Features of exocrine pancreatic insufficiency in patients with non-alcoholic fatty liver disease in combination with type 2 diabetes and COVID-19.

OBJECTIVE: Aim: The aim of the research was to study the features of pancreatic exocrine insufficiency (EPI) in patients with nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (DM) at COVID-19. PATIENTS AND METHODS: Materials and Methods: 72 patients with NAFLD and COVID-19 were examined. The patients have been divided into two groups: group 1 included 42 patients with NAFLD and insulin resistance (IR); group 2 consisted of 30 patients with NAFLD in the combination with type 2 DM. EPI was detected by 13С-mixed triglyceride breath test (13С-MTBT) in all the patients. RESULTS: Results: The result of 13С-MTBT indicates EPI in the examined subjects of the 2 group. A significant decrease in the maximum concentration of 13СО2 between 150 and 210 min was also diagnosed in group 1 patients. research (up to 8.2 ± 0.9% - p < 0.05), however, the total concentration of 13СО2 at the end of 360 min. the study reached only 27.7 ± 1.1% (p < 0.05). CONCLUSION: Conclusions: Based on the results of laboratory-instrumental methods of research, patients with NAFLD and type 2 diabetes with COVID-19 were diagnosed with severe EPI. The results of 13С-MTBT in NAFLD and IR with COVID-19 indicate a decrease in the functional reserves of the pancreas and the formation of its EPI.

IMMUNOLOGICAL DISORDERS AND COLON DYSBIOSIS IN OBESE PATIENTS WITH HYPOTHYROIDISM.

OBJECTIVE: The aim: To investigate the peculiarities of immunological changes and their relationship with colon dysbiosis in obese patients with HT. PATIENTS AND METHODS: Materials and methods: The examined patients included 48 patients with HT and obesity (group 1) and 34 patients with obesity (group 2). Patients under¬went fecal analysis for dysbiosis. The levels of complement, namely C3 and C4 and the concentration of immunoglobulins (IgA, Ig M, IgG) were determined by means of chromogenic analysis. RESULTS: Results: During the clinical examination, constipation and flatulence were more often diagnosed in patients of group I (58.3% and 66.7%, respectively - p<0.001), while in patients of group 2 with increased BMI without thyroid dysfunction, a tendency to diarrhea was more often found, accompanied by periodic pain along the colon (50.0% and 32.3% of patients, respectively - p<0.001). Changes in the immunological status of patients in both groups were found. In patients with HT and increase of BMI an increase in serum IgA, IgM, IgG levels were found. An increase in serum immunoglobulins (A, M and G) was also diagnosed in group 2 of examined patients too. CONCLUSION: Conclusions: 1. In patients with obesity decrease in the concentration of Bifidobacterium, Lactobacillus and increase in the number of Staphylococcus, Clostridium, Proteus and Klebsiella were detected, which is more pronounced in patients with a combination of obesity and hypothyroidism. 2. Impairment distinct of immu¬nological status in patients with hypothyroidism and obesity was diagnosed, which was manifested by increased levels of immunoglobulins, namly (A, M, G), as well as a decrease in blood serum complements (C3, C4). 3. The level of IgA, G directly depends on the decrese of Bifidobacterium, Lactobacillus and increse of Staphylococcus, Clostridium and Klebsiella in patients with obesity, which is more pronounced in patients with a combination of obesity and hypothyroidism.

CHANGES IN SERUM SOMATOSTATIN AND GASTRIN LEVELS IN PATIENTS AFTER CHOLECYSTECTOMY AND GASTROESOPHAGEAL REFLUX DISEASE.

