УДК: 616.36–004:616.24–008.811.6–036

The aim of the study. To determine the frequency and character of syntropic extrahepatic lesions in cirrhotic patients depending on the hepatopulmonary syndrome severity degree.

Materials and methods. In a randomized manner with preliminary stratification by the presence of hepatopulmonary syndrome were studied 93 patients with liver cirrhosis, who underwent the comprehensive clinical-laboratory and instrumental examination.

Results. According to the obtained results, most often in patients with liver cirrhosis associated with hepatopulmonary syndrome syntropic extrahepatic lesions affected other organ systems as follows: digestive system - 100.0 % patients under investigation; hematopoietic system - 84.9 %; nervous system - 81.7 %; integumentary system and mucous membranes - 78.5 %; blood circulatory system - 76. 3 %; osteoarticular system - 67.7 %; urinary system - 22.6 %. Increased severity of hepatopulmonary syndrome significantly (p < 0.05) correlated with thein creased frequency of lesions.

Among syntropic polymorbid lesions of the integumentary system and mucous membranes, 68.8 % patients with hepatopulmonary syndrome had jaundice, 66.7 % - telangiectasia. Among lesions of the osteoarticular system osteopenia was diagnosed in 44.7 % of patients, osteoporosis - in 27.7 %. Among lesions of the circulatory system 52.7% of patients suffered from heart rhythm disorders, 49.5 % - from arterial hypotension, 20.4 % - from cirrhotic cardiomyopathy. Among lesions of the hematopoietic system anemia (76.3 %), coagulopathy (73.1 %) and thrombocytopenia (61.3 %) were diagnosed most often. Digestive system lesionsinclude esophageal veins varicosities (94.6 % of patients), hemorrhoidal veins varicosites (68.8 %), and cirrhotic gastropathy (62.4 %). Among lesions of the urinary systemin 21.5 % of patientswas diagnosed type II hepatorenal syndrome. Among the lesions of central nervous system in 81.7 % of patientswas diagnosed hepatic encephalopathy. The frequency of syndromes and nosological units increased significantly (p < 0.05) with the increase of hepatopulmonary syndrome severity.

Conclusions. 100.0 % patients with liver cirrhosis accompanied byhepatopulmonary syndromewere affected by syntropic polymorbid lesionsof the digestive system, 94.6 % of which were represented by esophageal vein varicosites. Out of 84.9 % of patients with hematopoietic lesions anemia was diagnosed in 76.3 %, coagulopathy - in 73.1 % of cases. Of total 81.7 % patients withnervous system injurieshepatic encephalopathy was diagnosed in 81.7 % patients. In 78.5 % cases of damaged skin, its appendages and mucous membranesjaundice covered 68.8 %, and telangiectasia 66.7 % of cases. In 76.3 % of cardiovascular system lesions arrhythmias were diagnosed in 52.7 %. With the increasing severity of hepatopulmonary syndrome, the frequency of the above lesions increased significantly (p < 0.05).

Introduction: Rheumatoid arthritis (RA) is an autoimmune disease with a chronic inflammatory process that affects bone metabolism and leading to impaired bone mineral density (BMD). Therefore, the determination of laboratory markers of bone metabolism contributes to a better understanding of the pathogenesis of metabolic bone diseases.

The aim of the study: To characterize the bone metabolism parameters in rheumatoid arthritis patients with impaired bone mineral density, to find out their features and diagnostic value.

Materials and methods: The study included 76 patients randomly stratified by RA status who were treated in the Rheumatology Department of Lviv Regional Clinical Hospital, a municipal non-profit enterprise of Lviv Regional Council, from 2013 to 2019. The goal was achieved by performing three consecutive stages of the study. At the first stage, markers of bone formation and bone resorption were characterized. At the second stage, the peculiarities of these indicators were determined. The third stage was to determine the diagnostic value of the content of the markers of formation оsteocalcin (OCN) and procollagen type 1 amino-terminal propeptide (P1NP) and resorption marker isomerized C-terminal telopeptide specific for the degradation of type I collagen in the bone tissue (β-CrossLaps).

Results: According to the results of the study at the first stage, it was found that, in RA patients with osteoporosis (OP), the serum content of markers of osteoblastic bone function OCN (p=0.000) and P1NP (p=0.035) was significantly lower compared to the healthy individuals of CG, while the content of the marker of bone resorption β-CrossLaps was significantly higher (p=0. 021); in RA patients with OP, the serum content of both markers of osteoblastic bone function OCN (p=0.000) and P1NP (p=0.001) is significantly lower, while β-CrossLaps (p>0.050) is only slightly higher compared to healthy CG subjects. According to the results obtained at the second stage of the study, it can be stated that the content of OCN and P1NP in the blood serum is significantly lower in RA patients both with osteopenia and OP compared to RA patients without BMD disorders.

At the third stage of the study, it was found a significant relationship between the content of P1NP and belonging to a group with osteopenia (AC -0.52). A confirmed relationship was found between the content of OCN and belonging to the group with OP (direct direction of AC 0.57; p=0.017).

Conclusions: Bone structure disorders in rheumatoid arthritis patients with osteopenia are characterized by a weakening of bone formation and increased resorption processes; in rheumatoid arthritis patients with osteoporosis, the weakening of osteoblastic bone function is more pronounced compared to rheumatoid arthritis patients with osteopenia. For rheumatoid arthritis patients with unimpaired bone mineral density, the highest diagnostic value is provided by procollagen type I N-terminal propeptide. For rheumatoid arthritis patients with osteoporosis, osteocalcin is a diagnostically valuable marker.