Aim. To compare the secretion of erythropoietin in patients with infection caused by human immune deficiency virus (HIV infection) with anemia of chronic diseases (ACD), iron deficiency anemia (IDA), and their combination. Material and methods. 125 patients with HIV infection were examined: 101 with anemia (55 males, 46 women, 39.4±9.6 years), 24 - a control group of patients with HIV infection without anemia (13 males, 11 women, average age 37.6± 7.37 years). In all patients, the number of red blood cells, the concentration of hemoglobin, ferritin, C-reactive protein (CRP), transferrin saturation index (TSI) and erythropoietin were examined. All patients with anemia after determining TSI, CRP, ferritin based on Van Santen and Worwood criteria were divided into three groups depending on the type of anemia: group 1 - 36 patients with ACD (19 males, 17 women, average age 41.7 ± 11, 8 years, TSI 16.9[IQR, 10.2-23.1]%, ferritin 638.7[IQR, 326-861] μg/l, CRP 54.5 [IQR, 4.8-103.3] mg/l), group 2 – 30 patients with a combination of ACD/IDA (18 males, 12 women, average age 41.2±10 years, TSI 13.2[IQR, 9.8-14]%, ferritin 156.2 [IQR, 123-235] mcg/l, CRP 5.9 [IQR, 0.5-8.2] mg/l), group 3 – 35 patients with IDA (18 males, 17 women, average age 35.4 ±7.1 years, TSI 11.1[IQR, 4.7-13.7]%, ferritin 29[IQR, 4.2-38.9] µg/l, CRP 2.9[IQR, 0.4 -1.6] mg/l). For quantitative indicators, the median (Me), standard error of the mean (m), and interquartile range (IQR) were calculated. The significance of differences between several unrelated groups was determined using the Kruskal-Wallis test. Results. In the ACD group, a lower number of red blood cells was detected (3.3(2.7-3.8)×1012/l), compared to the group of patients with IDA (3.8(3.7-4.1)×1012/l ). Also, in the group of patients with ACD, the maximum concentration of erythropoietin was detected (28.5[11.2-28.5], U/ml), significantly higher than the concentration of this indicator in the ACD/IDA groups (14[8.1-16.3], U/ml), IDA (15.8[6.2-27.4], U/ml) and patients in the control group (6.3[4.9-7.8], U/ml). Conclusions. In the present study, ACD in isolated form or in combination with IDA was diagnosed in 65.3% of patients with HIV infection and anemic syndrome. In patients with ACD, an increased concentration of erythropoietin is combined with the lowest number of red blood cells in comparison with other groups of patients with anemia (p<0.05). The results obtained indicate a compensatory increase in erythropoietin secretion in response to suppressed erythropoiesis, or to reduced sensitivity of erythropoietin receptors. Further study of the importance of erythropoietin in the pathogenesis of chronic disease in patients with HIV infection is necessary, including to improve its treatment.

Aim. To develop based on the indicators of clinical blood tests, some biochemical markers, iron metabolism and cytokines a mathematical model that allows with high sensitivity and specificity to conduct differential diagnosis of anemia of chronic diseases (AHD) and iron deficiency anemia (IDA) in patients with inflammatory joint diseases (rheumatoid arthritis (RA), psoriatic arthritis (PSA), ankylosing spondylitis (AS)). Material and methods. The study included 104 patients with inflammatory joint diseases and anemic syndrome (37 males/67 females, age 48.4±5.42 years old), of which 54 patients with RA, 27 patients with PSA and 23 patients with AS. The control group consisted of 22 patients with inflammatory diseases of the joints without anemia (13 males/9 females, age 47.8±3.55 years old), of which 7 patients with RA, 10 with PSA, 5 with AS. For all patients, in addition to hemogram parameters, the concentrations of interleukin-6, interleukin-10, interleukin-1β, interferon-gamma, tumor necrosis factor alpha, ferritin, C-reactive protein, hepcidin, transferrin, soluble transferrin receptor were determined. For quantitative indicators, the median, standard error of the mean, and interquartile range was calculated. The significance of differences between several unrelated groups was determined using the Kruskal-Wallis test. The calculation of a mathematical model for the differential diagnosis of ACD and IDA was carried out using discriminant analysis. Results. As a result of the study, a canonical linear discriminant function (CLDF) was obtained: CLDF = 1.612171-0.002725× Hepcidin -0.005429× Ferritin The coordinates of the centroids are calculated, for ACD it is -1.44222008, and for IDA it is 1.52705656. A patient whose CLDF value is determined based on ferritin and hepcidin concentrations should be classified into the ACD or IDA group based on the minimum distance to the corresponding centroid. The resulting mathematical model has 100% sensitivity and 80% specificity. Conclusions. The equation based on hepcidin and ferritin (obtained from the results of discriminant analysis) allows, with high sensitivity, specificity and information ability, to carry out differential diagnosis of ACD and IDA in patients with inflammatory joints diseases instantly at the stage of initial contact with the doctor. Using of the equation will make it possible to more effectively diagnose and correct these types of anemia in this pathology, including for the purpose of more effective treatment.

