Vol 26, No 12 (2024): Коморбидность в клинике внутренних болезней

Background. Accelerated biological aging is associated with age-related diseases and an increased risk of mortality. Genetic predisposition may be an important factor in this process.

Aim. To determine the significance of genetic polymorphisms in the VDR and COL1A1 genes in accelerated aging.

Materials and methods. The study included 100 women aged 20–35 years, divided into groups with accelerated (Group 1) and normal/slow (Group 2) aging rates. We assessed biological age using V.P. Voytenko's formula. Genetic polymorphisms analyzed were: VDR 283 A>G (Bsml), VDR 2 A>G (Fokl), COL1A1 1546 G>T, COL1A1 -1997 C>A.

Results. The VDR 283 A>G (AA) polymorphism was associated with accelerated aging, occurring more frequently in Group 1 (18% vs 4% in Group 2, p=0.025). The COL1A1 -1997 C>A polymorphism was more prevalent in Group 2 (76% vs 56% in Group 1, p=0.035). A multifactorial model identified combinations of polymorphisms that predict accelerated or slow aging with an accuracy of 0.72.

Conclusion. Genetic predisposition plays a significant role in accelerated aging. Analysis of VDR and COL1A1 polymorphisms can help identify the risk of premature aging and may serve as a basis for further research and the development of new approaches to prevent age-related diseases.

Background. One of the important tasks of modern science is to search for key biomarkers of aging of various body systems. Parameters of carbohydrate metabolism play an essential role in maintaining vital activity. The prevalence of carbohydrate metabolism disorders increases with age, but the time course of changes in individual markers remains poorly understood. Therefore, it is important to investigate the patterns of changes in carbohydrate metabolism markers in different age groups among healthy participants, which is the objective of the RUSS-AGE study.

Aim. To evaluate changes in carbohydrate status markers (adiponectin, leptin, glucose, glycated hemoglobin, insulin, and carboxymethyllysine – CML) in different age groups of a healthy Russian population.

Materials and methods. The study was conducted at the Pirogov Russian National Research Medical University in collaboration with the Moscow City Outpatient Clinic No. 220. The study group included subjects 18 years of age and older who signed an informed consent form; the exclusion criteria were current acute disease, exacerbation of a chronic disease, surgical intervention within the last month, and moderate to severe chronic age-associated diseases. Blood samples were taken to measure aging markers: glucose (enzymatic ultraviolet method), insulin (chemiluminescent enzyme immunoassay), glycated hemoglobin (calorimetric method), CML, adiponectin, and leptin (enzyme immunoassay). The study was approved by the local ethics committee (Minutes No. 59 dated 13.09.2022). Statistical analysis was carried out using the R programming language version 4.4.0. The significance threshold for the p-value values given in the article is 0.05.

Results. The study included 711 participants, which were divided into eight age groups. According to the intergroup comparison, a statistically significant direct relationship of age with adiponectin (p<0.001), glucose (p<0.001), and glycated hemoglobin (p<0.001) was found. No significant correlation with age was found for leptin (p=0.116), insulin (p=0.078), and CML (p=0.506). After conducting a statistical analysis using linear regression to assess the dependence of variables on age, it was found that only adiponectin, glucose, and glycated hemoglobin significantly increase with age (p<0.001).

Conclusion. The study showed a significant increase in adiponectin, glucose, and glycated hemoglobin, while leptin, insulin and CML had no significant correlation with age.

According to the World Health Organization, 2 billion people all over the world suffer from infectious diseases every year. Infectious diseases remain among the leading causes of death and the first cause of premature death despite the implementation of vaccination programs. Vitamins and micronutrients are essential in supporting both the cellular and humoral parts of the immune system (IS), increasing resistance to infections. Micronutrient deficiency is a recognized global public health problem, and hypovitaminosis and nutrient deficiency conditions predispose to infections. Micronutrients such as vitamins A, C, D, E, B₂, B₆, B₁₂, folic acid, selenium, zinc, and iron are necessary to maintain immunocompetency. Both in adulthood and in old age, patients have an increased risk of occurrence and severity of infections due to the high prevalence of hypovitaminosis, a decrease in the function of the IS, and the presence of comorbidities. Nutritional support by vitamin and mineral complexes (VMC) with rational composition is a strategy to correct the immune response. VMCs should complement a healthy diet and contain micronutrients within the recommended amounts at the level of daily food requirement. It is advisable to use a differentiated approach to VMCs to modulate the IS function. Basic nutritional support with vitamins C, D, and zinc is most often sufficient for people without the risks of severe and complicated acute respiratory infections. Various mechanisms of action and different targets of micronutrients that correct the body's immune response and synergistic interactions support the discussion of the hypothesis of a more pronounced effect of multicomponent VMCs. In the presence of chronic diseases, in the case of comorbidity, it is advisable to use expanded formulation VMCs containing, in addition to vitamins C, D, and zinc, other micronutrients, such as vitamins A, E, B, copper, selenium, which helps reduce the risk of severe course and complications of respiratory infections in at-risk groups.

Background. Systems for self-determination of international normalized ratio (INR) may increase adherence to regular monitoring of hemostasis parameters in patients taking vitamin K antagonists. However, evidence of the effectiveness of self-determination of INR in real-world clinical practice in Russia is limited.

