moderate negative correlation between iron TFS (%) and hepatitis C virus (HCV) replication activity (мЕ/ml) was found: r = –0,4 (p <0,05). Biochemical parameters varied in relation to stage fibrosis and necroinflammatory activity. Iron was distributed in liver tissue mainly in macrophage line cells as opposite to hemochromatosis. Inflammatory activity and stage of fibrosis in liver tissue were statistically significantly higher in those patients with iron present in liver biopsy samples.
Mutant alleles of HFE gene have been revealed in 25% of patients. Their frequency correlated with parameters of iron overload. The contents of serum iron irrespective of sustained virologic response significantly decreased on a background of modern antiviral therapy. However at the responders this parameter was statistically significantly higher, than at patients with RNA HCV was still detected in 6 months after cessation of treatment.
Conclusions. Iron and ferritin levels in blood serum are elevated in the majority of CHC patients. Serum markers of iron metabolism statistically significantly varied at different stages of disease and in relation to inflammatory activity. Iron in liver tissue was distributed mainly in cells of macrophage lines. Mutations of HFE gene enhanced its accumulation. Elevation of serum iron level, probably, represented compensatory and adaptive reaction of human body to HCV-infection. Kolomoyets A.N., Rybin A.V.
Effect of duphalac on cytokine spectrum in chronic heart failure patients with chronic constipation Aim of investigation. To estimate effect of duphalac on dynamics cytokine profile at patients with chronic heart failure (CHF) with chronic constipation.
Methods. Effect of duphalac on contents proinflammatory cytokines in blood of patients with CHF and chronic constipation was investigated.
Forty patients with ischemic heart disease (IHD), postinfarction cardiosclerosis, I–II functional classes (FC) by NYCH criteria of CHF having chronic constipations (21 males, mean age 67,5±2,4 years; 19 females, mean age 67,7±1,8 years) were investigated. Patients were distributed in 2 groups: patients of the 1st group got complex therapy of basic disease along with 60–100 ml of duphalac per day, patients of the 2nd group – tablets of «dry senna extract» 300 mg per day.
Concentration of proinflammatory cytokines (IL-1a, IL-2, IL-6, IL-8, TNF a) was examined twice: at the beginning of the study and on the 20 day of treatment by duphalac and senadum respectively.
Results. All patients initially demonstrated redundant contents of the majority of proinflammatory cytokines. At patients of the 1st group on a background of normalization of bowel function the significant trend to decrease of contents of the majority of interleukins in blood was revealed. Concentrations of IL-1a remained elevated.
After treatment at patients of the 2nd group no significant changes of proinflammatory cytokines concentration was found.
Conclusions. The role of proinflammatory cytokines – immune system mediators in progression of heart failure and options of duphalac treatment of endogenous intoxication signs caused by chronic constipations is confirmed. During complex treatment duphalac promotes decrease of the contents of proinflammatory cytokines in blood. Vertkin A.L.,. Vovk Ye.I, Naumov A.V., Shamuilova M.M., Ivanov V.S., Filimonov V.S., Otpuschenko A.V.
Treatment and prophylaxis of gastro-intestinal mucosa lesions in therapeutic practice The aim of review. To characterize etiological factors, features of pathogenesis, clinical pattern, approaches to treatment and prophylaxis of gastro-intestinal bleedings (GIB) in patients with ischemic heart disease (IHD).
Basic statements. Acute erosions or ulcers of the stomach and duodenum, that led to GIB in patients died of myocardial infarction or aortic aneurysm dissection, are revealed in 21% of the cases. Among mortality causes at ambulance therapeutic hospital patients GIB frequency at acute diseases of the heart and aorta is 8 %. The key factors, leading to GIB at patients with IHD, first of all - at the acute stage of myocardial infarction, include Helicobacter pylori infection and nonsteroid anti-inflammatory drugs-related gastropathy (NSAID-related gastropathy).
