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Issue. Articles

2(49) // 2016

 

 

1. Original researches

 

The reasons for the ineffectiveness of antihypertensive therapy in patients with uncomplicated hypertension in real life setting

.. Amosova, Yu.V. Rudenko

O.O. Bogomolets National Medical University, Kyiv

Objective — to compare the clinical and demographic data, office and home blood pressure (BP), antihypertensive treatment regimens and adherence to treatment in patients with uncomplicated hypertension (UH), depending on the achievement or failure to achieve the target office BP (< 140/90 mm/Hg) after 6 months of stepwise algorithmic therapy in real life setting.
Materials and methods. The analysis included data of 443 patients with UH. The stepwise unified algorithm of treatment included the initial administration of the fixed drug combination of perindopril and amlodipine, and if the target BP level was not achieved, the subsequent administration of the indapamide retard, spironolactone, moxonidine or doxazosin  as needed. Office and home BP was measured with the use of the certified automatic oscillometric device. The treatment compliance was assessed with the use of questionnaire.
Results and discussion. After 6 months of treatment, the target office BP was achieved in 355 (80.1 %) patients
(1st group) and wasn’t achieved in 88 (19.9 %) patients (2nd group). In the 2nd group,  males prevailed (p < 0.01), as well as persons with baseline systolic BP ≥ 180 mm/Hg ( < 0.001) and HR ≥ 80 per minute ( < 0.2). Moreover, in this group the proportion was lower of subjects with newly diagnosed hypertension (p < 0.03), with higher baseline office BP (p < 0.001) and HR ( < 0.02). In patients of the 2nd group, levels of office and home BP throughout the study were higher than in the first (all p < 0.001). In 506 from 1004 visits to doctor, on which office BP exceeded the target values,  in 50.4% of all patients and in 45.4 and 58.4 % in the first and second groups, respectively (p < 0.01 ), doctors did not make a decision on enhancement of therapeutic interventions.  Only fixed combination of perindopril and amlodipin was administered to 52.3 % of patients with inadequate BP control level at the end of the study,  however, it’s maximal dose and 4 antihypertensive drugs were more often used  in patients of the 2nd group, than in the 1nd group. The proportion of people with high compliance level significantly increased in both groups of patients. With the comparable initial compliance in both groups, the proportion of subjects with high compliance was lower in the 2nd group, and with lower compliance was greater vs the 1nd group (p < 0.01).
Conclusions. Inadequate control of office BP despite of 6 months of algorithmic antihypertensive therapy in patients with UH in routine clinical practice was associated with male gender, higher BP and HR at rest, therapeutic inertia and worse treatment compliance.

Keywords: blood pressure, home blood pressure, hypertension, therapeutic inertia, treatment compliance.

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Original language: Ukrainian

2. Original researches

 

The possibilities of prediction and prevention of cardiovascular disease and type 2 diabetes mellitus comorbidity in a population of subjects with high cardiovascular risk

G.D. Fadieienko, A.O. Nesen, O.V. Babenko

SI «National Institute of Therapy after L.T. Mala of the NAMS of Ukraine», Kharkiv

Objective — to assess the structure of comorbidity of the coronary heart disease (CHD), arterial hypertension (AH) and type 2 diabetes mellitus (DM 2) in the population with  high cardiovascular risk (CVR), and to evaluate the risk factors’ level and prognosis.
Materials and methods. The study involved 1041 patients with comorbidity of CHD and AH who underwent inpatient treatment in the SI «National Institute of Therapy named after L.T. Mala of NAMS of Ukraine. All patients were divided based on gender: 624 (59.9 %) males and 417 (40.1 %) females, mean age (57.4 ± 8.19). To verify subjects with increased CVR, the European guidelines (ESC/EAS, 2011) and the recommendations of the Ukrainian Association of Cardiology (2012) for the prevention and treatment of cardiovascular diseases were used. The CVR calculation was performed using Riskcalculator (CV-Risk and Prevention); the comorbidity index was calculated with the use of the Charlson technique (ME et al.). The verification of the metabolic syndrome and type 2 DM was based on the criteria of the International Diabetes Federation (2005, 2011).
Results and discussion. As a result of survey of 1041 patients with CHD, AH and high CVR, the high incidence of 27.8 % of the concomitant type 2 DM was established. The presence of obesity (IMT ≥ 30.0 kg/m2) was revealed in 52.1 % in the group of patients with CHD, AH and concomitant type 2 DM, and in 39.4 % of subjects in the group without type 2 DM. The waist circumference was higher than 94 cm in males and 80 cm in females in 73.3 % of persons with type 2 DM and 66.4 % of those without type 2 DM. The comorbidity of CHD with hypertension and obesity was associated with a significant increase in index of comorbidity, the risk of concomitant liver and biliary tract diseases, disorders of carbohydrate metabolism, as well as the risk of cardiovascular events in patients with established type 2 DM. In the group of persons with CHD, AH and concomitant type 2 DM, 68.5 % of patients assessed their physical activity as a low (duration of physical exercises less than 4 hours per week); in the group of patients with CHD, AH and without type 2 DM this parameter was 61.3 %, p = 0.032. The fact of tobacco smoking was indicated by  8.6 and 8.8 % of subjects, respectively, p > 0.05.  In patients with type 2 DM it were found the higher levels of triglycerides and very low density lipoproteins cholesterol, low levels of high-density lipoprotein cholesterol, that stipulates the higher values of atherogenic factor, which was (3.77 ± 0.09) in persons with type 2 DM and (3.50 ± 0.08) in those without type 2 DM (p = 0.03). The normal lipids levels were established only in 4.8 % of patients with concomitant type 2 DM and in 11.3 % of those without type 2 DM. Based on the established peculiarities of risk factors, the criteria for assessment of the individual prognosis for the DM 2 were defined for the patients with CHD and AH, and in compliance with them, the questionnaire have been elaborated for the stratification of groups of patients with the risk of CHD, AH and DM 2 comorbidity in the population with the high CVR.
Conclusions. The possibility of stratification of group of patients with the risk of type 2 DM in patients with cardiovascular pathology and high CVR is important within the frameworks of preventive medicine, timely administration of the treatment and lifestyle modifications,  enabling prevention of the progression of the metabolic abnormalities and vascular complications.

