卷 88, 编号 5 (2016)
- 年: 2016
- 文章: 21
- URL: https://journal-vniispk.ru/0040-3660/issue/view/1812
Editorial article
Cardiovascular disease in rheumatic diseases
摘要
The representatives of immunoinflammatory diseases are rheumatic ones, such as primarily rheumatoid arthritis, juvenile idiopathic arthritis, spondyloarthritis, psoriatic arthritis, systemic lupus erythematosus, and other systemic connective diseases, which are characterized by a high risk for untimely death. The high risk of untimely death in these diseases has been found to be associated with the severity of an immunoinflammatory process that gives rise to severe irreversible damage to vital organs and systems and with the development of a wide spectrum of comorbidities (infections, interstitial lung disease, malignant tumors, osteoporotic fractures, etc.). Among them, diseases of the cardiovascular system, which are most commonly caused by the early development and accelerated progression of atherosclerotic coronary lesions, hold a central position. The paper gives the data available in the recent literature on the impact of antirheumatic therapy (disease-modifying antirheumatic drugs and biological agents) on the cardiovascular system.
Terapevticheskii arkhiv. 2016;88(5):4-12
4-12
Relationship between matrix metalloproteinase-3 levels and articular destructive changes in early and extended rheumatoid arthritis
摘要
Aim. To estimate a relationship between matrix metalloproteinase-3 (MMP-3) levels and articular radiographic changes in early and extended rheumatoid arthritis (RA); to analyze the role of this biomarker in predicting the progression of joint destruction in RA. Subjects and methods. Forty-five patients with early RA and 42 with extended RA were examined. Radiography of the hands and distal feet was performed before and one year after therapy. Serum MMP-3 levels were measured by an enzyme immunoassay prior to and 12 and 24 weeks after treatment. Results. After 52 weeks, in the early RA group, 16 patients continued monotherapy with methotrexate (MT); because of its inefficiency, 29 additionally received a biological agent in different follow-up periods. The extended RA group took tocilizumab for 24 weeks, then the drug was discontinued and the patients continued the former therapy with disease-modifying antirheumatic drugs, nonsteroidal anti-inflammatory drugs, and glucocorticosteroids. One year later, radiographic progression was recorded in 20.5 and 22.5% of the patients with early and extended RA, respectively. ROC analysis indicated that in the early RA group the MMP-3 level of more than 34.3 ng/ml at 12 weeks of MT therapy was associated with the radiographic progression of articular destructive changes after 52 weeks of therapy (the area under the curve (AUC) was 0.7; 95% confidence interval (CI) 0.46 to 0.93). In the patients with extended RA, the baseline MMP-3 levels of ≤51.3 ng/ml was related to no radiographic progression following 52 weeks (AUC, 0.587; 95% CI 0.33 to 0.84). Conclusion. MMP-3 may be regarded as an early marker for joint destruction in RA. The determination of MMP-3 level with other immunological markers may be useful to identify a group of patients who have a potentially severer disease course and need more intensive therapy.
