ISRCTN registry: Registration number ISRCTN19016626, registered 23 January 2013.

Харківський національний медичний університет Резюме. У статті висвітлені результати дослідження імунологічних порушень у хворих на хронічний некалькульозний холецистит на тлі гелікобактеріозу залежно від дисбіозу кишечнику. При цьому встановлено, що зазначена патологія супроводжується виникненням Т-лімфопенії, дисбалансом основних субпопуляцій Т-клітин, підвищенням у сироватці крові концентрації IL-1β, IL-2, TNFα на тлі відносної недостатності ІL-4 і пригнічення фагоцитарної активності моноцитів. Ключові слова: дисбіоз кишечнику, імунологічні порушення, ґелікобактеріоз, хронічний некалькульозний холецистит.

Among the comorbid conditions that significantly worsen quality of life and life expectancy are the chronic obstructive pulmonary disease and heart failure. Difficulties of drug therapy are the mutually exclusive approaches in the treatment of chronic obstructive pulmonary disease and concomitant cardiovascular pathology. Aim of this study was to provide scientific evidence of the possible use of the combined drug LCZ696 (angiotensin receptor neprilysin inhibitor, ARNI), which contains neprilysin inhibitor sacubitril (AHU377) and angiotensin II blocker valsartan, in patients with congestive heart failure. The article presents a review of the literature. It was demonstrated that the cause of mortality in patients with chronic obstructive pulmonary disease could be both changes in the respiratory system and complications in the cardiovascular system. It has been shown that progressive chronic obstructive pulmonary disease leads to the formation of pulmonary hypertension, right ventricular hypertrophy, decrease in its systolic function, subsequent dilatation of the right ventricle, and development of right ventricular heart failure, which is one of the most serious and difficult tests in the treatment process. The further development of such a combined pathology is left ventricular heart failure. The role of the system of natriuretic peptides, namely brain natriuretic peptide, brain natriuretic propeptide, C-type natriuretic peptide, and N-terminal precursor of C-type natriuretic peptide, as markers of chronic obstructive pulmonary disease and heart failure has been discussed. Natriuretic peptide is currently a recognized marker of heart failure, the high value of which is achieved for determining the prognosis and stratification of the risk of heart failure. Natriuretic peptide acts as a vasodilator, provides antiproliferative activity through the G-dependent protein kinase pathway and promotes bronchodilation, causing the release of acetylcholine from bronchial epithelial cells. Conclusions. All these properties suggest that natriuretic peptides may be a potential treatment in patients with cardiac complications and chronic obstructive pulmonary disease. The best way to prolong life of natriuretic peptide is to inhibit degradation of the natriuretic peptide with the neprilysin inhibitor sacubitril.

The average prevalence of сhronic heart failure in the adult population, according to the statistics of different countries, ranges from 1.5 % to 5.5 % and therefore the study of this problem and of finding new approaches to the treatment of сhronic heart failure is also still relevant at present. Objective is to show an innovative strategy in the treatment of сhronic heart failure, to show the benefits of using the combined drug sacubitril/valsartan (LCZ696) in comparison with the group of the mentioned above drugs for treating patients with сhronic heart failure and a reduced left ventricular ejection fraction, according to the results of a large randomized clinical research, based on its biochemical properties. Conclusions. The main positive effects of sacubitril and valsartan in patients with сhronic heart failure are associated with an increase in the amount of the natriuretic peptide and the simultaneous suppression by valsartan of the negative effects of angiotensin II. The indication for the use of the sakubitril / valsartan complex is сhronic heart failure (II-IV FC according to the NYHA classification) in patients with systolic dysfunction in order to reduce the risk of cardiovascular mortality and hospitalization for heart failure.

Cardiovascular pathology is one of the frequent comorbidities in patients with chronic obstructive pulmonary disease, due to both genetic predisposition and common risk factors (smoking, senile age, male gender, sedentary lifestyle, obesity). The article shows that development of endothelial dysfunction is one of the earliest phases of pathogenesis in this setting. Endothelial dysfunction mechanisms are defined and characterized, including an imbalance of vasoconstricting and vasodilating agents with the emergence of "vicious circles" that violate hemo-vascular homeostasis. The role of nitric oxide, endothelin-1, intercellular adhesion molecule-1 (ICAM-1) in the development of endothelial dysfunction in COPD patients is discussed. The article defines the concept of oxidative stress, the most potent oxidants and mechanisms of their damaging effect arebeing listed. A particular attention is paid to 8-isoprostane as a golden standard in assessment of oxidative stress in patients with COPD.