Vol 81, No 3 (2009)

Aim. To evaluate specific features of hepatopulmonary syndrome (HPS) in patients with cirrhosis and cirrhosis associated with chronic obstructive pulmonary disease (COPD). Material and methods. We made a retrospective analysis of case histories of 75 patients with hepatic cirrhosis (HC) of different etiology. The patients were divided into two groups: 23 patients with HC and COPD (group 1); 52 patients with HC without COPD (group 2). The patients were examined with spirography, gasometry. Single-breath carbon monoxide diffusion capacity (Dlco), TCO and TCO/VA were estimated. Transthoracic contrast-enhanced echocardiography was conducted for detection of intrapulmonary bypass in AaDO2 > 15 mm Hg. Results. COPD stage I and II were diagnosed in 14 of 23 and 9 of 23 patients of group 1, respectively. TCO and TCO/VA had a trend to lowering in group 1 (p > 0.05). PaO2 was lower (p < 0.05) while AaDO2 was higher (p < 0.05) in group 1. Four patients of group 1 had intrapulmonary bypasses: of the first degree (2 patients with hypoxemia) and of the first and second degree (2 patients with normoxemia). In group 2 three patients had intrapulmonary bypasses: of the fourth degree in 1 patient with hypoxemia and of the first and second degree in 2 patients with normoxemia. Conclusion. HC patients with COPD had more severe hypoxemia. Mild and moderate HPS were registered in both groups. In COPD the risk of HPS is 3 times higher.

Aim. To study efficacy of leukocytic interferon - inferon in combined treatment of patients with chronic obstructive pulmonary disease (COPD). Material and methods. The trial included 57 COPD patients (mean age 61.2 ± 1.04 years). Of them, 29 patients received standard treatment (antibiotics, broncholytics, mucolytics). Inferon was added to standard treatment of 28 patients. Results. Standard treatment alone was not highly effective in COPD patients as the symptoms often persisted and immune status was deficient. Adjuvant inferon activated immunity and raised efficacy of COPD therapy. Conclusion. Inferon enhanced immunity in COPD patients and improved treatment results.

Aim. To evaluate the link between promotional polymorphism -930A > G of the cytochrome b gene (CYBA) and onset of bronchial asthma; to examine effects of this locus on the risk of the disease development depending on the pro- and antioxidant action of environmental factors. Material and methods. We studied samples of DNA obtained from 214 healthy individuals and 215 patients with bronchial asthma treated in Regional Kursk Hospital. We used polymerase chain reaction and analysed polymorphism of restriction fragments lengths for genotyping of -930A > G polymorphism of CYBA gene. Results. Incidence of a variant allele -930G of CYBA gene among men with nonallergic bronchial asthma (nBA) was higher than in healthy men (OR 1.95; CI 1.02-3.73; p = 0.04). The homozygous variant genotype -930G/G was associated with a high risk of nBA in males (OR 2.66; CI 1.14-6.20; p = 0.02). In healthy individuals polymorphisms -930A > G and 640A > G were in negative linkage equilibrium (D = -0.057; p < 0.001) while in patients such associations were not registered. Male smokers with genotype -930G/G had the highest risk of nBA (OR 2.86; CI 1.06-7.77; p = 0.04) while non-smokers with this genotype had no risk of the disease (OR 1.50; CI 0.11-19.64; p = 0.70). Males with -930G/G on low or no vegetable diet had the highest risk of nBA (OR 3.11; CI 1.01-9.63; p = 0.04) while regular vegetable eaters had no risk to develop nBA (OR 0.73; CI 0.30-1.82; p = 0.50). Conclusion. We were the first to find relations between -930A > G polymorphism of CYBA gene and predisposition to nBA. This association exists in males and depends on the smoking status and vegetable diet.

Aim. To investigate immunity and lymphocytic-thrombocytic adhesion in pneumonia patients. Material and methods. The examination of 59 male patients with pneumonia aged 18-21 years included calculation of total leucocyte count, lymphocyte subpopulations, relative and absolute count of lymphocytic-thrombocytic aggregates (LTA), measurement of IgA, IgM, IgG concentrations. Results. Pneumonia patients have high count of leukocytes and low count of total and relative count of lymphocytes, low number of main lymphocytic subpopulations (CD4+, CD8+, CD16+, CD22+). Patients with uncomplicated pneumonia demonstrated high ability of lymphocytes for forming coaggregates with platelets. Patients with severe pneumonia complications may have either very high count of LTA (mean 403 ± 45.6) or very low (mean 42.6 ± 8.1). Percent of lymphocytes able to adhere to platelets (CD4+ with CD16+) in pneumonia is low. No correlation was found between LTA and the level of IgA, IgG, IgG. Conclusion. LTA is an objective indicator of cellular immunity status in pneumonia patients.

