Vol 90, No 3 (2018)


Disease associated with immunoglobulin g

Chuchalin A.G.


Diseases associated with disorders of immunoglobulin g synthesis and its subclasses are described. The analysis of the role of both deficiency and its increased production in the diagnosis and treatment of a number of diseases in humans.
Terapevticheskii arkhiv. 2018;90(3):4-9
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Pulse wave velocity and other indicators of arterial stiffness in hypertension comorbidity and chronic obstructive pulmonary disease

Aksenova T.A., Gorbunov V.V., Tsarenok S.Y.


The aim is to study pulse wave velocity (PWV) and other parameters of arterial stiffness in patients with comorbid arterial hypertension (AH) and chronic obstructive pulmonary disease (COPD). Materials and methods. 32 patients with a combination of AH and COPD (group 1), 30 patients with isolated hypertension (group 2), 18 patients with isolated COPD (group 3), 30 healthy subjects (control group) were examined. Applanation tonometry and pulse wave contour analysis at the carotid-femoral segment were made by SphygmoCor (AtCor Medical). Results. Aortic systolic blood pressure in patients with the combination of hypertension and COPD was higher compared to the group of the patients with isolated hypertension by 9.83% (p=0.02), and the patients with COPD by 41.5% (p = 0.000042), respectively. Central pulse pressure in the first group was higher compared to the second group by 29.58% (p=0.00022), in the third group - by 53.4% (p=0.0029). The combination of hypertension and COPD (β=0.42, p=0.00019), age (β=0.39, p=0.0002) and the level of aortic pulse pressure (β=0.54, p=0.001) were marked as independent factors of PWV increasing according to the multiple regression analysis. Conclusion. In patients with a combination of hypertension and COPD the increase in PWV, systolic and pulse pressure in the ascending aorta was observed, compared to patients with isolated hypertension, isolated COPD and the control group during applanation tonometry.
Terapevticheskii arkhiv. 2018;90(3):10-15
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Application of bacterial therapeutic vaccine Immunovac-VP4 in the treatment of pollinosis

Kostinov M.P., Poddubikova A.M., Magarshak O.O., Poddubikov A.V.


In-depth study of the function and structure of the lymphoid tissue of the gastrointestinal tract and respiratory tract opens wide opportunities for the use of mucosal vaccines to improve immunity to various infectious agents. One such drug is The immunovac-VP4 vaccine containing pathogen-associated molecular structures (PAMSs) of microorganisms. They are the antigens of Klebsiella pneumoniae, Proteus vulgaris, Escherichia coli, Staphylococcus aureus. Discovered in many studies and experiments, the ability of the vaccine to induce innate immunity provides opportunities for prevention and treatment of both infections and allergic diseases, because it promotes the switching of Th2 immune response to Th1. The aim of the study was to study the effectiveness of the complex use of bacterial therapeutic vaccine Immunovac-VP4 and allergen-specific immune therapy (ASIT) in pollinosis in children and adults. Materials and methods. Bacterial therapeutic vaccine Immunovac-VP4 was used annually, nasal and oral administration in patients before the course of ASIT standardized aqueous-salt solutions of allergens. Results. The therapeutic application of bacterial vaccines, Immunoac-ВП4 before the course ASIT has helped to reduce the frequency of acute respiratory infections in 8,5 times in comparison with the control group. Clinical efficacy of complex treatment according to the results of the survey of patients in 7 years after the start of therapy was 90%. There was a significant decrease In IgG4 to causally significant allergens, General immnunoglobulin E (IgE) and a tendency to decrease IgE. Conclusion. The use of bacterial therapeutic vaccine Immunovac-VP4, which is a natural ligand of toll-like receptors in combination with ASIT, seems to be an effective and promising direction in the treatment of allergic diseases.
Terapevticheskii arkhiv. 2018;90(3):16-20
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Expression of DROSHA and DICER genes in peripheral blood leukocytes in lung sarcoidosis

Malysheva I.E., Balan O.V., Tikhonovich E.L., Volkova T.O.


