Medicine/4. Therapy

Doctor of Medicine, M.D. Oparin A.A., Doctor of Medicine, M.D. Oparin A.G., Kudriavtsev A.A

Kharkiv Medical Acalemy of Postgraduate Education

The content of metabolites of nitric oxide at the gastroesophageal reflux disease and concomitant arterial hypertension taking into account the quality of life of patients

 

Questions of pathogenesis of a gastroesophageal reflux disease is not discovered to the end nowadays. Special complexity to this question is given by the fact that in considerable percent cases of GERD proceeds combined with pathology of other internals, the leading places of them is occupied by diseases of cardiovascular system, and arterial hypertension is allocated between them. The last significant not only complicates a current of GERD but also modifies it that conducts on the one hand to a delay of statement of the correct diagnosis, and with another – to need of development of the combined therapy. Therefore studying of the general pathogenetic mechanisms has great scientific and practical interest. In view of that in recent years a foreground of pathogenesis of GERD and AH is allocated for nitrogen oxide, studying the maintenance of its metabolites at a gastroesophageal reflux disease and the accompanying arterial hypertension taking into account quality of life of patients became the purpose of our research.

For an assessment of the quality of life (QL) we used the unified questionnaire of SF-36 which was filled by patients independently that provided high objectivity of results. The questionnaire included rating scales of physical health, namely: physical functioning (PF), role physical functioning (RP), intensity of pain (IP), general health (GH), role emotional functioning (RF), viability (VT), mental health (MH) and social functioning (SF).

Indicators is varied from 0 to 100 points. The assessment of 100 points corresponded to the level of full health.

To determinate level of an active metabolite NO2 (nitrogen oxide) in blood we applied the spectrophotometric method by Gris-Ilosvay.

For the purpose of carrying out the research have been created consisting of two groups of sick students. The first group included 55 patients with GERD with existence of not erosive esophagitis and with the accompanying ² stage hypertensive disease, 1-2 severity. The diagnosis of GERD was established according to ICD-10 and the Montreal consensus (2006). The diagnosis of arterial hypertension was established according to ICD-10.

Composition of the first group: 43 men (78,2%) and 12 women (21,8%); age structure: 18 – 20 years – 11 students (20%), 25 – 30 years – 25 students (45%), 30 – 35 years – 19 students (34,5%).

In the second group made of 38 sick GERD with not erosive form of an esophagitis, but without the combined pathology. Composition of the second group: men – 30 (78,9%), women – 8 (21,1%); age structure: 18 – 20 years – 8 patients (21%), 20 – 25 years – 17 patients (44,8%), 30 – 35 years – 13 patients (34,2%).

The control group had included 20 almost healthy people. It should be noted that the created groups on gender and age significantly didn't differ.

Statistical processing of results was carried out by the software package of Statistica 5,0. The analysis of results was carried out with use of parametrical and nonparametric methods of statistics. For a dependent variable average values and errors of averages (M+m) for each group, a significance value (p) of a difference between these groups have been calculated, and correlation communication was defined by means of coefficient of correlation (r).

We have established considerable decrease of indicators of quality of life among both groups patients , and in comparison with control group on all scales of a questionnaire of SF-36, the difference was statistically (p<0,001) reliable.

Results of researches gives the chance to draw a conclusion that among patients with GERD and without the combined pathology indicators of role physical functioning (34,1±2,8 points) and, especially intensity of pain (29,8±2,9 points) were at lower level, than among the patients from the accompanying AH (42,9±3,4 and 47,6±3,2 points respectively). When comparing the difference between them was statistically reliable (ð<0,001) while indicators of levels of role emotional functioning (38,1±3,9 points), viability (38,7±3,8), and mental health (37,3±3,0), on the contrary, the lowest were among patients with GERD from the accompanying AH, than among the patients of GERD without combined pathology (55,1±3,4 points, 52,2±3,5 and 51,3±2,9 points respectively).

Indicators of levels of the general health (38,9±4,1), physical (47,2±3,9) and social functioning (49,2±3,9) were lower among the patients with GERD and without the combined pathology (41,9±4,0; 51,1±4,0 and 52,4±3,9 points respectively), but the difference between them was statistically doubtful (ð<0,05).

The NO2 level (1,29±0,05 g/ml), on the contrary, among the patients with GERD from the accompanying AH fell authentically (ð<0,001) below not only norms (2,32±0,07 g/ml), but is statistically reliable below average values of group of patients with GERD and without the combined pathology (1,51±0,04 g/ml).

Between extent of decrease in NO2 and level of decrease in quality of life indicators of accurate correlation dependence is established. Consequently decrease in quality of life indicators of promote decrease in the NO2 level has important case in pathogenesis both GERD and AH.

 

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