Показники загальноклінічних методів обстеження як прогностичні маркери тяжкості перебігу системної склеродермії, ускладненої розвитком пневмосклерозу

Abstract

Purpose: to define clinical prognostic markers for evaluation of inflammation activity and prognosis of complications development in patients with systemic scleroderma. Materials and methods: The study included 32 people, all women, the average age – 43.2±2.23 years. All the examined patients (n=32) were divided into two groups: the main group (n=21) – patients with systemic scleroderma and concomitant pulmonary tissue involvement – pneumosclerosis. Group II (n=11) included patients with systemic scleroderma without signs of pneumosclerosis. The duration of the disease was 8.1±0.03 years. Patients underwent clinico-laboratory and anthropometric studies, chest radiography in two projections, questionnaire of mMRС for assessing the symptoms of dyspnea, blood saturation was measured with a pulse oximeter EchoCG, if necessary – computed tomography of light high resolution was performed and other general clinical studies in accordance with diagnosis, if necessary. Results and discussion: Patients of groups I and II had bilateral reinforcement of the pulmonary pattern mainly in the lower and middle sections. In Group I patients in the basal regions there were also single cyst-like changes, sometimes sections of the honeycomb lung, bronchiectasis, pleural adhesions. Patients of group II showed signs of focal pneumofibrosis (3 patients), who had pneumonia in anamnesis. There was a tendency of increased pressure in the pulmonary artery in patients with the presence of pulmonary tissue lesions, a decrease in the CSR of the left ventricle. When analyzing the data of the rheumatic complex and individual immunogram indices, the level of CIC and rheumatoid factor was higher in patients of group II, and the level of cryoglobulins was significantly increased in group I patients. In patients of group I, in addition to the increase in cryoglobulins, index of С-reactive protein (CRP) and ESR was increased. Conclusion: The affection of the lungs with the development of pneumosclerosis in patients with systemic scleroderma complicates the course of the disease, contributes to worsening of patients’ condition and formation of unfavorable prognosis. The increase in the level of cryoglobulins and CRP can be used not only to assess inflammation activity but also to predict the development of complications, it requires revision of the treatment of the main disease