Aim. To study the expression level of the genes DROSHA and DICER in peripheral blood leukocytes (PBL) of patients with sarcoidosis of the lungs Materials and methods. The study included 32 patients diagnosed with persistent lung sarcoidosis (mean age 41.56±1.27 years) and 36 healthy donors (control; mean age 42.79±1.95 years). The level of expression of messenger RNA (mRNA) of the genes DROSHA and DICER were determined in PBL of healthy donors and patients with sarcoidosis of the lung by polymerase chain reaction in real time. Results. As a result of the conducted researches it is established that the level of drosha gene expression in PBL patients with sarcoidosis of lungs is significantly reduced in comparison with the control (p<0.01). We also found a significant decrease in the number of Dicker gene transcripts in the PBL of the study group of patients (p<0.01). Conclusion. According to the results of the conducted studies, a significant decrease in the number of DROSHA and DICER transcripts in PBL patients with the development of lung sarcoidosis has been found, which can contribute to the pathogenesis of this disease.
Terapevticheskii arkhiv. 2018;90(3):21-24
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Features of cellular structure of the induced sputum and profile of cytokines at sintropiya of bronchial asthma and obesity at young patients

Soloveva I.A., Sobko E.A., Demko I.V., Kraposhina A.Y., Loktionova M.M., Gordeeva N.V.


Aim. To estimate changes of cellular structure of the induced sputum at young patients with bronchial asthma at interrelations with BMI and level of cytokines in blood plasma. Materials and methods. 164 patients with bronchial asthma were divided into 2 groups taking into BMI: the 1st group included patients with bronchial asthma and BMI from 18 to 25 kg/m2, patients with bronchial asthma and BMI from 30 to 40 kg/m2 entered into the 2nd group. The group of control was made by 40 almost healthy volunteers. Estimated existence of excess weight and defined obesity degree according to recommendations of World Health Organization. Studied the level of control of bronchial asthma, cellular structure of the induced sputum, the IL-2, IL-4, IL-6, IL-8, IL-10, IL-12, IL-15, IL-17, TNF-α, INF-γ levels in plasma of peripheral blood. Results. There are presented the results of the research of cellular profile of the induced sputum and profile of cytokines at patients with bronchial asthma depending on BMI and severity of the disease. The received results testify to prevalence of eosinophilic type of an inflammation in the group of patients with BMI less than 25 kg/m2 whereas at patients mainly paucigranulation inflammation decided on obesity. The highest content of the Il-17 was registered at patients with bronchial asthma and obesity as in comparison with indicators of patients with normal BMI, and with almost healthy that, perhaps, is the reason of low effect of steroid therapy at these patients. Conclusion. Endotype assessment before basic antiinflammatory therapy at patients with the first time diagnosed bronchial asthma, will be able to help with selection of the most optimum treatment to each specific patient.
Terapevticheskii arkhiv. 2018;90(3):25-32
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Verification of zinc role in pathophysiology of chronic obstructive pulmonary disease

Shevcova V.I., Zujkova A.A., Pashkov A.N., Kotova J.A., Shevcov A.N.


Aim. Determination of the level of zinc and its fractions, as well as the enzyme neutrophilic elastase and albumin in persons suffering from chronic obstructive pulmonary disease (COPD), as well as smoking actively and passively. Materials and methods. The study involved 30 patients with a diagnosis of COPD and 90 healthy persons (60 of them smoking at the present time, 30 - no) who underwent spirometry and determination of zinc levels and its pools, albumin, and neutrophil elastase. All data are subject to statistical processing. Results. It is determined that the studied parameters differ significantly in the groups of smokers with COPD, healthy smokers and non-smokers, and correlate with the volume of forced exhalation for 1 second as a percentage of the due. Conclusion. The revealed regularities make it possible to consider the indicator "share of bound zinc fraction" introduced in the study as a screening criterion in diagnosing COPD in smokers.
Terapevticheskii arkhiv. 2018;90(3):33-37
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Correlations between indicators of interleukin-10 and interleukin-6 in patients with periodic disease

Jndoyan Z.T., Bablumyan A.Y., Ginosyan K.V., Shekoyan S.V.


