Klinicheskaia meditsina最新文献

英文中文

[Extragastric symptoms associated with Helicobacter pylori infection]. [与幽门螺杆菌感染相关的胃外症状]。

Klinicheskaia meditsina

Pub Date : 2017-01-01

V A Akhmedov, O V Gaus

This review article highlights the modern views of manifestations associated with Hp infection. The data are presented about the negative impact of the infection on the state of the musculoskeletal system, the development of migraine, progression of diffuse liver disease and the risk of developing liver cancer. The paper also provides information on the possible effects of Helicobacter pylori infection on the formation of halitosis, tympanosclerosis, male reproductive health disorders, colorectal cancer, Alzheimer's and Parkinson's disease, pre-eclampsia during pregnancy, and idiopathic chronic urticaria. In addition, the negative relationship between Hp infection, bronchial asthma, and inflammatory bowel disease is considered.

这篇综述文章强调了Hp感染相关表现的现代观点。数据显示了感染对肌肉骨骼系统状态的负面影响，偏头痛的发展，弥漫性肝病的进展以及发展为肝癌的风险。本文还提供了幽门螺杆菌感染对口臭、鼓膜硬化、男性生殖健康障碍、结直肠癌、阿尔茨海默病和帕金森病、妊娠期先兆子痫和特发性慢性荨麻疹形成的可能影响的信息。此外，Hp感染、支气管哮喘和炎症性肠病之间存在负相关关系。

引用次数: 0

[PROINFLAMMATORY CYTOKINES AND SIGNALING PATHWAYS IN PERIPHERAL BLOOD MONONUCLEAR CELLS IN PATIENTS WITH CORONARY ARTERY DISEASE]. [冠心病患者外周血单核细胞的促炎细胞因子和信号通路]。

Klinicheskaia meditsina

Pub Date : 2017-01-01

A V Logatkina, V S Nikiforov, S S Bondar, I V Terekhov

Aim: To determine content of mononuclear ells (MNC) in peripheral blood of patients with coronary heart disease (CHD) and factors responsible for their functional state and cytokine production.

Materials and methods: Concentration of proteinkinases JNK1/2, ERK1/2, MAPK38, AKT1, JAK2, FAK, AMPK, p70S6K, STAT3, STAT5B and STAT6 was determined in MNC lysate by immune-enzyme assay. Interleukin 1β, 2, 4 and y-interferon levels were measured in blood sera.

Results: In patients with angina of effort and unstable angina, the JNK level was 59,8% and 53,1% higher than the normal one respectively (р=0,013) and (р=0,012). The level of the nuclear transcription factor was 26,9% (р=0,015) and 27,9% (р=0,017), JAK2 31,5% (р=0,022) and 48,6% (р=0,018), STAT3 49,6% (р=0,025) and 55,3% (р=0,02), STAT5B 21,5% (р=0,018) and 30,2% (р=0,011) lower. These changes were associated with a 13,1% (р=0,047) and 51,4% (р=0,019) rise in the STAT6 level, 30,1% (р=0,025) and 79,4% (р=0,003) FAK level, 7,6% (р=0,09) and 15,2% (р=0,039) АКТ1 level, 65,3 (р=0,02) and 76,2% (р=0,017) p70S6K level.

Conclusion: Results of the study suggest persistent pro-inflammatory activation of whole blood cells in CHD patients due to enhanced levels of IL-1 and IL-2, components of the MAPK/SAPK signal pathway in MNC and decreased STAT3 level determining cell sensitivity to IL-10. The elevated intracellular level of ERK and JNK us responsible for high responsiveness of MNC to pro-inflammatory cytokines.

