УДК 616.5-002.525.2-031.81-06:616.12-008-039.5]-037-074

Резюме. Системний червоний вовчак (СЧВ) – хронічна автоімунна недуга, за якої уражаються майже всі внутрішні органи і серед них – органи системи кровообігу (ОСК).

Мета. З’ясувати прогностичне значення діагностично цінних лабораторних маркерів системного черво-ного вовчака для визначення ймовірности виникнення коморбідних синтропічних уражень органів системи кровообігу.

Матеріали і методи.  У дослідження включено 125 хворих на СЧВ із наявністю уражень ОСК, серед яких переважали жінки молодого віку. Хворих стратифікували за наявністю коморбідних синтропічних уражень ОСК. Результати опрацьовано у програмі «Exсel», статистично достовірною вважали різницю, якщо р < 0,050. Зв’язок вважали підтвердженим, якщо коефіцієнт асоціації ≥ 0,50 або коефіцієнт контингенції ≥ 0,30.

Результати. З’ясували, що для визначення ймовірности виникнення ангіопатії сітківки у хворих на СЧВ найкраще прогностичне значення має констеляція із ↑ ЛПНЩ + ↑ ІА + ↑ anti-ds DNA + ↑ ANA; для капіляриту – окремий маркер ↑ АлТ; для синдрому А. Г. М. Рейно – окремий маркер ↓ С3; для ретикулярного ліведо – ↑ ШОЕ + ↑ малих ЦІК + ↑  anti-ds  DNA  + ↑ anti-Sm; для атеросклерозу  –  ↓ гемоглобіну + ↑ ЛПНЩ + ↑  ANA  + ↓ С4; для недостатности мітрального клапана – ↑ ШОЕ + ↑ anti-ds DNA + ↑ ANA + ↑ антифосфоліпідних антитіл Ig М; для ущільнення мітрального клапана  –  ↑ ШОЕ + ↑ ЛПНЩ + ↑ малих ЦІК + ↑  ANA; для перикардіального випоту  – еритропенія + ↑ С-РП + ↑ вовчакового антикоагулянту; для легеневої гіпертензії  –  гіперхолестеролемія + ↑ ЛПНЩ + ↑ anti-ds  DNA  + ↑  ANA; для міокардиту  –  окремий маркер ↓ С4; для ендокардиту  –  не виявлено; для симптоматичної артеріальної гіпертензії – ↑ ЛПНЩ + ↑ anti-ds DNA + ↑ ANA  + ↑ anti-SSA (Ro); для тромбозу вен – еритропенія + ↓ гемоглобіну + ↑ ЛПНЩ + ↑ ANA.

Висновки. Для кожного коморбідного синтропічного ураження органів системи кровообігу у хворих на системний червоний вовчак визначено діагностично цінні окремі лабораторні маркери або їхні констеляції, які мають найкраще прогностичне значення для визначення ймовірности виникнення цих уражень.

Background: The patients with liver cirrhosis (LC) have autonomic nervous system (ANS) imbalance that can be evaluated by the heart rate variability (HRV) study. ANS imbalance results into cirrhotic cardiomyopathy (CCMP) and the most easily diagnosed feature of CCMP is the prolonged QT interval. Usually, in the literature not all HRV parameters are characterized, or their assessment period is short, not allowing covering all the important moments and therefore needing further study.

Material and Methods: In a randomized way with the preliminary stratification by the presence of LC 33 patients after signing the informed consent were examined. In addition to routine screening methods, all patients underwent 24-hour ECG monitoring.

Results: Patients with LC and syntropic CCMP have the ANS disorders with a HRV decrease, predominance of the sympathetic over the parasympathetic system, heart rate regulation at the humoral-metabolic level. The ANS disorders severity depend on the LC severity according to C. G. Child - R. N. Pugh criteria. During the analysis of the received results the significant positive correlation between the SDNN index and maxQT, avg QT, positive correlation between HF and max QTc, avg QTc were found. The diagnostic sensitivity of SDNN index and HF was high in the patients with LC and CCMP.

Conclusions: The ANS imbalance can be regarded as syntropic comorbid disorder in the cirrhotic patients. The diagnostic sensitivity of SDNN index and HF was found to be high in the patients with LC and CCMP, serving as diagnostic markers of CCMP.

Introduction: Information about calcium-phosphorus metabolism (CPM) and bone turnover in patients with liver cirrhosis (LC), as well as clarifying their diagnostic value for assessing bone structure disorder, will help doctors to detect their lesions in timely manner and, based on the information received, to choose well-founded comprehensive treatment strategy.

Aim: To characterize the indicators of calcium-phosphorus metabolism and bone turnover in patients with liver cirrhosis, and to find out their diagnostic value for detecting bone structure disorder.

