Terapevticheskii arkhiv



The journal Therapeutic archive (ISSN key title is "Terapevticheskiy arkhiv") was founded by the prominent Russian therapists M.P. Konchalovsky and G.F. Lang in 1923. Then its editors-in-chief were Professors V.N. Vinogradov and A.G. Gukasyan. Since 1972, E.I. Chazov, Academician of the Russian Academy of Sciences, has been heading the editorial board of the journal.

Over 90 years, there have been more than 1000 issues where the authors and editorial staff have done their best for readers to keep abreast of current advances in medical science and practice and for physicians to master the advanced principles of recognition and treatment of a wide spectrum of visceral diseases.

The papers published in the journal (editorials, original articles, lectures, reviews, etc.) cover both current scientific achievements and practical experience in diagnosing, treating, and preventing visceral diseases. The authors of publications are not only Russian, but also foreign scientists and physicians. All papers are peer-reviewed by highly qualified Russian specialists.

The journal is published monthly. Traditionally, each issue has predominantly certain thematic areas covering individual therapy specializations. Every year, one of the issues is devoted to related problems in practical medicine (allergology and immunology, neurology and psychiatry, obstetrics, oncology, etc.). This all draws the attention of the reading public to the journal.



Irina Chazova
MD, PhD, Professor, Academician of the Russian academy of Sciences
ORCID: http://orcid.org/0000-0002-1576-4877



Monthly issues publish in print and online in Open Access under the Creative Commons NC-ND 4.0 International Licensee.



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Current Issue

Vol 92, No 8 (2020)

Novel coronavirus infection COVID-19: extrapulmonary manifestations
Maev I.V., Shpektor A.V., Vasilyeva E.Y., Manchurov V.N., Andreev D.N.

The novel coronavirus infection COVID-19 in most cases manifests with respiratory symptoms and fever, however, some patients may have cardiovascular and gastroenterological manifestations. A feature of the clinical syndrome of COVID-19 is the development of pronounced immunopathological reactions and disorders of hemostasis, leading to the development of a wide range of cardiovascular complications. The course of COVID-19 may be complicated by the development of acute myocardial infarction, venous and arterial thrombosis and thromboembolism in various vascular pools, the development of acute myocardial damage and myocarditis. Among the gastroenterological manifestations, diarrhea, nausea or vomiting, as well as abdominal pain, are most often detected. These symptoms may precede the appearance of respiratory signs of the disease, and in some cases come to the fore in the clinical picture of the disease. In addition, in some patients there are laboratory signs of liver injury (increased serum transaminases). The exact pathogenesis of the above disorders continues to be studied.

Terapevticheskii arkhiv. 2020;92(8):4-11
Interdisciplinary consensus on Russian-language terminology of anorectal sphincterometry and profilometry

Aim – to describe the results of a multidisciplinary discussion on the terminology of anorectal sphincterometry (AS) and profilometry (AP). We performed online survey with the use of public platform “Google forms” to harmonize Russian terms to be used to describe the results of AP and AS and their abbreviations. The invitation to participate in the survey was sent to the authors who use the results of AP and AS in clinical practice and perform the diagnostic procedures. The obtained answers were analyzed with the use of the aggregator and Statistica 10 (StatSoft Inc, USA) software. The level of consensus was analyzed with the use of modified Delphi criteria (C1 – agreement of ≥90% of participants, C2 agreement of ≥75 to <90%, C3 – less than 75%). Invitations sent 76, responses obtained 63 (response rate 82.9%). Consensus level 1 was reached for all the terms of AP and for 4out of 7 terms to describe the results of AS (3 out of 7 terms were of moderate agreement, C2). The need for the use of predefined abbreviations of terms for AS and AP was of a low rate of consensus (71.4%). The agreed terms of AS and AP should be used to prepare a conclusion for the diagnostic procedures and to publish scientific reports.

Terapevticheskii arkhiv. 2020;92(8):128-135
Original articles
Development of the Russian version of quality of life questionnaire in patients with GERD – GERD-HRQL
Ionova T.I., Nikitina T.P., Mayevskaya E.A., Cheremushkina N.V., Shaburov R.I., Kucheryavyy Y.A., Maev I.V.

