2012. – . 10, .1 612.12-008.46-036.12-092:612.017.1-07 . . , . . , . . СИСТЕМНОЕ ВОСПАЛЕНИЕ В ПАТОГЕНЕЗЕ ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТИ Кафедра микробиологии и вирусологии, кафедра патологической физиологии, кафедра госпитальной терапии ГБОУ ВПО «Тверская ГМА Минздравсоцразвития РФ» – , - , ( ( IMP) ) ( ( , ). 270 ) - , , , , , , - , sE- , -9 IMP-4. , , , , - , . . : , , , , . SYSTEMIC INFLAMMATION IN CHRONIC HEART FAILURE PATHOGENESIS E.N. Egorova, M.N. Kalinkin, E.S. Mazur Aim of the article is to compare a condition of a microbiocenosis of a large intestine, an endotoxin expression, an activity of a systemic inflammation and matrix metalloproteinases (MMP) and tissue inhibitors of metalloproteinases (TIMP) system in postinfarction cardiosclerosis (PICS) patients at different stages of a chronic heart failure (CHF). Clinical, echocardiographic and laboratory investigations including bacteriological feces research, a definition of an aminoterminal brain natriuretic propeptide, a lactate, a general concentration of peroxide products, an endotoxin, a tumor necrosis factor alpha, C-reactive peptide, sE-selectin, -9 and IMP-4 levels in blood plasma was performed for 270 CHF patients. It has shown that CHF advance has associated with a large intestine dysbiosis, a rising of endotoxin blood levels, of the system inflammation factors activation and a dysbalance in a MMP/TIMP system also. The hypothesis about the reasons and consequences of a systemic inflammation in CHF pathogenesis has formulated. Key words: chronic heart failure, pathogenesis, endotoxin, systemic inflammation, matrix metalloproteinases. ( 1990 , ( - )– , ) B. Levine et al. , (TNF ) - , [7]. , , , [15]. - , ( - ) ( IMP), , – - - - , [8, 18]. – [4, 13, 14, 16], - , [2]. , / IMP ( ) , . - , . , ; - , - , 230 . - – 47, ) 40 ( – 183 57,2 ± 2,3 62,3 ± 1,3 ( – 30 2012. – . 10, – 10, 1,6 54,5 ± 2,4 58,6 ± ). » [9]. - (NT-proBNP) ( . .). , « . .1 NT- proBNP (F = 36,6, p < 0,01). (NT-proBNP) , DXPRESS (LifeSign, ). LAL- safe® ( ). (TNF ), sE- , - Systems® ( ). , Charles River Endo-9, I -4 ( ), Bender Med- (F = 17,3, p < 0,01), ( , F = 275,7, p < 0,01), (F = 39,4, p < 0,01), TNF (F = 39,5, p < 0,01), hsCRP (F = 32,0, p < 0,01), sE(F = 20,3, p < 0,01) -9 (F = 19,2, p < 0,01). TIMP-4 , , (F = 11,7, p < 0,01). < TNF (rxy = 0,71) hsCRP (rxy = 0,82, -9 TNF hsCRP < 0,05), (rxy = 0,48 rxy = 0,52; IMP-4 – (rxy = –0,47 rxy = –0,53; < 0,05). D.A. Siwik et al. [17], 2- , 39IL-1 TNF . 0,01). (hsCRP), « - »( ). ). Biocon® ( - «Oxystat» (Biomedica, ). m. , - , . – - . [3, 5]. , rxy. (I ) II , 67 – II I, II , 62 I ( , 101 – II . III ) - ( .). (M ± m) NT-proBNP, , , / / 70 ± 13 1,5 ± 0,2 131 ± 22 24,1 ± 7,9 0,18 ± 0,01 1,1 ± 0,2 1,6 ± 0,2 9,6 ± 0,4 16,1 ± 1,5 2,3 ± 0,3 / ,% , ./ TNF , / hsCRP, / sE, -9, / TIMP-4, / / .* #– (p < 0,01) (p < 0,05) . , - I 251 ± 32 4,5 ± 0,4* 228 ± 15 38,1 ± 10,6 0,21 ± 0,01 1,7 ± 0,2 4,0 ± 0,5 20,5 ± 1,7* 23,6 ± 1,2 1,6 ± 0,1 II 1347 ± 175* 6,4 ± 0,4* 619 ± 23** 58,8 ± 8,4 0,31 ± 0,02*# 6,9 ± 0,8* 6,3 ± 0,4* 29,2 ± 1,6* 26,3 ± 1,2 1,4 ± 0,1 I ; ** – II 4280 ± 449*# 8,8 ± 0,6** 1539 ± 51** 70,1 ± 10,2# 0,47 ± 0,02*# 12,0 ± 0,9*# 8,1 ± 0,4* 49,9 ± 7,1# 32,5 ± 1,3*# 1,03 ± 0,1* II 2012. – . 10, .1 - - , . ( ), - - - , , . (2005) [1]. . . : – - , , - – - – , , – – - . MMP/TIMP – . (circulus vitiosus), . , . , - 1. - 2. . , - , 20% , [6]. . 