Terapevticheskii arkhiv. 2016;88(5):13-18
13-18
N-terminal pro-brain natriuretic peptide levels and diastolic dysfunction in patients with early rheumatoid arthritis before the administration of disease-modifying antirheumatic drugs
摘要
Aim. To determine N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in patients with early rheumatoid arthritis (RA) before the use of disease-modifying antirheumatic drugs (DMARDs); to compare NT-proBNP values with traditional risk factors (TRF), cardiovascular diseases (CVD), inflammatory markers, and left ventricular (LV) diastolic dysfunction (DD). Subjects and methods. The investigation enrolled 74 patients with a valid RA diagnosis (the 2010 ACR/EULAR criteria), 56 (74%) women, median (Me) age, 54 years; disease duration, 7 months; seropositive for IgM rheumatoid factor (87%) and/or anti-cyclic citrullinated peptide antibodies (100%) with no history of the use of DMARDs and glucocorticosteroids. Duplex scanning and echographic findings were used to assess TRF for CVD and carotid artery atherosclerosis (CAA) in all the patients with early RA prior to therapy. An E/A ratio was used as a criterion for LVDD. Results. NT-proBNP concentrations in patients with early RA proved to be higher than those in the control group (p<0.0001). Higher-than-normal NT-proBNP levels were seen in 36 (49%) patients. The patients with early RA and elevated NT-proBNP values were older and had a higher body mass index (BMI) than those with normal NT-proBNP levels. Those with elevated NT-proBNP concentrations were more frequently found to have CAA, coronary calcification, and coronary heart disease; their intima-media thickness was also larger and C-reactive protein (CRP) levels higher than in those with normal NT-proBNP values. There were correlations between NT-proBNP levels and erythrocyte sedimentation rate, CRP, simplified disease activity index, and clinical disease activity index. Multivariate analysis revealed that chronic heart failure (CHF), CAA, CRP and low-density lipoprotein (LDL) levels, and BMI correlated with NT-proBNP concentrations. LVDD was detected in 35 (48%) patients with early RA. The level of NT-proBNP in patients with DD was higher than in those without DD. Higher-than-normal NT-proBNP values were observed in 23 (65%) and 12 (32%) patients with and without LVDD, respectively. The optimal NT-proBNP level for CHF detection was equal to 237.4 pg/ml (86% sensitivity and 85% specificity); the area under the ROC curve was 0.879. Conclusion. Just at the early disease stage, the patients are noted to have a high NT-proBNP level that is influenced by higher BMI, low LDL levels, CAA, CHF, and high CRP values. In the patients with early RA, the diagnostically significant NT-proBNP concentration for CHF detection was higher (237 pg/ml) than in those without RA (125 pg/ml). The patients with early RA should undergo NT-proBNP determination, LVDD screening, correction of TRF for CVD, atherosclerosis treatment, and remission achievement.
Terapevticheskii arkhiv. 2016;88(5):19-26
19-26
Psychopharmacotherapy for depression in rheumatic patients
摘要
Aim. To study attitude towards the disease in rheumatic patients during antidepressant therapy and during further follow-up. Subjects and methods. Examinations were made in 122 patients with degenerative joint and vertebral column disease (DJVCD) and in 30 patients with rheumatoid arthritis (RA) and concomitant affective disorders during antidepressant therapy for 3 months. Results. Statistically significant differences were found between all components of the type of attitude towards disease (TATD) in patients with DJVCD or RA before the use of antidepressants. In the patients with RA, the mean value of adaptive types of TATD was significantly lower and that of disadaptive types significantly higher. After 3 months of treatment, the TATD profiles came closer. Only three components (anosognosia, hypochondriasis, and dysphoria) in the pattern of TATD remained significantly different after 6-month therapy. Conclusion. According to the TATD data, both the patients with DJVCD and those with inflammatory diseases of the locomotor apparatus showed unidirectional changes in attitude towards disease with a significant increase in the adaptive components and a reduction in the disadaptive ones.
Terapevticheskii arkhiv. 2016;88(5):27-31
27-31
Microcrystalline stress in the pathogenesis of osteoarthritis
摘要
Aim. To estimate the rate of articular cartilage microcrystallization in osteoarthritis (OA). Subjects and methods. The investigation included 110 people who had undergone total endoprosthetic replacement for coxarthrosis. A total of 50 patients with total hip endoprosthetic replacement for femoral neck fractures were recruited as a comparison group. An X-ray diffractometer was used to detect crystals. Results. Cartilage mineralization was seen in 72% of the patients with late-stage OA. Conclusion. Articular cartilage microcrystalline stress is a constant sign of late-stage OA requiring further clinical interpretation.
