卷 13, 编号 1 (2021)

Today, the most difficult in terms of diagnosis and treatment today among various types of myocardial infarction (MI) is MI type 2 (MI-2). The lack of clinical guidelines for management of patients with this type of MI, as well as the literature data on prevalence, patient characteristics and prognosis contributes to the scientific relevance of the further research.

Heart failure is detected in 2% of the population. The leading causes of heart failure are coronary heart disease, arterial hypertension, and valvular heart disease. The number of patients with chronic heart failure continues to increase despite the new methods of diagnosis and treatment. A special contribution is made by damage to target organs in the development of cardiovascular pathology. Impaired liver function or congestive liver is common in heart failure and increases the risk of death and requires further study. The mechanism of liver damage in chronic heart failure is complex and multicomponent. The sensitivity and specificity of standard clinical, laboratory and instrumental methods for the diagnosis of congestive liver are insufficient. With the increase, severity and duration of venous congestion, structural changes in the architectonics occur, leading to the formation of liver fibrosis. The development of cardiac liver fibrosis leads to a complication of the course of chronic heart failure and an increase in mortality.

Among the new diagnostic methods, the most important are serological markers of liver fibrosis, which have high diagnostic accuracy, as well as histological determination of fibrosis, as well as ultrasound examination of the liver in B-mode and determination of liver stiffness by elastography. Direct and indirect serological markers have a higher diagnostic value when using their combination in the composition of panels in the development of hepatopathy of different origins. An increase in the concentration of markers of fibrosis and liver stiffness during elastography correlates with the severity of heart failure and a long-term prognosis for mortality, including from extrahepatic diseases. Performing liver elastography in dynamics allows to monitor the course and treatment of heart failure. The optimal diagnostic method is a combination of direct and indirect markers of fibrosis, ultrasound diagnostics and elastography, in addition to clinical assessment of signs and direct assessment of hemodynamic parameters.

这项研究的目的是研究最可能的与靠谱系统性红斑狼疮患者的完整皮肤免疫反应谱。这项研究涉及94名患者，他们接受了标准的临床和实验室检查，并在三角肌区域进行了皮肤活检（狼疮带试验）。在靠谱系统性红斑狼疮的患者组（n=56），根据SLEDAI-2K，狼疮带试验在60.7%的病例中呈阳性，并与疾病活动相关（p=0.001）。同时，皮肤活检常显示免疫反应性IgM（85.3%），其荧光程度与双螺旋DNA抗体水平的升高直接相关（p<0.05）。在可能患有系统性红斑狼疮的检查患者中，47%的患者登记了狼疮带试验阳性，而72.2%的患者登记了IgM，这使他们更接近靠谱的系统性红斑狼疮患者组。然而，33.3%最可能的系统性红斑狼疮患者存在孤立的单一免疫反应物沉积，而靠谱系统性红斑狼疮的免疫反应（IgM + IgG）和（IgM + IgG + C3）的相关性分别为27.7例和5.5%。值得注意的是，C1q免疫反应在靠谱（38.2%）和可能的系统性红斑狼疮（39%）的皮肤活检中均检出。所获得的数据表明，具有特定免疫反应模式的狼疮带试验可作为诊断系统性红斑狼疮的一种附加试验。

绪论2019新型冠状病毒（COVID-19）通常伴有细胞因子风暴综合征。尽管许多白细胞介素具有预测价值，但单一标记物的敏感性和特异性是有限的。

该研究的目的是建立一个客观和内容丰富性的细胞因子风暴量表，用于评估COVID-19相关肺炎患者发生关键病程的风险。

材料与方法。我们研究了226例COVID-19病例，其中36例（16%）因该病死亡。细胞因子IL-1b、IL-2、 IL-6、IL-8、IL-10、IL-18，á肿瘤坏死因子，á-干扰素，ã-干扰素采用VektorBest（俄罗斯）生产的商业试剂盒进行酶免疫分析。

