ФГБОУ ВО «Волгоградский государственный медицинский университет»Министерства здравоохранения Российской Федерации, кафедра внутренних болезней педиатрического и стоматологического факультетов В статье обсуждается необходимость скрининговой диагностики неалкогольной жировой болезни печени (НАЖБП) у пациентов терапевтического приема как одного их самых распространенных заболеваний печени. Приведены методы неинвазивной диагностики, позволяющие оценить наличие стеатоза и фиброза печени при НАЖБП.Ключевые слова: неалкогольная жировая болезнь печени, стеатоз печени, фиброз печени, неинвазивная диагностика.
Patients with chronic heart failure and diabetes mellitus type 2 experience continuous progression of organ damage as a result of hemodynamic and metabolic disorders. An important role in pathogenesis of organ damage belongs to pathological types of microcirculation, endothelial dysfunction and insulin resistance. But the role of insulin resistance and its contribution to the formation of endothelial dysfunction and peculiarities of microcirculation in patients with chronic heart failure and type 2 diabetes mellitus is unknown. This study shows significant association between insulin resistance, disorders of carbohydrate and lipid metabolism, development of microcirculatory disturbances and endothelial dysfunction.
Introduction. The number of patients with chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) is increasing every year. In both CHF and COPD, secondary mitochondrial dysfunction is observed. In this regard, the attention of researchers is attracted by drugs that have their therapeutic effects at the level of mitochondria, one of which is meldonium. Meldonium has proven itself in the treatment of various diseases, however, the evaluation of the clinical efficacy of meldonium has not yet been carried out in comorbid patients with CHF and COPD.Aim. To study the effects of meldonium as part of basic therapy on the clinical condition, the main functional parameters of the heart and lungs, and the quality of life in patients with CHF and COPD.Materials and methods. The randomized open study included 60 patients with CHF II A stage, II–III FC (clinical recommendations of the RSC, OSSN 2020) and COPD I–III degree of airflow limitation (GOLD 2021 classification) in remission (age 45–70 years). The patients were divided into 2 groups: the 1st group – the main group (n = 30) with CHF and COPD took meldonium at a dosage of 1000 mg/day in addition to the basic therapy, the 2nd group – the control group (n = 30) was only on basic therapy for CHF and COPD. The observation period is 12 weeks.Results. In patients with CHF and COPD, in the dynamics of therapy with the inclusion of meldonium, as a result, the severity of clinical symptoms decreased, improvement was revealed in the main structural and functional parameters of the heart, external respiration function, and quality of life.Conclusions: a significant beneficial effect of combination therapy with the inclusion of meldonium on the clinical and functional parameters of the heart and lungs, indicators of quality of life in patients with CHF and COPD has been established, which makes it possible to recommend the use of meldonium as part of combination therapy in comorbid patients.
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