[The evaluation of prognostic value of biomarkers in patients with chronic cardiac insufficiency].

Nowadays, the laboratory markers of myocardial dysfunction (cerebral natriuretic peptide - NT-proBNP); instability of atherosclerotic plaque (highly sensitive C-reactive protein - hsCRP); damages of cardiac muscle (highly sensitive cardiac tropine I - hs-cTnl) play a key role in diagnostic, course prognostics and verification of risk of unfavorable outcomes in patients with chronic cardiac insufficiency. The article presents the results of study of dynamics of levels of NT-proBNP, hsCRP, hs-cTnl in 71 patients with chronic cardiac insufficiency of II and III functional class (according classification of New-York association of cardiologists - NYHA). The comparison was made concerning analyzed laboratory markers with fraction of output of left ventricle of heart and index of body mass relatively to their prognostic role inpatients with chronic cardiac insufficiency with different clinical conditions and various outcomes of disease. It is demonstrated that level of hs-cTnl is the most valuable in respect to unfavorable prognosis of course of chronic cardiac insufficiency and risk of lethal outcome. The level of NT-proBNP has invert correlation relationship with fraction of output of left ventricle of heart and can be considered as a laboratory indicator of functional condition of myocardium in patients with chronic cardiac insufficiency.

[Dynamics of laboratory markers of endothelial dysfunction during treatment of unstable angina].

This study was aimed to assess the diagnostic value of laboratory markers of endothelial lesions in patients with unstable angina (UA). Plasma levels of CRP, homocysteine, endothelin-1 (ET1), and pregnancy-associated plasma protein (pAPP-A) were measured by an ultrasensitive method in 51 patients. They were followed up for 4 months to evaluate the clinical picture of CHD and dynamics of laboratory parameters. The hospitalized patients with UA had elevated baseline levels of CRP (5.02+-3.35 mg/ml) during the entire study period. PAPP-A and homocysteine levels were significantly decreased (p<0.05 and p<0.0 respectively). Patients with deteriorated clinical picture of CHD had significantly elevated ET1 levels (p<0.05) both on day 1 and 4 months later It is concluded that ET1 levels increase in patients with UA and severe prognostically unfavourable CHD.

[Effect of body mass reduction on the level of adiponectin in patients with obesity and type 2 diabetes mellitus].

Patients with obesity and type 2 diabetes mellitus are known to have hypoadiponectinemia partially compensated by switching to low-caloric diet. Reduction of the body mass results in the proportional increase of the adiponectin level and decreased severity of insulin resistance.

[Diagnostics of inflammation activity in infectious endocarditis].

This work was designed to analyse dynamics of inflammation markers (C-reactive protein, TNF-alpha) and procalcitonin in 66 patients with infectious endocarditis (IE) followed up during 6 months. Comparison of clinical observations and laboratory data revealed specific trends in these parameters in patients with different clinical course of IE and at its different stages. Some of the changes are shown to be responsible for the unfavourable prognosis of IE. TNF-alpha levels are considered to be a sensitive and informative index of the patients" clinical conditions throughout the entire period of IE evolvement.

[Diagnostic efficiency of laboratory tests determining the functional status of the endothelium in patients with chronic diffuse liver diseases].

The patients with chronic diffuse liver diseases were found to have signs of endothelial damage, which manifests itself as increases in the count of desquamated endotheliocytes, the level of vascular endothelial growth factor, and the concentration of von Willebrand factor in plasma and to have signs of endothelial dysfunction as reduced nitric oxide levels and elevated endothelin-1 concentrations in plasma. The magnitude of changes in the indicators of endothelial dysfunction and in the markers of endothelial damage depends on the severity of hepatic damage.

[Specific features of the clincal course of infectious endocarditis in a multi-field hospital].

