Vol 80, No 8 (2008)

Aim. To characterize cardiorenal syndrome in ischemic renal disease (IRD). Material and methods. In examination of 105 IRD patients (63 males and 42 females, mean age 63.8 ±5.1 years) we estimated body mass index (BMI), indices of peripheral blood and urine, blood biochemistry, glomerular filtration rate (GFR). Plasmic homocystein concentration was measured in 30 patients. We also studied incidence of some cardiovascular risk factors, clinical variants of atherosclerosis and their correlation with GFR. Results. IRD patients most frequently had hypertriglyceridemia (67.6%), hypercholesterinemia (53.3%), smoking (47.1%), obesity (41.9%), metabolic syndrome (38.1%), type 2 diabetes mellitus, arterial hypertension of the third degree (70.6%), isolated systolic arterial hypertension (46.7%). GFR was significantly lower in smokers (p < 0.001), arterial hypertension of the third degree (p < 0.05), isolated systolic arterial hypertension (p < 0.001) and type 2 diabetes mellitus (p < 0.05). In GFR < 40 ml/min homocysteinemia increased significantly (p < 0.01). Coronary artery disease in IRD occurred in 52.4%, cerebrovascular diseases (brain stroke, transitory ischemic attacks) - in 29.5%, intermittent claudication - in 19.0%, aneurism of the abdominal aorta - in 7.6%, documented atherosclerotic affection of the upper limb arteries - in 2.8%. Patients with intermittent claudication were characterized by significantly less GFR compared to that in patients without clinical symptoms of affected arteries of the lower limbs (38.6 ± 8.2 and 44.6 ±7.3 ml/min, respectively; p < 0.01). Conclusion. Basic symptoms of cardiorenal syndrome in IRD are high rate of cardiovascular risk factors, some of them provoke aggravation of glomerular endotheliocyte dysfunction and deterioration of intrarenal hemodynamics leading to GFR reduction underlying appearance of new endothelium-tropic risk factors (hyperhomocysteinemia), and progression of atherosclerotic process with formation of its special clinical forms (intermittent claudication).

Aim. To study characteristics of cardiovascular affection in antiphospholipid syndrome (APS) with nonbacterial thrombotic endocarditis (NBTE). Material and methods. The trial included 28 patients with APS and NBTE (26 females, mean age 44 ± 13 years). Primary APS was diagnosed in 21 patients, secondary APS associated with systemic lupus erythematosus - in 7 patients. Transthoracic echocardiography was performed in all the patients, transesophageal echocardiography - in 86% of them. Statistic processing was made with logistic regression analysis. Results. All the patients had structural valvular changes: leaflet thickening, sclerosis, vegetations, focuses of calcinosis and valvular dysfunction. Vegetations located on mitral and aortic valves in 64% and occurred on damaged heart valves in 36% patients. An important problem in APS with NBTE was systemic embolism (54%), especially with involvement of central nervous system. Logistic regression revealed association of NBTE with structural changes of aortic and mitral valves, myocardial focal fibrosis and valvular insufficiency. Conclusion. APS with NBTE is characterized by absolute predominance of valvular heart lesion with vegetations location on the left heart valves and high risk of embolic complications.

Aim. To assess efficacy and tolerance to anti-B-cell drug rituximab in therapy of rheumatoid arthritis (RA) by the data of RF register of this drug. Material and methods. Rituximab was studied in 42 patients with high RA activity. 37 patients received rituximab according to a conventional scheme: 2 intravenous 1000 mg infusions with a 2-week interval. The rest patients received 2 intravenous 500 mg infusions. The response was evaluated by DAS28 index. Results. Rituximab administration resulted in almost complete elimination of B-cells from peripheral blood. This produced a significant positive effect manifesting with reduction in the number of inflamed and painful joints. This trend was evident to observation week 8 reaching maximum to week 24. Clinical response correlated with decline of inflammation as shown by ESR and CRP. According to DAS28 index, good and satisfactory results were registered in 8 weeks in 62% patients, in 16 weeks - in 86%, in 24 weeks - in 100%. Rituximab tolerance was good. Conclusion. Effective treatment with rituximab for rheumatoid arthritis opened a new perspective in antirheumatic biological therapy and demonstrated an important role of B-cells in the disease development. This drug is recommended for wide use in the treatment of severe rheumatoid arthritis resistant to prior therapy including TNF-alpha blockers.

Aim. To study prevalence of the principal symptoms of gastroesophageal reflux disease (GERD) in Moscow. Material and methods. A total of 1065 respondents aged 15-85 years (a random representative sample of population of one of the typical Moscow districts) participated in a questionnaire survey using the international questionnaire for detection of GERD incidence. Results. Epigastric burning (EB) occurs in 39.6% examinees. GERD prevalence is 14.2%. Subjects with EB have the following symptoms of GERD: regurgitation (66.3%), epigastric pain (discomfort) (53.0%), nausea (43.6%), vomiting (23.2%), dysphagia (20.6%), chest pain (18.0%), odinophagia (5.5%), singultus (4.6%). There is a direct correlation between incidence rate of EB, height, body mass index, number of alcohol excesses and smoked sigarettes. Conclusion. EB occurs in both young and aged men and women with similar frequency. Significant differences were detected only in the age group 45-59 years in which EB is more frequent in women. All the symptoms excluding cough and singultus were seen in women significantly more frequently. With age, these differences disappeared but noncardial pain in the chest that was less frequent in the elderly. Muscovites with GERD symptoms are older (61.26 ± 13.47 years) than those without such symptoms (58.44 ± 16.28, p < 0.0001).