Наукові праці. Кафедра внутрішньої медицини № 1

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A clinical case review of a patient with heartburn and dysphagia
(International Science Group, 2025) Vizir, Marina; Aleksandrova, Tetiana; Zakharchenko, Viktoria
Age-associated featurers of oxidative stress as marker of vascular aging in comorbid course of hypertension and type 2 diabetes mellitus
(2018) Shalimova, Anna; Nemtsova, Valeriya; Bilovol, Olexandr; Ilchenko, Iryna
A significant increase in the proportion of older people in the population of developed countries is accompanied by an increase in mortality from the main diseases of old age-diseases of the cardiovascular system, malignant neoplasms, neurodegenerative processes, reduced resistance to infection and diabetes mellitus.
Age-related changes of nesfatin-1 action in hypertensive women
(2019-04) Візір, Марина Олександрівна; Vizir, Maryna; Визир, Марина Александровна
Arterial hypertension is the most common cardiovascular risk factor, which is often accompanied by metabolic disorders, such as obesity and/or dysglycemia. Nesfatin-1 was found as an anorexigenic peptide secreted in hypothalamus, adipose tissue, pancreas, reproductive organs etc. It was shown that nesfatin-1 is associated with the occurrence of hypertension, insulin production and sensitivity, hormonal status, in particular the level of sex hormones.
Analysis of pathogenetic relations between clinical and metabolic parameters in patients with nonalcoholic fatty liver disease on the background of hypertension
(2019-09) Bashkirova, Anna
The article presents the factor analysis of pathogenetic relationships between metabolic parameters, EL levels and clinical parameters in patients with liver steatosis on the background of hypertension. The study have found that the most significant factor load on the severity of liver steatosis is reproduced by the concentration of insulin, triglycerides, HDL, and proatherogenic hyperdyslipidemia is closely associated with diet and alcohol intake.
Anti-inflammatory and pro-inflammatory biomarkers in patients with non-alcoholic fatty Liver disease and hypertension
(2022) Rozhdestvenska, Anastasiia; Zhelezniakova, Natalia
Introduction. Non-alcoholic fatty liver disease (NAFLD) affects up to 50% of patients with hypertension (HT). Research data indicate a decrease in the activity of anti-inflammatory biomarkers with a simultaneous increase in the levels of pro-inflammatory agents. Objective. To assess the changes in anti-inflammatory systems (using kallistatin, IL-10) and proinflammatory activity (using IL-1β; and high-sensitivity CRP (hsCRP)) in patients with NAFLD under the influence of concomitant HT. Design and method. 63 patients with NASH and HT and 52 patients with isolated NASH were examined. Plasma kallistatin, IL-10, IL-1β; and hsCRP levels were evaluate using ELISA. The results were statistically processed using standard methods. Results. Kallistatin levels in patients with NAFLD and HT were on average 65.03 ng/ml (95% CI 61.38; 68.68), which was significantly lower than in the group with isolated NAFLD (83.42 ng/ml (95% CI 81.89; 84.94), p<0.001) and control results (111.70 ng/ml (95% CI 106.14; 113.22), p<0.001). The level of anti-inflammatory IL-10 in the group of NAFLD and HT also reached minimal values (12.69 pg/ml (95% CI 11.93; 12.95) against 14.34 pg/ml (95% CI 13.27; 14,34) in the group with isolated NAFLD (p<0.001) and 16.19 pg/ml (95% CI 15.15; 17.74) in the control group (p<0.001)). The opposite results were observed in the study of IL-1β; content, which was increased in the group with NAFLD and HT (17.55 pg/ml (95% CI 17.06; 19.73) versus 15.72 pg/ml (95% CI 15,25; 17.44) in the group with isolated NAFLD (p<0.001) and 8.26 (95% CI 7.79; 8.46) in the control group (p<0.001)). In addition, patients with NAFLD and HT had an increase in CRP (7.90 mg/l (95% CI 7.96; 8.75) versus 6.55 mg/l (95% CI 6.47; 7.57) in the group with isolated NAFLD (p<0.001) and 2.07 mg/l (95% CI 1.83; 2.85 mg/l) in the control group (p<0.001)). It has been shown that with the progression of HT in patients with NAFLD, the level of kallistatin significantly decreases (p<0.001, p=0.011 for the HT stage and BP grade) and IL-10 (p<0.001) with a simultaneous increase in IL-1β; (p<0.001) and CRP levels (p<0.001). Conclusions. Thus, patients with NAFLD and HT are likely to experience changes in biomarker status toward a pro-inflammatory profile and deepening of these deviations with the progression of concomitant hypertension.
