23 research outputs found
ΠΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΡ ΠΊΠΎΠΌΠΏΡΠ΅ΡΡΠΈΠΎΠ½Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Π² ΠΏΡΠΎΡΠΈΠ»Π°ΠΊΡΠΈΠΊΠ΅ Π²Π΅Π½ΠΎΠ·Π½ΡΡ ΡΡΠΎΠΌΠ±ΠΎΡΠΌΠ±ΠΎΠ»ΠΈΡΠ΅ΡΠΊΠΈΡ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ COVID-19
Background The main method for preventing thrombotic complications in patients with coronavirus infection is anticoagulant therapy (ACT). However, its use is not always possible, in particular in patients with bleeding. The only method of prevention in this case is elastic compression (EC) of the lower extremities.Aim of study To evaluate the effectiveness of lower extremity EC for the prevention of venous thromboembolic complications (VTEC) in patients with a new coronavirus infection.Material and methods The study was approved by the local Ethics Committee of the Ryazan State Medical University of the Ministry of Health of Russian Federation and registered on the ClinicalTrials.gov platform (identifier NCT05143567). The study included 69 patients without prophylactic compression (Group 1) and 65 patients who used prophylactic compression stockings (Group 2). The patients were treated in the covid hospital from July to November 2021. All patients had verified coronavirus infection, they took ACT and underwent ultrasound duplex scanning of the veins of the lower extremities upon admission, in the intensive care unit and upon discharge. We assessed the frequency of venous thromboembolic complications (VTEC), hemorrhagic complications, and mortality. To assess the severity of bleeding, the classification of the Committee of the International Society on Thrombosis and Haemostasis (ISTH) was used.Results In patients without prophylactic compression (Group 1) there were 7 VTEC cases (10.14%); deep vein thrombosis (DVT) β 4 (5.8%), pulmonary embolism (PE) β 3 (4.3%). All 6 cases (8.7%) with PE were fatal. It was noted that 2 cases of PE (2.8%) were verified upon autopsy, and not clinically. In patients of the 2nd group with the use of elastic compression, the overall incidence of VTEC was only one case (1.6%). When analyzing the frequency of bleeding in the 1st group, there was one pulmonary bleeding (1.4%), in the 2nd group there was also one case