Gastroesophageal reflux disease (GERD) is a common chronic disease of the upper gastrointestinal tract with long course of the disease and followed by different symptoms significantly reducing quality of life (QoL) in pts. Assessment of QoL in pts with GERD may be of value for comprehensive evaluation of treatment effect as well as for monitoring of pts during treatment course in a real clinical practice.

Aim. Development of the Russian version of GERD-HRQL questionnaire to assess symptomatic outcomes of GERD in research and real clinical practice.

Materials and methods. GERD-HRQL questionnaire (V. Velanovich, USA) consists of 11 items: 10 items for assessment of the most frequent symptoms/problems related with QoL in pts with GERD and 1 item for assessment of patient-reported global satisfaction with health condition.

Results. In accordance with international guidelines, the new language version of the tool may be used in research and clinical practice after cross cultural adaptation, linguistic validation and psychometric testing. This paper presents the results of cross-cultural adaptation and linguistic validation of the Russian version of GERD-HRQL. The following steps of linguistic and cultural adaptation of GERD-HRQL for Russia were conducted after the permission from the author of GERD-HRQL was obtained: forward translation with creation of two forward translations of GERD-HRQL in Russian, reconciliation and expert evaluation of translations of GERD-HRQL in Russian and creation of the preliminary version of GERD-HRQL in Russian, back translation, harmonization, creation of the first test-version of GERD-HRQL in Russian, cognitive debriefing and decentering, creation of the second test-version of GERD-HRQL in Russian, final expert evaluation and development of the final test-version of GERD-HRQL in Russian. Satisfactory face validity of the Russian test-version of GERD-HRQL was shown: face validity indices were 0.98, 0.95, 0.92, and 0.97.

Conclusion. As the result of translation, cross cultural adaptation and linguistic validation, the Russian version of GERD-HRQL for the use in pts with GERD in Russia was developed. The Russian version of GERD-HRQL may be used in research studies and clinical practice after testing its psychometric properties.

Terapevticheskii arkhiv. 2020;92(8):12-17
Chronic gastrite: modern state of the problem
Minushkin O.N., Zverkov I.V., Lvova N.V., Skibina Y.S., Inevatova V.S.

Aim. Тo evaluate the modern view on the problem of chronic gastritis and the effectiveness of the drug ursodexic acid (UHC) Grinterol in the treatment of patients with chronic antral reflux-gastritis (biliar).

Materials and methods. The work provides modern ideas about chronic gastritis, the issues of etiology and pathogenesis are considered. Contemporary classifications and the attitude of the authors of the work to them are presented. Clinical studies were conducted in 50 patients with chronic antral reflux-gastritis biliary (32 women and 18 men) between the ages of 20 and 80 years (average age – 50.3 to 8.0 years). The treatment uses the drug Grinterol in a daily dose of 12.5 mg/kg of body weight for 4 weeks.

Results. Among patients with chronic antral gastritis isolated patients with reflux-gastritis biliary, the pathogenetic factor of which is the damaging property of aggressive bile acids. The main treatment for such patients are drugs UHC (in this study (this study uses Grinterol at a daily dose of 12.5 mg/kg of body weight); the duration of treatment is 4 years. The overall efficiency (according to endomorphological data) was 76%, according to clinical data – 100%.

Discussion. Critical consideration of the classifications used and proposed for consideration indicates that the time has come for the adoption of a new classification with the allocation of reflux-gastritis biliary. Treatment of this form of antral gastritis is effective with UDHC drugs.

Conclusion. the selection of a form of antral reflux-gastritis biliar in a separate classification group is scientifically justified. The results suggest that for the treatment of patients with chronic biliary refluxdrugs of choice are drugs UDHC.

Terapevticheskii arkhiv. 2020;92(8):18-23
Antibiotic resistance of Helicobacter pylori in the European part of the Russian Federation: first results
Maev I.V., Andreev D.N., Govorun V.M., Ilina E.N., Kucheryavyy Y.A., Oganesian T.S., Melnikova E.V., Zayratyants O.V., Parfenova T.V., Dzhedzheia L.V., Kirillova N.V., Maevskaya E.A., Fomenko A.K., Lobanova E.G., Zaborovskii A.V., Kriukov K.A.

Aim. Determine the primary antibiotic resistance of Helicobacter pylori (H. pylori) strains isolated from patients living in the European part of the Russian Federation.

