The dissertation presents the theoretical generalization and solving of the actual scientific problem - the increase of the treatment efficiency of the cirrhotic patients by improving the detection and establishing of the syntropic respiratory lesions severity, clarification of some pathogenic mechanisms of their appearance and complex characteristics. Also we studied the frequency of comorbid extrahepatic lesions of the organs’ systems in the cirrhotic patients. Such lesions were seen in 100.0% of the persons. It was found that the frequency of the respiratory lesions has been significantly increasing with the increase of the liver cirrhosis severity class. Syntropic hepatopulmonary syndrome (HPS) was seen in 45.4%, and concomitant disorders - in 54.6% of cases. For the first time, after the analysis of the correlations of the results of qualitative and quantitative indices of the examination of the cirrhotic patients with HPS, followed by the gradation of all indices according to their clinical rating, establishing the correlations, study of the statistical significance, the criteria for diagnosing of the severity of HPS, using the computer program (to facilitate the calculations) were established. These results allowed us to determine Ist degree HPS in 28 patients (30,1 %), IInd degree HPS - in 44 patients (47,3 %) and IIIrd degree HPS - in 21 patients (22,6 %). Also it was stated that the pathogenetic mechanisms of the appearance and increase of the hepatopulmonary syndrome severity was endothelial dysfunction (increased levels of cyclic guanosine monophosphate, endothelin-1), the role of proinflammatory cytokine tumor necrosis factor ?, violation of the renin-aldosterone system’s state, increased level of natriuretic peptide, and reduce of the impact of the central parts of the autonomic nervous system with the transition to the lowest - local level of the organism’s regulation, resulted into the activation of the cascade of the reactions with nitric oxide hyperproduction or direct vasorelaxative impact by the relaxation of the smooth muscle cells of the pulmonary vessels’ vascular wall, which makes them to be considered the criteria to justify the prescription of the complex treatment for the cirrhotic patients with the syntropic lesions of the lungs. For the first time we found out the nature and frequency of extrahepatic syntropic co- and polymorbid lesions of other organs and systems in cirrhotic patients with HPS of different severity. In the patients with Ist degree HPS there were diagnosed 35.7% of cases of comorbid and 64.3% - of polymorbid extrahepatic syntropic lesions, including the most often met lesions of the digestive and hemopoietic systems (in 64.3%), digestive, cardiovascular and nervous systems - in 50.0% of cases. In the patients with IInd degree HPS there were found 93.2% of cases of polymorbid extrahepatic syntropic lesions of the organs’ systems, among them the most often - combinations of the digestive disorders and lesions of the skin, its appendages and visible mucous membranes and central nervous system diseases (in 93.2%). In the patients with IIIrd degree HPS there were found 100.0% of polymorbid syntropic extrahepatic combinations of the systems’ lesions, among which the most frequent (in 100.0%) there were verified the lesions of skin, its appendages and mucous membranes with the lesions of the osteo-articular, hemopoietic, digestive and nervous systems. In patients with Ist degree HPS the most frequent combinations of the syndromes and nosologies: Ist degree varicose hemorrhoidal veins and coagulopathy (in 42.9%), osteopenia with arterial hypotension, thrombocytopenia and coagulopathy (in 35.7%); in patients with IInd degree HPS - coagulopathy with thrombocytopenia and telangiectasias (in 68.2%), jaundice with thrombocytopenia and coagulopathy (in 65.9%); in patients with IIIrd degree HPS of - coagulopathy with telangiectasias, arterial hypotension and jaundice (in 95.2%), jaundice and telangiectasias (in 90.5%). The results let us suggest that the incidence of all comorbid syntropic extrahepatic lesions in cirrhotic patients significantly (p<0.05) decreases and polymorbid - increases (p<0.05) with the increase of the HPS severity. This fact shows the relationship between the severity of HPS and the presence and expression of extrahepatic syntropic combinations and/or mixed nosologies, that it is important to consider during its diagnosis and treatment. So, during the diagnostics and treatment of the patients with liver cirrhosis is important to consider the combinations of the syntropic extrahepatic lesions of other organs and systems that in addition to the prescription of the pathogenetically justified treatment taking into the account the HPS severity can increase its efficiency and life quality of the patients. Industry - medicine.
