УДК : 616-074(075.8)

Підручник складено відповідно до нової навчальної програми за єдиним планом. Висвітлено загальні положення, етіологію, патогенез захворювань різних органів і систем, традиційні та сучасні можливості діагностики.

У розділі І описано управління якістю клінічних лабораторних досліджень, що на даний час є актуальним. У наступних розділах описано сучасні уявлення про обмін білків, вуглеводів, ліпідів, гормонів, мінералів та води, кислотно-лужному стану в нормі та при патологічних станах. Практичне застосування біохімічних досліджень оцінене через можливість ранньої діагностики захворювання, моніторинг життєво важливих функцій організму хворого, моніторинг реакції на лікувальні заходи.

Diabetic retinopathy (DR) is the most significant and common cause of visual impairment in diabetes patients. The aim of the study was to enhance the understanding of the pathogenesis of DR associated with metabolic syndrome (MS) and elucidate the role of cellular and humoral immunity factors. The study included 130 patients. Group 1 comprised 70 patients diagnosed with DR and insulin-dependent type 2 diabetes against the background of MS. Group 2 included 60 patients diagnosed with DR and non-insulin-dependent type 2 diabetes associated with MS. The immunological analysis focused on evaluating subpopulations of blood lymphocytes using flow cytometry; systemic inflammation markers, such as CRP, specific IgA, IgM, and IgG, cytokines measured by ELISA. Significant changes in immune status were observed in patients with DR associated with MS, depending on diabetes compensation. In Group 1 patients with DR, more pronounced alterations in the T-cell immunity pathway were observed, including T-cell immunodeficiency accompanied by the activation of killer and B-cell immunity, compared to non-insulin-dependent patients. Both groups exhibited type IV hypersensitivity reactions. Elevated CRP level was detected only in insulin-dependent patients with DR. An analysis of the immune parameters indicated predominant activation of the specific humoral immunity pathway, suggesting chronicity of the condition. Non-insulin-dependent patients showed significant activation of mucosal humoral defenses and early humoral protective mechanisms. The data revealed more pronounced changes in specific humoral immunity markers, such as immunoglobulins, compared to systemic inflammation markers like CRP.

УДК [616.24-002.5:615.015.8]:616-085.33:612.017.1

Анотація. Проведено дослідження змін імуно-метаболічного гомеостазу у хворих з новими випадками деструктивних форм мультирезистентного туберкульозу легень (МРТБЛ) після застосування режимів лікування бедаквеліном та лінезолідом. Встановлено, що до початку лікування у хворих виявлявся Т-клітинний імунодефіцит з достовірним зниженням рівня Т-хелперів (у 2,0 рази проти контролю), а також виявлено реакцію гіперчутливості першого типу за рівнем зростання CD23+ (у 2,5 раза від рівня у групі контролю) та виражену активацію гуморальної та кілерної ланки імунітету. За результатами комплексного клініко імунологічного обстеження хворих з новими випадками МРТБЛ після завершення інтенсивної фази лікування констатовано активацію Т- клітинної ланки імунітету за рахунок збільшення рівня Т-супресорів, особливо у групі хворих у схемі хіміотерапії яких було введено бедаквелін та лінезолід.

Abstract. The aim of the study was to investigatethe changes in immuno-metabolic homeostasis in the management of a new case of destructive forms of multidrug-resistant pulmonary tuberculosis with the use of individual chemotherapy regimens. In patients with new cases of multidrug-resistant pulmonary tuberculosis before treatment, Tcell immunodeficiency was found, with a significant decrease in the level of T-helpers (2,0 times against control, and revealed a hypersensitivity reaction of the first type with increasing levels of CD23 + (2.5 times relative to control group) and pronounced activation of the humoral and killer parts of the immune system. According to the results of a comprehensive clinical immunological examination of patients with new cases of multidrug-resistant pulmonary tuberculosis after the intensive phase of treatment revealed activation of the T-cell immune system due to increased levels of T-suppressors, especially in the group of patients who received chemotherapy bedaquiline and linezolid.