OBJECTIVE: The aim: To study of changes in the level of serum gastrin (GN) and somatostatin (SST) in patients with GERD after ChECT and determined their characteristics from clinical forms of GERD. PATIENTS AND METHODS: Materials and methods: 64 patients with different clinical forms of GERD were examined. The patients with GERD were divide into 2 clinical groups. Group 1 included 34 patients with GERD after ChECT, among them there were 14 males (41.2 %) and 20 females (58.8 %), with the average age of 40.2 ± 3.2 years. Group 2 consisted of 30 patients with GERD without ChECT. Among them there were 18 males (60.0 %) and 12 females (40.0%), with the average age of 38.9 ± 4.7 years. All patients were tested for serum SST and GN level by enzyme-linked immunosorbent assay (ELISA). RESULTS: Results: In all patients with GERD of both group there was a significant increase in the level of serum SST. At the same time, a more higher indicators have been established in 2 Group of patients (increase up to 0.702 ± 0.029 pg / ml - p <0.01). Noteworthy is the change in the level of SST in the serum in both groups of the examined patients depending on the clinical form of GERD, with the maximum increase in patients with atypical manifestation of GERD. The analysis of the level of GN in blood serum indicates its decrease in the examined patients. In this case, the most pronounced changes were found in patients with extraesophageal clinical signs of GERD. CONCLUSION: Conclusions: 1. In patients after ChECT gastroesophageal reflux disease often has atypical symptoms (mostly cardiac and bronchopulmonary forms in 45.0% and 25.0 % of examend patients). 2. There was detected an increase in the level of blood SST of patients with GERD while there was observed a decrease in the GN indicator in the serum, especially in its atypical forms. 3. Duodenogastric reflux is often diagnosed during endoscopic examination of patients with GERD after cholecystectomy. At the same time, its severity correlates with the level of SST in blood serum (r=0.76; p<0.01 in the typical form and r= 0.72; p<0.05 in the atypical clinical form of GERD).

BLOOD COAGULATION DISORDERS IN PATIENTS WITH LIVER CIRRHOSIS INFECTED COVID-19.

OBJECTIVE: The aim: To investigate the features of coagulation homeostasis in patients with liver cirrhosis (LC) in COVID-19 infection. PATIENTS AND METHODS: Materials and methods: At the clinical base of the Department of Propaedeutics of Internal Medicine, 32 patients with LC infected with COVID-19 were examined - 1 Group of patients. The study also included 30 patients with LC who were not infected with COVID-19 (2 Group of patients). RESULTS: Results: The analysis of the obtained data indicates disorders of the hemostasis system in patients with LC without the COVID-19 infection (Group 2), as well as in patients with LC at the time of being infected with COVID-19. The violation of the protein synthesis function of the liver is manifested through a decrease in the level of fibrinogen in blood serum (up to 2.0±0.5 gr/l in patients of Group 1 at the time of admission for inpatient care) and up to 21.9±0.5 gr/l in patients of group ІІ - р<0.05. This was accompanied by an acceleration of prothrombin time, thrombin time and activated partial thromboplastic time in patients with LC, as well as an increase in the level of antithrombin III. The level of D-dimer was reduced both in patients of group II and in patients of group I at the time of being infected with COVID-19. CONCLUSION: Conclusions: Changes in coagulation homeostasis characteristic of hypocoagulation syndrome have been established in patients with LC. COVID-19 infection in patients with LC leads to hypercoagulation, especially in patients with complicated stage of LC (ascites, encephalopathy, hepatorenal syndrome).

CHANGES IN PROSTAGLANDIN LEVELS IN BLOOD SERUM OF PATIENTS WITH GASTROESOPHAGEAL REFLUX DISEASE ON THE BACKGROUND OF THE OSTEOCHONDROSIS OF THE SPINE AND OBESITY.

OBJECTIVE: The aim: To study the features of changes in the level of prostaglandins (I2 and F2α) in blood serum of patients GERD on the background of OH of the cervical and thoracic spine and obesity. PATIENTS AND METHODS: Materials and methods: The examined patients included 56 patients with GERD and OH of the cervical and thoracic spine. All patients had their blood serum prostaglandin (Pg) F2α and 6-keto prostaglandin F1α (blood prostacyclin - Pg I2) levels examined using the method of immunoassay analysis. RESULTS: Results: In all patients with GERD and OH an excessive body weight or obesity of varying degrees was found while analyzing anthropometric study results. The determination of prostaglandin F2α and prostacyclin (Pg I2) levels in blood serum in patients with GERD and OH and healthy individuals was performed. A more pronounced increase of Pg I2 and Pg F2α in blood serum in patients with GERD and OH with III degree obese was found and the smallest concentration of prostaglandines in blood serum was diagnosed in patients with excessive weight (p<0.05). CONCLUSION: Conclusions: 1. In patients with GERD and OH, an increase in levels of prostaglandins F2α and I2 in blood serum has been established. 2. The relationship between the duration of excess body weigh, obesity and the dynamics of the level of prostaglandin Pg I2 and F2α in blood serum in patients with GERD on the background of OH has been established.

