Introduction. Comorbid syntropic lesions of the circulatory system in patients with liver cirrhosis, although often fatal, are poorly studied. The aim of the study. To distinguish syntropic lesions of the cardiovascular system in patients with liver cirrhosis, to determine some of their pathogenetic mechanisms, nature, and characteristics, to determine clinical markers with prognostic value, to justify and evaluate the effectiveness of their modified treatment. Materials and methods. We processed medical records of 603 patients with liver cirrhosis and detected circulatory system lesions in 490 patients. Some of them had only one type of lesions (study groups): 103 patients were diagnosed with cirrhotic cardiomyopathy, and 89 patients were diagnosed with arterial hypotension. Patients without the circulatory system lesions (113 patients) formed a comparison group. The purpose of the first step of the study was to determine syntropic comorbid lesions of the circulatory system. The purpose of the second step was to study some pathogenetic mechanisms of their formation. The purpose of the third step was to characterize these lesions, classify them, and determine their specific characteristics related to the severity of liver cirrhosis. The purpose of the fourth step was to determine their clinical markers. The purpose of the fifth step was to justify a modified course of treatment for patients with liver cirrhosis and syntropic cardiovascular lesions as well as to assess its effectiveness. Results. At the first step of the study, we found that 81.26 % of patients with liver cirrhosis had circulatory system lesions, in particular, secondary cirrhotic cardiomyopathy (57.50 % of patients with the circulatory system lesions) and persistent arterial hypotension (35.31 % of patients with the circulatory system lesions) as syntropic lesions. At the second step, we found that patients with liver cirrhosis and syntropic lesions of the circulatory system had also autonomic dysfunction and endothelial dysfunction. At the third step, we detected left ventricular remodeling in patients with liver cirrhosis and syntropic secondary cirrhotic cardiomyopathy, along with diastolic dysfunction and elevated S. Tei-index scores; these indicators worsened in parallel with the increase in the severity of cirrhosis; S. Tei-index scores should be used to classify secondary cirrhotic cardiomyopathy by severity. Patients with liver cirrhosis and syntropic persistent arterial hypotension had reduced ratio between blood pressures during the day and at night, low variability in blood pressure; in parallel with the increase in the severity of cirrhosis, arterial hypotension progressed with a disturbed circadian rhythm and pressure variability at all stages of the disease; the indicator of average daily arterial pressure should be used to classify arterial hypotension by severity. Conclusions. 81.26 % of patients with liver cirrhosis had comorbid lesions of the circulatory system, including secondary cirrhotic cardiomyopathy (57.50 %) and persistent arterial hypotension (35.31 %) as syntropic lesions; the activation of humoral and metabolic factors with disorders of the autonomic nervous system is one of the links in the pathogenesis of these syntropic lesions; syntropic secondary cirrhotic cardiomyopathy and persistent arterial hypotension have their specific characteristics, their manifestations worsen in parallel with the decompensation of liver cirrhosis, it is proposed to classify both diseases by severity.
Introduction The prevalence rate of the digestive system lesions in patients with systemic lupus erythematosus (SLE) ranges from 8.0 to 50.0%. The symptoms caused by systemic lupus erythematosus (immunocomplex inflammation, vasculitis, etc.) have not been clearly distinguished yet from those that are associated with co-occurring diseases or adverse effects of medications used to treat patients with SLE. Objective To characterize and clarify the prevalence of the digestive system lesions that are pathogenetically associated with systemic lupus erythematosus. Materials and methods 370 patients (331 women and 39 men), stratified by age, duration, and activity of SLE, were included in the study and subjected to comprehensive examinations. The results were processed in Microsoft Excel using descriptive statistics, χ2 test, z-test for comparisons between two proportions; the relationship was considered to be statistically significant when p < 0.05. Results The digestive system lesions were detected in 225 (60.81%) patients with systemic lupus erythematosus. The prevalence of steatohepatitis, autoimmune hepatitis, and chronic pancreatitis rose with the progression of the underlying disease, so we concluded that they may be considered to be pathogenetically associated with systemic lupus erythematosus as syntropic comorbid lesions. Other digestive system lesions – chronic pharyngitis, cardiochalasia, gastroesophageal reflux disease, esophagitis, chronic gastritis, peptic ulcer, chronic duodenitis, duodenogastric reflux, duodenal ulcer, chronic viral hepatitis B, chronic viral hepatitis C, toxic hepatitis, liver cirrhosis, acalculous cholecystitis, chronic cholecystitis (asymptomatic gallstones, chronic calculous cholecystitis, gallbladder polyps), irritable bowel syndrome, chronic colitis, hemorrhoids, dolichosigma, peritoneal adhesions – are only comorbidities, ie. co-occurring digestive system lesions, since there was no relationship between their prevalence and the progression of the underlying disease. The mesenchymal inflammatory syndrome was detected in most patients with systemic lupus erythematosus and pathogenetically associated syntropic comorbid steatohepatitis. Hepatocellular dysfunction syndrome was detected in the three-fourths of patients with SLE and steatohepatitis. The mesenchymal inflammatory syndrome was also detected in all patients with SLE and pathogenetically associated syntropic comorbid autoimmune hepatitis. More than half of the patients with SLE and autoimmune hepatitis were also diagnosed with hepatocellular dysfunction and hepatic cytolysis syndromes. The asthenic-neurotic clinical syndrome occurred in the three-fourths of patients with SLE and pathogenetically associated syntropic comorbid chronic pancreatitis. Almost every second patient with SLE and chronic pancreatitis had a dyspeptic syndrome. Steatohepatitis was detected predominantly in patients aged 25 to 59 (young age subgroup II and middle age group). It was not detected in patients with the SLE duration of less than one year. Autoimmune hepatitis was detected predominantly in elderly patients and patients with the SLE duration of more than ten years. Chronic pancreatitis was significantly less prevalent in women and more prevalent in elderly patients – it occurred in almost half of them. It was absent in patients with the SLE duration of less than one year. Patients with the SLE duration of 6-10 years had the highest prevalence of chronic pancreatitis.
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