ABSTRACT
BACKGROUND: The authors present evidence of the significance and role of the disturbances in platelet hemostasis in pathogenesis of co-morbid cardiac pathology and the absence of the unambiguous opinion as regards the expediency of the application of hyperbaric oxygenation (HBO) for their correction which implies the necessity of searching for new pathogenetically substantiated approaches to the treatment of the patients presenting with this condition. AIM: The objective of the present study was to evaluate the influence of hyperbaric oxygenation on the elastic properties of platelet membrane during spontaneous platelet aggregation in the patients presenting with cardiac co-morbidity. MATERIAL AND METHODS: Thrombocyte hemostasis was investigated in 24 patients at the age of 52.9±11.5 years (67% of men, 33% of women) presenting with functional class II angina of effort concomitant with arterial hypertension (AH). All the patients were given, in addition to the conventional treatment of the main diseases, the courses of daily (No. 5) 30-minute sessions of hyperbaric oxygenation in the 1,2ATA regime in the BLKS 301M and 303MK barochambers (Russia). Before and after HBO, spontaneous aggregation of thrombocytes (light agglomeration method) was determined with the use of a two-channel Biol LA-230-2 laser analyzer (Russia). The elastic properties of the platelet cell membrane were elucidated by atomic-force microscopy in the contact mode using the cantilever type PNP-DB on the Solver P47-PRO scanning probe microscope (Nt-MDT, Russia). RESULTS: The co-morbid cardiac pathology was accompanied by hyperaggregation and hypoaggregation of the platelets (33.3% and 25% respectively). The high levels of spontaneous aggregation in men (1.46±0.47) and the dependence of platelet plate stiffness on the aggregation state were documented. HBO sessions were accompanied by a reduction of spontaneous platelet aggregation in men (0.84±0.19) and a two-fold decrease in the modulus of elasticity in comparison with its initial value in the patients with platelet hyperaggregation (0.42±0.16, p<0.05). CONCLUSION: The membrane-modifying effect of HBO on the platelets is characterized by an increase in the elasticity of their membranes concurrent with a reduction of spontaneous aggregation of platelets, predominantly in men.
Subject(s)
Cardiovascular Diseases/therapy , Hyperbaric Oxygenation , Platelet Aggregation/physiology , Adult , Cardiovascular Diseases/epidemiology , Comorbidity , Female , Humans , Male , Middle Aged , RussiaABSTRACT
The poly-morbidity is an actual problem of clinical medicine. The chronic hepatitis and tuberculosis are among widespread socially significant diseases while their relationship needs further investigation. The purpose of study is to analyze rate of occurrence, structure and clinic а chronic hepatitis taking course in comorbidity with tuberculosis of various localizations. The technique of continuous sampling was applied to carry out cohort randomized single-staged study analyzing rate structure and clinic of chronic hepatitis in 1189 patients with tuberculosis including pulmonary (n=1125), extra-pulmonary (n=24), abdominal (n-40) localizations. The chronic hepatitis is established in 45% of all cases and in half of cases out of them at the stage of exacerbation (53.2%) when the disease is presented by viral (59.6%) predominantly hepatitis C, alcoholic (25.7%), non-alcoholic (9.8%) and medicinal (4.9%) steatohepatits. The chronic hepatitis associates with pulmonary tuberculosis 3.4-1.7 times more often than with extra-pulmonary and abdominal tuberculosis. The chronic hepatitis is characterized by minimal and moderate activity of inflammation. The chronic hepatitis in case of abdominal tuberculosis manifests more expressed alterations of all laboratory syndromes of hepatitis. The medicinal hepatitis was established only in case of pulmonary tuberculosis. The chronic hepatitis С and B progresses in a comorbide way, is characterized by little symptoms, cytolysis with 2.3-2.8 standards of ALT, AST, minimal parenchymatous jaundice and cholestasis with activity of GGTP 2.86 of standards, mesenchymal inflammation in 3.1-3.4 times more often in case of its comorbidity with extra-pulmonary and abdominal tuberculosis. The alcoholic steatohepatitis is characterized by higher cytolysis, predominance of activity of AST over ALT, more expressed parenchymatous jaundice and cholestasis. The non-alcoholic steatohepatitis is characterized by poly-morbidity with diabetes mellitus type II also, cardiovascular pathology, steatosis of liver, the lowest parameters of markers of cytolysis, mesenchymal inflammation, jaundice, cholestasis and normal values of markers of hepatic cellular inadequacy. The medicinal hepatitis is characterized by increasing of asthenia, nausea, development of jaundice, skin itching, hepatomegaly,cytolysis, cholestasis, hyper-bilirubinemia against the background of specific poly-chemotherapy.