Кафедра пропедевтики внутрішньої медицини № 2 та медсестринства

Permanent URI for this communityhttps://repo.knmu.edu.ua/handle/123456789/178

Browse

Subject: search.filters.subject.asthma

Search Results

Now showing 1 - 10 of 12
  • No Thumbnail Available
    Item
    Особливості вуглеводного обміну у хворих на бронхіальну астму з ожирінням
    (2022-03) Бездітко, Тетяна Василівна; Єрьоменко, Галина Володимирівна
    Asthma (As) and metabolic disturbances are widespread and socially significant states, obesity (Ob) being also one of them. The comorbidity of As and Ob both affects physiological mechanisms of bronchial obstruction syndrome, the course and prognosis of these two diseases and significantly complicates their treatment. A combination of changes in ventilation and a complex architectonics of the bronchi may contribute to worsening control over As. The performed study deals with the problem of early diagnosis and progression of the course in patients with comorbidity of As and Ob. The study involved 62 patients with As. Of them, there were 24 cases with the normal body mass (Group I) and 38 cases with As+Ob (Group II). Side by side with evaluation of their respiratory function values and anthropometric examination, all the patients underwent controlling of their carbohydrate metabolisms. It was found out that As combined with Ob were accompanied by a cascade of metabolic disorders: hyperinsulinemia, insulin resistance, and higher levels of HbA1с and fasting glucose versus the control group (р<0.05). According to correlation analysis data, Group II revealed negative correlations between values of HOMA-IR and 40≤FEV1<50% (r = -0.53; р<0.05), HOMA-IR and 50%≤FEV1<60% (r = -0.49; р<0.05), insulin level and 40≤FEV1<50% (r = -0.42; р<0.05) as well as a positive correlation between HPMA-IR value and BMI (r = 0.39; р<0.05). Conclusions. Patients with As, degree 1 Ob and a disorder of FEV1>60% revealed hyperinsulinemia and an increased level of insulin resistance index; this fact can be regarded as a prognostic criterion for an improved diagnosis, prognostication of unfavorable consequences and optimization of treatment approaches. In order to detect carbohydrate metabolic disturbances in patients with As+Ob it is not enough to determine levels of glucose and glycated hemoglobin. The necessity of studying insulin resistance and insulin level for systematization and determination of development of concomitant metabolic disturbances in the patients, whom ICS are prescribed, is proved.
  • No Thumbnail Available
    Item
    Peculiaritis of metabolic changes in asthma
    (2020-10) Bezditko, Tetyana; Yeryomenko, Galyna; Vysotska, Olene; Rysovana, Liubov; Pecherska, Anna
    Introduction. The numbers of patients having asthma (As) and As with metabolic syndrome (MS) keep steadily growing. The aim: revealing of clinical-pathogenetic peculiarities in manifestations of uncontrolled As+MS. Materials and methods. Sixty-five cases, divided into 2 groups: Group I – severe As (n=20), Group 2 – severe As+MS (n=45). The general clinical examination included fasting blood glucose, insulin level, HOMA-IR index, body mass index (BMI), spirometry, levels of ММР-9, МСР-1, IL-8 and IL-12. Results. In Group I, 20 patients (100%) had obstructive respiratory dysfunction. Group II had 13 cases (28.88%) with the restrictive, 15 (33.33%) with the obstructive and 17 (37.77%) with the mixed types. BMI revealed: Group I had the normal mass (BMI averaged 24.62 [22.76; 25.71]; Group II had 21 overweighed cases (46.66%) and 24 (53.33%) with grade 1 obesity, averaging 29.70 [28.35; 31.23]. Correlation analysis in Group II showed significant correlations between: age and WHR (r=0.52, p<0.001) (increase of abdominal fat depots during life), FEV1 and BMI (r=-0.63, р<0.001) (obesity affects pulmonary function). IL-8 and IL-12 levels in Group II were increased, respectively, by 27.86 and 13.18 times versus Group I. A relationship was found between MCP-1 and MMP-9 (r=0.77, р<0.05), Group II revealed direct correlation between MCP-1 and total FEV1 (r=0.53, р<0.05). Conclusions. Overweight and obesity in As+MS deteriorate respiratory function versus the same indices in isolated As. Relationships between proinflammatory cytokines and MMP-9 and MCP-1 prove pathogenetic peculiarities of systemic inflammation and metabolic homeostasis. As and MS can cause their coexistence, facilitating development of mutual aggravation.
