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11МЕДИЦИНСКИЕ НАУКИ
CHANGE ARTICULAR SYNDROME PATIENTS WITH RHEUMATOID ARTHRITIS ON THE BACKGROUND OF THE INFLUENCE XENOBIOTICS
Akhmedov Khalmurad
Candidate of Science, assistant professor, Tashkent Medical Academy. 100190, Tashkent, Uzbekistan
Razakova Feruza National University of Uzbekistan Rustamova Rano National University of Uzbekistan Ismailova Arofat National University of Uzbekistan Dalimova Gulnoza National University of Uzbekistan
ИЗМЕНЕНИЕ СУСТАВНОГО СИНДРОМА У БОЛЬНЫХ РЕВМАТОИДНОМ АРТРИТОМ НА ФОНЕ ВЛИЯНИЯ КСЕНОБИОТИКОВ
Ахмедов Х.С.
Кандидат медицинских наук, доцент, Ташкентская медицинская академия. 100190, Ташкент, Узбекистан
Разакова Ф.С.
Национальный университет Узбекистана
Рустамова Р.П.
Национальный университет Узбекистана
Исмаилова А.М.
Национальный университет Узбекистана
Далимова Г.М.
Национальный университет Узбекистана
АННОТАЦИЯ
Результаты дисперсионного анализа показали, что от степени загрязнения воздуха и почвы ксенобиотиками зависит от клинические, рентгенологические и сонографиче-ские признаки суставного синдрома при ревматоидном артрите.
ABSTRACT
The results of disperse analysis indicated degree of contamination of air and soil by xe-nobiotics. It depended on the clinical, radiographic and sonographic signs of articular syndrome in rheumatoid arthritis.
Ключевые слова: ревматоидный артрит, суставной синдром, экологические факторы, климатогеографические зоны.
Keywords: rheumatoid arthritis, articular syndrome, ecologic factors, climate geographic zone.
Climatic peculiarity of human habitat have always been the most important factor which affect to health. When marked effects of different environmental indicators to human health, it became clear that the priority of environmental factor composes - up to 30%. Of these, pollution accounts about 20% and climate geographic conditions - 10% [1]. Therefore, it is obvious that the problems associated with the disease can not be considered without debate and features of the environment.
Geographical factors, according to a study conducted under the auspices of the WHO are estimated as external risk factors that could adversely affect to functioning of all systems 28
of the human body, as well as the to course and outcome of various diseases, including rheumatic diseases [2]. In recent years, it began to discuss the possible connection of the current and future features of rheumatoid arthritis with unfavorable environmental factors [3]. RA is a multi factorial disease in which the interaction of genetic component and environmental factors determines not only the disease but also its pronounced clinical polymorphism [4, c. 2206]. Weighting of disease occurs under the simultaneous influence of environmental factors [5, 6, 7].
To date, Uzbekistan is the object of many investigations of medical and geographic directions, as Republic is distinctive by its geographical location, climate and nature of the development of industry and agriculture. Moreover, special attention should be paid to the environmental problem in certain areas of the Republic. As is known, deterioration of the nature does not occur immediately or instantly, this process is observed for a long time, in other words, the environmental situation gradually accumulates. The big environmental problem in Uzbekistan is the high degree of soil salinity. The real threat was extensive contamination of soil by various types of industrial and household wastes. One of the major problems is the quality of water resources, the problem of the disappearance of the Aral Sea and the threat of ecological safety in the country and contamination of air space. Our Republic of Uzbekistan is located in the arid zone and characterized by the presence of major natural sources of atmospheric dust as the Karakum and Kyzylkum deserts with frequent dust storms [8]. Therefore, we believe that actual study in this field, particularly in matters of environmental rheumatology, in particular on the issues of RA in various climatic and geographical regions of Uzbekistan. We are interested in properties of development and duration of RA associated with environmental factors.
The aim of this study was evaluate the influence of environmental factors to articular syndrome in patients from various regions of Uzbekistan.
Material and Methods
The study is included 460 patients with a documented diagnosis of RA at the age of 50,6 ± 9,1 years, disease duration 9,9 ± 4,7 years: I area, the northern region - Tashkent - 144 patients; II region, the western region - Khorezm region - 112 patients; III region, the eastern region - Namangan region - 104 patients; IV area, the southern region - Surkhandarya region -100 patients.