CHANGES IN SERUM GHRELIN AND ITS RELATIONSHIP WITH OF BODY MASS INDEX IN PATIENTS WITH GASTROESOPHAGEAL REFLUX DISEASE AND SPONDYLOARTHRITIS.

OBJECTIVE: The aim: To determine the features of changes in serum ghrelin levels and its relationship with the body mass index in patients with GERD and spondyloarthritis (SpA) with lesions of the cervical and thoracic spine. PATIENTS AND METHODS: Materials and methods: The examined patients included 80 patients with SpA with cervical and thoracic spine lesions in combination with GERD. The examined patients with SpA with predominant cervical and thoracic spine lesions were divided into two groups depending on the clinical course of GERD, namely: group I included 33 (41.2%) patients with typical esophageal manifestations of GERD (13 males (39.4%), 20 females (60.6%)), and group II consisted of 47 (58.8%) patients with atypical extraesophageal manifestations of GERD (among them were 17 (36.2%) males and 30 (63.2%) females). RESULTS: Results: All patients were tested for serum ghrelin by enzyme-linked immunosorbent assay. Analysis of clinical manifestations of atypical GERD (group II patients) revealed that most often patients with SpA of the cervical and thoracic spine were diagnosed with dental and otolaryngological masks of reflux disease (40.4 % and 25.5 % of patients, respectively). Maximum serum ghrelin levels were detected in patients with SpA with cardiac GERD (355.02 ± 4.75 ng/ml), while minimum values were found in patients with dental signs of reflux disease (298.17 ± 5.16 ng/ml - p <0.05). CONCLUSION: Conclusions: 1. In patients with SpA with cervical and thoracic spine lesions, GERD often has atypical symptoms (mostly dental and otolaryngological forms in 40.4% and 25.5% of patients). 2. In patients with SpA with esophageal clinical signs of GERD, normal weight or underweight is more common, while in patients with extraesophageal forms of GERD overweight or obesity of varying severity prevails. 3. In patients with SpA and GERD, an increase in serum ghrelin levels was found in patients with cardiac manifestations of reflux disease (355.02 ± 4.75 ng/ml). 4. The relationship between BMI changes in patients with SpA and GERD and increased serum ghrelin levels was found, namely: in group II patients with overweight and obesity a direct correlation was found, and in group I patients with underweight an inverse correlation was fund.

INTESTINAL LESIONS OCCURRING IN PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE AFTER SUFFERING THE COVID-19 INFECTION.

OBJECTIVE: The aim: To investigate the effectiveness of determining the activity of faecal calprotectin for detecting colonic lesions in patients with nonalcoholic fatty liver disease who have had a COVID-19 acute respiratory infection. PATIENTS AND METHODS: Materials and methods: The study included 46 patients with non-alcoholic fatty liver disease NAFLD at the stage of outpatient observation after suffering a COVID-19 acute respiratory infection. RESULTS: Results: One of the main clinical signs indicating intestinal lesions among the COVID-19-infected patients with NAFLD at the time of admission to hospital was diarrhea (identified in 43.5% of cases during the patients' examination), as well as bloating and pain in the colon (identified in 26.1% and 32.6% of cases during the patients' examination, respectively). The analysis of the data obtained indicates a slight increase in the level of faecal calprotectin among NAFLD patients infected with COVID-19 during hospital treatment, and in this regard the indicators did not exceed the reference values. A more pronounced deviation from the norm was observed 2 months after hospital treatment, namely, its increase to 101.6 ± 2.5 µg / L. CONCLUSION: Conclusions: A frequent clinical manifestation of intestinal lesions among NAFLD patients infected with COVID-19 is defaecation disorder, which at the beginning of the disease is more often manifested through alternating diarrhea (up to 43.5%) and constipation (32.6% of the examined patients). NAFLD patients infected with the COVID-19 virus are diagnosed with an intensified activity of faecal calprotectin and α1-antitrypsin in the blood serum and faeces, as well as the clearance, and this indicates the presence of inflammatory changes in the colon, which requires conducting further research of these patients' cases.

