Vol 88, No 12 (2016)

Aim. To investigate factors associated with pathological cardio-ankle vascular and ankle-brachial indices (CAVI and ABI) in patients with carbohydrate metabolic disorders (CMD). Subjects and methods. A cross-sectional study was conducted in the framework of the multicenter epidemiological study “Epidemiology of Cardiovascular Diseases and Their Risk Factors in the Russian Federation” (ESSE-RF) in March to October 2013. The standard ESSE-RF protocol was extended by an additional study of peripheral arterial stiffness, by estimating CAVI and ABI automatically. A sample of 1619 people was formed in several stages, in which 311 patients with type 2 diabetes mellitus and prediabetes were identified and divided into 3 groups: 1) 41 patients with pathological CAVI values (≥9.0); 2) 241 with normal CAVI (<9.0); 3) 29 with pathological ABI (<0.9). Results. In the population-based sample of patients with CMD, the pathological CAVI values (≥9.0) were detected in 14.5%, and the pathological ABI was in 9.3% of the examinees. Regression analysis showed that the pathological vascular indices (both CAVI and ABI) were significantly associated with increases in blood pressure (BP) and heart rate (HR), and a decrease in glomerular filtration rate. At the same time, only the pathological CAVI was associated with advancing age (odds ratio (OR), 1.111; 95% confidence interval (CI), 1.050-1.176; p < 0.001), visceral obesity (OR, 3.088; 95% CI, 1.001-10.495; p=0.038), smoking duration (OR, 1.093; 95% CI, 1.008-1.185; p=0.009), prior stroke (OR, 4.695; 95% CI, 1.408-15.658; p=0.018), and a need for insulin therapy (OR, 18.947; 95% CI, 1.902- 87.783; p=0.006). The pathological ABI was associated with male sex (OR, 2.227; 95% CI, 1.040-4.765; p=0.039), prior myocardial infarction (OR, 8.646; 95% CI, 2.174-34.378; p=0.005), obesity (OR, 2.439; 95% CI, 1.010-5.889; p=0.034); hyperglycemia (OR, 2.439; 95% CI, 1.010-5.889; p=0.034), hyperuricemia (OR, 4.009; 95% CI, 1.850-8.684; p=0.033), and increases in triglyceride levels (OR, 2.984; 95% CI, 1.376-6.470; p=0.004) and CAVI (OR, 1.193; 95% CI, 1.034-1.377; p=0.005). Conclusion. The pathological vascular indices CAVI and ABI are associated with different risk factors for cardiovascular events in a cohort of patients with CMD. The common factors associated with both CAVI and ABI are increases in blood pressure and HR and a reduction in glomerular filtration rate. The common factors associated with both CAVI and ABI are increases in blood pressure and HR and a reduction in glomerular filtration rate.

Aim. To identify predictors of fatal outcome in hospitalized patients with risk factors (RF) for pulmonary artery thromboembolism (PATE) during its occurrence. Subjects and methods. To determine predictors of fatal outcome in patients with PATE, the data of a 10-year city hospital pulmonary embolism registry were used to analyze RF for PATE (according to European and Russian guidelines), complaints, medical histories, and laboratory and instrumental data, which can be identified at general surgery or general therapy hospital, as well as a nosological entity existing in the patients. Results. According to the existing idea on thrombogenesis, RF for PATE and its fatal outcome, information about used treatment, and autopsy data, 137 parameters were selected in patients with PATE. For estimating the risk of death in patients with PATE, a logistic regression analysis was employed to make a mathematical model encompassing 10 indicators: bed rest; the presence/absence of lung diseases; chronic venous insufficiency; obesity; the symptom complex of cor pulmonale; postinfarction cardiosclerosis of the left ventricle, pericardial effusion; right atrial dilatation; right ventricular dilation; right ventricular systolic pressure >36 mm Hg as evidenced by echocardiography. Conclusion. The mathematical model built during the study allows the calculation of a risk for fatal outcome in the development of PATE for a specific patient in terms of its individual characteristics.

Aim. To investigate the ovarian reserve and a relationship between the level of anti-Müllerian hormone (AMH) with that of hormones in reproductive-aged women with abdominal obesity concurrent with and without polycystic ovary syndrome (PCOS). Subjects and methods. A total of 157 women aged 18 to 45 years with a body mass index (BMI) of more than 30 kg/m2 were examined. The 157 women with abdominal obesity were conventionally divided into 2 groups: 1) 20 with PCOS and 2) 137 without this condition. Morphometric parameters, the indicators of carbohydrate and lipid metabolism, and the levels of hormones, including AMH, were studied. Results. The patients with PCOS had statistically significantly elevated AMH levels (11.26±2.63 ng/ml; p<0.0001). The group of obese patients without PCOS showed a negative correlation of the levels of AMH with those of follicle-stimulating hormone (FSH) (p=0.0004), luteinizing hormone (LH) (p=0.0171), and HOMA-IR (p=0.0572). Conclusion. In reproductive-aged women with abdominal obesity without concomitant PCOS in the presence of insulin resistance, the ovarian reserve decreases and the levels of FSH and LH increase, which leads to accelerated aging processes in the reproductive system. In this case, the patients with PCOS display a significant increase in the AMH levels; therefore, their determination can be used in the algorithm for diagnosing PCOS.

