Наукові праці. Кафедра внутрішньої медицини № 1

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    Огляд сучасних методів лікування та профілактики серцево-судинних захворювань у хворих на цукровий діабет 2 типу
    (ГО «Міжнародний центр наукових досліджень», ТОВ «УКРЛОГОС Груп», 2024) Абдуллаєва, Айгюн Сахіб кизи; Александрова, Тетяна Миколаївна
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    Огляд сучасних методів лікування синдрому Вольфа-Паркінсона-Уайта
    (ГО «Молодіжна наукова ліга», ТОВ «УКРЛОГОС Груп», 2024) Александрова, Тетяна Миколаївна; Данелюк, Анна Дмитрівна
    Синдром Вольфа-Паркінсона-Уайта (WPW) — це порушення серцевої провідності, яке має потенційно небезпечні для життя наслідки. WPW синдром є досить поширеною патологією та зустрічається в 0.1-3.1% випадків з 1000 проведених електрокардіографій (ЕКГ), а у хворих із вродженими вадами серця – у 0,5% серед всіх вікових груп та виявляється у 1–30 на 10 тис. осіб. Співвідношення між чоловіками та жінками становить 3:2. У дитячому віці синдром WPWзустрічається частіше (7-10%), ніж у дорослому (3-6%). У більшості випадків клінічна маніфестація синдрому WPW виникає у молодому віці (від 10 до 20 років). Можливість розвитку раптової смерті (РРС) протягом 10 років становить від 0,15 до 0,39%, що вище за загальнопопуляційний ризик РРС (менше 0,1%).
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    Оцінка схильності до само- та взаємоосвіти у здобувачів вищої медичної освіти
    (2022) Тверезовська, Ірина Іванівна; Железнякова, Наталя Мерабівна; Молодан, Володимир Ілліч
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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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    Зв’язок показників обміну селену та протизапальної відповіді у пацієнтів з гіпертонічною хворобою та неалкогольною жировою хворобою печінки
    (2022) Тверезовська, Ірина Іванівна; Железнякова, Наталя Мерабівна
    Новітні дослідження розглядають оксидативний стрес як ключовий елемент у патогенезі розвитку серцево-судинної патології та неалкогольної жирової хвороби печінки (НАЖХП). Селенопротеїн Р (Сел Р) синтезується в гепатоцитах та є основним джерелом селену в організмі, обумовлюючи активацію та підтримку антиоксидантного захисту. Інтерлейкін-10 (ІЛ-10) є одним із основних протизапальних цитокінів, дія яких безпосередньо спрямована на запобігання запалення та формування фіброзу
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    Kallistatin, IL-10, IL-1β and hsCRP in the diagnosis of non-alcoholic fatty disease on the background of hypertension
    (2022) Rozhdestvenska, Anastasiia; Zhelezniakova, Natalia
    Background: Non-alcoholic fatty liver disease (NAFLD) affects 25% of the adult population and often develops in comorbidity with hypertension (HT). ROC-analysis allow to assess the diagnostic potential of biomarkers for liver fibrosis detection in NAFLD patients. Objective: To evaluate the kallistatin, IL-10, IL-1β and hsCRP role in determining of development and progression of liver fibrosis in NAFLD and HT patients. Methods: 63 patients with NAFLD on steatohepatitis stage and HT and 52 patients with isolated NAFLD were observed. Kallistatin, IL-10, IL-1β and hsCRP levels were determined by enzyme-linked immunosorbent assay. Results: The kallistatin showed significant potential in diagnosing the occurrence and progression of liver fibrosis in patients with NAFLD and HT (AUC=0.975, p=0.003, Sensitivity (Se)=95%, Specificity (Sp)=100%; AUC=0.881, p<0.001; Se=95%, Sp=76.9%), and with isolated NAFLD (AUC=0.867, p<0.001); Se=76.5%, Sp=81.0%; AUC=0.889, p<0.001, Se=92.3%, Sp=81.3%). IL-10 (AUC=0.769, p=0.012, Se=70%, Sp=64.1%; AUC=0.710, p=0.009, Se=94.4%, Sp=69.2%), IL-1β (AUC=0.752, p=0.02, Se=71.8%, Sp=75.0%; AUC=0.788, p=0.007, Se=84.6%, Sp=66.7%) showed good prognostic characteristics for liver fibrosis progression detection in both groups of patients, and the hsCRP revealed prognostic abilities only in NAFLD and HT patients (AUC=0.849, p<0.001, Se=71,8%; Sp=75.0%). Simultaneous determination of all biomarkers allowed to predict the occurrence and progression of liver fibrosis in NAFLD and HT patients (AUC=1.000, p=0.002, Se=100%, Sp=100%; AUC=0.874, p<0.001, Se=82.1%, Sp=85.0%), and isolated NAFLD patients (AUC=0.874, p<0.001, Se=94.1%, Sp=71.4%, AUC=0.889, p <0.001, Se=84.6%, Sp=94.4%). Conclusions. Kallistatin, IL-10, IL-1β, and hsCRP levels determination can detect liver fibrotic changes in NAFLD and HT patients may be an alternative to invasive diagnostic methods.
