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Wschodnioeuropejskie Czasopismo Naukowe (East European Scientific Journal) #9(13)/2016 31КЯ
3. Мишаювська О.М. Нейропсих1атричш симптоми, асоцшоваш з деменщею, !х корекц1я в позалжа-рняних умовах та вплив на тягар отки доглядача /О.М.Мишаювська // Лжи Украти плюс. - 2016. - № 1 (26). - С. 74-77.
4. Моюеенко Р.О. Пал1ативна тдтримка дтям в Укрш'ш, як складова системи пед1атрично! допо-моги / Р. О. Моюеенко, В. М. Князевич // Реабмтащя та пал1ативна медицина. - 2015. - № 2. - С. 31-38.
5. Москвяк £.М. Медико-сощальне обгрунтування створення заклад1в пал1ативно! медицини: дис. ...кандидата мед. наук: 14.02.03/Москвяк £вген Йосифович. - К., 2007. -117 с.
6. Шнчук 1.Я. Система реабштацп пащенпв з деменщею при хвороб1 Альцгеймера в стацюнарних та позалшарняних умовах: Дис... канд. мед. наук: 14.01.16 / Укра1нський НД1 сощально! i судово! псих1атрИ та наркологи. - К., 2002. - 168 арк. , табл. - Б1блюгр.: арк. 126-148.
7. Шнчук 1.Я. Медико-сощальне обгрунтування системи надання допомоги населенню похилого вжу з вадами псих1чного здоров'я: автореф. дис. ... д-ра мед. наук : 14.02.03 / I. Я. Шнчук, 2011. - 36 с.
8. Пустовойт М.М. Психосоматичш законом1рносп розвитку психотичних розлад1в у ж1нок в шво-люцй' (патогенез, клшжа, психодинашчна психотератя): автореф. дис. . д-ра мед. наук : 14.01.16 / М. М. Пустовойт. - Х., 2010. - 36, 1 с.
9. Чабан О.С. Депресивш розлади у пащенпв похилого вшу: проблеми д1агностики i терапй/ О.С. Чабан, О.О. Хаустова // ^^NEWS. - 2016. - № 2 (1). - С. 14-20.
10. Чайковська В.В. Сучасний стан i концепщя розвитку гер1атрично1 допомоги населенню Укра!ни: дисертащя д-ра мед. наук: 14.02.03 / В.В. Чайковська; Нац. мед. ун-т 1м. О.О.Богомольця. - К., 2003. - 32с.
11. Bail K.The cost of hospital-acquired complications for older people with and without dementia; a retrospective cohort study/ K. Bail, J. Goss, B.Draper [et al.]//BMC Health Services Research.-2015.
12. Desai A.K. Recognition and Management of Behavioral Disturbances in Dementia/A.K. Desai, G.T.Grossberg // Prim. Care Companion J. Clin. Psychiatry. - 2001. - V. 3, №3. - P. 93-109.
13. Porsteinsson A.P. Neuropsychiatry Symptoms in Dementia: A Cause or Consequence?/ A.P. Porsteinsson, I.M. Antonsdottir// Am. J. Psychiatry. -2015. - V.172, №5. - P. 410-411.
14. Radbruch L. White Paper on standards and norms for hospice and palliative care in Europe : part 2/ L. Radbruch, S. Payne // European Journal of Palliative Care. -2010. -Vol. 17, № 1. - P. 22-33.
15. Rome B.R. The Role of Palliative Care at the End of Life/R.B.Rome, Luminais H.H., Bourgeois D.A., Blais C.M.// Ochsner J. - 2011.-V.11, № 4.- P.348-352.
16. White Paper on standards and norms for hospice and palliative care in Europe: part 1 // European Journal of Palliative Care. - 2009. - Vol. 16, № 6. -P. 278 -289.
17. http://melzdrav.mlt.gov.ua/files/ReformGaluzi/NorPravBaza/Strategiya_UKR.pdf
18. http://zakon3.rada.gov.ua/laws/show/z0229-13
Bilovol O. M.
Academician of the National Academy of Medical Sciences (NAMS) of Ukraine, MD, Professor of Clinical
Pharmacology Department of Kharkiv National Medical University
Bobronnikova L. R.