Цель. У выживших и умерших пострадавших с ожоговой болезнью выполнить сравнительный анализ состояния эритроцитарного и мегакариоцитарного ростков в пунктате костного мозга. Оценить наличие взаимосвязи между состоянием эритро- и тромбоцитопоэза и тяжестью состояния по шкале APACHE II, а также общей площадью ожогов и площадью глубоких ожогов. Материалы и методы. Обследованы 23 пациента мужского пола, возраст – 33 [24–47] года, поступивших в специализированный стационар на 2-е [1–3] сутки после получения ожоговой травмы. В зависимости от клинического исхода пациенты разделены на две группы. В 1-ю группу включены 12 выживших пострадавших, возраст – 33 [25–38] года, общая площадь ожогов (TBSA) 27 [17–39]%, площадь глубоких ожогов 9,2 [0–16]%, APACHE II 6,5 [5–7] балла, индекс Франка (FI) 47 [30–62] баллов. Во 2-ю группу включены 11 умерших пострадавших, возраст – 26 [23–43] лет, общая площадь ожогов 57 [45–71]%, TBSA 32 [22–35]%, APACHE II 24,3 [21,5–28] балла, FI 137 [129–175] баллов. Выполнялся клинический анализ крови с определением эритроцитов, тромбоцитов, лейкоцитов, гемоглобина и микроскопическим исследованием пунктата костного мозга. У каждого показателя рассчитывали медиану (Mе) и межквартильный интервал (IQR). Достоверность различий между исследуемыми выборками определяли с помощью U-критерия Манна – Уитни (р<0,05). Определялся коэффициент корреляции Спирмена (r). Результаты. У пострадавших с летальным исходом в гемограмме, в сравнении с выжившими, выявлено снижение числа эритроцитов, тромбоцитов и концентрации гемоглобина (p<0,05). При анализе миелограммы у пациентов 2-й группы, в сравнении с 1-й группой, установлено достоверное снижение цитоза – 30 [29–58] и 103 [85–237] × 109/л соответственно, числа базофильных нормобластов (БНБ) – 0,15 [0,13–0,2] и 0,95 [0,34–1,4] ×109/л, полихроматофильных нормобластов (ПНБ) – 2,4 [1,5–2,8] и 14,6 [6,9–22,2] ×109/л, мегакариоцитов – 3,6 [1–6,2] и 25 [12,5–50] ×109/л. Выявлена корреляция между цитозом костного мозга и FI (r=–0,72), TBSA (r=–0,77), APACHE II (r=–0,61), площадью глубоких ожогов (r=–0,68), между мегакариоцитами, FI (r=–0,74), TBSA (r=–0,79), площадью глубоких ожогов (r=–0,83), APACHE II (r=–0,8), между ПНБ FI (r=–0,85), TBSA (r=–0,89), площадью глубоких ожогов (r=–0,85), APACHE II (r=–0,72). Заключение. Низкий цитоз костного мозга, а также сниженное число БНБ, ПНБ и мегакариоцитов на 1–3-и сутки после ожога являются предикторами неблагоприятного исхода ожоговой болезни. Выявлена взаимосвязь между низким цитозом костного мозга, числом мегакариоцитов и ПНБ с FI, APACHE II, TBSA и площадью глубоких ожогов, что отражает возможность их использования для оценки тяжести ожоговой травмы и состояния пострадавшего. Purpose. In survivors and dead victims with burn disease, perform a comparative analysis of erythrocyte and megakaryocyte germ cells in the bone marrow punctate. To assess the relationship between the state of erythro- and thrombocytopoiesis and the severity of the condition on the APACHE II scale, as well as the total area of burns and the area of deep burns. Materials and methods. 23 male patients aged 33 [24–47] years who were admitted to a specialized hospital for 2 [1–3] days after receiving a burn injury were examined. Depending on the clinical outcome, patients are divided into two groups. The 1st group included 12 survivors, aged 33 [25–38] years, total area of burns (TBSA) 27 [17–39]%, area of deep burns 9.2 [0–16]%, APACHE II 6.5 [5–7] points, Franc index (FI) 47 [30–62] points. The 2nd group included 11 dead victims, age 26 [23–43] years, total area of burns 57 [45–71]%, TBSA 32 [22–35]%, APACHE II 24.3 [21.5–28] points, FI 137 [129–175] points. A clinical blood test was performed with the determination of erythrocytes, platelets, leukocytes, hemoglobin and microscopic examination of bone marrow punctate. Median (Me) and interquartile interval (IQR) were calculated for each parameter. The reliability of the differences between the studied samples was determined using the Mann – Whitney U-test (p<0.05). The Spearman correlation coefficient (r) was determined. Results. The number of erythrocytes, platelets and the concentration of hemoglobin decreased in the victims with a fatal outcome in comparison with the survivors (p<0.05). Also, in group 2, in comparison with group 1, there are less cytoses (30 [29–58]) and 103 [85–237], ×109/l), the number of basophilic normoblasts (BNB) (0.15 [0.13–0.2] and 0.95 [0.34–1.4], ×109/l), polychromatophilic normoblasts (PNB) (2.4 [1.5–2.8] and 14.6 [6.9–22.2], ×109/l), megakaryocytes (3.6 [1–6.2] and 25 [12.5–50], ×109/l). Correlation between bone marrow cytosis and FI (r=–0.72), TBSA (r=–0.77), APACHE II (r=–0.61), deep burns area (r=–0.68), between megakaryocytes, FI (r=–0.74), TBSA (r=–0.79), deep burns area (r=–0.83), APACHE II (r=–0.8), between PNB FI (r=–0.85), TBSA (r=–0.89), deep burns area (r=–0.85), APACHE II (r=–0.72). Conclusion. Low cytosis of the bone marrow, as well as a reduced number of PNB, PNB and megakaryocytes on 1–3 days after the burn indicates an unfavorable outcome of burn disease. The relationship between low bone marrow cytosis, the number of megakaryocytes and PNB with FI, APACHE II, TBSA and the area of deep burns was revealed, which reflects the possibility of their use to assess the severity of burn injury and the condition of the victim.