Aim. To determine the nature of changes in fibroblast growth factor 23 (FGF-23) and other bone mineral metabolism parameters detectable in the blood of patients with end-stage chronic renal failure (CRF) and to analyze their links to the development of cardiovascular events in uremic intoxication. Subjects and methods. A total of 75 patients (45 men and 30 women) aged 23 to 66 years (mean age, 53±2.1 years) with Stage VD CKF were examined. The levels of parathyroid hormone (PTH), calcium, phosphorus, the morphogenetic protein FGF-23, and the cardiospecific protein troponin I were investigated. Doppler echocardiography was performed on an Aloka 4000 machine. Left ventricular (LV) mass index (LVMI), LV systolic and diastolic function, and peak systolic blood flow velocity in the aortic arch (Vps) were estimated. Results. As LVMI became higher, there were increases in the level of PTH and that of FGF-23 that plays a significant role in the processes of bone remodeling and vascular calcification. Analysis of correlations between a change in FGF-23 concentrations depending on the morphological and functional parameters of the cardiovascular system (CVS) revealed a strong direct correlation between FGF-23 levels and LVMI (r=0.746; p<0.01), a significant inverse correlation between FGF-23 and ejection fraction (r=-0.901; p<0.05), and a direct correlation of FGF-23 and troponin I (r=0.544; p<0.05). Conclusion. FGF-2 increasing from moderate to very high levels indicates that there is a high risk for remodeling processes in the CVS even in the absence of baseline echocardiographic signs of myocardial hypertrophy, normal aortic pulse wave velocity, and compensation of other risk factors, such as hypertension, uremia, hyperparathyroidism, even without increasing the markers of cardiovascular events, such as hyperphosphatemia. The elevated level of FGF-23 suggests that there is a need for cardioprotective therapy, the goal of which is to correct of the level of this factor.

Aim. To estimate the diagnostic and informative value of clinical and laboratory parameters in the development and progression of liver fibrosis in patients with nonalcoholic fatty liver disease (NAFLD) to enhance efficiency of their treatment. Subjects and methods. An open-label case-control study included 77 patients with NAFLD. Clinical and laboratory examinations were done. To search for additional noninvasive fibrosis markers, the investigators studied the serum concentrations of insulin, leptin, adiponectin, matrix metalloproteinase-9 (MMP-9) and its inhibitors, such as tissue inhibitor of matrix metalloproteinases 1 (TIMP-1) and TIMP-2. All the patients underwent elastometry to assess the degree of liver fibrosis with the Metavir scale with the use of a Fibroscan machine. Results. The serum levels of low-density lipoproteins, glucose, MMP-9, and leptin proved to be most informative in assessing the progression of the initial stages (1-2) of fibrosis, as were the increased liver size detected by physical examination, systolic blood pressure, carbohydrate metabolic disorders, alanine/aspartate aminotransferase levels, waist-to-hip ratio, TIMP-1, and TIMP-2 in evaluating the progression of Stage II fibrosis 2 to Stage 3. Conclusion. The clinical and laboratory parameters can serve as reliable noninvasive markers that reflect the progression of fibrotic changes in liver tissue.

Aim. To evaluate the clinical efficacy and tolerability of etoricoxib and meloxicam in patients with gonarthrosis. Subjects and methods. A postregistration, open-labeled, prospective, comparative randomized study was conducted. 40 patients aged 37 to 75 years with primary knee osteoarthritis were examined. Therapeutic effectiveness was evaluated determining the functional index WOMAC with the use of a visual analogue scale (VAS). The tolerability of the drugs was assessed according to the opinions of a patient and a physician. Results. Both drugs caused a reduction in WOMAC and VAS scores for pain and the severity of the disease. Etoricoxib demonstrated a significantly high rate of occurrence and completeness of its analgesic effect. Meloxicam showed a less pronounced decrease in joint stiffness and an insufficient analgesic effect. The incidence of side effects was similar in both groups. Conclusion. Both drugs demonstrated a good tolerability and a low incidence of side effects. The efficacy of etoricoxib was significantly higher than that of meloxicam.