Materials and methods. As part of a clinical laboratory study, from 2015 to 2018, 27 gastrobiopsy samples obtained from H. pylori-infected patients were analyzed. H. pylori infection was verified using a rapid urease test or a 13C-urea breath test. The values of the minimum inhibitory concentration (MIC) of antibiotics were determined by the diffusion method using E-test strips (BioMerieux, France) according to the recommendations of the manufacturer. The sensitivity of the isolates was determined for 6 antibacterial drugs (amoxicillin, clarithromycin, metronidazole, levofloxacin, tetracycline, rifampicin).

Results. According to the data obtained, resistance to amoxicillin was 0%, clarithromycin – 11.1%, metronidazole – 59.3%, levofloxacin – 3.7%, tetracycline – 0%, and rifampicin – 14.8%. Dual resistance to clarithromycin and metronidazole was recorded in two isolates (7.4%).

Conclusion. Thus, the first results of the evaluation of H. pylori antibiotic resistance in the European part of the Russian Federation indicate a low resistance of the microorganism to clarithromycin and quite high to metronidazole.

Terapevticheskii arkhiv. 2020;92(8):24-28
Clinical features of the comorbid course of non-alcoholic fatty liver disease and gallstone disease
Cherkashchenko N.A., Livzan M.A., Krolevets T.S.

Aim. To determine the diagnostic value of clinical features of the comorbid course of non-alcoholic fatty liver disease (NAFLD) and gallstone disease (GD) to improve the effectiveness of patient management.

Materials and methods. 183 patients with NAFLD were included into the open comparative study. The main group was represented by patients with NAFLD and GD (n=88), of which 53 patients underwent cholecystectomy (CE). The comparison group was represented by patients with NAFLD without GD (n=95). A standard laboratory and instrumental examinations were performed, including elastometry to assess of the stage of liver fibrosis.

Results. There were more women in the main group (÷2=8.48; p≤0.01). There were positive correlations between the age of patients and the duration of NAFLD with the presence of GD and CE (rs=0.135; p≤0.01 and rs=0.168; p≤0.01 respectively). Patients of the main group had the general weakness and fatigue (÷2=11.33, rs=0.234; p≤0.01 and ÷2=15.68, rs=0.281; p≤0.01 respectively), as well as a bitter taste in the mouth (÷2=11.66; p≤0.01; rs=0.147; p≤0.01). Coronary heart disease was diagnosed more often among people suffering from NAFLD and GD (25% vs 9.47% in patients of the comparison group, p≤0.01). Both of NAFLD and GD were associated with the development of type 2 diabetes (rs=0.164; p≤0.01). Individuals suffering from GD after CE had higher LDL and GGT values (rs=0.228; p≤0.01 and rs=0.298; p≤0.01 respectively). The number of people with advanced fibrosis were significantly higher (26.31%) in the GD group, especially among people after CE (30.18%). The stage of liver fibrosis had a positive significant relationship with CE (rs=0.366; p≤0.01).

Conclusion. Patients suffering from GD and NAFLD had a symptom of dyspepsia and general weakness. High prevalence of type 2 diabetes and сoronary heart disease, high level of LDL and GGT were found in patients with GD and after CE. CE in patients suffering from GD and NAFLD was associated with the formation of progressive stages of liver fibrosis.

Terapevticheskii arkhiv. 2020;92(8):29-36
Results of decision support system implementation for prescribing anticoagulants to patients with atrial fibrillation in hospital
Chernov A.A., Kleymenova E.B., Sychev D.A., Yashina L.P., Nigmatkulova M.D., Otdelenov V.A., Payushchik S.A.

Background. In 8–19% of patients with atrial fibrillation (AF) with anticoagulant therapy (ACT), hemorrhagic complications occur, including due to excess doses of AC. At the same time, ACT is necessary for patients with AF, since anticoagulants effectively reduces the risk of ischemic stroke. To make a decision on the appointment of ACT, it is necessary to correlate the risks of ischemic stroke and bleeding, this requires knowledge of current clinical using ACT recommendations and instructions. Among patients admitted to hospital, 30% receive ACT, so increasing adherence to clinical recommendations for prescribing AC to patients with AF by doctors of various profiles is an urgent task.