3. , - 38% , -9 . , 1. [11] , - 3. , [10, 12]. , TNF (rxy = 0,71) hsCRP (rxy = 0,82, MMP-9 hsCRP (rxy = 0,48 rxy = 0,52; 0,05) 4. . – 2011. – . ., . ., , hsCRP (rxy = –0,47 , rxy = // . – 2011. – . ., 6. . ., , 5. – . 72–76. . . . 19 – 22. 7. « 8. . ., « . . . . », 2008. – 552 . 6. – . 49–55. 9. « 9, - . . - 10. . ., . . , .– 2. – .: : . – 2001. – . 41. – // »( , - // // . – 2009. – , /TIMP, TIMP 4- - // 1. – . 3–7. . . . . – 2011. – 1. – . 56–59. 5. . ., . ., . [17]. , TNF < 0,05). . . – 2007. – 4. – . 9–21. . ., . . . . ., < - IMP-4 –0,53; . . // . TNF 2. – . ., // . – 2005. – . 6. – 5. – . 176–180. . ., . ., . . – , , < 0,01). . ., , , IMP-4. . 91500.11.0004-2003. 231 09.06.2003). , - 2012. – . 10, . – 2010. – . ., 11. . // 4. – . 21–37. . . - 15. Levine B., Kalman J., Mayer I. et al. Elevated circulating level of tumor necrosis factor in severe chronic heart failure // New Engl. J. Med. – 1990. – 223. – . 236–241. 16. Niu J., Kolattukudy P.E. Role of MCP-1 in cardiovascular disease: molecular mechanisms and clinical implications // Clinical science. – 2009. – Vol. 117. – 3. – . 95–109. 17. Siwik D.A., Chang D.L.-F., Colucci W.S. Interleukin-1 and Tumor Necrosis Factor- Decrease Collagen Synthesis and Increase Matrix Metalloproteinase Activity in Cardiac Fibroblasts In Vitro // Circulation Research. – 2000. – Vol. 86. – . 1259–1265. 18. Spinale F.G. Matrix Metalloproteinases: Regulation and Dysregulation in the Failing Heart // Circulation Research. – 2002. – Vol. 90. – . 520–529. - III « – 2008». – 2008. – . 41–42. . . 12. .1 - // .– 2003. – 1. – . 31–40. 13. Anker S.D., von Haehling S. Inflammatory mediators in chronic heart failure: an overview // Heart. – 2004. – Vol. 90. – 4. – P. 464 – 470. 14. Lamblin N., Mouquet F., Hennache B. et al. High-sensitivity C-reactive protein: potential adjunct for risk stratification in patients with stable congestive heart failure // European Heart Journal. – 2005. – Vol. 26. – 21. – P. 2245–2250. ( . )– . . (4822) 34-55-98. 616.366-003.7-089.819 . . , 1 . . . . , 2 , 4 . . . . , . . . 1 , 5 . , 3 1 СПЕКТР КЛИНИЧЕСКИХ ФОРМ ЖЕЛЧНО-КАМЕННОЙ БОЛЕЗНИ У ХИРУРГИЧЕСКИХ ПАЦИЕНТОВ НА СОВРЕМЕННОМ ЭТАПЕ Кафедра госпитальной хирургии с курсом урологии ГБОУ ВПО «Тверская ГМА Минздравсоцразвития РФ»; 2 Центральная клиническая больница Управления делами Президента Российской Федерации, г. Москва; 3 Кафедра общей хирургии ГБОУ ВПО «Тверская ГМА Минздравсоцразвития РФ»; 4 ГУЗ «Областная клиническая больница», МУЗ «Городская клиническая больница № 7», МУЗ «Городская клиническая больница скорой медицинской помощи», г. Тверь; 5 НУЗ «Отделенческая больница на станции Тверь» ОАО «РЖД» 1 2008 15 754 1999. , . - . : - . SPECTRUM OF CLINICAL FORMS OF A CHOLELITHIASIS AT SURGICAL PATIENTS AT THE PRESENT STAGE S.V. Lebedev, A.T. Brontvein, A.G. Eremeev, E.M. Mokhov, A.O. Svistunov, A.S. Ledunkin, I.O. Svistunov The multicenter retrospective analysis of results of diagnostics and treatment of 15754 patients with a cholelithiasis, hospitalised in surgical hospitals with 1999 for 2008, is made. Dynamic changes of number of patients with various forms of a cholelithiasis are studied. The carried out analysis showed a tendency of increase in a share of complicated forms of a cholelithiasis among patients annually hospitalised in a surgical hospital. Key words: cholelithiasis. [4], - ( . [1, 9], - ) [5, 7, 8] , . [6] . - 19