Background. Anemia represents one of the most frequent complications in inflammatory bowel disease and severely impairs the quality of life of affected patients. The etiology of anemia in inflammatory bowel disease patients can be multifactorial, often involving a combination of iron deficiency anemia and anemia of chronic disease. The choice of therapy, focused on the leading cause of anemia, allows for individualized therapy, minimizing the risk of side effects and the cost of therapy.Aim. A comparative analysis of blood parameters before and after treatment was performed.Materials and methods. For 5 years, 47 patients (15 women, 32 men) with inflammatory bowel disease with a median age of 48 years (from 28 to 65 years) were studied. Two groups were formed: patients with iron deficiency anemia and patients with anemia of chronic disease. Patients with combination of iron deficiency anemia and anemia of chronic disease D (n = 21) were not included. A division was also made according to the type of treatment performed.Results. In the iron deficiency anemia group, a statistically significant increase in hemoglobin level was revealed as a result of the use of intravenous iron. During therapy with oral iron and B vitamin therapy, as well as therapy aimed only at correcting gastrointestinal tract pathology, no reliable dynamics of the studied parameters was observed. In the anemia of chronic disease group, there were no significant changes in red blood cell parameters with any of the treatment options (p >0.05).Conclusion. The effectiveness of various therapeutic approaches to correct anemia is controversial. Further follow-up and an increase in the sample size are needed, which will help individualize therapy and improve the patients’ quality of life.

Aim. To compare the secretion of interleukin-6 (IL-6), interleukin-10 (IL-10) and tumor necrosis factor-alpha (TNF-α) in cancer patients with anemia of chronic disease (ACD), iron deficiency anemia (IDA) and a combination of these two anemia types. To assess the effect of the studied cytokines on erythropoiesis in patients with malignant neoplasms separately for each type of anemia studied. Materials and methods. 106 patients with stage II–IV of solid malignant neoplasms were examined: 84 with anemia (55 men, 29 women, 67.1 ± 9.9 years), 22 without anemia (17 men, 5 women, mean age 60.2 ± 14.9 years). In accordance with Van Santen and Worwood criteria, by determining the transferrin saturation coefficient, ferritin concentrations, C-reactive protein, patients were divided into 4 groups: group 1 – patients with ACD, 31 (20 / 11 patients), 2 group – ACD / IDA, 28 (18 / 10 patients), group 3 – IDA, 25 (17 / 8 patients), group 4 (control) – 22 patients without anemia. In all patients, the number of erythrocytes, the concentration of hemoglobin, ferritin, C-reactive protein, transferrin saturation coefficient, IL-6, TNF-α, IL-10 were determined. For quantitative indicators, the arithmetic mean and interquartile range (IQR) were calculated. Significance of differences between several unrelated groups was determined using the Kruskal–Wallis test. To assess the relationship between variables, the Spearman correlation coefficient (r) was calculated. Results. In the ACD group, the maximum IL-6 concentration was 73.3 (IQR 6.2–51), TNF-α – 24.4 (IQR 15.3–60.7) and IL-10 – 8.7 (IQR 4.7–12.1) compared with the ACH3 / IDA group (IL-6 – 9.3 [IQR 4.4–13.2], TNF-α – 7.2 [IQR 4.5–9.6] and IL-10 – 6.7 [IQR 4.1–11.4]), and the IDA group (IL-6 – 3.4 [IQR 1.4–5.9], TNF-α – 4.6 [IQR 3.7–6] and IL-10 – 2.5 [IQR 0–5]) ( p <0.05). In the ACD group, the highest correlation coefficients were found between IL-6 and erythrocytes (r = –0.74) and hemoglobin (r = –0.88), between TNF-α and erythrocytes (r = –0.66) and hemoglobin (r = –0.77), between IL-10 and erythrocytes (r = –0.36) and hemoglobin (r = –0.63). In the IDA group, the correlation coefficients between cytokines, erythrocytes, and hemoglobin are low or absent. Conclusion. In cancer patients, ACD, IDA, as well as their combination can occur. Increased cytokine secretion in ACD group patients is important due to the proven strong negative effect of cytokines on erythropoiesis. Further study of ACD pathogenesis is needed in order to improve treatment.

Aim. To compare the secretion of interleukin-6 (IL-6), interleukin-10 (IL-10), interleukin-1-beta, tumor necrosis factor-alpha (TNF-α), interferon-gamma (INF-γ) in patients with HIV infection with anemia of chronic disease (ACD), iron deficiency anemia (IDA), as well as their combination. To assess the effect of the studied cytokines on erythropoiesis in each of the studied types of anemia in this category of patients. Material and methods. 125 patients with HIV infection were examined: 101 with anemia (55 men, 46 women, 39.4±9.6 years), 24 patients with HIV infection without anemia (13 men, 11 women, mean age 37.6± 7.37 years). In accordance with the Van Santen and Worwood criteria, by determining the transferrin saturation index (TSI), ferritin concentrations, C-reactive protein (CRP), patients with anemia were divided into 3 groups: group 1 – 36 patients with ACD (19 men, 17 women, mean age 41.7±11.8 years), group 2 – 30 patients with a combination of ACD/IDA (18 men, 12 women, mean age 41.2±10 years), group 3 – 35 patients with IDA (18 men, 17 women, mean age 35.4±7.1 years). In all patients, the number of erythrocytes, the concentration of hemoglobin, ferritin, CRP, CNT, interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), interleukin-10 (IL-10), interleukin-1beta (IL-1β), interferon-gamma (INF-γ). For quantitative indicators, the arithmetic mean, standard error of the mean, and interquartile range (IQR) were calculated. Significance of differences between several unrelated groups was determined using the Kruskal-Wallis’s test. To assess the relationship between variables, the Spearman correlation coefficient I was calculated. Results. In the ACD group, the maximum concentration of IL-6 (36.6 [IQR, 11.5-51.1]) and IL-10 (21.6 [IQR, 11.4-28.8]) compared with the ACD/IDA group (IL-6 (9.1 [IQR, 5.1-11.4]), IL-10 (15.5 [IQR, (7.1-21.6)]), and IDA (IL- 6 (6.2 [IQR, 1.6–7.2]), IL-10 (8.6 [IQR, 3.9–9.3]) (p<0.05). In the groups of patients with ACD and ACD/IDA, the maximum and almost equal concentrations of TNF-α (15.2 [IQR,6.1-24.1] in the ACD group and 17.3[IQR,7.9-17.3] in the ACD/IDA group), IL-1β (16.7[IQR,4.7-28.9] in the ACD group and 19.2 [IQR,3.9-28.8] in the ACD/IDA group), INF-γ ( 62.6[IQR,4.6-85.3] in the ACD group and 58.3[IQR,8.5-37.5] in the ACD/IDA group), which were statistically significantly higher than the concentrations of these cytokines in patients with IDA and the control group. There were no significant differences in the concentrations of TNF-α, IL-1β, IL-10 and IFN-γ between patients with IDA and the control group. Significant moderate and strong negative correlations were found in the groups of patients with ACD and ACD/IDA between all studied cytokines, erythrocytes and hemoglobin. In the IDA group, the correlation coefficients between cytokines, erythrocytes, and hemoglobin are low or absent. Conclusions. In patients with HIV infection, a wide prevalence of ACD has been shown, especially in patients with immunodeficiency and in the late stages of the disease. ACD, unlike IDA, has a complex multicomponent pathogenesis. This study shows the importance of pro-inflammatory and inflammatory cytokines in the development of ACD in HIV patients, including due to their negative effect on erythropoiesis and hemoglobin synthesis. A working version of the classification of ACD (with a predominant iron deficiency, with impaired regulatory mechanisms of erythropoiesis, with insufficient production of erythropoietin) has been proposed. It is necessary to further study the pathogenesis of ACD in this category of patients to improve treatment.

