Наукові праці. Кафедра внутрішньої медицини № 1

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Start date: 2020Subject: search.filters.subject.arterial hypertension

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    Роль селенопротеїну Р в оптимізації діагностики, лікування та прогнозування перебігу неалкогольної жирової хвороби печінки на тлі гіпертонічної хвороби
    (2023-12) Тверезовська, Ірина Іванівна; Tverezovska, Iryna
    Неалкогольна жирова хвороба печінки є сукупним поняттям та включає в себе низку патологічних станів від стеатозу та неалкогольного стеатогепатиту (НАСГ) до цирозу печінки та гепатоцелюлярної карциноми [1-5, 7, 33, 35]. Неалкогольна жирова хвороба печінки є найбільш поширеною причиною розвитку хронічної хвороби печінки з частотою 20–50 % [1,33,193], яка має тенденцію до збільшення із віком пацієнтів [1, 2, 3, 4]. Генетичні особливості, наявність метаболічного синдрому [33], спосіб життя, порушення дієти, надмірне вживання хлориду натрію, призводить до надмірного накопичення абдомінального жиру. [6–16, 22, 35]. Були визначені певні асоціації поширеності НАЖХП відносно віку та статі пацієнтів. Так, Lonardo et al. [3] показують, що частота НАЖХП більша серед чоловіків, особливо у молодому та середньому віці; у чоловіків 50–60 років визначається зниження частоти даної патології. У жінок частота НАЖХП збільшується у віці старше 50 років, досягаючи максимуму в 60–69 років із подальшим зниженням [3]. В останні роки визначають більше асоціацій НАЖХП та серцево-судинної патології [15, 36, 66]. Зазначено, що НАЖХП є незалежним фактором ризику розвитку серцево-судинної патології [18, 66]. На даний час проводяться чисельні дослідження для визначення патофізіологічних механізмів розвитку серцево-судинних захворювань на тлі НАЖХП [9], проте більшість факторів, які впливають на перебіг даної коморбідності ще точно не встановлено [66]. Зазначається, що найбільшу увагу приділяють оксидативному стресу [111; 113; 201], атерогенній дисліпідемії [42; 154], субклінічному запаленню [119], інсулінорезистеності, ендотеліальній дисфункції та надмірній експресії цитокінів [9, 66]. Безумовно важливим аспектом є вчасна діагностика субклінічного перебігу та ризику розвитку ССЗ у пацієнтів із НАЖХП [15].
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    Рentraxin-3 and endothelial dysfunction parameters in patients with metabolic dysfunction-associated steatotic liver disease and arterial hypertension
    (ГО “Наукова спільнота”, WSZIA w Opolu, 2024) Molodan, Volodymyr; Aleksandrova, Tetiana; Molodan, Dmytro; Chervona, Oksana
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    The association of systemic inflammatory biomarkers with metabolic dysfunction-associated steatotic liver disease and arterial hypertension
    (2024) Aleksandrova, Tetiana; Zheleznyakova, N.; Prosolenko, Kostyantyn; Vizir, Maryna; Chervona, Oksana
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    Therapeutic potential of sodium selenite in patients with non-alcoholic fatty liver disease and hypertension disease
    (2023-06) Tverezovska, Iryna; Zhelezniakova, Natalia
