5 research outputs found
Features of endothelial dysfunction in renal hypertension
Endothelial dysfunction is a marker of vascular disease, as well as the development and progression of hypertension in chronic kidney disease.
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Increased cholinergic contractions of jejunal smooth muscle caused by a high cholesterol diet are prevented by the 5-HT(4 )agonist β tegaserod
BACKGROUND: Excess cholesterol in bile and in blood is a major risk factor for the respective development of gallbladder disease and atherosclerosis. This lipid in excess negatively impacts the functioning of other smooth muscles, including the intestine. Serotonin is an important mediator of the contractile responses of the small intestine. Drugs targeting the serotonin receptor are used as prokinetic agents to manage intestinal motor disorders, in particular irritable bowel syndrome. Thus, tegaserod, acting on 5-HT(4 )receptor, ideally should obviate detrimental effects of excessive cholesterol on gastrointestinal smooth muscle. In this study we examined the effect of tegaserod on cholesterol-induced changes in the contractile responses of intestinal smooth muscle. METHODS: The effects of a high cholesterol (1%) diet on the in vitro contractile responses of jejunal longitudinal smooth muscle from Richardson ground squirrels to the cholinergic agonist carbachol were examined in the presence or absence of tetrodrodotoxin (TTX). Two groups of animals, fed either low (0.03%) or high cholesterol rat chow diet, were further divided into two subgroups and treated for 28 days with either vehicle or tegaserod. RESULTS: The high cholesterol diet increased, by nearly 2-fold, contractions of the jejunal longitudinal smooth muscle elicited by carbachol. These cholinergic contractions were mediated by muscarinic receptors since they were blocked by scopolamine, a muscarinic receptor antagonist, but not by the nicotinic receptor antagonist, hexamethonium. Tegaserod treatment, which did not affect cholinergic contractions of tissues from low cholesterol fed animals, abrogated the increase caused by the high cholesterol diet. With low cholesterol diet TTX enhanced carbachol-evoked contractions, whereas this action potential blocker did not affect the augmented cholinergic contractions seen with tissues from animals on the high cholesterol diet. Tegaserod-treatment removed the effects of a high cholesterol diet on neuronal muscarinic receptors, as the potentiating effect of TTX on carbachol-elicited contractions was maintained in these animals. CONCLUSION: A high cholesterol diet causes significant changes to cholinergic neurotransmission in the enteric nerves of the jejunum. The mechanisms by which these effects of cholesterol are reversed by tegaserod are unknown, but relate to removal of an inhibitory effect of cholesterol on enteric nerves