Relevance. Myocardial ruptures during myocardial infarction remain one of its most dangerous complications. Aim. To evaluate the features of risk factors for the development of myocardial infarction complicated by rupture in young and middle-aged men for predictive modeling of this complication to improve its prevention. Material and methods. The results of examination and treatment of men aged 19-60 years with myocardial infarction were studied. Patients were divided into two age-comparable groups: I – study group, with myocardial rupture – seven patients; II - control, without it - 558 patients. A comparative analysis of clinical, instrumental and laboratory parameters was performed, as well as an analysis of their influence (Pearson's Chi-square) on the risk of myocardial ruptures. Using binary and stepwise logistic regression, a model for predicting the risk of myocardial rupture was created. Results. The study group differed from the control group in terms of a more severe condition of patients (recurrent extensive lesions with multiple complications), the most significant of which were: electrocardiographic signs of right ventricular enlargement (absolute risk: 21.4%; relative: 27.0; p˂0.0001), the presence of thromboembolism (17.9%; 17.5, respectively; p˂0.0001) and pulmonary edema (9.0%; 44.6; p˂0.0001) among the complications myocardial infarction, history of coronary artery bypass surgery (6.6%; 11.0; р˂0.0001), III and IV severity class of acute heart failure according to T. Killip (12.1%; 21.3; р˂ 0.0001), the presence of asystole (18.8%; 23.5; p˂0.0001) and complete atrioventricular block (15.8%; 19.7; p˂0.0001). Conclusions. These factors were used to build a model for predicting the risk of myocardial rupture with good predictive characteristics, suitable for practical use.

Anemia is a frequently diagnosed complication in patients with various diseases of the esophagus and stomach, which negatively affects the quality of life and aggravates the course of the prior disease. There are three main mechanisms for reducing hemoglobin in the pathology of the upper gastrointestinal tract: bleeding, malabsorption, chronic inflammation. A combination of pathogenetic factors often leads to anemia associated with a deficiency of both iron and vitamin B complex. Anemia of chronic diseases is less common.Material and methods. 38 people with diseases of the esophagus and stomach were examined: 20 women and18 men. The average age was 70 years old. All patients were divided into groups according to the diagnosed variant of anemia: iron deficiency anemia (IDA), anemia of chronic diseases (ACD) and a combination of IDA and ACD, as well as by the type of therapy performed (therapy with iron preparations, B vitamins and treatment of the prior disease).Results. A comparative analysis of the hematopoietic lineage indices before and after the treatment was performed. A clinically significant increase in hemoglobin, erythrocytes and erythrocyte indices was observed in patients with IDA who received parenteral therapy with iron preparations, as well as combined treatment with iron preparations and B vitamins. In the ACD and ACD + IDA groups, there were no significant changes in the parameters of the hematopoietic lineage in any of the therapy variants.Conclusion. The effect of the treatment was found only in patients with IDA who received parenteral therapy with iron preparations. The rest treatment options did not show a positive effect on the dynamics of blood indices in any of the groups. Perhaps a longer follow-up and an increase in the sample of patients will allow creating an effective individualized algorithm for anemia therapy.