    Liver parenchyma damage is associated with significant activation of oxidative stress. Correction of oxidative stress can be a promising direction in the treatment of arterial hypertension. It has been established that in patients with hepatopathies, lower concentrations of selenium are found in blood and erythrocytes, which gives reason to consider selenium as a potential therapeutic agent in patients with liver pathology.Objective — to determine the therapeutic potential of sodium selenite in patients with non-alcoholic fatty liver disease in combination with hypertension.Materials and methods. 100 patients with nonalcoholic fatty liver disease (NAFLD) were included in the study: the main group — 49 patients (67.3 % women, median age is 51.0 years) with concomitant NAFLD and arterial hypertension (HTN), the comparison group — 51 patients (58.8 % women, median age is 52.0 years) with NAFLD isolated course. The control group included 20 practically healthy people (55.0 % women, median age is 51.0 years). Among the patients of the main group, the first degree of HTN was diagnosed in 28.6 % of patients (14 people), the second degree — 71.4 % (35 people). Among these patients, 32.7 % (16 people) had the first stage of HTN, 67.3 % (33 people) had the second stage. In the main group, 55.1 % of patients had steatosis, 44.9 % had steatohepatitis. In the comparison group, 58.8 % had steatosis, 41.2 % had steatohepatitis (2 = 0.141, p= 0.707). The levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured according to the standard method (kinetic method). Gamma-glutamine transpeptidase (GGTP) was measured by the enzy-matic colorimetric method, alkaline phosphatase (AP) by the colorimetric method. Selenium and selenoprotein P (Sel P) levels were determined using the immunofluorescence method. Ultrasound examination of the liver was performed according to the standard method on an empty stomach.Results. Body mass index corresponded to normal or increased body weight: in the main group — 27.8 [26.6; 28.5] kg/ m2 and 27.3 [24.2; 28.3] kg/ m2 in the comparison group, in the control group — 24.3 [21.9; 26.0] kg/ m2. In patients of the main group was determined a significant (p < 0.001) predominance of ALT levels (45 [43.0; 47.5] U/ L), AST levels (53 [51.0; 56.0] U/ L), AP levels (285.7 [217.6; 321.1] U/ L) and GGTP levels (96.2 [75.0; 108.9] U/ L) opposite to comparison group (respectively 36 [34.0; 39.0] U/ L, 41 [40.0; 45.0] U/ L, 215.5 [183.2; 246.7] U/ L and 65.5 [51.5; 76.8] U/ L) and control group levels (respectively 25.5 [24.0; 30.8] U/ L, 23 [19.3; 26.0] U/ L, 129.2 [116.9; 140.6] U/ L and 22.6 [16.1; 31.7] U/ L). A two-fold decrease in selenoprotein P levels was obtained in patients with NAFLD and HTN compared to patients with NAFLD (19.7 [8.0; 26.7] ng/ mL and 43.1 [41.3; 45.4] ng/ mL respectively, p < 0.001), and selenium in one and a half times compared to patients with NAFLD (43.5 [39.9; 49.1] g/ L and 67.2 [61.5; 77.4] g/ L respectively, p < 0.001). The highest Sel P median levels (71.0 [54.3; 76.1] ng/ ml and selenium levels (108.0 [96.9; 118.8] g/ L) registered in the control group (p < 0.001). Evaluating the data on selenium metabolism and liver tests depending on the intake of sodium selenite, a significant increase in the levels of Sel P (53.6 [43.1; 60.4] ng/ ml, p < 0.001) and selenium (89.1 [63, 4; 99.5] g/ L, p < 0.009), as well as a decrease in AST levels (41.7 [32.6; 43.2] U/ l, p < 0.001) in the group with isolated NAFLD, while in the group with NAFLD and HTN comorbid course, no significant changes in the studied parameters were detected.Conclusions. The obtained results provide a basis for sodium selenite use in the therapy of patients with NAFLD. Further research on the duration of such therapy and sodium selenite dosing regimen in patients with a comorbid course of NAFLD and HTN is a promising and relevant direction
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    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.
