Peculiarities of dynamics of level of the acute phase C-reactive protein and its connection with the immune system of organism in patients, suffering the ulcer gastro-intestinal hemorrhage with concurrent cardio-vascular pathology
Objective. To improve the investigated efficacy of treatment in elderly and senile patients, suffering the ulcer gastro-intestinal hemorrhage, in accordance to dynamics of levels of C-reactive protein, the immune system indices, and in connection with clinical picture studied.
Materials and methods. Prospective investigation was conducted in 35 patients of elderly and senile age (in accordance to classification of The World Health Organization – 61 - 90 yrs old), suffering the ulcer gastro-intestinal hemorrhage, the course of which was complicated by cardio-vascular pathology – an acute coronary syndrome (angina pectoris, atrial fibrillation, extrasystole, arrhythmia of various genesis) and an acute myocardial infarctionі in 2019 - 2021 yrs. There were 16 (46%) women and 19 (54%) men. Average age of the patients have constituted 76.3 yrs old. This category of patients was distributed in accordance to methods of treatment of coexistent cardio-vascular pathology: Group A – 20 patients, who took hypotensive therapy in accordance to standard scheme, Group B – 15 patients, who took a «double» therapy. The control group consisted of 50 relatively healthy persons (donors), who have had approximately equal age, the gender distribution with the patients investigated, while procedure of the indices determination in them was the same.
Results. Degree of the blood loss in accordance to classification of Marino (1998) was investigated. In Group A a small blood loss was observed in 7 (35%), and a middle one – in 13 (65%) patients. In group B big blood loss was noted in 9 (60%), while a massive one – in 6 (40%) patients. The term before admittance to hospital and preparations, which the patients took for treatment of cardio-vascular pathology – anticoagulants, antiaggregants, hypotensive, and their combinations as well – have impacted the blood loss degree. The dynamics of levels of C-reactive protein, іnterleukin-6 and іnterleukin-4 in these groups of patients was determined.
Conclusion. On the 7th day in groups A and B normalization of levels of the acute phase index of C-reactive protein, proinflammatory interleukin-6 and proinflammatory interleukin-4 (in group B especially expressed) was not revealed. Potent interrelationship between levels of С-reactive protein and interleukin-6 was revealed, but it was statistically nonsignificant due to small size of statistical sample of the groups. Level of interleukin-4 was sharply reduced without a tendency to normalization (p <0,01). At the same time, therapy of comorbidities in patients with cardio-vascular pathology influenced a state of interleukins mentioned above. Clinical significance of immune indices was proved on multiple clinical examples and may constitute one of objective criteria for estimation of the patients’ state, prognostication of the disease course and correction of the treatment initialized.
Lavro ZY, Lebed HB, Yastremska OO, Maksymyuk HV, Demianchuk NR, Porokhnavets LYe. Evaluation of the state of hemostasis in patients with gastrointestinal bleeding. Bulletin of problems of biology and medicine. 2019;(3):138-43. Ukrainian. doi: 10.29254/2077-4214-2019-3-152-138-143.
Alekseev SA, Kozlov IB, Nikolaev NOT, Alekseev DS. Features of diagnosis and medical practice in acute gastroduodenal bleeding of ulcerative etiology. In: Gostishchev VK, editor. Theory and practice of modern surgery. Materials of the 10th (anniversary) All-Russian Conference of general surgeons with international participation and a conference of young scientists-surgeons. Ryazan; 2018: 21-4. Russian. ISBN 978-5-8423-0183-6.
Sood R, Mancinetti M, Betticher D, Cantin B, Ebneter A. Management of bleeding in palliative care patients in the general internal medicine ward: a systematic review. Ann Med Surg (Lond). 2019 Dec 18;50:14-23. doi: 10.1016/j.amsu.2019.12.002. PMID: 31908774; PMCID: PMC6940657.
Shapovalenko IS. Features of the course of coronary heart disease in the elderly and senile age, depending on the presence of cardiovascular risk factors. PhD [thesis]. Kyiv: NMAPO; 2019. 24 p. Ukrainian.
Shaprynskyi VO, Romanchuk VD, Koval VM. Tactics and results of treatment of acute hemorrhage in gastroduodenal erosive ulcers due to application of gastro-aggressive preparations. Klin Khir. 2014 Sep;(9):10-3. Ukrainian. PMID: 25509425.
Trofimov NV, Kryshen VP, Barannik SI, Chukhryenko AV, Chabanenko GN, Gayterov AN. Clinical and statistical aspects of gastrointestinal bleeding course in patients with cardiovascular system pathology. Med Perspekt. 2019 Apr12;24(1):35-9. Ukrainian. doi: 10.26641/2307-0404.2019.1.162176.
Petri A, Sabin K. Visual statistics in medicine. Moscow: GEOTAR; 2019.216 p. Russian. ISBN: 978-5-9704-4884-7.
Dziak HV, Pertseva TO, Kuzmina AP, Potabashnii VA, Desiateryk VI. Methodological approaches to the assessment of immune status. Kryvyi Rih; 2014. 208 p. Ukrainian. ISBN 978-966-2775-82-2.
Trofimov MV, Kryshen VP, Chukhriienko AV, vynakhidnyky; Trofimov MV, Kryshen VP, Chukhriienko AV, patentovlasnyk. Method of surgical treatment of bleeding ulcer of pilorobulbar department of stomach. Patent of Ukraine No.139011. 2019 December, 10.Ukrainian.
This work is licensed under a Creative Commons Attribution 4.0 International License.