Цель. Изучить особенности секреции растворимого рецептора трансферрина (sTfR) у пациентов с ревматической патологией с анемией хронических заболеваний и железодефицитной анемией. Оценить влияние интерлейкина-6 (ИЛ-6), интерлейкина-10 (ИЛ-10), интерлейкина-1β (ИЛ-1β), интерферона гамма (ИФН-γ), фактора некроза опухоли-альфа (ФНО-α) на sTfR. Изучить возможность использования sTfR в качестве маркера для дифференциальной диагностики анемии хронических заболеваний и железодефицитной анемии у пациентов ревматического профиля.Материалы и методы. Обследованы 126 ревматических пациентов: 34 мужчины (45,8 (36–54,9) года), 92 женщины (49,5 (38–60) года). В 1-ю группу вошел 41 пациент с анемией хронических заболеваний (АХЗ), во 2-ю – 34 с железодефицитной анемией (ЖДА), в 3-ю – 29 с сочетанием АХЗ и ЖДА, в контрольную группу – 22 без анемии. Выполнен сравнительный анализ между группами с анемией и без нее показателей гемограммы, обмена железа, С-реактивного белка (СРБ). Выполнен корреляционный анализ между sTfR, показателями гемограммы, ИЛ-6, ИЛ-1β, ИЛ-10, ИНФ-γ, ФНО-α.Результаты. В группе АХЗ повышены концентрации ферритина, СРБ в сравнении с другими группами. У пациентов с АХЗ, АХЗ/ЖДА и ЖДА выявлена более высокая концентрация sTfR в сравнении с пациентами без анемии (p<0,05). У пациентов трех групп с анемией не выявлено межгрупповых различий в концентрации sTfR (p>0,05). Выявлена отрицательная корреляционная связь между концентрацией sTfR и гемоглобина (r=–0,5) и числом эритроцитов (r=–0,7). Доказана взаимосвязь между концентрациями sTfR и ИЛ-6 (r=0,4), ИЛ-10 (r=0,6), ИНФ-γ (r=0,4) и ИЛ-1β (r=0,3).Заключение. У пациентов ревматического профиля с АХЗ и ЖДА не выявлено значимых различий в концентрации растворимого рецептора трансферрина, при обоих типах анемии концентрации этого рецептора повышаются. Таким образом, у пациентов с ревматическойпатологией использование sTfR для дифференциальной диагностики АХЗ и ЖДА нецелесообразно. Выявленные корреляционные связи между sTfR и цитокинами свидетельствуют об их влиянии на синтез этого рецептора. Необходимы дальнейшие исследования возможных маркеров для дифференциальной диагностики АХЗ и ЖДА, в том числе у ревматических пациентов. Purpose. To study the features of secretion of soluble transferrin receptor (sTfR) in patients with rheumatic pathology with anemia of chronic diseases and iron deficiency anemia. To assess the effect of interleukin-6 (IL-6), interleukin-10 (IL-10), interleukin-1β (IL-1β), interferon gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α) on sTfR. To study the possibility of using sTfR as a marker for differential diagnosis of anemia of chronic diseases and iron deficiency anemia in rheumatic patients.Materials and Methods. 126 rheumatic patients, 34 men (45.8 (36–54.9) years old), 92 women (49.5 (38–60) years old) were examined. Group 1 consisted of 41 patients with ACD, group 2 – 34 patients with iron deficiency anemia (IDA), group 3 – 29 patients with a combination of ACD and IDA, the control group – 22 patients without anemia. A comparative analysis was performed between the groups with and without anemia on the hemogram parameters, iron metabolism, and C-reactive protein (CRP). Correlation analysis was performed between the sTfR, hemogram indicators, interleukin-6 (IL-6), IL-1β, IL-10, interferon gamma (INF-γ), tumor necrosis factor alpha (TNF-α).Results. In the ACD group, the concentrations of ferritin and CRP are increased in comparison with other groups. In patients with ACD, ACD / IDA, and IDA, a higher concentration of sTfR was found in comparison with patients without anemia (p<0.05). In patients of three groups with anemia, there were no intergroup differences in the concentration of sTfR (p>0.05). There was revealed the negative correlation between the concentration of sTfR and hemoglobin (r=–0.5) and the number of erythrocytes (r =–0.7). The relationship between the concentrations of sTfR and IL-6 (r=0.4), IL-10 (r=0.6), INF-γ (r=0.4) and IL-1β (r=0.3) was proved.Conclusion. In rheumatic patients with ACD and IDA, no significant differences were found in the concentration of the soluble transferrin receptor; in both types of anemia, the concentrations of this receptor increase. Thus, in patients with rheumatic pathology, the use of sTfR for differential diagnosis of ACD and IDA is inappropriate. The revealed correlations between sTfR and cytokines indicate their influence on the synthesis of this receptor. Further studies of possible markers for the differential diagnosis of ACD and IDA are needed, including in rheumatic patients.

Aim.To study the eff ect of hepcidin, soluble transferrin receptor (sTfR ), and cytokines on iron metabolism and the development of anemia in rheumatologic patients, to propose a working version of the classifi cation of anemia of chronic diseases (ACD) according to the major nosotropic factor.Material and methods.126 patients with rheumatic disease, 34 men (45.8 (36–54.9) years old), 92 women (49.5 (38–60) years old) were examined. Group 1 included 41 patients with ACD. Group 2 included 29 patients with the combination of ACD and IDA and 34 patients with iron defi ciency anemia (IDA). Group 3 included 34 patients with IDA and 29 — with the combination of ACD and IDA. Control group included 22 patients without anemia. Comparative analysis between groups with and without anemia and correlation analysis of hemogram parameters, iron metabolism, C-reactive protein (CRP), hepcidin, sTfR , interleukin-6 (IL-6), IL-1β, IL-10, interferon gamma (INF-γ) and tumor necrosis factor alpha (TNF-α) were performed.Results.In the ACD group, the concentrations of hepcidin, ferritin, CRP, IL-6 were increased in comparison with other groups. The correlation was revealed between erythrocytes, hemoglobin and IL-6 (r = −0.3 and −0.6), IL-10 (r = −0.4 and −0.4), INF-γ (r = −0.4 and −0.3), TNF-α (r = −0.3 and −0.3), hepcidin (r = −0.5 and −0.7), sTfR (r = −0.5 and −0.7). Dependence was shown between IL-6 and iron (r = –0.6), transferrin saturation index (TSI) (r = −0.5), ferritin (r = −0.5), CRP (r = 0.5), between TNF-α and TIBС (r = −0.6), transferrin (r = −0.6), ferritin (r = −0.7), between IL-1β and TIBC, ferritin, transferrin (r = −0.4). The correlation was noted between hepcidin and IL-6 (r = 0.5), IL-10 (r = 0.4), between sTfR and IL-6 (r = 0.4), IL-10 (r = 0.6), INF-γ (r = 0.4).Conclusion.The multicomponent genesis of anemia in patients with rheumatologic disease was detected. The signifi cance of disorders in iron metabolism, the eff ect of hepcidin, sTfR and cytokines on the development of anemia was found. A working version of ACD classifi cation (with a predominant iron defi ciency, with violations of the regulatory mechanisms of erythropoiesis, with insuffi cient production of erythropoietin) has been put forward.