Aim. Determination of the concentration of interleukin-10 (IL-10) and interleukin-6 (IL-6) in serum of patients with periodic disease (PD) before and after treatment with colchicin, as well as the identification of correlation between the indicators of these parameters. Materials and methods. We examined 188 patients with PD (89 men, 99 women) aged from 12 to 69 years, as well as 44 patients with rheumatoid arthritis (RA) as a comparison group and 41 healthy people of the control group. Patients were divided into groups: 1 - PD colchicinotherapy patients with seizures without amyloidosis that do not respond to treatment maximum dose of colchicine 2.0 mg/day; 2nd-PD patients without amyloidosis, not responding to treatment 1.5 mg/day colchicine; 3rd - PD patients that responds to certain doses of colchicine (0.5 to 2.0 mg/day); 4th - PD patients without amyloidosis who did not receive treatment; 5-I of the healthy persons of the control group; 6-I - RA patients. The concentration of IL-10 in blood serum was determined by enzyme immunoassay ELISA, and IL-6 - immunochemiluminescent method. For statistical processing the computer program SPSS is used. The results were considered statistically significant at the level of reliability p<0.05. The results and discussion. The results of the studies showed the same nature of changes in IL-10 production in different groups of patients. Statistically significant positive correlation of elevated serum concentrations of IL-6 and IL-10 (p<0.05) was found in patients with PD of all groups, as well as in patients with RA. Conclusion. In patients with PD (both colchicin-resistant and colchicin-sensitive) increased serum concentration of IL-10 was accompanied by an increased level of IL-6 in serum. Changes in the level of IL-10 in PD have a certain prognostic and pathogenetic significance and lead to the development of "persistent, sluggish" inflammatory process in the extracurricular period of PD in both colchicin-resistant and other groups of patients with PD.
Terapevticheskii arkhiv. 2018;90(3):38-41
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Clinical significance of the determination of surfactant proteins A and D in assessing the activity of lung sarcoidosis

Beketov V.D., Lebedeva M.V., Mukhin N.A., Serova A.G., Ponomarev A.B., Popova E.N., Yanakaeva A.S., Solomka V.A., Kondrashov A.V., Konovalov D.V.


The results of a clinical study showing the importance of surfactant proteins A and D in assessing the activity and progression of idiopathic pulmonary fibrosis and chronic lung sarcoidosis are presented. Aim. To study the clinical significance of SP-A, SP-D in assessing the activity of idiopathic pulmonary fibrosis and sarcoidosis. We examined 81 patients with morphologically confirmed diagnoses of idiopathic pulmonary fibrosis (ILF) and sarcoidosis, a control group of 20 healthy individuals. The MSCT of the thoracic organs of the chest was performed, the diffusivity of the lungs was examined, oxygen saturation was determined. In the serum, the surfactant proteins SP-A and SP-D were determined by the enzyme-linked immunosorbent assay. Results. A significant increase in SP-A and SP-D (p<0.05) was observed in patients compared with patients in the control group, a direct correlation was found with signs of activity: SP-A with alveolitis (p<0.05), SP- D with progressive fibrosis (p<0.05), inverse correlation of surfactant proteins with respiratory function indices (p<0.05). Conclusion. Serological parameters of SP-A and SP-D reflect the activity of alveolitis and the progression of pulmonary fibrosis in patients with ILF and sarcoidosis.
Terapevticheskii arkhiv. 2018;90(3):42-46
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Analysis of compliance dynamics in patients with chronic obstructive pulmonary disease on the background of vaccination against pneumococcal infection

Jgnatova G.L., Antonov V.N.


Aim. The analysis of the dynamics of compliance in patients with chronic obstructive pulmonary disease (COPD) on a background of vaccination. Material and Methods. A total of 394 male patients are covered by this study. The main endpoints of observation are as follows: 1. To evaluate the effectiveness It’s important the dynamics of scores for mMRC, FEV1, the number of exacerbations, hospitalizations, the number of pneumonia cases. 2. To assess compliance it’s necessary to conduct a test for adherence to the Moriska-Green questionnaire. For vaccine prophylaxis, 13-valent conjugated pneumococcal vaccine Prevenar-13 and a 23-valent polysaccharide vaccine Pnevmo23 were used. The dynamics of changes in the parameters studied was evaluated within 4 years of the therapy initiation. Results. The inclusion of vaccine prophylaxis of PCV13 in the patient management plan allows to reduce a degree of dyspnea and stabilize the main functional parameters of the respiratory system not only in the short term, but also for at least next 4 years. PCV13 vaccination of can be considered as a basic therapy along with bronchodilator therapy. The use of vaccine prophylaxis PCV13 significantly increases the compliance and adherence of patients to a therapy. Conclusions. The use of vaccine prophylaxis PKV13 significantly increases patients ' compliance and adherence to the therapy.
Terapevticheskii arkhiv. 2018;90(3):47-52
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The influence of weather-climatic and social factors on population mortality from circulatory diseases in Russia

Zolotokrylin A.N., Titkova T.B., Bokuchava D.D.


