Головна » Файли » 2013 » 2 (116) |
28.05.2014, 17:02 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Резюме УДК 616.366-002+616.12-008.331.1]-08-053.81 ДЗ «Луганський державний медичний університет» ГЗ «Луганский государственный медицинский университет» 91045, кв. 50-летия Обороны Луганска, 1 г, Луганск, Украина State Establishment "Lugansk State Medical University" 91045,50 Rokyv Oborony Luganska Block, 1G, Lugansk,Ukraine propedevtika2011@yandex.ru Introduction. The presence of united pathology is characteristic for a modern patient that results in the origin of independent process in organism that has its pathogenetic mechanisms and clinical symptoms [3,8]. Nowadays it is registered the incidence rate [9] including in Ukraine on 42,3% [2], in 7,5-14% cases CUC (chronic uncalculary cholecystitis) proceeds in combination with coronary heart disease (CHD) including one of its forms stable effort angina that remains the issue of the day of modern medicine [4]. The role of infection of Helicobacter pylori (НР) at the united biliary and cardiac pathology is remained as not enough investigated that is not only the factor of origin of erosive ulcerative defeats of gastroduodenal zone but it is observed in bilis and mucous membrane of gall bladder (GB) and has influence on development of CHD [10]. Research of immune mechanisms will allow to work out the pathogenetic reasonable ways of treatment optimization for improvement of life quality of patients with CUC in combination with CHD and helicobacteriosis. In this context possibility of using in treatment combination of home medicinal agents that contain arginine - donator NO (сorargine) and lipoic acid attracts attention . Connection of the work with scientific programs, plans, themes The work is accomplished in accordance with the basic plan of research works (RW) of government facility "Lugansk State Medical University" and it is a fragment of themes of RW of the department of propedeutic and internal medicine where a candidate is a participant: "Medical rehabilitation of patients with united pathology"(№ state registration 0109U004608). The aim of the research is investigation of dynamics concentration of circulatory immune complexes and their molecular composition for patients with chronic uncalculary cholecystitis in combination with coronary heart disease and helicobacteriosis at treatment of espa-lipon and сorargine. Materials and research methods It was examined 269 patients with CUC in combination with CHD that were treated on the bases of department of propedeutic and internal medicine ( 82 men - 30,5%; 187 women - 69,5%) middle age of the patients was 42,5±4,5 years old, with duration of united pathology from 1 to 12 years, among whom 187 persons had CUC in combination with CHD and helicobacteriosis (I group). The indexes of clinical, laboratory and instrumental researches for these patients were compared with analogical ones of group ІІ that consisted of 82 patients ( men - 32,7%, women - 67,3%) with CUC in combination with CHD without helicobacteriosis (middle age 41,6±4,4 years old). Later on it was formed two randomized groups of patients from group I depending on facilities of treatment by gender, age and duration of united pathology: basic (110 persons) and comparison (77 persons). The concentration of circulatory immune complexes (CIC) was studied by the method of precipitation in the solution of polyethyleneglycol (PEG) with molecular mass of 6000 dalton; molecular composition of CIC was studied by differentiated precipitation in 2%, 3,5% and 6% solutions of PEG [6]. It was considered that according to the level of CIC especially the most pathogenic (midmolecule and small molecule fractions) it was possible to judge about evidence of immune toxicosis syndrome [7]. Verification of CUC was carried out according to the Order of the Ministry of Healthcare of Ukraine № 271 "About approval of protocols of medical aid provision specialty "Gastroenterology"" (13.06.2005); CHD (the stable angina of ІІ FC) - the Order of the Ministry of Healthcare of Ukraine № 436 "About approval of protocols of medical aid provision specialty "Cardiology"(03.07.2006) and also on the basis of recommendations of the Ukrainian association of cardiologists(2011). The treatment of the examined patients was carried out according to the Order of the Ministry of Healthcare of Ukraine № 271(2005) and the Order of the Ministry of Healthcare of Ukraine № 436(2006). The patients were prescribed standard therapy of CHD that included β-blocators, ACE inhibitors, aspirin, nitrates of necessity , statins; standard therapy of CUC included antibacterials of necessity, spasmolytics, cholekinetics, antihistaminics, enzymic preparations, herbal brews with antiinflammatory and choleretic action, physical therapy procedures and helicobacteriosis - carrying out of "triple" antihelicobacteriosis therapy during 14 days with control of eradication efficiency. The patients of basic group got corargine (per os before meal 1 pill 3 times per twenty-four hours during three weeks) additionally. The effect of that was conditioned by stimulant influence on synthesis of NO and inhibitory one on activity of freely-radical processes [1] and modern medicinal product espa-lipon (0,9 g one dose in the morning during 2 months) that is one of major components of the system of antioxidant defense of organism, assists supporting of balance in the system of glutathione and ubiquinone, prevents the damage of mitochondria, releases of cytochrome and cell death that is conditioned by the action of cytokinins , has a positive lipotropic action, subdues the sizes of atherosclerotic atherosclerosis plaque [5]. Statistical data processing of the got results was produced on the base of computer center of the V. Dahl East-Ukrainian national university using the packages of the licensed softwares of Microsoft Office 2000, Microsoft Excel and Statistica 6.1/ prof. Obtained results and discussions While studying the content of CIC in the blood serum it was set that examined patients had reliable changes of general level of CIC and its molecular composition that depended on the presence and degree of semination НР. As a result of conducted researches it was set that all examined