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Aim. To analyze the modes of immunosuppressive therapy as a risk factor for new-onset diabetes after transplantation (NODAT) in kidney recipients. Materials and methods. The retrospective analysis included data from 1367 recipients (755 men and 612 women) who lived more than one year after NODAT and were observed at the Moscow City Nephrology Center from January 1989 to December 2018. NODAT was established for 178 (13%) patients based on criteria from the World Health Organization and the American Diabetes Association. The modes of immunosuppressive therapy using cyclosporin A (CSA), tacrolimus (Tac), mTOR inhibitors, glucocorticoids in patients with NODAT and without NODAT were evaluated. To assess the impact of risk factors, descriptive statistics methods were used, the odds ratio (OR) and the 95% confidence interval (CI) were calculated. Results. NODAT was diagnosed in 105 men and 73 women. The OR for men was 1.19 (95% CI 0.87–1.64), the OR for women was 0.84 (95% CI 0.61–1.15). At the time of transplantation, the average age of the kidney recipients in the NODAT group was higher than in the group without NODAT: 51 [43; 57] and 43 [32; 52] years, respectively ( p =0.0001). Most patients with NODAT (82%) were older than 50 years, while in the group without NODAT, the proportion of patients of the same age was 48.5% ( p =0.0001). Among patients without NODAT, transplantation of a kidney from a living donor was significantly more often compared with the group with NODAT+ (7.1% vs 1.1%; p =0.001). Among the recipients who received the regimen with CSA, diabetes developed in 75 (42.1%), those who received Tac in 102 (57.3%; p >0.05). The chance (risk of development) of NODAT in patients receiving i-mTOR + Tac was 3.2 (95% CI 1.47–6.78; p =0.032), and for patients receiving i-mTOR + cyclosporin A, the chance of development NODAT was 1.95 (95% CI 0.88–4.35; p =0.044). Conclusion. 13% of recipients developed de novo kidney diabetes after allograft. Age at the time of allotransplantation, gender, as well as the use of tacrolimus in combination with i-mTOR are the most significant risk factors for the development of NODAT.