ASSESSMENT OF THE IMPACT OF ANTIREFLUX THERAPY ON THE COURSE OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE.

OBJECTIVE: The aim: To examine the effect of antireflux therapy on the course of COPD. PATIENTS AND METHODS: Materials and methods: Under observation were 60 patients who were hospitalized in the «Transcarpathian Regional Clinical Hospital named after Andrei Novak¼ with a diagnosis of COPD II gr B in combination with GERD and 36 patients diagnosed with GERD who were treated on an outpatient basis. To study the effectiveness of antireflux therapy and its impact on the course of COPD, patients are divided into 2 groups: 1 group (main) (n = 60) - patients with COPD in combination with GERD, group 2 (control) (n = 36) - patients with isolated GERD. Patients with positive Helicobacter pylori status received antihelicobacter therapy. Patients in group 1 were divided into subgroups: 1a (n = 34) - COPD in combination with esophageal manifestations of GERD and 1b (n = 26) - COPD in combination with extraesophageal manifestations of GERD. Group 1a received complex therapy, which consisted of basic therapy of COPD in combination with antireflux and with rebapimide, group 1b - only basic therapy of COPD in combination with antireflux. RESULTS: Results: After treatment, the clinical signs of GERD significantly decreased in all patients receiving complex therapy, improved the course of respiratory symptoms of COPD. After treatment, patients showed a clinically significant reduction in systemic inflammation, which is best seen in the group with the use of rabipimide. CONCLUSION: Conclusions: Comprehensive treatment of combined pathology with the use of antireflux therapy has a positive effect not only on the clinical symptoms of the disease, but also on the indicators of external respiratory function in patients with combined COPD and GERD.

FEASIBILITY OF CYSTATIN C DETERMINATION FOR EARLY DIAGNOSIS OF KIDNEY DAMAGE IN PATIENTS WITH TYPE 2 DIABETES COMBINED WITH NONALCOHOLIC FATTY LIVER DISEASE AND OBESITY EXPOSED TO COVID-19 INFECTION IN THE PAST.

OBJECTIVE: The aim: To examine the diagnostic possibilities of determining the level of cystatin C in the blood serum in order to ascertain the functional status of the kidneys in patients with type 2 diabetes (those who recovered from COVID-19 infection) depending on the presence or absence of non-alcoholic fatty liver disease (further - NAFLD) and malnutrition. PATIENTS AND METHODS: Materials and methods: We investigated 18 patients with type 2 DM, who were included in the first group of the patients examined; group 2 consisted of 20 patients with type 2 DM and non-alcoholic fatty liver disease (NAFLD), namely with non-alcoholic steatohepatitis; and group 3 of the patients examined consisted of 30 patients with type 2 DM and obesity. RESULTS: Results: Renal damage in patients with metabolically associated diseases in the background of respiratory disease due to COVID-19 infection was also indicated by changes in urine test indicators, and namely - proteinuria and erythrocyturia, leukocyturia in urine sediment. The examination of cystatin C (Cys C) level indicates its statistically significant increase in patients of all examined groups, with the highest levels established in group 3 patients (with its increase up to 2.58 ± 0.11 mg/L, compared with the norm of 0.75 ± 0.04 mg/L in the control group - p < 0.01). The examination of GFR by calculation, where the Cys C index in serum was used, revealed a significant decrease in this parameter in all the examined groups of patients. At the same time, the maximum values were found in group 1 patients (65.7 ± 1.4 ml/min per 1.73 m2 of the body surface), and the minimum values - in group 3 patients (48.3 ± 2.7 ml/min per 1.73 m2 of the body surface). CONCLUSION: Conclusions: An increase in serum cystatin C levels was determined in type 2 diabetes patients, with the lowest level in group 1 patients (1.24 ± 0.07 mg/L - p < 0.05), and the highest level in patients suffering from type 2 diabetes combined with NAFLD and obesity (2.58 ± 0.11 mg/L - p < 0.01). A moderate to severe course of COVID-19 infection in patients with type 2 diabetes as well as with its combination with NAFLD and obesity contributes to the development of renal functional disorders in these patients. Moreover, an increase in serum Cys C levels is a more sensitive and earlier marker of renal damage development in comorbid pathology.

