Introduction: Over the years, heart failure remains one of the most common and prognostically unfavorable conditions. The aim of our study was to determine the frequency of complications in patients with CHF depending on the body weight and intoxication syndrome of varying degrees of severity. Materials and methods: A complete clinical examination was performed in 58 patients (41 (70.6%) men and 17 (29.4%) women) with CHF. In addition to the standard examination in accordance with the protocol, the level of endogenous intoxication was determined by the level of medium-weight molecules (MWM254) and leptin. The patients were randomized into 4 groups depending on their body mass index and the degree of endogenous intoxication. Statistical processing of the results was carried out using the methods of variation statistics “Statistica 6.0”. Results: It was revealed that the worst survival rate is observed in patients with normal body mass against the background of the expressed endogenous intoxication syndrome, the best survival rate is observed provided that there are a normal body mass and endogenous intoxication of a minimum degree. An inverse correlation between the body mass index and the endogenous intoxication indicator (blood MWM) was detected. Patients with CHF should have their leptin level evaluated. An increase in its level was associated with arterial hypertension, an increase in blood glucose levels and lipid metabolism disorders. Conclusions: Increased level of blood MWM worsens the forecast of CHF. The unfavorable outcome was observed in patients with the combination of hypoleptinemia with severe endogenous intoxication.

Важную роль в патогенезе хронической сердечной недостаточности (ХСН) занимает синдром эндогенной интоксикации (СЭИ) [1][2][3][4][5], который характеризуется ме-таболическими, морфологическими, функциональ-ными нарушениями различных органов и систем и воз-никает в ответ на совокупность факторов внешней и внут-ренней среды. В результате в тканях и биологических жидкостях происходит накопление продуктов нор-мального и нарушенного обмена веществ или факто-ров клеточного ответа [6], которые обладают токсиче-ским действием. При ХСН, кроме непрерывного воз-действия продуктов асептического воспаления, воз-никают гипоксия кишечника (что приводит к мальаб-сорбции), нарушения тканевого метаболизма, сниже-ние детоксикационной функции печени. Все это спо-собствует появлению в крови молекул средней массы (МСМ), фенола, мочевины и т.п., что усиливает эндо-токсикоз. Прямое и косвенное токсическое действие на ткани ухудшает микроциркуляцию и еще больше углуб-ляет органную патологию [7]. Экспериментальные ис-следования показали, что в условиях хронической эн-дотоксемии в сердечной мышце происходят тканевые преобразования -дисметаболическая кардиомиопа-тия [8]. Установлена связь между проявлениями мета-болической интоксикации и степенью снижения со-кратительной способности миокарда, поскольку пока-зано, что МСМ обладают отрицательным инотроп-ным действием [9]. Однако этот вопрос в литературе освещен недостаточно.В связи с этим целью работы стало установление из-менений структурно-функциональных показателей сердца у больных с ХСН в зависимости от уровня мо-лекул средней массы. Материалы и методыПроведено полное клиническое обследование 110 пациентов с ХСН, вызванной хроническими формами ишемической болезни сердца (ИБС) и артериальной ги- Цель. Изучить особенности структурно-функциональных параметров сердца у больных хронической сердечной недостаточностью (ХСН) в зависимости от степени выраженно-сти синдрома эндогенной интоксикации, который определяли по уровню молекул средней массы (МСМ) в периферической крови. Материал и методы. У 110 больных ХСН кроме стандартных клинических, лабораторных и инструментальных (эхокардиография) обследований определяли уровень МСМ, по которому пациенты были разделены на группы с минимальной, умеренной и выраженной эндогенной интоксикацией. Результаты. 41,8% больных имели минимальную выраженность эндогенной интоксикации, средняя степень была у 39,1%, высокая степень -у 19,1%. Больные с максималь-ными показателями МСМ характеризировались низкой фракцией выброса левого желудочка (р<0,05), наибольшим размером правого желудочка, минимальной частотой ди-агностики сохраненной функции левого желудочка и высокой частотой обнаружения увеличенных размеров левого предсердия, межжелудочковой перегородки и правого же-лудочка. Заключение. Уровень МСМ может служить критерием прогноза ХСН. Худший прогноз имеют пациенты с высоким содержанием МСМ крови. Ключевые слова: хроническая сердечная недостаточность, молекулы средней массы, эндогенная интоксикация, структурно-функциональные параметры сердца. РФК 2013;9(1):40-43S...