Materials and methods: In randomized manner 90 patients with LC (27 women and 63 men of age from 18 to 66), who were treated at the Lviv Regional Hepatological Center (Communal Non-Commercial Enterprise of Lviv Regional Council “Lviv Regional Clinical Hospital”) between 2016 and 2020, were included in the research. The research was carried out in two stages. The purpose of the first stage was to obtain information that would allow characterizing indicators of CPM (total calcium, ionized calcium, phosphorus, total vitamin D (25-hydroxyvitamin D), and parathyroid hormone) and bone turnover (osteocalcin, P1NP, alkaline phosphatase (bone formation markers), and β-Cross Laps (bone resorption marker)) in patients with LC, and the purpose of the second stage was to find out their diagnostic value for assessing bone structure disorder of them. To perform research, an experimental group (EG) (72 patients with impaired bone mineral density (BMD)), which was divided into EG A (46 patients with osteopenia) and EG B (26 patients with osteoporosis), and a comparison group (18 patients with normal BMD) were formed. The control group consisted of 20 relatively healthy people.

Results: At the first stage, it was established that the frequency of cases of increased alkaline phosphatase content was statistically significantly different in LC patients with osteopenia and osteoporosis (p = 0.002), as well as with osteoporosis and normal BMD (p = 0.049). Impaired BMD in general had significant direct stochastic relationship with vitamin D deficiency, decrease in osteocalcin content and increase in P1NP content in serum (Yule's Coefficient of Association (YCA)) >0.50); osteopenia – with decrease in phosphorus content, vitamin D deficiency and increase in P1NP content (YCA >0.50); and osteoporosis – with vitamin D deficiency, decrease in osteocalcin content, increase in P1NP content, and increase in alkaline phosphatase content in serum (YCA >0.50). Significant inverse stochastic relationship was recorded between vitamin D insufficiency and each of the impaired BMD manifestations (YCA <-0.50), which most likely indicates that it is characteristic of normal BMD. At the second stage, it was found that among indicators of CPM and bone turnover, only increase in alkaline phosphatase content in serum can be diagnostically valuable marker of osteoporosis in patients with LC (р <0.050; YCA >0.50; coefficient contingency = 0.32), which has medium sensitive (80.77 %) and positive predictive value (70.00 %) for it. Although other indicators of CPM and bone turover did not confirm their diagnostic value in our research, they may be useful for monitoring pathogenetic changes in bone structure disorder and evaluating the effectiveness of their treatment in patients with LC.

Conclusion: Indicators of calcium-phosphorus metabolism and bone turnover, which are characteristic of bone structure disorder and its absence in patients with liver cirrhosis, were revealed. Among them, an increase in alkaline phosphatase content in serum, which is a moderately sensitive marker of osteoporosis, is diagnostically valuable.

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.

Introduction: Systemic lupus erythematosus (SLE) is an autoimmune disease caused by many polyclonal autoantibodies and characterized by numerous comorbid lesions of internal organs and systems. Research with respect to the role of various infectious agents in the development and course of SLE, and primarily the role of cytomegalovirus (CMV) and Epstein-Barr virus (EBV), is ongoing. It is important to find out whether patients with SLE are infected with CMV and EBV, since the clinical manifestations of SLE and active viral infection are similar.

Aim: To find out the infection of SLE patients with CMV and EBV.

Materials and methods: The study included 115 patients with SLE, among whom women of working age predominated. The study was conducted in three stages: to find out CMV infection, to detect EBV infection, to determine the simultaneous infection of SLE patients with CMV and EBV and, in particular, their active phases. The actual material was processed on a personal computer in Excel (Microsoft) and IBM SPSS Statistics using descriptive statistics.

Results: It was found that the serum of the vast majority of SLE patients has specific antibodies to CMV, and only three have no antibodies to the virus. IgM antibodies to CMV were detected in 22.61% of patients, which may indicate an active phase of infection. Most often, the CMV seroprofile was detected as a combination of IgG (+) and IgM (-) (74.78%) among patients with SLE. It was established that the absolute majority of SLE patients are infected with EBV (98.26%). Active EBV infection was found in 15.65% of SLE patients, and chronic persistent - in 53.91%. Most often (53.91%) there are SLE patients with a seroprofile in the combination of EBV IgG to NA (+) IgG to EA (+) VCA IgM (-).

Most often (41.74%) SLE patients had a combination of laboratory markers of viral infection in the form of seroprofile CMV IgG (+) IgM (-); EBV IgG to EA (+) IgG to NA (+) IgM to VCA (-). The active phase of CMV and/or EBV infection was present in 32.17% of SLE patients, of which: 16.52% had only active CMV infection, 9.57% - only active EBV infection, and 6.09% – a combination of active CMV and EBV infections, which indicates that more than a third of SLE patients have active CMV and/or EBV infections, which can affect the clinical manifestations of the disease and require specific treatment tactics.

Conclusion: Almost all patients with SLE are infected with CMV, among whom 22.61% of patients have active infection. The absolute majority of SLE patients are infected with EBV, of which 15.65% had an active infection. Most often, SLE patients had a combination of laboratory markers of infection in the form of seroprofile CMV IgG (+) IgM (-); EBV IgG to EA (+) IgG to NA (+) IgM to VCA (-). The active phase of CMV and/or EBV infection was present in 32.17% of patients with SLE, of which: 16.52% had only active CMV infection, 9.57% only active EBV infection, and 6.09% – a combination of active CMV and EBV infections.