Кафедра пропедевтики внутрішньої медицини № 2 та медсестринства
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Item Особливості вуглеводного обміну у хворих на бронхіальну астму з ожирінням(2022-03) Бездітко, Тетяна Василівна; Єрьоменко, Галина ВолодимирівнаAsthma (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.Item The role of diabetes mellitus 2 type of asthma course(2020-05) Yeryomenko, Galyna; Iliucha, SergeyBackground: 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).Item The state of immune homeostasis in patients with the comorbid course of asthma, obesity and diabetes mellitus type 2(2017) Yeryomenko, GalynaКоморбідність 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 IgEItem Peculiarities of asthma and insulin resistance depending on the types of obesity(2018) Yeryomenko, GalynaThe purpose of the study was to examine specific clinical and laboratory signs and peculiarities of fatty tissue distribution in patients with bronchial asthma associated with diabetes mellitus, and their effect on respiration function (RF). Material and methods. 78 patients with non-controlled severe-course asthma and diabetes melli-tus type 2 were studied. The patients were divided into 2 groups, with android and gynoid obesity types, according to anthropometric signs. Blood chemistry panel was performed: glycated hemoglobin (HbAlc), glucose, triglycerides (TG), total cholesterol (CHOL), low density lipoproteins (LDL), high density lipopro-teins (HDL), and insulin resistance index (HOMA-IR). Concentrations of total CHOL, TG, high density lipo-proteins (HDL), and low density lipoproteins (LDL) were determined using enzymatic method via pho-tometer Solar PM 2111. Expiratory reserve flow (ERF), forced vital capacity (FVC) and forced expira-tory volume for 1st second (FEV1) condition was evalu-ated based on analysis on a spirograph Spìrokom (Ukraine). Besides, the control level of asthma symp-toms was considered using questionnaires ACQ-5. Results and discussion. The android type patients were older and had longer disease history versus the patients with gynoid obesity type. The increase of ab-dominal fat depots in patients with android type obe-sity was associated with more pronounced changes in carbohydrate-fat metabolism parameters, which was manifested through elevated glucose, TG, LDL serum values and decreased HDL concentrations. HbAlc and HOMA-IR were reliably increased. Assessment of external respiration function via a spirometer showed that FEV1 %, FVC % in patient groups with gynoid and android obesity types were different as well. In pa-tients with android obesity type, FEV1 and FVC pa-rameters were reliably lower than in the group with gynoid obesity type. Higher degree of ventilation dis-orders in individuals with high waist circumference – thigh circumference index can be due to fatty tissue central topography type. Conclusions. The obtained data are indicative of various carbohydrate metabolism disorders, dependence of insulin resistance on obesity type, hormonal balance, and RF decrease. Nevertheless, further complex studies, aimed at investigation of clinical peculi-arities and hormonal support of pathological processes in patients with the examined pathology are required.Item The role of fractalkine and monocyte chemoattractant protein-1 in the progression of asthma(2018) Yeryomenko, GalynaTo 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.Item The role of allergens in the progression of obesity and hyperglycemia in the asthma patients(2017-06-18) Bezditko, Tetyana; Yeremenko, GalynaItem State of humoral immunity in patients with asthma combined with obesity(2017) Yeryomenko, G.; Khimich, Tetyana; Bolokadze, Ievgenia; Mizhiritskaya, T.; Bezditko, Tetyana; Ospanova, T.It was found out in patients having asthma combined with obesity that in cases of a higher body mass index versus patients with asthma and healthy persons the “waist/hip volume” ratio was reliably increased. An examination of the state of humoral immunity indices in patients with asthma found out an increase of non-specific (with rising concentrations of immunoglobulins Ig A, M, G) and specific (with a rising level of Ig E) immunity. Patients with comorbidity of asthma and obesity revealed differently directed changes in the concentration of the main immunoglobulins: with a decrease in the levels of IgA and IgM there was a significant increase in the concentration of IgG. Those changes were accompanied by a significant reduction in the number of circulating immune complexes and an increasing concentration of lymphocyte antibodies in the blood of patients with comorbidity of asthma and obesity. This fact may indicate an aggravating effect of obesity on the course of asthma and a change in the direction of the pathological process to the autoimmune one that should be taken into consideration when treating such patients.Item Cardiac remodeling in patients with COPD combined with obesity(2016-11-04) Pionova, Olena; Bolokadze, Ievgenia