The Head of Clinical Pharmacology Department of Kharkiv National Medical University, MD, Professor Al-Trawneh O. V.
Postgraduate student of Clinical Pharmacology Department of Kharkiv National Medical University
THE LEVELS OF ADIPOKINES AND INTERLEUKINS IN PATIENTS WITH HYPERTENSION AND TYPE 2 DIABETES, DEPENDING ON BODY WEIGHT
Abstract. The article describes the characteristics of pathogenic interaction of carbohydrate and lipid metabolism with hormones of adipose tissue and interleukins in patients with arterial hypertension combined with diabetes mellitus type 2, depending on body weight.
Keywords: arterial hypertension, diabetes mellitus type 2, immune disorders, omentin, adiponectin, obesity
Arterial hypertension (AH) with concomitant diabetes mellitus (DM) type 2 common is the most common issues of our time [1]. The main reason for increased frequency of DM type 2 with AH is increased prevalence of overweight and obesity among the population [2]. The prospective examine was performed on men and women patients has shown the connection between the obesity and DM type 2 [4].
Almost 90% of patients with DM type 2 have obesity that recognized as the most important modifiable risk factor for diabetes. The risk of DM type 2 progression increases with the increasing body weight, increase of the degree and duration of obesity [5]. The risk of DM type 2 progression is increased by 2 times with the obesity at I grade, by 5 times - obesity at II degree and more than by 10 times - at III-IV degree of obesity [7].
Wschodnioeuropejskie Czasopismo Naukowe (East European Scientific Journal) #9(13)/2016
The risk of AH progression by 50% higher for people with obesity that foe people with normal body weight. The systolic blood pressure increased by 4.4 mmHg in men and by 4.2 mmHg in women for every extra 4.5 kg that shown in Framingham study [6]. The direct proportion identified between the body weight and the overall mortality. Mostly the increased mortality caused by cardiovascular pathology [3].
Adipose tissue recently considered not only as a power station, but also as an endocrine organ producing adipocytokines that are involved in the maintenance of metabolic processes in the organism [8]. Thus an actual issue for studying is the pathogenic interaction of hormones and adipose tissue (omentin, adiponectin) and interleukins (IL0-1, IL-4, IL-6) with metabolic disorders in patients with AH and DM type 2.
The purpose of research - to study the effect of the adipokin and interleukin imbalance on growth and progression of the metabolic disorders in patients with combined AH and DM type 2 accordingly to the body mass index.
Materials and methods. The research includes 75 patients with AH of II stage and 2nd degree were examined (43 men and 32 women). The average age of the patients between 54,7 ± 5,4 years. The patients were divided into groups: group 1 (p = 38), patients with AH without DM type 2; group 2 (p = 37) with combined AH and DM type 2. The control group (p = 20) was the most comparable in age and sex to the patients examined.
The AH diagnosis provided according to the recommendations of the European Society for AH and the European Society of cardiologists (ESH/ESC, 2013), also the Ukrainian Association of cardiologists for AH presentation and treatment (2013). According to the WHO (1997) criterions, the diagnosis of abdominal obesity formed by using anthropometric measures and calculating the body mass index (BMI), and the degree of obesity under IDF criterions (2015). The diagnosis of DM type 2 formed according to the general recommendations of the European Association for DM (EASD, 2013). The subcompensated diabetes is a criterion involved into the research: this is glycaemia on an empty stomach in proportion no more than 8,5 mmol/l, postprandial hyperglycemia is no more than 11 mmol/l and HbA1c level is no more than 9%.
The omentin level identifined by the method of enzyme immunoassays by using reagents set «BioVen-dor» (Czech Republic). The adiponectin concentration (AN) in blood serum, tumor necrosis factor - (TNF -a) and C - reactive protein (CRP) is researched by using immunoenzyme method with reagents set «DRG» (USA). The content of IL-1b, IL-4, IL-6 in blood serum is identified by the method of enzyme multiplied im-munoassay by using the set "Protein contour" (St. Petersburg).
The lipid metabolism research: the total cholesterol (TC) in blood serum, high density lipids (HDL), triglycerides (TG) are defined by the enzymatic colori-metric method by using set «Human» (German). The
cholesterol concentration in low density lipoprotein (LDL) identified by formula Friedewald W.T.: HDL (mmol/l) = TCC - (HDL + TG / 2,22).
