СОДЕРЖАНИЕ ЛИПИДОВ, АДИПОКИНОВ И ГРЕЛИНА ПРИ РАЗВИТИИ ИНСУЛИНОРЕЗИСТЕНТНОСТИ У ПАЦИЕНТОВ С ИНФАРКТОМ МИОКАРДА

Aim. The estimate insulin resistance in myocardial infarction. Patients and methods. The study involved 200 patients with myocardial infarction, in which on the 1st and 12th day of hospitalization measured glucose, insulin, insulin resistance index (IR), lipid profile, the concentration of adipokines and ghrelin. Results. IR was detected in 77% of patients and was associated with a history of factors of cardiovascular risk, adverse clinical course of the disease, lipid disorders. The most important marker was the level of free fatty acids. High risk associated with increased in 9 times the concentration of free fatty acids in blood plasma. Patients with IR observed increased concentrations of leptin, resistin, and reduced the protective effect of adiponectin. The high specificity and sensitivity characteristic of the concentration of ghrelin: its reduction by 4 times in the acute phase of myocardial infarction increases the risk of MI by 78%. Conclusions. Significant risk factors for MI myocardial infarction, along with insulinemia and glycemia, is to increase the concentration of free fatty acids and the disbalance in the system adipokines against deficiency of ghrelin in acute and early recovery periods of the disease. Free fatty acids and ghrelin are promising markers to stratify the risk of insulin resistance in patients with myocardial infarction. Цель исследования: оценка инсулинорезистентности при инфаркте миокарда. Пациенты и методы:  в исследование включено 200 пациентов с инфарктом миокарда,  у которых на 1-е и 12-е сут госпитализации определяли содержание глюкозы, инсулина, индекс инсулинорезистентности (ИР), показатели липидного профиля, концентрацию адипокинов и грелина. Результаты: ИР была выявлена у 77% больных и ассоциировалась с наличием в анамнезе факторов сердечно-сосудистого риска, неблагоприятным клиническим течением заболевания, нарушением липидного обмена. Наиболее информативным маркером оказался уровень свободных жирных кислот. Высокий риск развития ИР связан с возрастанием  в 9 раз концентрации свободных жирных кислот в плазме крови. У больных с ИР наблюдается увеличение концентрации лептина, резистина, и снижение защитного действия адипонектина. Высокая специфичность и чувствительность характерна для концентрации грелина: ее снижение в 4 раза в остром периоде инфаркта миокарда повышает риск развития ИР на 78%.Выводы: значимыми факторами риска ИР при инфаркте миокарда, наряду с инсулинемией и гликемией, является увеличение  концентрации  свободных жирных кислот и дисбаланс в системе адипокинов  на фоне дефицита грелина в остром и раннем восстановительном периодах заболевания. Свободные жирные кислоты и грелин являются перспективными маркерами для стратификации риска развития инсулинорезистентности у больных с инфарктом  миокарда.

ОЦЕНКА ДИНАМИКИ СТОЙКОЙ ЭРИТЕМЫ НА КОЖЕ ЛИЦА У ПАЦИЕНТОВ, ПРИНИМАЮЩИХ ГИПОТЕНЗИВНУЮ ТЕРАПИЮ B - АДРЕНОБЛОКАТОРАМИ И НЕПРЯМЫМИ АНТИКОАГУЛЯНТАМИ В СРАВНЕНИИ С ТЕРАПИЕЙ КОМБИНИРОВАННЫМ ПРЕПАРАТОМ ЭКСФОРЖ

Relevance: the Observations showed that vascular skin changes characterize patients in the combined antihypertensive therapy with β-blockers, vasodilators and indirect anticoagulants. The pharmacotherapy of patients receiving antihypertensive therapy, directly affects the physiological parameters of the skin and the formation of rosacea.Наблюдения показали, что сосудистые изменения на коже лица характерны для пациентов, получающих в составе комплексной гипотензивной терапии β-адреноблокаторы, вазодилятаторы и непрямые антикоагулянты. Показатели коагулограммы и характер фармакотерапии пациентов, получающих гипотензивную терапию, напрямую влияют на физиометрические показатели кожи и формирование розацеа[1]

ОЦЕНКА ДИНАМИКИ СТОЙКОЙ ЭРИТЕМЫ НА КОЖЕ ЛИЦА У ПАЦИЕНТОВ, ПРИНИМАЮЩИХ ГИПОТЕНЗИВНУЮ ТЕРАПИЮ B - АДРЕНОБЛОКАТОРАМИ И НЕПРЯМЫМИ АНТИКОАГУЛЯНТАМИ В СРАВНЕНИИ С ТЕРАПИЕЙ КОМБИНИРОВАННЫМ ПРЕПАРАТОМ ЭКСФОРЖ

Relevance: the Observations showed that vascular skin changes characterize patients in the combined antihypertensive therapy with β-blockers, vasodilators and indirect anticoagulants. The pharmacotherapy of patients receiving antihypertensive therapy, directly affects the physiological parameters of the skin and the formation of rosacea.Наблюдения показали, что сосудистые изменения на коже лица характерны для пациентов, получающих в составе комплексной гипотензивной терапии β-адреноблокаторы, вазодилятаторы и непрямые антикоагулянты. Показатели коагулограммы и характер фармакотерапии пациентов, получающих гипотензивную терапию, напрямую влияют на физиометрические показатели кожи и формирование розацеа[1]

