Zalyubovs'ka O. Endothelium Dysfunction and Possibilities of Its Therapeutic Correction of the Patients Suffered of Heart Disease with Diabetes of the 2-n.

Object of the study: the course of coronary disease (CD) in patients with diabetes mellitus (DM) type 2. Purpose of the research: increase of the efficacy in treating patients with CD in the presence of DM type 2 on the basis of the study of peculiarities of their endothelial function with its further correction using different doses of adenosine-converting enzyme inhibitor (ACE-i) and ?-adrenergic blocking agents (?-ABA). Methods of the research: general clinical, immunological, biochemical, sonographic, statistical ones. Theoretical and practical results: the prognostic value of the level of tumour necrosis factor ? (TNF-?) in blood serum of CD patients with manifestations of chronic cardiac insufficiency (CCI) accompanied by DM type 2 and metabolic syndrome (MS). Indications for applying combined therapy with use of different doses of ACF-i and ?-ABA were established. A differential approach to the choice of ACF-i and ?-ABA as components of the combined therapy for CD patients with manifestations ofCCI and DM type 2 in the presence of MS. A clinical approbation of the combined method of treatment was made with the resultant data, which demonstrate the desired direction of the action and efficacy of using different doses of ACF-i and ?-ABA in the therapy of the above type of patients with regard of the following parameters: a) endocardiac haemodynamics; b) those which characterize the endothelial function, carbohydrate metabolism, lipid and cytokine homeostasis. Novelty: for the first time, peculiarities in carbohydrate and cytokine metabolisms were revealed in CD patients having manifestations of CCI and DM type 2 in the presence of MS versus both CD patients with manifestations of CCI without any disturbance in carbohydrate metabolism and patients with CD type 2 having MS without CD and CCI. The character of changes in the endothelial function of CD patients having manifestations of CCI against a background of MC accompanied by CD type 2 was specified. The mutual influence of CD with manifestations ofCCI and DM type 2 in the presence of MS on the disease course was proved, it manifesting itself by more profound disturbances in lipid metabolism and heart remodelling. Peculiarities were revealed in the positive effect of a combination of different doses of ACF-i and ?-ABA in the complex treatment of a combined pathology: CD with CCI and DM type 2 in the presence of MS. Degree of introduction: results of the research were introduced in Kharkiv Regional Hospital and Kharkiv Regional Students’ Hospital, multi-type hospital No. 17, Kharkiv City hospitals Nos 8 and 27, Dergachi Central District Hospital. Sphere of application: medicine, therapy.