The high prognostic significance of the concentration of the N-terminal - pro-B-type natriuretic peptide (NT-proBNP) in the development of cardiovascular diseases (CVD) was identified for rheumatoid arthritis (RA) and general populations.to investigate the significance of NT-proBNP level in patients (pts) with RA with the ineffectiveness and/or intolerance of basic anti - inflammatory therapy; compare the level of NT-proBNP with atherosclerotic lesion of the brachiocephalic arteries (BCA), traditional risk factors and inflammatory markers.The investigation enrolled 28 pts (24women/4men) with the lack of efficacy/resistance and/or intolerance of basic anti - inflammatory drugs (DMARDs); median age was 55 [46; 61] years, median disease duration 114 [60; 168] month; DAS28 6,2 [5.1; 7.0]; SDAI 35.0[23.9; 51.0], CDAI 30.0[21.0; 42.0], serum positivity for rheumatoid factor (RF) (100%)/anti - cyclic citrullinated peptide antibodies (ACCP) (86%). The study did not include RA pts with congestive heart failure. High incidence of traditional risk factors was found in RA pts: arterial hypertension - in 75%, dyslipidemia - 61%, smoking - 17%, overweight - 61%, family history of cardiovascular diseases - 36%, hypodynamia - 68%. Coronary artery disease was diagnosed in 11% RA pts. Lack of efficacy of 3 or more DMARDs was found in 46% of pts, intolerance to previous therapy with DMARDs - in 54% pts. 47% were receiving methotrexate (20 [18; 25] mg/week), 11% - leflunomide, 7% - sulfasalazine, 46% - glucocorticoids, 75% - non - steroidal anti - inflammatory drugs. The control group consisted of 20 healthy donors, comparable to pts by age and sex. Serum levels of of NT-proBNP were measured using electrochemiluminescence method Elecsys proBNP II (Roche Diagnostics, Switzerland). The determination of the intima - media thickness (IMT) BCA were assessed from duplex scanning. Atherosclerotic lesion of BCA was assessed by the presence of atherosclerotic plaque (IMT ≥1.2 mm).NT-proBNP concentrations in RA pts proved to be higher (78.7 [41.4; 101.3] pg/ml) than those in the control group (55.3 [36.6; 67.3] pg/ml, p100 pg/ml - 1 group (n=6) and ≤100 pg/ml - 2 group (n=22). Groups of RA pts did not differ in gender, age, activity of RA, frequency of detection of traditional risk factors. Atherosclerotic lesion of the BCA was detected in 3 (50%) pts of the 1 group and in 8 (36%) pts of the 2 group (p0.05). In RA pts the level of NT-proBNP correlated with age (r=0.39; p.Выявлена высокая прогностическая значимость концентрации N-концевого фрагмента предшественника мозгового натрийуретического пептида В-типа (N-terminal fragment of brain natriuretic peptide progenitor, NT-proBNP) в развитии сердечно - сосудистых заболеваний (ССЗ) при ревматоидном артрите (РА) и в общей популяции. Цель: уточнить значение NT-proBNP у больных РА с неэффективностью и/или непереносимостью базисной противовоспалительной терапии, сопоставить уровень NT-proBNP с атеросклеротическим поражением брахиоцефальных артерий (БЦА), традиционными факторами риска (ТФР) ССЗ и маркерами воспаления. Материалы и методы. Обследовано 28 пациентов с РА (24 женщины и 4 мужчин) с неэффективностью и/или непереносимостью базисных противовоспалительных препаратов (БПВП); медиана возраста составила 55 [46; 61] лет; продолжительность болезни - 114 [60; 168] мес; DAS28 - 6,2 [5,1; 7,0] балла; SDAI - 35,0 [23,9; 51,0], CDAI - 30,0 [21,0; 42,0]. Все больные были серопозитивны по ревматоидному фактору (РФ), 86% - по антителам к циклическому цитруллинированному пептиду (АЦЦП). Внесуставные проявления выявлялись у 54% больных. На момент включения в исследование 47% больных получали метотрексат (медиана дозы 20,2 [18; 25] мг/нед), 11% - лефлуномид, 7% - сульфасалазин, 46% - глюкокортикоиды, 75% - нестероидные противовоспалительные препараты. У 46% пациентов отмечена неэффективность 3 и более БПВП, у 54% - непереносимость предшествовавшей терапии БПВП. В исследование не включались пациенты с РА, имеющие хроническую сердечную недостаточность. У больных РА обнаружена высокая частота ТФР: артериальная гипертензия - у 75%, дислипидемия - 61%, курение - 17%, избыточная масса тела - 61%, отягощенная наследственность по ССЗ - 36%, гиподинамия - 68% больных. Ишемическую болезнь сердца диагностировали у 11% пациентов. Контрольную группу составили 20 здоровых доноров, сопоставимых с больными по возрасту и полу. Концентрацию NT-proBNP определяли в сыворотке крови методом электрохемилюминесценции (Roche Diagnostics, Швейцария). Всем пациентам проведено дуплексное сканирование экстракраниального отдела БЦА с определением толщины комплекса интима - медиа (КИМ). Атеросклеротическое поражение БЦА оценивали по наличию атеросклеротической бляшки (толщина КИМ≥1,2 мм). Результаты. У пациентов с РА выявлены более высокие уровни NT-proBNP (78,7 [41,4; 101,3] пг/мл) по сравнению с группой здорового контроля (55,3 [36,6; 67,3] пг/мл, p100 пг/мл - 1-я группа (n=6) и ≤100 пг/мл - 2-я группа (n=22). Группы больных РА не различались по полу, возрасту, активности РА, частоте выявления ТФР. Атеросклеротическое поражение БЦА выявлено у 3 (50%) пациентов 1-й группы и у 8 (36%) больных 2-й группы (р0,05). У пациентов с РА уровень NT-proBNP положительно коррелировал с возрастом (r=0,39; p.

