[NGAL as a marker for some extrarenal complications in acute coronary syndrome].

AIM: To study the role of neutrophil gelatinase-associated lipocalin (NGAL) as a marker for extrarenal complications in patients with acute coronary syndrome (ACS). MATERIALS AND METHODS: For 110 patients with ACS on days 1-3 of hospitalization, concentrations of NGAL, serum (s-NGAL) and urinary (u-NGAL) NGAL, and N-terminal fragment of pro-B natriuretic peptide (NT-proBNP) were measured, and transthoracic echocardiography was performed. Incidence of cardiovascular complications was determined during the stay in the hospital; hemodynamic parameters (systolic and diastolic blood pressure, heart rate) were measured on admission. RESULTS: Concentrations of u-NGAL were significantly higher in acute heart failure (AHF) [10.4 (2.7; 51.2) ng/ml] than in absence of AHF [3.8 (1.7; 8.6) ng/ml, р=0.03]. Concentrations of u-NGAL and NT-proBNP were higher in patients with [10.17 (4.87; 51.2 ng/ml) and 744.6 (368.7; 2034.9) pg/ml] than without signs of pulmonary hypertension [3.41 (1.72; 7.39) ng/ml; р=0.004 and 431.8 (99.6; 780.1) pg/ml; р=0.012]. The u-NGAL values >9.96 ng / ml were shown to be predictive for AHF, and values >5.81 ng/ml - for pulmonary hypertension. Levels of u-NGAL significantly, directly correlated with values of end-diastolic dimensions and end-systolic dimensions and inversely correlated with values of end-diastolic volume and ejection fraction; levels of s-NGAL positively correlated with cardiac output and heart index. Levels of u-NGAL significantly, directly correlated with NT-proBNP values. CONCLUSION: Urinary levels of NGAL were significantly higher in ACS patients with than without AHF or signs of pulmonary hypertension. NGAL values >9.96 ng/ml were associated with an increased probability of AHF during stay in the hospital, and NGAL values >5.81 ng/ml - with a higher incidence of ACS patients with signs of pulmonary hypertension. In ACS, direct correlations of blood and urinary levels of NGAL with some echocardiographic parameters reflecting the systolic function and the LV dimensions and geometry were identified. Levels of u-NGAL were found to be positively correlated with blood levels NT-proBNP. NGAL may be used as a supplementary marker not only for acute kidney injury and chronic kidney disease but also for severity of cardiovascular conditions and heart remodeling in patients after exacerbation of ischemic heart disease.

[THE CONTENT OF ELECTROLYTES IN DIFFERENT BIOLOGICAL MEDIUMS UNDER ACUTE CORONARY SYNDROME].

The sampling of study included 172 patients with ischemic heart disease: 146 with acute coronary syndrome, including myocardial infarction (88 patients) and unstable stenocardia (58 patients); 26 patients with stable stenocardia functional class II-III. At the 1-3 day of hospitalization blood was taken of cubital vein. The mixed unstimulated saliva was selected. In both of them conte of calcium, sodium and potassium was tested (mmol/l). Under acute coronary syndrome, in blood content of calcium was 2. sodium--139.6 and potassium--4.5 i.e. the content was lower than in case of stable stenocardia (2.4; 139.8; 4.7 correspondingl In saliva under acute coronary syndrome higher content of calcium (1.05) and potassium (34.66) and lower content of sodiu (25.42) was established in comparison with stable stenocardia (0.81; 33.7; 28.08 correspondingly). The distribution coefficien (blood/saliva) of calcium, sodium and potassium were higher under myocardium infarction than under unstable stenocardia at uncomplicated course of acute coronary syndrome.

[BIOMARKER CONTENT AND ROLE IN HOSPITAL PERIOD OF ACUTE CORONARY SYNDROME].

The study involved 172 patients with coronary heart diseases (CHD) of whom 146 presented with acute coronary syndrome (ACS) including 88 with myocardial infarction (MI), 58 with unstable angina (UA) and 26 with FC II-III stable angina (SA). Interleukin (IL-6, 10), natriuretic peptide (NT-proBNP) levels in blood and 6-hydroxymelatonin level in urine were determined on days 1-3 after hospitalization. These daytime values in ACS were higher than in SA whereas the melatonin level at night was higher in SA than in ACS. Patients with ACS in the absence of ST elevation had higher IL and melatonin (night) levels but lower NT-proBNP and melatonin daytime levels than patients with ACS and elevated ST segment. IL-6 , 10 and melatonin (night and daytime) levels in MI were lower and NT-proBNP level higher than in UA. IL-6, 10 and melatonin daytime levels increased in uncomplicated ACS while melatonin (night) and NT-proBNP levels were higher in complicated ACS.

