ABSTRACT
OBJECTIVE: The aim: To investigate the clinical and pathogenetic peculiarities of formation and course of CCP and the relationship between clinical, hemodynamic and neurohumoral factors of comorbidity development in COPD combined with arterial hypertension (AH). PATIENTS AND METHODS: Materials and methods: The object of the study were 484 patients with COPD. Among them, 350 patients with CCP as a result of cardiac insufficiency/severe congestive heart failure (COPD III-IV) out of aggravation, combined with AH II stage (non-symptomatic organ damage) and 1 - 3 grades, including 55 patients (43 men, 12 women) with compensated CCP (average age 43.7 ± 3.4 years), and 295 patients (212 men and 83 women) with decompensated CCP and chronic heart failure (CHF), average age 63.2 ± 8.9 years. RESULTS: Results: It was found that the development and progression of the left and right CHF in patients with CCP combined with AH occurs due to the disorders of the central hemodynamic, progression of pulmonary hypertension, bronchial obstruction syndrome, neurohumoral and systemic immunoinflammatory activation, disorders of endothelial regulation of vascular tension, overproduction of epithelial and mitogenic growth factors, inducers of apoptosis, and is accompanied by increasing levels of natriuretic peptides. CONCLUSION: Conclusions: The main pathogenetic formation mechanisms of the heart failure on the background of CCP combined with AH are: neurohumoral and systematic immune-inflammatory activation with the development of endothelial dysfunction and (neo)angiogenesis, induction of pathological apoptosis, increase in the intrathoracic pressure, and deposition of blood in the extrathoracic tissues, which result in pulmonary and systemic hypertension, metabolic and hemodynamic remodelling and heart dysfunction.
Subject(s)
Heart Failure , Hypertension, Pulmonary , Hypertension , Pulmonary Disease, Chronic Obstructive , Adult , Aged , Female , Heart Failure/complications , Hemodynamics , Humans , Hypertension/complications , Hypertension, Pulmonary/complications , Male , Middle Aged , Pulmonary Disease, Chronic Obstructive/complicationsABSTRACT
OBJECTIVE: The aim: Of this study was to improve the efficiency of complex medicamental treatment of generalized periodontitis (GP) in patients with concomitant CAD using of differentiated immunotropic therapy, especially herbal medicine «Immuno-ton¼. PATIENTS AND METHODS: Material and methods: 130 patients with GP were observed (43 without and 81 with chronic CAD - stable angina, functional classes II-III (CCS)) with detection of oral hygiene indices for Green-Vermillion, inflammation of gums PMA, bleeding of gums PBI, depth of periodontal pockets (determined by direct method). The levels of TNF-α and sPECAM-1 in gingival fluid were detected by ELISA method. RESULTS: Results: The following article is dedicated to studying on the effectiveness of the proposed method of GP I and II degree of development treatment in patients with a concomitant coronary artery disease (CAD) using of herbal medicines with immunomodulating effect. The offered methods provide disappearance of clinical signs of inflammation in the periodontal tissues and prevention of inflammation recurrence in the long terms. Also, it was proved that usage of the forward method of the GP immunotropic therapy with including of herbal immunomodulators leads to normalization of dynamics of tumor necrosis factor -alfa (TNF-α) and soluble platelet-endothelial cell adhesion molecule -1 (sPECAM-1) in oral fluid of abovementioned contingent of patients. CONCLUSION: Conclusions: The progression of generalized periodontitis in patients with stable coronary heart disease is accompanied with manifestation of systemic inflammation, which have been reduced by immunomodulator Immuno-Ton and extratemporal gel with "Enterosgel" and herbal concentrate "Dzherelo".