  • No Thumbnail Available
    Item
    Peculiaritis of metabolic changes in asthma
    (2020-10) Bezditko, Tetyana; Yeryomenko, Galyna; Vysotska, Olene; Rysovana, Liubov; Pecherska, Anna
    Introduction. The numbers of patients having asthma (As) and As with metabolic syndrome (MS) keep steadily growing. The aim: revealing of clinical-pathogenetic peculiarities in manifestations of uncontrolled As+MS. Materials and methods. Sixty-five cases, divided into 2 groups: Group I – severe As (n=20), Group 2 – severe As+MS (n=45). The general clinical examination included fasting blood glucose, insulin level, HOMA-IR index, body mass index (BMI), spirometry, levels of ММР-9, МСР-1, IL-8 and IL-12. Results. In Group I, 20 patients (100%) had obstructive respiratory dysfunction. Group II had 13 cases (28.88%) with the restrictive, 15 (33.33%) with the obstructive and 17 (37.77%) with the mixed types. BMI revealed: Group I had the normal mass (BMI averaged 24.62 [22.76; 25.71]; Group II had 21 overweighed cases (46.66%) and 24 (53.33%) with grade 1 obesity, averaging 29.70 [28.35; 31.23]. Correlation analysis in Group II showed significant correlations between: age and WHR (r=0.52, p<0.001) (increase of abdominal fat depots during life), FEV1 and BMI (r=-0.63, р<0.001) (obesity affects pulmonary function). IL-8 and IL-12 levels in Group II were increased, respectively, by 27.86 and 13.18 times versus Group I. A relationship was found between MCP-1 and MMP-9 (r=0.77, р<0.05), Group II revealed direct correlation between MCP-1 and total FEV1 (r=0.53, р<0.05). Conclusions. Overweight and obesity in As+MS deteriorate respiratory function versus the same indices in isolated As. Relationships between proinflammatory cytokines and MMP-9 and MCP-1 prove pathogenetic peculiarities of systemic inflammation and metabolic homeostasis. As and MS can cause their coexistence, facilitating development of mutual aggravation.
  • No Thumbnail Available
    Item
    Peculiaritis of metabolic changes in asthma
    (2020-10) Bezditko, Tetyana; Yeryomenko, Galyna; Vysotska, Olene; Rysovana, Liubov; Pecherska, Anna
    Introduction. The numbers of patients having asthma (As) and As with metabolic syndrome (MS) keep steadily growing. The aim: revealing of clinical-pathogenetic peculiarities in manifestations of uncontrolled As+MS. Materials and methods. Sixty-five cases, divided into 2 groups: Group I – severe As (n=20), Group 2 – severe As+MS (n=45). The general clinical examination included fasting blood glucose, insulin level, HOMA-IR index, body mass index (BMI), spirometry, levels of ММР-9, МСР-1, IL-8 and IL-12. Results. In Group I, 20 patients (100%) had obstructive respiratory dysfunction. Group II had 13 cases (28.88%) with the restrictive, 15 (33.33%) with the obstructive and 17 (37.77%) with the mixed types. BMI revealed: Group I had the normal mass (BMI averaged 24.62 [22.76; 25.71]; Group II had 21 overweighed cases (46.66%) and 24 (53.33%) with grade 1 obesity, averaging 29.70 [28.35; 31.23]. Correlation analysis in Group II showed significant correlations between: age and WHR (r=0.52, p<0.001) (increase of abdominal fat depots during life), FEV1 and BMI (r=-0.63, р<0.001) (obesity affects pulmonary function). IL-8 and IL-12 levels in Group II were increased, respectively, by 27.86 and 13.18 times versus Group I. A relationship was found between MCP-1 and MMP-9 (r=0.77, р<0.05), Group II revealed direct correlation between MCP-1 and total FEV1 (r=0.53, р<0.05). Conclusions. Overweight and obesity in As+MS deteriorate respiratory function versus the same indices in isolated As. Relationships between proinflammatory cytokines and MMP-9 and MCP-1 prove pathogenetic peculiarities of systemic inflammation and metabolic homeostasis. As and MS can cause their coexistence, facilitating development of mutual aggravation.