Terapevticheskii arkhiv. 2016;88(5):32-36
32-36
Bone mineral density in patients with scleroderma systematica
摘要
Aim. To study the frequency and magnitude of a reduction in bone mineral density (BMD) and its association with clinical parameters in patients with scleroderma systematica (SDS). Subjects and methods. Fifty-six postmenopausal women aged 45-71 years (58.1±7.1 years) with a valid diagnosis of SDS and 44 age-matched healthy women were examined. Dual-energy X-ray absorptiometry (Hologic QDR 4500, Waltham, MA) was performed in all the included patients to measure BMD in the lumbar spine (LI—LIV), femoral neck, and proximal femur. Results. The patients with SDS and the healthy women showed no differences in body mass index (BMI) (24.7±4.6 and 25.7±3.5 kg/m2, respectively) and postmenopause duration (9.6±6.4 and 9.5±7.0 years, respectively); menopause occurred earlier in the patients with SDS than in the healthy women (46.9±3.6 and 49.7±3.0 years, respectively (p<0.001). The patients with SDS versus the controls had a significantly lower BMD in the lumbar spine (0.821±0.121 and 0.861±0.092 g/cm2; р<0.05), femoral neck (0.620±0.129 and 0.736±0.112 g/cm2; p<0.0001), and proximal femur (0.736±0.148 and 0.884±0.124 g/cm2; р<0.0001). Osteoporosis (OP) was detected in 29 (52%) of the 56 patients and in only 5 (11%) of the 44 control women (р<0.0001). The patients with diffuse SDS displayed a much greater reduction in BMD in all the regions than those with circumscribed SDS. BMD was significantly lower in the patients treated with glucocorticosteroids (GCS) than in the untreated ones. In the control group, BMD was associated with age, duration of menopause, and BMI. In the patients with SDS, BMD was correlated with BMI and inversely correlated with duration of menopause, and the magnitude of a BMD reduction was closely related to disease duration. The patients also showed an inverse correlation of BMD with the daily dose of GCS. Conclusion. The postmenopausal women with SDS were found to have a lower BMD in 80% of cases. In this category of women, the reduction in BMD was significantly commoner and more pronounced than in the age-matched healthy women. Low BMI, diffuse SDS, disease duration, and GCS use are risk factors for reduced BMD and OP.
Terapevticheskii arkhiv. 2016;88(5):37-42
37-42
Peripheral vessel wall changes in hypertensive patients with gout
摘要
Aim. To investigate the specific features of arterial wall endothelial dysfunction and stiffness in patients with hypertension concurrent with gout. Subjects and methods. A total of 54 patients were examined and divided into 2 groups. A study group consisted of 33 hypertensive patients with gout and a comparison group included 21 hypertensive patients without hyperuricemia. The patients did not differ in blood pressure (BP) readings. Uric acid was determined by the reaction with tungstophosphoric solution AT (Reagent, Dnepropetrovsk, Ukraine). The validity of results was checked using the control sera (Biocont C, Russia). Enzyme immunoassays and Doppler studies were used to investigate peripheral vasoregulation. Body mass index, intima-media thickness (IMT), pulse wave velocity (PWV), cardio-ankle vascular index (CAVI), endothelin-1 (ET-1), and endothelium-dependent vasodilation (EDVD) were determined. Results. All the studied indicators have directly or indirectly a negative impact, by deteriorating the function of the vessel wall. The found arterial structural changes suggest that there is an early atheromatous process in the arterial wall of hypertensive patients with gout. Addition of gout promotes endothelial dysfunction and worsens the course of hypertension. An elevation of indicators, such as PWV, CAVI, and ET-1 levels, has the poorest prognosis for the course of hypertension. Conclusion. The determination of CAVI, PWV, ET-1 levels, arterial stiffness index along with additional criteria, such as EDVD and IMT, may be used as criteria for a cardiovascular risk in hypertensive patients.