ΠΡΠΊΡΠ²Π°Π½Π½Ρ Π΄ΡΡΠ΅ΠΉ Π· Π΄ΠΈΡΡΡΠ½ΠΊΡΡΡΡ ΠΆΠΎΠ²ΡΠ½ΠΎΠ³ΠΎ ΠΌΡΡ ΡΡΠ° Ρ ΡΡΡΠ½ΠΊΡΠ΅ΡΠ° ΠΠ΄Π΄Ρ ΡΠ° Π·Π°Π»ΡΠ·ΠΎΠ΄Π΅ΡΡΡΠΈΡΠΎΠΌ
Background. The significant prevalence rate of gallbladder and sphincter of Oddi dysfunction (GSOD) as well as latent iron deficiency (LID) in children in Ukraine, and undeveloped therapeutic tactics in combination of these conditions makes them an actual problem of modern pediatrics. Objectives: to study the efficiency of complex treatment including singlet-oxygen therapy (SOT) with choleretic herbs and combined iron supplementation a prospective study was conducted in 91 children of 9β17 years age with GSOD exacerbation and LID. Among them, 31 in addition to the conventional treatment used medical complex under study, 30 received combined iron supplementation, and 30 received conventional treatment. Methods the study of anamnesis, clinical examination, CBC, serum iron, TIBC indexes, percent transferrin saturation calculation, dynamic ultrasound cholecystography, follow-up for period of 12 months. Results: the study found that the medical complex under study was the most effective in children with GSOD and LID as compared to using a combined iron supplementation and traditional therapy. It provided a rapid regression of clinical symptoms, a normalization of biliary tract motor function, and a long-term clinical remission of GSOD. Conclusion. Use of complex therapy including a combined iron supplementation, and SOT with choleretic herbs in children with GSOD and LID contributes to a rapid regression of disease acute phase clinical manifestations, a bile ducts motor-evacuation function normalization in 82.4%β87.75% of patients and reduces the frequency of relapse within a year at 65%. Key words: children, gallbladder and sphincter of Oddi dysfunction, latent iron deficiency, singlet.oxygen therapy.Β ΠΠ½Π°ΡΠΈΡΠ΅Π»ΡΠ½Π°Ρ ΡΠ°ΡΠΏΡΠΎΡΡΡΠ°Π½Π΅Π½Π½ΠΎΡΡΡ Π΄ΠΈΡΡΡΠ½ΠΊΡΠΈΠΈ ΠΆΠ΅Π»ΡΠ½ΠΎΠ³ΠΎ ΠΏΡΠ·ΡΡΡ ΠΈ ΡΡΠΈΠ½ΠΊΡΠ΅ΡΠ° ΠΠ΄Π΄ΠΈ (ΠΠΠΠΈΠ‘Π), ΠΊΠ°ΠΊ ΠΈ Π»Π°ΡΠ΅Π½ΡΠ½ΠΎΠ³ΠΎ Π΄Π΅ΡΠΈΡΠΈΡΠ° ΠΆΠ΅Π»Π΅Π·Π° (ΠΠΠ), Ρ Π΄Π΅ΡΠ΅ΠΉ Π² Π£ΠΊΡΠ°ΠΈΠ½Π΅, Π° ΡΠ°ΠΊΠΆΠ΅ Π½Π΅ΡΠ°Π·ΡΠ°Π±ΠΎΡΠ°Π½Π½Π°Ρ ΡΠ΅ΡΠ°ΠΏΠ΅Π²ΡΠΈΡΠ΅ΡΠΊΠ°Ρ ΡΠ°ΠΊΡΠΈΠΊΠ° ΠΏΡΠΈ ΡΠΎΡΠ΅ΡΠ°Π½ΠΈΠΈ ΡΡΠΈΡ
ΡΠΎΡΡΠΎΡΠ½ΠΈΠΉ Π΄Π΅Π»Π°Π΅Ρ ΠΈΡ
Π°ΠΊΡΡΠ°Π»ΡΠ½ΠΎΠΉ ΠΏΡΠΎΠ±Π»Π΅ΠΌΠΎΠΉ ΡΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΠΎΠΉ ΠΏΠ΅Π΄ΠΈΠ°ΡΡΠΈΠΈ. Π¦Π΅Π»Ρ: ΠΈΠ·ΡΡΠΈΡΡ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΡ ΠΊΠΎΠΌΠΏΠ»Π΅ΠΊΡΠ½ΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ Ρ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ΠΌ ΡΠΈΠ½Π³Π»Π΅ΡΠ½ΠΎ-ΠΊΠΈΡΠ»ΠΎΡΠΎΠ΄Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ (Π‘ΠΠ’) Ρ ΠΆΠ΅Π»ΡΠ΅Π³ΠΎΠ½Π½ΡΠΌΠΈ ΡΡΠ°Π²Π°ΠΌΠΈ ΠΈ ΠΊΠΎΡΡΠ΅ΠΊΡΠΈΠ΅ΠΉ ΠΆΠ΅Π»Π΅Π·ΠΎΠ΄Π΅ΡΠΈΡΠΈΡΠ½ΠΎΠ³ΠΎ ΡΡΠ°ΡΡΡΠ° ΠΏΡΠΈ ΡΠΎΡΠ΅ΡΠ°Π½ΠΈΠΈ ΠΠΠΠΈΠ‘Π ΠΈ ΠΠΠ Ρ Π΄Π΅ΡΠ΅ΠΉ ΡΠΊΠΎΠ»ΡΠ½ΠΎΠ³ΠΎ Π²ΠΎΠ·ΡΠ°ΡΡΠ°. ΠΠ°ΡΠΈΠ΅Π½ΡΡ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. ΠΡΠΎΠ²Π΅Π΄Π΅Π½ΠΎ ΠΏΡΠΎΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΠΎΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Ρ 91 ΡΠ΅Π±Π΅Π½ΠΊΠ° Π² Π²ΠΎΠ·ΡΠ°ΡΡΠ΅ 9β17 Π»Π΅Ρ Ρ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠ΅ΠΌ ΠΠΠΠΈΠ‘Π ΠΈ ΠΠΠ. ΠΠ΅ΡΠΈ Π±ΡΠ»ΠΈ ΡΠ°ΡΠΏΡΠ΅Π΄Π΅Π»Π΅Π½Ρ Π½Π° Π³ΡΡΠΏΠΏΡ: 31 (Π Π³ΡΡΠΏΠΏΠ°) ΡΠ΅Π±Π΅Π½ΠΎΠΊ Π΄ΠΎΠΏΠΎΠ»Π½ΠΈΡΠ΅Π»ΡΠ½ΠΎ ΠΊ ΡΡΠ°Π΄ΠΈΡΠΈΠΎΠ½Π½ΠΎΠΌΡ Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΏΠΎΠ»ΡΡΠ°Π» ΠΈΡΡΠ»Π΅Π΄ΡΠ΅ΠΌΡΠΉ Π»Π΅ΡΠ΅Π±Π½ΡΠΉ ΠΊΠΎΠΌΠΏΠ»Π΅ΠΊΡ, 30 Π΄Π΅ΡΠ΅ΠΉ (ΠΠ Π³ΡΡΠΏΠΏΠ°) Π΄ΠΎΠΏΠΎΠ»Π½ΠΈΡΠ΅Π»ΡΠ½ΠΎ ΠΏΠΎΠ»ΡΡΠ°Π»ΠΈ ΠΊΠΎΠΌΠ±ΠΈΠ½ΠΈΡΠΎΠ²Π°Π½Π½ΡΠΉ ΠΏΡΠ΅ΠΏΠ°ΡΠ°Ρ ΠΆΠ΅Π»Π΅Π·Π° ΠΈ 30 Π΄Π΅ΡΠ΅ΠΉ (ΠΠΠ Π³ΡΡΠΏΠΏΠ°) ΠΏΠΎΠ»ΡΡΠ°Π»ΠΈ ΡΠΎΠ»ΡΠΊΠΎ ΡΡΠ°Π΄ΠΈΡΠΈΠΎΠ½Π½ΠΎΠ΅ Π»Π΅ΡΠ΅Π½ΠΈΠ΅. ΠΠ΅ΡΠΎΠ΄Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ Π²ΠΊΠ»ΡΡΠ°Π»ΠΈ: ΠΈΠ·ΡΡΠ΅Π½ΠΈΠ΅ Π°Π½Π°ΠΌΠ½Π΅Π·Π°, ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠ΅ ΠΎΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅, ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΠΈ ΠΠΠ, Π‘Π, ΠΠΠ‘Π‘Π‘Π, ΡΠ°ΡΡΠ΅Ρ ΠΠΠ’, Π΄ΠΈΠ½Π°ΠΌΠΈΡΠ΅ΡΠΊΡΡ ΡΠ»ΡΡΡΠ°Π·Π²ΡΠΊΠΎΠ²ΡΡ Ρ
ΠΎΠ»Π΅ΡΠΈΡΡΠΎΠ³ΡΠ°ΡΠΈΡ, ΠΊΠ°ΡΠ°ΠΌΠ½Π΅ΡΡΠΈΡΠ΅ΡΠΊΠΎΠ΅ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΠ΅ Π² ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ 12 ΠΌΠ΅ΡΡΡΠ΅Π². Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. Π£ΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΎ, ΡΡΠΎ ΠΈΡΡΠ»Π΅Π΄ΡΠ΅ΠΌΡΠΉ Π»Π΅ΡΠ΅Π±Π½ΡΠΉ ΠΊΠΎΠΌΠΏΠ»Π΅ΠΊΡ Π±ΡΠ» Π½Π°ΠΈΠ±ΠΎΠ»Π΅Π΅ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΡΠΌ Ρ Π΄Π΅ΡΠ΅ΠΉ Ρ ΠΠΠΠΈΠ‘Π ΠΈ ΠΠΠ ΠΏΠΎ ΡΡΠ°Π²Π½Π΅Π½ΠΈΡ Ρ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ΠΌ ΠΊΠΎΠΌΠ±ΠΈΠ½ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠ³ΠΎ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠ° ΠΆΠ΅Π»Π΅Π·Π° ΠΈ ΡΡΠ°Π΄ΠΈΡΠΈΠΎΠ½Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠ΅ΠΉ ΠΈ ΠΎΠ±Π΅ΡΠΏΠ΅ΡΠΈΠ²Π°Π» Π±ΡΡΡΡΡΠΉ ΡΠ΅Π³ΡΠ΅ΡΡ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠΈΠΌΠΏΡΠΎΠΌΠ°ΡΠΈΠΊΠΈ, Π½ΠΎΡΠΌΠ°Π»ΠΈΠ·Π°ΡΠΈΡ ΠΌΠΎΡΠΎΡΠ½ΠΎΠΉ ΡΡΠ½ΠΊΡΠΈΠΈ ΠΆΠ΅Π»ΡΠ½ΡΡ
ΠΏΡΡΠ΅ΠΉ ΠΈ Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΡΡ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΡΡ ΡΠ΅ΠΌΠΈΡΡΠΈΡ ΠΠΠΠΈΠ‘Π. ΠΡΠ²ΠΎΠ΄Ρ. ΠΡΠΈ ΠΊΠΎΠΌΠΏΠ»Π΅ΠΊΡΠ½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Ρ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ΠΌ ΠΊΠΎΠΌΠ±ΠΈΠ½ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠ³ΠΎ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠ° ΠΆΠ΅Π»Π΅Π·Π° ΠΈ Π‘ΠΠ’ Ρ ΠΆΠ΅Π»ΡΠ΅Π³ΠΎΠ½Π½ΡΠΌΠΈ ΡΡΠ°Π²Π°ΠΌΠΈ Ρ Π΄Π΅ΡΠ΅ΠΉ Ρ ΠΠΠΠΈΠ‘Π ΠΈ ΠΠΠ ΠΈΠΌΠ΅ΡΡ ΠΌΠ΅ΡΡΠΎ Π±ΡΡΡΡΡΠΉ ΡΠ΅Π³ΡΠ΅ΡΡ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΏΡΠΎΡΠ²Π»Π΅Π½ΠΈΠΉ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ Π² ΡΠ°Π·Π΅ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΡ, Π½ΠΎΡΠΌΠ°Π»ΠΈΠ·Π°ΡΠΈΡ ΠΌΠΎΡΠΎΡΠ½ΠΎ-ΡΠ²Π°ΠΊΡΠ°ΡΠΎΡΠ½ΠΎΠΉ ΡΡΠ½ΠΊΡΠΈΠΈ ΠΆΠ΅Π»ΡΠ½ΡΡ