Aim. To compare the effectiveness of remote monitoring of INR using the CoaguChek® INRange coagulometer in patients who have undergone mechanical heart valve implantation with traditional INR control by measuring it in the outpatient department laboratory.

Materials and methods. A prospective study enrolled 101 patients receiving warfarin after a mitral or aortic mechanical heart valve prosthesis implantation. In Group 1 (n=51), conventional laboratory INR control was used; in Group 2 (n=50), patients monitored INR by themselves using a CoaguChek® INRange coagulometer. The follow-up duration was 1 year.

Results. Patients in Groups 1 and 2 did not differ in INR: 2.62 [2.45; 2.85] vs 2.6 [2.5; 2.8], respectively (data are presented as the median [1st to 3rd quartile]), and the time of INR in the therapeutic range: 66.7% [50; 78.6] vs 67.7% [53.2; 80.6]. The intervals between INR determinations in Group 1 were significantly longer: 30.5 [29.5; 31] days vs 20 [13; 25] days.

Conclusion. The CoaguChek® INRange system enables remote patient monitoring during continuous warfarin therapy and achievement of the target INR with a time in the therapeutic range comparable to that for patients with INR measurements in outpatient laboratories.

Background. Prolonged, including asymptomatic hyperuricemia (HU) for 7–10 years leads to the formation of sodium monourate deposits in various organs and tissues.

Aim. To study the incidence of noninfectious uveitis (NU) caused by HU.

Materials and methods. A retrospective evaluation of medical records of 217 patients diagnosed with NU in the ophthalmologic department of the general clinic for 10 years was carried out. Inclusion criteria: excess of serum uric acid values beyond the reference value (464 μmol/L), absence of other reasons explaining uveitis in the medical history. Exclusion criteria: glaucoma, recurrence of uveitis, pathology of ENT organs and oral cavity. Data are presented as median and interquartile range. Spearman's rank correlation coefficient was used as a criterion to assess the relationship between quantitative variables. The threshold level of statistical significance was taken as 0.05.

Results. There were 19 patients, mean age of men – 60 years (54–69 years), mean age of women – 60 years (37–67 years), leukocyte count – 7.8×10⁹ (6.4–9.4×10⁹), SOE – 52.5 mm/h (47–61 mm/h), CRP – 62.6 mg/L (53–68.1 mg/L), MC – 560 μmol/L (531–601 μmol/L). Among the concomitant pathology: cataract was detected in 8 patients (44.4% of the total), hypertension – in 7 (38.9%) patients, CHD in its various forms – in 6 patients (33.3%), chronic obstructive pulmonary disease and bronchial asthma – in 2 (11.1%) patients, diabetes mellitus – in 1 (5.3%) patient, gout – in 2 (11.1%) patients, and urolithiasis – in 4 (21%) patients. Statistically significant direct correlations were found between uric acid levels with COE (ρ=0.993; p<0001), CRP (ρ=0.998; p<0001). All identified correlations had strong closeness according to the Cheddock scale.

Conclusion. Despite the low incidence of HU-induced NU, examination of serum urate levels is an important diagnostic criterion in recognizing the cause of uveitis.

Background. Closed abdominal trauma is often accompanied by damage to the abdominal organs and retroperitoneal space. With the development of medicine, minimally invasive methods of treating patients with bleeding due to closed abdominal trauma have become available, including endovascular embolization of the bloodstream, which allows one to avoid traditional operations (laparotomy) in this category of patients and achieve rapid rehabilitation of patients.

Aim. To evaluate the possibility of X-ray endovascular embolization in the treatment of patients with closed abdominal trauma.

Materials and methods. At the Sklifosovsky Research Institute of Emergency Medicine in 2022–2024 treated 68 patients with a diagnosis of “closed abdominal trauma”, of which 14 underwent direct angiography. In 4 (28.6%) patients, the intervention was diagnostic, in 10 (71.4%) it was therapeutic and diagnostic. These patients were included in this study: 8 (57.1%) men and 6 (42.9%) women.

Results. Selective embolization of the splenic artery was performed in four (28.5%) cases, the renal artery in 2 (14.2%), the lumbar artery in 2 (14.2%), and the hepatic artery in 2 (14.2%). A retroperitoneal (perinephric) hematoma was punctured percutaneously under ultrasound guidance in one case to exclude urinary leakage in a patient with a kidney injury. One (7.1%) patient required laparotomy due to recurrent bleeding. There were no complications from X-ray endovascular interventions. There were no cases of hematoma infection. One (7.1%) death in a 70-year-old patient with a closed abdominal injury, subcapsular hematoma of the spleen with comorbid pathology.

Conclusion. The use of X-ray endovascular embolization made it possible to avoid traditional surgical interventions (laparotomy) in 20.6% of cases. The introduction of X-ray endovascular hemostasis is one of the priorities in the treatment of patients with closed abdominal trauma.

Clinical observation is of interest due to the shift in the vector of the main complaints of the classic manifestation of Randu–Osler–Weber disease in the form of epistaxis and anemia syndrome towards the syndrome of severe respiratory failure, the cause of which is the presence of arteriovenous malformations in the lungs. The importance of an interdisciplinary approach to the diagnosis and treatment of patients with Randu–Osler–Weber disease is discussed.