[The acoustic indicator of saliva under stress].

The situation of stress affects various organs and systems that results in development of functional disorders and/or somatic diseases. As a result, different noninvasive, including salivary, techniques of diagnostic of stress conditions are in the process of development. The dynamics of acoustic indicator of saliva is studied during the period of passing the exams. The relationship of indicator with levels of potassium, sodium, glucose and protein of saliva was analyzed. The sampling consisted of 102 students of 5 and 6 academic years of medical university. To detect the acoustic indicator of saliva acoustic analyzer AKBa-01- "BIOM" was applied. The level of potassium and sodium in saliva was detected using method of flame photometry. The level of glucose in saliva was detected by glucose oxydase technique using analyzer "EXAN-G". The protein in saliva was detected by biuretic technique. The correlation between acoustic indicator of saliva and analyzed indicators of saliva was established.

[The role of necrosis and inflammation markers in prognostication of acute coronary heart disease].

With the incessant growth of cardiovascular mortality, mainly due to myocardial infarction makes prognostication of acute coronary syndrome a principal goal of clinical practice. Biochemical markers (creatine phosphokinase-MB and troponins) are extensively used for diagnostics and prediction of acute coronary heart syndrome (ACS). However, drawbacks of necrosis markers necessitate the search for new ones identifiable at early stages of atherosclerotic plaque instability. Lately atherosclerosis has been considered as an immuno-inflammatory reaction involving cytokines, chemokines, C-reactive protein, natriuretic peptide, and tumor necrosis factor-alpha. Their prognostic value has been demonstrated in many clinical studies, but these data are contradictory and need to be confirmed.

[Immunogenetic predisposition to chronic nonspecific inflammatory bowel disease].

Immunology has grown beyond the classic doctrine of immunity to infectious diseases, and gradually covered the problems of general physiology and pathology, genetics, embryology, transplantation, oncology and many other disciplines. A new direction has appeared--immunogenetics, which should help to answer questions the disposition and/or resistance to disease, as well as influence of environmental factors on implementation of predisposition to the development of pathology. Much attention is paid to investigation of HLA in IBD. These data indicate a significant polymorphism of major histocompatibility complex antigens in this disease in different countries. The aim of our study was to investigate the immunogenetic susceptibility and resistance to the development of ulcerative colitis (UC), and Crohn's disease (CD), the character of their flow, as well as the associated extraintestinal manifestations, in particular predisposition development of bronchial obstruction (BO) in patients with inflammatory bowel disease (IBD). A study of DNA frozen blood samples of 75 patients with IBD of both sexes has been conducted. The obtained results have been compared with the results of the study 1700 of samples of umbilical cord blood of newborns (apparently healthy children), born at 37-41 weeks' gestation in Moscow (control). The group of patients with UC revealed a positive association of HLA specificities-B*38, HLA-Cw*12 and HLA-DRV1*15, which can be regarded as potentially high risk of developing the disease. The presence of the specificity of HLA-DQV1*02 can be considered as a factor in resistance to the development of UC. High risk of developing Crohn's disease among residents of Moscow associated with groups of alleles of HLA B*41, HLA-B*56, HLA-Cw*05, HLA-Cw*08, HLA-DRV1*01, HLA-DRV1*11, HLA-DQV1*04, and the presence of specificity of HLA-DQV1*05 can be considered as a factor of resistance to the development of BC. High risk of developing BO in patients with IBD is associated with specificities HLA-DQB1*02, DQB1*03, DRB1*15.

Polymorbidity in inflammatory bowel diseases.

Peculiarities of the electromotor activity of the small intestine and ascending and descending portions of the colon were revealed in patients with inflammatory bowel diseases associated with bronchopulmonary system dysfunction. Functional test revealed an increase in the vital capacity of the lungs due to increased patency of small bronchi.

[Complete elimination of cytomegalovirus without antiviral therapy after systemic mesenchymal stromal cell transplantation in a patient with ulcerative colitis (a clinical case)].

Cytomegalovirus (CMV) is one of the common pathogens of opportunistic infections in patients with inflammatory bowel diseases. When the patients are treated with immunosuppressants that make them more susceptible to CMV, the course of ulcerative colitis (UC) becomes considerably worse. Antiviral therapy sometimes can reduce the risk of complications and the rate of colectomies. At the same time, antiviral therapy is not mandatory for all UC patients with CMV infection, as shown by the results of numerous investigations. One of the properties of mesenchymal stromal cells (MSC) is to suppress the body's immune reactions to allostimulation, rather than to infection invasion. In vivo and in vitro studies have demonstrated that MSCs have antiviral and antimicrobial activities. The described clinical case shows that clinical improvement occurred and a drastic activation of proliferative processes in the colonic mucosa was detected in the patient with UC after MSC transplantation. Administration of cultured MSCs also promoted the elimination of CMV without antiviral therapy and the overcoming of hormone dependence/ resistance in the patient with UC.

