Абстракт Цель исследования. Изучить частоту встречаемости и выраженность эндотелиальной дисфункции, как маркера раннего атеросклероза, факторы риска сердечно-сосудистых заболеваний и течения системной красной волчанки, ассоциированные с эндотелиальной дисфункцией. Материалы и методы. Обследованы 72 больных системной красной волчанкой (СКВ), преимущественно женщин среднего возраста 36 (26; 47) лет и 15 здоровых лиц соответствующего возраста без клинических признаков атеросклероза. Оценивали популяционные факторы риска сердечно-сосудистых заболеваний (ССЗ) и наличие критериев антифосфолипидного синдрома (АФС). Эндотелиальную дисфункцию (ЭД) определяли ультразвуковым методом путем определения эндотелийзависимой и эндотелийнезависимой вазодилатации на плечевой артерии. Результаты. У больных СКВ достоверно чаще встречались артериальная гипертония (73,61%), отягощенная наследственность по ССЗ (12,52%), курение (6,94%), дислипидемия (63,88%). ЭД выявлена у 51 (70,83%) пациента, в основном средней и тяжелой степени (56,93%). Наличие ЭД коррелировало с более высоким индексом массы тела (ИМТ) и уровнем атерогенных липопротеидов, а также характеризовалось более высокой активностью СКВ, чаще отмечались АФС и волчаночный нефрит. Корреляционный анализ показал достоверные взаимосвязи диаметра плечевой артерии с ИМТ, наличием артериальной гипертонии, уровнем атерогенных липопротеидов и фактора Виллебранда. Скорость кровотока в плечевой артерии коррелировала с индексами SLEDAI-K2 и SLICC/ACR, уровнем вч-СРБ и фибриногена. Заключение. Признаки ЭД, как раннего маркера атеросклероза, имеются у большинства больных СКВ. Наличие и тяжесть ЭД ассоциируется с такими факторами риска как ИМТ и атерогенная дислипидемия. Отмечается значимая взаимосвязь ЭД с активностью СКВ, наличием волчаночного нефрита и АФС.

The purpose of the research was studying of features of clinic, course, medical tactics and outcomes of infectious endocarditis in 25 patients suffering from “salt” drug addiction. Materials and methods: we examined 25 patients with infectious endocarditis, the host “salt” intravenously. To verify the diagnosis in addition to standard studies of blood, urine, sputum, was performed transthoracic EchoCG, x-ray study of the chest (twice, at admission and before discharge of the patient from the hospital). For certain indications used diagnostic fiber-optic bronchoscopy and computed tomography of the lungs, consulted a neurologist, cardiologist, infectious disease. Results and discussion: 84% of patients diagnosed with HIV. The acute course of the disease and presence of accompanying pathology of organs and systems was observed in the majority of patients, with a predominance of neurological changes (88%). Typical meager cardiac symptoms (noise in the region of the heart were heard in 12% of patients), frequent lung as a result of pulmonary embolism (64%). Identified infectious agents (in most cases Staphylococcus aureus -32%), the defeat of the heart valves according to the EchoCG (in 72% of patients vegetation on tricuspid valve with varying degrees of regurgitation). The choice of antimicrobial medicines was optimized (cephalosporins I-III generation, aminoglycosides, vancomycin). The positive outcome of a disease was observed in 84% of patients, mortality was 16%. Conclusions: for infectious endocarditis injecting a “salt” of the drug revealed the following: acute disease; pronounced General symptoms, atypical clinical picture, involvement of the heart valves, lungs result in pulmonary embolism, early development of multiple organ failure, high mortality. In comparison with injection drug users who inject other drugs, “salt” addicts are characterized by the frequent development of infectious endocarditis, which is apparently connected with the influence of “salt” on the immune system and joining the bright and varied neurological symptoms.

The goal of the research was to value the cost-effectiveness and the efficacy of reperfusion therapy in myocardial infarction including one — year prospective examenation. Methods. The immediate and long-term results of reperfusion therapy in myocardial infarction with ST-elevated (MISTE) were analyzed. The immediate results of reperfusion therapy were estimated in 349 patients with MISTE by the hospital mortality, the duration of hospitalization, the length of treatment in the resuscitation and intensive care unit. The long-term results were estimated in 137 MISTE patients by the frequency of emergency call-outs and the frequency of hospital admissions for ischemic heart disease (IHD) within the post-infarction period. The costs of hospital treatment, reperfusion therapy, emergency call-outs and out-patient treatment were calculated using the rates of compulsory medical insurance fund. The lost years of potential life and open amount of Domestic Product due to premature mortality were also calculated. Results. The hospital mortality was 2.9 times less in the patients with MISTE who received reperfusion therapy, than in the patients who did not. Reperfusion therapy was attended with reduction of the duration of hospitalization and the length of treatment in the resuscitation and intensive care unit. Economic benefit as a result of the increase of labor potential due to hospital mortality reducing with reperfusion therapy in MI was higher than financial expenditure of reperfusion therapy. The frequency of hospital admissions for IHD within the post-infarction period per one patient was less in the patients with MI who received reperfusion therapy than in patients who did not. There were not significant differences between two groups of patients — with and without reperfusion therapy — in view of the frequency of emergency call-outs for IHD. There was little percentage of patients treated by the therapist and the cardiologist in out-patient departments in both groups of the patients throughout the year after MI. Conclusion. Reperfusion therapy is effective and profitable in the patients with MISTE. However the low quality of periodic health examination within the post-infarction period probably impairs the long-term results of fibrinolytic therapy and angioplasty and raises the risk of investment to reperfusion therapy in the patients with MI.