The urgency of the study is determined by the lack of data necessary in order to assess the safety of prolonged use of proton pump inhibitors (PPI) in patients with IHD combined with anti-aggregant therapy. The aim of the study was to study the relationship between the use of PPI and the risk of thrombotic complications in patients undergoing planned procedures of percutaneous coronary interventions (PCI) and receiving dual antiplatelet therapy. Materials and methods. The study is a prospective register of patients who successfully underwent planned percutaneous coronary intervention (PCI). The effect of PPI (omeprazole and pantoprazole) on the frequency of the combined end point cardiovascular death, ACS, AI, TIA, peripheral arterial thrombosis and PE was assessed using the Log-Rank criterion, as well as in a multivariate analysis (Cox proportional risk regression model). Results. A total of 391 patients were included in the study (23.1% women, mean age 61.2 [Symbol] 10.4 years). The median duration of follow-up was 18 months. During this period of time, 34 adverse events were recorded. Log-Rank analysis showed that the proportion of patients without adverse events in the omeprazole group was significantly lower in comparison with patients who did not receive PPI (0.56 vs. 0.84, Log-Rank p=0.003), and for pantoprazole no such pattern was found (0.89 against 0.84, Log-Rank p=0.21). The average level of residual platelet reactivity (ORT), as well as the number of patients with high ORT (> 208 PRU), did not differ significantly between the groups of omeprazole, pantoprazole and the group of patients not receiving PPI. According to multivariate analysis, omeprazole was an independent predictor of thrombotic complications after a planned PCI (OR 3.75, 95% confidence interval 1.72-8.17, p=-0.0009). Conclusion. Long-term use of omeprazole (at least 30 days) is an independent predictor of thrombotic complications in patients who underwent planned PCI.

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 (Ml) 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 CYD and systemic inflammation underlie the development of atherosclerosis in PsA. It is pointed out that the risk of CYD 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-a (TNF-a) inhibitors are considered; the data of investigations showing that the treatment of PsA patients with TNF-a inhibitors results in a reduction in carotid artery intima-media thickness are given. lt 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.Псориатический артрит (ПсА) - хроническое иммуноопосредованное заболевание, которое наблюдается у 8-30% больных псориазом. В последние годы установлено, что ПсА и псориаз тесно связаны с высокой распространенностью метаболического синдрома, артериальной гипертонии, абдоминального ожирения и риском развития сердечно-сосудистых заболеваний (ССЗ), включая фатальные инфаркты миокарда (ИМ) и острые нарушения мозгового кровообращения (ОНМК), что снижает продолжительность жизни больных по сравнению с общей популяцией. Высказано мнение, что при ПсА в основе развития атеросклероза лежит синергическое действие традиционных факторов риска (ФР) развития ССЗ и системного воспаления. Отмечено, что снижение риска развития ССЗ у больных ПсА возможно не только при условии мониторирования традиционных факторов ФР развития ССЗ, но и надежного подавления системного воспаления. Рассмотрены кардиопротективные возможности метотрексата и ингибиторов α-фактора некроза опухоли (α-ФНО), приведены данные исследований, в которых показано, что лечение больных ПсА ингибиторами α-ФНО приводит к уменьшению толщины комплекса интима-медиа сонных артерий. Отмечена необходимость раннего мониторирования традиционных ФР развития ССЗ у больных ПсА и создания междисциплинарных национальных рекомендаций.

To compare the prevalence of risk factors, clinical and subclinical manifestations of cardiovascular diseases (CVD) and their complications in methotrexate (MT)-treated and untreated patients with rheumatoid arthritis.The investigation enrolled 193 patients (168 women and 25 men) less than 60 years of age (mean age 49 [44; 53] years) with RA. The patients were divided into 2 groups: 1) 69 patients who received MT in a dose of 15.1 [10.2; 21] mg/week for at least 12 months (mean disease duration 25 [18; 48] months); 2) 124 patients who did not take MT. The patient groups were matched for age, gender, disease duration, RA activity, and the rate of rheumatoid factor (RF) seropositivity and extraarticular manifestations.Dyslipidemia was significantly less frequently identified in MT-treated patients (35/69 or 51%) than in MT-untreated ones (85/124 or 69%; p = 0.01). The serum from the patients treated with MT exhibited higher high-density lipoprotein cholesterol concentrations ((1.8 [0.9; 2.0] mmol/l) than in those untreated with MT (1.2 [1.0; 1.6] mmol/l; p = 0,047). In Group 1, hypertension (49%) and diabetes mellitus (3%) were slightly rare than in Group 2 (62 and 13%, respectively; p0.05). Carotid atherosclerotic plaques were found in 19 and 16% and intima-media thickness (IMT) enlargement was seen in 53 and 56% of the patients in Groups 1 and 2, respectively. Silent myocardial ischemia was diagnosed in every 10 patients; heart disease (exertional angina, myocardial infarction) was in every 5 patients in both groups. Aortocoronary bypass surgery was performed in 2 (3%) patients from those who received MT and had experienced MI and in one (1.6%) patient from the MT-untreated group.Long-term MT therapy was associated with the lower rate of dyslipidemia, but it failed to affect the incidence of CVD in patients with RA.