Введение. Анемия - одно из наиболее часто встречающихся осложнений у пациентов с воспалительными заболеваниями кишечника (ВЗК) и хроническими заболеваниями печени. Для коррекции анемии в клинической практике все чаще применяют препараты железа, вводимые парентерально. Однако такая терапия может привести к избытку железа и ухудшить течение основного заболевания. Понимание патогенеза анемии важно для подбора терапии и минимизации риска осложнений. Материалы и методы. Проанализированы 10 пациентов с гастроэнтерологической патологией. Средний возраст составил 52,5 года. Пациенты были разделены на 2 группы: 1-я группа - 5 пациентов с ЖДА, протекающей на фоне патологии гепатобилиарной системы (ЗГБС), 2-я группа - 5 пациентов с воспалительными заболеваниями кишечника (ВЗК), осложненными анемией хронических заболеваний. Результаты. В обеих группах не было зарегистрировано достоверного прироста эритроцитов и гемоглобина (р>0,05), что, скорее всего, связано с коротким периодом наблюдения. При оценке феррокинетики выявлена статистически значимая положительная динамика всех показателей во 2-й группе (р<0,05), в 1-й группе достоверно изменился только показатель ферритина (р=0,009). Заключение. Необходимо дальнейшее исследование пациентов с гастроэнтерологической патологией, осложненной анемией, для формирования окончательного заключения об эффективности и целесообразности применения парентеральных форм препаратов железа у данных категорий пациентов. Introduction. Anemia is one of the most common complications in patients with inflammatory bowel disease (IBD) and chronic liver disease. In clinical practice, the intravenous iron is frequently administered. However, this therapy can lead to excess iron and cause exacerbation of the disease. Understanding the pathogenesis of anemia is important for the selection of therapy and minimizing the risk of complications. Materials and methods. 10 patients with gastroenterological pathology were analyzed. The average age was 52.5 years. The patients were divided into 2 groups: the first group - 5 patients with hepatobiliary system disease complicated by IDA, the second group - 5 patients with inflammatory bowel diseases (IBD) complicated by anemia of chronic diseases (ACD). Results. A statistically increased level of erythrocytes, hemoglobin, hematocrit in the both groups was not revealed (p>0.05). Statistically significant positive dynamics of all ferrokinetic parameters was detected in the group 2 (p<0.05). Only the ferritin indicator was changed significantly in the group 1 (p=0.009). Conclusion. Further study of patients with gastroenterological pathology complicated by anemia is required to form a final conclusion on the effectiveness and appropriateness of the intravenous iron administration in these categories of patients.

Relevance. Anemia of chronic diseases has a significant impact on the quality of life of patients with malignant neoplasms, as well as on the course of the underlying disease and prognosis. Aim. To study the characteristics of the secretion of interleukin-1β (IL-1β), interferon-γ (INF-γ) in patients with malignant neoplasms with and without anemia of chronic diseases. To study the effect of these cytokines on hemoglobin synthesis, erythropoiesis and some indicators of iron metabolism. To propose a working version of the classification of anemia of chronic diseases based on the leading pathogenetic factor in the development of anemia. Material and methods. The study involved 42 (27 patients with anemia - 19 men, 8 women, average age 65.1 ± 8.1 years, 15 without it, 10 men, 5 women, average age 61.1 ± 10.1 years) patients with II- Stage IV malignant neoplasm. A comparative analysis was carried out between groups with and without anemia and a correlation analysis between IL-1β, INF-γ and indicators of hemogram, iron metabolism, C-reactive protein (CRP), hepcidin. Results. In patients with malignant neoplasms and ACD, in comparison with patients in the control group, a more pronounced inflammation was proved, accompanied by an increase in the synthesis of ferritin, CRP and IL-1β, INF-γ (p <0.05). For IL-1β, a moderate correlation was found with the concentration of iron (r = 0.46), CST (r = 0.48), hemoglobin (r = -0.61) and a strong correlation with the concentrations of hepcidin (r = 0.8), ferritin (r = 0.78), CRP (r = 0.87). A weak correlation was found between IL-1β and the number of erythrocytes, TIBC and transferrin. For IFN-γ, a moderate correlation was established with erythrocytes (r = -0.68), hemoglobin (r = -0.57), CST (r = -0.57), ferritin (r = 0.57) and a strong correlation connection with CRP (r = 0.83), hepcidin (r = 0.9), transferrin (r = -0.83). A weak correlation has been established between INF-γ and the concentration of iron, TIBC. Conclusions. In patients with malignant neoplasms and ACD, a more pronounced inflammation was proved, accompanied by an increase in the synthesis of ferritin, CRP and IL-1β, INF-γ. The influence of the investigated cytokines on erythropoiesis, synthesis of hemoglobin and hepcidin, and iron metabolism has been proved. This reflects the pleiotropic effect of these cytokines and the complex pathogenesis of ACD in patients with malignant neoplasms, including erythropoiesis disorders, changes in iron metabolism, and increased synthesis of proinflammatory cytokines. A working version of the classification of ACD (with a predominant iron deficiency, with impaired regulatory mechanisms of erythropoiesis, with insufficient production of erythropoietin) has been proposed.