Aim. To study the links between the standard mortality rate of the population from circulatory system diseases (CSD) with factors: weather-climatic (inter-day jumps in air temperature and atmospheric pressure by seasons and for the year) and social (average annual income per person and the number of doctors of all specialties) in Russia for the period 1995-2015. Materials and methods. According to station data and data of reanalysis, seasonal and annual amounts of day-to-day jumps in air temperature were calculated more than the absolute value of 4° and 6°C and the atmospheric pressure more than the absolute value of 8 GPa. The links between climate variables and the mortality rate of the population, taking into account social factors, were investigated using factor analysis, including regression and variance analyses. Results. Annual amounts of temperature (pressure) jumps of different signs vary greatly on the territory: the maximum amounts are 3-4 times higher than the minimum ones. The geographical distribution of air temperature fluctuations differs from the distribution of atmospheric pressure fluctuations. The sum of temperature jumps in the absolute value of more than 6°C is about twice less than the sum of jumps more than 4°C, but they are characterized by similarity of geographical distribution. The sum of the jumps of temperature (pressure) is reduced during the summer is approximately two times compared to the winter. The maximum jumps are observed mainly in the Northern regions with low population density, but with high per capita income, while the minimum is observed in the South-Western parts of the European part of the country with high population density, as well as middle and low income. Global warming does not significantly affect the reduction of annual amounts of temperature (pressure) jumps. Factor analysis of social and climatic variables in the territory for each year indicates the dominance of the influence of the social factor (per capita income) on the mortality rate from CSD. Conclusion. Factor analysis is integrated in the annual scale climatic and social variables showed a dominant effect on the coefficient of mortality from CSD, the factor of standard of living (per capita income of the population). Then the significance of the impact factors is consistently reduced: negative atmospheric pressure jumps, average seasonal pressure, health care level, positive pressure jumps. The significance of temperature variables is the smallest.
Terapevticheskii arkhiv. 2018;90(3):53-59
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Stem Cell Therapy for Perianal Crohn’s Disease

Knyazev O.V., Fadeeva N.A., Kagramanova A.V., Belyakov N.I., Orlova N.V., Lishchinskaya A.A., Konoplyannikov A.G., Parfenov A.I.


Aim. To compare the effectiveness of the effect of combination therapy (local and systemic administration) with bone marrow mesenchymal stromal cells (MSC), anticlitokine therapy with infliximab (IFX), and antibiotic (AB)/immunosuppressive (IS) therapy on the frequency of healing of simple perianal fistulas in Crohn's disease. Materials and methods. In our study, the 1-st group of patients aged 19 to 58 years (Me-29) (n = 12) received MSCs culture systemically according to the scheme and locally. The 2-nd group of patients with CD (n = 10) from 20 to 68 years old (Me-36) received anticytokine therapy with infliximab (IFX) according to the scheme. The 3-d group of patients with CD (n=14) from 20 to 62 years old (Me-28) received antibiotics (AB) and immunosuppressors (IS). Efficacy was assessed by the index of perianal activity of Crohn's disease (PCDAI) and the frequency of relapses. Results. After 12 weeks among patients of the 1-st group, healing of simple fistulas was noted in 8/12 patients (66.6%), in the 2-nd group in 6/10 (60.0%) In the 3-d group, in 1/14 patients (7.14%). After 6 months in the 1-st group of patients, healing of simple fistulas was preserved in 8/12 (66.6%), in the 2-nd group - in 6/10 (60.0%). In the 3-d group - in 1/14 patients (7.14%). After 12 months in the 1-st group, healing of simple fistulas was preserved in 7/12 (58.3%), in the second group - in 6/10 (60.0%). In the 3-d group - in 2/14 patients (14.3%). After 24 months, among the patients of the 1-st group, fistula closure was maintained in 5/12 patients (41.6%), in the 2-nd group - in 4/10 (40.0%). In the 3-d group - in 0/14 patients (0.0%). Conclusion. Combined cellular and anticytokine therapy of CD with perianal lesions significantly contributes to the more frequent and prolonged closure of simple fistulas, as compared to antibiotics/immunosuppressors, and to a decrease in the frequency of recurrence of the disease.
Terapevticheskii arkhiv. 2018;90(3):60-66
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Management of acute coronary syndrome in older adults (data from russian federal acute coronary syndrome registry)