The level of glycated hemoglobin (HbA1c) in whole blood conducted by using test system "Reagent" (Ukraine). The index for insulin resistance (HOMA-IR) calculated by formula HOMA-IR = insulin, (insulin on an empty stomach (mIU/ml) x glucose on an empty stomach (mmol/l)/ 22,5.The concentration of fasting blood glucose (FBG) and insulin in blood serum tested by immunoenzyme method using DRG sets (USA). There glucose tolerance test was made to define glucose tolerance index.
The statistical analysis for the result of the research were achieved by applying the software package Statistica - 8.0.
Results and discussions. The results of the tropol-ogycal status analysis identified characteristic features in both groups. The patients with BMI varied between 18,5—24,9 kg/m2 (4 patients) are identified into a group of AH isolated progression, obesity of 3rd degree (BMI is more than 40,0 kg/m2) is diagnosed in two patients with AH and in 6 patients with combined DM type 2 progression. In many of the patients with isolated and combined disease progression (65,1% and 54,6% accordingly) had BMI within 30-34,9 kg/m2. However, men prevail (67,2%) among the patients with AH BMI 30-34,9 kg/m2, but BMI within 35-39,9 kg/m2 and more , prevail women (74,6%).
The analysis for adoption changes AN in blood serum in patients with isolated and combined disease progression identified the decrease of AN level into both groups of patients compared to the control the most apparent hypoadiponectinemia occurred in patients with combined AH and DM type 2 (p<0,05) progression and negatively correlated HOMA-IR (r=-0,52; p<0,05), concentration of TG (r=-0,52; p<0,05), the glucose level (r=-0,44; p<0,05), BMI (r=-0,44; p<0,05) and HbAlc (r=-0,57; p<0,01), that proves its influence on the progression and formation IR and influence on carbohydrate and lipid metabolism.
The certain increasing of TNF-a in blood serum compared to control group is (p<0,05). The most increasing index within 2,6 (p<0,001) has been observed in combined AH and DM type 2. The level of CRP in blood serum exceeded the control items in both groups of examined patients (p<0,05).
The largest increase (in 2,1 times) observed in patients with combined progression of AH and DM type 2 diabetes (p<0,05) and correlated with BMI (r=0,47; p<0,001), the level of FBG (r=0,44; p<0,001), the level of TG (r=0,35; p<0,04), HOMA-IR (r=0,43; p<0,001).
Thus, it identified that AN levels decreased in a linear regression with BMI in patients with combined disease progression: patients whose BMI is 25,0 - 29,9 kg/m2 the middle level of AN was 12,2 ± 3,6 ng/ml, and with BMI 35,0 -39,5 kg/m2 the index was 7,4 ± 2,2 ng/ml (p<0,05), that can be considered as a marker of atherosclerosis vessel defeat progression in this category of patients.
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Wschodnioeuropejskie Czasopismo Naukowe (East European Scientific Journal) #9(13)/2016 üSkl
Table 1
Items of hormones of adipose tissue and inflammatory markers in patients with combined progression of AH and DM type 2 (M±SD)_
Idexes Control group n=20 BMI = 25,0 -29,9 kg/m2; n=20 BMI = 30,0 -34,9 kg/m2; n=10 BMI = 35,0 -39,5 kg/m2; n=7 Р
1 2 3 4
AN, ng/ml 13,6±7,1 12,4± 5,7 10,26 ±4,85 P2-3 =0,24 7,3 ±3,83 P2-4 =0,06 P3-4 =0,24 P1-2 =0,43 P1-3 =0,085 P1-4 =0,053
Omentin ng/ml 397,6 ± 5,3 321,52 ± 14,92 276,52 ± 1,92 P2-3 =0,26 252,52 ± 14,92 P2-4 =0,04 P3-4 =0,22 P1-2 =0,23 P1-3 =0,073 P1-4 =0,054
TFN-a, pg/ml 5,24 ± 3,3 7,6 ± 3,63 10,4 ± 4,93 P2-3 =0,087 14,1 ±6,64 P2-4 =0,002 P3-4 =0,14 P1-2 =0,04 P1-3 =0,0004 P1-4 =0,0001
CRP, mg/l 3,79 ± 1,83 4,8 ± 1,91 7,6 ± 3,85 P2-3 =0,002 11,4 ±6,1 P2-4 =0,0002 P3-4 =0,13 P1-2 =0,24 P1-3 =0,0002 P1-4 =0,0001
The omentin concentration in blood serum was significantly lower in patients with combined pathology in 1,5 times compared to patients with AH (p<0,001). It also noted a feedback between the omentin concentration into blood plasma and indexes of SAP (r = -0,61; p<0,05 ), DBP (r = -0,68; p<0,001), BMI (r=-0,36; p<0,05), level of TG (r = -0,44; p<0,001), CRP (r=-0,38; p<0,001), TFN - alpha (r=-0,44; p<0,001).