The features of erythropoietin secretion in patients with a rheumatic pathology and anemia of the chronic diseases in comparison with patients having iron deficiency anemia, as well as the relationship between erythropoietin, hepcidin, proinflammatory, and antiinflammatory cytokines, have been investigated. 126 patients suffering from the rheumatic pathology were examined, including 34 men aged 3655 years and 92 women aged 3860 years. At the same time, 104 (82.5%) patients suffered from anemia, 22 (17.5%) patients did not have it. Patients suffering from anemia, depending on the leading pathogenetic factor, were divided into three groups such as: the 1st group patients suffering from anemia of chronic diseases; 2nd grouppatients suffering from a combination of anemia of chronic diseases and iron deficiency anemia; 3rd grouppatients suffering from iron deficiency anemia. In patients suffering from anemia of chronic diseases, the maximum concentration of interleukin-6, hepcidin, and the minimum concentration of erythropoietin were detected in comparison with the patients suffering from iron deficiency anemia and patients suffering from anemia of chronic diseases, and iron deficiency anemia (p 0.05). The maximum concentration of the erythropoietin has been established in patients suffering from iron deficiency anemia. About the concentrations of interleukin-10 and interleukin-1, tumor necrosis factor-, interferon-, no differences were found in the study groups. A direct correlation was found between the erythropoietin and erythrocytes (r = 0.57), hemoglobin (r = 0.41), hepcidin (r = 0.65). There was a strong negative correlation between the erythropoietin and interleukin-6 (r = 0.75), and a weak relationship with interferon gamma, tumor necrosis factor alpha, interleukin-10, and interleukin-1 (r 0.3). Thus, for patients with a rheumatic profile, a specific molecular profile should be identified, leading to the development of anemia of the chronic diseases, which consists in increased concentrations of hepcidin and interleukin-6 in combination with the insufficient secretion of erythropoietin. The found changes fit into the structure of the previously proposed working version of the classification of anemia of chronic diseases (with a predominant iron deficiency, with disturbances in the regulatory mechanisms of the erythropoiesis, with an insufficient production of erythropoietin). Isolation of the leading factor in the development of anemia of chronic diseases in the future will allow for a more optimal approach to its correction, including with the targeted therapy drugs.

Цель. Оценить эффективность и целесообразность применения нескольких вариантов терапии для коррекции анемии у пациентов с различными патологиями желудочно-кишечного тракта. Предложить алгоритм, согласно которому лечение у данной категории пациентов будет более персонифицировано. Материалы и методы. Обследованы 52 человека с патологией желудочно-кишечного тракта (ЖКТ): 16 женщин от 23 до 80 лет (медиана возраста 62,5 года) и 36 мужчин от 21 до 88 лет (медиана возраста 53 года). Было произведено разделение пациентов на группы в соответствии с установленным вариантом анемии (железодефицитная анемия (ЖДА), анемия хронических заболеваний (АХЗ) и сочетание ЖДА и АХЗ), а также по виду проведенной терапии (парентеральная терапия препаратами железа, пероральная терапия препаратами железа, терапия витаминами группы В и отсутствие терапии анемии). Результаты. Выполнен сравнительный анализ показателей гемограммы (оценивался динамический уровень эритроцитов, гемоглобина, гематокрита, среднее содержание гемоглобина в эритроците, средний объем эритроцита, средняя концентрация гемоглобина в эритроците, ширина распределения эритроцитов, коэффициент вариации, ширина распределения эритроцитов, стандартное отклонение) до и после проведенного лечения. Выявлен статистически значимый прирост эритроцитов, гемоглобина, гематокрита к группе ЖДА в результате применения парентеральных форм препаратов железа (p=0,01). При терапии пероральными формами железа, витаминотерапии, а также терапии, направленной только на коррекцию патологии ЖКТ, достоверной динамики исследованных показателей не отмечалось. Вгруппе АХЗ и АХЗ+ЖДА не выявлено достоверных изменений показателей красного ростка кроветворения ни при одном из вариантов терапии (p>0,05). Purpose. To assess the effectiveness and feasibility of using several therapy options in patients with gastroenterological pathology; to suggest an algorithm, according to which the treatment of this category of patients will be more personalized. Materials and methods. 52 people with gastrointestinal tract (GIT) pathology were examined: 16 women from 23 to 80 years old (median of age - 62.5 years) and 36 men from 21 to 88 years old (median of age - 53 years). The patients were divided into groups in accordance with the revealed variant of anemia (iron deficiency anemia (IDA), anemia of chronic diseases (ACD), and a combination of IDA and ACD), as well as by the type of performed therapy (parenteral therapy with iron preparations, oral therapy with iron preparations, therapy B vitamins, and the absence of therapy for anemia). Results. A comparative blood test analysis was performed (the dynamic level of erythrocytes, hemoglobin, hematocrit, the average hemoglobin content in the erythrocyte, the average erythrocyte volume, the average concentration of hemoglobin in the erythrocyte, the width of the distribution of erythrocytes, the coefficient of variation of the width of distribution of erythrocytes, the standard deviation) before and after the treatment. A statistically significant increase of erythrocytes, hemoglobin, hematocrit in the IDA group was revealed as a result of use of parenteral forms of iron preparations (p=0.01). In the therapy with oral forms of iron, vitamins, as well as the therapy directed only to correction of the pathology of the gastrointestinal tract, the reliable dynamics of blood parameters was not observed. ACD and ACD+IDA groups had no significant changes of the red blood cells in any of the therapy options (p>0.05). Conclusion. The ambiguity of the effectiveness of therapy with various drugs is showed. The area of application of parenteral forms of iron therapy is indicated. Further investigation of patients with gastroenterological pathology complicated by anemia is required to form a final conclusion on the need for one or another form of therapy.