Keywords: comorbidity, risk factors, coronary heart disease, hypertension, type 2 diabetes mellitus, prediction, prevention.

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Original language: Ukrainian

3. Original researches

 

Platelet hemostasis and dual antiplatelet therapy in patients with coronary artery disease combined with type 2 diabetes mellitus

S.A. Serik, T.G. Ovrakh

SI «National Institute of Therapy named L.T. Mala of NAMS of Ukraine», Kharkiv

Objective — to study the specific effects of dual antiplatelet therapy on platelet hemostasis parameters in patients with coronary artery disease (CD) in combination with type 2 diabetes mellitus (DM) after acute coronary syndrome (ACS) taking into account carbohydrate and lipid metabolism.
Materials and methods. The study included 48 patients with CAD, who suffered from ACS (6 ± 2) weeks before the inclusion in the study, and were administered dual antiplatelet therapy (acetylsalicylic acid (ASA) 75—100 mg/day and clopidogrel 75 mg/day). From them, 30 patients had DM and 18 were patients without DM. The comparison group consisted of 30 patients with CAD (15 patients with DM and 15 patients without DM), who only ASA 75—100 mg/day.  Control group involved 15 people without DM and CAD, who were not taking antiplatelet medicines. Platelet hemostatic parameters (platelet count, mean platelet volume (MPV), platelet distribution width (PDW), adenosine diphosphate (ADP)/arachidonic acid — induced platelet aggregation), carbohydrate metabolism (fasting glucose, glycosylated hemoglobin (HbA1c), insulin, HOMA-IR), lipid metabolism (total cholesterol, triglyceride, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol) were estimated.
Results and discussion. It has been established, that the mean platelet volume (MPV) in patients with CAD combined with DM after ACS during dual antiplatelet therapy was higher than in patients without diabetes, with no differences in platelet count. Dual antiplatelet therapy effectively blocked ADP-induced platelet aggregation in CAD patients after ACS regardless of the presence of DM, while arachidonic acid-induced aggregation in patients with diabetes was depressed less than in patients without DM. Positive correlation between the HbA1c level and total index of platelet aggregation — arachidonic acid (r = 0.39, p = 0.05), MPV and HbA1c (r = 0.35, p = 0.05), MPV and LDL cholesterol (r = 0.61, p = 0.03) and total cholesterol and total index of platelet aggregation — ADP (r = 0,49, p = 0.05) was found only in patients with CAD combined with DM who have had recent ACS and were on dual antiplatelet therapy.
Conclusions. The signs of the greater residual platelet reactivity have been established in patients with CAD and DM after ACS and under the dual antiplatelet therapy with ASA and clopidogrel, as compared to the patients without DM. Obviously, residual platelet reactivity depends considerably on hyperglycemia and hypercholesterolemia in patients with DM only with ACS, while in patients with DM with the stable CAD these factors play less significant role in platelet activation increase.

Keywords: coronary artery disease, type 2 diabetes mellitus, acetylsalicylic acid, clopidogrel, platelet.