Arterial hypertension and non-alcoholic fatty liver disease: adipokine activity
(2017) Goptsii, Olena; Buriakovska, Olena; Vovchenko, Maryna; Reznik, Larisa
The leptin level, TNF-α and the HOMA-IR index (leptin 12.73±0.82 ng/ml, female patients: 12.93±0.99 ng/ml, male patients: 11.92±1.23 ng/ml; TNF-α 8.40±0.44 mg/ml; HOMA-IR index 4.09±0.49 CU) were significantly higher in the patients patients with AH and NAFLD with AO than such of the patients with AH and NAFLD without AO: (leptin 6.66±0.48 ng/ml, female patients: 6.25±1.19 ng/ml, male patients: 6.78±0.53 ng/ml; TNF-α 5.31±0.37 ng/ml; HOMA-IR index 2.0±0.22 CU). Conclusion. The levels of leptin, TNF-α and insulin resistance index were elevated statistically significant in patients with AH and NAFLD with AO.
Association between adipocytokines and insulin resistance in patients with metabolic disorders
(2015) Goptsii, Olena
The activity of TNF-α and leptin increase evidently in hypertensive patients with IR in comparison to the group of patients without IR (p<0.001). Direct correlation dependence in the group of the patients with IR between the levels of TNF-α, leptin and Insulin Resistance Index was established.
Association of IRS-1 polymorphism with various components of the metabolic syndrome in hypertensive patients
(2019) Kochuieva, Maryna; Psarova, Valentyna; Ruban, Valentyna; Kyrychenko, Nataliia; Alypova, Olga; Matlai, Olga; Shalimova, Anna
Introduction: The metabolic syndrome is one of the most discussed cross-disciplinary problems of modern medicine. Now there are various definitions and criteria of diagnostics of metabolic syndrome. The abdominal obesity is considered the main component of the metabolic syndrome, as a reflection of visceral obesity which degree is offered to be estimated on an indirect indicator – a waist circumference. Alongside with abdominal obesity, a number of classifications distinguish insulin resistance (IR) as a diagnostic criterion of metabolic syndrome. It is proved that IR is one of the pathophysiological mechanisms influencing the development and the course of arterial hypertension (AH), type 2 DM and obesity. There are two components in the development of IR: genetic (hereditary) and acquired. In spite of the fact that IR has the accurate genetic predisposition, exact genetic disorders of its appearance have not been identified yet, thus demonstrating its polygenic nature. The aim: To establish possible associations of the insulin receptor substrate-1 (IRS-1) gene polymorphism with the severity of the metabolic syndrome components in patients with arterial hypertension (AH). Materials and methods: 187 patients with AH aged 45-55 years and 30 healthy individuals. Methods: anthropometry, reactive hyperemia, color Doppler mapping, biochemical blood analysis, HOMA-insulin resistance (IR), glucose tolerance test, enzyme immunoassay, molecular genetic method. Results: Among hypertensive patients, 103 had abdominal obesity, 43 - type 2 diabetes, 131 - increased blood triglycerides, 19 - decreased high density lipoproteins, 59 - prediabetes (33 - fasting hyperglycemia and 26 - impaired glucose tolerance), 126 had IR. At the same time, hypertensive patients had the following distribution of IRS-1 genotypes: Gly/Gly - 47.9%, Gly/Arg - 42.2% and Arg/Arg - 10.7%, whereas in healthy individuals the distribution of genotypes was significantly different: Gly/Gly - 86.8% (p<0.01), Gly/ Arg - 9.9% (p<0.01) and Arg/Arg - 3.3% (p<0.05). Hypertensive patients with Arg/Arg and Gly/Arg genotypes had significantly higher HOMA-IR (p<0.01), glucose, insulin and triglycerides levels (p<0.05), than in Gly/Gly genotype. At the same time, body mass index, waist circumference, blood pressure, adiponectin, HDL, interleukin-6, C-reactive protein, degree of endothelium-dependent vasodilation, as well as the frequency of occurrence of impaired glucose tolerance did not significantly differ in IRS-1 genotypes. Conclusions: in hypertensive patients, the genetic polymorphism of IRS-1 gene is associated with such components of the metabolic syndrome as hypertriglyceridemia and fasting hyperglycemia; it is not associated with proinflammatory state, endothelial dysfunction, dysglycemia, an increase in waist circumference and decrease in HDL.