Ρ
ΠΎΠ΄ΠΎΠ² Ρ 82,4β87,75% ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΈ ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΠ΅ ΡΠ°ΡΡΠΎΡΡ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠΉ Π² ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ Π³ΠΎΠ΄Π° Π½Π° 65%. ΠΠ»ΡΡΠ΅Π²ΡΠ΅ ΡΠ»ΠΎΠ²Π°: Π΄Π΅ΡΠΈ, Π΄ΠΈΡΡΡΠ½ΠΊΡΠΈΡ ΠΆΠ΅Π»ΡΠ½ΠΎΠ³ΠΎ ΠΏΡΠ·ΡΡΡ ΠΈ ΡΡΠΈΠ½ΠΊΡΠ΅ΡΠ° ΠΠ΄Π΄ΠΈ, Π»Π°ΡΠ΅Π½ΡΠ½ΡΠΉ Π΄Π΅ΡΠΈΡΠΈΡ ΠΆΠ΅Π»Π΅Π·Π°, ΡΠΈΠ½Π³Π»Π΅ΡΠ½ΠΎ-ΠΊΠΈΡΠ»ΠΎΡΠΎΠ΄Π½Π°Ρ ΡΠ΅ΡΠ°ΠΏΠΈΡ.ΠΠ½Π°ΡΠ½Π° ΠΏΠΎΡΠΈΡΠ΅Π½ΡΡΡΡ Π΄ΠΈΡΡΡΠ½ΠΊΡΡΡ ΠΆΠΎΠ²ΡΠ½ΠΎΠ³ΠΎ ΠΌΡΡ
ΡΡΠ° Ρ ΡΡΡΠ½ΠΊΡΠ΅ΡΠ° ΠΠ΄Π΄Ρ (ΠΠΠΡΠ‘Π), ΡΠΊ Ρ Π»Π°ΡΠ΅Π½ΡΠ½ΠΎΠ³ΠΎ Π΄Π΅ΡΡΡΠΈΡΡ Π·Π°Π»ΡΠ·Π° (ΠΠΠ), Ρ Π΄ΡΡΠ΅ΠΉ Π² Π£ΠΊΡΠ°ΡΠ½Ρ, Π° ΡΠ°ΠΊΠΎΠΆ Π½Π΅Π²ΠΈΠ·Π½Π°ΡΠ΅Π½ΡΡΡΡ ΡΠ΅ΡΠ°ΠΏΠ΅Π²ΡΠΈΡΠ½ΠΎΡ ΡΠ°ΠΊΡΠΈΠΊΠΈ ΠΏΡΠΈ ΠΏΠΎΡΠ΄Π½Π°Π½Π½Ρ ΡΠΈΡ
ΡΡΠ°Π½ΡΠ² ΡΠΎΠ±ΠΈΡΡ ΡΡ
Π°ΠΊΡΡΠ°Π»ΡΠ½ΠΎΡ ΠΏΡΠΎΠ±Π»Π΅ΠΌΠΎΡ ΡΡΡΠ°ΡΠ½ΠΎΡ ΠΏΠ΅Π΄ΡΠ°ΡΡΡΡ. ΠΠ΅ΡΠ°: Π²ΠΈΠ²ΡΠΈΡΠΈ Π΅ΡΠ΅ΠΊΡΠΈΠ²Π½ΡΡΡΡ ΠΊΠΎΠΌΠΏΠ»Π΅ΠΊΡΠ½ΠΎΠ³ΠΎ Π»ΡΠΊΡΠ²Π°Π½Π½Ρ ΡΠ· Π·Π°ΡΡΠΎΡΡΠ²Π°Π½Π½ΡΠΌ Π‘ΠΠ’ ΡΠ· ΠΆΠΎΠ²ΡΠΎΠ³ΡΠ½Π½ΠΈΠΌΠΈ ΡΡΠ°Π²Π°ΠΌΠΈ Ρ ΠΊΠΎΡΠ΅ΠΊΡΡΡΡ Π·Π°Π»ΡΠ·ΠΎΠ΄Π΅ΡΡΡΠΈΡΠ½ΠΎΠ³ΠΎ ΡΡΠ°ΡΡΡΡ ΠΏΡΠΈ ΠΏΠΎΡΠ΄Π½Π°Π½Π½Ρ ΠΠΠΡΠ‘Π Ρ ΠΠΠ Ρ Π΄ΡΡΠ΅ΠΉ ΡΠΊΡΠ»ΡΠ½ΠΎΠ³ΠΎ Π²ΡΠΊΡ. ΠΠ°ΡΡΡΠ½ΡΠΈ Ρ ΠΌΠ΅ΡΠΎΠ΄ΠΈ. ΠΡΠΎΠ²Π΅Π΄Π΅Π½Π΅ ΠΏΡΠΎΡΠΏΠ΅ΠΊΡΠΈΠ²Π½Π΅ Π΄ΠΎΡΠ»ΡΠ΄ΠΆΠ΅Π½Π½Ρ Ρ 91 Π΄ΠΈΡΠΈΠ½ΠΈ Π²ΡΠΊΠΎΠΌ 9β17 ΡΠΎΠΊΡΠ², ΡΠΎ ΠΌΠ°Π»Π° Π·Π°Π³ΠΎΡΡΡΠ΅Π½Π½Ρ ΠΠΠΡΠ‘Π Ρ ΠΠΠ. ΠΡΡΠΈ Π±ΡΠ»ΠΈ ΡΠΎΠ·ΠΏΠΎΠ΄ΡΠ»Π΅Π½Ρ Π½Π° Π³ΡΡΠΏΠΈ: 31 (Π Π³ΡΡΠΏΠ°) Π΄ΠΈΡΠΈΠ½Π°Π΄ΠΎΠ΄Π°ΡΠΊΠΎΠ²ΠΎ Π΄ΠΎ ΡΡΠ°Π΄ΠΈΡΡΠΉΠ½ΠΎΠ³ΠΎ Π»ΡΠΊΡΠ²Π°Π½Π½Ρ ΠΎΡΡΠΈΠΌΡΠ²Π°Π»Π° Π΄ΠΎΡΠ»ΡΠ΄ΠΆΡΠ²Π°Π½ΠΈΠΉ Π»ΡΠΊΡΠ²Π°Π»ΡΠ½ΠΈΠΉ ΠΊΠΎΠΌΠΏΠ»Π΅ΠΊΡ, 30 Π΄ΡΡΠ΅ΠΉ (ΠΠ Π³ΡΡΠΏΠ°) Π΄ΠΎΠ΄Π°ΡΠΊΠΎΠ²ΠΎ ΠΎΡΡΠΈΠΌΡΠ²Π°Π»ΠΈ ΠΊΠΎΠΌΠ±ΡΠ½ΠΎΠ²Π°Π½ΠΈΠΉ ΠΏΡΠ΅ΠΏΠ°ΡΠ°Ρ Π·Π°Π»ΡΠ·Π° Ρ 30 Π΄ΡΡΠ΅ΠΉ (ΠΠΠ Π³ΡΡΠΏΠ°) ΠΎΡΡΠΈΠΌΡΠ²Π°Π»ΠΈ ΡΡΠ»ΡΠΊΠΈ ΡΡΠ°Π΄ΠΈΡΡΠΉΠ½Π΅ Π»ΡΠΊΡΠ²Π°Π½Π½Ρ. ΠΠ΅ΡΠΎΠ΄ΠΈ Π΄ΠΎΡΠ»ΡΠ΄ΠΆΠ΅Π½Π½Ρ Π²ΠΊΠ»ΡΡΠ°Π»ΠΈ: Π²ΠΈΠ²ΡΠ΅Π½Π½Ρ Π°Π½Π°ΠΌΠ½Π΅Π·Ρ, ΠΊΠ»ΡΠ½ΡΡΠ½Π΅ ΠΎΠ±ΡΡΠ΅ΠΆΠ΅Π½Π½Ρ, ΠΏΠΎΠΊΠ°Π·Π½ΠΈΠΊΠΈ ΠΠΠ, Π‘Π, ΠΠΠΠ‘Π, ΠΎΠ±ΡΠΈΡΠ»Π΅Π½Π½Ρ ΠΠΠ’, Π΄ΠΈΠ½Π°ΠΌΡΡΠ½Ρ ΡΠ»ΡΡΡΠ°Π·Π²ΡΠΊΠΎΠ²Ρ Ρ
ΠΎΠ»Π΅ΡΠΈΡΡΠΎΠ³ΡΠ°ΡΡΡ, ΠΊΠ°ΡΠ°ΠΌΠ½Π΅ΡΡΠΈΡΠ½Π΅ ΡΠΏΠΎΡΡΠ΅ΡΠ΅ΠΆΠ΅Π½Π½Ρ ΠΏΡΠΎΡΡΠ³ΠΎΠΌ 12 ΠΌΡΡΡΡΡΠ². Π Π΅Π·ΡΠ»ΡΡΠ°ΡΠΈ. ΠΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΎ, ΡΠΎ Π΄ΠΎΡΠ»ΡΠ΄ΠΆΡΠ²Π°Π½ΠΈΠΉ Π»ΡΠΊΡΠ²Π°Π»ΡΠ½ΠΈΠΉ ΠΊΠΎΠΌΠΏΠ»Π΅ΠΊΡ Π±ΡΠ² Π½Π°ΠΉΠ±ΡΠ»ΡΡ Π΅ΡΠ΅ΠΊΡΠΈΠ²Π½ΠΈΠΌ Ρ Π΄ΡΡΠ΅ΠΉ Π· ΠΠΠΡΠ‘Π Ρ ΠΠΠ ΠΏΠΎΡΡΠ²Π½ΡΠ½ΠΎ ΡΠ· Π·Π°ΡΡΠΎΡΡΠ²Π°Π½Π½ΡΠΌ ΠΊΠΎΠΌΠ±ΡΠ½ΠΎΠ²Π°Π½ΠΎΠ³ΠΎ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΡ Π·Π°Π»ΡΠ·Π° Ρ ΡΡΠ°Π΄ΠΈΡΡΠΉΠ½ΠΎΡ ΡΠ΅ΡΠ°ΠΏΡΡ ΡΠ° Π·Π°Π±Π΅Π·ΠΏΠ΅ΡΡΠ²Π°Π² ΡΠ²ΠΈΠ΄ΠΊΠΈΠΉ ΡΠ΅Π³ΡΠ΅Ρ ΠΊΠ»ΡΠ½ΡΡΠ½ΠΎΡ ΡΠΈΠΌΠΏΡΠΎΠΌΠ°ΡΠΈΠΊΠΈ, Π½ΠΎΡΠΌΠ°Π»ΡΠ·Π°ΡΡΡ ΠΌΠΎΡΠΎΡΠ½ΠΎΡ ΡΡΠ½ΠΊΡΡΡ ΠΆΠΎΠ²ΡΠ½ΠΈΡ
ΡΠ»ΡΡ
ΡΠ² Ρ ΡΡΠΈΠ²Π°Π»Ρ ΠΊΠ»ΡΠ½ΡΡΠ½Ρ ΡΠ΅ΠΌΡΡΡΡ ΠΠΠΡΠ‘Π. ΠΠΈΡΠ½ΠΎΠ²ΠΊΠΈ. ΠΡΠΈ ΠΊΠΎΠΌΠΏΠ»Π΅ΠΊΡΠ½ΡΠΉ ΡΠ΅ΡΠ°ΠΏΡΡ ΡΠ· Π·Π°ΡΡΠΎΡΡΠ²Π°Π½Π½ΡΠΌ ΠΊΠΎΠΌΠ±ΡΠ½ΠΎΠ²Π°Π½ΠΎΠ³ΠΎ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΡ Π·Π°Π»ΡΠ·Π° ΡΠ° Π‘ΠΠ’ Π· ΠΆΠΎΠ²ΡΠΎΠ³ΡΠ½Π½ΠΈΠΌΠΈ ΡΡΠ°Π²Π°ΠΌΠΈ Ρ Π΄ΡΡΠ΅ΠΉ Π· ΠΠΠΡΠ‘Π Ρ ΠΠΠ ΠΌΠ°Ρ ΠΌΡΡΡΠ΅ ΡΠ²ΠΈΠ΄ΠΊΠΈΠΉ ΡΠ΅Π³ΡΠ΅Ρ ΠΊΠ»ΡΠ½ΡΡΠ½ΠΈΡ
