卷 13, 编号 2 (2021)

The high prevalence and variability of neurological and psychiatric symptoms in systemic lupus erythematosus has become the basis for emphasizing the special neuropsychiatric form of the disorder. Affective disorders (pathological changes in mood and anxiety) are the second most common neuropsychiatric manifestations in patients with systemic lupus erythematosus. However, the current nomenclature primarily focuses on the general clinical manifestations of affective disorders in neuropsychiatric form systemic lupus erythematosus, without evaluating the problems of their etiopathogenesis. Thereby, the aim of this review is the integration of information on the pathological mechanisms of depression and anxiety in patients with systemic lupus erythematosus. The available data on the biological aspects of the anxiety and depression in systemic lupus erythematosus indicate that the complex pathological models may be the best approach for studying, diagnosing, and treating comorbid pathology. The latter can be based on expanding the existing clinical categories, supplementing them with data on pathological mechanisms specific to particular sub-cohorts of patients. Such an approach can provide the specific and most effective preventive, diagnostic and therapeutic measures for each category of patients.

The review article is devoted to the problem of lipid metabolism disorders in the liver in patients with chronic hepatitis B and chronic hepatitis C. The results of modern biological, epidemiological and clinical studies aimed at studying the causes and mechanisms of the formation of liver steatosis and steatohepatitis, their prevalence and influence on the course of infectious pathology are presented. Particular attention is paid to the generalization and systematization of the currently available data on the mechanisms of lipid metabolism disorders in the liver, mediated by the molecular structures of hepatitis B and C viruses. In conclusion, the need for timely diagnosis and treatment of pathological conditions caused by the development of lipid metabolism disorders in the liver is substantiated in order to increase the quality of medical care for patients with chronic hepatitis B and C.

论证。新型冠状病毒感染（COVID-19）的流行对免疫炎症性风湿性疾病患者尤其危险。新的冠状病毒感染伴随着广泛的肺外临床和实验室表现的发展，这是许多免疫炎症性风湿性疾病的特征。

研究的目的是评估新冠病毒感染患者免疫炎症性风湿病的临床病程特征。

材料与方法。我们分析了2020年3月至2021年2月接受新型冠状病毒感染的324名患者的免疫炎症性风湿病的临床病程。在圣彼得堡国家预算医疗机构“25号临床风湿病医院”接受治疗，以治疗基础疾病的恶化。

结果。通过多因素分析发现，免疫炎症性风湿病中新型冠状病毒感染重症病程的危险因素为年龄大于60岁、存在合并症（缺血性心脏病、慢性心力衰竭、慢性阻塞性肺疾病)，在病毒感染发展之前，每天使用超过12.5毫克的泼尼松龙，并且红细胞沉降率值≥40毫米/小时。免疫抑制治疗和基因工程生物治疗不影响免疫炎症风湿病患者病毒感染病程的严重程度。1/4的患者出现感染后综合征，其特征是3.6%的患者形成感染后关节炎，49%的患者将未分化的关节炎转化为各种风湿性疾病（更常见于早期类风湿性关节炎），以及83.4%的晚期类风湿性关节炎患者的基础疾病恶化。全身性结缔组织疾病患者中，由于抗核因子的作用，免疫活性显着增加（最高可达1：163 840）。介绍了与病毒感染相关的关节炎发展和新型冠状病毒感染后发生类风湿性关节炎的临床病例。

结论。SPbgbuz“25号临床风湿病医院”观察到的免疫血管性风湿病患者中新的冠状病毒感染以一半患者的平均严重程度的变异进行，68.6%的患者开始出现肺部病变；与病毒感染相关的关节炎-3.6%的患者；由未分化关节炎转化而来的免疫性风湿性疾病—49%的病例中，绝大多数患者的基础疾病恶化。免疫血管疾病患者中，揭示了新的冠状病毒感染的不良结果的高风险，特别是在疾病的不稳定过程或这组疾病的恶化的情况下。

这项工作的目的是确定阿莫西林的全身转运特征，阿莫西林是根除治疗方案中最常见的抗生素H. pylori进入有萎缩性胃炎的胃腔。

材料与方法。采用胃粘膜洗涤法对萎缩性胃炎模型及对照组大鼠胃腔中阿莫西林的系统转运进行了研究静脉注射药物后。阿莫西林从血流到胃腔的运输也被评估为萎缩性胃炎和非营养性胃炎患者通过鼻窦吸入胃液口服药物后的探头。用色谱质谱法测定了样品中的阿莫西林浓度。

结果。实验组大鼠经宏观检查发现胃粘膜充血及急性糜烂性改变，以及胃体外非活动性慢性胃炎和非活动性慢性体外萎缩性胃炎的显微特征。实验组大鼠胃粘膜冲洗中阿莫西林浓度在所有时间点（30、60、120、 240分钟用药后）均可靠（p<0.01）较高，而不是控制组的老鼠。患者胃液中阿莫西林的平均浓度在胃侧部萎缩时最低(p<0,01)。胃黏膜萎缩患者在吸入第180分钟时观察到阿莫西林在胃分泌物中的最大浓度，对于对照组的人-从第30分钟到第120分钟。胃黏膜萎缩患者在吸入第180分钟时观察到阿莫西林在胃分泌物中的最大浓度，对于对照组的人-从第30分钟到第120分钟。

结论。胃黏膜的急性糜烂性改变进入大鼠的胃腔，导致阿莫西林转运增加。患者中胃窦部的黏膜萎缩程度大于胃体，其特征是口服药物后阿莫西林从体循环到胃腔的转运减少。预测根除疗法的有效性时H. pylori慢性胃炎患者要考虑到胃黏膜萎缩的存在。

Hodgkin lymphoma is a malignant disease with clonal proliferation of B-cells and high-level reactive inflammatory microenvironment. The main clinical sings are lymphadenopathy and toxic symptoms. Neurological symptoms as usual can be a result of compression or tumor infiltration of nervous structures. The primary damage of CNS occurs from 0,2% to 0,5% of all cases HL.

Paraneoplastic neurological syndrome is a group of rare (an average 1 case on 10000 patients) neurological disorders against the background of oncological process. The pathophysiologic mechanism is due to production of antibody which is both to tumor cells and nerve cells. These antibodies are called onconeural autoantibodies. The hallmark which make diagnostics harder is the fact that onconeural autoantibodies rare take place in patients with lymphomas unless anti-Tr and anti-mGluR1 in patients with limbic encephalitis or paraneoplastic cerebellar degeneration.

There are two case reports about patients with PNS in onset of Hodgkin lymphoma in article.