IntroductionThe presence of background HCV infection cannot be overestimated in view of the prevalence of chronic hepatitis C and the risk of adverse outcomes of this disease. Purpose of this study was to evaluate the effectiveness of the combined use of antiviral therapy (Roferon + Vero-Ribavirin) and resort factors in patients with chronic hepatitis C in the phase of replication.Material and methodsWe observed 48 patients with chronic hepatitis C; the minimum level of activity of the process defined the phase of replication. Markers of HCV infection were determined by enzyme linked immunosorbent assay (ELISA) (a-HCV and HCV-Ig M). HCV RNA was determined twice by the polymerase chain reaction (PCR). Genotyping of hepatitis C virus was performed. Biochemical blood analysis and the study of HCV infection markers were carried out four times. Results of therapy were assessed immediately after the end of the resort (spa) treatment, then at 3, 6 and 12 months after starting treatment. At 12 months after starting treatment, all the observed patients had persistent clinical and biochemical remission. Elimination of the virus from the blood was noted in 56% of the control group and 74% of patients in the study group.ConclusionsFor patients with moderately active HCV, the replication phase was characterized by asthenic-vegetative syndrome (100% of patients) with severe depression (22.92%), pain (77.08%) and dyspeptic syndrome (33.33%), moderate hypertransferaseemia (100%), slightly pronounced cholestasis (33% of patients), and signs of mesenchymal-inflammatory response.
Б локаторы ангиотензиновых рецепторов (БРА)относительно новый класс препаратов, вошедший в клиническую практику лишь с конца 90-х годов XX века. Первоначально БРА (сартаны) рассматривались в качестве альтернативы ингибиторам ангиотензинпревращающего фермента (АПФ) и назначались лишь при непереносимости последних [1, 2]. Однако исследования последних лет радикально изменили представления об этой группе препаратов и привели к экспоненциальному росту частоты применения БРА в различных клинических ситуациях [3-6]. В последние годы частота применения сартанов в США и Европе увеличилась в 2 раза, а в нашей стране-в 10 раз [6]. Функционирование ренин-ангиотензинальдостероновой системы (РААС) на разных этапах сердечно-сосудистого континуума Открытие компонентов, механизмов действия и эффектов РААС стало основополагающим в формировании представлений о возникновении и прогрессировании большинства сердечно-сосудистых заболеваний (ССЗ). При этом сформулированная V. Dzau и E. Braunwald в 1991 г. концепция сердечно-сосудистого континуума, описывающая качественные переходы от генетически обусловленных и поведенческих факторов риска (ФР) развития ССЗ и их осложнений вплоть до терминальной стадии сердечной недостаточности и смертельного исхо
ВведениеПатогенетическая роль ренин-ангиотензин-альдо-стероновой системы (РААС) в развитии и прогресси-ровании сердечно-сосудистых заболеваний в настоя-щее время является общепризнанной. С течением времени открываются все новые и новые тканевые и ге-модинамические эффекты как отдельных ее компо-нентов, так и конечного продукта этой цепи -альдо-стерона. В связи с этим применение антагонистов аль-достерона при различных клинических состояниях, сопровождающихся явлениями гиперальдостерониз-ма, становится все более обоснованным. История применения блокатора РААС спиронолактонаПервым препаратом, механизм действия которого связан с блокадой РААС, стал антагонист альдостеро-на спиронолактон. Сам альдостерон -стероидный гормон коры надпочечников был открыт в начале 1950-х годов. С этого же времени начали активно из-учать его физиологические и патофизиологические эф-фекты Значение ренин-ангиотензин-альдостероновой системы в патогенезе различных клинических состояний хорошо изучено. Рассматривается ведущая роль блокаторов альдостероновых рецепторов, в частности, спиронолактона, в лечении больных с первичным гиперальдостеронизмом, резистентной артериальной гипертензией, отечным синдромом в рамках хронической сердечной недостаточности, нефротического синдрома и портального цирроза печени. Освещается развитие представлений о кардио-, вазо-и нефропротективном действии этой группы препа-ратов и возможностях их влияния на прогноз пациентов.Ключевые слова: антагонисты альдостерона, спиронолактон, хроническая сердечная недостаточность, артериальная гипертензия, цирроз печени. The importance of renin-angiotensin-aldosterone system in pathogenesis of different clinical conditions is studied well. The key role of aldosterone receptor blockers, particularly spironolactone, in treatment of such conditions as primary hyperaldosteronism, resistant hypertension, edematous syndrome in congestive heart failure, nephrotic syndrome, and portal cirrhosis is considered in the article. Development of ideas about cardio-, vaso-and nephroprotective effects of these drugs is highlighted as well as their influence on patient prognosis.
