Резюме
Іванова Л.М., Налапко К.К., Сидоренко Ю.В., Холіна О.А., Височин М.В., Ліпатнікова Г.С. Особливості клінічного перебігу сполученої патології у хворих на неалкогольний стеатогепатит, хронічний бронхіт та ожиріння.
У хворих з неалкогольним стеатогепатитом у сполученні з хронічним бронхітом та ожирінням клінічний перебіг характеризувався поєднанням астено-невротичного, больового абдомінального, диспептичного синдромів, гепатомегалії та проявів хронічного бронхіту.
Ключові слова: неалкогольний стеатогепатит, хронічний бронхіт, ожиріння, клініка.
Резюме
Иванова Л.Н., Налапко К.К., Сидоренко Ю.В., Холина Е.А., Височин М.В., Липатникова А.С. Особенности клинического течения сочетанной патологии у больных с неалкогольным стеатогепатитом, хроническим бронхитом и ожирением.
У больных с неалкогольным стеатогепатитом, хроническим бронхитом и ожирением клиническое течение характеризовалось сочетанием астено-невротического, болевого абдоминального, диспептического синдромов, гепатомегалии и проявлениями хронического бронхита.
Ключевые слова: неалкогольный стеатогепатит, хронический бронхит, ожирение, клиника.
Summary
Ivanova L.N., Nalapko K.K., Sydorenko Y.V., Kholina E.A., Vysochin M.V., Lipatnikova A.S. Clinical features of non-alcoholic steatohepatitis, combined with chronic bronchitis in patients with obesity.
In patients with non-alcoholic steatohepatitis, combined with chronic bronchitis and obesity clinical picture was characterized with asthenic-neurotic, pain abdominal, dyspeptic syndromes, hepatomegaly and signs of chronic bronchitis.
Key words: non-alcoholic steatohepatitis, chronic bronchitis, obesity, clinic.

Рецензент: д.мед.н., проф. Я.А. Соцька

УДК 616.36 – 002 – 003.826 + 616.233 – 002.2

ДЗ «Луганський державний медичний університет»

ГЗ «Луганский государственный медицинский университет»

State Establishment "Lugansk State Medical University"

propedevtika2011@yandex.ua, ksenia-777@ukr.net, siderman@ukr.net, e-holina@mail.ru, mishadoctor@ukr.net, boba@dsip.net

In the structure of morbidity significant role belongs to the conjugate disease that occurs in 25.6% 41.7%, negatively affecting the clinical course and prognosis of diseases. According to modern clinical and epidemiological studies, the incidence of nonalcoholic steatohepatitis (NSH) is about 23%. In Ukraine for the last 5 years the incidence steatohepatitis increased by 76.5%, while prevalence has increased 2.2 times. Primary Nash closely associated with endogenous lipid and glucose metabolism, including obesity and hyperlipidemia. Both chronic bronchitis (CB), according to who, being found in 38 % of the population over the age of 45 years and 47 % - older than 55 years. The combination NSH, chronic bronchitis and obesity may significantly influence the nature of the clinical picture and the course of diseases.

The aim was to define the features of clinical course of nonalcoholic steatohepatitis, United with chronic bronchitis and obesity. Under our supervision there were 68 patients with NSH combined with CB and obesity (women 62.5%, men 37.5%), ranging in age from 23 to 75 years. Duration of comorbidity ranged from 1 to 10 years. Patients NSH combined with CB and obesity clinic was characterized by the combination asthenoneurotic (100%), abdominal pain (88.3%), diarrhea (41.7%) syndromes, hepatomegaly (100%) and characteristics CB (100%). Patients were under surveillance, was traced clinical symptomatology with a combination of signs of lesions in the liver parenchyma and symptoms of asthenoneurotic syndrome. Abdominal pain syndrome manifested heavy, moderate stupid or aching pain in the right hypochondrium, 60 (88.3%) patients. Dyspeptic syndrome was characterized by a bitter or metallic taste in the mouth 53 (78.5%) patients, decreased appetite 26 (37.6%), flatulence in 58 (85.8%), violations of the chair - 56 (82.7%) patients. All surveyed (100%) was observed hepatomegaly of different severity.

Chronic bronchitis manifested classic triad of symptoms: coughing, secretion of mucous or mucopurulent sputum, dyspnea, considerable physical loads. So, when interviewing patients NSH combined with CB and obesity is established that the main symptom CB was coughing. In 58 (85.8%) patients showed shortness of breath that occurs when physical activity. During acute (anamnesis) increase body temperature was observed in 39 (32.5%) patients, while it generally had the character of a low grade. Auscultation unchanged vesicular breath was determined in 58 (85.0%) patients, 6 (8.3%) - hard breathing, which in 5 (6.7%) patients was combined with the weakening. With acute CB 64 (94.4%) of the examined patients had a dry rales in the face of weak vesicular or hard breathing, increased body temperature is 66 (96.7%) patients. However, the main complaint of patients remained cough, with the appearance of which the patients started the countdown is on sick leave.

Laboratory data (in the study of blood changes was absent or was determined moderate changes: neutrophilic leucocytosis, a slight increase in the concentration of fibrinogen, sialic acids, positive reaction on C-reactive protein; sputum often with exacerbations of mucopurulent or purulent) and instrumental (radiological changes are absent or poorly expressed, bronchial passability saved) studies that reflect the presence of CB under mild exacerbation and incomplete remission. When antropometrical study found that 57 (47.5%) of patients had grade I, 43 (35.8%) - II degree and 20 (16.7%) - III degree of obesity.

Conclusions: Among patients with nonalcoholic steatohepatitis, combined with chronic bronchitis and obesity clinic was characterized by the combination of asthenoneurotic (100%), abdominal pain (88.3%), diarrhea (41.7%) syndromes, hepatomegaly (100%) and manifestations of chronic bronchitis (100%).

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