Terapevticheskii arkhiv. 2016;88(5):43-46
43-46
The possibility of selecting optimal antiplatelet therapy in patients with coronary heart disease in terms of CYP2C19 polymorphism
摘要
Aim. To estimate whether optimal antiplatelet therapy can be selected in terms of CYP2C19 polymorphism. Subjects and methods. The prospective randomized trial included 124 patients (93 men and 31 women) who were to undergo percutaneous coronary intervention. They initially received dual antiplatelet therapy: clopidogrel 75 mg + acetylsalicylic acid (ASA) 300 mg. Genetic testing was performed in all the patients to reveal the carriage of allelic variants of the genes of cytochrome P-450 isoenzymes and the efficiency of antiplatelet therapy was evaluated. The carriers of one allele (CYP2C19*2/*1) were randomized into 3 subgroups according to further antiplatelet therapy. The therapy was not changed in Subgroup 1. The dose of clopidogrel was increased up to 150 mg/day and that of ASA remained unchanged in Subgroup 2. In Subgroup 3, the therapy was completely changed to the regimen: ASA 300 mg + ticagrelor 90 mg twice daily. Three days later, platelet aggregation was reinvestigated in all the three subgroups. Results. In our investigation, the prevalence of carriage of at least one of the CYP2C19*2 alleles was about 35%. Comparison of the baseline platelet aggregation levels during the same platelet therapy showed statistically significant differences between the carriers and non-carriers: 32.7±11.6 and 44.8±12.9 (p=0.0024). Compared with the baseline values, there was a drug therapy switching-induced reduction in platelet aggregation in Subgroups 2 and 3 (p=0.0001 and p=0.0056, respectively). No statistically significant differences were found in Subgroup 1. Conclusion. The determination of CYP2C19 gene polymorphism allows a personalized approach to be applied in antiplatelet therapy for all patients with coronary artery disease.
Terapevticheskii arkhiv. 2016;88(5):47-54
47-54
Effect of cytoflavin on the clinical and autonomic-psychological manifestations of hypertensive disease
摘要
Aim. To evaluate the impact of incorporating cytoflavin in a treatment regimen for patients with different stages of hypertensive disease (HD). Subjects and methods. The results of treatment were analyzed in 140 patients with HD (53 with Stage I, 50 with Stage II, and 37 with Stage III). According to the treatment regimen, the patients were divided into 2 groups. A study group (n=74) received combination treatment involving antihypertensive therapy and cytoflavin intravenously dropwisely in a single dose of 200 ml of 5% glucose solution for 10 days, then 2 tablets twice daily for 60 days, with a total cycle time being 70 days. A comparison group (n=66) had antihypertensive therapy only. Thirty apparently healthy individuals (a control group) were examined to have reference values. All the patients were examined using conventional clinical and laboratory studies. The patients’ complaints and neurological status were assessed using respective questionnaires over time — before and after treatment. Results. The incorporation of cytoflavin in a treatment regimen was ascertained to reduce the degree of anxiety, depressive, dissomnic, and cognitive disorders, improves quality of life in patients with Stage I HD, and lowers the degree of asthenic and autonomic disorders in all disease stages. Conclusion. The found efficacy and safety of the drug may recommend its incorporation in combination therapy regimens for Stages I—III HD.
Terapevticheskii arkhiv. 2016;88(5):55-61
55-61
Choice of optimal vaccination tactics against pneumococcal infection from immunological and clinical standpoints in patients with chronic obstructive pulmonary disease
摘要
Aim. To provide a rationale for choosing the optimal tactics of vaccination against pneumococcal infection in patients with chronic obstructive pulmonary disease (COPD) in the context of evidence-based medicine and on the basis of immunological and clinical data. Subjects and methods. Patients with COPD were examined during a year after vaccination with a 13-valent pneumococcal conjugate (Prevenar-13, PCV13) and a 23-valent pneumococcal polysaccharide (Pnemo-23, PPV23) vaccines. The following vaccination schemes were used: PCV13 monovaccination, PPV23 monovaccination, sequential vaccination with PPV23/PCV13, and sequential vaccination with PCV13/PPV23. Results. Vaccination using all the analyzed schemes in the patients with COPD caused a statistically significant reduction in the frequency of exacerbations, the number of antibiotic cycles, and the number of hospital admissions, as shown by the results of analysis of short-term data. The use of PCV13 was followed by additional effects that were unobserved in the use of PPV23, namely: it promoted the formation of immunological memory to Streptococcus pneumoniae antigens, resulted in the enhanced activity of nonspecific resistance factors, and caused activation of antiviral defense factors. Conclusion. If patients with COPD need to be vaccinated against pneumococcal infection, preference should be given to PCV13 monovaccination. Short-term observations have shown that the sequential use of pneumococcal conjugate and polysaccharide vaccines is redundant and gives no additional benefit to patients with COPD. However, the sequential application of both vaccines may have additional advantages in the long term.