目的:探讨冠心病(CHD)患者外周血单核细胞(MNC)含量及其功能状态和细胞因子产生的相关因素。材料与方法:采用免疫酶法测定MNC裂解液中蛋白激酶JNK1/2、ERK1/2、MAPK38、AKT1、JAK2、FAK、AMPK、p70S6K、STAT3、STAT5B、STAT6的浓度。测定血清白细胞介素1β、2、4和y-干扰素水平。结果:用力型心绞痛和不稳定型心绞痛患者JNK水平分别比正常人高59.8%和53.1% (p < 0.05) (p < 0.05)。核转录因子水平分别为26.9%(0.015)和27.9% (0.017)，JAK2 31.5%(0.022)和48.6% (0.018)，STAT3 49.6%(0.025)和55.3% (0.02)，STAT5B 21.5%(0.018)和30.2%(0.011)。这些变化与STAT6水平上升13.1%(0.047)和51.4%(0.019)、FAK水平上升30.1%(0.025)和79.4%(0.03)、7.6%(0.09)和15.2% (0.039)АКТ1水平、65.3(0.02)和76.2% (0.017)p70S6K水平升高相关。结论:研究结果表明，冠心病患者全血细胞持续的促炎激活是由于MNC中MAPK/SAPK信号通路成分IL-1和IL-2水平的升高以及决定细胞对IL-10敏感性的STAT3水平的降低。细胞内ERK和JNK水平的升高是MNC对促炎细胞因子的高反应性的原因。

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引用次数: 0

[SYSTEMIC LUPUS ERYTHEMATOSUS WITH LUPUS NEPHRITIS IN THE ELDERLY (CLINICAL OBSERVATION)]. 老年人系统性红斑狼疮合并狼疮性肾炎(临床观察)。

Klinicheskaia meditsina

Pub Date : 2017-01-01

M Z Kanevskaya, O M Kuznetsova

We report a clinical case of SLE in a women affected at the age of 63 years who had recurrent nephrotic syndrome with the development of renal insufficiency at the onset and a good outcome of therapy with a large total dose cyclophosphamide.

我们报告一例63岁女性SLE患者，复发性肾病综合征，发病时伴有肾功能不全，大剂量环磷酰胺治疗效果良好。

引用次数: 0

[PERSONALIZED MEDICINE IN INTERNAL MEDICINE]. [内科个体化医疗]。

Klinicheskaia meditsina

Pub Date : 2017-01-01

V G Kukes, V F Marinin, Yu V Olefir, G V Ramenskaya, N B Lazareva, V V Smirnov, M V Zhuravleva, A B Prokofiev, E V Shih, A S Zhestovskaia, N A Rumyantsev, D V Mandich, O A Goroshko

Personalized medicine - a new direction in medicine, which is based on the study of various biomarkers and the use of new methods of molecular analysis (primarily evaluating the activity of isoenzymes of cytochrome P450), allowing individualized approach to the selection of both the drugs and the selection of the dosing regimen for the purpose of maximize the effectiveness and safety of pharmacotherapy. This personalized medicine is to change the development and use of preventive and curative interventions. Genetic polymorphism isozymes of cytochrome P450 may determine the individual activity of a particular isozyme, and thus, to predict the clinical effectiveness, and in some cases, the risk of adverse reactions. The article is an example of the use of information on the activity of cytochrome P450 in clinical practice in matters of diagnosis, treatment and prevention of diseases. The scheme of the five best-known activity of isoenzymes of cytochrome P450 is shown.

个体化医学——医学的一个新方向，它基于对各种生物标志物的研究和使用新的分子分析方法(主要是评估细胞色素P450同工酶的活性)，允许个体化方法来选择药物和选择给药方案，以最大限度地提高药物治疗的有效性和安全性。这种个性化医疗将改变预防和治疗干预措施的发展和使用。细胞色素P450基因多态性同工酶可以决定特定同工酶的个体活性，从而预测临床疗效，在某些情况下，还可以预测不良反应的风险。这篇文章是在诊断、治疗和预防疾病的临床实践中使用细胞色素P450活性信息的一个例子。给出了细胞色素P450同工酶的5种最著名的活性谱图。

引用次数: 0

[EVALUATION OF BODY MASS INDICES AND ARTERIAL PRESSURE AS CARDIOVASCULAR RISK FACTORS IN THE ADULT POPULATION OF THE CITY OF VORONEZH]. [评价沃罗涅日市成人体重指数和动脉压作为心血管危险因素]。

