BONE FORMATION MARKERS (N-TERMINAL PROPEPTIDE TYPE I PROCOLLAGEN, OSTEOCALCIN AND VITAMIN D) AS EARLY PREDICTORS OF OSTEOPOROSIS IN PATIENTS SUFFERING FROM CHRONIC OBSTRUCTIVE LUNG DISEASE.

The aim of the work was to find out whether markers of bone formation can be early predictors of osteoporosis in patients with COPD. The study involved 66 patients with COPD with disease duration from 10 to 30 years, age 53.59±12.83 years. 37 (66.06%) patients smoked, the pack / year index was (29.08±16.62). According to the results of CAT testing, all patients were divided into 4 clinical groups: GOLD I-IV. The content of serum markers of bone formation was determined: N-terminal procollagen type I propeptide (PINP), osteocalcin and vitamin D depending on the age and severity of COPD. A decrease in all markers of bone formation was found with the age of patients and the severity of COPD. Thus, in patients under 45 years, the P1NP level was 48.75% higher than in patients aged 75 and older (p<0.001). A significant relationship was established between the age of patients and the P1NP level (r= -0.46; p=<0.05). With GOLD I, a decrease in the P1NP content was observed in 40.0% of patients, with GOLD II - 48.0%, GOLD III - in 45.0%, and with GOLD IV, such a decrease was in 66.67% of patients. The level of osteocalcin decreased in patients with COPD of old age compared with the control by 2.72 times and in young people - by 1.88 times. With GOLD I, a decrease in osteocalcin content was observed in 66.67%, with GOLD II - 89.0%, GOLD III - in 85.0%, and with GOLD IV, a decrease was observed in all (100%) patients. The concentration of vitamin D was reduced in all patients with COPD, and severe vitamin D deficiency was diagnosed in 23.08% of patients under 45 years, in 70.59% of elderly patients, in 100% of elderly people. Among the representatives of GOLD IV, the level of vitamin D decreased by 1.75 times as compared with patients with GOLD I. A severe form of vitamin D deficiency was diagnosed in 46.67% of patients with GOLD I, 40.0% in GOLD II, 65.0% in GOLD III, and in 100% of patients with GOLD IV. The data obtained indicate that with increasing age and increasing severity of COPD, the formation of markers of bone tissue formation is inhibited. These processes occur against the background of vitamin D deficiency. As a result of this imbalance, favorable conditions are created for the development of osteoporosis. Considering that the first signs of these disorders, in particular a decrease in the levels of vitamin D and osteocalcin, are diagnosed already with GOLD I, it can be argued that COPD is the leading factor.

[CHANGES INTESTINAL MICROBIOTA IN DIFFERENT AGE GROUPS OF AGRICULTURAL WORKERS WITH CHRONIC NON-SPECIFIC LUNG DISEASE].

One of inductors various pathological conditions, including respiratory system increasingly acts violation intestinal microbiota. Effect of chronic inflammatory diseases of the lung for diseases of the gastrointestinal tract can be caused by the development of systemic inflammation, chronic infection, metabolic disorders, changes in blood gas, inhaled and systemic corticosteroids, impaired microcirculation. The aim of this research to study the features of breach of intestinal microbiota and its changes in chronic non-specific lung disease among workers in agriculture. A total of 195 workers agriculture male patients with chronic nonspecific lung diseases. In 111 (56.92%) diagnosed with chronic obstructive lung disease (COLD), of whom 50 (45.05%) diagnosed with COLD I and 61 (54.95%) - COLD II. At 84 people (43.08%) diagnosed with chronic bronchitis. To determine the state of the microbiota studied the microbiological tests of stool with the definition of species composition and population level microflora by the procedure R.B. Epstein-Litvak, F.L. Olshansky (1977). In 50 (25.64%) showed signs of dyspeptic syndrome, as well as reducing the number of bifidobacteria and lactobacilli, Escherichia with normal enzymatic activity and an increase in the number of lactose-negative Escherichia coli, fungi of the genus Candida, Staphylococcus and other representatives of conditionally pathogenic flora. The diagnosis of intestinal dysbiosis of I stage in 36 (72%) people and II stage - in 14 (28%) patients. The most significant clinical changes depended on the stage and functional features of bronchitis, smoking experience, age of male patients.

[APPLICATION OF CLIENT-CENTERED PSYCHOTHERAPY IN THE COMPLEX TREATMENT OF ADOLESCENTS WITH PSYCHOSOMATIC DISORDERS].

Treatment of psychosomatic disorders does not allow to do without medication intervention, although psychotherapy is important, aimed at correcting psychopathological symptoms. That's why, the definition of a method of therapy, which is better and more likely to cause positive results. The aim - determining which the better method of treatment and more effective of the causes a positive shift in the dynamics of clinical syndromes. The group of 90 adolescents (34 boys and 56 girls) with psychosomatic disorders divided into 2 groups, were inspected using received comprehensive clinical psychopathological examination. The average age of adolescents was 14.4 ± 0.06 years old. The 1-st group (57 persons) consisted of adolescents, who received treatment with Lamotrigine and Sertraline 25 mg / day for persons from 12 to 16 years old and 50 mg / day - over 16 years old. The duration of treatment was 1.5-2 months. Adolescents of the 2-nd group (33 persons) were prescribed Lamotrigine and Sertraline therapy in combination with psychotherapy. Control of therapeutic effectiveness was evaluated by clinical and Spielberger anxiety questionnaire (STPI - State Trait Personal Inventory), Phillips' school anxiety test and CDI scale (Children Depression's Inventory) by M. Kovacs. Statistical processing was carried out on the basis of the computer program "Statistica 6.1." (Stat Soft Inc., USA). The anxiety level moved to an average level after medication, except situational negative experiences, which remained at a high level. In adolescents of the 1-st and 2-nd groups the fear of self-expression decreased significantly by comparison with it before treatment. The anxiety test scores decreased to an average level after complex treatment. At the same time the level of personal cognitive activity remained high, which confirmed the positive effect of combined treatment of psychosomatic disorders due to increased interest, curiosity, interest, which activates cognitive activity of adolescents. The level of depression in the 1-st group of adolescents after the treatment was 2.16 ± 0.16, which corresponded to the level of subdepression or masked depression with high scores on scale B. On the background of combined treatment in adolescents the level of depression decreased to 1.71 ± 0.12, which corresponded to slight decrease of mood with high scores on scale B. Adolescents with psychosomatic disorders who responded positively to psychotherapy were characterized by low level of somatization, but higher specific weight of psychological problems and difficulties in interpersonal relationships in the internal picture of the illness with peaks at subclasses of interpersonal sensitivity and hostility. The obtained results of treatment of psychosomatic disorders in adolescents show positive influence of both methods of therapy. However, adolescents with psychosomatic disorders were most susceptible to complex treatment, which accelerates the regression of clinical manifestations and increases the effectiveness of treatment 2.85 times.