Aim. To assess the effect of renal dysfunction on the galectin-3 level in patients with chronic heart failure (HF) with preserved, intermediate and reduced left ventricular ejection fraction (EF).Material and methods. Along with a clinical examination, 69 patients with HF (NYHA class II-IV) underwent tests for the level of NT-proBNP and galectin-3 in serum using enzyme immunoassay.Results. Study participants were divided into 3 groups: 23 patients with preserved EF (HFpEF), 26 patients with midrange EF (HFmrEF), 20 patients with reduced EF (HFrEF). There was a trend to increase the concentration of galectin-3 with increase in NT-proBNP level. Correlation analysis showed significant feedback (r=−0.41, p<0.05) between galectin-3 and EF only in patients with preserved systolic function. In the same group of HFpEF patients, the maximum serum galectin-3 level was 10.5 [6.5; 14.5] ng/ml. Serum galectin-3 level showed negative correlated with the GFR in patients with CHF (r=−0.513, p<0.05). In patients with HF and glomerular filtration rate (GFR) <60 ml/min/1.73 m2 it was higher than in patients with GFR>60 ml/min/1.72 m2 (9 [5.3; 12.6] ng/mL vs 11.8 [6.2; 15.3] ng/mL, p<0.05). According to the ROC-analysis data, galectin-3 level >10.3 ng/ml indicates a high risk of chronic kidney disease stage 3-4 stage development (sensitivity 60%, specificity 75%) and can be considered as a risk factor for development of cardiorenal syndrome in HF patients.Conclusion. Galectin-3 level in patients with HF is more influenced by the degree of reduction in GFR rather than the left ventricular systolic function impairment.
Aim To study clinical and laboratory associations of hepatic fibrosis indexes in patients with decompensated NYHA functional class II-IV chronic heart failure (CHF).Material and methods The study included 128 patients admitted to the cardiological or therapeutic department of the University Clinical Hospital #4 at the I. M. Sechenov First Moscow State Medical University (Sechenov University) with symptoms of CHF associated with ischemic heart disease (IHD) and/or arterial hypertension (AH). All patients had signs of liver disease (liver enlargement on physical examination ± diffuse changes in hepatic tissue according to ultrasound data). Mean age was 70.59±10.71 years. Along with general clinical examination, severity of hepatic fibrosis was evaluated by calculated indexes, FIB-4, APRI, MELD-XI, and BARD. All calculations were based on laboratory data obtained within the first two days of hospitalization for decompensated CHF, at the onset of active therapy with intravenous diuretics. Statistical analyses were performed with the R programming language (3.6.1).Results In patients with NYHA FC II–IV CHF, the FIB-4 index significantly increased with the increase in NYHA FC (р<0.05). Also, the high liver density by most fibrosis indexes correlated with the probability of LV EF decrease to <40 % (FIB-4: RR, 1.32 at 95 % CI from 0.53 to 3.28, р=0.079; MELD-XI: RR, 1.62 at 95 % CI from 1.19 to 2.20, р=0.004; BARD: median LV EF, 42.5 % vs. 56 %, р=0.019), and a tendency to heart rhythm disorders was observed (FIB-4: RR, 1.92 at 95 % CI from 0.75 to 4.90, р=0.218; BARD: RR, 1.09 at 95 % CI from 0.97 to 1.22, р=0.174; MELD-XI: RR, 1.34 at 95 % CI from 0.94 to 1.90, р=0.101). Increases in liver fibrosis indexes correlated with other multiorgan disorders in CHF patients evident as a decrease in platelet count (FIB-4: р<0.01; APRI: р=0.045) and a tendency to a decrease in hemoglobin (FIB-4: 127 g/l vs. 137 g/l, p=0.249; APRI: 127 g/l vs. 136 g/l, p=0.749). Patients with a high liver density more frequently had cardiorenal syndrome diagnosed by reduced glomerular filtration rate (GFR) estimated by CKD-EPI to less than 60 ml/min / 1.73 m2 (FIB-4: р<0.03; MELD-XI: p=0.0001; BARD: р=0.005). In comparing liver fibrosis indexes in subgroups of CHF patients with preserved and reduced left ventricular ejection fraction (LV EF), significant differences were found only for MELD-XI (12.08 vs. 9.32, р=0.001).Conclusions For all studied indexes, correlations were observed with LV EF, decreases in hemoglobin, and incidence of heart rhythm disorders. For the BARD, FIB-4, and MELD-XI indexes, high results of calculations correlated with the presence of other predictors for unfavorable prognosis and disease severity (LV EF, NYHA FC, presence of type 2 diabetes mellitus, chronic kidney disease, and lower GFR). Liver fibrosis indexes are a new and promising but understudied instrument for evaluation of prognosis in CHF patients, which requires further study to determine most appropriate prognostic formulas.
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