These hygienic assessment of environmental pollution, in particular xenobiotics in its three objects - air, soil and water (surface water and underground water sources) were obtained as a result of laboratory tests of sanitary stations, government offices of regional committees in the field of hydrometeorology, control of natural condition and environmental safety, as well as governmental Committee of Uzbekistan by protection of nature. Total emissions of air pollutants from stationary and mobile sources characterize the general anthropogenic load to the air. According to these data, the level for 5 years in the atmospheric emissions to the area of the experimental zones includes following: in the I area for the year was 302,76 ± 96,12 t / km2, to 1 patient with RA -17,2 ± 29,16 kg; in the II area of 81,2 ± 16,2 t / km2, to 1 patient with RA -31,2 ± 1,8 kg; in the III area 68,51 ± 11,4 t / km2, to 1 patient with RA -9,1 ± 1,1 kg; in the IV area of 90,5 ± 8,9 m / km2, to 1 patient with RA -35,1 ± 3,4 kg.
Using of integral indicators of environmental burden to the atmosphere (y), water (o) and soil (ro), compared them with clinical signs of RA (F) on the number of patients and with integral criterion in the study areas of Uzbekistan (G).
Statistical analysis of the results of research carried out by computer variations, correlation, one (ANOVA) and multivariate (ANOVA/MANOVA) dispersion analysis (programs «Microsoft Excel» and «Statistica-Stat-Soft», USA).
Results and discussion
Among the studied patients predominance women - 336 (93.3%). 85 (18.5%) patients suffered from this disease less than 5 years, from 5 up to 10 years - 255 (55.4%), and more
29
than 10 years - 120 patients (26.1%). Drug remission was determined in 80 patients (17.4%), the activity is preserved - in 366 patients (79.6%). Poly arthritis were in 440 patients (95.7%). Systemic manifestations were detected in 269 patients (58.5%). In addition to the articular syndrome, the most frequent complaints were general weakness (65.2%), irritability, sleep and attention disorders (56.5%), restlessness and anxiety (65.2%), low-grade fever (39.1%). Almost all RA patients had signs of anemia of chronic inflammation.
The results of our analysis establishes the impact of the degree of environmental pollution by xenobiotics air y to the ro soil, as well as direct correlation ro with integral parameter of contamination of groundwater and drinking water o. There are significant positive correlations with the degree of ro plant emissions of harmful substances into the atmosphere, with a level of accumulation in the regions of industrial waste and fluoride chloride (FH) load by xenobiotics, sulfates and phosphates in drinking water. At the same time the degree of dust y depends on ro salinity (r = 0,76; p = 0.032).
It is known that the content of substances in the soil enters into the human body through the vegetable and animal food. In turn, plants and animals are supplied by micronutrients from the soil [9]. Thus, the composition of minerals in the soil has a positive or negative effect to the human body, thereby specifically affects to duration of diseases, in particular to RA [3]. Especially, human activity and anthropogenic impact influence to the composition of the soil. Thus parameters G influence to the levels in the soil zone of residence of patients with RA as toxic microelements as nickel, aluminum and fluorine, and sulfates, which shown results from one factor dispersion analyses. Indicators G directly correlated with the content in the soil of nickel and aluminum fluoride (r = 0.69; r = 0.77; r = 0.71) and backwards - with concentrations of zinc (r = -0,66).
According to ANOVA integral indicator of soil contamination with nickel ro significantly affect to the radiological stage of the disease and indexes Ritchie and Larsen. It should be noted that there is a significant direct correlation between the values of ro and articular syndrome, however, high aluminum content of the soil was significantly affected to the localization of the articular syndrome. So, in figures G <2 Aluminum G has a negative correlation (r = -0,44; r = -0,42; r = -0,32) with NPJ, NSJ and duration of morning stiffness, which become positive (r = 0.89; r = 0, 73; r = 0,79) in rates G> 2. It means that increasing of accumulation in the soil influences to pronounced degree of articular syndrome. As can be seen from pic. 1, area with high aluminum in the soil (IV area) is valid pronounced characters of above symptoms (p = 0.0042 &; p = 0,033J).
of painful joints; NSJ - the number of swollen joints.
It should be noted that on the background G> 2, the severity of air pollution by xenobi-otics significantly influences (in the figure indicated in black) to the incidence of lesions of the elbow (p = 0.023), the shoulder (p = 0.052), knee (p = 0.049) and hip (p = 0.037). It is
noteworthy, as shown by one-factor disperse analysis to the functional index of HAQ affects ro soil zinc (Zn). This performance is directly correlated with the G Ritchie index (r = 0,59) and back to the index HAQ (r = -0,67). Thus, by decreasing of ro, i.e. decreasing of concentration of Zn in the soil degraded functionality of the joint, which reflect on the index of HAQ, in particular in zones II and IV and contrast with the increasing of concentration in the soil improved HAQ, in particular in the zone III (p = 0.0034$, p = 0.043J). It should be noted, according to the literature [10], against changes in the level of Zn in the blood of patients with RA in synovial environment increases the number of proteolytic activity of matrix metallo-proteinase, which are involved in the implementation of preinflammatory and destructive action to the joint.
