The aim – to improve the diagnosis efficiency of patients with arterial hypertension (AH) combined with undifferentiated connective tissue dysplasia (UCTD) based on the study of clinical course, the severity of UCTD external and internal symptoms with determining the levels of IL-1, IL-6, TNF-a, free and general blood oxyproline. Material and Methods. The study implied examination of 90 patients (52 women and 38 men) with AH of stage 2 from first to third degrees with manifestations of UCTD, who were on inpatient treatment in the Cardiology Department of the Lviv City Communal Clinical Emergency Hospital. The mean age of patients was (61.14±2.58) years. Patients were divided into 3 groups depending on the stage and degree of hypertension. Group I (n=16) included patients with hypertension of the first degree, group II (n=35) – with AH of the second degree, group III (n=39) – with AH of the third degree. The control group consisted of 20 patients with hypertension without manifestations of CTD. Patients underwent clinical (checkup, palpation, percussion, auscultation), laboratory (determination of IL-1, IL-6, TNF-a, free and general oxyprolin blood levels) and instrumental studies (ECG, echocardiography, DBPM, ultrasound examination of internal organs and vessels of the lower extremities, ultrasound duplex examination of the carotid and vertebral arteries, radiological examination of the osteoarticular system), consultations of an ophthalmologist, neurologist, traumatologist and dentist. Results. As a result of the study, in the group I of patients (n=16) UCTD of slight degree of severity was revealed in 13 (81 %), of medium degree – in 3 (19 %) persons. In the group II of patients (n=35), UCTD of moderate severity was found in 30 (86 %), severe – in 5 patients (14 %). In the group III of patients (n=39), UCTD of moderate severity was found in 32 patients (82 %), severe – in 7 (18 %). In the study of the level of TNF-a, an increase compared to the control group was detected, particularly, in the group I of patients its level exceeded in 37.4 times, in the group II – in 39.6 times, in the group III – in 46.2 times (p<0.001). IL-1b increased by 2.6-fold (р<0.05) in the group I of patients compared to the control group, 3.1-fold (р<0.01) – in the group II, and by 3.7-fold, that was the foremost (р<0.001), in patients of the group III. In turn, IL-6 in the group I of patients exceeded the indicators of the control group by 4.3 times (p<0.001), in the group II – 4.8 times (p<0.001), in the group III – 5.7 times (р<0.001). The study of the level of free oxyproline revealed its increase in comparison with the control group, namely in the group I of patients exceeded in 6.12 times, in the group II – in 6.81 times, in the group III – by 7.56 times (р<0.01). The study of the general of bound oxyproline revealed its increase in comparison with the control group, namely in the group I of patients exceeded by 6.98 times, in the group II – by 7.79 times, in the group III – by 9.42 times (p<0.01), which indicates an increase in fibrillogenesis and more pronounced destructive and inflammatory processes in connective tissue. Conclusions. Patients with AH of the stage 2 from first to third degrees with manifestations of UCTD have increased levels of IL-1, IL-6 and TNF-a, which are not only sensitive markers of inflammation, but also play an important role in the pathogenesis and progression of vascular lesions, occurrence and destabilization of atherosclerotic plaques and thrombotic vessels occlusion. The determination of blood oxyprolin in patients with hypertension combined with UCTD confirms the presence of CTD, namely the decay of collagen is more pronounced in patients with severe dysplasia.
Ëüâ³âñüêèé íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò ³ìåí³ Äàíèëà Ãàëèöüêîãî, ì. Ëüâ³â, Óêðà¿íà ϳäãîòîâêà ñ³ìåéíèõ ë³êàð³â íà äîòà ï³ñëÿäèïëîìíîìó åòàï³, ïðîáëåìè òà øëÿõè ¿õ âèð³øåííÿ Ðåçþìå. Àêòóàëüí³ñòü. Ó ñòàòò³ ïðîàíàë³çîâàí³ ïðîãðàìè ñïåö³àë³çàö³¿ ë³êàð³â-³íòåðí³â ³ êóðñàíò³â öèêëó ïåðåï³äãîòîâêè ä³ëüíè÷íèõ ë³êàð³â òåðàïåâò³â ³ ïåä³àòð³â çà ñïåö³àëüí³ñòþ «Çàãàëüíà ïðàêòèêà -ñ³ìåéíà ìåäèöèíà». Çàïðîïîíîâàíî øëÿõè âèð³øåííÿ äåÿêèõ ïðîáëåì, ïîâ'ÿçàíèõ ç ï³äãîòîâêîþ ë³êàð³â â Óêðà¿í³. Ìåòîþ äîñë³äaeåííÿ º ïðîàíàë³çóâàòè òà îïòèì³çóâàòè ñèñòåìó ï³äãîòîâêè ñ³ìåéíèõ ë³êàð³â íà äî-òà ï³ñëÿäèïëîìíîìó åòàï³. Ðåçóëüòàòè. Ðåôîðìóâàííÿ îõîðîíè çäîðîâ'ÿ íà çàñàäàõ ñ³ìåéíî¿ ìåäèöèíè º äîö³ëüíèì, íåóõèëüíèì ³ íåçâîðîòí³ì ïðîöåñîì â Óêðà¿í³. гøåííÿ ùîäî ðåôîðìóâàííÿ ïîâèíí³ áóòè âèâàaeåíèìè òà, ïåðø çà âñå, â³äïîâ³äàòè ÷èííîìó çàêîíîäàâñòâó Óêðà¿íè. Âèñíîâêè. Ñó÷àñíèé ñòàí ñ³ìåéíî¿ ìåäèöèíè ñâ³ä÷èòü ïðî òå, ùî îðãàí³çàö³éíà ñòðóêòóðà, ïîðÿäîê ô³íàíñóâàííÿ, êàäðîâå, ìàòåð³àëüíî-òåõí³÷íå çàáåçïå-÷åííÿ âèìàãàþòü óäîñêîíàëåííÿ øëÿõîì íàáëèaeåííÿ ¿¿ äî íàñåëåííÿ, çá³ëüøåííÿ îáñÿãó ïîñëóã, ï³äâèùåííÿ ¿õ ÿêîñò³ òà åôåêòèâíîñò³. Ðåôîðìóâàííÿ ñèñòåìè îõîðîíè çäîðîâ'ÿ íà çàñàäàõ ñ³ìåéíî¿ ìåäèöèíè â Óêðà¿í³, îñîáëèâî àêòèâíå â îñòàíí³ ðîêè, ïîêàçàëî äåÿê³ ïîçèòèâí³ ðåçóëüòàòè, àëå ðàçîì ç òèì ïðîáëåìè ÿêîñò³ ìåäè÷íî¿ îñâ³òè ³ íàâ÷àííÿ ïîòðåáóþòü ïîäàëüøîãî âèð³øåííÿ.
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