of intense intermuscular hematoma (1.6%). Significant bleeding was observed in one patient (1.4%) of the 1st group, and in 3 (4.8%) cases of the 2nd group. The minor bleeding was observed in 11 patients (15.9%) of the 1st group, and in 8 (12.7%) patients of the 2nd group. The mortality during hospitalization was 11 (15.9%) cases in patients of the 1st group (without EC) and 7 (11.1%) in patients of the 2nd group (with EC) (p=0.419).Conclusions The mortality in patients with coronavirus infection without compression therapy is higher than in patients with compression stockings (p=0.419). Patients wearing compression stockings in the hospital had a low incidence of VTEC (1.6% of cases in group 2 versus 10.14% of cases in group 1, p=0.039). The study groups had the same frequency of bleeding (group 1 β one case (1.4%), group 2 β one case (1.6%). The use of preventive compression at the inpatient stage of treatment of a new coronavirus infection makes it possible to prevent VTEC in patients with bleeding when anticoagulant therapy is not possible.ΠΠΊΡΡΠ°Π»ΡΠ½ΠΎΡΡΡ ΠΡΠ½ΠΎΠ²Π½ΡΠΌ ΠΌΠ΅ΡΠΎΠ΄ΠΎΠΌ ΠΏΡΠΎΡΠΈΠ»Π°ΠΊΡΠΈΠΊΠΈ ΡΡΠΎΠΌΠ±ΠΎΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ
ΠΊΠΎΡΠΎΠ½Π°Π²ΠΈΡΡΡΠ½ΠΎΠΉ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠ΅ΠΉ ΡΠ²Π»ΡΠ΅ΡΡΡ Π°Π½ΡΠΈΠΊΠΎΠ°Π³ΡΠ»ΡΠ½ΡΠ½Π°Ρ ΡΠ΅ΡΠ°ΠΏΠΈΡ (ΠΠΠ’). ΠΠ΄Π½Π°ΠΊΠΎ ΠΈ Π΅Π΅ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ Π½Π΅ Π²ΡΠ΅Π³Π΄Π° Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎ, Π² ΡΠ°ΡΡΠ½ΠΎΡΡΠΈ, Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΊΡΠΎΠ²ΠΎΡΠ΅ΡΠ΅Π½ΠΈΡΠΌΠΈ. ΠΠ΄ΠΈΠ½ΡΡΠ²Π΅Π½Π½ΡΠΌ ΡΠΏΠΎΡΠΎΠ±ΠΎΠΌ ΠΏΡΠΎΡΠΈΠ»Π°ΠΊΡΠΈΠΊΠΈ Π² Π΄Π°Π½Π½ΠΎΠΌ ΡΠ»ΡΡΠ°Π΅ ΡΠ²Π»ΡΠ΅ΡΡΡ ΡΠ»Π°ΡΡΠΈΡΠ΅ΡΠΊΠ°Ρ ΠΊΠΎΠΌΠΏΡΠ΅ΡΡΠΈΡ (ΠΠ) Π½ΠΈΠΆΠ½ΠΈΡ
ΠΊΠΎΠ½Π΅ΡΠ½ΠΎΡΡΠ΅ΠΉ.Π¦Π΅Π»Ρ ΡΠ°Π±ΠΎΡΡ ΠΡΠ΅Π½ΠΈΡΡ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΡ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ ΠΠ Π½ΠΈΠΆΠ½ΠΈΡ
ΠΊΠΎΠ½Π΅ΡΠ½ΠΎΡΡΠ΅ΠΉ Π² ΠΏΡΠΎΡΠΈΠ»Π°ΠΊΡΠΈΠΊΠ΅ Π²Π΅Π½ΠΎΠ·Π½ΡΡ