The risk of NSAID-related gastropathy is the highest among patients with peptic ulcer in the past history, over 65 years of age and taking corticosteroid drugs. Respiratory failure, coagulopathy, assisted pulmonary ventilation for more than 48 hs are independent factors of the highest risk of GIB at patients in critical state with no relation to the basic disease. Adequate antisecretory therapy allows to cope with at least three challenges: to stop active bleeding, to prevent its relapse and GIB in general. On the basis of results of evidence-based studies, proton pump inhibitors are recognized to be optimal by antisecretory activity, time of effect onset, absence of resistance, safety and simplicity of application at patients with GIB (grade of evidence А).
Conclusion. GIB bring essential impact to the pattern of mortality at patients with cardio-vascular pathology. Unique efficient strategy of their prophylaxis at high risk patients is prescription of proton pump inhibitors. Denisov N.L.
Local immune system and peptic ulcer of the stomach Aim of investigation. To study a state of the first (secretory immunoglobulin – sIgA) and the second line of local immune defense of the stomach mucosa (SM) – IgA, IgG, lymphoplasmacytic infiltration (LPI), neutrophilic infiltration (NI), features of general immune system in relation to morphological changes of the SM and contagious factor at peptic ulcer of the stomach (PUS).
Methods. Overall 58 patients with PUS were investigated. Group of comparison included patients with chronic multifocal atrophic gastritis (CMAG) (n=31). The control group included 27 generally healthy people. During gastroscopy gastric juice aspiration and SM biopsy at the antral region and body was carried out for assessment of concentration IgA, IgG and sIgA. Parameters, describing SM were studied: pre-
sence and severity of atrophy, LPI and NI density. Results were estimated from 0 to 3 points. Presence of infection and density of Helicobacter pylori contamination was estimated in smears-impresses (0 to 4 points).
Results. PUS patients demonstrated high levels of sIgA concentration, significantly exceeding control and over 2 times higher than level of this immunoglobulin at patients with CMAG (0,380±0,022, 0,280±0,024 and 0,180±0,015 g/l respectively). Н.pylori investigation at PUS, CMAG and in control group has shown significant quantitative differences both in frequency of SM infection, and in density of Н. pylori contamination as 87 % and 3,20±0,24 points, 94% and 1,90±0,15 points, 32% and 0,63±0,18 points respectively. This observation has confirmed development of different state of sIgA production in response to Н. pylori-infection at CMAG .
LPI of the SM in all groups significantly exceeded control values. Maximal 10-fold increase over control (2,50±0,15 and 2,5±0,1 vs 0,270±0,06) was revealed at PUS patients. No effect of SM atrophy on the level of infiltration was found. The NI level at CMAG also exceeded that in control group, however it was considerably (almost 5-fold) lower than at PUS with 2–3 point SM atrophy. Positive correlation between sIgA and IgA concentration in gastric juice (r=0,44, р=0,026) was revealed in the control group. At CMAG (r=0,08) and PUS (in both subgroups irrespective of atrophy degree r=0,2 and r =–0,04) it was lost. Absence of interrelation between sIgA and IgA contents in main group and comparison group was accompanied by negative correlation between sIgA and IgG levels: r=–0,48, р=0,008; r=–0,58, р=0,04 and r=–0,62, р=0,002 respectively. Besides, negative correlation between sIgA level and NI severity (r =–0,8, р=0,01 and r=–0,51, р=0,01) was typical for PUS patients.
Conclusion. Chronic inflammation in the stomach develops and progresses at close interaction of three major factors: immune, contagious and morphological. At PUS Н. pylori aggressive potential is realized at the state of altered mutual relations between basic functions of local immunodefence: immune exception (sIgA) and immune elimination of the SM. Their activity, in turn, depend upon severity of SM atrophy. Changes of local immunodefence at PUS are characterized by strong increase of activity of immune elimination function as manifold increase in NI and development of negative correlations between NI and immune exception function. At patients with CMAG, despite of very high frequency of Н. pylori infection, fervent depression of immune exception function, combined with low activity of immune elimination function is observed. Higher attestation commission
Thesis abstracts: information from the Higher attestation commission Bueverov A.O.
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