The clinical course of infectious endocardities (IE) was followed in 112 patients admitted to the Botkin City Hospital in 2000-2007 with reference to the age and social structure of the pathology, its clinical symptoms, results of laboratory and instrumental analysis, strategy of antibacterial therapy, and outcome of the disease. The data were compared with those obtained in the previous period (1987-1955). He study demonstrated an increased number of men with IE (up to 65%) in the recent years and an almost two-fold rise in the incidence of primary endocardities. The frequency of thromboembolic complications also increased (from 34 to 69%) involving the pulmonary artery system (24%). The same refers to the number of patients with multivalvular lesions (2, 3 or 4 heart valves) and affected right cardiac chambers (28.4%). Shortcomings at various stages of the treatment of patients with endocarditis have been revealed.

[Comparison of the effects of carbohydrate metabolism compensation and atorvastatin treatment on lipid metabolism and C-reactive protein in type 2 diabetes mellitus].

AIM: To compare effects of atorvastatin treatment and carbohydrate metabolism compensation on lipid spectrum and a C-reactive protein (CRP) level in patients with type 2 diabetes mellitus (DM). MATERIAL AND METHODS: The lipid spectrum was studied in a random sample of 165 patients (66 males, 99 females) with type 2 DM (age median 57 years, duration of the disease 7 years). Out of this sample 26 patients with LDLP cholesterol >3 mmol/l were randomized into 2 groups. The study group received 20 mg/day atorvastatin for 3 months, the control group received no inhibitors of GMG-Coa-reductase. The patients' blood was tested for glycosylated hemoglobin, aminotransferase, creatinphosphokinase, total, HDLP, LDLP cholesterol. RESULTS: Changes in the lipid spectrum were detected in 98.2% patients, 42.4% of them had combined dyslipidemia: elevated total cholesterol (TC), LDLP cholesterol, triglycerides (TG) and low HDLP cholesterol. After 3 months of therapy both groups demonstrated the same significant lowering of HbA(1c). The control group had also elevated level of HDLP cholesterol, unchanged levels of TC, LDLP cholesterol, TG. 3-month therapy with atorvastatin lowered TC from 6.41 to 4.76 mmol/l, LDLP cholesterol from 4.19 to 1.87 mmol/l, TGfrom 2.69 to 1.62 mmol/l, apo B from 1.64 to 1.13 mg/dl, raised HDLP from 0.99 to 1.21 mmol/l (p < 0.05). CRP fell from 5.65 to 2.33 mg/dl (p=0.026) irrespective of carbohydrate metabolism compensation (CRP in the control group did not change). CONCLUSION: More than 98% type 2 diabetics have atherognic impairment of the lipid spectrum. Atorvastatin produces an antiatherogenic effect due to both improvement of the lipid metabolism and CRP level reduction irrespective of the degree of compensation of carbohydrate metabolism in type 2 DM

[Effect of blood pressure on the plasma renin-angiotensin system].

The relationship of systolic and diastolic blood pressure (BP) to the peripheral blood renin-angiotensin system (RAS) has been examined. BP has found to be inversely related to the concentration and activity of plasma RAS components. It has been shown that angiotensin-converting enzyme (ACE) affects BP more greatly than do other plasma RAS components. It is suggests that RAS activation or depression is an adjustment to BP elevation or lowering. Altered BP triggers the biochemical mechanisms responsible for regulating vascular tone, cardiac output, and water-salt balance. All RAS components under study show a weak association with BP in some patients. It is concluded that the laboratory plasma RAS test is of low informative value in diagnosing hypertension and hypotension in clinical practice.

[Angiotensin converting enzyme activity in the clinical course and forming of cor pulmonale in patients with chronic obstructive pulmonary diseases].