Positive correlation connection has been defined between the level of omentin and the concentration of Table 2
HDL (r=0,46; p<0,001) and AH (r=0,44;p<0,05). The feedback was identified between the omentin level and glucose (r=-0,34;p<0,05), HOMA-IR (r=-0,46;p<0,001), that proves the omentin influence on metabolic disorders and arteriosclerosis progression in patients with combined AH and DM type 2.
Analyzing immunometabolic indexes in groups of examined patients observed confirmed increasing TNF-a level in blood serum with control group (p <0,05). The largest increase of the index in 4,1 times (p <0,05) was observed in combined AH and DM type 2.
Indicators of the level of interleukins in patients of the examined groups
The unit of meas- Control AH AH+DM type 2
ure indexes (n=20) (n=38) (n=37)
IL-1ß, pg/ml 36,8±5,6 86,2±6,3* 93,1±9,5* / #
IL-6, pg/ml 19,1±1,2 33,5±3,7* 36,4±4,3* /#
IL-4, pg/ml 42,9±2,4 69,1±3,4* 79,4±2,1* /#
* p <0,05 - reliability of differences compared to control group;
# p <0,05 - reliability of differences in compared to patients of the third group.
All patients had been identified as having a significant increase of IL-1p level comparatively to the control group (p <0,05) (table.2), the most observed in patients with combined AH and DM type 2 (p<0,05) statistically significant negative feedbacks was defined between omentin and AN (r = -0.34, p <0,01; r = -0.42, p<0,01) thus accordingly to protein synthesis stimulation of acute phase of inflammation.
The marked increased activity of IL-4 level, Ha 22,3% (p<0,001) and direct correlation IL-4 with IL-1p (r= 0,42, p <0,01) and IL -6 (r = 0,44, p <0,01) indicated the compensatory, self-regulating of IL-4 activity, aimed at stabilization of the inflammation process.
The defined regularities in the combined AH and DM type 2 additionally emphasize the consistency and regularity of metabolic disorders.
Identified negative correlation between IL-6 (r = -0.46, p <0,01; r = -0.42, p <0,01) omentin and AN, accordingly, that proves the nature of the antiatherogenic
adipokines data. A positive correlation with BMI (r = 0,44; p <0,01), indicates increasing activity of IL-6 with increasing degree of obesity, that contributes to the progression of metabolic disorders and insulin resistance in patients with the combined AH and DM type 2.
Conclusions.
It has been found that patients with the combined AH and DM type 2 are characterized by the development of atherogenic dyslipidemia.
The close pathogenetic link between the increasing body weight, imbalance of adipokines (omentin, adiponectin) and pro-inflammatory interleukins (ILp-1, IL-6) was proved, that should be considered as an unfavorable factor of combined AH and DM type 2 progression, which contributes to the progression of insulin resistance, atherosclerosis and the progression of the combined pathology.
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References.
1. Bell D.S.H. Heart Failure: A serious and common comorbidity of diabetes/ D.S.H. Bell// Clinical Diabetes. - 2004. - V.22. - P.61-65.
2. Fonseca V.A. Defining and Characterizing the Progression of Type 2 Diabetes/ V.A. Fonseca // Diabetes Care.- 2009.- V.32(2).-P.151-56.
3. Frankel D.S. Resistin, Adiponectin and Risk of Heart Failure: the Framingham Offspring Study / D.S. Franke // J. Am. Coll. Cardiol. - 2009. - Vol. 53(9). - P.754-762.