ΠΏΡΠΎΡΠ²ΡΠ² Π·Π°Ρ
Π²ΠΎΡΡΠ²Π°Π½Π½Ρ Ρ ΡΠ°Π·Ρ Π·Π°Π³ΠΎΡΡΡΠ΅Π½Π½Ρ, Π½ΠΎΡΠΌΠ°Π»ΡΠ·Π°ΡΡΡ ΠΌΠΎΡΠΎΡΠ½ΠΎ-Π΅Π²Π°ΠΊΡΠ°ΡΠΎΡΠ½ΠΎΡ ΡΡΠ½ΠΊΡΡΡ ΠΆΠΎΠ²ΡΠ½ΠΈΡ
Ρ
ΠΎΠ΄ΡΠ² Ρ 82,4β87,75% ΠΏΠ°ΡΡΡΠ½ΡΡΠ² Ρ Π·Π½ΠΈΠΆΠ΅Π½Π½Ρ ΡΠ°ΡΡΠΎΡΠΈ Π·Π°Π³ΠΎΡΡΡΠ΅Π½Ρ ΠΏΡΠΎΡΡΠ³ΠΎΠΌ ΡΠΎΠΊΡ Π½Π° 65%. ΠΠ»ΡΡΠΎΠ²Ρ ΡΠ»ΠΎΠ²Π°: Π΄ΡΡΠΈ, Π΄ΠΈΡΡΡΠ½ΠΊΡΡΡ ΠΆΠΎΠ²ΡΠ½ΠΎΠ³ΠΎ ΠΌΡΡ
ΡΡΠ° Ρ ΡΡΡΠ½ΠΊΡΠ΅ΡΠ° ΠΠ΄Π΄Ρ, Π»Π°ΡΠ΅Π½ΡΠ½ΠΈΠΉ Π΄Π΅ΡΡΡΠΈΡ Π·Π°Π»ΡΠ·Π°, ΡΠΈΠ½Π³Π»Π΅ΡΠ½ΠΎ-ΠΊΠΈΡΠ½Π΅Π²Π° ΡΠ΅ΡΠ°ΠΏΡΡ
ΠΠ»ΡΠ½ΡΡΠ½Ρ ΠΏΡΠΎΡΠ²ΠΈ Ρ ΠΆΠΈΡΠ½ΠΎΠΊΠΈΡΠ»ΠΎΡΠ½ΠΈΠΉ Π±Π°Π»Π°Π½Ρ Ρ Π΄ΡΡΠ΅ΠΉ ΡΠ· Π±ΡΠ»ΡΠ°ΡΠ½ΠΎΡ Π΄ΠΈΡΡΡΠ½ΠΊΡΡΡΡ Ρ Π΄Π΅ΡΡΡΠΈΡΠΎΠΌ Π·Π°Π»ΡΠ·Π°
Objectives: to study the effect of iron deficiency (ID) on the clinical manifestation and erythrocytes, plasma and saliva fatty acids spectrum in children with functional disorders of the biliary tract (FDBT) 160 children 9β17 years old were examined who had been treated in hospital for FDBT exacerbation. According to the iron metabolism parameters children were divided into 3 groups: I β 29 children with FDBT and I-degree ID anemia; II β 91 children with FDBT and latent ID; III β 40 children with FDBT and normal iron metabolism tests. Methods: the study of anamnesis, clinical examination, CBC, serum iron, TIBC indexes, percent transferrin saturation calculation, ultrasound of the abdomen and dynamic ultrasound cholecystography with choleretic breakfast, chromatographic analysis of erythrocytes, plasma and saliva fatty acid spectrum. Results: it was found that ID children have an increase in the frequency and duration of FDBTexacerbations, increased frequency of dyspeptic and asthenic-vegetative symptoms during exacerbation, decreased gallbladder motility and hypotonic-hypokinetic FDBT type. Changes in the erythrocytes, plasma and saliva fatty acid spectra were unidirectional in children with FDBT, and exhibited an increase in the fatty acid saturation. These changes were statistically significantly (p<0.05) more expressed in patients with ID. Conclusion: Burdened course of FDBT is observed in children with ID due to increased frequency and duration of exacerbations, dyspeptic and asthenic-vegetative symptoms in the acute phase, minor bile ducts motility, as well as increased fatty acid spectra saturation in erythrocytes, plasma and mixed saliva, which indicates increased lipid peroxidation. Key words: children, functional disorder of the biliary tract, iron deficiency, fatty acid spectrum, rythrocytes, plasma, saliva.Π¦Π΅Π»Ρ: ΠΈΠ·ΡΡΠ΅Π½ΠΈΠ΅ Π²Π»ΠΈΡΠ½ΠΈΡ Π΄Π΅ΡΠΈΡΠΈΡΠ° ΠΆΠ΅Π»Π΅Π·Π° (ΠΠ) Π½Π° ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΏΡΠΎΡΠ²Π»Π΅Π½ΠΈΡ ΠΈ ΡΠΏΠ΅ΠΊΡΡ ΠΆΠΈΡΠ½ΡΡ
ΠΊΠΈΡΠ»ΠΎΡ (ΠΠ) ΡΡΠΈΡΡΠΎΡΠΈΡΠΎΠ², ΠΏΠ»Π°Π·ΠΌΡ ΠΊΡΠΎΠ²ΠΈ ΠΈ ΡΠ»ΡΠ½Ρ Ρ Π΄Π΅ΡΠ΅ΠΉ Ρ ΡΡΠ½ΠΊΡΠΈΠΎΠ½Π°Π»ΡΠ½ΡΠΌ ΡΠ°ΡΡΡΡΠΎΠΉΡΡΠ²ΠΎΠΌ Π±ΠΈΠ»ΠΈΠ°ΡΠ½ΠΎΠ³ΠΎ ΡΡΠ°ΠΊΡΠ° (Π€Π ΠΠ’). ΠΠ°ΡΠΈΠ΅Π½ΡΡ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. ΠΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΎ 160 Π΄Π΅ΡΠ΅ΠΉ 9β17 Π»Π΅Ρ, ΠΏΡΠΎΡ