Klinicheskaia meditsina

Pub Date : 2017-01-01 DOI: 10.18821/0023-2149-2017-95-2-148-153

A. Kryuchkova, N. M. Seminina, Yu.V. Kondusova, I. Poletaeva, A. Knyazeva

Aim To determine body mass index (BMI) and blood pressure (BP) of the Voronezh city adult population. Materials and methods 1108 residents of Voronezh city at the age from 20 to 75 years were examined in 2015 including measurement of their height, body mass, arterial pressure, and BMI calculation. Medical histories were analyzed to reveal arterial hypertension in the preceding period in the following age groups: 20-29, 30-39, 40-49, 50-59, 60-75 yr and the entire study group (20-75 yr). Results The mean BMI of the residents of Voronezh was 28.5 (23.8; 33.1) kg/m. The highest values were found between 40 and 59 years. BMI in women under 40 was lower than in men of the same age. The education level affected the prevalence of obesity in that people with secondary vocational education were more likely to be obese than those given higher education. At the age of 40, the incidence of hypertension among women was lower than among men of the same age, it more frequently occurred at the age of 60-75 years. Both age and BMI were related to the level of blood pressure: higher BMI and blood pressure were recorded at an older age. The prevalence of hypertension also increased with age. Conclusion Obesity was detected in 29.7% of the Voronezh population recruited to the study. The prevalence of obesity among young adults (20-29 years) iproved lower than in the middle and old age groups. 30.9% of the residents suffered from AH.

目的测定沃罗涅日市成年人群的体重指数(BMI)和血压(BP)。材料与方法2015年对沃罗涅日市1108名年龄在20 ~ 75岁的居民进行了身高、体重、动脉压测量和BMI计算。分析病史以揭示以下年龄组的前期动脉高血压:20-29岁、30-39岁、40-49岁、50-59岁、60-75岁和整个研究组(20-75岁)。结果沃罗涅日市居民平均BMI为28.5 (23.8;33.1公斤/米。在40岁到59岁之间发现了最高的数值。40岁以下女性的身体质量指数低于同龄男性。受教育程度影响肥胖的流行程度，中等职业教育的人比受过高等教育的人更容易肥胖。40岁时，女性高血压发病率低于同龄男性，60-75岁多见。年龄和身体质量指数都与血压水平有关:年龄越大，身体质量指数和血压越高。高血压患病率也随着年龄的增长而增加。结论在沃罗涅日市纳入研究的人群中，有29.7%的人存在肥胖症。年轻人(20-29岁)肥胖患病率的改善程度低于中老年人群。30.9%的居民患有AH。

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引用次数: 0

[THE PREVALENCE OF RESPIRATORY SYMPTOMS AMONG RESIDENTS OF THE RUSSIAN FAR NORTH]. [俄罗斯极北地区居民呼吸道症状的流行程度]。

Klinicheskaia meditsina

Pub Date : 2017-01-01 DOI: 10.18821/0023-2149-2017-95-3-260-263

S. Andronov, A. Lobanov, A. Popov, A. Emelyanov

Aim To study the frequency of respiratory symptoms among the reindeer herders of the Yamal region in the Far North of Russia. We conducted a cross-sectional study of the occurrence of respiratory symptoms among 500 subjects of the tundra Nenets population (28.1% of the adult Nenets population in the district), of which 38.3% were men and 61.7% women (average age 40.1 years). All patients were matched for age and occupation. Medical examination was carried out by a pulmonologist with the use of the GARD questionnaire (WHO, 2004) and spirometry. Spirometry was performed with a SpiroUSB device (UK) according to a unified standard and the criteria of ATS/ERS 2005. The frequency of respiratory symptoms among the tundra population was estimated at 71.8%. Cough with expectoration and dyspnea were found in 22.8% of the respondents. 70.0% of the examined subjects worked in the cold, 33% were exposed to the open flame at home, and 34.4% smoked. Respiratory symptoms developed in 16.3% of those working in the cold and in 37% exposed to open fire. The combination of such complaints as cough and sputum production occurred in smokers twice as frequently as in non-smokers (54.1%) (p<0.01).The combination of such complaints as cough and sputum production was twice as likely note in his those who smoked (54.1% vs 20.2%) (p<0.01). The combination of these problems dyspnea was three times more common in the smokers (23,3%vs 7,3%) (p<0.001). At presence at patients of such a factor as work in the cold and the absence of other only 16.3% of them have respiratory symptoms. When using at home the open flame and the absence of other factors leading up 37.0% of the individuals with symptoms of chronic bronchitis. Cough, sputum and dyspnea are formed only among 26.3% of the smokers face when smoking is the only risk factor. If the surveyed residents of all three negative factors respiratory symptoms met at 62.1%. Disorders of respiratory function according to spirometry were not observed in none of the study participants. Respiratory symptoms developed in 62.1% of the subjects exposed to all three risk factors. External respiration indices remain normal in all he examine subjects. It is concluded that residents of the Far North frequently suffer respiratory symptoms without disorders in the external respiratory function. In most cases they associated with three factors (work in the cold, exposure to open fire at home, and smoking). Compensatory stimulation of lung functions may create additional difficulties for diagnostics of bronchial obstruction.