4. Gerstein H.C., Islam S., Anand S., et al. Dysglycaemia and the risk of acute myocardial infarction in multiple ethnic groups: an analysis of 15,780 patients from the INTERHEART study/ H.C. Gerstein, S. Islam,S. Anand, et al. // Diabetologie- 2010.-Vol.53(12).- P. 2509-2517.
5. Hackam D.G. The 2010 Canadian Hypertension Education Program recommendations for the management of hypertension /D.G. Hackam // Can. J. Cardiol.- 2010.-Vol. 26, №5.-P. 249-258.
6. Pereira M., Lunet N., Azevedo A., Barros H. Differences in prevalence, awareness, treatment and control of hypertension between developing and developed countries / M. Pereira et al. // J. Hypertens. - 2009. - Vol. 27. - P.963-975.
7. Sarwar N., Gao P., Seshasai S.R., et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies/N. Sarwar,P. Gao, S.R. Seshasai, et al. // Lancet.- 2010.-Vol.375 (9733).-P.2215-22.
8. Tan B.K., Adya R., Randeva H.S. Omentin: a novel link between inflammation, diabesity, and cardiovascular disease / B.K. Tan et al. //Trends Cardiovasc. Med.-2010.-Vol.20 (5)-P.143-148.
P.R. Herych, R.I. Yatsyshyn
SHEI "Ivano-Frankivsk National Medical University "
UDC 616-071+616.24+616-005.4+616.12
STATE OF THE PULMONARY VENTILATION FUNCTION, INTRA-CARDIAC AND PULMONARY HEMODYNAMICS DURING EXACERBATION OF COPD OF THE IIIRD DEGREE OF SEVERITY COMBINED WITH STABLE ISCHEMIC
HEART DISEASE
Abstract. The peculiarities of clinical signs, ventilation violations, structural and hemodynamic parameters heart using echocardiography (EchoCG) and doppler echocardiogram (DpEchoCG) were analyzed in 72 patients with chronic obstructive pulmonary disease (COPD) of the IIIrd degree, who were divided into two groups - patients with an isolated course of COPD and patients with concomitant or combined cardiorespiratory pathology (CRP). The last group consisted of 44 patients with COPD of the IIIrd degree, clinical course of which was complicated by a combination of related and comorbid stable ischemic heart disease (SIHD).
Keywords: chronic obstructive pulmonary disease, comorbid and concomitant stable ischemic heart disease, indicators of echocardio- and doppler echocardiography.
Introduction. The high incidence of COPD is now mainly stated during clinically significant process in the presence of complications and the presence of combined diseases, generating high disability and mortality [1, 2]. It is believed that over the past two decades the mortality of patients with COPD will be at the peak. Experts of WHO predict that in 2020 COPD will come to third place among all causes of mortality and cause the death of about 4.5 million people per year [3].
The peak of COPD incidence occurs usually in 5565 years. It is known that this age population is characterized by polymorbidity and comorbidity. COPD is usually not the only disease for the elderly people. In older and senile age COPD can run in conjunction with underlying chronic diseases. Often this disease is accompanied by cardiogenic complications (angina pec-toris attacks, myocardial infarction), which significantly worsen the prognosis of the disease [1, 2, 5, 6].
Causes and course of ischemic heart disease in patients with COPD are not studied enough. Mechanisms of their combined course are complex and continue to be actively studied. To date, there is no doubt that is-chemic heart disease, which develops against the back-
ground of COPD, is comorbid disease that requires special treatment in terms of diagnostic and therapeutic plan [7]. The above-mentioned demonstrates the urgent need to consider the problems in pulmonological and cardiological practice in a large number of specific clinical situations in a single block [8].
The aim of research is to study the clinical characteristics, functional parameters of pulmonary ventilation function and structural-functional state of the heart during exacerbation of COPD of the IIIrd degree of severity, groups C and D combined with SIHD, stable angina pectoris (SAP) of I-II FC.
Materials and methods. The study involved 72 patients with verified diagnosis of COPD exacerbation of the IIIrd degree of severity, groups C and D. The study included 60 (83.33%) men and 12 (16.66%) women with isolated course of COPD of the IIIrd degree of severity and combined with SIHD, SAP of I-II FC. The average age of studied patients was - 56.9±6.8 years.
According to the results of clinical-laboratory and functional examinations there were formed two groups of patients. I (control) group consisted of 28 (38.88%)