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Original language: Ukrainian

4. Original researches

 

Lipidlowering effect of atorvastatin depending on the polymorphism of Xbal locus of the gene receptor to estradiol in perimenopausal women

G.S. Isayeva, L.A. Reznik, M.M. Vovchenko, O.A. Buryakovska, O.V. Goptsii

SI «National Institute of Therapy named after L.T. Mala of NAMS of Ukraine», Kharkiv

Objective — to study the relationship between polymorphism of gene a-receptor to estradiol and efficacy of the lipid-lowering atorvastatin therapy in perimenopausal women.
Materials and methods. Investigation involved 147 women with high and very high cardiovascular risk. The detection of alleles of the polymorphic loci XbaI (rs9340799; A/G; xx/XX) of gene ESR1 were performed with PCR method with the thermocycler «Tercyc» («DNA-technology») with subsequent electrophoretical analysis of the polymorphism of the restriction fragments’ length. Blood lipid spectrum was analyzed with enzymatic method with the use of ormay laboratory kits (Poland). The daily atorvastatin dose depended on the presence of the coronary heart disease (CHD): patients with CHD received 40 mg atorvastatin daily, without CHD in a dose of 20 mg daily. The statistical analysis of the data was conducted using statistical software package SPSS 21 (IBM), Microsoft Office Exel-­2003.
Results and discussion. The most significant reduction of cholesterol of very low density lipoproteins (Cl VLDL) was revealed in patients with GG genotype of the polymorphic loci XbaI of gene ESR1. Women with the established AG genotype of the polymorphic loci XbaI of gene ESR, also demonstrated the considerable Cl VLDL reduction in the dynamics of atorvastatin treatment. No significant Cl VLDL reduction in the dynamics of therapy was defined in patients with the established AA genotype. Among patients with genotype, only 57.9 % of subjects achieved the target Cl VLDL levels, in the group of AG genotype this portion was 62.1 %, while in the group with GG genotype, the target Cl VLDL level was achieved in  91.6 % of patients.
Conclusions. The presence of GG genotype of the polymorphic loci XbaI of gene ESR1 was associated with the most significant lipid-lowering effect of atorvastatin.

Keywords: women, dyslipedemia, estradiol, estradiol receptors, atorvastatin.

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Original language: Ukrainian

5. Original researches

 

Comparative clinical and biochemical characteristics of arterial hypertension and its comorbidity with gastroesophageal reflux disease

.. Gridniev

SI «National Institute of Therapy named after L.T. Mala of NAMS of Ukraine», Kharkiv

Objective — to identify possible differences between the clinical manifestations and some biochemical parameters in the course of isolated arterial hypertension and its comorbidity with gastroesophageal reflux disease.
Materials and methods. The study included 126 patients with gastroesophageal reflux disease (GERD) in combination with arterial hypertension (AH) stage 2, —, degrees and 95 patients with isolated AH stage 2,  
— degrees. The control group consisted of 20 healthy individuals. Determining the stage and grade of arterial hypertension was performed according to the clinical guidelines for hypertension ESN/ESC (2013). The diagnosis of GERD was established according to the Montreal Consensus (2006). Anthropometric measurements were performed with standard conventional method. The standard techniques were used to assess lipid peroxidation (LPO) processes and antioxidant system based on the levels of malonic dialdehyde, SH-groups, glutathione peroxidase. The lipid profile was evaluated based on the measurements of blood serum levels of total cholesterol (TCl), cholesterol of high density lipoproteins (HDL), triglycerides, with the use of standard techniques with consequent calculations of the Chl of low and very low density (LDL and VLDL).
Results and discussion. Patients with isolated AH had greater BMI than patients with comorbid GERD and AI), and more often demonstrated of very high risk. Patients in both groups revealed the presence of abdominal obesity, while in the group with comorbid disorders, it was more pronounced in females and in the group with isolated AI in male patients. Patients with concomitant GERD and AH more often that patients with isolated AH, complained on the dizziness, general weakness and fatigue, palpitations and disruption of the heart. In case of combination with GERD, the AH in male patients was of mild degree, whereas in case of isolated AH, male patients had more severe hypertension. The LPO process and antioxidant protection in both groups of patients had significant differences (p < 0.05) from that of the control group. However, in patients with isolated AH, the malonic dialdehyde level was significantly higher (p < 0.01) than in patients with a combination of GERD and AH, and levels of SH-groups and glutathione peroxidase were lower. Thus, isolated AH course vs the combined GERD and AH, resulted in more pronounced activation of the LPO process against the background of the torpidity of antioxidant defense system. At combined GERD and AH course in female patients, in contrast to male subjects, the less imbalance ( < 0.01) was revealed in the ratio of the processes and LPO and AOD system, and the system preserved the relative equilibrium and balance. In the groups with isolated AH, no significant gender-related differences in the parameters of LPO-AOD were revealed. The changes, revealed in both groups, testify the exhaustion of the antioxidants’ system   against the background of gradual increase of the LPO levels. Patients with combined GERD and AH, has significantly more favorable lipid profile ( < 0.01) than in patients with isolated AH, and respectively, the lower atherogenic factor.
Conclusions. Patients with combined GERD and AH, compared to the patients with isolated arterial hypertension, had more frequent complaints of dizziness, general weakness and fatigue, heart palpitations, and cardiac disruptions. Patients with the isolated AH demonstrated more pronounced imbalance in the LPO-AOD system in comparison with the subjects with combined GERD and AH, with LPO processes activation against the background of the reduction of antioxidants’ parameters, that promoted formation of oxidative stress and was particularly evident in case of AH duration of more than 10 years. The male patients with combined GERD and AH had less pronounced excessive body mass and abdominal obesity, than female patients, and respectively, milder degrees of hypertension. Whereas at the isolated AH, the male patients has more pronounced abdominal obesity and excessive body mass, and correspondingly, more severe AH degrees. It has been shown that patients with combined GERD and AH had more favorable lipid profile, than subjects with isolated AH.