Association of nesfatin-1 activity with renal function in hypertensive patients
(2019-04-10) Візір, Марина Олександрівна; Vizir, Maryna; Визир, Марина Александровна
Background: Chronic kidney disease is often caused or progressed by such risk factor as hypertension. A neuropeptide nesfatin-1 is considered to be related to occurrence of hypertension as well as accompanied metabolic disturbances. But its possible contribution to renal impairment remains unclear. Objective: The study aimed at identifying the relationship between nesfatin-1 activity and kidney function in patients with essential hypertension. Methods: 106 patients with essential hypertension at the median age of 61 [55;66] years were examined. 68 % of patients had accompanied obesity and 39 % had dysglycemia (prediabetes or type 2 diabetes mellitus). Nesfatin-1 plasma levels (ng/ml) were measured using ELISA method. GFR was calculated using CKD-EPI creatinine equation. According to GFR categories all patients were divided into 2 groups: A (57 patients with normal or mildly decreased GFR ≥ 60 ml/min/1.73 m2) and B (49 patients with moderately or severely decreased GFR < 60 ml/min/1.73 m2). Obtained data were analyzed with the methods of nonparametric statistics by Statistica10.0 software with the significance (p) < 0.05. Results: The hypertensive patients of the group A had higher nesfatin-1 levels compared with the group B (7.63 [6.79;9.71] vs 7.26 [6.57;8.16], p = 0.03). Nesfatin-1 positively correlated with GFR in all hypertensive patients (r = 0.228; p < 0.001) and in particular in the group A (r = 0.249; p < 0.01). Data analysis of hypertensive patients with obesity showed associations of nesfatin-1 with GFR (r = 0.185; p < 0.01) and creatinine (r = -0.172; p < 0.05). Conclusions: Nesfatin-1 may have contribution to occurrence of renal impairment in hypertensive patients in case of decreasing of its level, while hypernesfatinemia shows renoprotective features. These findings are more prominent in case of accompanied obesity than disturbances of carbohydrate metabolism.
Biomarkers usage in minimally invasive diagnosis of nonalcoholic steatohepatitis in nonalcoholic fatty liver disease patients
(2017) Babak, Oleg; Molodan, Volodymyr; Lapshyna, Kateryna; Prosolenko, Kostyantyn
Plasma CK-18 and FGF-21 levels are increased in patients with NASH and also associate with atherogenic dyslipidemia and impaired liver enzyme activity. Study plasma levels of CK-18 and FGF21 allows to establish the presence of NASH in patients with NAFLD. The findings suggest the possibility of using these biomarkers for minimally invasive screening diagnosis of NASH and represent the perspective of further research.
Blood Lipids in Patients with High and Low Physical Activity Depending on Polymorphism of Beta-2 and 3-adrenergic Receptor Genes
(2018) Isayeva, Ganna; Vovchenko, Maryna; Shalimova, Anna; Halchynska, Valentina; Peteneva, Lyudmila; Bondar, Tetiana
The aim of the study was to investigate the lipid levels in patients with various physical activity and polymorphous variants of ADRB2 (Gln27Glu and Arg16Gly) and ADRB3 (Trp64Arg) genes.
