В работе были изучены показатели функционального состояния сосудистого эндотелия (коэффициент эндотели-альной функции, уровни эндотелина-1 и натрийуретического пептида типа С), перекисного окисления белков (карбо-нильные производные), липидов (ТБК-активные продукты), антиоксидантной защиты (супероксиддисмутаза) и воспа-ления (С-реактивный белок и фракталкин) у 35 пациентов с хронической обструктивной болезнью легких (ХОБЛ) и 50 соматически здоровых лиц Астраханского региона. У больных ХОБЛ установлено наличие дисфункции эндотелия и окислительного стресса, опосредованного перекисной деструкцией как липидных, так и белковых молекул. Констати-рована прямая корреляционная зависимость между уровнем плазменного эндотелина-1 и уровнем ТБК-активных про-дуктов, отражающая увеличение продукции вазоконстрикторов при увеличении уровня продуктов перекисного окис-ления липидов у больных ХОБЛ. Было доказано, что исследование 4а/4b полиморфизма гена eNOS имеет важное зна-чение в диагностике повреждения эндотелия при ХОБЛ.Ключевые слова: хроническая обструктивная болезнь легких, гомеостаз, эндотелиальная дисфункция, оксида-тивный стресс, воспаление, полиморфизм генов.
HOMEOSTATIC DISORDERS IN CHRONIC OBSTRUCTIVE PULMONARY DISEASEAkhmineeva A.Kh., Polunina O.S., Sevostyanova I.V.
Department of Internal Diseases of Pediatric Faculty of Astrakhan State Medical University, AstrakhanThe research studied the parameters of the vascular endothelium functional state (the ratio of endothelial function, levels of endothelin-1 and natriuretic peptide of type C) of peroxide oxidation of proteins (carbonyl derivatives), of lipids (TBAactive products), of antioxidant protection (superoxide dismutase) and inflammation (C -reactive protein and fractalkine) in 35 patients with chronic obstructive pulmonary disease (COPD) and 50 somatically healthy persons of Astrakhan region. It was revealed that COPD patients had endothelial dysfunction and oxidative stress due to the peroxide destruction of both lipid and protein molecules. We stated a direct correlation between the level of plasma endothelin-1 and the level of TBA-active products reflecting an increase in production of vasoconstrictors with increasing levels of lipid peroxidation products in patients with COPD. It has been proven that the study of 4a/4b polymorphism of the eNOS gene is important in the diagnosis of endothelial damage in COPD.
Ассоциация полиморфизма 4а / 4b и 4b / 4b гена эндотелиальной синтазы оксида азота с маркерами дисфункции эндотелия у больных ХСН Ключевые слова: ХСН, эндотелин-1, натрийуретический пептид типа С
Introduction and purpose. The leading role in the pathogenesis of chronic heart failure (CHF) belongs to disturbances in the vascular endothelium. The aim of this work is the identification and analysis of the responses of the microvascular endothelium in patients with CHF, depending on the ejection fraction. Methods. We have examined 280 patients with CHF. Analysis of the reactivity of the endothelium of microvessels was carried out using laser Doppler flowmetry. Results. We have identified 3 types of response of the microvascular endothelium, thus all responses were decrement. Patients with CHF with reduced ejection fraction of the left ventricle was the predominant hyporeactive-decrement type response of the vascular endothelium. Conclusions. Results indicate torpidity of microvascular endothelium and the unidirectionality of the processes state changes of the vascular endothelium with a reduction in myocardial contractile function.
Астраханский государственный медицинский университет, Россия feaTures of microVascular reacTiViTY in paTienTs WiTh Bronchial asThma comBineD WiTh arTerial hYperTension anD ischemic hearT Disease akhmineeva a. Kh., polunina o. s., sevostyanova i. V., Voronina l. p. astrakhan state medical university, russia Изучались особенности микрососудистой реактивности на ионофорез эндотелий-зависимого вазодилататора у больных бронхиальной астмой (БА) в сочетании с артериальной гипертензией (АГ), ишемической болезнью сердца (ИБС). Обследовано 35 больных БА, 35 больных АГ, 35 больных ИБС и 40 пациентов с со-Сведения об авторах:
Introduction. Frequent comorbidity of chronic obstructive pulmonary disease and myocardial infarction is due to the commonality of a number of etiopathogenetic links and the development of endogenous intoxication syndrome. The convincing markers of endogenous intoxication syndrome are medium and low molecular weight molecules including medium and low molecular weight substances and oligopeptides.Aim. To study the levels of medium and low molecular weight substances in patients with myocardial infarction against the background of chronic obstructive pulmonary disease.Materials and methods. 225 patients with myocardial infarction were examined. In 195 patients the infarction developed against the background of COPD, in 130 patients – without COPD. The comparison group consisted of 110 somatically healthy individuals. Substances of medium and low molecular weight (MLMWS) and oligopeptides (OP) were determined by direct spectrometry (according to M.Y. Malakhova, 1995) in plasma, erythrocytes and urine. Endogenous intoxication indices and intoxication coefficient were calculated on the basis of these indices. Statistical processing of the data was performed using SPSS 26.0 software package.Results. In blood plasma and erythrocytes, the levels of average molecules in both studied groups were statistically significantly higher compared to controls. The highest levels were detected in comorbid patients. In the group of patients with myocardial infarction without chronic obstructive pulmonary disease 60% of the examined patients had phase I endogenous intoxication. Phase III intoxication prevailed among comorbid patients with myocardial infarction against chronic obstructive pulmonary disease – 62,6%.Conclusions. Molecules of average mass have proven to be informative indices of endogenous intoxication syndrome in patients with myocardial infarction accompanied by chronic obstructive pulmonary disease. This opens the prospect of using these indices in the development of assessment scales and the creation of prognostic algorithms in patients with cardiorespiratory comorbidity.
Background. Chronic obstructive pulmonary disease is a socially significant disease affecting patient’s quality of life. Assessment of endogenous intoxication in patients with chronic obstructive pulmonary disease will allow to understand pathogenetic features of different phenotypes of this disease, which can be taken into account when predicting its course.The aim of the study. To determine the prognostic value of levels of mediumand low-molecular-weight substances and oligopeptides in patients with chronic obstructive pulmonary disease.Materials and methods. One hundred and four patients with chronic obstructive pulmonary disease (COPD) and 110 somatically healthy individuals were examined. Molecular weight medium and low molecular weight substances (LMWSM) and oligopeptides (OP) were determined in blood plasma, erythrocytes and urine. Based on these indicators mathematically calculated indices of endogenous intoxication and coefficient of elimination were defined. Statistical processing of the data was performed using the SPSS 26.0 software package (IBM Corp., USA).Results. In all biological fluids, the levels of average molecules and calculated indices in the COPD patients’ group were statistically significantly different from those in the control group. The indices characterizing endotoxin accumulation were statistically significantly higher, while those characterizing toxin elimination were lower. The level of endotoxemia was correlated with the frequency of exacerbations, clinical manifestations severity, quality of life, COPD group and phenotype.Conclusions. Frequent exacerbations, groups C and D, bronchitic and mixed COPD phenotypes are characterized by more severe endotoxicosis manifested by high levels of LMWSM, OP and calculated indices.
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