Keywords: arterial hypertension, gastroesophageal reflux disease, lipid peroxidation, antioxidant protection.

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Original language: Russian

6. Original researches

 

The polymorphism 825t (rs5443) of b3-subunit G-protein gene and heart failure

S.M. Pivovar1, Yu.S. Rudyk1, A.S. Popovich1, O.V. Vysotskaya2, G.M. Strashnenko2

1 SI «National Institute of Therapy named after L.T. Mala of NAMS of Ukraine», Kharkiv
2 Kharkiv National University of Radio Electronics

Objective — to determine the prevalence and impact of polymorphism C825T (rs5443) of G-protein b3-­subunit gene on the course of heart failure.
Materials and methods. 170 patients with heart failure were included to study. The clinical course of the disease was assessed. The intracardiac hemodynamics was evaluated with Doppler echocardiography. Molecular-genetic study of polymorphism C825T (rs5443) gene GNB3 (G-protein) b3-­subunit was performed in the laboratory of biochemical and immunoassay research methods of clinical morphology. Peripheral blood leukocytes of patients were  used as a material for molecular genetic investigations. Extraction of the genomic DNA from white blood cells for molecular genetic studies was carried out using a commercial kit DNA Sorbo-In (Amplias Sense, Russia) according to the instructions. The primer sequences were used for PCR.
Results and discussion. From 170 patients with heart failure, 80 were homozygous for the wild allele S825 (CC). 11 patients had two mutated alleles T825 (TT). 79 patients with heart failure were heterozygotes (C825T) (CT). C-allele carriers (homozygous and heterozygous) had a greater age to under-development of heart failure ((65.9 ± 10.6) years) compared to homozygous carriers of the T-allele ((59.3 ± 7.8) years) (p < 0.05). Also, the C-allele carriers (homozygous and heterozygous) had lower levels of blood monocytes (4.1 ± 1.9) compared to homozygous carriers of the T-allele (6.3 ± 4.5) (p < 0.001). Patients who are homozygous carriers of the T-allele (TT) have the highest frequency of abnormal blood creatinine (18.2 %)
at the same time homozygous carriers of the C-allele (CC genotype) had a deviation of blood creatinine only 13.7 %.
Conclusions. The prevalence of polymorphic variations C825T (rs5443) gene of G-protein b3-­subunit among patients with heart failure was determined. 47.1 % of patients are homozygous carriers of «wild» C825 allele, 46.5 % of patients — heterozygotes (C825T), 6.5 % of patients are homozygotes for «mutated» allele (C825T). Carriers of «mutated» T-allele gene of b3-­subunits of G-protein have younger age of heart failure development ((59.3 ± 7.8) years) compared to patients with CC genotype ((65.9 ± 10.6) years) and higher level of blood monocytes (6.3 ± 4.5 to 4.1 ± 1.9 (p < 0.001)). Patients who are homozygous carriers of the T-allele (TT) have higher frequency of abnormal blood creatinine (18.2 %) in contrast to homozygous carriers of the C-allele (13.7 %).

Keywords: heart failure, clinical course, gene polymorphism, G-protein, b3-subunit.

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Original language: Ukrainian

7. Original researches

 

Comparative efficacy and safety of the hypotensive therapy with amlodipine versus valsartan