PECULIARITIES OF DETERMINING THE GASTRIC ACID SECRETION AND DIABETIC AUTONOMIC NEUROPATHY IN PATIENTS WITH CHRONIC PANCREATITIS AND TYPE 2 DIABETES.

OBJECTIVE: The aim: Is to determine the peculiarities of changes in the gastric acid secretion against the background of diabetic autonomic neuropathy and autonomic dysfunction in patients with chronic pancreatitis (CP) and type 2 diabetes (T2DM). PATIENTS AND METHODS: Materials and methods: We investigated 64 patients with CP and T2DM, who were included in the first group of the patients examined; Group II consisted of 40 patients with T2DM; and Group III of the patients examined consisted of 34 patients with CP. RESULTS: Results: Differences were found in assessing the degree of autonomic nervous system (ANS) dysfunction in the examined patients, namely - the most pronounced ANS dysfunction according to the Wayne questionnaire was diagnosed in patients Group I, while patients of Group III. Analysis of gastric acid secretion indicates that no patients of Group III had normal acidity. Normal acidity is more often found in the second group of subjects. Both in patients with CP and T2DM, and in isolation with CP, moderate hyperacidity was more often determined. CONCLUSION: Conclusions: The predominance of the parasympathetic division of the ANS, as well as manifestations of severe ANS dysfunction, are observed in patients with CP and T2DM. The prevalence of gastric hyperacidity on the background of DAN was established in patients with CP and T2DM. In this case, the absence of clinical symptoms or their minimal severity is determined, which indicates the lesion of the digestive tract in these patients.

PECULIARITIES OF CHANGES IN HOMOCYSTEINE LEVELS DEPENDING ON VITAMIN STATUS IN PATIENTS WITH CHRONIC PANCREATITIS AND TYPE 2 DIABETES.

OBJECTIVE: The aim: To determine the peculiarities of changes in the homocysteine levels in the patients with chronic pancreatitis and type 2 diabetes blood serum depending on the vitamin status. PATIENTS AND METHODS: Materials and methods: We investigated 36 patients with chronic pancreatitis and type 2 diabetes, who were included in the first group of the patients examined; Group 2 consisted of 34 patients with chronic pancreatitis; and Group 3 of the patients examined consisted of 40 patients with type 2 diabetes. RESULTS: Results: All patients examined were diagnosed with type 2 diabetes mellitus of moderate severity. Also, the diagnosis of chronic pancreatitis was confirmed in all patients with type 2 diabetes, which was manifested by exocrine pancreatic insufficiency according to the results of clinical, laboratory and instrumental methods of examination. There was a significant decrease in the level of all B vitamins and 25-(OH)D in patients with chronic pancreatitis and type 2 diabetes (Group I). An increase in the concentration of homocysteine in the serum in all examined groups of patients was established, with the maximum deviation from the norm in patients with chronic pancreatitis and type 2 diabetes (up to 32.7 ± 0.8 µmol / L <0.01). The correlation analysis revealed a strong direct relationship between the level of homocysteine and vitamins B12, B6, 25-(OH)D and an inverse correlation between vitamin B9 in the group of patients with chronic pancreatitis and type 2 diabetes. CONCLUSION: Conclusions: Patients with chronic pancreatitis and type 2 diabetes have a decreased levels of B vitamins (B1, B6, B9, B12) and 25-(OH)D, which is accompanied by an increase in serum homocysteine. In patients with chronic pancreatitis and type 2 diabetes, the level of homocysteine in the blood serum directly depends on the decrease in the levels of vitamins B6, B12 and 25-(OH)D in blood serum, as well as inverse depends on vitamin B9 levels in these patients.