ΡΡΠΎΠΌΠ±ΠΎΡΠΌΠ±ΠΎΠ»ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ (ΠΠ’ΠΠ) Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Π½ΠΎΠ²ΠΎΠΉ ΠΊΠΎΡΠΎΠ½Π°Π²ΠΈΡΡΡΠ½ΠΎΠΉ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠ΅ΠΉ.ΠΠ°ΡΠ΅ΡΠΈΠ°Π» ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ ΠΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ ΠΎΠ΄ΠΎΠ±ΡΠ΅Π½ΠΎ Π»ΠΎΠΊΠ°Π»ΡΠ½ΡΠΌ ΡΡΠΈΡΠ΅ΡΠΊΠΈΠΌ ΠΊΠΎΠΌΠΈΡΠ΅ΡΠΎΠΌ Π€ΠΠΠΠ£ ΠΠ Π ΡΠ·ΠΠΠ£ ΠΠΈΠ½Π·Π΄ΡΠ°Π²Π° Π ΠΎΡΡΠΈΠΈ ΠΈ Π·Π°ΡΠ΅Π³ΠΈΡΡΡΠΈΡΠΎΠ²Π°Π½ΠΎ Π½Π° ΠΏΠ»Π°ΡΡΠΎΡΠΌΠ΅ ClinicalTrials.gov (ΠΈΠ΄Π΅Π½ΡΠΈΡΠΈΠΊΠ°ΡΠΎΡ NCT05143567). Π ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π²ΠΊΠ»ΡΡΠ΅Π½Ρ 69 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π±Π΅Π· ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ ΡΡΠΈΠΊΠΎΡΠ°ΠΆΠ° (1-Ρ Π³ΡΡΠΏΠΏΠ°) ΠΈ 65 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², ΠΊΠΎΡΠΎΡΡΠΌ ΠΏΡΠΈΠΌΠ΅Π½ΡΠ»ΡΡ ΠΏΡΠΎΡΠΈΠ»Π°ΠΊΡΠΈΡΠ΅ΡΠΊΠΈΠΉ ΠΊΠΎΠΌΠΏΡΠ΅ΡΡΠΈΠΎΠ½Π½ΡΠΉ ΡΡΠΈΠΊΠΎΡΠ°ΠΆ (2-Ρ Π³ΡΡΠΏΠΏΠ°). ΠΠΎΠ»ΡΠ½ΡΠ΅ ΠΏΡΠΎΡ
ΠΎΠ΄ΠΈΠ»ΠΈ Π»Π΅ΡΠ΅Π½ΠΈΠ΅ Π² ΠΊΠΎΠ²ΠΈΠ΄Π½ΠΎΠΌ Π³ΠΎΡΠΏΠΈΡΠ°Π»Π΅ Ρ ΠΈΡΠ»Ρ ΠΏΠΎ Π½ΠΎΡΠ±ΡΡ 2021 Π³. ΠΡΠ΅ ΠΏΠ°ΡΠΈΠ΅Π½ΡΡ Π±ΡΠ»ΠΈ Ρ Π²Π΅ΡΠΈΡΠΈΡΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠΉ ΠΊΠΎΡΠΎΠ½Π°Π²ΠΈΡΡΡΠ½ΠΎΠΉ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠ΅ΠΉ, ΠΈΠΌ Π½Π°Π·Π½Π°ΡΠ°Π»ΠΈ ΠΠΠ’ ΠΈ ΠΏΡΠΎΠ²ΠΎΠ΄ΠΈΠ»ΠΈ ΡΠ»ΡΡΡΠ°Π·Π²ΡΠΊΠΎΠ²ΠΎΠ΅ Π΄ΡΠΏΠ»Π΅ΠΊΡΠ½ΠΎΠ΅ ΡΠΊΠ°Π½ΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ Π²Π΅Π½ Π½ΠΈΠΆΠ½ΠΈΡ
ΠΊΠΎΠ½Π΅ΡΠ½ΠΎΡΡΠ΅ΠΉ ΠΏΡΠΈ ΠΏΠΎΡΡΡΠΏΠ»Π΅Π½ΠΈΠΈ, Π² ΠΎΡΠ΄Π΅Π»Π΅Π½ΠΈΠΈ ΡΠ΅Π°Π½ΠΈΠΌΠ°ΡΠΈΠΈ ΠΈ ΠΏΡΠΈ Π²ΡΠΏΠΈΡΠΊΠ΅. ΠΡΠ΅Π½ΠΈΠ²Π°Π»ΠΈ ΡΠ°ΡΡΠΎΡΡ Π²Π΅Π½ΠΎΠ·Π½ΡΡ
ΡΡΠΎΠΌΠ±ΠΎΡΠΌΠ±ΠΎΠ»ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ (ΠΠ’ΠΠ), Π³Π΅ΠΌΠΎΡΡΠ°Π³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΡ, Π»Π΅ΡΠ°Π»ΡΠ½ΠΎΡΡΡ. ΠΠ»Ρ ΠΎΡΠ΅Π½ΠΊΠΈ ΡΡΠΆΠ΅ΡΡΠΈ ΠΊΡΠΎΠ²ΠΎΡΠ΅ΡΠ΅Π½ΠΈΠΈ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π»ΠΈ ΠΊΠ»Π°ΡΡΠΈΡΠΈΠΊΠ°ΡΠΈΡ ΠΠΎΠΌΠΈΡΠ΅ΡΠ° ΠΠ΅ΠΆΠ΄ΡΠ½Π°ΡΠΎΠ΄Π½ΠΎΠ³ΠΎ ΠΎΠ±ΡΠ΅ΡΡΠ²Π° ΠΏΠΎ ΡΡΠΎΠΌΠ±ΠΎΠ·Ρ ΠΈ Π³Π΅ΠΌΠΎΡΡΠ°Π·Ρ (International Society on Thrombosis and Haemostasis, ISTH).Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ Π£ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π±Π΅Π· ΡΡΠΈΠΊΠΎΡΠ°ΠΆΠ° (1-Ρ Π³ΡΡΠΏΠΏΠ°) ΠΠ’ΠΠ ΡΠΎΡΡΠ°Π²ΠΈΠ»ΠΈ 7 ΡΠ»ΡΡΠ°Π΅Π² (10,14%); ΡΡΠΎΠΌΠ±ΠΎΠ· Π³Π»ΡΠ±ΠΎΠΊΠΈΡ
Π²Π΅Π½ (Π’ΠΠ) β 4 (5,8%), ΡΡΠΎΠΌΠ±ΠΎΡΠΌΠ±ΠΎΠ»ΠΈΡ Π»Π΅Π³ΠΎΡΠ½ΠΎΠΉ Π°ΡΡΠ΅ΡΠΈΠΈ (Π’ΠΠΠ) β 3 (4,3%). ΠΡΠ΅ 6 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² (8,7%) Ρ Π’ΠΠΠ β ΡΠΎ ΡΠΌΠ΅ΡΡΠ΅Π»ΡΠ½ΡΠΌ ΠΈΡΡ