Aim. To analyze the adherence of physicians to recommendations for prescribing ACT before and after the introduction of decision support system (DSS) in patients with AF in a multi-specialty hospital.

Materials and methods. A single-center non-randomized study with historical control to assess adherence to recommendations based on the analysis of medical prescriptions and the structure of drug errors in patients with AF in a multi-specialty hospital in Moscow before and after the introduction of DSS. Compliance with the recommendations of physicians was evaluated in the sections «indications /contraindications to AC» and «dosage regimen of AC». The presence of deviations from the clinical recommendations /instructions for medical use of AC was regarded as «management of the patient with non-compliance with recommendations». Physicians adherence level to recommendations was calculated as the ratio of cases of «compliance with recommendations» to the total number of cases.

Results. In the control and experimental groups, there was a significant increase in the proportion of POAC at discharge in comparison with admission to hospital: from 54.5 to 76.8% (p=0.0005) and from 63 to 85.7% (p=0.0002), respectively. However, only in the experimental group it was possible to significantly reduce the number of patients without a prescribed ACT (if there are indications) from 7.6 to 1% (p=0.04) in comparison with admission. During the study, it was possible to significantly increase physicians adherence level to the recommendations for the AC dosage regimen in patients with AF from 59% (44 discrepancies for 107 prescriptions) to 84.6% (16 discrepancies for 104 prescriptions); p<0.005. Before the introduction of the DSS, the analysis of drug prescriptions revealed 56 drug errors (0.5 errors per patient), after the introduction of the DSS, the number of drug errors significantly decreased to 21 (0.2 errors per patient); p<0.05. After the introduction of DSS, the number of sub-therapeutic doses of AC was reduced from 31 (27.7%) to 8 (7.6%); p<0.05.

Conclusion. The level of adherence to the recommendations for prescribing ACT to patients with AF in the hospital is high. The use of DSS increases the level of adherence to the recommendations on the AC dosage regimen in patients with AF, as well as eliminates errors in calculating the risk of ischemic stroke and systemic thromboembolic complications, and contributes to reducing the frequency of prescribing sub-therapeutic doses of AC.

Terapevticheskii arkhiv. 2020;92(8):37-42
Analysis of carrying clinically significant allelic variants of TPMT and DPYD genes associated with the response to drug therapy in cancer practice among 9 ethnic groups of the Russian Federation
Mirzaev K.B., Fedorinov D.S., Akmalova K.A., Abdullaev S.P., Kachanova A.A., Sozaeva Z.A., Grishina E.A., Shuev G.N., Kitaeva E.Y., Shprakh V.V., Suleymanov S.S., Bolieva L.Z., Sozaeva M.S., Zhuchkova S.M., Gimaldinova N.E., Sidukova E.E., Burashnikova I.S., Shikaleva A.A., Zabudskaya K.G., Sychev D.A.

Aim. To study the peculiarities of carrying clinically significant allelic variants of TPMT and DPYD genes associated with the response to drug therapy in cancer practice among 9 ethnic groups of the Russian Federation.

Materials and methods. The study included 1446 conditionally healthy volunteers from 9 ethnic groups. Carriage of polymorphic TPMT and DPYD gene markers was detected by the Real-Time PCR (polymerase chain reaction) method.

Results. In all ethnic groups, the distribution of genotypes and alleles matched the equilibrium of Hardy-Weinberg. TPMT*3A (rs1800460) and TPMT*3C (rs1142345) were observed in heterozygous state in all investigated ethnic groups. In the Kabardinian group (n=204) the frequency of the TPMT*3A minor allele (MAF, %) was 2.94%; Balkars (n=200) – 1.25%; Ossetians (n=239) – 1.67%; Chuvashes (n=238) – 1.89%: Mari (n=206) – 1.21%; Tatars (n=141) – 1.77%; Russians (n=134) – 4.85%. The frequency of the TPMT*3C minor allele (MAF, %) in the Kabardinian group (n=204) MAF was 4.90%; Balkars (n=200) – 1. 75%; Buryats (n=114) – 0.44%; Ossetians (n=239) – 1.88%; Chuvashes (n=238) – 1.68%: Mari (n=206) – 1.21%; Tatars (n=141) – 1.42%; Russians (n=134) – 4.48%. The results of the analysis of DPYD*2A polymorphism (rs3918290) demonstrated ethnic peculiarities of distribution. In the heterozygous state it was found only in the groups of Kabardins (n=204, MAF 1.22%), Balkars (n=200, MAF 2.00%), and Ossetians (n=239, MAF 0.63%).

