The dissertation for the scientific degree of the Candidate of Medical Sciences obtaining in specialty 14.01.02 – Internal diseases. – Danylo Halytsky Lviv National Medical University of the Ministry of Health of Ukraine, Lviv, 2017. The dissertation was aimed at improving of diagnosis and correction of comorbid pathology in patients with arterial hypertension and Helicobacter pylori associated gastritis. Totally 127 persons were included into the study. The main group (I) was comprised with 71 patients with arterial hypertension combined with chronic gastritis (37 patient were Helicobacter pylori positive persons and 34 – Helicobacter negative); 56 patient with chronic gastritis were included into the comparison group II (33 patient were Helicobacter pylori positive and 23 – Helicobacter negative). All participants underwent anthropometry, general examination, as well as comprehensive laboratory testing, particularly measurement of serum level of homocysteine, vitamin B12, C-reactive protein, lipid profile, 24-hour monitoring of blood pressure, ECG, the investigation of stomach (fibrogastroscopy with biopsy of stomach mucosa); we used 2 methods for diagnostic Helicobacter pylori infection: breathing test – Helic test and microscopy investigation. As the result of the study, we found that the presence of Helicobacter pylori infection in patient with arterial hypertension and chronic gastritis causes increasing of cardiovascular risk, especially increased serum homocysteine level, C-reactive protein, decreased level of vitamin B12 and changes profile of blood pressure. Also it was stated that patient with arterial hypertension and chronic gastritis has some peculiarities, in particular 52.11% of patients have pangastritis (total gastritis) with atrophy (54.93%), moderate stage with edema of mucosa and erosive damage. Patient with Helicobacter pylori infection in 64.86% have pangastritis as Helicobacter pylori negative persons only in 38.24%, p<0.05. More of patients with arterial hypertension and Helicobacter pylori associated gastritis have duodenogastral reflux(59.46%, p<0.05) and total atrophy of stomach mucosa (72,34%). Significant changes of lipid metabolism (p<0.05) were found in case of patients with severe degree of Helicobacter pylori contamination. Presents of Helicobacter pylori in patient with arterial hypertension and chronic gastritis contributed violation daily profile of blood pressure, increased variables systolic and diastolic pressure. Analysis of the daily monitoring of the blood pressure showed that patients in group II compared with group I had significant variability in systolic blood pressure as well as diastolic blood pressure, in both groups the index of night time systolic blood pressure differed significantly (72.34±2.5 vs 41.43±5.38, p<0.05), as well as the index of night time diastolic blood pressure (58.64±4.68 to 17.77±6.42) and the area index of night systolic blood pressure (542.70±20.36 to 391.95±17.01, p<0.05). For an integrated evaluation of the factors influencing the daily blood pressure, a correlation analysis of indicators of cardiovascular risk factors such as standard body mass index, index waist/hip and abdominal obesity was conducted. In patients of the I group daily systolic blood pressure correlated with body mass index (r=0.83, p<0.05) and abdominal obesity (r=0.82, p<0.05), time index of systolic blood pressure correlated with body mass index (r=0.62, p<0.05) and abdominal obesity (r= 0.72, p<0.05), area index of systolic blood pressure correlated with waist/hip index (r=0.58, p<0.05) and abdominal obesity (r=0.51, p<0.05), time index of diastolic blood pressure with a body mass index (r=0.63, p<0.05). In the group II a significant correlation between systolic blood pressure and body mass index (r=0.65, p<0.05) was found. Elevated serum level of homocysteine were associated with patients age (r=0.7, p<0.05), and duration of the chronic gastritis (r=0.62, p<0.05), also level of vitamin B12 was associated with duration of the chronic gastritis (r=-0.72, p<0.05), it shows negative influence of chronic gastritis for hyperhomocysteinemia, as cardiovascular risk marker. Level of vitamin B12 was lower for men comparing to womean, in oldest people and the Helicobacter pylori infections contamination. Inverse correlation connectivity between duration of chronic gastritis and level of vitamin B12 represents pathogenetic role of chronic gastritis not only hypovitaminosis B12 and in hyperhomocysteinemia. Inclusion to standards eradication therapy solution vitamin B12 for injections every other day in daily dose 0.5 mg, shows better result for corrections of increased level of homocysteine and C-reactive protein. Regarding patients who received combined therapy, we saw changes profile daily blood pressure, especially time index for systolic blood pressure and level of systolic blood pressure. Industry - medicine.