目的研究俄罗斯远北亚马尔地区驯鹿牧民呼吸道症状的发生频率。我们对500名苔原涅涅茨人(占该地区成年涅涅茨人口的28.1%)的呼吸道症状发生情况进行了横断面研究，其中38.3%为男性，61.7%为女性(平均年龄40.1岁)。所有患者的年龄和职业相匹配。一名肺科医生使用GARD问卷(世卫组织，2004年)和肺活量测定法进行了医学检查。肺活量测定采用SpiroUSB(英国)设备，按照ATS/ERS 2005的统一标准和标准进行。冻土带人群中出现呼吸道症状的频率估计为71.8%。咳嗽伴咳痰、呼吸困难者占22.8%。70.0%的被调查者在寒冷环境中工作，33%的人在家暴露在明火下，34.4%的人吸烟。在寒冷环境中工作的人中有16.3%出现呼吸道症状，暴露于明火的人中有37%出现呼吸道症状。吸烟者咳嗽、咳痰的发生率是不吸烟者的两倍(54.1%)(p<0.01)。咳嗽、咳痰是吸烟人群的两倍(54.1% vs 20.2%) (p<0.01)。合并这些问题的呼吸困难在吸烟者中是前者的三倍(23.3% vs 7.3%) (p<0.001)。在病人在场的情况下，如在寒冷中工作，而没有其他因素，只有16.3%的人有呼吸道症状。在家中使用时，明火和没有其他因素导致37.0%的个体出现慢性支气管炎症状。当吸烟是唯一的危险因素时，只有26.3%的吸烟者会出现咳嗽、痰和呼吸困难。若被调查居民呼吸道症状的三种阴性因素均达到62.1%。根据肺活量测定，在所有研究参与者中均未观察到呼吸功能障碍。暴露于所有三种危险因素的受试者中有62.1%出现呼吸道症状。所有检查对象的外呼吸指标均正常。结论是，远北地区居民经常出现呼吸道症状，但外部呼吸功能没有紊乱。在大多数情况下，它们与三个因素有关(在寒冷的环境中工作，暴露在家里的明火中，吸烟)。肺功能代偿性刺激可能给支气管梗阻的诊断带来额外的困难。

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引用次数: 1

[THE HISTORY OF DEPARTMENT OF FACULTY THERAPY, AT THE VORONEZH HIGHER EDUCATION INSTITUTION (ON THE OCCASION OF THE CENTENARY ANNIVERSARY OF N.N. BURDENKO VORONEZH STATE MEDICAL UNIVERSITY)]. [沃罗涅日高等教育机构教师治疗系的历史(在新布登科沃罗涅日国立医科大学成立一百周年之际)]。

Klinicheskaia meditsina

Pub Date : 2017-01-01 DOI: 10.18821/0023-2149-2017-95-2-189-192

A. Budnevsky, V. Provotorov, Yu I Filatova

The article is devoted to the history of the Department of Faculty Therapy, N.N. Burdenko Voronezh State Medical University. The history of its creation is inextricably linked to the Derpth (Yurievsky) University that was transferred to Voronezh in 1918. While the Department of Faculty Therapy remained in Voronezh, it several times changed location making use of various city hospitals as its branches. It simultaneously expanded its activities by organizing courses of physical therapy, endocrinology, and other medical disciplines. The article focuses on the events pertaining to the formation and development of the Department of Faculty Therapy, main directions and achievements of its scientific work.