Blood pressure dipping status affects the relationship between glucose fluctuation and heart rate variability in type 1 diabetic patients
(2018) Shalimova, Anna; Graff, Beata; Szyndler, Anna; Wolf, Jacek; Blaszkowska, Magdalena; Orlowska-Kunikowska, Elzbieta; Wolnik, Bogumil; Narkiewicz, Krzysztof
Cardiac autonomic neuropathy is a frequent complication of type 1 diabetes (DM1). However, none of the previous study has assessed the inter-relationship between glucose fluctuation, circadian blood pressure rhythm and features of heart rate variability (HRV). The aim: to test the hypothesis that in patients with longstanding DM1 the relationship between HRV and glucose fluctuation is influenced by blood pressure diurnal profile. Methods: We examined 42 subjects with longstanding (>20 years) history of DM1 (without cardiovascular disease, including hypertension). In all patients, simultaneous 24-hour continuous glucose monitoring, ABPM and Holter electrocardiographic recording were performed. Subjects were divided into two groups according to dipping pattern (dippers n=20, non-dippers n=22). Results: Both groups of patients did not differ with respect to duration of hypo-, normo- and hyperglycaemia, while time- and frequency domain HRV parameters were significantly lower in non-dippers (p<0.05). Several HRV parameters including SDANN and LF spectrum power were positively related to duration of hypoglycaemic episodes both in dippers and non-dippers (p<0.05). However, other HRV parameters were associated with glucose fluctuation only in non-dippers. Time of hypoglycaemia was positively related to pNN50, rMSSD, diurnal and night HF spectrum power, in the presence of its negative correlations with 24-hour and day VLF% (p<0.05); time of hyperglycaemia was negatively related to pNN50, rMSSD, 24-hour, day and night ULF, VLF and HF spectrum power (p<0.05). Conclusions: In non-dippers with longstanding DM1, HRV is lower but more sensitive to glucose fluctuation than in dippers.
Blood presure is related to glucose fluctuation in longstanding type 1 diabetes
(2018) Shalimova, Anna; Graff, Beata; Szyndler, Anna; Wolf, Jacek; Blaszkowska, Magdalena; Orlowska-Kunikowska, Elzbieta; Wolnik, Bogumil; Narkiewicz, Krzysztof
Mechanisms underlying relationship between hypertension and metabolic abnormalities are well established in type 2 diabetes. Much less is known about this link in type 1 diabetes. None of the previous studies has assessed relationship between glucose variability and diurnal blood pressure profile in patients with longstanding type 1 diabetes (DM1). The aim: to investigate the possible association of glucose fluctuation with BP levels in longstanding DM1. Design and methods: We examined 36 patients with longstanding (>20 years) history of DM1 (without overt cardiovascular disease, including hypertension) and episodes of hyperglycemia >160 mg/dL during 24-hour continuous glucose monitoring (CGM). In all patients simultaneous 24-hour CGM and ambulatory blood pressure monitoring (ABPM) were performed. Intima-media thickness (IMT) of the common carotid artery was also assessed. Patients were divided into two groups: with and without severe hypoglycemia <50 mg/dL (n=18 in each group). Results: Compared to patients with hypoglycemia, patients without hypoglycemia had a significantly lower day-time SBP variability expressed as standard deviation (12.6 ± 2.5 and 10.9 ± 3.0 mmHg, respectively, p<0.05). In patients without hypoglycemia, mean amplitude of glycemic excursion both up and down was associated with increase in DBP (r=0.49, p<0.05 and r=0.59, p<0.05, respectively), whereas in patients with hypoglycemia it was associated with increase in SBP (r=0.53, p<0.05). In patients without hypoglycemia, time of hyperglycemia was associated with increase in DBP (r=0.57, p<0.05) and in patient with hypoglycemia – with increase in SBP (r=0.67, p<0.05). Furthermore, in patients with short hypoglycemic episodes, time of hypoglycemia was associated with increase in SBP (r=0.57, p<0.05). In patients with hypoglycemia, SBP level had also positive correlation with IMT (r=0.50, p<0.05). Conclusions: In patients with longstanding DM1, BP is related to glucose fluctuation. While the change in glucose levels towards hypoglycemia is associated with an increase in SBP, hyperglycemia is linked to an increase in DBP. The mechanisms underlying these associations remain to be determined.