The important point, indicating the degree of progression of disease and complication of anatomical defects of joint in RA is radiological evidence of articular syndrome. As mentioned above, the rate of soil contamination ro significantly affect to the radiological stage of the disease and the index of Larsen. As can be seen from pic. 3, in contrast from other zones in zone IV with increasing of accumulation of nickel (r = 0.089) will increase cases with ankylosis (IV radiographic stage of RA) and significantly increase Larsen index (p=0.0023$, p=0,033J).
70 60 50 40 30 20 10 0
62,5 >
39,5 3,9 36,8
>7,6 28,9 33,4 OA (
>1,1 l 62 ¿2,1 _ 14 77,2
4,5 5,6
—1~ 1,5 1,5 0,5 m~i I
■ G aluminum soil
□ R-I step
□ R-II step
□ R-III step
□ R-IV step
I zone
II zone
III zone
IV zone
Picture 3. X-ray changes in the RA depend on index G aluminum in soil.
At the same time multivariate dispersion analysis also shows a high degree of impact on the overall y sonographic signs of RA. The degree of atmospheric pollution by xenobiotics significantly influences (in the figure indicated in black) to the frequency of sonographic and radiographic signs of RA.
It is noted the dependence of tendovaginitis, enthesopathies, ligamentosus, intra-articular calcifications, changes of horns of the menisci, Baker's cysts and bodies of Hoff on the parameters y. As the one-factor dispersion analysis to the frequency of sonographic and radiographic signs of RA affects to the degree of ro salinity. Thus, in ro salinity G> 2 (II zone) observed its direct strong correlation with indicators such as the tendovaginitis (r = 0,84), lig-amentosus (r=0,97), Baker's cyst (r=0,77) and body of Hoff (r=0,91). It means that with increasing of salinity of the soil whereas increases above cases. We should note that F articular syndrome in RA are not associated with the parameters of sulfates and phosphates in the drinking water(p>0.05).
Thus, the results of disperse analysis indicate the degree of ro and y depend on clinical, radiographic and sonographic signs of articular syndrome in RA. It means that changes in the micro elementary composition of soil and air which depends on the zone of residence of patients with RA in Uzbekistan contributes rate of progression of joint syndrome.
Literature
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TOLL-ПОДОБНЫЕ РЕЦЕПТОРЫ 4 И 9 В ЭТИОПАТОГЕНЕЗЕ ПСОРИАЗА
Дащук Андрей Михайлович
Доктор медицинских наук, профессор, заведующий кафедрой дерматологии, венерологии и СПИДа Харьковского национального медицинского университета
Украина, г.Харьков Почернина Валерия Вадимовна Магистрант кафедры дерматологии, венерологии и СПИДа Харьковского национального медицинского университета
Украина, г.Харьков
Анотащя: ncopia3 - одне з найпоширешших захворювань шюри, яке носить хро-шчний характер. Вщкриття TOLL-pe^nropiB i виявлення 1х тдвищено'1 кшькосп в шкiрi хворих на ncopia3 дають можливосп для бшьш глибокого вивчення його етюлоги та патогенезу. У статп докладно розглянуто класифшащя i будова TOLL-рецепторiв, а також 1х участь у регуляцп та шщаци iмунноi вщповвд при псорiазi.
Ключов1 слова: псорiаз, TOLL-подiбнi рецептори, хрошчш дерматози
Summary: Psoriasis - one of the most common chronic skin diseases. Opening TOLL-receptors and detection of an increased amount in the skin of psoriasis patients provide opportunities for more in-depth study of its etiology and pathogenesis. The article discussed in detail classification and structure TOLL-receptors, and their involvement in the initiation and regulation of immune response in psoriasis.
Keywords: psoriasis, TOLL-like receptors, chronic dermatoses.
Псориаз является одним из самых распространенных хронических мультифакто-риальных заболеваний, при котором доминирует генетический компонент склонности к возникновению заболевания и нарушений многочисленных звеньев нейроэндокринных, метаболических и регуляторно-трофических процессов. Удельный вес псориаза в общей структуре заболеваний кожи составляет от 7% до 10%, а среди госпитализированных больных с кожными болезнями до 20-25% [2,7]
По данным Международной Федерации ассоциации псориаза (International Federation of Psoriasis Associations) распространенность псориаза в мире неодинакова, она зависит от региона и колеблется в пределах 1,2% -5%, а средний показатель 32