In late 2015, the Russian Federation registered the new non-selective endothelin receptor antagonist macitentan for the pathogenetic therapy of pulmonary arterial hypertension. The given clinical case demonstrates the possibility of using macitentan in a female patient with idiopathic pulmonary hypertension and its ability to affect the clinical, hemodynamic, and functional status of patients and to slow down the progression of the disease.

Idiopathic pulmonary fibrosis (IPF) is a severe lung disease, with death occurring within 2-5 years after its onset. IPF affects people in the second half of life. Its causes are unknown. Before 1999, IPF was out from the group of idiopathic interstitial lung diseases as a separate nosological entity. Practitioners very often (80%) make diagnostic errors in IPF and prescribe antibiotics, anti-inflammatory drugs, which worsen the course of this disease. The distinctive feature of the pathogenesis of IPF is the absence of inflammation, which is clinically manifested by the inefficacy of glucocorticosteroids and other anti-inflammatory drugs. Pharmacological agents for the treatment of IPF have been designed since 2000. One of them has been registered and permitted for use in the Russian Federation. This paper is a review of an update on the problem of IPF, which should facilitate the appropriate orientation of physicians in diagnosing and treating this severe disease.

The analytical paper summarizes the main results of recent investigations of the relationships of depression, anxiety, and stress with overall and cardiovascular mortality. It shows that depression and stress are associated with an increased risk of death mainly from cardiovascular diseases, and depression treatment and stress control can increase life expectancy.

Over the past 20 years after the discovery of adiponectin, much knowledge about its effect in health and disease has been gained. Adiponectin has antidiabetic, antiatherogenic, anti-inflammatory, immunomodulatory, metabolic, vasoprotective, and antiapoptotic properties. However, an understanding stems from the given literature review that much remains to be explored. Adiponectin has not yet commonly used in clinical practice, but cardiologists, endocrinologists, pediatricians, oncologists, and physicians of many specialties are interested in its preventive and therapeutic applications.

At present, Helicobacter pylori (Нр) infection is the most common chronic bacterial infection in humans, the pathogen of which colonizes approximately 50% of the world’s population. Hp eradication is required to control complications of Hp-related diseases (gastric and duodenal ulcers). Nevertheless, a number of investigations have demonstrated widespread antibacterial therapy inefficiency due to Hp antibiotic resistance and patient non-compliance with treatment regimens. Due to the growing need to elaborate alternative eradication regimens, some researchers have drawn their attention to probiotics and immunomodulators derived from Lactobacillus in particular for eradication therapy in Нp-positive patients to enhance the effect of antibacterial drugs. The review analyzes the results of 10 meta-analyses of randomized clinical trials with a similar design, which were published in 2007 to 2015, and other clinical trials assessing the role of probiotics and probiotic-based immunomodulators as an adjuvant therapy for Hp eradication. The results of the analysis have established that Lactobacillus strain-containing probiotics, both monocomponent probiotics and those as part of multicomponent ones, when used as an adjunct to anti-Hp therapy, significantly increase the level of Нp eradication by 8.1—20.0% (p<0.05; Level of Evidence, 1A; Recommendation Grade A). The use of N-acetylglucosaminyl-N-acetylmuramyl dipeptide (Licopid, a Lactobacillus bulgaricus-based immunomodulator) 0.001 and 0.01 g/day as an adjuvant to first-line triple anti-Hp therapy was shown to increase the level of Hp eradication by 7.1—8.9%. The intake of licopid 0.001 and 0.01 g/day during 7-day triple anti-Hp therapy results in the absence of recurrent Hp infection, as compared with 7- and 14-day treatment protocols without licopid, and leads to a significantly low incidence of Hp reinfection within 2—5 years after successful bacterial eradication, as compared with the 7-day protocol without adjuvant therapy with glucosaminylmuramyl dipeptide (p<0.05).

The paper reviews investigations studies that have demonstrated that chronic pain syndrome is mixed in rheumatic diseases. The nervous system is involved in its pathogenesis with different frequency and different mechanisms. Under the influence of afferent pain impulses from damaged joints, there are changes in the excitability of spinal cord neurons, which is called central sensitization (CS). A number of patients have enhanced CS and clinical manifestations as neuropathic sensitive phenomena. The mixed model of the development of chronic pain in joint diseases and its presence along with nociceptive (inflammatory) and neuropathic pain components may explain the discrepancy between joint inflammatory and structural changes and pain intensity, the presence of distant pain and sensitive disorders in the areas outside the joint, and sometimes the efficiency of anti-inflammatory therapy. The presence of the neuropathic pain component serves as a rationale for combined therapy by adding centrally acting drugs, such as anticonvulsants.