CC BY
18
Results. It was revealed that with increasing severity of disease and patient's age COPD inflammation activity increases with increasing levels of markers of systemic inflammation. It has been determined significant inverse correlations between markers of systemic inflammation and bone formation, and direct correlations between markers of bone resorption, which confirm the adverse effect of active inflammation in the metabolic processes in the bone tissue. It has been determined significant (p < 0.05) negative correlation between COPD stage and axial skeleton BMD of the lumbar spine (r = —0.80), radius (r = —0.73), femur (r = —0.75), all skeletal sites (r = -0.73); trunk (r = -0.71); pelvis (r = -0.71); limbs (r = -0.62).
We determined the frequency of osteopenic syndrome, osteoporosis and osteoporotic fractures in COPD patients according to age, sex, severity and duration of illness. Risk factors of osteoporosis for patients with chronic obstructive pulmonary disease were also determined. A lumbar spine was found the most vulnerable area for osteoporosis in COPD patients, as evidenced by a significant decrease of bone mineral density in this area in patients with at least stage II of the disease.
The study established the relationship of bone metabolism with bad habits of patients, severity of COPD, age, systemic inflammation, and formation of negative adaptive responses.
We found new aspects of pathogenesis of osteoporosis in COPD patients. Hypoxia and acidosis, chronic inflammation and hyperinflation, frequent exacerbations, accompanied with intoxication syndrome, stress reactions of nonspecific resistance of organism, vitamin D deficiency/insufficiency, deterioration of microcirculation and nutritional status were found disturbances arising from development of systemic inflammation syndrome and drivers of osteo-deficiency conditions in COPD patients.
Conclusions. We developed an algorithm of COPD patients' supervision that served as a basis for reducing a period of diagnostic process and definition of ultimate risk group in terms of development of systemic osteoporosis and its complications. The particular attention should be paid to such osteoporosis risk factors as severity of bronchial obstruction, low BMI values, smoking experience and age of COPD patients as the most important ones.
OSYPENKO I., SOLYEYKO O., SOLEYKO L.
Vinnytsia National PyrogovMedical University, Vinnytsia,
Ukraine
Injury of Musculoskeletal System in Young Patients with Undifferentiated Connective Tissue Dysplasia
Introduction. Problem of undifferentiated connective tissue dysplasia (UCTD) as pathology of collagen, is a significant problem of modern medicine because of the high prevalence, multiorgans injury and serious affects. Congenital defects of connective tissue can be diagnosed at the stage of physical examination of the patient at combined rating of phenotypic markers. Thus, a big numbers of external markers of dysplasia are founded at UCTD. Prevalence of some external phenotypes according to various sources is extremely high: single external markers detected in 94 % of young people, numerous (more than 6 features) ones are found in 42 % of patients. The most studied and dangerous for the complications at the syndrome of UCTD is idiopathic mitral valve prolapse (MVP), which often occurred with cardiac arrhythmias. At the same time, injury of the thoracic spine at UCTD causes to arrhythmic complications of verte-brogenic character.
The aim of our study was to find external (phenotypic) markers of UCTD from the side of musculoskeletal system in patients with idiopathic MVP and detect prog-nostically important parameters for further formation of risk groups.
Materials and methods. We examined 120 patients of age 16 to 35 years with idiopathic MVP (average age — 25.1 ± 0.4 years). All patients had a complex clinical and instrumental examination (general clinical, biochemi-
cal, ECG, Holter ECG monitoring, Doppler echocardiography examination, X-ray examination). Somato-metric examination of the patients conducted by the method of V.V. Bunaka (1939, 1941) in modification of P.P. Shaparenko (1989).
Results. By the study results 100 % of patients had the skeletal system injury regardless of the degree of MVP. However, the evidences of a musculoskeletal system injury differed depending on the degree of MVP. Thus, the phenotypic markers of the spine (scoliotic curvature, kyphoscoliosis, straight back and hollowed chest) significantly more often detected in patients with II degree of MVP (p < 0.05). Phenotypic stigmas of the upper and lower extremities (short and crooked little finger, «like sandal» cleft foot, flat feet, dolichostenomielia) were founded in the same number of patients regardless of the degree of MVP (64.1 %). Changes of the oral cavity (abnormalities of dentition structure, high palate) were found in 52.1 % of patients with idiopathic MVP. Hypotrophy (61.4 %) often was observed among stigmas muscle in patients with idiopathic mitral valve prolapse, incidence of which was increased significantly with the degree of MVP (p < 0.05).
Cardiac rhythm disorder was observed in 51 patients (42.5 %). Supraventricular extrasystole, sinus tachycardia, ventricular arrhythmia dominated among the patients with I degree of MVP. Supraventricular extrasystole, paroxysmal supraventricular tachycardia, ventricular extrasystole, sinus tachycardia, fibrillation were registered in patients with II-III degree of MVP more often. Correlation analysis revealed a strong direct connection between the degree of MVP and the numbers of musculoskeletal stigmas (r = +0.72). Risk assessment in the form of calculating the odds ratio (OR) in patients with II—III
92
Brnb. CyMo6u. Xpe6eT, ISSN 2224-1507
№ 2 (18), 2015
degree of MVP showed that the probability of arrhythmic disorders they may have in 6.3 times higher than in patients with I degree of MVP (OR = 6.3). On this base we select the group of patients with high risk of arrhythmic complications of idiopathic MVP: young men with II— III degree of MVP and the presence of 4 or more musculoskeletal dysembriogenesis stigmas.