  • Thumbnail Image
    Item
    The role of diabetes mellitus 2 type of asthma course
    (2020-05) Yeryomenko, Galyna; Iliucha, Sergey
    Background: combination of bronchoobstructive diseases and metabolic disorders is under a great interest of scientists. Diabetes mellitus (DM) is not only associated with abdominal obesity, arterial hypertension, cardiovascular disorders but also associated with deterioration of pulmonary function, particularly decreasing of forced expiratory volume-1-second (FEV1).
  • Thumbnail Image
    Item
    The state of immune homeostasis in patients with the comorbid course of asthma, obesity and diabetes mellitus type 2
    (2017) Yeryomenko, Galyna
    Коморбідність бронхіальної астми (БА), цукрового діабету 2-го типу (ЦД2Т) і ожиріння (О) залишається актуальною проблемою сучасної медицини. Мета: дослідити стан клітинного, гуморального імунітету, факторів неспецифічного захисту при БА та в поєднанні з ЦД2Т та О. Матеріали та методи дослідження. Обстежено 269 хворих на БА, виділено 3 групи: перша група – хворі з БА (n = 61), друга група – хворі з БА і ЦД2Т (n = 94), третя група - хворі з БА та О (n = 114). Стандартні методи дослідження на БА, визначення клітинної ланки імунітету проводили з використанням еритроцитарних діагностикумів «Анти-CD», визначення кількості субпопуляцій Т- і В-лімфоцитів – за допомогою реакції розеткоутворення з еритроцитами. Оцінку результатів дослідження проводили в світловому мікроскопі з імерсійною системою. Дослідження гуморальної ланки імунітету включало визначення кількості імуноглобулінів А, М, G, активності комплементу, рівня циркулюючих імунних комплексів (ЦІК). Для кількісного визначення імуноглобулінів у сироватці крові був використаний метод імуноферментного аналізу (ІФА). Вміст ЦІК в сироватці крові визначали нефелометричним методом. У комплекс імунологічних досліджень входило визначення параметрів фагоцитарної активності нейтрофілів, НСТ-тест. Результати. Виявлені достовірні зміни як показників клітинного, так і гуморального імунітету у всіх групах досліджених хворих. Зміни клітинного імунітету більш виражені в групі обстежуваних БА + ЦД2Т, особливо відзначено зниження кількості СD4 і СD22. У групі БА + О мало місце виражене зниження кількості CD4. В обох групах зазначені зміни розвивалися на тлі достовірно значущої лімфопенії. Значне зниження відсотка фагоцитуючих нейтрофілів лише в групі хворих на БА + ЦД2Т також підтверджує розвиток вторинного імунодефіциту при ЦД2Т. У всіх 3 групах відзначено підвищення показників НСТ-тесту, найбільш виражене в групі БА + О, що побічно вказує на недостатність фагоцитарної ланки. Висновки. В результаті проведених клініко-імунологічних досліджень показано, що в основі коморбідного перебігу БА з О та ЦД2Т лежить прогресуюче хронічне запалення автоімунного характеру. У пацієнтів з поєднаною патологією відзначається зниження рівня клітин з Т-хелперною активністю і компенсаторне збільшення вмісту цитотоксичних Т-лімфоцитів, що призводить до дисбалансу клітинної ланки імунної системи і зниження імунорегуляторного індексу. Виявлені ознаки вторинного імунодефіциту при БА і ЦД2Т (дефіцит клітинної і фагоцитарної ланок) не забезпечують належний рівень патогенетичних імунологічних реакцій, зокрема вироблення IgE
  • No Thumbnail Available
    Item
    The dependence of the endothelial function on comorbid states in patients with asthma
    (2018) Yeryomenko, Galyna
    Introduction: the purpose of the research consisted in the study of the functional state of the endothelium in patients having persistent asthma (A) with an uncontrolled course in combination with diabetes mellitus type 2 (DM2T) and obesity (O) The aim: on the basis of a complex study of nitric oxide metabolites (nitrosothiols, S-NO), von Willebrand factor (VWF) and endothelin-1 (EТ-1). Materials and methods: The study involved 90 A patients with comorbid states, who were divided into 3 groups. Group 1 included patients with A, group 2 consisted of A with DM2T (A+DM2T), group 3 was composed of A and obesity (A+O); the control group had 21 persons. Results: Lower S-NO levels in patients from groups 2 and 3 and an increase of ET-1 in these groups versus the control one demonstrate an imbalance of the indices, which produce an effect on the vascular tone. Statistically, the activity of VWF as the marker of an endothelial damage was significantly higher: it was 169.0 (147.0;178.50) in cases from group 2 and 156.0 (142.75;165.0) in those from the group of A+O. Thus, indices of a disrupted endothelial function were more expressed in patients from group 2. Positive relations of ET-1 with VWF and negative ones with S-NO. Conclusions: The conducted study has proved that the endothelial function in patients with A+DM2T and A+O is characterized by a disturbed relationship between relaxing and constricting endothelial factors. The obtained data make it possible to receive an opportunity to correct the above impairments in future.