这篇文章专门介绍了N.N.布尔登科沃罗涅日国立医科大学教师治疗系的历史。它的创建历史与1918年转移到沃罗涅日的深度(尤里夫斯基)大学密不可分。虽然院系治疗部仍在沃罗涅日，但它多次改变地点，利用各城市医院作为其分支机构。同时，它通过组织物理治疗、内分泌学和其他医学学科的课程来扩大其活动。本文着重介绍了学院治疗系的形成和发展过程、主要研究方向和取得的科研成果。

引用次数: 0

[THE ROLE OF LOW-FREQUENCY PIEZOTHROMBOELASTOGRAPHY IN THE COMPREHENSIVE EVALUATION OF HEMOSTASIS IN CORONARY BYPASS SURGERY WITH CARDIOPULMONARY BYPASS]. [低频压电血栓弹性成像在冠状动脉搭桥术合并体外循环止血的综合评价中的作用]。

Klinicheskaia meditsina

Pub Date : 2017-01-01 DOI: 10.18821/0023-2149-2017-95-3-245-253

E. Fanaskova, O. Gruzdeva, O. Akbasheva, I. Tyutrin, T. Penskaya, E. Uchasova, G. Plotnikov, K. E. Krivoshapova, O. Barbarash

Aim To monitor the hemostatic system during platelet concentrate transfusions using low-frequency piezothromboelastography in patients with coronary bypass surgery given aspirin therapy. Materials and Methods The study involved 148 patients with coronary bypass surgery, with 76 ones undergoing intraoperative transfusion of platelet concentrate and 72 treated without transfusion. The control group consisted of 20 healthy individuals. In the perioperative period indicators of vascular-platelet, coagulation, anticoagulant and fibrinolytic components of hemostasis were evaluated by low-frequency pezotromboelastography using the ARP-01M "Mednord" hardware and software system (Russia). Results It was shown that the antiplatelet effect of aspirin in the preoperative period was manifest as inhibition of the initial stage of blood coagulation accompanied by increased thrombin potential, the total gain of anticoagulant and fibrinolytic activity of the blood. Heart-lung bypass was accompanied by structural and chronometric anticoagulation, reduction of anticoagulation and increase of blood fibrinolytic activity. In the postoperative period, structural and chronometric anticoagulation was more pronounced in patients who did not undergo transfusion of platelet concentrate than in the group of patients with transfusion. Donor platelets further increased the blood hemostatic potential by neutralizing the antiplatelet effect of aspirin. Perioperative thrombohemorrhagic complications were absent in both groups. Conclusion Low-frequency piezothromboelastography provides a tool for real-time monitoring the functional state of hemostasis system. Transfusion of platelet concentrate is not advisable given that the thrombin potential is preserved as confirmed by the results of low-frequency piezothromboelastography.

目的应用低频血栓弹性成像技术监测冠状动脉搭桥术后给予阿司匹林治疗的患者血小板浓缩输注时的止血系统。材料与方法148例冠状动脉搭桥术患者，术中输注浓缩血小板76例，未输注血小板72例。对照组由20名健康个体组成。围手术期血管血小板、凝血、抗凝、纤溶等止血指标采用俄罗斯美诺公司ARP-01M软硬件系统进行低频血小板弹性成像评估。结果术前阿司匹林的抗血小板作用主要表现为抑制凝血初始阶段，并伴有凝血酶电位升高，血液抗凝和纤溶活性总增加。体外循环伴结构性和时度性抗凝，抗凝功能降低，血纤溶活性升高。术后未输注浓缩血小板的患者比输注浓缩血小板的患者结构抗凝和计时抗凝更为明显。供体血小板通过中和阿司匹林的抗血小板作用进一步增加血液的止血潜能。两组患者围手术期均无血栓出血性并发症。结论低频血栓弹性成像为实时监测止血系统功能状态提供了一种工具。输血血小板浓缩物是不可取的，因为凝血酶的潜力被保留，由低频压电血栓弹性成像的结果证实。

