The study was conducted with the aim of improving the diagnostic and treatment tactics in COPD with anemia of a chronic disease by clarifying the clinical and functional features of the course, the severity of systemic inflammation syndrome, endogenous intoxication and adaptation processes.
The dissertation research is based on the analysis of the study of the frequency and nature of anemia in patients with COPD and the characteristics of ACD; determination of the features of the course of COPD under the conditions of ACD and its severity; study of the activity of inflammatory and endogenous intoxication (EI) syndromes in patients with COPD and ACD; study of adaptation processes in patients with a combination of COPD and ACD; improvement of the strategy and tactics of treatment in patients with COPD and ACD, in those, who was treated in the therapeutic department of the 5th city clinical hospital, and allergological department of the 1st city clinical hospital. The retrospective stage of the study included 350 patients with exacerbation of COPD, and the comparative stage involved 150 patients with COPD and ACD who were hospitalized with exacerbation of COPD in 2017-2020; a control group was created with the participation of 100 patients with COPD without anemic syndrome of the appropriate age and gender range.
It was established that anemia occurred in 31,6% of patients with COPD. Anemia of a chronic disease occurred in 15,8% of patients with COPD and was characterized mainly by a mild course (82,0%), normochromic character (100%) with normal values of the average hemoglobin content in erythrocytes (MCH: 30,66 ± 0,53pg), average concentration of hemoglobin in erythrocytes (MCHC: 32,72 ± 0,80 g/l); serum iron (8,2 ± 1,2 μmol/l); ferritin (250,55 ± 40,14 ng/ml), transferrin (215,94 ± 15,82 mg/dl), the total iron-binding capacity of serum (60,44 ± 5,03 μmol/l), saturation of transferrin with iron (14,13 ± 2,01%). ACD was diagnosed more often in older patients (69,39 years vs 63,90 years) and among men (61,33% vs 38,67%; both p < 0,05).
The using of higher doses of glucocorticoids led not only to a decreasing of the severity of systemic inflammation, endogenous intoxication, and an improvement in the main parameters of FEB, which is especially important for patients with a combination of COPD and ACD, but also to a significantly higher hemoglobin content, color index, and average hemoglobin content in erythrocytes, i.e. to reducing the severity of anemic syndrome.
The expediency of determining the integral hematological indices for determining the activity of inflammation and endogenous intoxication, which do not require an increase in the scope of the examination, are available and more informative than the using of usual hemogram. An increasing of these indices indicates the activation of inflammation and endogenous intoxication and requires the intensification of anti-inflammatory treatment even under conditions of normal levels of peripheral blood leukocytes.
Distress reactions and an unsatisfactory state of adaptation were accompanied by a worse course of COPD, so, there is a need for additional diagnosis of the types and states of adaptation processes. The modification of standard treatment leads to the correction of anemia of a chronic disease, which makes more effectively influence the course of COPD, shorten the period of exacerbation and the length of the patient's treatment in hospital.