Conclusions. Thus, UCTD syndrome is a unique abnormal background for the existence of various clinical conditions with a wide range of symptoms. Early detection and correction of phenotypic markers of UCTD from the side of the musculoskeletal system will improve the quality of life of such patients and reduce possibility of disability in a future.
PANASIUK Y., KORDA M.
Ternopil State Medical University named after
I.Ya. Horbachevsky, Ternopil, Ukraine
Using of Lovastatin Nanoparticles for the Osteoporosis Treatment and Fracture Risk Reduction (Experimental Study)
Introduction. A new published experimental data and clinical studies demonstrate the ability of lovastatin to affect osteoregeneration. This effect of statins is realized through the increased expression of bone morphogene-tic protein 2. However, current studies on the possibility of statins to reduce the risk of fractures are controversial. The positive effect of statins on bone metabolism was observed with oral administration of these drugs but in very high doses. That is why it is so important to develop the new ways of statins delivering to fracture zones, particularly in the form of nanoparticles.
Aim. To investigate the possibility of using lovastatin in nanoparticles to restore posttraumatic bone defects in rats.
Materials and methods. White mature male rats (n = 168) were used in experiment. All animals were divided into four groups: I — intact animals, II — control group (animals with simulated bone defect), III — animals with bone defect, which were administered with lovastatin transdermally, IV — animals with bone defect treated with lovastatin incorporated into polymeric nanoparticles. The bone defect (2.0 mm in diameter) was
made by dental drill in the upper third of the tibia. The
III group of animals received lovastatin in doses 0.1, 1.0, 5.0 mg/kg during the whole period of experiment. The
IV group of rats was injected with lovastatin incorporated into polymeric nanoparticles directly into the fracture zones in a dose 1.0 mg/kg. The animals were decapitated on the 3rd, 7th, 14th and 28th day. Biochemical (activity of alkaline and acid phosphatases, mineralization index, collagenolytic activity of plasma, oxyproline Ca and P levels in plasma), radiographic, histological, and statistical methods were used in the study.
Results. Our results showed a positive effect of transdermal sdministration of lovastatin only in dose 5 mg/kg, which is significantly higher than the average therapeutic dose. There was no effect of transdermal applying of lovastatin in dose 0.1 and 1.0 mg/kg. At the same time the using of lovastatin incorporated into polymeric nanoparticles resulted in a significant decrease of the bone resorption symptoms on the 3rd and 7th day of the experiment, which was confirmed by the biochemical markers and histological examination. Using of incorporated into polymeric nanopar-ticles lovastatin also resulted in the strengthening of osteo-regeneration on the 14th day of experiment and resumption of posttraumatic bone defect on the 28th day.
Conclusion. In our studies we have shown that the incorporated into polymeric nanoparticles lovastatin induces posttraumatic osteoregeneration. The obtained results require further extensive research in this area.
PANKIV I.
Institute of Gerontology named after D.F. Chebotarev AMS Ukraine, Kyiv, Ukraine
Hypovitaminosis D in Autoimmune Thyroiditis Patients with Subclinical and Overt Hypothyroidism
Introduction. There is increasing interest in the role of vitamin D deficiency in a number of chronic health problems including autoimmune diseases. A number of factors have been implicated in pathogenesis of most autoimmune disorders, one of the most recent agents found to be associated with autoimmunity is vitamin 25(OH)D. Serum 25(OH)D, the most abundant circulating precursor of active vitamin D, is the most widely accepted indicator of vitamin D status and reflects combined contributions from cutaneous synthesis. Importantly, both vitamin D and thyroid hormone bind to similar receptors called steroid hormone receptors. A different gene in the
vitamin D receptor was shown to predispose people to autoimmune thyroid disease including Graves' disease and Hashimoto's thyroiditis.
Aim: to investigate the total vitamin 25(OH)D in 70 autoimmune thyroiditis patients with subclinical (n = 21) and overt (n = 49) hypothyroidism.
Material and methods. 70 patients and 20 apparently healthy individuals with matched age and sex were underwent a detailed clinical examination, thyroid function tests (TSH, fT4, fT3, thyroid peroxidase antibodies) and serum total vitamin 25(OH)D. They were living in Kolomyja region and recruiting to outpatient clinic of Central Regional Hospital during the period from September 2013 to July 2014. Written consent was taken from all participants in this study. They were classified into three main groups: Group I. Patients with autoimmune thyroiditis and subclinical hypothyroidism. It included 21 patients (3 male (14.3 %) and 18 female (85.7 %)), their mean ages 46.36 ± 2.84 years. They were
№ 2 (18), 2015
www.mif-ua.com
93