ΠΎΠ΄ΠΈΠ²ΡΠΈΡ
Π»Π΅ΡΠ΅Π½ΠΈΠ΅ Π² ΡΡΠ°ΡΠΈΠΎΠ½Π°ΡΠ΅ ΠΏΠΎ ΠΏΠΎΠ²ΠΎΠ΄Ρ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΡ Π€Π ΠΠ’. ΠΠΎ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΡΠΌ ΠΎΠ±ΠΌΠ΅Π½Π° ΠΆΠ΅Π»Π΅Π·Π° Π΄Π΅ΡΠΈ Π±ΡΠ»ΠΈ ΡΠ°ΡΠΏΡΠ΅Π΄Π΅Π»Π΅Π½Ρ Π½Π° 3 Π³ΡΡΠΏΠΏΡ: I β 29 Π΄Π΅ΡΠ΅ΠΉ Ρ Π€Π ΠΠ’ ΠΈ Π°Π½Π΅ΠΌΠΈΠ΅ΠΉ I ΡΡΠ΅ΠΏΠ΅Π½ΠΈ; II β 91 ΡΠ΅Π±Π΅Π½ΠΎΠΊ Ρ Π€Π ΠΠ’ ΠΈ Π»Π°ΡΠ΅Π½ΡΠ½ΡΠΌ ΠΠ; III β 40 Π΄Π΅ΡΠ΅ΠΉ Ρ Π€Π ΠΠ’ ΠΈ Π½ΠΎΡΠΌΠ°Π»ΡΠ½ΡΠΌΠΈ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΡΠΌΠΈ ΠΎΠ±ΠΌΠ΅Π½Π° ΠΆΠ΅Π»Π΅Π·Π°. ΠΠ΅ΡΠΎΠ΄Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ Π²ΠΊΠ»ΡΡΠ°Π»ΠΈ: ΠΈΠ·ΡΡΠ΅Π½ΠΈΠ΅ Π°Π½Π°ΠΌΠ½Π΅Π·Π°, ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠ΅ ΠΎΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅, ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΠΈ ΠΠΠ, Π‘Π, ΠΠΠΠ‘Π, ΡΠ°ΡΡΠ΅Ρ ΠΠΠ’, ΡΠ»ΡΡΡΠ°Π·Π²ΡΠΊΠΎΠ²ΠΎΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ ΠΎΡΠ³Π°Π½ΠΎΠ² Π±ΡΡΡΠ½ΠΎΠΉ ΠΏΠΎΠ»ΠΎΡΡΠΈ ΠΈ Π΄ΠΈΠ½Π°ΠΌΠΈΡΠ΅ΡΠΊΡΡ ΡΠ»ΡΡΡΠ°Π·Π²ΡΠΊΠΎΠ²ΡΡ Ρ
ΠΎΠ»Π΅ΡΠΈΡΡΠΎΠ³ΡΠ°ΡΠΈΡ Ρ ΠΆΠ΅Π»ΡΠ΅Π³ΠΎΠ½Π½ΡΠΌ Π·Π°Π²ΡΡΠ°ΠΊΠΎΠΌ, Ρ
ΡΠΎΠΌΠ°ΡΠΎΠ³ΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΠΉ Π°Π½Π°Π»ΠΈΠ· ΡΠΏΠ΅ΠΊΡΡΠ° ΠΠ ΡΡΠΈΡΡΠΎΡΠΈΡΠΎΠ², ΠΏΠ»Π°Π·ΠΌΡ ΠΊΡΠΎΠ²ΠΈ ΠΈ ΡΠ»ΡΠ½Ρ. Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. Π£ΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΎ, ΡΡΠΎ ΠΏΡΠΈ ΠΠ Ρ Π΄Π΅ΡΠ΅ΠΉ Ρ Π€Π ΠΠ’ ΠΈΠΌΠ΅Π΅Ρ ΠΌΠ΅ΡΡΠΎ ΡΠ²Π΅Π»ΠΈΡΠ΅Π½ΠΈΠ΅ ΡΠ°ΡΡΠΎΡΡ ΠΈ Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΠΈ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠΉ Π€Π ΠΠ’, ΠΏΠΎΠ²ΡΡΠ΅Π½Π½Π°Ρ ΡΠ°ΡΡΠΎΡΠ° Π΄ΠΈΡΠΏΠ΅ΠΏΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΈ Π°ΡΡΠ΅Π½ΠΎ-Π²Π΅Π³Π΅ΡΠ°ΡΠΈΠ²Π½ΡΡ
ΠΏΡΠΎΡΠ²Π»Π΅Π½ΠΈΠΉ ΠΏΡΠΈ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠΈ, ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΠ΅ ΠΌΠΎΡΠΎΡΠΈΠΊΠΈ ΠΆΠ΅Π»ΡΠ½ΠΎΠ³ΠΎ ΠΏΡΠ·ΡΡΡ ΠΈ Π³ΠΈΠΏΠΎΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΈ-Π³ΠΈΠΏΠΎΠΊΠΈΠ½Π΅ΡΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΠΈΠΏ Π€Π ΠΠ’. ΠΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡ ΠΆΠΈΡΠ½ΠΎΠΊΠΈΡΠ»ΠΎΡΠ½ΠΎΠ³ΠΎ ΡΠΏΠ΅ΠΊΡΡΠ° ΡΡΠΈΡΡΠΎΡΠΈΡΠΎΠ², ΠΏΠ»Π°Π·ΠΌΡ ΠΊΡΠΎΠ²ΠΈ ΠΈ ΡΠ»ΡΠ½Ρ Ρ Π΄Π΅ΡΠ΅ΠΉ Ρ Π€Π ΠΠ’ Π±ΡΠ»ΠΈ ΠΎΠ΄Π½ΠΎΠ½Π°ΠΏΡΠ°Π²Π»Π΅Π½Π½ΡΠΌΠΈ ΠΈ Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΠ·ΠΎΠ²Π°Π»ΠΈΡΡ ΠΏΠΎΠ²ΡΡΠ΅Π½ΠΈΠ΅ΠΌ Π½Π°ΡΡΡΠ΅Π½Π½ΠΎΡΡΠΈ ΡΠΏΠ΅ΠΊΡΡΠ° ΠΠ. Π£ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΠ ΡΡΠΈ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡ Π±ΡΠ»ΠΈ ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈ Π΄ΠΎΡΡΠΎΠ²Π΅ΡΠ½ΠΎ (Ρ<0,05) Π±ΠΎΠ»Π΅Π΅ Π²ΡΡΠ°ΠΆΠ΅Π½Π½ΡΠΌΠΈ. ΠΡΠ²ΠΎΠ΄Ρ. ΠΡΠΈ ΠΠ Ρ Π΄Π΅ΡΠ΅ΠΉ Π½Π°Π±Π»ΡΠ΄Π°Π΅ΡΡΡ ΠΎΡΡΠ³ΠΎΡΠ΅Π½Π½ΠΎΠ΅ ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ Π€Π ΠΠ’ Π·Π° ΡΡΠ΅Ρ ΠΏΠΎΠ²ΡΡΠ΅Π½Π½ΠΎΠΉ ΡΠ°ΡΡΠΎΡΡ ΠΈ ΠΏΡΠΎΠ΄ΠΎΠ»ΠΆΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΠΈ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΠΉ, Π΄ΠΈΡΠΏΠ΅ΠΏΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΈ Π°ΡΡΠ΅Π½ΠΎ-Π²Π΅Π³Π΅ΡΠ°ΡΠΈΠ²Π½ΡΡ