CORRECTION OF AUTONOMIC AND COGNITIVE DISTURBANCES IN PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE.

OBJECTIVE: The aim: To explore the features of the congnitive (CD) and neurovegetative dysfunctions (NVD) of patients with different forms of non-alcoholic fatty liver disease NAFLD (nonalcoholicfatty hepatosis (NAFH) and non-alcoholic steatohepatitis (NASH)) and type 2 diabetes mellitus (T2DM), as well as their dynamics against the background of complex therapy using armadin (2-ethyl-6-methyl-3-hydroxypyridine succinate). PATIENTS AND METHODS: Materials and methods: 50 patients with NAFLD (24 patients with NAFH and 26 patients with NASH) and T2DM were examined. Dysfunction of central and vegetative nervous system was carried out with the help of neuro-psychometric testing. RESULTS: Results: The analysis of the conducted research before treatments indicates the NVD in the surveyed patients. Cognitive dysfunctions (mostly mild and moderate) was revealed in all of our patients in both groups. The most pronounced disturbances before treatments were determined in the areas of attention and concentration, memory, less pronounced - visually constructive area, especially among patients with NASH and T2DM. Stressful situations have a pronounced impact on the lives of these patients, but they are not critical enough to any issues. Patients of Group 2 before treatments had the lowest level of resistance to stress. They found a slight vulnerability even from minor impacts. CONCLUSION: Conclusions: In patients with NAFLD and T2DM, congnitive and neurovegetative dysfunctions were found, according to neuro-psychometric testing. Complex therapy using 2-ethyl-6-methyl-3-hydroxypyridine succinate is an effective and safe method for the correction of congnitive and neurovegetative dysfunctions in patients with NAFLD and T2DM.

Changes in the level of α1-antitrypsin in patients with non-alcoholic fatty liver disease.

OBJECTIVE: The aim: To investigate changes in the level of α1-antitrypsin (A1AT) in blood and in stool and their diagnostic value in patients with NAFLD and with impaired carbohydrate metabolism at different stages of liver damage. PATIENTS AND METHODS: Materials and methods: 34 patients with non-alcoholic fatty hepatosis (NAFH) and 40 patients with non-alcoholic steatohepatitis (NASH) were examined. Enzyme-linked immunosorbent assay for all patients with serum and coli was performed by determining the level of A1AT. RESULTS: Results: In patients with NAFLD, in combination with IR, the level of A1AT in the blood plasma is only 1.6 times higher than that of the control group (p <0.05), and in the case of combination of NAFH and type 2 diabetes mellitus (T2DM) - it is 2 times higher (p <0.05). In patients with NASH in combination with insulin resistance (IR), the level of A1AT in the serum was 4.1 times higher than in the control group, and for NASH and type 2 diabetes - 4.2 times. CONCLUSION: Conclusions:The level of A1AT in the blood plasma increases proportionally to the degree of progression of liver damage (from the minimum values at NAFH to the maximum at NASH), regardless of the type of carbohydrate metabolism disturbance. The combination of NAFLD and T2DM is accompanied by a more pronounced increase in A1AT in stool and α1-antitrypsin clearance than the combination of NAFLD and IR.

DYNAMICS OF GASTRIN LEVEL IN PATIENTS WITH DIABETES MELLITUS 2 TYPE AND CHRONIC GASTRITIS AFTER HELICOBACTER PYLORI ERADICATION THERAPY.