Conclusion. The results obtained in the study will be useful for developing personalized algorithms of antitumor therapy in cancer practice, including those aimed at increasing the safety of chemotherapy.

Terapevticheskii arkhiv. 2020;92(8):43-51
European Registry on the management of Helicobacter pylori infection: features of diagnosis and treatment in Kazan
Abdulkhakov S.R., Bordin D.S., Abdulkhakov R.A., Safina D.D., Gizdatullina A.R., Gimadieva L.Z., Safina G.M., Ziyatdinov A.I., Maturina A.M., Nyssen O.P., Megraud F., O’Morain C., Perez-Gisbert J.

Background. As part of an observational multicenter prospective study “European Registry on the management of Helicobacter pylori infection”, conducted on the initiative of the European H. pylori and Microbiota Study Group, the compliance of clinical practice in the management of patients with Helicobacter pylori infection in Kazan with clinical guidelines was assessed.

Materials and methods. The data of 437 patients included into the register by clinical sites in Kazan in 2013–2019 were analyzed. The methods used for the initial diagnosis of H. pylori infection and eradication control were evaluated. The frequency of various eradication therapy regimens prescription was analyzed in 379 cases. Data regarding the effectiveness of eradication therapy was analyzed in 173 patients.

Results. The rapid urease test (44.2% of cases) and cytology/histology (60% of cases) were most often used for the initial diagnosis of H. pylori infection; however non-invasive methods such as 13C-urea breath (9.2%), serology (6.2%), H. pylori stool antigen test (2.3%) were less common. In 21.7% of patients two methods of H. pylori detection were used for primary diagnosis. The control test to evaluate the effectiveness of eradication therapy at the recommended timepoint was performed in 46.2% of patients. 13C-urea breath test (31.7%), stool PCR/stool antigen test (28.7%), rapid urease test (22.3%), cytology/histology (26.2% of cases) prevailed in the assessment of eradication rate. Standard triple therapy, including proton pump inhibitor, clarithromycin and amoxicillin was most commonly prescribed as first-line therapy (64.6% of cases). The duration of eradication therapy was 14 days in the majority of cases with pantoprazole as the most common proton pump inhibitor in standard triple therapy regimens (84.8%). The efficacy of 14-day standard triple therapy (mITT) was 87.0%.

Conclusion. The results indicate a high frequency of non-invasive methods use for assessing the effectiveness of eradication therapy; however, the overall rate of eradication efficacy assessment is low, limiting the possibility of analyzing the eradication results. The effectiveness of the most common 14-day standard triple first-line therapy in Kazan doesn’t reach the recommended 90% eradication level. This could be explained by high rate of pantoprazole use, which is not an optimal proton pump inhibitor in eradication therapy regimens.

Terapevticheskii arkhiv. 2020;92(8):52-59
Comparative effectiveness of ursodeoxycholic acid preparations in the treatment of biliary sludge
Butorova L.I., Ardatskaya M.D., Osadchuk M.A., Drobysheva A.E., Zagrebina E.A., Kadnikova N.G., Kalashnikova M.A., Lukianova E.I., Pavlova L.N., Plavnik R.G., Sayutina E.V., Topchiy T.B., Trunova S.N., Tuayeva E.M., Shustova N.U.

In the clinical classification of cholelithiasis, biliary sludge (BS) is distinguished as the pre-stone stage. Ursodeoxycholic acid (UDCA) is a drug with an evidence base for effective and safe effects on BS. The therapeutic equivalence of various UDCA drugs remains an important issue for clinical practice.

Aim. To conduct a comparative analysis of the effectiveness of the use of UDCA: Ursofalk with other UDCA drugs for the treatment of BS in a fixed dose of 10 mg/kg of body weight.

Material and methods. The observation group consisted of 225 patients with various types of BS. In randomized groups, the comparison of the effectiveness of UDCA drugs in the dissolution of BS was determined by the data of ultrasound of the gallbladder. Dynamic ultrasound cholecystography using a standardized technique was performed to study the effect of the compared drugs on the contractile function of the liver. When analyzing the impact of ursotherapy on the clinical manifestations of BS, the dynamics of biliary pain syndrome and dyspeptic disorders were evaluated.