Rheumatoid arthritis (RA) is a' disease conferring high risk for cardiovascular events (CVE). Systemic inflammation underlying RA favors 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.Ревматоидный артрит (РА) - заболевание с высоким риском развития сердечно-сосудистых осложнений (ССО). Системное воспаление, лежащее в основе РА, способствует развитию ССО. Безопасность генно-инженерных биологических препаратов в отношении влияния на сердечно-сосудистую систему изучена недостаточно. С одной стороны, они уменьшают активность РА, с другой, могут увеличивать риск развития ССО. В настоящем обзоре проанализированы данные литературы, преимущественно последних лет, касающиеся влияния ингибитора рецепторов интерлейкина-6 (рИЛ-6) на сердечно-сосудистую систему. Показано, что тоцилизумаб является перспективным средством для снижения кардиоваскулярного риска. Полученные результаты нуждаются в клиническом подтверждении. Необходимо проведение проспективных долгосрочных исследований, которые позволят более точно определить влияние ингибирования рИЛ-6 на развитие ССО.

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.Представителями иммуновоспалительных заболеваний являются ревматические болезни, в первую очередь ревматоидный артрит, ювенильный идиопатический артрит, спондилоартриты, псориатический артрит, подагрический артрит, системная красная волчанка и другие системные заболевания соединительной ткани, для которых характерен высокий риск преждевременной смерти больных. Установлено, что высокий риск преждевременной смерти при этих заболеваний связан с 'тяжестью' иммуновоспалительного процесса, приводящего к тяжелому необратимому повреждению жизненно важных органов и систем, и с развитием широкого спектра сочетанных состояний (инфекции, интерстициальное заболевание легких, злокачественные новообразования, остеопоретические переломы и др.). Среди них центрально место занимает патология сердечно-сосудистой системы, наиболее часто обусловленная ранним развитием и ускоренным прогрессированием атеросклеротического поражения коронарных сосудов. В статье представлены данные литературы последних лет, касающиеся влияния антиревматической терапии (базисных противовоспалительных и генно-инженерных биологических препаратов) на сердечно-сосудистую систему.

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).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.NT-proBNP concentrations in patients with early RA proved to be higher than those in the control group (p0.0001). 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.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.Цель исследования. Определить уровень N-концевого натрийуретического пептида (NT-proBNP) у больных ранним ревматоидным артритом (РА) до назначения базисных противовоспалительных препаратов (БПВП), сопоставить уровень NT-proBNP с традиционными факторами риска (ТФР), сердечно-сосудистыми заболеваниями (ССЗ), маркерами воспаления и диастолической дисфункцией (ДД) миокарда левого желудочка (ЛЖ). Материалы и методы. В исследование включили 74 пациента с достоверным диагнозом РА (критерии ACR/EULAR, 2010), 56 (74%) женщин, медиана (Ме) возраста 54 года, длительности заболевания 7 мес; серопозитивные по ревматоидному фактору класса IgM (87%) и/или антителам к циклическому цитруллинированному пептиду (100%) без опыта приема БПВП и глюкокортикостероидов. Оценка ТФР развития ССЗ, атеросклероза сонных артерий (АСА) по данным дуплексного сканирования и эхокардиография проведены у всех пациентов с ранним РА до начала терапии. В качестве критерия ДДЛЖ использовали соотношение Е/А. Результаты. Концентрация NT-proBNP у больных ранним РА оказалась выше, чем в группе контроля (р0,0001). У 36 (49%) больных РА уровень NT-proBNP превышал норму. Пациенты с ранним РА и повышенным уровнем NT-proBNP были старше, обладали более высоким индексом массы тела (ИМТ), чем больные РА с нормальным уровнем NT-proBNP. При повышенном уровне NT-proBNP чаще, чем при нормальном, выявлялись АСА, кальциноз коронарных артерий, ИБС, а также была больше толщина комплекса интима-медиа слева, выше уровень С-реактивного белка (СРБ). Выявлены корреляции между уровнем NT-proBNP и СОЭ, СРБ, SDAI, CDAI. По данным многофакторного анализа, с уровнем NT-proBNP коррелируют наличие ХСН, уровень СРБ, наличие АСА, уровень ЛПНП, ИМТ. ДДЛЖ выявлена у 35 (48%) пациентов с ранним РА. Уровень NT-proBNP у больных с ДД выше, чем у пациентов без ДД. У 23 (65%) с ДДЛЖ и у 12 (32%) больных без ДДЛЖ уровень NT-proBNP превышал норму. Оптимальный уровень NT-proBNP для выявления ХСН равен 237,4 пг/мл (чувствительность 86%, специфичность 85%), площадь под ROC-кривой 0,879. Заключение. У пациентов с РА уже на ранней стадии заболевания отмечается высокий уровень NT-proBNP, на повышение которого влияют увеличение ИМТ, низкий уровень ЛПНП, наличие АСА, ХСН, высокий уровень СРБ. У пациентов с ранним РА диагностически значимый уровень NT-proBNP для выявления ХСН выше (237 пг/мл), чем у пациентов без РА (125 пг/мл). У пациентов с РА необходимо уже на ранней стадии заболевания определять уровень NT-proBNP, проводить скрининг ДДЛЖ и коррекцию ТФР развития ССЗ, лечение атеросклероза и достигать ремиссии заболевания.