The aim of the study was to evaluate the influence of ACE in various biological media (blood, sputum, and lung tissue) on the clinical manifestations and morphofunctional cardiac variables in 137 patients with chronic obstructive pulmonary disease (COPD), of whom 17% had mild, 70% had medium, and 13% had severe degree of the disease according to Federal program, 1999. Seventy percent of the patients had stage II pulmonary hypertension according to Paleyev, 1986, while the number of patients with stage I and III was 14 and 16%, respectively. Circulatory insufficiency was mild (NYHA I to II) in 124 patients, and medium (NYHA III) in 13 patients only. The results of the study demonstrate that COPD exacerbation is accompanied by an increase in ACE activity, mostly in the lung tissue, induced sputum (IS), and, to a lesser degree, in blood serum; ISA CE activity is almost the same as that in the lung tissue. The study established a direct correlation between IS ACE activity and the level of C-reactive protein, an inflammatory process activity marker, and a reverse correlation between IS ACE activity and respiratory function variables, the latter characterizing bronchial obstruction. The study shows a strong direct correlation between IS ACE activity and the degree of right ventricular (RV) and left ventricular (LV) hypertrophy, as well as diastolic function disturbances according to RV isovolumetric relaxation time and LV early diastolic filling delay time. There is a strong reverse correlation between IS ACE activity and the disbalance of the ratio of blood flow velocities during early and late diastolic ventricular filling. The study found no significant correlations between ACE activity and the variables of ventricular systolic function. The study demonstrates a significant role of ACE activity changes in the progression of obstruction, inflammation, and myocardial remodeling.

[Potential of antiinflammatory therapy in patients with chronic obstructive lung disease].

The aim of the study was to investigate the effects of erespal (fenspirid) on the clinical manifestations and parameters of inflammation in patients with chronic obstructive lung disease (COLD). The two stages of the study included 3-weak treatment during exacerbation periods and a 3-month outpatient follow-up during clinical remission periods. Erespal was administered twice a day in a total dose of 160 mg/day. The study included evaluation of clinical symptoms, respiratory function, bronchoscopic data, laboratory indices of inflammation, antioxydative status, life quality (LQ), as well as cytological and cytochemical analysis of induced sputum (IS). During exacerbation periods of COLD the researchers observed early and noticeable antitussive and mucolytic action of erespal, which were associated with lessening of bronchial obstruction and inflammation, significant fall of C-reactive protein level, cytosis in IS, proportion of neutrophiles (p < 0.01), elevation of lysosomal cation proteins in neutrophiles (p < 0.01), increase of total oxidant serum level (in 46.2% of the patients vs. 26.3% of the patients in the conventional therapy group). Long term (3 months) treatment with erespal led to further positive dynamics of clinical and laboratory indices of inflammation, and improved the results of cytological and cytochemical study of IS. The results of the study demonstrate that inclusion of erespal in complex therapy of COLD increases efficacy of treatment, due to its anti-inflammatory action during the periods of exacerbation and relative remission, prevents augmenting of bronchial obstruction, and improves patients' LQ.

[Acoustic (ultrasound) determination of concentration of whole protein and protein fractions in blood serum].

A new method is suggested for determining the concentration of whole protein and the distribution of protein fractions in blood serum by means of an ultrasound device. The acoustic method is based on measuring the proliferation rate and absorption of the ultrasound signal in the examined serum. The findings of the method were compared with those obtained by routine tools in examining both blood sera of patients and controls. A high correlation factor was registered for the biuret method in the determination of the concentration of whole protein (R = 0.95; p < 0.05). It was demonstrated as possible to use the discussed method as a screening tool in evaluating the distribution of protein fractions. The examination findings are generated by the instrument as in the electrophoretic examination. The method is simple in use. No reagents are needed.

[Effects of hyper- and dyslipidemias on activity of angiotensin-converting enzyme (biochemical disturbances in metabolic syndrome)].

AIM: To study influence of lipoprotein complexes on activity of angiotensin-converting enzyme (ACE). Material and methods. Lipoproteins fraction was isolated from the serum of 53 healthy males and females and was studied for lipoproteins action on ACE in vitro. In addition, the examination covered 783 individuals. The data were analysed mathematically for relationships between ACE activity and parameters of lipid metabolism. RESULTS: It was found that blood serum lipoproteins inhibit activity of soluble ACE. Serum ACE activity depends on concentration of total cholesterol (TC) and triglycerides. Maximal activity of ACE is observed in TC 9.41 mM/l and TG concentration 3.05 mM/l. Albumin-related free fatty acids affect ACE activity neither in aqueous solution nor in the presence of lipoprotein complexes. CONCLUSION: . Development of most common atherogenic hyperlipidemias raises 2-fold plasma ACE activity. Elevated ACE activity may be an integral component of biochemical disturbances in metabolic syndrome.

