42 Оригинальные работыДля корреспонденции: Гома Татьяна Владимировна -664017, Иркутск, ул. Помяловского, д. 10, кв. 53. Тел. 8 (902) 170 26 76; e mail: tanyagoma@mail.ru.Исследование посвящено оценке уровня антител к рецептору тиреотропного гормона (АТ рТТГ), некоторых цитокинов (ФНО α, ИЛ 8, ИЛ 10) у больных с болезнью Грейвса (БГ) с хронической сердечной недостаточностью (ХСН) и выяв лению прогностических факторов формирования ХСН. При обследовании 89 больных БГ ХСН диагностирована у 46 (51,7%), из них 1 я стадия -у 27 (58,7%) больных, 2А стадия -у 17 (37%), 2Б стадия -у 2 (4,3%). Однако тахикардия, одышка и ряд других сердечно сосудистых изменений при ХСН 1 й стадии могут быть проявлениями как ХСН, так и БГ, поэтому в 1 ю группу ("ХСН+", или с ХСН) включили 19 (21,3%) больных БГ с ХСН 2А и 2Б стадии, во 2 ю группу ("ХСН ", или без ХСН) -43 больных БГ без признаков ХСН. Контрольную группу (3 я) составили 30 здоровых лиц. Вы явлено, что с возникновением ХСН у больных БГ ассоциированы наличие постоянной формы фибрилляции предсердий и артериальной гипертензии, возраст старше 40 лет, мужской пол, длительность БГ 10 лет и более, наличие 6 и более эпи зодов тиреотоксикоза. Прямой связи между повышением уровня АТ рТТГ и возникновением ХСН у больных БГ не об наружено. У больных БГ по сравнению с контрольной группой выявлены дисбаланс системы цитокинов, преобладание "провоспалительной активации", однако статистически значимых взаимосвязей между уровнями ИЛ 8, ИЛ 10 и ФНО α и возникновением ХСН у больных БГ не обнаружено.

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Aim. Assessment of vascular age by volumetric sphygmography and its relationship with the main clinical and laboratory parameters in patients with arterial hypertension.Materials and methods. 46 patients with arterial hypertension were examined, including 26 women (56.5%) and 20 men (43.5%). The mean age was 67.0 [60.0; 73.5] years. Clinical and laboratory parameters were analyzed, including body mass index, lipidogram, fibrinogen, blood creatinine levels, and glomerular filtration rate. Vascular age was assessed using the BPLab-Vasotens apparatus (LLC Petr Telegin, Russia).Results. Vascular age in patients with arterial hypertension was 69.0 [64.0;76.0] years and did not differ statistically from the passport age (p>0.05). Positive relationships were found between vascular age and the level of pulse pressure (r=0.65, p<0.001), index of reflection (augmentation) of pulse wave growth (r=0.29, p=0.04). No relationship was found between the stage of arterial hypertension, the presence of comorbid pathology, body mass index, lipid profile, creatinine, glomerular filtration rate, fibrinogen, and vascular age. In men, vascular age was less than in women – 65.5 [59.0; 70.5] years and 72.5 [67.0; 78.0] years, respectively (p = 0.02). In the group of women, the augmentation index of pulse wave growth and the level of fibrinogen were higher than in the group of men.Conclusions. There were no statistically significant differences in passport and vascular age, determined by volumetric sphygmography, in patients with hypertension at various stages of the disease, depending on the presence of comorbid pathology, lipid status, and renal dysfunction. When analyzing hemodynamic parameters, direct links were established between vascular age and pulse arterial pressure, the index of reflection (augmentation) of the pulse wave increase. In the group of women with a higher indicator of vascular age, an increase in the augmentation index of the increase in pulse wave and fibrinogen was revealed.

The article presents a clinical case of the fatal Mallory- Weiss syndrome, which suddenly developed in an 86-year-old patient with a new coronavirus infection COVID-19, complicated by bilateral polysegmental pneumonia. The patient had no history of gastroesophageal refl ux disease, gastric ulcer or duodenal ulcer. The level of D-dimer on admission was elevated, but the patient was prescribed a reduced dose of anticoagulants (heparin). Despite the initial positive dynamics of the condition, the patient had a wave-like course of COVID-19, followed by the development of Mallory- Weiss syndrome, extremely severe post-hemorrhagic anemia and multiple organ failure, which became the cause of death.

Background. Production of pro-inflammatory cytokines including interleukin 6 (IL-6) is activated in COVID-19. Using olokizumab which inhibits IL-6 production in treatment of COVID-19 is pathogenetically justified.The aim. To study in real clinical practice the efficacy and safety of using the IL-6inhibitor (olokizumab) in treatment of patients with confirmed COVID-19 pneumonia.Materials and methods. The first group included 41 hospitalized patients with confirmed COVID-19 pneumonia having complex therapy including olokizumab. The control group consisted of 66 patients with confirmed COVID-19 pneumonia who did not have therapy with IL-6 inhibitor. We analyzed clinical (volume of lung involvement, respiratory failure degree, body mass index) and laboratory data (levels of T-troponin, lactate, procalcitonin, natriuretic peptide, C-reactive protein, fibrinogen, D-dimer, ferritin, erythrocyte sedimentation rate, glomerular filtration rate).Results. The groups did not differ in gender, age, body mass index of patients, volume of lung tissue injury, and duration of hospitalization (p > 0.05). Respiratory failure of 2–3rd degree was more common in patients of the first group (χ2 = 6.3; p = 0.010). The initial levels of C-reactive protein (50.9 [34.2; 76.2] and 32.2 [9.9; 69.1] mg/L respectively; p = 0.009) and fibrinogen (6.0 [5.3; 6.7] and 5.2 [4.3; 6.2] g/l respectively; p = 0.005) in patients having therapy including olokizumab were significantly higher than in the control group. The levels of erythrocyte sedimentation rate, fibrinogen and ferritin, D-dimer, detected upon admission of patients to the hospital, didn’t have statistically significant differences. At discharge, the erythrocyte sedimentation rate in patients receiving olokizumab was statistically significantly lower (9.0 [5.5; 14.5] and 13.0 [7.0; 27.0] mm/h; p = 0.018).Conclusions. Using olokizumab in the treatment patient with COVID-19 pneumonia has demonstrated a positive effect on clinical and laboratory parameters (erythrocyte sedimentation rate, fibrinogen level) in patients with pronounced inflammatory changes and respiratory impairment.