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экспериментальная и клиническая гастроэнтерология | выпуск 117 | № 5 2015
информация | information
Materials and methods. A survey was conducted in 34 patients aged from 57 to 65 years old, suffering from cardiovascular disease in combination with diabetes, constantly receiving antiplatelet agents. The control group included 30 people ranging in age from 56 to 67 years, with diseases of the cardiovascular system without diabetes. From the study were excluded patients with complicated peptic ulcer history, as well as individuals receiving NSAIDs concerning other diseases.
Results. When performing gastroscopy in patients of the 1st group in 22 % of cases had erosive lesions of the mucous membrane of the upper parts of the gastrointestinal tract, while in the control group of such patients was only 12 %. All patients with symptoms of NSAID gastropathy was administered pantoprazole
at a dose of 40 mg/day for 14 days, followed by a control gastroscopy. As a result among the patients of the control group, there was complete restoration of the integrity of the gastric mucosa, whereas among the patients ofthe 1st group healing erosions occurred in 77 % of cases. In the future, these patients was prolonged course of pantoprazole in the same dose for 14 days. The follow-up gastroscopy were observed complete healing of erosions.
The conclusions. In patients with pathology of the cardiovascular system in combination with diabetes mellitus therapy with antiplatelet agents is more likely to occur erosive lesion of the mucous membrane of the upper parts of the gastrointestinal tract. For the treatment of such patients requires a longer course of antisecretory drugs.
116. Features of non alcoholic fatty liver disease at patients of advanced age
Krivosheev A. B., Kondratova M. A., Rybina O. V., Bogoryanova P. A., Tuguleva T. A.
NSMU, Novosibirsk, Russia, e-mail: krivosheev-ab@narod.ru
Objective: to estimate in the comparative plan of feature of a clinical course of non alcoholic fatty liver disease (NAFLD) at patients of advanced age.
Materials and Methods. 29 elderly persons aged from 60 to 77 years (the 1-st group) and 84 patients of middle age from 45 to 59 years (the 2-nd group) are examined. Complex examination is conducted.
Results. 1. Separately IHD was registered with an identical frequency of both groups. 2. Separately AG mainly was found in patients of the 2-nd group (7 times more often at men and is 2.5 times more often at women). 3. The combination of IHD and AG 2.5 times more often was registered at patients of the 1-st group. Pathology of bodies of digestion mainly came to light at patients of the 2-nd group. Frustration of a carbohydrate exchange were found in patients of the 2-nd group 3 times more often) more often. At all patients
the excess body weight and abdominal type of obesity took place. Diabetes of type 2 was mainly observed at patients of the 2-nd group (3 times more often at women). At patients ofthe 2-nd group the giperinsulinemiya appeared more significant and significantly exceeded norm, and also it was authentically above (p<0.05) in comparison with the 1st group. The HOMA-IR index was also much higher at patients of the 2-nd group, respectively 4,92±0,62 and 5,94±0,89. Frustration of a lipidic exchange had no basic distinctions at patients of both groups.
Conclusion. At patients of the 1-st group the ko-morbidnost is observed. At patients of the 2-nd group frustration of a carbohydrate exchange dominated, the insulinorezistentnost was more significant that is a pathogenetic basis of formation and progressing of NAFLD.
117. Liver injury in patients with metabolic syndrome
Larina N. A., Dudanova O. P., Tsekhanovich K. B.
Petrozavodsk State University, Russia, e-mail: Larina@okb10.ru
Objective: to estimate the frequency and character of liver injury in patients with metabolic syndrome.
Materials and methods. One hundred and forty seven patients with MS were enrolled. Liver functional status was assessed by laboratory tests (ALAT level, AST level, bilirubin, albumin, alkaline phosphatase, cholesterol), its structural state — by ultrasonic examination (U/S) and in 10 patients (6.8 %) — by histological investigation.
Results. All patients (100 %) had symptoms of NAFLD: 94 patients (63.9 %) had hepatic steatosis (HS), 53 patients (36.1 %) — steatohepatitis (SH), including 41 patients (77.4 %) with low activity (LA) of SH, 6 (11.3 %) — with moderate activity (MA) and 6 patients (11.3 %) — with high activity (HA). HS was characterized by increase of liver size and its echogenicity during U/S, while SH was characterized by cytolitic syndrome and histological activity. ALAT level in case of LA was (44.7±11.3) U/l, in case of MA — (100.6±31.9) U/l
(p<0.05) and in case of HA — (166.5±70.1) U/l (p>0.05), respectively. In case of SH of LA and MA there were signs of cholestasis: ALP was (329.5±188.3) U/l and (354.6±98.7) U/l; cholesterol was (6.5±1.1) mmol/l and (7.8±1.0) mmol/l (p<0.05) respectively. Protein synthetic and pigmentary functions ofliver did not change significantly. Dyslipidemia was increasing along with increasing SH activity, increase of TGs level was particularly pronounced: (3.44±1.68) mmol/l; (8.0±4.3) mmol/l (p<0.05) and (7.3±7.9) mmol/l respectively. According to U/S results, the size of the right lobe of liver closely correlated with the waist circumference: r=0.7 (p<0.02) and with BMI — r=0.6 (p<0.05).
Conclusions: All patients with MS had signs of NAFLD: 63.4 % patients had signs of steatosis, 36.1 % — signs of steatohepatitis, mainly of low activity (77.4 %). Dyslipidemia was characterized by pronounced tri-glyceridemia. Physical markers of MS correlated with the size of the right lobe of liver.