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引用次数: 0

[The risk of cardiovascular death in type 2 diabetes]. [2型糖尿病的心血管死亡风险]。

Klinicheskaia meditsina

Pub Date : 2017-01-01

N V Zeinalova, Y Z Kurbanov, V A Mirzazade, R A Rzayeva, M S Novruzova

Aim: To evaluate effects of metabolic disorders on the risk of cardiovascular death in patients with type II diabetes based on Framingham risk score. We analyzed results of examination of 210 men and 210 women with type 2 diabetes who applied for medical care to the VM center of Endocrinology during 1997-2014. A virtual control group was formed matching real patients in terms of the number, sex, age, and height having ideal body mass index, total cholesterol and high-density lipoprotein cholesterol levels. The average risk of cardiovascular death in patients with type 2 diabetes was equal to 4,56±0,254% compared with 0,6±1,028% in the virtual control group. The differences was significant (p <0,001). The minimum risk for the patients of the two groups was estimated at 0,001% and 0,01% respectively. The maximum risk of cardiovascular death is 34,17% in patients with diabetes and 8,24% in controls. It is concluded that type 2 diabetes and related metabolic disorders significantly increase the risk of cardiovascular death.

目的:基于Framingham风险评分评价代谢紊乱对2型糖尿病患者心血管死亡风险的影响。我们分析了1997-2014年在VM内分泌中心就诊的210名男性和210名女性2型糖尿病患者的检查结果。在人数、性别、年龄、身高等方面与真实患者相匹配，形成虚拟对照组，使患者的身体质量指数、总胆固醇、高密度脂蛋白胆固醇水平达到理想水平。2型糖尿病患者心血管死亡的平均风险为4,56±0,254%，而虚拟对照组为0,6±1,028%。差异有统计学意义(p

引用次数: 0

[Pathogenesis of myocarditis in patients with bronchial asthma and pecilomycosis]. 【支气管哮喘和纤毛菌病合并心肌炎的发病机制】。

Klinicheskaia meditsina

Pub Date : 2017-01-01

V M Akhunov, Zh M Sizova, A M Akhunova, T P Lavrent'eva

We studied the influence of activation ofpecilomycotic infection in blood on the morphofunctional state of myocardium based on the clinical and pathomorphological data. The study included 23 patients with bronchial asthma (BA) concomitant with pecilomycosis after acute viral respiratory infection; protocols of autopsies and pathological sections of the heart muscle of the patients who died from asphixy and acute cardiac insufficiency were analyzed. Histological sections showed up vascular dystonia of the microcirculation bed, arteriole spasms, wall destruction in small and medium-size vessels and the adjacent muscular tissue, stromal oedema, valvular swelling, andperiwall endocarditis. Cardiac cavities and coronary vessels contained erythrocyte-rich thrombi with ferulas of Paecilomyces at different stages of development. Clinical manifestations of destructive changes in the heart muscle developing under effect of Paecilomyces infection had the form of rhythm and conductivity disorders. The local protective inflammatory reaction of productive type had the form of intermediate and vascular-type myocarditis passing to postmyocarditic cardiosclerosis. Periodic bursts of activation ofpecilomycotic infection in blood with the accumulation of fungal phospholipase A2 and lipid metabolites produced membranotoxic effect and can play the key role in the development of atherosclerosis and hypertensive disease in patients with BA and pecilomycosis.

我们结合临床和病理形态学资料，研究了血中纤毛菌感染激活对心肌形态功能状态的影响。本研究纳入23例急性病毒性呼吸道感染后支气管哮喘(BA)合并纤毛菌病患者;分析了窒息和急性心功能不全死亡患者的尸检方案和心肌病理切片。组织学切片显示微循环床血管张力障碍、小动脉痉挛、中小血管及邻近肌肉组织壁破坏、间质水肿、瓣膜肿胀、心内膜炎。在不同发育阶段的心腔和冠状血管中含有含有拟青霉阿魏的富红细胞血栓。拟青霉感染后心肌发生破坏性改变，临床表现为节律和传导障碍。生产性型局部保护性炎症反应以中间型和血管型心肌炎的形式向心肌后心肌硬化过渡。随着真菌磷脂酶A2和脂质代谢物的积累，血液中周期性爆发的青霉感染激活产生膜毒性作用，并在BA和青霉病患者的动脉粥样硬化和高血压疾病的发展中发挥关键作用。

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