Brugada syndrome: clinical features, diagnosis, and modern approaches to treatment
(International Science Group, 2025) Kharkivska, Dariia; Vizir, Maryna; Aleksandrova, Tetiana
C-реактивный белок как маркер системного воспаления у пациентов с коморбидностью хронической обструктивной болезни легких и хронического панкреатита
(2015) Бабак, Олег Якович; Степанова, Олена Володимирівна; Зелена, Ірина Іванівна; Железнякова, Наталя Мерабівна; Пасієшвілі, Тетяна Михайлівна
Коморбидное течение заболеваний внутренних органов является актуальной проблемой современной медицинской науки. Наличие сопутствующей патологии может оказывать значительное влияние на течение хронической обструктивной болезни легких и усугублять патологические изменения
Certain pathogenetic mechanisms of systemic inflammation in patients with comorbidity of chronic obstructive pulmonary disease and chronic pancreatitis
(2015) Zhelezniakova, Natalia; Железнякова, Наталя Мерабівна; Zelena, Iryna; Зелена, Ірина Іванівна; Pasiieshvili, Tamara; Пасієшвілі, Тамара Мерабівна
Circadian rhythm of blood pressure is related with heart rate but not with glucose variability in longstanding type 1 diabetic patients
(2018) Graff, Beata; Shyndler, A; Shalimova, Anna; Wolf, Jacek; Blaszkowska, Magdalena; Orlowska-Kunikowska, Elzbieta; Wolnik, Bogumil; Narkiewicz, Krzysztof
Objective: Non-dipping pattern has been associated with cardiac autonomic neuropathy (CAN) in diabetic patients. However, in normotensive patients with type 1 diabetes (DM1) ambulatory blood pressure monitoring (ABPM) is not routinely performed. Surprisingly, none of the previous studies analyzed the relationship of autonomic regulation, glucose variability and non-dipping status (defi ned as less than 10% night-time blood pressure (BP) drop) in DM1. The aim of the study was to investigate the possible association of circadian BP rhythm with glucose levels and its variability as well as with parameters of autonomic regulation. Design and method: We examined 42 subjects with long-standing (>20 years) history of DM1 (without cardiovascular disease, including hypertension). In all patients, simultaneous 24-hour continuous glucose monitoring (iPro2), ABPM (Spacelabs 90217) and Holter electrocardiographic recording (Medilog Darwin, Schiller) were performed. Time- and frequency heart rate variability (HRV) parameters were used as indicators of cardiovascular autonomic regulation. Subjects were divided into two groups depending on presence of dipping pattern (dippers n = 20, non-dippers n = 22). Results: Groups with dipping and non-dipping pattern did not differ with respect to age, BMI, mean heart rate, mean glucose levels, parameters of glucose variability and its long-term control (HbA1c).
Cluster analysis of the pathogenetic relationships of metabolic parameters in patients with non-alcoholic fatty liver disease on the background of hypertension
(2019) Babak, Oleg; Bashkirova, Anna
The aim of the study was to conduct a cluster analysis of pathogenetic relationships between metabolic parameters, endothelial lipase levels, the severity of steatosis, and clinical parameters in patients with non-alcoholic fatty liver disease with hypertension. To analyze pathogenetic relationships, a cluster analysis was performed with the distribution of parameters into 4 clusters using the Ward's method. The most dense metabolic link by cluster analysis endothelial lipase forms with NAFLD liver fat score (2.639 cu), HbA1C (2.084 cu), total cholesterol (2.272 cu), and alcohol units (2.797 cu).