ΠΏΡΠΎΡΠ²Π»Π΅Π½ΠΈΠΉ Π² ΡΠ°Π·Π΅ ΠΎΠ±ΠΎΡΡΡΠ΅Π½ΠΈΡ, ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΠ΅ ΠΌΠΎΡΠΎΡΠ½ΠΎΠΉ ΡΠΏΠΎΡΠΎΠ±Π½ΠΎΡΡΠΈ ΠΆΠ΅Π»ΡΠ½ΡΡ
Ρ
ΠΎΠ΄ΠΎΠ², Π° ΡΠ°ΠΊΠΆΠ΅ ΠΏΠΎΠ²ΡΡΠ΅Π½ΠΈΠ΅ Π½Π°ΡΡΡΠ΅Π½Π½ΠΎΡΡΠΈ ΠΆΠΈΡΠ½ΠΎΠΊΠΈΡΠ»ΠΎΡΠ½ΡΡ
ΡΠΏΠ΅ΠΊΡΡΠΎΠ² ΡΡΠΈΡΡΠΎΡΠΈΡΠΎΠ², ΠΏΠ»Π°Π·ΠΌΡ ΠΊΡΠΎΠ²ΠΈ ΠΈ ΡΠΌΠ΅ΡΠ°Π½Π½ΠΎΠΉ ΡΠ»ΡΠ½Ρ, ΠΊΠΎΡΠΎΡΠΎΠ΅ ΡΠΊΠ°Π·ΡΠ²Π°Π΅Ρ Π½Π° ΡΡΠΈΠ»Π΅Π½ΠΈΠ΅ ΠΠΠ. ΠΠ»ΡΡΠ΅Π²ΡΠ΅ ΡΠ»ΠΎΠ²Π°: Π΄Π΅ΡΠΈ, ΡΡΠ½ΠΊΡΠΈΠΎΠ½Π°Π»ΡΠ½ΠΎΠ΅ ΡΠ°ΡΡΡΡΠΎΠΉΡΡΠ²ΠΎ Π±ΠΈΠ»ΠΈΠ°ΡΠ½ΠΎΠ³ΠΎ ΡΡΠ°ΠΊΡΠ°, Π΄Π΅ΡΠΈΡΠΈΡ ΠΆΠ΅Π»Π΅Π·Π°, ΡΠΏΠ΅ΠΊΡΡ ΠΆΠΈΡΠ½ΡΡ
ΠΊΠΈΡΠ»ΠΎΡ, ΡΡΠΈΡΡΠΎΡΠΈΡΡ, ΠΏΠ»Π°Π·ΠΌΠ°, ΡΠ»ΡΠ½Π°.ΠΠ΅ΡΠ°: Π²ΠΈΠ²ΡΠ΅Π½Π½Ρ Π²ΠΏΠ»ΠΈΠ²Ρ Π΄Π΅ΡΡΡΠΈΡΡ Π·Π°Π»ΡΠ·Π° (ΠΠ) Π½Π° ΠΊΠ»ΡΠ½ΡΡΠ½Ρ ΠΏΡΠΎΡΠ²ΠΈ Ρ ΡΠΏΠ΅ΠΊΡΡ ΠΆΠΈΡΠ½ΠΈΡ
ΠΊΠΈΡΠ»ΠΎΡ (ΠΠ) Π΅ΡΠΈΡΡΠΎΡΠΈΡΡΠ², ΠΏΠ»Π°Π·ΠΌΠΈ ΠΊΡΠΎΠ²Ρ Ρ ΡΠ»ΠΈΠ½ΠΈ Ρ Π΄ΡΡΠ΅ΠΉ Π· ΡΡΠ½ΠΊΡΡΠΎΠ½Π°Π»ΡΠ½ΠΈΠΌ ΡΠΎΠ·Π»Π°Π΄ΠΎΠΌ Π±ΡΠ»ΡΠ°ΡΠ½ΠΎΠ³ΠΎ ΡΡΠ°ΠΊΡΡ (Π€Π ΠΠ’). ΠΠ°ΡΡΡΠ½ΡΠΈ Ρ ΠΌΠ΅ΡΠΎΠ΄ΠΈ. ΠΠ±ΡΡΠ΅ΠΆΠ΅Π½ΠΎ 160 Π΄ΡΡΠ΅ΠΉ Π²ΡΠΊΠΎΠΌ 9β17 ΡΠΎΠΊΡΠ², ΡΠΎ ΠΏΡΠΎΡ
ΠΎΠ΄ΠΈΠ»ΠΈ Π»ΡΠΊΡΠ²Π°Π½Π½Ρ Π² ΡΡΠ°ΡΡΠΎΠ½Π°ΡΡ Π· ΠΏΡΠΈΠ²ΠΎΠ΄Ρ Π·Π°Π³ΠΎΡΡΡΠ΅Π½Π½Ρ Π€Π ΠΠ’. ΠΠ° ΠΏΠΎΠΊΠ°Π·Π½ΠΈΠΊΠ°ΠΌΠΈ ΠΎΠ±ΠΌΡΠ½Ρ Π·Π°Π»ΡΠ·Π° Π΄ΡΡΠΈ Π±ΡΠ»ΠΈ ΡΠΎΠ·ΠΏΠΎΠ΄ΡΠ»Π΅Π½Ρ Π½Π° 3 Π³ΡΡΠΏΠΈ: Π β 29 Π΄ΡΡΠ΅ΠΉ ΡΠ· Π€Π ΠΠ’ ΡΠ° Π°Π½Π΅ΠΌΡΡΡ Π ΡΡΡΠΏΠ΅Π½Ρ; ΠΠ β 91 Π΄ΠΈΡΠΈΠ½Π° Π· Π€Π ΠΠ’ ΡΠ° Π»Π°ΡΠ΅Π½ΡΠ½ΠΈΠΌ ΠΠ; ΠΠΠ β 40 Π΄ΡΡΠ΅ΠΉ Π· Π€Π ΠΠ’ Ρ Π½ΠΎΡΠΌΠ°Π»ΡΠ½ΠΈΠΌΠΈ ΠΏΠΎΠΊΠ°Π·Π½ΠΈΠΊΠ°ΠΌΠΈ ΠΎΠ±ΠΌΡΠ½Ρ Π·Π°Π»ΡΠ·Π°. ΠΠ΅ΡΠΎΠ΄ΠΈ Π΄ΠΎΡΠ»ΡΠ΄ΠΆΠ΅Π½Π½Ρ Π²ΠΊΠ»ΡΡΠ°Π»ΠΈ: Π²ΠΈΠ²ΡΠ΅Π½Π½Ρ Π°Π½Π°ΠΌΠ½Π΅Π·Ρ, ΠΊΠ»ΡΠ½ΡΡΠ½Π΅ ΠΎΠ±ΡΡΠ΅ΠΆΠ΅Π½Π½Ρ, ΠΏΠΎΠΊΠ°Π·Π½ΠΈΠΊΠΈ ΠΠΠ, Π‘Π, ΠΠΠΠ‘Π, ΠΎΠ±ΡΠΈΡΠ»Π΅Π½Π½Ρ ΠΠΠ’, ΡΠ»ΡΡΡΠ°Π·Π²ΡΠΊΠΎΠ²Π΅ Π΄ΠΎΡΠ»ΡΠ΄ΠΆΠ΅Π½Π½Ρ ΠΎΡΠ³Π°Π½ΡΠ² ΡΠ΅ΡΠ΅Π²Π½ΠΎΡ ΠΏΠΎΡΠΎΠΆΠ½ΠΈΠ½ΠΈ Ρ Π΄ΠΈΠ½Π°ΠΌΡΡΠ½Ρ ΡΠ»ΡΡΡΠ°Π·Π²ΡΠΊΠΎΠ²Ρ Ρ
ΠΎΠ»Π΅ΡΠΈΡΡΠΎΠ³ΡΠ°ΡΡΡ Π· ΠΆΠΎΠ²ΡΠΎΠ³ΡΠ½Π½ΠΈΠΌ ΡΠ½ΡΠ΄Π°Π½ΠΊΠΎΠΌ, Ρ
ΡΠΎΠΌΠ°ΡΠΎΠ³ΡΠ°ΡΡΡΠ½ΠΈΠΉ Π°Π½Π°Π»ΡΠ· ΡΠΏΠ΅ΠΊΡΡΠ° ΠΆΠΈΡΠ½ΠΈΡ
ΠΊΠΈΡΠ»ΠΎΡ (ΠΠ) Π΅ΡΠΈΡΡΠΎΡΠΈΡΡΠ², ΠΏΠ»Π°Π·ΠΌΠΈ ΠΊΡΠΎΠ²Ρ Ρ ΡΠ»ΠΈΠ½ΠΈ. Π Π΅Π·ΡΠ»ΡΡΠ°ΡΠΈ. ΠΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΎ, ΡΠΎ ΠΏΡΠΈ ΠΠ Ρ Π΄ΡΡΠ΅ΠΉ Π· Π€Π ΠΠ’ ΠΌΠ°Ρ ΠΌΡΡΡΠ΅ Π²ΠΈΡΠ° ΡΠ°ΡΡΠΎΡΠ° Ρ ΡΡΠΈΠ²Π°Π»ΡΡΡΡ Π·Π°Π³ΠΎΡΡΡΠ΅Π½Ρ Π€Π ΠΠ’, ΠΏΡΠ΄Π²ΠΈΡΠ΅Π½Π° ΡΠ°ΡΡΠΎΡΠ° Π΄ΠΈΡΠΏΠ΅ΠΏΡΠΈΡΠ½ΠΈΡ
Ρ Π°ΡΡΠ΅Π½ΠΎ-Π²Π΅Π³Π΅ΡΠ°ΡΠΈΠ²Π½ΠΈΡ
ΠΏΡΠΎΡΠ²ΡΠ² ΠΏΡΠΈ Π·Π°Π³ΠΎΡΡΡΠ΅Π½Π½Ρ, Π·Π½ΠΈΠΆΠ΅Π½Π½Ρ ΠΌΠΎΡΠΎΡΠΈΠΊΠΈ ΠΠ Ρ Π³ΡΠΏΠΎΡΠΎΠ½ΡΡΠ½ΠΎ-Π³ΡΠΏΠΎΠΊΡΠ½Π΅ΡΠΈΡΠ½ΠΈΠΉ ΡΠΈΠΏ Π€Π ΠΠ’. ΠΠΌΡΠ½ΠΈ ΠΆΠΈΡΠ½ΠΎΠΊΠΈΡΠ»ΠΎΡΠ½ΠΎΠ³ΠΎ ΡΠΏΠ΅ΠΊΡΡΠ° Π΅ΡΠΈΡΡΠΎΡΠΈΡΡΠ², ΠΏΠ»Π°Π·ΠΌΠΈ ΠΊΡΠΎΠ²Ρ Ρ ΡΠ»ΠΈΠ½ΠΈ Ρ Π΄ΡΡΠ΅ΠΉ Π· Π€Π ΠΠ’ Π±ΡΠ»ΠΈ ΠΎΠ΄Π½ΠΎΡΠΏΡΡΠΌΠΎΠ²Π°Π½ΠΈΠΌΠΈ Ρ Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΠ·ΡΠ²Π°Π»ΠΈΡΡ ΠΏΡΠ΄Π²ΠΈΡΠ΅Π½Π½ΡΠΌ Π½Π°ΡΠΈΡΠ΅Π½ΠΎΡΡΡ ΡΠΏΠ΅ΠΊΡΡΠ° ΠΠ. Π£ ΠΏΠ°ΡΡΡΠ½ΡΡΠ² ΡΠ· ΠΠ ΡΡ Π·ΠΌΡΠ½ΠΈ Π±ΡΠ»ΠΈ ΡΡΠ°ΡΠΈΡΡΠΈΡΠ½ΠΎ Π΄ΠΎΡΡΠΎΠ²ΡΡΠ½ΠΎ (Ρ<0,05) Π±ΡΠ»ΡΡ Π²ΠΈΡΠ°Π·Π½ΠΈΠΌΠΈ. ΠΠΈΡΠ½ΠΎΠ²ΠΊΠΈ. ΠΡΠΈ ΠΠ Ρ Π΄ΡΡΠ΅ΠΉ ΡΠΏΠΎΡΡΠ΅ΡΡΠ³Π°ΡΡΡΡΡ ΠΎΠ±ΡΡΠΆΠ΅Π½ΠΈΠΉ ΠΏΠ΅ΡΠ΅Π±ΡΠ³ Π€Π ΠΠ’ Π·Π° ΡΠ°Ρ