Rheumatoid arthritis (RA) is a chronic autoimmune disease with a proved high risk of cardiovascular diseases (CVD). An increase of this risk is mainly due to accumulation of conventional factors of CVD development (arterial hypertension - AH), dislipidemia, et cet). Causes of high prevalence of AH in RA, the role of chronic inflammation, effects of antirheumatic drugs with potentially hypertensive effects are outlined and recommendations on AH prevention and treatment in RA patients are given.

to study the impact of the autonomic nervous system on the development of renal lesion in patients with metabolic syndrome (MS).One hundred and nine patients (45 females and 54 males) aged 29 to 72 years who had MS were examined. Glomerular filtration rate (GFR) was estimated using the Cockroft-Gault formula, by correcting the obtained result on the body surface. According to the level of GFR, the patients were divided into 3 groups: 1) 30 MS patients with hyperfiltration (GFR110 ml/min/1.73 m2); 2) 55 patients with normal GFR (110-60 ml/min/1.73 m2); 3) 24patients with lower GFR (60 ml/min/1.73 m2). All the patients underwent physical examination; autonomic tonus was examined by 24-hour cardiac rhythm variability (CRV) study using the Holter monitoring system, by applying the time analysis. The presence of autonomic dystonia syndrome (ADS) and its degree were determined by a questionnaire to detect autonomic nervous system (ANS) dysfunction.Each of 3 groups was found to have signs of autonomic imbalance with a preponderance of sympathetic activity with decreased parasympathetic activity, these impairments being more pronounced in Group 1. The obtained regulation reflects the entire decrease in autonomic actions on the cardiovascular system in patients with MS and suggests the maximum hyperactivation of the sympathetic ANS in early-stage renal lesion--hyperfiltrationWhen the first signs of renal lesion (hyperfiltration) occur in patients with MS, there is significant hypersympaticotonia that promotes the progression of target organs, including the kidneys.

A steady increase in glomerular filtration rate is considered to be one of the first stages of renal lesion in essential hypertension, metabolic syndrome, and type 2 diabetes mellitus. The paper discusses methods for detection of hyperfiltration and gives their comparative characterization and indications for their use.