.O. Yakovleva, O.V. Kyrychenko

National Pirogov Memorial Medical University, Vinnytsya

Objective — to improve therapy of hypertensive patients by means of investigation of the effects of antihypertensive treatment with amlodipine vs valsartan on serum homocysteine level.
Materials and methods. The study involved 67 patients with EH I—III stages, aged (58.29 ± 0.84) years. Patients were randomized into two clinical groups. Patients of the 1st clinical group (n = 33) were treated with amlodipine, and patients of the 2nd group (n = 34) were administered valsartan and diuretic as needed. Control group consisted of
34 healthy individuals. The effectiveness of antihypertensive therapy was determined by blood pressure daily monitoring. The total Hcy level was determined by ELISA set Homocysteine EIA before and after treatment. The follow up duration was three months.
Results and discussion. The average SBP decrease against the background of antihypertensive therapy was
(25.94 ± 0.93) mm Hg in the 1st clinical group and (25.81 ± 0.67) mm Hg in subjects of the 2nd group. Three months therapy resulted in the average DBP reduction in the 1st and 2nd groups by (13.21 ± 0.68) and (16.27 ± 0.59) mm Hg respectively (p < 0.05). The BP variability reduction has been also established, particularly for SBP it was by 13.02 and 19.41 % (p < 0.05) in the groups of amlodipine and valsartan pharmacotherapy, respectively. Serum Hcy elevation has been revealed in patients of both clinical groups vs control group, by 35.7 and 37 % respectively. The comparison of the baseline  and re-Hcy concentrations in patients and clinical groups did not show their  dynamic changes ((14.3 ± 0.97) vs (13.8 ± 0.84) mmol/L; p > 0.05). There was no significant differences in serum Hcy levels in patients after three months of valsartan pharmacotherapy ((14.6 ± 1.09) vs (13.6 ± 0.89) mmol/L; p > 0.05).
Conclusions. Three months of valsartan administration to hypertensive patients resulted in the reduction of both daily systolic and diastolic blood pressure, its effects probably did not differ from those of amlodipine therapy. Serum homocysteine elevation was observed in hypertensive patients compared to healthy individuals. It has been established that nor valsartan, neither amlodipine did not significantly changed serum homocysteine levels, thus it is advisable to combine the additional antihypertensive therapy with pharmacological correction of hyper-homocysteinemia.

Keywords: hypertension, hyperhomocysteinemia, homocysteine, valsartan, amlodipine.

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Original language: Ukrainian

8. Original researches

 

Changes in the parameters of cardiac relaxation in patients with type 2 diabetes mellitus with previous non-Q-wave myocardial infarction against the background of treatment with alpha-lipoic acid and zinc sulfate

N.V. Altunina

O.O. Bogomolets National Medical University, Kyiv

Objective — to estimate the parameters of cardiac relaxation in patients with type 2 diabetes mellitus (DM) with previous non-­Q-wave myocardial infarction (non-­Q­-MI) and their dynamics during treatment with alpha-lipoic acid (ALA) and zinc (Zn) sulfate.
Materials and methods. The study involved 44 patients (mean age 61.34 ± 1.56 years) with type 2 DM and previous non­-Q-­MI. In addition to the basic treatment, they received 600 mg of ALA/day and the Zn sulfate 248 mg/day. The duration of treatment was 4 months. The echocardiography with assessment of diastolic heart function parameters was performed to all patients at baseline and after the treatment completion.
Results and discussion. It has been established that LV diastolic dysfunction (LV DD) in patients with type 2 DM and non-­Q­-MI was predominantly of type I (65.9 %), type II was established in 29.5%, and type III in 4.6 % of patients. The impairment of right ventricular (RV) relaxation by type I was observed in 79.5 % and by type II in 15.9 %. The normal RV relaxation was revealed only in 4.6 % of examined patients.
The use of ALA and Zn sulfate treatment resulted in the significant decrease of proportion of patients with type
LV DD — by 18.2 % ( < 0.05), and increase of proportion of subjects with normal LV DD by 9.1 % ( < 0.05); besides, proportion of patients with type RV DD decreased by 13.6 % ( < 0.05). and portion of patients with normal RV DD increased by 20.4 % ( < 0.01).
Conclusions. Diastolic dysfunction of LV was established in all patients with type 2 DM who had non-Q-MI, and were mainly represented by I and II types with a small percentage of restrictive DD. Impairment of RV relaxation was found in 95.4 % of investigated patients with a significant predominance of type I DD and absence of restrictive DD. The 4-month treatment with ALA and Zn sulfate of patients with type 2 DM and previous non-­Q-MI resulted in the improvement  of diastolic function of both left and right cardiac chambers.

Keywords: diastolic dysfunction, type 2 diabetes mellitus, non-Q-wave myocardial infarction, alpha-lipoic acid, zinc sulfate.