The basic aspects of the endogenous intoxication syndrome (EIS) in the pathogenesis of many diseases are still poorly understood - an increase in the content of a wide variety of compounds, most of which belong to middle mass molecules (MMM) with a mass of 500-2000 D, the content of which under the conditions of metabolically associated steatosis of the liver (MASL) as the initial stage of the fatty disease has not been yet established. In order to determine the content of molecules of average mass of total and their fractions in the blood and urine in patients with MASL, 25 patients were examined (14 men, 11 women; average age 63,8 years) with coronary artery disease (CAD), atherosclerotic cardiosclerosis, heart failure of I-II FC and sonographically diagnosed fatty liver disease (19 with MACL and 6 with steatohepatitis (SH)), in which MMMs were additionally determined at 238, 254, 266 and 282 nm in blood and urine at 238, 254, 266, 280, 288, 310 nm; coefficients of aromaticity were calculated, peptide-nucleotide, distributive; de Ritis indices and hepato-steatosis, AST/platelet ratio. The results were calculated statistically. The level of significance is p<0,05. The results. In patients with chronic forms of coronary artery disease, under the conditions of concomitant MASL, the content of total MMM was significantly higher (0,63±0,06 vs 0,34±0,02; p<0,05), which correlated with the level of high-sensitivity C-reactive protein (r=0,86; p<0,05). It was accompanied by the elevation of MMM at all wavelengths in the blood (238, 254, 266, and 280 nm) and hydrophilic chain MMM238 in urine and was associated by significantly higher values of aromaticity coefficients (2,14±0,23 vs 1,60±0,05) and peptide-nucleotide (2,65±0,37 vs 1,38±0,05), all p<0,05. The group with concomitant MASL differed from patients with comorbid SH significantly only in the lower content of hydrophilic MMM238 in urine (1,92±0,18 vs 2,30±0,03; p<0,05). Conclusion. Metabolic-associated steatosis of the liver is accompanied by the activation of the endogenous intoxication syndrome with an increase of the content of MMM in the blood and urine, which occurs in parallel with the syndrome of systemic inflammation.

The correlations of right coronary artery (RCA) diameter with gallbladder (GB) width and GB distension with the development of coronary arteries anomalies have already been described. Accordingly, the GB disorders are accompanied by structural and functional heart changes, but its exact criteria have not yet been established. Therefore, the substantiation of the prognostic role of GB distension as a risk factor for the coronary arteries anomalies development determined the usefulness of our study.The aim of this study was to establish correlations of GB condition with clinical, laboratory and instrumental parameters in patients with ischemic heart disease (IHD). Materials and мethods.We analyzed 35 clinical, laboratory and instrumental parameters of 98 patients with verified IHD (40 % -acute myocardial infarction, 60 % -unstable angina pectoris; 79 % males and 21 % females; mean age -61.7 ± 1.6 years). These patients were divided into groups depending on GB condition (intact GB, n = 29; sludge and cholesterosis, n = 13; bend GB body, n = 13; GB neck deformations and cholecystitis, n = 27; cholelithiasis, n = 11; cholecystectomy in anamnesis, n = 5). Obtained data were analyzed with the help of correlation analysis (correlations of quantitative parameters -by Pearson's method and correlations of qualitative parameters -by Spearman's method). We took into account only significant correlations (P < 0.05). Ranking of GB condition was held on the background of GB disorders' pathogenesis: changes usually start from sludge and cholesterosis, which in case of various GB deformations together with bile flow difficulties and impaired GB motility lead to cholelithiasis. Complications of cholelithiasis can lead to cholecystectomy, which was rated the worst GB condition.Results. The GB condition significantly correlated with RCA affection grade, alanine aminotransferase (ALT) activity and prothrombin time: worsening of GB condition was accompanied by increase of RCA stenosis grade on the background of decrease in prothrombin time (which shows tendency to hypercoagulability and thrombi formation) and absence of hepatocytes cytolysis. Correlations of RCA stenosis grade depended on GB conditions including metabolic, inflammatory and haemostatic parameters, size and blood supply of left atrium. Prothrombin time increasing was associated with left ventricle hypertrophy, hyperkaliemia, diastolic dysfunction and higher grade of RCA affection. ALT activity was proportional to ejection fraction together with general fibrinogen in case of GB sludge and to fasting glucose level in case of bent GB body.Conclusions. Established reliable correlations of both type and degree of GB damage with RCA stenosis grade and other clinical, laboratory and instrumental parameters (prothrombin time, fibrinogen and ALT levels, hypertrophy and diastolic dysfunction of the left ventricle etc.) are associated with a tendency to hypercoagulability and thrombi formation, hyperkaliemia, and define both morphological and functional interrelations of GB disord...

Ursodeoxycholic acid (UDCA) influences bile formation and excretion. Apart from that, UDCA has some pleiotropic effects, which can be a basis for usage of this drug for treatment of cardiovascular diseases. We held a scientific literature review in РubМed database and domestic literature sources according to key words “ursodeoxуcholic acid”, “chenodeoxуcholic acid”, “enterohepatic circulation”, “bile acids”. It was revealed that UDCA has a wide spectrum of action because of its cytoprotective, anti-apoptotic, anti-inflammatory, anti-oxidative and immune-modulating effects, which are of particular importance in cardiology. Some authors propose to use UDCA in patients with ischemic heart disease, especially in case of comorbid metabolic syndrome and nonalcoholic steatohepatitis. We determined the level of leptin in the blood by immunoenzyme method in 43 patients with arterial hypertension before and after a month of outpatient treatment by atorvastatin or ursodeoxycholic. It was shown that both drugs led to significant decrease of blood serum atherogenic influence due to decrease of total cholesterol and cholesterol of low-density lipoproteins (more expressed in the statin group) and due to decrease of previously increased leptin level (more expressed in the UDCA group). Investigation of drug influence on adipocytokinessynthesis in patients with cardiovascular diseases is perspective in terms of its correction possibilities.