To study the time course of changes in glomerular filtration rate (GFR) in different age groups of males with metabolic syndrome (MS).Eighty-six male patients with MS whose age 35 to 69 years (mean age 53.6 years) were examined. The patients were divided into 3 age groups: 1) 30-50 years (mean age 43.5 years; n = 30); 2) 50-60 years (mean age 54.9 years; n = 36); 3) 60-70 (mean age 66 years; n = 20). The study included only MS patients with stages I-II chronic renal disease (CRD) (according to the NKF K/DOQI classification, 2002). GFR was determined by the Cockroft-Gault formula corrected and uncorrected for a standard body surface area (GFRst, GFRc-g). The obtained values of GFRst and GFRc-g were compared with the population-based standards determined for each formula. The authors identified an increased GFRst (110 ml/min/1.73 m2), a normal GFRst (60-110 ml/min/1.73 m2), and a decreased GFRst (60 ml/min/1.73 m2), as well as an increased GFRc-g (120 ml/min), a normal GFRc-g (80-120 ml/min), and a decreased GFRc-g (80 ml/min). GFRst60 ml/min/1.73 m2) was defined as CRD.Each age group was found to have deviations of GFR from the normal values towards both its increase and decrease. The young age group showed a larger number of patients with increased GFR and a smaller number of patients with decreased GFR than did the old age group. This trend was seen for both GFRst and GFRc-g, but in the latter case, the spread of hyperfiltration was higher in the age group of 30-50 years and in the total group of patients.In the first age group, a predominance of hemofiltration precedes the development of CRD in the third age group and may reflect the trend of MS-induced renal lesion.

One of the key causes of lethality in rheumatoid arthritis (RA) are cardiovascular catastrophes (myocardial infarction, stroke, sudden cardiac death) resultant from early development and rapid progression of atherosclerotic vascular lesion. The article presents current approaches to prevention of cardiovascular diseases in RA including assessment of overall cardiovascular risk for design of optimal strategy of correction of modification factors increasing probability of cardiovascular complications, strong control over inflammation and adequate use of drugs which may be harmful (glucocorticosteroids, nonsteroid anti-inflammatory drugs). Much attention is paid to perspectives of ACE inhibitors, angiotensin II receptor blockers, statins, TNFalpha inhibitors in prevention of cardiovascular complication in RA

