Grygorenko N. Pathogenetic role of cytokines (interleukin 1 beta, tumor necrosis factor alfa) and fibronectin under chronic cholecystitis in patients ill with diabetes mellitus.

Object of the study: CC with GB dyskinesia (hypotonic-hypokinetic and mixed) in DM. Purpose of the study: To optimize the diagnosis and prognosis of CC course in DM based of the determining the state of cytokines (IL-1b, TNF-a) and FN and to improve the results of treatment by means of developing correcting therapy. Methods: clinical laboratory, biochemical, immunological, immunoenzyme, instrumental. Theoretical and practical results: The obtained findings expand the idea about the balance of IL-1b, TNF-a and FN, feature their role in the disease pathogenesis and allow to substantiate the necessity of investigation of their amount in CC in patients with DM with the purpose of noninvasive quick diagnosis of CC. Interrelation of the process activity in the GB and the level of IL-1b, TNF-a and FN was revealed, which allow to consider these substances the markers of the inflammatory process in the GB in CC in patients with DM. The findings of the research suggest a positive effect of therapeutic complexes(espa-lipon-polysorb-ursochol and espa-lipon-ursochol) on the parameters of cytokine state and FN in CC in patients with DM. Elimination of the inflammatory process in the GB promoted stable metabolic control in patients with DM. Novelty: GB and bile duct dysfunction was revealed in DM patients with CC, they manifested by hypertonic-hypokinetic and hypotonic-hypokinetic dyskinesia and marked changes in the physical-chemical and biochemical properties of the bile. Disturbances of cellular, humoral immunity and cytokine state in CC in patients with DM (100%) were established. The influence of the changes of cytokine state and FN on the activity of the pathological process in the GB was proven. The features of cytokine state and FN in DM patients with CC depending on the type of DM and the variant of dyskinetic disorders were revealed. The association of the type of DM, the changes of biochemical parameters and cytokine state and FN was revealed in DM patients with CC. Positive correlation of FN and glycolized hemoglobin was proved which confirms the influence of glycemia on FN level. Positive correlation of TNF-a and CS in DM patients with CC was established. which increases formation of dyscholia syndrome and lithogenic properties of the bile as well as negative influence of TNF-a on FA in the bile reducing the factors of anti-nuclear protection. Positive influence of the suggested therapeutic schemes on the pa-rameters of cytokine state and FN in DM patients with CC was proven. Therapeutic complexed (espa-lipon-polysorb-ursochol and espa-lipon-ursochol) in DM patients with CC produce a pro-nounced correcting effect. Degree of introduction: The findings of the research were intro-duced to the clinical practice of gastroenterology, endocrinology and therapy departments of regional clinical hospital (Kharkiv), Blyzniuky, Volchansk, Veliky Burluk, Krasnokutsk, Merefa cen-tral district hospitals (Kharkiv region). Sphere of application: medicine, gastroenterology.