Обсуждается проблема совершенствования современных диагностических технологий. Внедрение алгоритмического подхода в условиях стремительного роста стоимости лабораторно-инструментальных исследований способно оптимизировать диагностический поиск и затраты на него. Рассматриваются различные алгоритмические модели, их свойства и структура. В качестве примера приводится алгоритм дифференциальной диагностики гипокалиемии. Ключевые слова: алгоритм, лабораторная диагностика, гипокалиемия РФК 2007;4:46-50 The algorithmic model of laboratory diagnostics optimization G.I. Nazarenko, O.V. Andropova Medical Centre of Bank of Russia, Moscow The problem of improvement of modern diagnostic technologies is discussed. Introduction of algorithmic approach is able to optimize diagnostics and its costs. Various algorithmic models, their features and structure are reviewed. As an example the algorithm of differential diagnostics of hypokaliemia is presented.

Cardiovascular diseases are the leading cause of disability, premature mortality and economic loss worldwide. Despite the proven effectiveness of preventive measures in reducing the risks of development and progression of cardiovascular diseases, these programs are the most difficult to implement. 75–90 % of visits to primary care physicians in Western Europe and the United States are associated with physical fatigue and stress disorders, back pain and injuries. Studies have shown that workers with risk factors for chronic noncommunicable diseases are often absent from the workplace, have a higher level of disability and lower labor productivity. A worker with depression costs the employer almost 1,5 times more expensive than people without diseases. Elevated glucose levels, arterial hypertension, smoking and obesity cause an increase in the employer’s medical expenses by 34,8; 31,6; 31 and 27,4 %, respectively. The cost of US employers to pay for medical services, to compensate for the absence or ineffective presence due to illness costs $ 200 billion annually – more than $ 1,500 per employee.The health of workers is determined by both risk factors specific to the workplace and general population and individual risks..Modern technologies of health management, changing the profile of the health of labor collectives, can improve the image of the employer and increase the profitability of companies. The return on investment in corporate health programs is from 3 to 10 US dollars for each dollar invested. The programs implemented at the enterprises of the Russian Federation made it possible to reduce the duration of diseases with disability by 20–30 %, reduce mortality and the initial exit to disability by 45–60 %. The widespread introduction of the most effective corporate wellbeing programs of workers in the activities of medical organizations and companies of various profiles will ensure the implementation of the national projects “Healthcare” and “Demography”.

The calcined aortic stenosis is one the most frequently occurring cardio-vascular diseases with unfavorable prognosis of course. The modern concepts about risk factors of development, pathogenesis and course of disease starting with inflammation and endothelial dysfunction and terminating with bone metaplasia permit determining prospective directions of deceleration of progression of calcined aortic stenosis. The high risk of unfavorable cardio-vascular occurrences associated with calcinosis of valvular apparatus of heart, availability of concomitant diseases making difficulties for correction of valvular impairments makes searching for causes of development and progression of ectopic calcification of aortic valve especially actual. The development of strategy of modification of risk factors and prevention of progression of early valvular impairments and blood circulation insufficiency are actual to the same extent. The review considers main clinical factors associated with development of calcined aortic stenosis, significance of genetic polymorphism in development of this heart disease and also main pathogenic mechanisms of its progressing.

Дегенеративный аортальный стеноз: особенности патогенеза и принципы терапии О.В. Андропова, В.Н. Анохин Медицинский центр Центрального банка Российской Федерации, Москва Цель. Выявить иммунные маркеры прогрессирования кальцификации и определить возможности нехирургического лечения дегенеративного аортального стеноза (ДАС). Материал и методы. Одномоментное исследование 85 пациентов с дегенеративным кальцинозом аортального клапана (42 пациента с ДАС и 43 пациента без признаков стенозирования аортального отверстия). Всем пациентам выполнено эхокардиографическое исследование, многосрезовая спиральная компьютерная томография сердца, определены показатели липидного спектра и воспаления. Результаты. У пациентов с ДАС выявлены значимо более высокие, чем у больных без стеноза, уровни общего холестерина и липопротеидов низкой плотности в крови. У них отмечены также более высокие уровни маркеров воспаления: С-реактивного белка и интерлейкина-6. Установлена значимая связь между тяжестью аортального стеноза, нарушениями липидного обмена и системной воспалительной реакцией. Заключение. Атерогенез и воспаление могут играть патогенетическую роль в прогрессировании кальцификации аортального клапана и формировании ДАС посредством липидной инфильтрации и повреждения эндотелия. Ключевые слова: дегенеративный аортальный стеноз, многосрезовая спиральная компьютерная томография, маркеры воспаления, ингибиторы ангиотензинпревращающего фермента, статины РФК 2006; 1: 31-36 Degenerative aortic stenosis: pathogenesis and new principles of treatment O.V. Andropova, V.N. Anokhin Medical Center of Central Bank of Russian Federation Aim. To reveal of markers of inflammation and progression of calcification in patients with degenerative aortic stenosis (DAS). Material and methods. A single-stage study was done in 85 patients with degenerative calcification of aortic valve (42 patients with DAS and 43 patients without DAS). The techniques for assessing the severity of aortic valve calcification included ultrasonic diagnostics and multislice spiral computed tomography. Markers of inflammation and lipid profile were investigated. Results. Higher blood levels of total holesterol and holesterol of low density lipoprotein were revealed in patients with DAS in comparison with patients without DAS. They also had higher levels of inflammation markers: C-reactive protein and interleukin-6. There were significant correlations between DAS severity, lipid metabolism disturbances and inflammation markers. Conclusion. Atherogenesis and inflammation may have pathogenic influence on progression of aortic valve calcification and DAS development by lipid infiltration and endothelium cells damage.