Ocshepkova E.V., Sagaydak O.V., Chazova I.E.


The frequency of cardiovascular diseases is increasing progressively with age, and the global aging of the population poses the problem of treatment of patients of older age groups in a row with other relevant medical and socio-economic problems. Aim. In the present study was to investigate the quality of medical care for patients with acute coronary syndrome (ACS) old age and compliance of the treatment current guidelines. The data is exported from the system of the Federal register OKS. Materials and methods. Analyzed medical history 33 893 patients with ACS entered in the system registry of ACS for the period from 01.01.2016 to 31.12.2016. a comparison was made of the quality of care in patients with ACS elderly (75 years and older, n=8773) and in younger patients. Results. The results of the study showed that in patients of senile age, when compared with younger patients, comorbid conditions are significantly more often observed, as well as a significantly higher risk of hospital and 6-month death, calculated on the GRACE scale. Conclusion. Patients of senile age with ACS are almost twice less likely to undergo percutaneous coronary interventions than younger ones, which worsens the prognosis in these patients and increases mortality.
Terapevticheskii arkhiv. 2018;90(3):67-71
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Combination therapy is a new standard for treatment of pulmonary arterial hypertension

Avdeev S.N., Tsareva N.A., Gaisin I.R.


At present, compelling evidence has been obtained that combined therapy of pulmonary arterial hypertension (PAH) with specific drugs can significantly slow progression of PAH. Therefore, in current guidelines combination therapy is already considered as standard treatment for a significant proportion of patients with moderately severe and severe forms of PAH. However, the quality of life and long-term prognosis of patients receiving combination therapy, should be the object of further research. The future research is absolutely necessary to identify the most optimal strategy of treatment of patients with PAH, such as initial combination therapy or rapid sequential combination therapy, double or triple combinations as well as exploring new signaling pathways PAH, which can become targets for new specific drugs PAH.
Terapevticheskii arkhiv. 2018;90(3):72-80
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Chronic obstructive pulmonary disease and cerebrovascular diseases: functional and clinical aspect of comorbidity

Geltser B.I., Kurpatov I.G., Kotelnikov V.N., Zayats Y.V.


Literature data of chronic obstructive pulmonary disease (COPD) and cerebrovascular diseases (CVD) comorbidity are represented in this review. Key aspects of this interaction and its importance for clinical medicine have been considered. CVD and COPD are the main mortality factors in adults, which contribute to great economic wastes. The incidence of chronic cerebral ischemia for COPD patients is almost three times as high as for general population. The incidence of ischemic stroke for COPD patients is 1,2 times higher than in general population. For hemorrhagic stroke and subarachnoid haemorrhages, this figures are 1,3 and 1,46 respectively. Chronic systemic inflammation, tissue hypoxia and oxidative stress play the crucial role in respiratory and cerebrovascular comorbidity. Metabolites of these processes (especially proinflammatory cytokines, reactive oxygen species, C-reactive protein and some neurotrophins) increase the permeability of blood-brain barrier, destroy brain cells and activate atherogenesis in pre - and intracerebral arteries. Endothelial dysfunction affects autoregulation of cerebral circulation. Systemic symptoms of COPD are closely associated with different structural-functional disorders of the brain such as reduction in white matter integrity, grey matter volume reduction and cerebral microbleeds. Also, venous encephalopathy is developed as a result of intrathoracic pressure elevation and stasis in superior vena cava system. These processes result in neurological symptomatology. The intensity of symptoms depends on COPD severity. The occurrence of cognitive impairment, psychic tension, depression, panic disorders also increases. However COPD and CVD comorbidity is an important problem of modern medicine, pathophysiologic mechanisms and clinic aspects of this problem remain unresolved. Understanding of their role opens perspectives for rational pharmacotherapy.
Terapevticheskii arkhiv. 2018;90(3):81-88
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Effect of N-acetylcysteine on mucosal immunity of respiratory tract

Kalyuzhin O.V.