The goal of the research was to value the cost-effectiveness and the efficacy of reperfusion therapy in myocardial infarction including one — year prospective examenation.Methods. The immediate and long-term results of reperfusion therapy in myocardial infarction with ST-elevated (MISTE) were analyzed. The immediate results of reperfusion therapy were estimated in 349 patients with MISTE by the hospital mortality, the duration of hospitalization, the length of treatment in the resuscitation and intensive care unit. The long-term results were estimated in 137 MISTE patients by the frequency of emergency call-outs and the frequency of hospital admissions for ischemic heart disease (IHD) within the post-infarction period. The costs of hospital treatment, reperfusion therapy, emergency call-outs and out-patient treatment were calculated using the rates of compulsory medical insurance fund. The lost years of potential life and open amount of Domestic Product due to premature mortality were also calculated.Results. The hospital mortality was 2.9 times less in the patients with MISTE who received reperfusion therapy, than in the patients who did not. Reperfusion therapy was attended with reduction of the duration of hospitalization and the length of treatment in the resuscitation and intensive care unit. Economic benefit as a result of the increase of labor potential due to hospital mortality reducing with reperfusion therapy in MI was higher than financial expenditure of reperfusion therapy. The frequency of hospital admissions for IHD within the post-infarction period per one patient was less in the patients with MI who received reperfusion therapy than in patients who did not. There were not significant differences between two groups of patients — with and without reperfusion therapy — in view of the frequency of emergency call-outs for IHD. There was little percentage of patients treated by the therapist and the cardiologist in out-patient departments in both groups of the patients throughout the year after MI.Conclusion. Reperfusion therapy is effective and profitable in the patients with MISTE. However the low quality of periodic health examination within the post-infarction period probably impairs the long-term results of fibrinolytic therapy and angioplasty and raises the risk of investment to reperfusion therapy in the patients with MI.

Aim. To estimate the comparative nephroprotective influence of combined and mono kinds of lipid-lowering therapy atpatients with type 2 diabetes in decompensated stage. Materials and methods. 5In study was included 68 patients with decompensated type 2 diabetes, not receiving lipid-lowering therapy. All patients were randomised on three comparable groups. The patients of the first group (26 persons) was admitted simvastatin 40 mg daily. The patients of the second group (18 persons) received the combined lipid-lowering therapy with simvastatin (40 mg daily) and ezetimibe (10 mg daily). In 24 patients of third group Hpid-lowering therapy was not performed. In all patients the lipid panel, biochemical indicators of liver function, glomerular filtration rate and the intensity of microalbuminuria was determined before and after six months of treatmentperiod. Results. The improvement of indicators of lipid metabolism as well as during mono and combined lipid-lowering therapy was shown on patients with decompensated type 2 diabetes. It was marked the decrease in level of the general cholesterol, low density lipoproteins cholesterol, triglycerides, atherogenic index and insignificant increase in level of high density lipoproteins cholesterol. The marked decrease of low density lipoproteins cholesterol from 4.42+0.27 to 3.01+0.23 mmol/l at combined therapy in compare with from 3.58+0.29 to 3.14+0.16mmol/l on simvastatin only was determined. The level of triglycerides decreased by 15.4% at simvastatin therapy in compare with 30.6% on combined therapy. The lipid-lowering therapy was accompanied by the increasing of glomerular filtration rate from 91.61+7.74 to 107.18+8.35ml/min/1.73m 2 and the reduction r treatment. All kinds of therapy lead to the reduction of microalbuminuria to 32.4% at combined versus 17.6% at monotherapy. The assessment of afunctional condition of a liver after lipid-lowering therapy inpatients with decompensated diabetes showed theirsafety. ConcXasion. At patients with type 2 diabetes the beginning of lipid-lowering therapy in decompensated stage leads to the normalisation of indicators of a lipid metabolism and malfunction more expressive at combined therapy. The initiation of treatment in a decompensated stage is safe and doesn''tinfluence on indicators of a liverfunction.

The review contains an analysis of the literature on the problems of optimization approaches in the treatment of myocardial infarction, as well as methods of risk management. The necessity of the development and implementation of the strategy of risk management in clinical practice of myocardial infarction, as well as tasks that should be solved, managing risk of myocardial infarction. Identified risks and incidents of occupational risks of myocardial infarction.

Aim – to define cardio and nephroprotective properties of statins inclusion in a treatment of patients with diabetes 2 types with arterial hypertension.The decrease cholesterol level in statin group of patients with diabetes 2 types with arterial hypertension was revealed. Cardioprotective action of statins expressed in lack of increase of myocardium mass is noted. Reduction of expressiveness of a microalbuminuria and lack of decrease in speed of GFR is revealed at statin group.