OBJECTIVE: The aim: To study the gastrin level dynamics in patients with diabetes mellitus (DM) 2 type and chronic gastritis (CG) on the background of antihelicobacter therapy (AHT). PATIENTS AND METHODS: Materials and methods: 60 patients with DM type 2 and HP-associated CG underwent examination. Patients were divided into two groups of 30 patients each: group 1 included patients who received only standard AHT, group 2 - patients who in addition to standard AHT received the drug SB (Normagut, company Mega) 2 capsules 2 times/day. RESULTS: Results: According to our study results yeast SB, not only increase the HP eradication rate but together with the standard AHT contribute to the serum gastrin reduction, which is a gastric acid stimulator, which in turn leads to an improvement in the CG clinical course. CONCLUSION: Conclusions: Patients with DM type 2 and CG associated with HP should include yeast SB to standard AHT as they reduce side effects from this treatment (by an average of 20%), increase the eradication frequency (by 10%), and also lead to significant decrease in serum gastrin (up to 82.15 ± 2.47 pg/ml).A decrease in serum gastrin levels in patients with HP-associated CG and DM type 2 leads to an improvement in the clinical course of the diseases, namely a decrease in nausea, diarrhea, abdominal pain, and discomfort incidence.

Effect of kallistatin and ghrelin on the formation of endothelial dysfunction in patients with chronic pancreatitis and atherosclerosis.

OBJECTIVE: Introduction: The article is devoted to the optimization of complex diagnosis of endothelial dysfunction in patients with a combination of chronic pancreatitis and atherosclerosis. The aim: To study the level and effects of kallistatin and ghrelin on the formation of endothelial dysfunction in patients with chronic pancreatitis and atherosclerosis. PATIENTS AND METHODS: Materials and methods: 54 patients with chronic pancreatitis were examined. The serum kallistatin level was determined by immunoassay using the Human Serpin A4 ELISA Kit from RayBiotech according to the application method. The serum ghrelin level was determined by immunoassay using the Human/Mouse/Rat Ghrelin Enzyme Immunoassay Kit from RayBiotech. Endothelial dysfunction was determined by the method proposed by D.Celermajer. RESULTS: Results: The study of endothelial-dependent and endothelial-independent vasodilatation is indicative of the presence of a pronounced ndothelial dysfunction in patients with chronic pancreatitis and atherosclerosis, which was manifested by a decrease in their level to 8.7±0.4% and 16.8±0.7%, respectively. The level of kallistatin and ghrelin in patients with chronic pancreatitis and atherosclerosis (15.44 ± 3.97 ng/ml and 276.69 ± 10.06 ng/ml respectively) also confirmed their important role in the formation of еndothelial dysfunction in these patients. CONCLUSION: Conclusions: The study of ghrelin and kallistatin level in serum can serve as a criterion for determining the severity of chronic pancreatitis and atherosclerosis, the development of endothelial dysfunction, and be a marker for predicting their future course.

Changes in cholecystokinin level in patients with gastroesophageal reflux disease on the background of type II diabetes.

OBJECTIVE: Introduction: The question of the combination and combined influence of the gastroesophageal reflux disease (GERD) and many other chronic diseases of internal medicine, including diabetes, have not been studied enough. The aim: To investigate the changes in cholecystokinin (CCK) levels in blood serum of patients with GERD on the background of type II diabetes. PATIENTS AND METHODS: Materials and methods: On the basis of the propaedeutics of internal diseases department of the medical faculty of the SHEI "UzhNU" during the period of 2016 - 2017, 48 patients were examined for type II diabetes with GERD (main group: group I). The comparison group comprised 18 patients with GERD (group II). All of the patients had their blood serum cholecystokinin levels examined with the help of enzyme-linked immunosorbent assay (ELISA) using the test system of the "Peninsula Laboratories" (USA) company. RESULTS: Results: The gathered data points to an increase of the CCK levels in blood serum in patients with GERD, as compared to the indices of the control group. This being said, we can highlight that in patients with the background of combined pathology, type II diabetes and GERD in particular, the level of CCK exceeds the average by 6 times, whereas in patients with GERD (comparison group) it exceeds only by 2.4 times. Further analysis of the gathered results points out an interesting pattern in the changes of blood serum CCK levels in patients with GERD on the background of type II diabetes depending on the BMI, in particular - the maximal indices were observed in patients with excess body weight. CONCLUSION: Conclusions: In patients with GERD an increase of CCK level is observed, as compared to the indices of healthy individuals. The combination of GERD and type II diabetes is accompanied by a more prominent increase of CCK in blood serum, with a correlation between the disorder of the nutritional status and the CCK level had been established, namely - its maximal indices in patients with excess body weight.