ΠΎΠ΄ΠΎΠΌ. ΠΡΠΌΠ΅ΡΠ΅Π½ΠΎ, ΡΡΠΎ 2 ΡΠ»ΡΡΠ°Ρ Π’ΠΠΠ (2,8%) Π±ΡΠ»ΠΈ Π²Π΅ΡΠΈΡΠΈΡΠΈΡΠΎΠ²Π°Π½Ρ Π½Π° Π°ΡΡΠΎΠΏΡΠΈΠΈ, Π° Π½Π΅ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈ.Π£ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² 2-ΠΉ Π³ΡΡΠΏΠΏΡ Ρ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ΠΌ ΡΠ»Π°ΡΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΊΠΎΠΌΠΏΡΠ΅ΡΡΠΈΠΈ ΠΎΠ±ΡΠ°Ρ ΡΠ°ΡΡΠΎΡΠ° ΠΠ’ΠΠ ΡΠΎΡΡΠ°Π²ΠΈΠ»Π° Π²ΡΠ΅Π³ΠΎ ΠΎΠ΄ΠΈΠ½ ΡΠ»ΡΡΠ°ΠΉ (1,6%). ΠΡΠΈ Π°Π½Π°Π»ΠΈΠ·Π΅ ΡΠ°ΡΡΠΎΡΡ ΠΊΡΠΎΠ²ΠΎΡΠ΅ΡΠ΅Π½ΠΈΠΉ Π² 1-ΠΉ Π³ΡΡΠΏΠΏΠ΅ Π±ΡΠ»ΠΎ ΠΎΠ΄Π½ΠΎ Π»Π΅Π³ΠΎΡΠ½ΠΎΠ΅ ΠΊΡΠΎΠ²ΠΎΡΠ΅ΡΠ΅Π½ΠΈΠ΅ (1,4%), Π²ΠΎ 2-ΠΉ Π³ΡΡΠΏΠΏΠ΅ ΡΠ°ΠΊΠΆΠ΅ ΠΎΠ΄ΠΈΠ½ ΡΠ»ΡΡΠ°ΠΉ Π½Π°ΠΏΡΡΠΆΠ΅Π½Π½ΠΎΠΉ ΠΌΠ΅ΠΆΠΌΡΡΠ΅ΡΠ½ΠΎΠΉ Π³Π΅ΠΌΠ°ΡΠΎΠΌΡ (1,6%). ΠΠ½Π°ΡΠΈΠΌΡΠ΅ ΠΊΡΠΎΠ²ΠΎΡΠ΅ΡΠ΅Π½ΠΈΡ Π² 1-ΠΉ Π³ΡΡΠΏΠΏΠ΅ Π½Π°Π±Π»ΡΠ΄Π°Π»ΠΈΡΡ Ρ ΠΎΠ΄Π½ΠΎΠ³ΠΎ Π±ΠΎΠ»ΡΠ½ΠΎΠ³ΠΎ (1,4%), Π° Π²ΠΎ 2-ΠΉ Π³ΡΡΠΏΠΏΠ΅ β Ρ 3 (4,8%). ΠΠ°Π»ΡΠ΅ ΠΊΡΠΎΠ²ΠΎΡΠ΅ΡΠ΅Π½ΠΈΡ Π² 1-ΠΉ Π³ΡΡΠΏΠΏΠ΅ ΠΎΡΠΌΠ΅ΡΠ΅Π½Ρ Ρ 11 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² (15,9%), Π²ΠΎ 2-ΠΉ Π³ΡΡΠΏΠΏΠ΅ β Ρ 8 (12,7%). ΠΠ΅ΡΠ°Π»ΡΠ½ΠΎΡΡΡ Π²ΠΎ Π²ΡΠ΅ΠΌΡ Π³ΠΎΡΠΏΠΈΡΠ°Π»ΠΈΠ·Π°ΡΠΈΠΈ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² 1-ΠΉ Π³ΡΡΠΏΠΏΡ (Π±Π΅Π· ΠΠ) ΡΠΎΡΡΠ°Π²ΠΈΠ»Π° 11 Π±ΠΎΠ»ΡΠ½ΡΡ
(15,9%) , Π²ΠΎ 2-ΠΉ Π³ΡΡΠΏΠΏΠ΅ (Ρ ΠΠ) β 7 (11,1%) (Ρ=0,419).ΠΡΠ²ΠΎΠ΄Ρ ΠΠ΅ΡΠ°Π»ΡΠ½ΠΎΡΡΡ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΊΠΎΡΠΎΠ½Π°Π²ΠΈΡΡΡΠ½ΠΎΠΉ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠ΅ΠΉ Π±Π΅Π· ΠΊΠΎΠΌΠΏΡΠ΅ΡΡΠΈΠΎΠ½Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Π²ΡΡΠ΅, ΡΠ΅ΠΌ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ΠΌ ΠΊΠΎΠΌΠΏΡΠ΅ΡΡΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ ΡΡΠΈΠΊΠΎΡΠ°ΠΆΠ° (Ρ=0,419). Π£ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², Π½ΠΎΡΠΈΠ²ΡΠΈΡ
ΠΊΠΎΠΌΠΏΡΠ΅ΡΡΠΈΠΎΠ½Π½ΡΠ΅ ΡΡΠ»ΠΊΠΈ Π² ΡΡΠ°ΡΠΈΠΎΠ½Π°ΡΠ΅, ΠΎΠ±Π½Π°ΡΡΠΆΠ΅Π½Π° Π½ΠΈΠ·ΠΊΠ°Ρ ΡΠ°ΡΡΠΎΡΠ° ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΠ’ΠΠ (1,6% ΡΠ»ΡΡΠ°Π΅Π² Π²ΠΎ 2-ΠΉ Π³ΡΡΠΏΠΏΠ΅ ΠΏΡΠΎΡΠΈΠ² 10,14% ΡΠ»ΡΡΠ°Π΅Π² Π² 1-ΠΉ Π³ΡΡΠΏΠΏΠ΅, Ρ=0,039). Π ΠΈΡΡΠ»Π΅Π΄ΡΠ΅ΠΌΡΡ
Π³ΡΡΠΏΠΏΠ°Ρ
Π±ΡΠ»Π° ΠΎΠ΄ΠΈΠ½Π°ΠΊΠΎΠ²Π°Ρ ΡΠ°ΡΡΠΎΡΠ° Π±ΠΎΠ»ΡΡΠΈΡ