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    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
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    Diagnostic and prognostic value of selenium and selenoprotein P in patients with comorbid course of non-alcoholic fatty liver disease and arterial hypertension
    (2022) Zhelezniakova, Natalia; Tverezovska, Iryna
    Objective. To evaluate the diagnostic and prognostic value of Selenoprotein P and selenium in the progression of liver damage in patients with nonalcoholic fatty liver disease (NAFLD). Methods. The study involved 120 patients: 50 with isolated NAFLD, 50 - with comorbid NAFLD and hypertension, established according to the world and local guidelines. Control group included 20 relatively healthy volunteers. Liver function parameters, selenium and Selenoprotein P levels were assessed, and predictors of steatohepatitis were identified. Pearson's χ2, Mann-Whitney test, logistic regression were used. Results. The study found significant predominance of levels of Selenoprotein P (Sel P) and selenium in controls (71.0 [54.3; 76.1] ng/ml and 108.0 [96.9; 118.8] ng/ml respectively) compared with the NAFLD + hypertension (19.7 [8.0; 26.7] ng/ml and 43.5 (39.9; 49.1] ng/ml, p <0.001) and the NAFLD group (43.1 [41.3; 45.4] ng/ml and 67.2 [61.5; 77.4] ng/ml, respectively, p <0.001). Regression analysis determined association of Sel P and Sel levels with steatohepatitis: respectively, OR = 1,143 [95.0% CI 1,068–1,224] (p <0.001) and OR = 1,054 [95.0% CI 1,012–1,098] (p = 0.011). Other predictors of steatohepatitis were aspartateaminotransferase (OR = 1,421 [95.0% CI 1,198–1,687], p <0.001) and systolic blood pressure (OR = 1,089 [95.0% CI 1,017–1,116], p = 0.014). Conclusions. Levels of selenium and Selenoprotein P are associated with greater liver damage in patients with NAFLD, and the concomitant increase in systemic blood pressure is an additional factor that adversely affects the course of NAFLD, increasing the intensity of liver damage in such patients.
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    The impact of sleep disorders in the formation of hypertension
    (2022) Isayeva, Ganna; Buriakovska, Olena; Shalimova, Anna
    Hypertension is one of the most common chronic non-communicable diseases in the world. Risk factors, methods of prevention and treatment of hypertension have been sufficiently studied. However scientists are still looking for pathogenetic mechanisms of its development. At the same time, 36.9% of patients with hypertension had different sleep disorders. Patients with insomnia have a 21% higher risk of developing hypertension compared with those who have quality sleep. Hypnotics are given up to 15% of patients with hypertension. Hypnotics have been shown to increase the risk of cardiovascular events. As much as 44.1% of patients with established diseases of the cardiovascular system have problems with the quality or duration of sleep. At this time, hypertension and sleep disorders are considered mutually aggravating diseases.
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    Different faces of resistant hypertension in obesity
    (2022) Shalimova, Anna
    Background: The aim was to conduct a comparative assessment between pseudo-resistant (due to different causes) and true resistant hypertension (RH) in obesity. Material and methods: The study included 302 patients with uncontrolled hypertension and obesity. Initial treatment efficacy was assessed 3 months after dual therapy was administered. Those patients who did not reach target blood pressure (BP) with dual therapy were switched to triple therapy. Among patients who received triple therapy, 69 people did not reach target BP (they received the fourth drug, spironolactone). All patients were additionally examined 6 months after the initiation of antihypertensive therapy. Results: Despite the achievement of target BP after 6 months of therapy, patients with resistant hypertension had significantly higher BP and more pronounced disturbances of the circadian rhythm compared with non-resistant patients. After 6 months of therapy, patients with true resistance had significantly higher SBP compared with pseudo-resistant patients. The normal circadian rhythm in patients with true resistance was significantly less common than in patients with pseudo-resistance. Compared with pseudo-resistance, the presence of true resistance in obesity was associated with higher SBP and aldosterone levels, as well as lower body mass index (BMI) and low-density lipoprotein cholesterol (LDL-C). Conclusions: Even when target BP levels in antihypertensive therapy are achieved, obese resistant patients are characterized by more pronounced disturbances of the circadian rhythm and higher levels of office and out-of-office BP, compared with non-resistant patients. New data were obtained in the difference in the systolic blood pressure (SBP) levels (significantly higher with true resistance) and LDL-C (significantly lower with true resistance).