Aim. To study a plasmic concentration of the brain natriuretic peptide (BNUP) in patients with interstitial pulmonary disease (IPD) as a possible diagnostic parameter in pulmonary hypertension (PH). Material and methods. Plasmic BNUP concentration, external respiration function were studied in 24 patients with IPD. The following tests were also made: 6-min walk, echocardiography (echo-CG) with estimation of systolic pressure in the pulmonary artery, multislice computed tomography of the chest with measurement of the mean diameter of the pulmonary artery trunk. Results. As shown by echo-CG and chest MSCT half of the IPD patients had PH. IPD patients with PH had a significant elevation of plasmic BNUP concentration which, in intact left ventricular contractile function indicates development of secondary PH characterized by reduction of volume parameters of the respiratory pulmonary function. The rise of BNUP concentration correlated with reduction of 6-min walk distance and functional lung capacity. Conclusion. Plasmic BNUP can be used for diagnosis of PH in IPD patients.

Aim. To investigate arterial stiffness (AS) in healthy subjects and its correlation with standard cardiovascular risk factors (CRF). Material and methods. AS was estimated on Tensioclinic arteriograph (Tensiomed, Hungary) in 97 subjects (76 females and 21 males) having symptoms of neither atherosclerosis nor coronary heart disease (CHD). Detection of CRF was made by questionnaire survey. 10-year CHD risk and cardiovascular death risk (SCORE) were estimated. Results. With age, there was a rise of augmentation index (AI) (r = 0.76; p < 0.001) and pulse wave velocity (PWV) in the aorta (r = 0.61; p < 0.001), AI changes arose earlier than those of aortic PWV. Arterial hypertension is an independent factor of arterial stiffness deterioration. High blood cholesterol, AS, body mass index, smoking index directly correlate with AI and PWV in young subjects. CHD risk and SCORE rise with an AS increase (r = 0.30; p < 0.05 and r = 0.34; p < 0.05, respectively). Conclusion. Of CRF, most significant determinant of AS are arterial hypertension and age. AI is a more sensitive marker of AS in young subjects. Increased aortic PWV is more typical for persons over 50 years of age. The study of pulse wave characteristics with application of Tensioclinic arteriograph is a simple and significant method of detecting early changes in AS.

Aim. To evaluate effects of 6-month therapy with losartan in combination with indapamide on a clinical course, immunological, metabolic parameters, left ventricular function, exercise tolerance and quality of life in patients with coronary heart disease (CHD) associated with metabolic syndrome (MS). Material and methods. Forty six CHD patients with postinfarction cardiac dysfunction in MS were randomized into two groups. Group 1 consisted of 22 patients with impaired glucose tolerance, group 2 - of 24 type 2 diabetics. Treatment included combination of losartan (50 mg/day) with indapamide (1.5 mg/day), on demand nitrates, nebivolol. Basic therapy in diabetes included sugar-reducing drugs. Clinical condition, findings of echocardiography, parameters of lipid and carbohydrate metabolisms, immunoglobulins, circulating immune complexes, autoantibodies to cardiolipin (AB to CL), spectrum of proinflammatory cytokines were studied before and 3 months after course treatment. Results. Overactivation of cytokines (primarily IL-2, IL-1, TNFalpha) with high expression of IgA, IgG, CIC, AB to CL was found in CHD patients with type 2 diabetes mellitus and less evident in impaired glucose tolerance. Losartan in both groups had an antihypertensive effect, stabilized LV hypertrophy, improved clinical symptoms leading to cytokines expression decline: TNFalpha by 9.8%, IL-1 - by 6.1%, IL-6 - by 6.7%. Losartan was well tolerated, caused no negative metabolic effects. Conclusion. New original facts of cytokine overactivation and humoral immunity disturbances were discovered which play an essential role in pathogenesis of postinfarction dysfunction and LV remodeling developing in type 2 diabetes mellitus. Losartan 6-month treatment in the fixed combination has a positive effect on clinicohemodynamic and immunometabolic indices. This gives grounds for wider use of losartan in CHD combined with type 2 diabetes mellitus.