Results. A comparative analysis of the effectiveness of UDCA drugs for BS lysis with a high degree of confidence established the advantage of Ursofalk: after 3 months in 80%, and after 6 months of therapy in 95.65% of patients, a regression of BS was detected. In the group of patients who took other UDCA, the corresponding indicators were 46.36% and 67.27%. The greatest effectiveness of ursotherapy was demonstrated in the BS variant by the type of suspension of hyperechogenic particles, the lowest in the variant by the type of putty-like bile in the form of mobile or fixed clots. In the last variant of BS, the relationship between the success of lysis with the extension of the UDCA intake period to 6 months and the preferred choice of Ursofalk was traced. Normalization of the contractile function of the gallbladder was noted in patients who took Ursofalk.

Conclusion. From the standpoint of therapeutic effectiveness, the drug of choice for the treatment of BS, regardless of its type, is Ursofalk, which has proven the best dynamics of BS litolysis, recovery of the contractile function of the gastrointestinal tract, and relief of clinical symptoms.

Terapevticheskii arkhiv. 2020;92(8):60-65
Food patterns in Russian patients with gastroesophageal reflux disease: the results of pilot comparative study
Kropochev V.S., Morozov S.V., Lantseva M.A., Sasunova A.N., Pilipenko V.I., Isakov V.A.

Aim. To evaluate nutritional patterns in patients with gastroesophageal reflux disease (GERD) compared to the control group without GERD.

Materials and methods. The data of complex examination of patients referred to perform esophageal pH-impedance recording and who gave written informed consent to participate in the study served as a source data. All the participants underwent complex examination, including clinical data (presence of heartburn and acid regurgitation), symptom evaluation (GERD-Q questionnaire), esophagogastroscopy, esophageal pH-impedance recordings and food frequency questionnaire. Diagnosis of GERD was based on GERD-Q score ≥8, acid exposure time >6%, number of gastroesophageal refluxes >80/day by 24-hrs esophageal pH-impedance recordings. Nutritional patterns were assessed with the use of “healthy eating pyramid” principles.

Results. Overall 165 patients were enrolled and the data of 150 of them (34 with confirmed GERD and 116 of the control group) were available for the final analysis. The patients of the both groups consumed lower compared to the recommended amounts of dairy and higher amounts of meat. Those with GERD consumed larger amounts of fruits (0.91±0.68 compared to the values of “healthy eating pyramid” vs 0.52±0.57 in the control group, p=0.001), and fats (0.69±0.55 vs 0.49±0.55, p=0.001). Compared to the controls, patients with GERD consumed lower amounts of vegetables (0.86±0.46 of the “healthy eating pyramid” vs 0.94±0.63 in the control group, р=0.004) and sugars & confectionaries (0.38±0.39 vs 1.93±0.98, p=0.0001).

Conclusion. Nutritional patterns of patients with gastroesophageal reflux disease significantly differ compared to the control group. The obtained data may be used for diet modification in patients with arterial hypertension.

Terapevticheskii arkhiv. 2020;92(8):66-72
Non-alcoholic fatty liver disease and type 2 diabetes mellitus: issues of the liver fibrosis diagnostics
Anisonyan A.V., Sandler Y.G., Khaimenova T.Y., Keyan V.A., Saliev K.G., Sbikina E.S., Vinnitskaya E.V.

Aim. To evaluate the frequency of liver fibrosis progression to stage 3–4 among patients with non-alcoholic fatty liver disease (NAFLD), type 2 diabetes and obesity, to identify predictors of severe liver fibrosis, to propose an algorithm for diagnosing fibrosis in this category of patients.

Materials and methods. 160 patients with NAFLD, type 2 diabetes mellitus (DM) and obesity and 50 patients with NAFLD without diabetes were comprehensively examined. Patients underwent laboratory examination (clinical blood test, biochemical analysis, immunoglobulins G, M, autoantibody assay, coagulogram), liver ultrasound. All patients underwent determination of the liver fibrosis stage by two methods: the serological test FibroMax and indirect ultrasound elastometry of the liver; 40 patients underwent a liver biopsy. Statistical data processing was performed using the programming language and statistical calculations R: we used correlation analysis, multiple logistic regression method, one-way analysis of variance, multi-factor analysis, the Kruskal-Wallis method, and comparison of the number of patients using the Fisher test.