  • Thumbnail Image
    Item
    The role of fractalkine and monocyte chemoattractant protein-1 in the progression of asthma
    (2018) Yeryomenko, Galyna
    To improve the effectiveness of diagnosis and prediction of adverse asthma comorbid conditions based on research of clinical manifestations features, functional disorders of the airways and endothelial dysfunction. 79 patients were selected for the study. All the patients were divided into 3 groups: group 1 – patients with asthma (n-22); group II (n-24) – patients with asthma + diabetes mellitus type 2; group III (n-33) - patients with asthma + obesity + arterial hypertension (AH) and control group (n-17) – healthy people. All the patients underwent clinical examination. Spirography indicators were tested, and full patients’ examination was conducted. The levels of fractalkine (CX3CL1) and Monocyte Chemoattractant Protein – 1(MCP-1) were determined by Enzyme-linked immunosorbent assay (ELISA) test using Ray Bio® Human Fractalkine system manufactured by Ray Biotech, Inc., USA; "Human MCP-1" (eBioscience, Austria), respectively. Statistical processing of parameters of endothelial function, МСР-1 andCX3CL1, depending on comorbid pathology, has identified statistically significant elevated level of the separametersinall studied groups. The most pronounced changes of both parameters were registered in group 2 patients, indicative of the most significant manifestations of endothelial dysfunction in this patient group.Assessment of endothelium dysfunction markers depending on external respiration function was performed. It has been found out that МСР-1 affects vital pulmonary capacity (χ2=14.466; р=0.002) and forced expiratory volume in 1 second (FEV1) (χ2=8.471; р=0.037). Besides, CX3CL1 exerts influence on these parameters as well (χ2=19.385, р=0.001); (χ2=11.476, р=0.009), respectively. The decrease in rate parameters, in particular, FEV1, MEF 25, MEF 50, and MEF 75, was identified in all patient groups. Based on these data, we can assume that patients with a combination of asthma and diabetes mellitus type 2 demonstrate more cases of endothelial malfunction, leading to the worsening of respiratory function, compared to the group with asthma, obesity and arterial hypertension and a group without comorbidity.
  • Thumbnail Image
    Item
    The treatment of patients with asthma and comorbidity
    (2018-03) Bezditko, Tetyana; Yeryomenko, Galyna
    The increasing prevalence of asthma (A) and diabetes mellitus type 2 (DM2T) necessitates administration of the adequate antiasthmatic long-term basic therapy with consideration of comorbid states. The purpose consisted in revealing the therapeutic potential of Tiotropium bromide (TB) and L-arginine (Tivortine) in patients having uncontrolled moderately severe asthma in combination with DM2T (A+DM2T). Forty seven A+DM2T patients underwent an in-depth study before and after their treatment. They were divided into 2 groups: treatment (group 1, n=28) and comparison (group 2, n=19). Both groups received the standard 2-component therapy: budesonide/formoterol fumarate dihydrate – 160/4.5μg by 2 breaths twice a day and metformin at a dose of 500 mg twice a day. The complex of their basic therapy for group 1 additionally included TB (18 μg a day) and arginine hydrochloride preparation (Tivortine® aspartate, Yuriya-Farm) orally by 15 ml twice a day during 3 months (90 days). The patients were followed up 3 months and one year later. Their general condition demonstrated positive dynamics in both groups, the number of exacerbations in group 1 reducing by a factor of 4. The complex use of L-arginine and TB preparations against a background of the basic therapy in A+DM2T patients produced a better control over the disease, a more rapid elimination of obstruction manifestations, achievement and prolongation of the clinical spirographic remission, an improvement of the quality of life, correction of disturbances in haemocoagulation, fibrinolysis and the functional state of endothelium.
  • No Thumbnail Available
    Item