ΡΠ½ΠΎΠΊ ΠΏΡΠ΄Π²ΠΈΡΠ΅Π½ΠΎΡ ΡΠ°ΡΡΠΎΡΠΈ Ρ ΡΡΠΈΠ²Π°Π»ΠΎΡΡΡ Π·Π°Π³ΠΎΡΡΡΠ΅Π½Ρ, Π΄ΠΈΡΠΏΠ΅ΠΏΡΠΈΡΠ½ΠΈΡ
ΡΠ° Π°ΡΡΠ΅Π½ΠΎ-Π²Π΅Π³Π΅ΡΠ°ΡΠΈΠ²Π½ΠΈΡ
ΠΏΡΠΎΡΠ²ΡΠ² Ρ ΡΠ°Π·Ρ Π·Π°Π³ΠΎΡΡΡΠ΅Π½Π½Ρ, Π·Π½ΠΈΠΆΠ΅Π½Π½Ρ ΠΌΠΎΡΠΎΡΠ½ΠΎΡ Π·Π΄Π°ΡΠ½ΠΎΡΡΡ ΠΆΠΎΠ²ΡΠ½ΠΈΡ
Ρ
ΠΎΠ΄ΡΠ², Π° ΡΠ°ΠΊΠΎΠΆ ΠΏΡΠ΄Π²ΠΈΡΠ΅Π½Π½Ρ Π½Π°ΡΠΈΡΠ΅Π½ΠΎΡΡΡ ΠΆΠΈΡΠ½ΠΎΠΊΠΈΡΠ»ΠΎΡΠ½ΠΈΡ
ΡΠΏΠ΅ΠΊΡΡΡΠ² Π΅ΡΠΈΡΡΠΎΡΠΈΡΡΠ², ΠΏΠ»Π°Π·ΠΌΠΈ ΠΊΡΠΎΠ²Ρ Ρ Π·ΠΌΡΡΠ°Π½ΠΎΡ ΡΠ»ΠΈΠ½ΠΈ, ΡΠΊΠ΅ Π²ΠΊΠ°Π·ΡΡ Π½Π° ΠΏΠΎΡΠΈΠ»Π΅Π½Π½Ρ ΠΠΠ. ΠΠ»ΡΡΠΎΠ²Ρ ΡΠ»ΠΎΠ²Π°: Π΄ΡΡΠΈ, ΡΡΠ½ΠΊΡΡΠΎΠ½Π°Π»ΡΠ½ΠΈΠΉ ΡΠΎΠ·Π»Π°Π΄ Π±ΡΠ»ΡΠ°ΡΠ½ΠΎΠ³ΠΎ ΡΡΠ°ΠΊΡΡ, Π΄Π΅ΡΡΡΠΈΡ Π·Π°Π»ΡΠ·Π°, ΡΠΏΠ΅ΠΊΡΡ ΠΆΠΈΡΠ½ΠΈΡ
ΠΊΠΈΡΠ»ΠΎΡ, Π΅ΡΠΈΡΡΠΎΡΠΈΡΠΈ, ΠΏΠ»Π°Π·ΠΌΠ°, ΡΠ»ΠΈΠ½Π°.
Rivaroxaban with or without aspirin in stable cardiovascular disease
BACKGROUND: We evaluated whether rivaroxaban alone or in combination with aspirin would be more effective than aspirin alone for secondary cardiovascular prevention. METHODS: In this double-blind trial, we randomly assigned 27,395 participants with stable atherosclerotic vascular disease to receive rivaroxaban (2.5 mg twice daily) plus aspirin (100 mg once daily), rivaroxaban (5 mg twice daily), or aspirin (100 mg once daily). The primary outcome was a composite of cardiovascular death, stroke, or myocardial infarction. The study was stopped for superiority of the rivaroxaban-plus-aspirin group after a mean follow-up of 23 months. RESULTS: The primary outcome occurred in fewer patients in the rivaroxaban-plus-aspirin group than in the aspirin-alone group (379 patients [4.1%] vs. 496 patients [5.4%]; hazard ratio, 0.76; 95% confidence interval [CI], 0.66 to 0.86; P<0.001; z=β4.126), but major bleeding events occurred in more patients in the rivaroxaban-plus-aspirin group (288 patients [3.1%] vs. 170 patients [1.9%]; hazard ratio, 1.70; 95% CI, 1.40 to 2.05; P<0.001). There was no significant difference in intracranial or fatal bleeding between these two groups. There were 313 deaths (3.4%) in the rivaroxaban-plus-aspirin group as compared with 378 (4.1%) in the aspirin-alone group (hazard ratio, 0.82; 95% CI, 0.71 to 0.96; P=0.01; threshold P value for significance, 0.0025). The primary outcome did not occur in significantly fewer patients in the rivaroxaban-alone group than in the aspirin-alone group, but major bleeding events occurred in more patients in the rivaroxaban-alone group. CONCLUSIONS: Among patients with stable atherosclerotic vascular disease, those assigned to rivaroxaban (2.5 mg twice daily) plus aspirin had better cardiovascular outcomes and more major bleeding events than those assigned to aspirin alone. Rivaroxaban (5 mg twice daily) alone did not result in better cardiovascular outcomes than aspirin alone and resulted in more major bleeding events