Results. DM is a risk factor for the liver fibrosis progression in patients with NAFLD. Significant markers of severe fibrosis in this category of patients are increased levels of GGTP, haptoglobin and alpha-2-macroglobulin, lower platelet and prothrombin levels. Obesity and isolated steatosis without steatohepatitis are not markers of severe liver fibrosis at present, but obesity can be considered a risk factor for the progression of fibrosis in the future.

Conclusion. All patients with NAFLD in combination with diabetes need screening to detect advanced liver fibrosis: it is advisable to determine the levels of GGTP, haptoglobin and alpha-2-macroglobulin.

Terapevticheskii arkhiv. 2020;92(8):73-78
Association of nutritional patterns and arterial hypertension in Russia: does it exist?
Lantseva M.A., Sasunova A.N., Vlasova A.V., Kropochev V.S., Pilipenko V.I., Morozov S.V., Isakov V.A.

Aim. To evaluate nutritional patterns in patient with arterial hypertension (AH) compared to the control group without elevated blood pressure.

Materials and methods. Retrospective search for unique records of the patients aged 18–75 y.o. with complete data on usual nutrition with food frequency methods who had no mentions of diabetes mellitus, food intolerance or allergies, and history of major abdominal surgery, as well as signs of secondary reasons of AH. Nutritional patterns were assessed with the use of «healthy eating pyramid» principles. Ststistical analysis was performed with the use of SPSS 13.0 for Windows software (SPSS Inc., USA).

Results. The data of 711 patients were available for the final analysis (595 of them in AH group). Both groups consumed lower compared to the recommended amounts of fruits, dairy and higher amounts of meat. Those with AH consumed larger amounts of vegetables (1.13±0.74 compared to the values of «healthy eating pyramid» vs 0.94±0.63 in the control group; p=0.004), fruits (0.80±0.66 vs 0.52±0.57; p=0.001), meat (1.85±1.05 vs 1.62±0.91; p=0.002) and fats (0.77±0.60 vs 0.49±0.55; p=0.001). On the other hand, there were lower rates of consumption of sugars, and confectionaries in the structure of nutritional patterns in patients with AH compared to the control group: (0.35±0.44 of the «healthy eating pyramid» in AH vs 1.93±0.98, in the control group; p=0.0001).

Conclusion. Nutritional patterns of patients with arterial hypertension significantly differ compared to the control group. The obtained data may be used for diet modification in patients with arterial hypertension.

Terapevticheskii arkhiv. 2020;92(8):79-85
The treatment of tuberculosis under current conditions
Sinitsyn M.V., Kalinina M.V., Belilovskiy E.M., Galstyan A.S., Reshetnikov M.N., Plotkin D.V.

Aim. Study of the current state of problems of treatment of patients with tuberculosis based on literature data and their own experience.

Materials and methods. In the Russian Federation, the number and proportion of patients with co-infection with HIV/tuberculosis continues to increase against the background of improvement in the main epidemiological indicants for tuberculosis. In 2017, 20.9% of newly diagnosed tuberculosis patients had HIV infection. The combination of the two infections significantly complicates the further improvement of the situation with tuberculosis, and the appearance of drug-resistant strains of Mycobacterium tuberculosis sometimes completely neutralizes the results of chemotherapy. The article describes the schemes of modern tuberculosis chemotherapy taking into account HIV/tuberculosis co-infection, as well as MDR in combination with surgical treatment methods, as well as analyzes the data of epidemiological monitoring of treatment of 1115 tuberculosis patients newly diagnosed in 2017 in Moscow, 360 tuberculosis patients with MDR MBT (cohort 2013–2014), the results of treatment with the use of new chemotherapy regimens for tuberculosis (bedaquiline, linezolid, moxifloxacin) in 36 patients, the effectiveness and safety of surgical methods in 192 patients.