Aim. To study the characteristics of interleukin-6 (IL-6), interleukin-1β(IL-1β), interferon-γ(INF-γ) secretion in rheumatic patients with and without anemia of chronic diseases. To assess the influence of these cytokines on the development of anemia of chronic iseases in patients with various rheumatic pathologies. To propose a working version of the classification of anemia of chronic diseases based on the leading pathogenetic factor in the development of anemia. Material and methods. 126 rheumatic patients, 34 men (45,8 (36–54,9) years old), 92 women (49,5 (38–60) years old) were examined. Group 1 included 41 patients with ACD, 34 with iron deficiency anemia (IDA). Group 2 had 29 patients with a combination of ACD and IDA, 22 in the control group without anemia. Comparative analysis between groups with and without anemia and correlation analysis of hemogram parameters, iron metabolism, C-reactive protein (CRP), interleukin-6 (IL-6), IL-1β, interferon gamma (INF-γ) were performed. Results. In the ACD group, the concentrations of ferritin, CRP, IL-6 were increased in comparison with other groups. With regard to IL-1β, INF-γ, no intergroup differences were found in the study groups (p>0,05). It was found that the greatest influence on the maturation of erythrocytes is exerted by INF-γ (r=-0,4). The greatest effect on hemoglobin synthesis is exerted by IL-6 (r=-0,6) and IL-1β (r=-0,4). The effect of the studied cytokines on erythropoiesis and hemoglobin synthesis can be realized through their effect on iron metabolism. This is confirmed by the results of the performed correlation analysis. A negative moderate correlation was shown between IL-6 and iron (r=-0,6), total iron binding capacity (TIBС)(r=-0,3), transferrin saturation index (TSI) (r=-0,5), ferritin (r=-0,5), transferrin (r=-0,3), and a moderately positive correlation with CRP (r=0,5). For INF-γ, a negative correlation was found with TIBC (r=-0,3), ferritin and transferrin (r=-0,3). For IL-1β, a moderate negative correlation was shown with TIBC, ferritin and transferrin (r=-0,4). Conclusion. It was found that patients with rheumatic pathology and anemia of chronic diseases had high concentration of IL-6, while the concentrations of INF-γ and IL-1β did not differ from the values in the groups of patients with IDA, a combination of AChD / IDA and without anemia. Despite this, the influence of all three investigated cytokines on erythropoiesis, hemoglobin synthesis and iron metabolism has been proven. The data obtained reflect the complex pathogenesis of ACD in patients with rheumatic pathology, including erythropoiesis disorders, changes in iron metabolism, and increased synthesis of some pro-inflammatory cytokines. A working version of the classification of ACD (with a predominant iron deficiency, with violations of the regulatory mechanisms of erythropoiesis, with insufficient production of erythropoietin) has been proposed.

Актуальность. Легочная гипертензия (ЛГ) ухудшает прогноз инфаркта миокарда (ИМ). Цель. Установить наиболее значимые факторы риска развития ЛГ в подостром периоде ИМ для ее прогнозирования. Материалы и методы. В исследование включен 451 мужчина 19-60 лет с ИМ. Пациентам выполнялся стандартный диагностический алгоритм, включавший комплексную эхокардиографию, в первые 48 часов и в конце третьей недели заболевания. Исследуемую группу составили 84 пациента с ЛГ, возникшей в конце третьей недели заболевания при исходно нормальном уровне среднего давления в легочной артерии (СДЛА). В контрольную группу вошли 367 пациентов с нормальным уровнем СДЛА в обе фазы исследования или нормализацией этого показателя в конце подострого периода заболевания. С помощью корреляционного (по Т. Спирмену) и многофакторного дисперсионного анализа (ANOVA) из аналитической базы отбирали показатели, имеющие достоверные связи с уровнями СДЛА, или значимое влияние на риск возникновения ЛГ в конце подострого периода ИМ. Результаты. К наиболее значимым для развития ЛГ в подостром периоде ИМ факторам относятся: метаболические (концентрации в плазме крови натрия, калия, хлора; глюкозы и липидов) и гемодинамические (частота сердечных сокращений (ЧСС), уровень диастолического артериального давления, размеры левого предсердия и конечный диастолический – правого желудочка, индексы конечных систолического и диастолического объемов левого желудочка, сердечный, общее легочное сопротивление, наличие регургитации на аортальном клапане) параметры. Выводы. Использование сочетания перечисленных факторов для прогностического моделирования в первые часы ИМ позволит выделить среди мужчин моложе 60 лет с группу высокого риска развития ЛГ в подостром периоде ИМ с целью своевременного проведения превентивных диагностических и лечебных мероприятий.

Objective: to study the importance of cytokines, hepcidin, a soluble transferrin receptor, iron metabolism in the development of anemia of chronic diseases in patients with malignant neoplasms and rheumatic pathology, to identify the leading factors in the development of anemia for each of the studied groups and to develop a working classification of anemia of chronic diseases.Materials and methods. 63 patients with rheumatic pathology were examined. The study group included 41 (17 men/24 women, average age 53.4 ± 4 years) patients with anemia, the control group included 22 (9 men/13 women, age 49.3 ± 1.78 years) patients without anemia. The patients (n = 63) with stage II–IV malignant neoplasms were examined. The study group included 41 patients with anemia (34 men/7 women, age 67.1 ± 9.9 years), in the control group 22 patients without it (17 men/5 women, age 60.2 ± 14.9 years). The number of red blood cells, the hemoglobin level, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, concentrations of serum iron, total iron binding capacity (TIBC), ferritin, transferrin, C-reactive protein (CRP), transferrin saturation index (TSI), and soluble transferrin receptor (sTfR), hepcidin, interleukin (IL) – 6, – 10, tumor necrosis factor-α (TNF-α) were determined. Mann – Whitney U Test was applied to check for statistically significant differences in study samples.Results. Compared with the control group, elevated concentrations of ferritin, CRP, hepcidin, sTfR and IL-6 (p <0.05) were found for patients with rheumatic pathology and anemia and no differences were found in the concentrations of iron, TIBC, TSI, transferrin. For patients with solid malignant neoplasms and anemia, lower concentrations of iron, TIBC, TSI and higher concentrations of CRP, hepcidin, sTfR, IL-6, IL-10, TNF-α (p <0.05) are shown in comparison with the control group and there were no differences in the concentrations of ferritin, transferrin (p >0.05).Conclusion. The multicomponent anemia genesis in patients with cancer and rheumatic pathology is shown. The contribution of each mechanism to the development of anemia may vary depending on the specific nosological form. In patients with cancer, functional iron deficiency, activation of IL-6, IL-10, TNF-α synthesis and an increase in hepcidin synthesis lead to the development of anemia of chronic diseases. In patients with a rheumatic profile and anemia, a more pronounced synthesis of hepcidin and an increase IL-6 concentration are indicated. A working version of the classification of anemia of chronic diseases based on the leading pathogenetic factor is proposed (with a predominant iron deficiency, with impaired regulatory mechanisms of erythropoiesis, with insufficient production of erythropoietin).