Terapevticheskii arkhiv. 2016;88(5):62-69
62-69
The differential diagnosis of Erdheim-Chester disease and IgG4-related diseases
摘要
The paper describes Russia’s first diagnosed case of Erdheim—Chester disease (systemic histiocytosis) in a 65-year-old man who has been long treated for Ormond’s disease (idiopathic retroperitoneal fibrosis). It also gives the data available in the literature on the pathogenetic components of these diseases and on the similarity of many clinical, laboratory, and morphological characteristics of these two immunoinflammatory diseases and covers the issues of their differential diagnosis. Invasive procedures with a careful morphological/immunomorphological examination of biopsy specimens obtained from affected tissues are shown to be necessary for accurate diagnosis.
Terapevticheskii arkhiv. 2016;88(5):70-76
70-76
Pulmonary fibrosis as the first manifestation of scleroderma systematica overlap syndrome
摘要
The paper describes a clinical case of a female patient with signs of visceral scleroderma systematica and rheumatoid arthritis (RA). Interstitial pulmonary fibrosis was the first manifestation of overlap syndrome. The articular and cutaneous of the syndrome were moderate and cast doubts upon whether the systemic rheumatic disease was present. Postmortem examination confirmed the presence of pulmonary fibrosis, scleroderma, and RA. The case is of interest from the point of view of the atypical onset of the disease.
Terapevticheskii arkhiv. 2016;88(5):77-78
77-78
A rare complication of bariatric surgery: Polyradiculoneuropathy as a type of Guillain-Barré syndrome
摘要
The number of bariatric (weight loss) surgeries have increased steadily in the past decade. Along with the tangible benefit of this treatment, there is a risk for postoperative complications, the main cause of which is impaired absorption of nutrients. The paper describes polyradiculoneuropathy running as a type of Guillain-Barré syndrome.
Terapevticheskii arkhiv. 2016;88(5):79-83
79-83
Analysis of ineffective antiviral therapy with pegylated interferon and ribavirin in a patient with chronic hepatitis C infected with HCV genotype 2
摘要
The paper describes a case of ineffective dual antiviral therapy (pegylated interferon and ribavirin) in a patient with chronic hepatitis C infected with hepatitis C virus (HCV) genotype 2 according to the data from the use of a commercial test system. Analysis of the predictors of failure of antiviral therapy (AVT) (the HCV recombinant variant RF2k/1b, a high viral load before the start of therapy, an unfavorable IL-28B genotype, a high body mass index, and a need for a lower ribavirin dose after 12 weeks of AVT because of adverse reactions for less than 4 weeks) in this patient has shown that no virological response is mainly associated with the presence of the HCV recombinant variant, the treatment effectiveness of which is comparable with that in HCV genotype 1 and obesity. In this connection, when HCV genotype 2 is identified, sequencing the NS5B region of the HCV genome is additionally recommended to rule out the virus recombinant strain and, if it is detected, highly effective interferon-free therapy with direct-acting antivirals is indicated.
Terapevticheskii arkhiv. 2016;88(5):84-85
84-85
Current approaches to diagnosing and treating eosinophilic granulomatosis with polyangiitis: The 2015 international guidelines
摘要
The 2015 international guidelines for the diagnosis and treatment of eosinophilic granulomatosis with polyangiitis, formerly known as the Churg-Strauss syndrome, are detailed and an attempt is made to expand an evidence base, by attracting more recent available publications. The new guidelines should not be regarded as final standards; these are primarily to extend the possibilities of choosing a personified management strategy for patients with eosinophilic granulomatosis with polyangiitis and to serve as the starting point for further in-depth investigations.
Terapevticheskii arkhiv. 2016;88(5):86-92
86-92
Interleukin-6 inhibition and cardiovascular disease in patients with rheumatoid arthritis
摘要
Rheumatoid arthritis (RA) is a disease conferring a high risk for cardiovascular events (CVE). Systemic inflammation underlying RA favors the development of CVE. The safety of biological agents acting on the cardiovascular system has been inadequately investigated. On the one hand, they decrease RA activity and, on the other, may increase the risk of CVE. This review analyzes the literature data predominantly published in recent years on the effect of an IL-6 receptor inhibitor on the cardiovascular system. Tocilizumab is shown to be a promising agent to reduce cardiovascular risk. The findings need to be clinically verified. Long-term prospective investigations should be conducted to determine more exactly the impact of IL-6 receptor inhibition on the development of CVE.