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Original language: Ukrainian

9. Original researches

 

The peculiarities of changes in the immunological reactivity in patients with rheumatoid arthritis combined with arterial hypertension and its changes under the influence of different types of treatment

V.S. Pekhenko

O.O. Bogomolets National Medical University, Kyiv

Objective — to investigate the peculiarities of changes in immunological reactivity in patients with rheumatoid arthritis (RA) combined with arterial hypertension (AH) and its changes under the influence of different types of treatment.
Materials and methods. The study involved 89 RA patients who were distributed into three groups depending on the degree of activity and the type of RA treatment, and 20 healthy individuals.
Results and discussion. Observations in the dynamics of patients of the first group demonstrated the increase in the number of -lymphocytes (T-L) in 1.8 times vs baseline values (p < 0.05). Moreover a tendency to the optimization of the major subpopulations of T-L was observed with the iteration of the main immunoregulatory factor (MIRF) to the values of healthy subjects. Investigations of the lymphocytic functional activity in blast transformation reaction (RBTL) showed the decrease in the T-L functional activity in relation to the performance of healthy individuals in 1.09 times
(p < 0.05). It was found that the functional activity of B-lymphocytes (B-L) in response to mitogen stimulation exceeded indicators of healthy individuals in 1.28 times (p < 0.05).
In the second group, 6 months of treatment resulted in the increase of T-L levels in 1.09 times vs baseline values
(p < 0.05). Furthermore, the reduction of T-helpers (T-h) was established, with MIRF optimization towards its reduction by 91.93 % vs the baseline value. However, this index was higher than in healthy subjects. The reduction in B-L levels vs baseline values by 12.86 %, and this parameter was close to the values in the control group. The values of T-killers remained virtually unchanged and was lower than in healthy subjects.  
In the third group, after 3 and 6 months of the study, the trend was observed to the increase of T-L levels vs baseline values, however these changes were not statistically significant. The MIRF increase in 2.43 times and a trend to the raise of natural killers CD16+ vs baseline values was established. The B-L level exceeded the baseline levels in 1.23 times (p < 0.05), and parameters in healthy subjects in 1.34 times (p < 0.05).
Regarding the changes in indicators of activity of humoral immunity, the following results were obtained. In the first group 6 months of treatment resulted in the increase of the immunoglobulins (Ig, IgG) vs the baseline levels  with decrease of the Ig and Ig levels by 10.22 % and 21.21 % (p < 0.05), respectively, and levels of the circulating immune complexes (CIC) by 22.66 % (p < 0.05). In the second group, Ig, IgG levels increased by 10.75 and 8.67 % vs baseline (p < 0.05) respectively. At the same time, the reduction in the Ig and Ig levels by 11.11 % and 54.59 % (p < 0.05), respectively, was observed, vs the baseline. However, these parameters were higher than in healthy subjects. CIC levels decreased by  25.08 % (p < 0.05) vs baseline.
In the third group, the trend was defined to the increase of the Ig levels vs baseline in 1.08 times with the unchanged levels of IgG, Ig and  Ig. CIC levels exceeded parameters for healthy subjects in 3.19 times (p < 0.05).
Conclusions. It has been established that indices of the cellular immunity were considerably improved in the group of patients, received combined treatment with Methotrexate and Infliximab, in comparison with the groups treated with Methotrexate only.

Keywords: rheumatoid arthritis, hypertension, cellular immunity, humoral immunity.

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Original language: Ukrainian

10. Original researches

 

Effect of estradiol on the changes of lipid profile in patients with hypertension and type 2 diabetes mellitus in postmenopausal period

L.V. Zhuravlyova, T.S. Butov

Kharkiv National Medical University

Objective — t study estradiol effects on the lipid profile (LP) in postmenopausal patients with arterial hypertension (AH) and type 2 diabetes mellitus (DM 2).
Materials and methods. The examinations involved 106 postmenopausal women with AH and DM 2.
All patients were aged 45 to 60 years in early post­menopausal stage. The control group included 31 women in early post­menopause with comparable characteristics by age.
Examinations included determining  of the venous blood estradiol levels, LP including triglycerides (TG), total cholesterol (TC), HDL-cholesterol (HDL-C) and cholesterol of low density lipoprotein (LD), determined with enzymatic method, as well as correlation between them.
Results and discussion. The analysis of LP and estradiol indices in the investigated subjects revealed significant changes in all groups of patients. The study of correlation between estradiol and LP resulted in the positive relationship between the estradiol and HDL, and negative correlation between estradiol and TC, LDL, TG.
Conclusions. Postmenopausal women with 2—3 AH stage, DM 2 and combined pathology (2—3 AH stage and DM 2) demonstrated disorders of lipid exchange against the background of significant changes of the venous blood levels of estradiol.

Keywords: hypertension, diabetes, lipid profile, estradiol, postmenopausal.

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Original language: Ukrainian

11. Original researches

 

Acute coronary syndrome with ST segment elevation: the predictor of in-hospital mortality

S.V. Korol

Ukrainian Military Medical Academy, Kyiv

Based on the results of the prospective survey STIMUL (ST Elevation Myocardial Infarction in Ukraine and Its Mortality Rate), which involved 1103 patients with acute coronary syndrome with ST segment elevation, the independent prognostic factors of the unfavorable in-hospital disease course  have been established. They included age, female gender, Killip heart failure classes at admission, systolic blood pressure < 100 mm Hg, heart rate > 100 b/min, hemoglobin levels < 100 g/l, glomerular filtration rate of 65 ml/min and lower, troponin ≥ 8 ng/ml, non-performed reperfusion therapy, history of the signs of congestive heart failure.