[Pulmonary disorders in patients with chronic inflammatory bowel disease].

The article devoted to respiratory pathology (RP) in patients with UC and CD with clinical-radiological and functional (a function of external respiration--ERF) methods. The study included 220 patients with IBD (164--with UC and 56--with CD), aged 18-76 years (average age 40.6 years). ERF was studied by spirograph and recording flow-volume curve of forced expiration using pnevmotaograph "Eton-1" (Russia), 11 patients underwent HDCT at on multislice computer tomograph Toshiba Aquilion-16 (Japan). The study found that RP was most often detected by pulmonary function tests (44.1%), with a targeted detection of respiratory symptoms (32.9%), especially during HDCT. Much less marked physical (8.6%) and radiological (12.3%), signs of pulmonary disease, which indicates the low sensitivity of standard X-ray study of the CO. Airflow obstruction in the majority (78.3%) patients were represented mainly by obstruction of small bronchus, while in 51.6% of patients with impaired respiratory functions had no respiratory complaints, and 79.4% of patients had no radiographic signs of RP.

[External respiratory function in patients with Crohn's disease].

This article presents the results of a study of respiratory function (SRF) in 56 patients with Crohn's disease (CD) who were hospitalized in the Department of intestine pathology in Central research institute of gastroenterology. SRF was determined by spirography and registration of the curve flow--volume forced exhale ("Eton-1, RF). Violations of pulmonary function in CD occurred in 44.6% of patients, which exceeded the rate of violations in the control group (60 healthy individuals) is about 5 times (p < 0.001). Identified breaches were presented in most cases with obstructive pathology of bronchial tubes, much less restrictive observed (8.0%) and mixed (16.0%), disorders of ventilation. The highest frequency of pulmonary function was observed during prolonged (more than 10 years) history of illness (81.2%) and in patients with ileocolitis (64.7%).

[Neural regulation of the lung-bronchial system in norm and inflammatory bowel disease].

Review focuses on respiratory manifestations of inflammatory bowel disease, identified in the form of fibrosis, emphysema, bronchiectases, and alveolitis. Pathogenesis of the bronchopulmonary complications unduced by a violations of autonomic innervation of the intestine and the bronchial system, changements of the permeability of vascular wall and alveolar epithelium, the development of autoimmune processes.

[Bronchopulmonary lesions in chronic inflammatory bowel diseases].

The paper reviews the literature on bronchopulmonary lesion, one of the least studied systemic manifestations associated with inflammatory bowel diseases (IBD). Knowledge of the entire diversity of extraintestinal manifestations of IBD, including respiratory diseases, allows clinicians to optimize their diagnosis and treatment as the asymptomatic course of the latter may lead to the development of severe respiratory complications. The detection of bronchopulmonary pathology in its early period or during current therapy contributes to the objective assessment of the pattern of the disease, to the correction of treatment and improvement of disease prognosis.

[Gender characteristics of the external respiration violations in patients inflammatory bowel disease].

Article presents results of the study pulmonary function tests in 88 patients (mean age 40.6 yr) with inflammatory bowel disease (IBD): 19 with Crohn's disease and 69 with ulcerative colitis, 44 women and 44 men, 40 smokers and 48 nonsmokers. A pulmonary function abnormality was present in 43 (48.9%) of the 88 patients. Pulmonary function abnormalities was present of small airway disease. The prevalence of pulmonary function abnormalities was significantly higher among womens than among mens: prevalence ratio was 1.5 (p < 0.05). Smoking is increased risk of pulmonary function abnormalities in patients with UC.

[Peculiarities of respiratory function in elderly patients with ulcerative colitis].

This article presents a comparative analysis of the frequency and types of violations of respiratory function (RF) in ulcerative colitis (UC) in 29 elderly patients and in 108 patients younger than 60 years. Pulmonary function was studied by spirometry and record the flow curve--forced expiratory volume ("Eton-1"). Prescribe a higher rate of airflow obstruction in older compared with patients younger than 60 years (from 65.5 and 39.8% respectively, p < 0.05), which increased with the duration of the disease Yak (in the elderly to a greater extent than in patients younger than 60 years), had no clear connection with the extent of inflammation in the intestine, while staying within 60-71.4% at any site of inflammation.