[Lipoproteins of blood serum and the activity of angiotensin-converting enzyme]. / Vliianie lipoproteinov syvorotki krovi na aktivnost' angiotenzinprevrashchaiushchego fermenta.

We studied the influence of native lipoproteins on the activity of the angiotensin-converting enzyme (ACE). Lipoproteins of blood serum were inhibiting the activity of soluble ACE. The ACE activity in blood serum was found to depend on a concentration of total cholesterol and of triglycerides. The maximal ACE activity was observed at a concentration of total cholesterol of 9.41 mM/l and at a concentration of triglycerides of 3.05 mM/l. The albumin-linked non-etherified fatty acids affected the ACE activity neither in water solutions nor in presence of lipoprotein complexes. According to the study, the progression of most frequent atherogenic hyperlipidemia results in a 2-fold increase of the ACE activity. It is suggested that an intensified ACE activity in blood plasma can be regarded as an integral component of biochemical disorders in metabolic syndrome.

[Changes in angiotensin-converting enzyme activity in pneumonia and chronic obstructive lung diseases]. / Izmenenie aktivnosti angiotenzinprevrashchaiushchego fermenta pri pnevmonii i khronicheskikh obstruktivnykh bolezniakh legkikh.

The activity of angiotensin converting enzyme (ACE) was analysed in blood serum and bronchial fluid of 69 patients with acute pneumonia and 77 patients with chronic obstructive pulmonary diseases (COPD). In patients with pneumonia in acute phase ACE activity was lower in both serum and bronchial fluid. During recovery of patients with acute pneumonia ACE activity was normalizated. In patients with COPD ACE activity was lower in remission stage and higher (both serum and bronchial fluid) during COPD exacerbation. The changes of ACE activity were more pronounced in bronchial fluid than serum in both COPD and pneumonia.

[The change in the activity of angiotensin converting enzyme in patients with pneumonia and chronic obstructive pulmonary diseases]. / Izmenenie aktivnosti angiotenzinprevrashchaiushchego fermenta u bol'nykh pnevmoniiami i khronicheskimi obstruktivnymi zabolevaniiami legkikh.

The activity of angiotensin-converting enzyme (ACE) was measured in the serum and bronchial contents of 69 patients with pneumonia and 77 with chronic obstructive pulmonary diseases (COPD). ACE activity was decreased both in the blood and bronchial contents during the acute phase of pneumonia. With resolution of the inflammatory process, ACE activity normalized. In patients with COPD, the activity of ACE is decreased during remission in comparison with the mean values in the population. During COPD exacerbation the activity of ACE increases both in the blood and bronchial contents. Changes in ACE activity in pneumonia and COPD are more pronounced in the bronchial contents than in the blood. Presumably alteration of the enzyme concentration is the only cause of alteration of its activity in patients with COPD and pneumonia.

[Acarbose (glucobai) effects on lipid metabolism in patients with non-insulin dependent diabetes mellitus]. / Vliianie akarbozy (gliukobaia) na lipidnyi metabolizm bol'nykh insulinonezavisimym sakharnym diabetom.

AIM: To investigate the effect of acarbose, intestinal alpha-glucosidase inhibitor, on lipid metabolism in patients with non-insulin-dependent diabetes mellitus (NIDDM). MATERIAL AND METHODS: Glucobai was given for 6 months in a dose 300 mg/day to 63 NIDDM patients aged 40-69 years. The examination covered indices of glycemia, glycosylated hemoglobin, pancreatic insulin secretion, total cholesterol (TC), triglycerides (TG), HDLP and LDLP cholesterol, atherogenic index. RESULTS: Glucobai has improved glycemic profile, reduced insulinemia and body mass index, TC, TG, atherogenic index. Blood levels of HDLP cholesterol elevated by 62%. CONCLUSION: Long-term intake of acarbose improves carbohydrate metabolism and produces a hypolipidemic effect.