Keywords: acute coronary syndrome with ST segment elevation, register, predictors, in-hospital mortality.

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Original language: Ukrainian

12. Original researches

 

The role of nitric oxide biologically active compound in the development of arterial hypertension and its complications

N.M. Gorobets

O.O. Bogomolets National Medical University, Kyiv

Objective — to investigate the role of the nitric oxide biologically active compound in the development of arterial hypertension and its complications.
Materials and methods. The study involved 64 patients with arterial hypertension (AH) aged 26 to 70 years (the mean age (49.1 ± 3.02) years), among whom there were 36 men and 28 women. Patients with AH, at whom liver and kidney dysfunction, diabetes mellitus and heart failure of IIB—III stages were revealed at the time of the survey, were not included in the study. The complaints, medical history, genetic predisposition, social status, availability of unhealthy habits were assessed in all patients. Body mass was measured and the body mass index (BMI) was determined. The following laboratory investigations were performed: routine blood biochemistry and urine tests, bilirubin levels, ALT, AST, creatinine, urea, fibrinogen, blood sugar, blood lipid spectrum, nitric oxide stable metabolites and their ratio; indexes reflecting the microalbuminuria severity: NAG (KF 3.2.1.52) activity and the  b-2 M contents in the urine were assessed from the labora­tory studies. NO was defined by the concentration of its stable metabolites – nitrites (NO2) and nitrates (NO3) in the citrated blood by the spectrophotometry with the Griess reagent with the sulfanilic acid and 1-napthyla­mine. The instrumental investigations included ECG, echocardiogram and daily blood pressure monitoring. The the ECG investigations, performed to all patients, included the LVH evaluation with the use of Sokolow—­Lyon and Minnesota Code criteria.
Results and discussion. In the group of AH patients, the NO2 level (NO’s first metabolite) was lower by 61.11 % as compared with the indexes in the group of almost healthy individuals. NO3 levels in AH patients were lower by 43.65 % compared to almost healthy individuals. The sum of NO2 + NO3 was considerably lower (by 51.39 %) in the examinees with hypertension than in the control group. The NO2/NO3 ratio was lower by 28.57 % in the group of AH patients vs healthy controls. The NO2 percentage in the total amount of NO’s stable metabolites was lower by 21.05% in patients with hypertension compared to the healthy subjects.
Conclusions. As a result of the study of patients with arterial hypertension, the reduction of all parameters, characterizing the NO metabolism has been established, suggesting the deficiency of NO in their organism. The revealed endothelial NO deficiency may be caused by a number of factors, with the most significant ones are: the reduction of NO synthesis in endothelial NOS; lack of coenzymes or substrates for NO synthesis; inactivation of NO by free radicals; increase in the synthesis of endogenous inhibitors of NO synthase.

Keywords: arterial hypertension, endothelial dysfunction, nitric oxide.

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Original language: Ukrainian

13. Original researches

 

The impact of the modified and unmodified factors on the severity of the atherosclerotic lesions of the coronary arteries in patients with coronary artery disease, depending on the presence of type 2 diabetes mellitus

N.. Lopina

Kharkiv National Medical University

Objective — to assess impact of the modified and unmodified risk factors on the severity of atherosclerotic lesions of the coronary arteries in patients with coronary artery disease (CAD) depending on the presence of type 2 diabetes mellitus (T2DM).
Materials and methods. Examinations involved 131 patients with CAD (89 men, 42 women), mean age of
(59.6 ± 9.11) years. Depending on the presence of T2DM, patients with CAD were divided into 2 groups: 1 group
(n = 70) — patients with concomitant T2DM, 2 group (n = 61) — patients with CAD without concomitant T2DM. To verify CAD diagnosis, coronary angiography was performed to all patients. Other investigations included measurement of the levels of total cholesterol, high density lipoproteins (HDL), low density lipoproteins, very low density (VLD) lipoproteins, triglycerides (TG), indicators of long and short term glycemic control, body mass index.
Results and discussion. The peculiarities of coronary lesions in patients with CAD were analyzed depending on the presence of T2DM. The unfavorable course of the atherosclerotic process was defined in patients with T2DM. Patients of the 1st group had significantly higher average TG values compared to 2nd group. The following factors had the major impact on the indicators of coronary arteries lesions in patients of the 1st and 2nd groups: age, CAD duration, body mass index, and in patients with diabetes the duration of carbohydrate metabolism disorders. Patients in both groups had weak correlations between the character of atherosclerotic vascular lesions and the levels of total cholesterol, LDL cholesterol, and in patients with T2DM with TG, VLD. In addition, in patients with concomitant diabetes, HbA1c levels, indicating the long-term glycemic control, weakly positively correlated with the characteristics of vascular lesions. The unmodified risk factors had greater impact on the progression of atherosclerosis in comparison with modified factors.
Conclusions. The obtained results demonstrated the impact on the development and progression of atherosclerosis in addition to unmodified risk factors, not only lipid metabolism, carbohydrate metabolism, but also other pathogenic mechanisms, that require further rectification to develop the effective methods of early diagnosis and treatment in order to improve primary prevention.

