Mozgova Y. Dynamics of apoptose-induced and immunoin-flammatory factors in treatment of chronic heart failure by ?-blockers.

Object of the study: chronic heart failure (CHF) with a decreased systolic function of the left ventricle. Purpose of the study: an increase in the diagnosis and treatment of CHF on the basis of a complex assessment of the level of pro- and anti-inflammatory cytokines, C-reactive protein, indices of apoptosis-mediated factors, parameters of the morphofunctional state of the heart and participation of the above changes in the realization of ?-adrenoblocker effects. Methods of research: clinical-instrumental, anthropometrical, immunoenzyme and statistic methods. Theoretical and practical results: the assessment of the tolerance to physical load, indices of the morphofunctional state of the heart, the body weight index in CHF patients with a decreased systolic function of the left ventricle makes it possible to separate cases with an unfavorable 18-month prognosis and makes it possible to optimize the diagnosis and control over the treatment of CHF patients. The use of ?-adrenoblockers in CHF patients makes it possible to reduce progressing and regression of the pathological myocardium remodeling, as well as a decrease of serum levels of proinflammatory cytokines and the transducer of the receptor way of the systemic apoptosis activation. With regard for pharmacological properties of ?-adrenoblockers, the use of Carvedilol is expedient in CHF patients with a high blood pressure, the use of Bisoprolol demonstrates its value in tachycardia. Novelty: peculiarities in the activation of apoptosis-mediated factors were studied in patients with CHF depending upon the severity of its course. It was revealed that in the disease functional classes (FC) II and III the transducer-receptor system was the main way for the apoptosis process realization. In FC IV, the apoptosis activation was realized both owing to the receptor-mediated and receptor-free ways. The research continued the study of dependences of the dynamics in the levels of pro- and anti-inflammatory cytokines, C-reactive protein depending upon the FC of heart failure. It was revealed that patients with FC III and IV developed higher serum levels of TNF-? and IL-1?, lower levels of IL-4 in FC IV. The serum level of C-reactive protein progressively rose, beginning with FC II. For the first time, with help of step-by-step regression analysis, models of functional classes of the disease were built. The research continued the effects of Carvedilol and Bisoprolol on the course of the disease. It was found out that the use of Carvedipol versus Bisoprolol more contributed to a regression of the pathological myocardium remodeling, lower serum levels of TNF-? and C-reactive protein, a well as resulted in a lower amount of IL-1? and a decrease in IL-1?/IL4 index. The use of both ?-adrenoblockers equally reduced the concentration of the transducer of the exogenous way of systemic apoptosis activation (sCD95). Degree of introduction: results of the research are used in the teaching process of the Department of Hospital Therapy of Kharkiv State Medical University ad the Department of Therapy and Nephrology of Kharkiv Academy of Postgraduate Education; they are introduced into medical work of the Cardiology Department of the Sumy Regional Hospital for invalids of the Second World War, the Therapy Department of the Sumy Regional Hospital, the Therapy Department of the Balakleya Central District Hospital, the Infarction Department of Kharkiv City Hospital No. 27. Sphere of application: medicine, cardiology, therapy.