Cognitive Dysfunctions in Type 1 Diabetes
(2019) Shalimova, Anna; Graff, Beata; Gąsecki, Dariusz; Wolf, Jacek; Sabisz, Agnieszka; Szurowska, Edyta; Krzysztof, Jodzio; Narkiewicz, Krzysztof
The review summarizes key studies assessing epidemiology, mechanisms, and consequences of cognitive dysfunction (CD) in type 1 diabetes (DM1). Evidence Synthesis: In a number of studies, the severity of CD in DM1 was affected by the age of onset and diabetes duration, the presence of proliferative retinopathy and autonomic neuropathy. Diabetes-related CD has been observed not only in adults but also in children and adolescents. Most neuroimaging studies in DM1 did not show any differences in whole brain volumes, however, they did reveal selective deficits in grey matter volume or density within the frontal, posterior and temporal cortex, subcortical grey matter. Studies of middle-aged adults with long-standing DM1 using diffusion tensor imaging have demonstrated partial lesions of white matter and decreased fractional anisotropy in posterior brain regions. The mechanisms underlying diabetes-related CD are very complex and include factors related to diabetes per se and to diabetes-related cardiovascular disease and microvascular dysfunction: chronic hyperglycemia, hypoglycemia, macro- and microvascular disease, increased expression of inflammatory cytokines. The above mechanisms may contribute to the development and progression of both vascular dementia and Alzheimer disease. Conclusions: Higher rates of CD and its faster progression in DM1 can be explained by both the direct effects of altered glucose metabolism on the brain and diabetes-related cardiovascular disease. Since the presence and progression of CD significantly worsens the quality of life of diabetic patients, further multidisciplinary studies based on the recent progress in both neuroimaging and type 1 diabetes management are warranted to tackle this problem.
Comparison of structural and functional vascular disorders in patients with comorbidity of non-alcoholic fatty liver disease and two types of arterial hypertension
(2023) Prosolenko, Kostyantyn; Molodan, Volodymyr; Panchenko, Galyna; Lapshyna, Kateryna; Shalimova, Anna
Background: The aim was to conduct a comparative assessment of structural and functional vascular disorders in patiets with comorbidity of non-alcoholic fatty liver disease (NAFLD) and two types of arterial hypertension (HTN). Material and methods: The study included 329 patients 18–66 years old. All patients were divided into five groups:patients with comorbidity of NAFLD and primary HTN (121 subjects), patients with comorbidity of NAFLD and renal parenchymal HTN (88 subjects), patients with NAFLD (60 subjects), patients with primary HTN (30 subjects), patients with renal parenchymal HTN (30 people). The control group consisted of 20 healthy individuals of similar age and gender categories. Results: In the comparative analysis of the structural and functional ultrasonographic parameters of vessels, no significant differences between two comorbidity groups NAFLD + primary HTN and NAFLD + renal parenchymal HTN were found. The influence of AH and degree of liver steatosis on ultrasound indicators of arteries in examined patients with comorbidity was evaluated by MANOVA analysis. The influence of the HTN factor and the influence of the liver steatosis factor were evaluated separately, after which the influence of the comorbidity factor, i.e., the combined influence of these factors and one or another indicator, was evaluated. The additive effect of the factors of AH and liver steatosis was identified according to the parameters: intima media thickness, pulse wave velocity in the carotid artery, pulse wave velocity in the abdominal aorta and endothelial-related vasodilation, which indicates an important comorbid effect of NAFLD and primary/renal parenchymal HTN on the structural and functional state of arteries. Conclusions: There are no differences between the structural and functional indicators of arteries in patients with comorbidity of NAFLD + primary HTN and NAFLD + renal parenchymal HTN. The factor of the presence of HTN and the degree of liver steatosis significantly affect structural and functional indicators of the studied arteries. Key words: structural and functional vascular alterations; non-alcoholic fatty liver disease; hypertension