结果。因为IL-6、IL-10、IL-18和降钙素原水平与疾病的严重程度和死亡相关，这些分数被整合成一个12分的量表，称为细胞因子风暴量表。得分超过6分的患者有疾病不良结局的高风险。ROC分析显示，细胞因子风暴量表的曲线下面积均大于四种标志物的曲线下面积[AUC 0.90 (95% CI 0.8455–0.9592)，p<0.001]。

结论。因此，细胞因子风暴规模与COVID-19病程不良预后风险的信息含量相当高。

AIM: The purpose of the study is to investigate the occurrence of the main forms of chronic gastritis, metaplastic and dysplastic changes in the gastric mucosa, the degree of their severity, and to assess their potential risk for the development of gastric cancer.

MATERIALS AND METHODS: The study involved 2982 patients who underwent esophagogastroduodenoscopy with a standard biopsy of the gastric mucosa for morphological assessment and bacterioscopy. If autoimmune gastritis was suspected, an additional serological diagnosis was performed. When detecting intestinal metaplasia of the gastric mucosa as well as neoplastic changes according to the histological report, the description of this report was analyzed in order to identify possible equivalents in the macroscopic description of the mucous membrane.

RESULTS: Out of 2982 histological studies of gastric mucosa biopsies, 1273 cases (42.7%) were found to contain H. pylori contamination. In 726 cases (24.3%), intestinal metaplasia. 66 biopsies (2.21%) showed the presence of low-grade intraepithelial neoplasia of the mucosa, 2 biopsies showed indeterminate neoplasia and 4 biopsies showed high-grade neoplasia. In 3 out of the total number of the samples, intravascular gastric adenocarcinoma was detected. In 168 cases (5.6%), gastritis was detected with predominant inflammation of the fundal region characteristic of autoimmune gastritis. In 286 biopsies (10.6%), inflammatory and/or atrophic changes and/or metaplastic changes were preserved, which, as a rule, did not have high activity and pronounced inflammation. In the remaining 1279 cases (42.9%), there was no significant inflammation or atrophic changes. The analysis of endoscopic findings showed that the detectability of intestinal metaplasia of the gastric mucosa without a biopsy study was 13.3%.

DISCUSSION OF THE RESULTS: According to the results of the conducted research and analysis, it can be stated that at present, the correct diagnosis of chronic gastritis with the establishment of the etiological factor, prognosis and risks of stomach cancer development is practically not feasible within the modern health care system. This not only deprives a doctor of the opportunity to make a correct diagnosis and prescribe adequate treatment to a patient, but also makes almost all cascades of carcinogenesis, including early cancer, “invisible”.

BACKGROUND: Iron deficiency is a common comorbidity in many patients with chronic heart failure.

AIM: To study the parameters of intracardiac hemodynamics in the patients with chronic heart failure in the presence of iron deficiency.

MATERIALS AND METHODS: We examined 179 patients (36 men and 143 women, mean age 71.6 ± 7.9 years) with heart failure of functional class 2-4 (NYHA). All the patients underwent a clinical examination, a 6-minute walk test, a general blood test; the level of NT-proBNP, iron, transferrin, and ferritin in blood serum were studied; the percentage of transferrin saturation with iron was calculated. The presence of iron deficiency was assessed based on a decrease in the level of serum ferritin less than 100 μg/L or ferritin ranging from 100 to 299 μg/L and saturation of transferrin with iron less than 20%. All the patients underwent echocardiography in one-dimensional, two-dimensional and Doppler modes (pulse-wave, constant-wave and tissue) in standard positions according to the generally accepted technique.

RESULTS: It was found that in the patients with chronic heart failure and iron deficiency compared with the patients without iron deficiency; the end systolic volume of the left ventricle, the size of the right ventricle and the systolic pressure in the pulmonary artery were significantly higher, and the speed of movement of the fibrous ring of the mitral and tricuspid valves and the working capacity were lower. Significant correlations were established between the concentration of iron and ferritin and the parameters of intracardiac hemodynamics.

CONCLUSIONS: Iron deficiency in the patients with chronic heart failure without anemia contributes to an early initial decrease in cardiac contractility with an intact ejection fraction.