Results. The application of new individualized anti-TB chemotherapy schedules in patients with HIV co-infection/tuberculosis with MDR-MBT has allowed to improve the treatment efficacy. The surgical intervention combined with modern chemotherapy regimens in patients with HIV/tuberculosis co-infection with MDR MBT has been proved to be effective and safe, contributes to the improving the results of treatment for this category of patients.

Conclusion. The confluence of two global problems of co-infection HIV/TB and MDR TB, significantly prevents from the end of the tuberculosis epidemic in the world. At the same time, advances in the development and implementation of new anti-TB drugs and surgical treatment methods give hope for significant progress for resolving this situation.

Terapevticheskii arkhiv. 2020;92(8):86-94
Experience of using dupilumab in the treatment of severe asthma
Ignatova G.L., Antonov V.N., Makarova E.A., Kochetkova S.A.

The article provides data on modern approaches to the treatment of patients with severe uncontrolled bronchial asthma with an emphasis on the use of dupilumab, a human recombinant monoclonal antibody to the alpha subunit of the interleukin (IL)-4 receptor, which inhibits signal transmission from both IL-4 and IL-13. The results of dupilumab pivotal randomized clinical trials DRI12544, QUEST and VENTURE are summarized. Indications for use of this medicinal product are listed in Federal Clinical Guidelines on the management of asthma (year of revision 2019). Clinical cases with various clinical course of bronchial asthma are described, including cases with frequent exacerbations. In conclusion, dupilumab could be a treatment of choice for the patients with severe bronchial asthma and it is reasonable from an economic, clinical and pathogenetic point of view.

Terapevticheskii arkhiv. 2020;92(8):95-99
The eosinophilic esophagitis and IgG4-related disease involving the esophagus
Bakulina N.V., Simanenkov V.I., Vorobyev S.L., Tikhonov S.V., Lishchuk N.B., Bakulin I.G.

The study of eosinophilic esophagitis has become a dynamic field with an evolving understanding of the pathogenesis, diagnosis, and treatment. Immunoglobulin G4 (IgG4)-related disease exhibits systemic involvement but very rarely involves the esophagus. The article presents a clinical case: the history of ulcer and stricture of the esophagus in a young man of 17 years. The patient was finally diagnosed with IgG4-related and eosinophilic esophagitis and showed a good response to corticosteroid therapy. We herein report a rare case of dysphagia associated with IgG4-related disease and eosinophilic. We presented a review of modern data on the relationship of eosinophilic esophagitis and pathological IgG4-response.

Terapevticheskii arkhiv. 2020;92(8):100-107
Evaluation and management of infectious esophagitis in immunocompromised patients and immunocompetent individuals
Trukhmanov A.S., Makushina A.A., Storonova O.A., Ivashkina N.Y.

Among the many causes of the inflammatory process in the esophagus, infectious diseases are becoming increasingly important due to their steady growth. Previously esophageal infections have traditionally been associated with immunodeficiency syndromes, but now in clinical practice, these disorders are becoming increasingly recognized in immunocompetent individuals. Early diagnosis of infectious esophagitis is necessary to develop effective treatment tactics, and, as a result, reduce the risk of complications and adverse outcomes of the disease. This study reviewed the most clinical relevant pathogens of infectious esophagitis, both among patients with immunodeficiency and among healthy individuals. Specific diagnostic, risk factors, clinical presentation and therapeutic features were considered depending on the immune status of patients.

Terapevticheskii arkhiv. 2020;92(8):108-117
Diet therapy for irritable bowel syndrome
Bakulin I.G., Avalueva E.B., Оrеshkо L.S., Sitkin S.I., Shevyakov M.A., Serkova M.U., Semenova E.A.

The review provides present information on the pathogenesis of irritable bowel syndrome (IBS), the relationship of endogenous and exogenous factors with the development of IBS-symptoms, questions of diet therapy are discussed, diets traditionally prescribed in IBS treatment and diets, such as FODMAP and gluten-free diet, which are the most promising and have a positive effect on the symptoms of IBS.

Terapevticheskii arkhiv. 2020;92(8):118-127
In memory of Andrei Ivanovich Vorobyov (01.11.1928-15.06.2020)

He was a good doctor. He did not know how to lie, joked a little and took all his patients very seriously - he had the gift of fully focusing on the problems of the patient in front of him, and each time he did everything he could.

Terapevticheskii arkhiv. 2020;92(8):136

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