ΠΊΡΠΎΠ²ΠΎΡΠ΅ΡΠ΅Π½ΠΈΠΉ (1-Ρ Π³ΡΡΠΏΠΏΠ° β ΠΎΠ΄ΠΈΠ½ ΡΠ»ΡΡΠ°ΠΉ (1,4%), 2-Ρ Π³ΡΡΠΏΠΏΠ° β ΠΎΠ΄ΠΈΠ½ (1,6%) ΡΠ»ΡΡΠ°ΠΉ). ΠΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ ΠΏΡΠΎΡΠΈΠ»Π°ΠΊΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΡΡΠΈΠΊΠΎΡΠ°ΠΆΠ° Π½Π° ΡΡΠ°ΡΠΈΠΎΠ½Π°ΡΠ½ΠΎΠΌ ΡΡΠ°ΠΏΠ΅ Π»Π΅ΡΠ΅Π½ΠΈΡ Π½ΠΎΠ²ΠΎΠΉ ΠΊΠΎΡΠΎΠ½Π°Π²ΠΈΡΡΡΠ½ΠΎΠΉ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ Π²ΡΠΏΠΎΠ»Π½ΡΡΡ ΠΏΡΠΎΡΠΈΠ»Π°ΠΊΡΠΈΠΊΡ ΠΠ’ΠΠ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΊΡΠΎΠ²ΠΎΡΠ΅ΡΠ΅Π½ΠΈΡΠΌΠΈ ΠΏΡΠΈ Π½Π΅Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΠΈ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΡ Π°Π½ΡΠΈΠΊΠΎΠ°Π³ΡΠ»ΡΠ½ΡΠ½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ
P45 Impact of lymphoid infiltration of tumor on survival ofyoung patients with breast cancer
Elevated asymmetric dimethylarginine (ADMA) and inverse correlation between circulating ADMA and glomerular filtration rate in children with sporadic focal segmental glomerulosclerosis (FSGS)
Background. Steroid-resistant nephrotic syndromes (NS) with focal and segmental glomerulosclerosis (FSGS) can be differentiated into sporadic and syndromic forms. In sporadic NS, a circulating FSGS-factor is discussed in the pathogenesis and is thought to inhibit the synthesis of nitric oxide (NO) from l-arginine by blocking the NO synthase (NOS). Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of all types of NOS. In a previous study we did not find an elevation of ADMA in a syndromic form of FSGS, the Schimke-immuno-osseous dysplasia. Here we report for the first time data on the l-arginine/NO pathway in sporadic FSGS of childhood. Methods. Nine children (5 to 18 years of age) suffering from sporadic FSGS and age-matched healthy controls were investigated. ADMA in plasma and urine as well as l-arginine in plasma were determined by gas chromatography-tandem mass spectrometry. The NO metabolites nitrate and nitrite were measured in plasma and urine by gas chromatography-mass spectrometry (GC-MS). The ADMA metabolite dimethylamine (DMA) was measured in urine by GC-MS. Results. We found elevated plasma levels of ADMA in children suffering from sporadic FSGS compared to healthy controls (851 nmol/L versus 684 nmol/L, P = 0.008). An inverse correlation between ADMA and glomerular filtration rate (GFR) was found in sporadic FSGS (Pearson's correlation coefficient β0.784, P = 0.012). Conclusion. Our study suggests that ADMA synthesis is elevated in sporadic FSGS. This finding argues for the involvement of ADMA in the pathogenesis of this disease in childhoo