616.34-008.87:616-056.52:(616.379-008.65+616.441)

Modern studies show that it is the transit microflora, the percentage of which is negligible compared to the total volume of the intestinal microbiota, that can cause severe damage and cause the appearance of chronic and acute diseases not only of the intestines but also of the immune, nervous, endocrine systems, etc. Instead, the obligate intestinal microbiota and even the opportunistic microbiota exhibit a number of beneficial properties, ranging from the synthesis of short-chain fatty acids, butyrate, and acetate to promoting the synthesis of vitamins and hormones such as dopamine, serotonin, etc. At the same time, the adverse effects of the gut microbiota cannot be discounted.

The aim. The study aims to find correlations between gut microbiota, body mass index, and age in patients with type 2 diabetes and thyroid dysfunction..\

Materials and methods. The study included 84 patients with type 2 diabetes, obesity, and thyroid dysfunction. To analyze the composition of the intestinal microbiota, fecal samples were taken, and the quantitative and qualitative composition was calculated using the principle of PCR sequencing. Statistical methods of comparison and correlation of variables were used.

Results. In patients, several significant correlations were found between the gut microbiota and the parameters studied. A negative correlation was found between body mass index and Bifidobacterium spp. and Escherichia coli, and a positive correlation was found between body mass index and some opportunistic pathogens. Thus, with Shigella spp. and Staphylococcus aureus, there is a direct weak reliable relationship, while an inverse reliable relationship with Helicobacter pylori. Interesting correlations were found with a tendency to confidence with Salmonella spp. and Bacteroides thetaiotaomicron direct weak and a tendency to probable feedback between BMI and Faecalibacterium prausnitzii and Candida spp.

Conclusion. We found that body mass index has a greater impact on the gut microbiota than age. Also, the data obtained indicate that obesity negatively affects the number of some beneficial bacteria. We can assume that, like metformin, one of the most common drugs for the treatment of type 2 diabetes mellitus, it can affect the composition of the intestinal microbiota

UDC: 616.24-002.5:615.015.8]-085.281-078.73-092-036

Immunological methods are important for diagnosing tuberculosis, evaluating the process activity, and forecasting the course of the disease and recovery. 
Materials and methods. 47 patients with first diagnosed destructive sputum smear-positive pulmonary tuberculosis underwent a complex immunoassay. The patients were divided into two groups based on the sensitivity/resistance of mycobacterium tuberculosis to antimycobacterial agents. The first group consisted of 22 patients with first-diagnosed chemosensitive tuberculosis with preserved sensitivity to antimycobacterial agents. The second group consisted of 25 patients with multi-drug resistant tuberculosis pulmonary tuberculosis (MDR-TBP). 
The research was conducted during the 2018-2021 years. Results Specific cell response disorders in patients with pulmonary tuberculosis are associated with the multistructural T-cell protection misbalance caused by the quantitative changes of its components, the increase/decrease in the quantity of certain lymphocyte pools specifying the immune response vector. In cases of tuberculosis, phagocytosis plays an important role. Phagocytosis might release cells from the tuberculosis pathogen. To achieve this, the activation of cells should reach a certain level. However, the initial protective nature of cell activation might become aggressive. The T-cell immunity disorders were more evident in patients with MDR-TBP versus donors and patients with chemosensitive tuberculosis. The apparent decrease in СD3+СD56+, СD3+СD4+ pools and the increase in СD3+СD8+ were revealed in cases of MDR-TBP tuberculosis versus chemosensitive tuberculosis. The difference in СD3+СD4+, СD3+СD8+, СD3+СD4+/СD3+СD8+, CD3+СD8+HLA-DR+, СD16/56+8+ between the study and observational groups was statistically confirmed. The evident specific cell immunity disorders in patients with MDR-TBP aggravate the clinical course of the disease, causing destructive changes and acute and extensive processes. Conclusions Changes in different components of the immune system might occur during pulmonary tuberculosis (in T- and B-cells, phagocytic cells), specific and enzymatic processes are activated, and autoimmunization is evident. The intensity of the changes varies at different stages of the disease. Most immune disorders caused by the specific inflammation process require immune correction
Keywords: immune responsiveness, phagocytosis, T- and B-cell immunity, multi-drug resistant and chemosensitive tuberculosis