Keywords: coronary atherosclerosis, coronary heart disease, type 2 diabetes mellitus, hypertriglyceridemia, dyslipidemia, modified risk factors, unmodified risk factors.

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Original language: Russian

14. MEDICINES in therapy

 

A role of antileukotriene drugs in the treatment of bronchial asthma

T.M. Bentsa

P.L. Shupyk National Medical Academy of Postgraduate Education, Ministry of Healthare of Ukraine, Kyiv

Cysteinyl leukotrienes are the most potent inflammatory mediators and play a central role in the pathophysiology of asthma. Leukotriene receptor antagonist, namely montelukast, provides a safe and effective additional anti-inflammatory treatment option.
The article presents the characteristics of montelukast in the treatment of bronchial asthma. Montelukast can be used as monotherapy as an alternative to low dose inhaled corticosteroid (particularly in the step-down strategy) or in addition to inhaled corticosteroids for improving clinical manifestations by an increase in anti-inflammatory effects.
The comorbid conditions can impair the progress of bronchial asthma by enhancing leukotriene-associated inflammation. Montelukast was proved as a particularly effective in asthma associated with allergic rhinitis, exercise­induced asthma, asthma in obese patients, asthma in smokers, aspirin-induced asthma, virus-associated asthma. The safety profile of montelukast is very good.

Keywords: bronchial asthma, leukotriene, montelukast.

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Original language: Russian

15. CLINICAL CASE

 

Conditions that mimic myocardial infarction. Brugada syndrome

M.P. Kopytsya, .. Lytvyn, .. Abolmasov

SI «National Institute of Therapy named after L.T. Mala of NAMS of Ukraine», Kharkiv

It is known, that a number of conditions can manifest with chest pain and ECG changes, similar to the changes at the acute myocardial infarction with ST segment elevation. The article describes a clinical case of a patient with Brugada syndrome in combination with chest pain. During prehospital examinations, it was mistakenly diagnosed as myocardial infarction. The misdiagnosis resulted in the incorrect implementation of therapeutic measures, that were corrected on the stage of the highly professional care.

Keywords: acute myocardial infarction with ST segment elevation, Brugada syndrome, alternative diagnosis.

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Original language: Russian

16. Reviews

 

Smoking and dyslipidemia: some aging, gender and metabolic aspects

V.A. Chernyshov

SI «National Institute of Therapy named after L.T. Mala of NAMS of Ukraine», Kharkiv

The review is devoted to an actual scientific problem such as influence of smoking on human lipid spectrum. Some aging, gender and metabolic aspects of dyslipidemia associated with smoking are considered in the review.
Some peculiarities of tobacco smoke action on the blood lipid spectrum in long-livers are discussed. The data about some gender differences in the blood lipid spectrum in smokers are adduced. Nicotine metabolic effects connected with the mechanisms of nicotine action on carbohydrate and lipid exchange are considered. Some metabolic and haemodynamic consequences of smoking cessation are discussed.

Keywords: smoking, dyslipidemia, longevity, insulin resistance, nicotine metabolic effects.

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Original language: Russian

17. Reviews

 

Chronic obstructive pulmonary disease and related pathological conditions. The peculiarities of cardiac rhythm disorders

O.O. Krakhmalova, V.V. Shtorkh, O.. Hetman, D.M. Kalashnyk, O.. Kolesnikova

SI «National Institute of Therapy named after L.T. Mala of NAMS of Ukraine», Kharkiv

The article gives considerations of the peculiarities of pathogenic factors and mechanisms of cardiac arrhythmias at chronic obstructive pulmonary disease (COPD) in conjunction with coronary heart disease (CHD) in the presence of obstructive sleep apnea/hypopnea (SOAS).
In the developed countries, COPD and cardiovascular diseases are the leading causes of death, and recently their clinical significance progressively increases. The comorbidity is often associated with a high risk for SOAS that adversely affect the clinical course and outcome of disease. Irregular heartbeat is one of the most frequent reasons underlying the sudden death.
Only an understanding of correlation of the diseases’ course and comprehensive approach to the examination and correction of pathological conditions caused by these diseases will improve the prognosis and quality of life of patients.

Keywords: chronic obstructive pulmonary disease, coronary artery disease, syndrome of obstructive sleep/hypopnea sleep, comorbidity, heart rhythm disorders.

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Original language: Ukrainian


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