The thesis presents the results of the new solving of an actual clinical problem that allowed us to improve the principles of the treatment of the cirrhotic patients on the base of the results of the characteristics of the syntropic comorbid extrahepatic lesions depending on the severity of portal hypertension. Through the diagnostics of all extrahepatic lesions of other organs and systems in the patients with liver cirrhosis, it was proved the feasibility of using the complex clinical-laboratory and instrumental methods of examination of the skin, its appendages and mucous membranes, osteo-articular, respiratory, circulatory, hemopoietic, digestive, urinary, reproductive and nervous systems with the aim to isolate among them the syntropic lesions from the concomitant ones. According to the results of our study it was found the syntropic lesions of the skin, its appendages and mucous membranes in 87.5% of the cirrhotic patients (dyschromias, liver stigmata); osteo-articular system - in 80.8% (osteopenia, osteoporosis); respiratory - in 43.8% (hepatopulmonary syndrome, portopulmonary hypertension); circulatory - in 77.1% (hypotension, cirrhotic cardiomyopathy, sinus tachycardia, atrial fibrillation); hemopoietic - in 86.7% (anemia, leukocytosis, thrombocytopenia, coagulopathy); digestive - in 92.9% (varicose veins of the esophagus, cirrhotic gastropathy, varicose hemorrhoidal veins); urinary and reproductive - in 22.9% (hepatorenal syndrome type I and II); nervous - in 81.3% (cirrhotic encephalopathy); all the others - concomitant lesions. Using the developed modified protocol of Doppler-floumetric ultrasound examination of the abdominal cavity vessels and site program "HepatoPort" (http://hepatoport16mb.com), the portal hypertension of the I degree was diagnosed in 122 patients (50.8%), II degree - in 57 patients (23.8%), III rd degree - in 61 patients (25.4%) with liver cirrhosis. In the pathogenesis of it there were involved: imbalanced autonomic nervous system with the predominant influence of the sympathetic over the parasympathetic branch and the transition of the regulation to the local (humoral-metabolic) levels in case of its severity increase; elevated levels of endothelin-1, cyclic guanosine monophosphate, tumor necrotizing factor ?, renin, aldosterone and natriuretic peptide in blood plasma. All them have directly proportional dependence on the portal hypertension severity degree, that allows to consider them as "markers" of its severity and as criteria for the reasoning of the treatment of the cirrhotic patients. Diagnosing the extrahepatic syntropic mono- and comorbid extrahepatic lesions of other organs and systems, it was established that the incidence of all monomorbid diseases significantly (p < 0.05) decreases, and comorbid diseases - increases (p < 0.05) with the increasing of the portal hypertension severity. Thus, in the patients with the I degree portal hypertension monomorbid extrahepatic syntropic affected systems were diagnosed in 27.5 %, comorbid - in 60.0 % of the cases, the most common were the disorders of the digestive and hemopoietic system (in 56.6 %), among the variants of mono-, combined and/or united syntropic nosologies there were found 5.4 % of monomorbid and 51.4 % of comorbid, including the most common I degree esophageal varices and osteopenia (in 50.0 %). In the patients with the II degree portal hypertension in 3.5 % of the cases there were diagnosed monomorbid extrahepatic syntropic affected systems in 3.5 % and comorbid - in 96.5 % of the cases, the most common - combinations of the digestive and osteo-articular systems (in 91.7 %), and in the same amount - the disorders of the nervous and osteo-articular; among the variants of mono-, combined and/or united syntropic nosologies there were found 2.7 % of monomorbid and 89.2 % of comorbid, including the most common - telangiectasias and jaundice (64.9 %), and in the same amount of patients caput medusae and jaundice. In the patients with the III degree portal hypertension there were diagnosed 100.0 % of extrahepatic syntropic affected systems, the most common were the disorders of the digestive and osteo-articular or hemopoietic or nervous or skin, its appendages and visible mucous membranes lesions, and in the same amount of the patients - osteo-articular and circulatory or respiratory or hemopoietic, or nervous, or cirrhotic skin stigmata; among the variants of combined and/or united syntropic nosologies the most often - jaundice and the I degree varicose veins of the esophagus (in 90.2 %), that allowed to consider them as the factors that can complicate the course of the disease, determine the tactics of the treatment, prognosis of its effectiveness and life quality of the patients. The results shows that during the treatment of the patients with liver cirrhosis it is important to take into account the pathogenetic features of the portal hypertension severity degree and dependent combinated and/or united syntropic extrahepatic lesions. Thus, the complex treatment of the cirrhotic patients with the I degree portal hypertension should include nonselective в-blockers (carvedilol 6.25 mg - 1 tablet per day); with the II degree portal hypertension - angiotensin II receptor antagonists (valsartan 40.0 mg - 1 tablet per day) and aldosterone antagonists (spironolactone 50.0 mg - 1 tablet twice a day); with the III degree portal hypertension - angiotensin-converting enzyme inhibitors (enalapril 5.0 mg - 1 tablet per day), phosphodiesterase inhibitors (pentoxifylline 100.0 mg - 1 tablet twice a day) and aldosterone antagonists (spironolactone 100.0 mg - 1 tablet twice a day). Industry - medicine.