To estimate the rate of diastolic dysfunction (DD) of the left and right ventricles (LV and RV) in patients with early rheumatoid arthritis (RA) before using disease-modifying antirheumatic drugs (DMARDs) therapy and to investigate its association with traditional risk factors (TRFs) for cardiovascular diseases (CVD) and inflammatory markers.The investigation enrolled 74 patients with a valid diagnosis of RA, including 56 (74%) women (median age, 54 years; disease duration, 7 months); the patients who were seropositive for rheumatoid factor (RF) (87%) and/or anti-cyclic citrullinated peptide (anti-CCP) antibodies (100%) who had not been on DMARDs or glucocorticosteroids. TRFs for CVD and carotid artery atherosclerosis were assessed from duplex scanning data and echocardiography was performed in all the patients with early RA before starting the therapy. The ratio of the maximum blood flow velocity during early diastolic filling (E) to that during atrial systole (A) was used as a criterion for LVDD and RVDD. There were 3 types of impaired ventricular filling: 1) E/A1; 2) E/A = 1-2; 3) E/A2.LVDD and RVDD were detected in 35 (48%) and 17 (23%) patients, respectively. RVDD was recorded only in conjunction with LVDD. Among LVDD and RVDD, the former was prevalent. All the patients with early RA were divided into 3 groups: 1) patients with LVDD and RVDD; 2) those with LVDD; 3) those without ventricular DD. All the three groups were matched for the level of DAS28, anti-CCP antibodies, and RF. The incidence of arterial hypertension, dyslipidemia, and abdominal obesity was higher in the patients of Groups 1 and 2 than in those of Group 3. There was a progressive decrease in high-density lipoprotein (HDL) cholesterol concentrations and increases in triglyceride (TG) levels and atherogenic index from Group 3 to Group 1, with the concentrations of total cholesterol and low-density lipoprotein cholesterol being similar in the 3 groups. Coronary heart disease was recorded more frequently in Group 2 than in Group 3. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) proved to be also significantly higher in the patients with DD than in those without DD. Correlations were found between LV E/A and ESR, CRP, HDL cholesterol, TG, RV E/A and ESR, DAS28, TG.The patients with early-stage RA were found to have high incidence rates of LVDD and RVDD, which is related to the high prevalence of CVD, the high spread of TRF for CVD, and the high activity of an inflammatory process.Цель исследования. Определить частоту диастолической дисфункции левого желудочка (ДДЛЖ) и правого желудочка (ДДПЖ) у больных ранним ревматоидным артритом (РА) до назначения базисных противовоспалительных препаратов (БПВП), изучить ее связь с традиционными факторами риска (ТФР) развития сердечно-сосудистых заболеваний (ССЗ) и маркерами воспаления. Материалы и методы. В исследование включили 74 пациента с достоверным диагнозом РА, из них 56 (74%) женщин, медиана возраста 54 года, длительности заболевания - 7 мес; серопозитивные по IgM ревматоидному фактору - РФ (87%) и/или антителам к циклическому цитруллинированному пептиду - АЦЦП (100%) без опыта приема БПВП и глюкокортикостероидов. Оценку ТФР развития ССЗ, атеросклероза сонных артерий по данным дуплексного сканирования и эхокардиография провели у всех пациентов с ранним РА до начала терапии. В качестве критерия ДДЛЖ и ДДПЖ использовали отношение максимальной скорости кровотока во время раннего диастолического наполнения (Е) к максимальной скорости потока во время предсердной систолы (А). Выделены 3 вида нарушения наполнения желудочков: I - при Е/А1, II - при Е/А=1-2, III - при Е/А2. Результаты. ДДЛЖ выявлена у 35 (48%) пациентов с ранним РА, ДДПЖ - у 17 (23%). ДДПЖ регистрировалась только в сочетании с ДДЛЖ. Среди ДДЛЖ и ДДПЖ преобладал I вид. Все пациенты с ранним РА разделены на 3 группы: 1-я - с ДДЛЖ и ДДПЖ, 2-я - с ДДЛЖ, 3-я - без ДД желудочков. Все 3 группы сопоставимы по уровню DAS28, АЦЦП, РФ. Частота развития артериальной гипертонии, дислипидемии, абдоминального ожирения оказалась выше у пациентов 1-й и 2-й групп, чем 3-й. Отмечены прогрессирующее снижение концентрации холестерина (ХС) липопротеинов высокой плотности (ЛПВП), увеличение уровня триглицеридов (ТГ) и индекса атерогенности от 3-й к 1-й группе, при этом концентрация общего ХС, ХС липопротеинов низкой плотности в 3 группах не различалась. Ишемическая болезнь сердца во 2-й группе больных регистрировалась чаще, чем в 3-й. СОЭ и уровень СРБ у больных с ДД также оказались достоверно выше, чем у пациентов без ДД. Выявлены корреляции между Е/А ЛЖ и СОЭ, СРБ, ХС ЛПВП, ТГ, Е/А ПЖ и СОЭ, DAS28, ТГ. Заключение. У пациентов с РА на ранней стадии заболевания отмечена высокая частота развития ДДЛЖ и ДДПЖ, что связано с высокой распространенностью ССЗ, ТФР развития ССЗ и высокой активностью воспалительного процесса.

To study features of heart disease in patients with alkylosing spondyloarthritis (ASA).We examined 56 ASA patients. Most of the examinees had spinal problems, moderate activity, x-ray sacroileitis stage III.Pulmonary hypertension was detected in 60.7%, right ventricular (RV) hypertrophy--in 37.5%, RV dilation--in 30.4% patients. Interventricular septum, left ventricular posterior wall were thickened (p0.05). Left ventricular diastolic dysfunction was registered in 18.2% ASA patients. The changes correlated with the disease duration, spinal lesion, especially of thoracic part.Pulmonary hypertension is a frequent finding in ASA patients. Echocardiography (ECG) is highly informative in detection of pulmonary hypertension and right heart disorders in ASA patients. ECG is a screening method in diagnosis of pulmonary hypertension in ASA patients.

To investigate involvement of patients into control of their pressure to improve quality of treatment for arterial hypertension (AH).134 hypertensive patients (76 females and 58 males) were interviewed. Criteria of efficacy of AH control were ability and motivation of self-measurement of blood pressure and its maintenance at the optimal level.For the past year, 40% of the patients measured pressure regularly (once a day or more frequently), 34%--1-3 times a week, 9%--1-3 times a month, 17%--rarely, mostly, males. Most of the patients controlled their pressure insufficiently. This is explained by "working pressure" (high in many cases) which was registered in most of the examinees. When part of the patients reached that working pressure they discontinued treatment.Involvement of hypertensive patients and members of their families into control of hypertension is a feasible and valuable method of improving quality of hypertension treatment.