Terapevticheskii arkhiv. 2016;88(5):93-101
93-101
Cardiovascular risk in patients with psoriatic arthritis
摘要
Psoriatic arthritis (PsA) is a chronic immune-mediated disease that is observed in 8-30% of psoriatic patients. It has been recently established that PsA and psoriasis are closely associated with the high prevalence of metabolic syndrome, hypertension, abdominal obesity, and a risk for cardiovascular diseases (CVD), including fatal myocardial infarction (MI) and acute cerebrovascular accidents, which shortens lifespan in the patients compared to the general population. The authors state their belief that the synergic effect of traditional risk factors (RFs) for CVD and systemic inflammation underlie the development of atherosclerosis in PsA. It is pointed out that the risk of CVD may be reduced not only provided that the traditional RFs for CVD are monitored, but also systemic inflammation is validly suppressed. The cardioprotective abilities of methotrexate and tumor necrosis factor-α (TNF-α) inhibitors are considered; the data of investigations showing that the treatment of PsA patients with TNF-α inhibitors results in a reduction in carotid artery intima-media thickness are given. It is noted that there is a need for the early monitoring of traditional RFs for CVD in patients with PsA and for the elaboration of interdisciplinary national guidelines.
Terapevticheskii arkhiv. 2016;88(5):102-106
102-106
Anemic syndrome in rheumatoid arthritis: Diagnostic approaches and treatment opportunities
摘要
Anemia of chronic disease (ACD) is a leading cause of anemic syndrome in patients with rheumatoid arthritis (RA). Enhanced hepcidin production mainly stimulated by excess interleukin-6 levels is a key pathogenetic component of ACD (frequently known as anemia of inflammation). By causing the degradation of the transmembrane protein ferroportin, hepcidin impairs iron metabolism. On the basis of the material of recent publications, the review gives present-day views on the pathogenesis of ACD in RA, approaches to the diagnosis and differential diagnosis of ACD, especially in its concomitance with iron-deficiency anemia, as well as approaches to therapy for the type of anemic syndrome with the complex mechanism for its development.
Terapevticheskii arkhiv. 2016;88(5):107-112
107-112
The problem of cardiac safety of nonsteroidal anti-inflammatory drugs
摘要
The paper considers an update on the mechanisms for the development of adverse reactions of nonsteroidal anti-inflammatory drugs on the cardiovascular system.
Terapevticheskii arkhiv. 2016;88(5):113-117
113-117
Oral probiotics as anti-infectious immune response stimulators in the respiratory tract
摘要
This review analyzes whether it is expedient to use oral probiotics for the stimulation of immune response against pathogens in the respiratory tract. It considers a relationship between mucosal microbial colonization in different biotopes of the body and mucosal immunity in the respiratory tract. The principal and terminological controversial issues of colonic dysbiosis and the possibilities of using the medicines and products containing live commensals/symbionts to correct microbiota disturbances are examined. There are data on the degree of resistance and resilience of the colonic microbial community exposed to destabilizing factors, antibiotics in particular. The properties of probiotics that have been proven to enhance host response against pathogens and the phenomena that characterize these probiotics as immunomodifiers and distinguish them from other immunostimulating/immunomodulating agents are described. Criteria for choosing effective and safe oral probiotics to stimulate an immune response in the respiratory tract are formulated. Finally, we review the data on the clinical and immunomodulatory effects of dietary supplement containing a combination of three probiotic strains (Lactobacillus gasseri PA 16/8, Bifidobacterium bifidum MF 20/5 and Bifidobacterium longum SP 07/3) with vitamins and minerals as an agent to prevent and reduce the severity of acute and recurrent respiratory tract infections.
Terapevticheskii arkhiv. 2016;88(5):118-124
118-124
Wasting syndrome in HIV-infected patients
摘要
The review of literature analyzes scientific data on wasting syndrome in HIV-infected patients. It considers its etiology, diagnosis, and therapeutic approaches.
Terapevticheskii arkhiv. 2016;88(5):125-129
125-129