VARIANTS OF NONSPECIFIC ULCERATIVE COLITIS COURSE IN CHILDREN: PREDICTION AND TREATMENT

Nonspecific ulcerative colitis has different masks, which make it hard for diagnostics. The course of the disease has many variants depending on the kind of therapy, its efficiency. prediction the course of the ulcerative colitis is very important to define the long term treatment management in order to increase the therapy efficiency and improve life quality.Key words: nonspecific ulcerative colitis, prediction the course of the disease, therapy, children

SORPTION РATHOGENETIC THERAPY OF ENDOGENOUS INTOXICATION OF PEDIATRIC CHRONIC INFLAMMATORY BOWEL DISEASES

Gut endotoxicosis caused by penetration of bacterial and metabolic toxins from chime on the background of increasing permeability of gut wall is of great importance in pathogenesis of chronic inflammatory bowel diseases (nonspecific ulcerative colitis — NUC and Crohn’s disease). It is accompanied by disturbance of regulating homeostasis system with the following disturbances of organs and systems of toxication. Developed endotoxicosis accordingly contributes to maintain and to progress of metabolic and immunological changes. To obtain the precise degree and phase of development of endotoxicosis we estimated quantitative and qualitative changes of metabolic status in accordance with content in erythrocytes, plasma and urine LMMWP (low and medium molecular weight peptides). Taking into concideration the peculiarities of children endotoxicosis with, we suggested patogenetical absorption therapy. Therefore, the therapeutic complex was added enterosorbent ensoral, which absorb eczo and endogenic toxins and, moreover, positive influence for composition of intestinal microflora. Prominent clinical effect was accompanied by positive dynamics of laboratory-instrumental parameters.Key words: endogenous intoxication, inflammatory bowel diseases, nonspecific ulcerative colitis, Crohn’s disease, low and medium molecular weight peptides, enterosorbents, children

FUNCTIONAL FECAL INCONTINENCE IN CHILDREN (DIFFERENTIAL DIAGNOSTICS AND TREATMENT APPROACHES)

Impairment of the intestinal content continence, a common clinical situation with various pathogenetic mechanisms. Disease proceeds with the child’s maladjustment events. 33 cases of encopresis have been analyzed. This condition has various clinical and instrumental diagnostic criteria depending on the origin which simplifies differential diagnostics. Using a differential diagnostics table helps expedite the process of making a diagnosis and hence start an adequate treatment in a timely manner.Key words: encopresis, differential diagnostics, treatment, children

MEDICAL NUTRITION FOR NON SPECIFIC ULCERATIVE COLITIS AND CROHN'S DISEASE IN CHILDREN

Disturbances of nutritive status are typical of patients with non specific ulcerative colitis и crohn's disease with such symptoms as body weight deficiency, disturbance of metabolism associated with the lack of proteins, macro and microelements, energy substrata. Nutrition plays a key role not only in the growth and development processes but also is one of the crucial factors determining the adequacy of the inflammatory response, adaptation compensatory processes. The article considers issues of medicated nutrition under this pathology, including the basic diet, usage of specialized mixes and enteral feeding to correct the protein energy disturbances, and as an independent treatment method.Key words: crohn's disease, non-specific ulcerative colitis, children, diet, enteral feeding, bowel disease

SORPTION РATHOGENETIC THERAPY OF ENDOGENOUS INTOXICATION OF PEDIATRIC CHRONIC INFLAMMATORY BOWEL DISEASES

Gut endotoxicosis caused by penetration of bacterial and metabolic toxins from chime on the background of increasing permeability of gut wall is of great importance in pathogenesis of chronic inflammatory bowel diseases (nonspecific ulcerative colitis — NUC and Crohn’s disease). It is accompanied by disturbance of regulating homeostasis system with the following disturbances of organs and systems of toxication. Developed endotoxicosis accordingly contributes to maintain and to progress of metabolic and immunological changes. To obtain the precise degree and phase of development of endotoxicosis we estimated quantitative and qualitative changes of metabolic status in accordance with content in erythrocytes, plasma and urine LMMWP (low and medium molecular weight peptides). Taking into concideration the peculiarities of children endotoxicosis with, we suggested patogenetical absorption therapy. Therefore, the therapeutic complex was added enterosorbent ensoral, which absorb eczo and endogenic toxins and, moreover, positive influence for composition of intestinal microflora. Prominent clinical effect was accompanied by positive dynamics of laboratory-instrumental parameters.Key words: endogenous intoxication, inflammatory bowel diseases, nonspecific ulcerative colitis, Crohn’s disease, low and medium molecular weight peptides, enterosorbents, children

VARIANTS OF NONSPECIFIC ULCERATIVE COLITIS COURSE IN CHILDREN: PREDICTION AND TREATMENT

Nonspecific ulcerative colitis has different masks, which make it hard for diagnostics. The course of the disease has many variants depending on the kind of therapy, its efficiency. prediction the course of the ulcerative colitis is very important to define the long term treatment management in order to increase the therapy efficiency and improve life quality.Key words: nonspecific ulcerative colitis, prediction the course of the disease, therapy, children