A RELATIONSHIP BETWEEN IMMUNOLOGICAL DISTURBANCES, HYPOXIA AND LIPOPEROXIDATION IN EROSIVE/ULCEROUS LESIONS OF DUODENUM IN PRESENCE OF COMORBIDITIES

The aim of present work was to assess the role of immunological disorders, hypoxia and lipoperoxidation in development and progression of erosive/ulcerative lesions of duodenum accompanied by chronic cerebrovascular insufficiency. We have studied a cohort of 125 patients with erosive and ulcerative lesions of duodenum associated with chronic disorders of cerebral circulation, aged from 48 to 74 years old. They underwent outpatient treatment and care at the Clinical Hospital No.5 (Saransk) over 2015-2018. A comparison group consisted of 39 patients with chronically impaired cerebral circulation, who did not show signs of erosive/ulcerative lesions of stomach and duodenum over the study period. Patients received conventional anti-ulcer therapies for 14 days. The cytokine profile, indexes of hypoxia, and serum markers of lipid peroxidation were evaluated. The study has shown an increase in the level of pro-and anti-inflammatory cytokines in cases with erosive/ ulcerative duodenal lesions associated with chronic impairment of cerebral circulation throughout the observation period, thus indicating to evolving imbalance of immunoregulatory system. The development of hypoxic changes in the blood plasma was observed, which was confirmed by increased contents of lactic and pyruvic acids, like as the hypoxia coefficient at all the observation terms. The lipid peroxidation processes were also activated in the course of evolving disorder, as judged by increased contents of diene conjugates, triene conjugates and the malonic dialdehyde levels upon admission, as well as on day 7 and 14 of observation, associated with decrease in the antioxidant potential of blood plasma, estimated by the superoxide dismutase index. A trend for a decrease in the indexes of diene conjugates, triene conjugates, malonic dialdehyde and an increased levels of superoxide dismutase was registered as late as after 30 days of observation. Hypoxia and lipid peroxidation may be viewed as predictors of chronic inflammation. Developing imbalance between pro-inflammatory, anti-inflammatory cytokines, and chronic hypoxia are of significant value for pathogenesis of erosive-ulcerative lesions of duodenum, being associated with chronic impairment of cerebral circulation. Under such conditions, oxidative stress is observed, with a shift of equilibrium towards pro-oxidants, along with exhausted potential of antioxidant defense system. In general, these disturbances determine the pathogenetic mechanisms of damage that occur in erosive and ulcerative lesions of duodenum, being associated with chronic cerebrovascular insufficiency, which have a mutually negative influence in the course of disease progression