The outcome of diseases accompanied or caused by mucostasis depends both on the restoration of drainage function of the airways and on the effectiveness of immune mechanisms against pathogens. N-acetylcysteine (NAC) is widely used as mucolytic and antioxidant remedy in clinical practice. In this regard, the data of the scientific literature on the direct and indirect effects of NAC on the mucosal immunity of the respiratory tract have been reviewed. NAC possesses pleiotropic immunomodulating properties, most of which contribute to the regression of clinical manifestations of acute and chronic inflammatory diseases of the respiratory tract. Biological and pharmacological effects of NAC include improvement in rheological properties of mucus, reduction of excess mucin production, restoration of mucociliary clearance and production of sIgA, suppression of excess production of IgE and IgG4, destruction of biofilms and inhibition of their formation, suppression of adhesion of pathogenic bacteria to epithelial cells, antioxidant activity, regulation of the production of pro-inflammatory and profibrotic cytokines. There was no convincing evidence that NAC is able to suppress any component of mucosal immunity. For final conclusions on this subject, further research are required.
Terapevticheskii arkhiv. 2018;90(3):89-95
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Primary lymphangiectasia of the gastrointestinal tract

Esedov E.M., Abasova A.S., Akhmedova F.D., Musaeva L.N.


Intestinal lymphangiectasia is a very rare pathology, characterized by the presence of enlarged lymphatic vessels in all layers of the intestinal wall and in the mesentery. As a result, "lymphatic lakes" are formed, through which lymph exudates into the lumen of the intestine. The main manifestation is hypoproteinemic edema. Diagnosis of the disease is based on laboratory-instrumental methods of investigation, including by determining in the stool α-1 antitrypsin as a screening test. Treatment includes: a diet rich in calcium, trace elements, be sure to use medicinal foods enriched with medium chain triglycerides, substitution and symptomatic therapy.
Terapevticheskii arkhiv. 2018;90(3):96-98
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Pulmonary vasculitis: diagnosis and treatment

Anaev E.K., Baranova I.A., Belevsky A.S.


Pulmonary vasculitis is a group of rapidly progressing severe diseases characterized by vascular inflammation, destruction and necrosis of the pulmonary tissue. The pathological process in the lungs varies from diffuse alveolar hemorrhage to inflammation of the parenchyma, pleural effusion, thrombotic and thromboembolic complications. Depending on the size of the affected vessels, vasculites are divided into vasculites of large, medium and small vessels. Most frequently the lung is found in the small vessels vasculitis, including ANCA-associated vasculitis [granulomatosis with polyangiitis (GP), eosinophilic granulomatosis with polyangiitis (EGPA) and microscopic polyangiitis (MPA)] and the disease is glomerular basement membrane (goodpasture syndrome). Clinical examination of other systems and organs involved in the pathological process, including the skin and kidneys, as well as the detection of autoantibodies can improve approaches to early diagnosis and treatment of vasculitis. Treatment of life-threatening pulmonary bleeding and irreversible damage to organs, especially the kidneys, requires rapid diagnosis of these conditions. Vasculitis is a rare disease with lesions of many organs, and methods of their treatment, including biological, are rapidly developing, which requires the cooperation of doctors of various specialties and specialized centers to achieve better control of the disease.
Terapevticheskii arkhiv. 2018;90(3):99-106
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Hemochromatosis - modern condition of the problem

Voloshina N.B., Osipenko M.F., Litvinova N.V., Voloshin A.N.


The iron overload syndrome can be associated with various acquired states and hereditary factors. Hereditary hemochromatosis is the most common genetic disorder. Without therapeutic intervention the disease can lead to the development of life-threatening complications such as cirrhosis, hepatocellular carcinoma. The article presents data on pathogenesis, diagnosis and treatment of hereditary hemochromatosis. Own clinical observation is given.
Terapevticheskii arkhiv. 2018;90(3):107-112
pages 107-112 views

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