patients had the increase of general concentration of CIC in the blood serum and at the same time the most expressed were changes in the Іst group (infection НР). So the level of CIC in this group increased on the average in 1,7 and formed 3,19±0,09 g/l ( while the norm is1,88±0,12 g/l; р<0,001) however in the ІІnd group the repetition factor of difference with a norm was 1,25 and general content of CIC was equal 2,35±0,05 g/l (р<0,05). Let notice that the repetition factor of difference of general level of CIC between groups was1,36 times(р<0,01). While analysing the general concentration of CIC for patients with the different degree of semination НР it was set that at a high degree it formed 4,25 g/l that was on the average in 2,26 times higher than norm (р<0,001), at moderate semination it was 3,17 g/l (the repetition factor of difference with a norm 1,69; р<0,01) and at weak it was 2,44 g/l that was higher than norm in 1,3 times (р<0,05) and at the same time belower than indexes at high and moderate degree of semination in 1,74(р<0,05) and 1,3(р<0,05) times accordingly. Thus it is evident the dependence of general level of CIC in the blood serum from the degree of semination НР. The research of molecular composition of CIC for patients with CUC in combination with CHD and helicobacteriosis allowed to reveal that the increase of level of CIC took place mainly due to the most toxigenic fractions: midmolecule (11S-19S) and small molecule (<11S) (table.1). Table 1 Concentration of CIC and their molecular composition in examined patients with CUC in combination with CHD and helicobacteriosis in dependence of degree of semination НР(M±m)
Note: Р1 is probability of difference concerning the norm; Р2 is probability of difference between indexes for patients with high and moderate degree of semination НР; Р3 is probability of difference between indexes for patients with moderate and low degree of semination НР. Thus increase of content of CIC in the blood serum of patients especially with high degree of semination НР took place mainly due to an accumulation of the most toxigenic fractions that was probably related to suppression of phagocytic activity of monocytes (PAM) that belonged a basic role in elimination of CIC from blood. As a result of immunological research it was set that all examined patients had the increase of general concentration of CIC in the blood serum (table 2). Table 2 The level of CIC and their molecular composition for patients with CUC in combination with CHD and helicobacteriosis at the beginning of treatment(M±of m)
Note: there is possibility of difference concerning the norm * - at Р<0,05, ** - at Р<0,01, *** - at Р<0,001; the column Р is an index of possibility of differences between a basic group and group of comparison in the tables 2-3 .
So the level of CIC in the basic group was increased at the average in 1,7 times and it made 3,12±0,09 g/l (a norm is 1,88±0,12 g/l; р<0,001), in the group of comparison it was increased at the average in 1,6 times reaching 3,02±0,12 g/l. Research of molecular composition of CIC for patients with CUC in combination with CHD and helicobacteriosis allowed to reveal that the increase of the level of CIC took place mainly due to the most toxigenic fractions : midmolecule (11S-19S) and small molecule (<11S). So the total content of these fractions in the period of recrudescence of CUC in the basic group of patients at the average it was 67±1,6% at the norm 55,8±0,5р<0,05), in the group of comparison it was 65,9±0,7%. Determination of absolute content of sum of the indicated fractions of CIC allowed to mark their considerable increasing: in the basic group on the average in 2 times, in the group of comparison in 1,9 times(р<0,001). In connection with the increase of content of small molecule and midmolecule immune complexes the relative content of big molecule CIC had a tendency to the decline of specific gravity in a basic group on the average in 1,34 times concerning the index of norm(44,5±2,3 р<0,01) and in the group of comparison in 1,28 times(р<0,05). At the same time in connection with the increase of general CIC level next to the increase of concentration of small molecule and midmolecule fractions it was marked increasing of absolute count of fraction of big molecule complexes though in a less degree: in a basic group to 1,02±0,06 g/l, that was in 1,21 times (at a norm 0,84±0,04; р<0,05) and in the group of comparison in 1,25 times(1,05±0,06 g/l; р<0,05). Thus the changes of CIC for the patients of both groups were of the same type (р>0,05). After ending of treatment in both groups of patients the positive changes of concentration and molecular composition of CIC in the blood serum were determined . So the multipleness of reduction of CIC concentration for the patients of basic group was at the average 1,9 times(р<0,001), in the group of comparison in 1,4 times (р<0,01). The concentration of CIC in the blood serum in a basic group at the moment of ending of treatment for certain did not differ from the index of reference norm; in the group of comparison it exceeded the norm in 1,5 times(р<0,01). The repetition factor of this index between the patients of basic group and group of comparison made 1,3 times(р<0,01). The analysis of fractious composition of CIC testified that fractious composition of CIC recommenced after ending of treatment for the patients of basic group. In the group of comparison the studied indexes not having regard to a certain positive dynamics remained different from the norm and data of basic group (table.3). Table 3 Concentration of CIC and their molecular composition for patients with CUC in combination with CHD and helicobacteriosis after ending of treatment(M±of m)
Thus the using of corargine and espa-lipon assisted reduction of concentration of CIC in the blood serum and to renewing of their molecular composition for the patients of basic group. At the same time for the patients of group of comparison after ending of treatment the level of CIC was kept increased with predominating of the most toxigenic midmolecule and small molecule fractions. Conclusions
Література
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Переглядів: 486 | Завантажень: 0 | |
Всього коментарів: 0 | |