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    Morphometric parameters of esophageal mucous in young people with gastroesophageal reflux disease and autoimmune thyroiditis
    (2022) Zhelezniakova, Natalia; Gargin, Vitaliy; Bocharova, Tetiana; Pasiieshvili, Tamara; Pasiieshvili, Liudmyla
    Background & objectives: Gastroesophageal reflux disease (GERD) takes one of the leading positions in internal organs` pathology with comorbidity. Objective of our work was evaluation of morphometric parameters of the esophageal mucous membrane in young people with GERD and autoimmune thyroiditis (AIT). Methods: Patients with GERD and AIT (main group) and 45 people with isolated GERD (comparison group) matched for age, gender, and social status were examined. The mean age in the groups was 21.9 ± 2.7 and 21.2 ± 2.4 years. Morphometric parameters were obtained (total thickness of the epithelium, basal layer thickness, the height of connective tissue papillae, and intercellular space). Results: The histological study showed that in patients with GERD and AIT all the morphometric parameters studied had a significantly more severe course and exceeded similar indicators of the group with isolated GERD: epithelium total thickness 319.3±9.1 μm against 286.1±8.2 μm (p<0.01), epithelium basal layer thickness 79.6±3.2 μm versus 49.7±2.1 μm (p<0.01), connective tissue papillae height 224.8±7.3 μm against 172.7±4.6 μm (p<0.01), intercellular space 1.55±0.11 μm versus 1.12±0.09 μm (p<0.01). Considerable aggravation of the deviations in patients with AIT may reflect the involvement of an additional autoimmune inflammatory component in the pathological process. Conclusion: GERD and euthyroid AIT comorbidity in the student population is accompanied by statistically more pronounced disorganization of esophageal mucosal epithelium compared with isolated GERD. The obtained data allow us to consider concomitant AIT as an unfavorable prognostic factor in the progression of GERD in the student population.
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    Kallistatin as a biomarker of non-alcoholic fatty liver disease progression in patients with hypertension
    (2021-10) Rozhdestvenska, Anastasiia; Zhelezniakova, Natalia
    Background and Aims: The prevalence of nonalcoholic fatty liver disease (NAFLD) ranges from 17% to 46% worldwide. Searching for non-invasive diagnostic methods of the NAFLD severity and progression becomes a central objective, especially, in patients with combination of NAFLD and arterial hypertension (HT). Kallistatin is an tissue kallikrein inhibitor, endogenous protein, which is predicted to play an important role in anti-inflammatory protection and prevention of the chronic liver diseases progression. The aim of the study was to determine the role of kallistatin as a diagnostic biomarker of NAFLD progression in patients with concomitant HT. Matherials and methods: We examined 115 patients with NAFLD in non-alcoholic steatohepatitis (NASH) stage. They were divided into two groups: the main group consisted of 63 patients with NAFLD on the background of HT and the comparison group consisted of 52 patients with isolated NAFLD. The control group was composed of 20 relatively healthy volunteers. Anthropometric parameters were obtained using standard methods. Plasma kallistatin levels were measured using the Human SERPINA4 (Kallistatin) ELISA Kit (Elabscience, USA). The level of C-reactive protein (CRP) was determined using the hs-CRP ELISA Kit (Biomerica USA). The data was statistically processed using standart PC-programmes. Results: The kallistatin level in patients with comorbidity of NAFLD and HT averaged 65.98 ng/ml (95% CI 62.85; 69.12), that was less, than in group of isolated NAFLD (83.42 ng/ml (95% CI 81.89; 84.94)) and control group (111.70 ng/ml (95% CI 106.14; 113.22)) in 1.3 (p < 0.001) and 1.7 times (p < 0.001), respectively. The levels of kallistatin were decreased in patients on condition of increasing body mass index (BMI) both in the group with NAFLD and HT and in the group with isolated NAFLD (r = -0.58, p < 0.001; r = 0.54, p = 0.002, respectively). The content of kallistatin decreased with the progression of HT in patients from the main group: in patients with HT I stage the level of biomarker averaged 73,38 ng/ml (95% ДІ 70,24; 78,19) while in patients with HT II stage its values were 61,87 ng/ml (95% ДІ 58,12; 65,62), p < 0.001. At the same time, the biomarker levels were significantly different in patients with HT II, depending on hypertension grade and declined with increase of blood pressure (BP) numbers. The highest CRP value was found in the NAFLD and HT group (7.90 mg/l (95% CI 7.96; 8.75)) versus 6.55 mg/l (95% CI 6.47; 7.57) and 2.07 mg/l (95% CI 1.83; 2.85) in the isolated NAFLD group and control results, respectively. The correlations between kallistatin and CRP were signed as very strong (r = -0.89) and strong (r = -0.61) in group with comorbidity of NAFLD and HT and in patients with isolated NAFLD, respectively. Conclusions: We founded the significant decrease in the content of kallistatin in plasma of patients with NAFLD. It was proven that concomitant HT, stage of target organs injury, higher BP grade, as well as increased BMI and CRP levels are associated with significantly more pronounced deviations of this biomarker. This data provide the possibility to consider kallistatin as a biomarker of NAFLD progression, in particular, in patients with NAFLD and HT.
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