Terapevticheskii Arkhiv最新文献

{"title":"[A new paradigm of the pathogenesis of primary sclerosing cholangitis associated with ulcerative colitis: microbiota and system intestine-liver. A review].","authors":"E S Sbikina, E V Vinnitskaya, A I Parfenov","doi":"10.26442/00403660.2026.02.203529","DOIUrl":"https://doi.org/10.26442/00403660.2026.02.203529","url":null,"abstract":"<p><p>The close relationship between primary sclerosing cholangitis and ulcerative colitis has given rise to a number of hypotheses aimed at deciphering their pathogenesis from the standpoint of bidirectional connections involving immune, endocrine and inflammatory mechanisms. The review examines the main directions of the concept of the \"gut-liver axis\" from the point of view of the pathogenetic relationships of primary sclerosing cholangitis associated with ulcerative colitis and intestinal microbiota.</p>","PeriodicalId":22209,"journal":{"name":"Terapevticheskii Arkhiv","volume":"98 2","pages":"119-124"},"PeriodicalIF":0.3,"publicationDate":"2026-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147378590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Chronic gastroduodenitis, associated and not associated with <i>Helicobacter pylori</i> infection, and its relationship with functional intestinal pathology depending on the content of fecal calprotectin].","authors":"E D Mironova, M A Osadchuk, M T Chernov, M M Osadchuk","doi":"10.26442/00403660.2026.02.203531","DOIUrl":"https://doi.org/10.26442/00403660.2026.02.203531","url":null,"abstract":"<p><strong>Background: </strong>In recent years, the role of chronic gastroduodenitis in the occurrence of functional intestinal diseases within the framework of the crossover syndrome, which occurs against the background of minimal inflammation in the stomach and intestines associated with <i>Helicobacter pylori</i> infection, has become increasingly relevant.</p><p><strong>Aim: </strong>To determine the relationship of chronic gastroduodenitis, associated and not associated with <i>H. pylori</i> infection, with the level of fecal calprotectin (FC) and clinical symptoms of functional intestinal disorders.</p><p><strong>Materials and methods: </strong>The study included 158 patients with chronic gastroduodenitis: group 1 (80 patients with gastroduodenitis associated with <i>H. pylori</i> infection in the stomach) and group 2 (76 patients without <i>H. pylori</i> infection). All patients had clinical symptoms of the gastrointestinal tract for at least a year. The patients underwent esophagoduodenoscopy and colonoscopy. Verification of <i>H. pylori</i> was based on data from histiobacterioscopy of impression smears from the mucous membrane of the antrum of the stomach. FC content was determined using an express analyzer.</p><p><strong>Results: </strong>Patients of the first group significantly more often complained of pain, a burning sensation and fullness after eating in the epigastric region, nausea, belching, heartburn, flatulence, pain along the large intestine, a feeling of incomplete evacuation after defecation compared to the group without <i>H. pylori</i> infection. At the same time, in patients with <i>H. pylori</i> infection, FC values were most often determined in the range from 50 to 200 μg/g - in 28.75%, and in patients not infected with <i>H. pylori</i> infection - 13.15% (<i>p</i> < 0.05).</p><p><strong>Conclusion: </strong>The studies conducted indicate the presence of a statistically significant relationship between chronic gastroduodenitis and functional intestinal disorders, which can be bidirectional in nature, the basis of which is minimal inflammation caused by the presence of <i>H. pylori</i> infection and increased production of FC.</p>","PeriodicalId":22209,"journal":{"name":"Terapevticheskii Arkhiv","volume":"98 2","pages":"110-114"},"PeriodicalIF":0.3,"publicationDate":"2026-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147378629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Gastrointestinal bleeding after mitral valve implantation. Case report].","authors":"G O Isaev, O I Trushina, B M Tlisov, S V Cherniavskii, J V Boriskina, O A Pallia, V V Fomin","doi":"10.26442/00403660.2026.02.203528","DOIUrl":"https://doi.org/10.26442/00403660.2026.02.203528","url":null,"abstract":"<p><p>Performing surgical interventions on the mitral valve is one of the main high-tech treatment methods that requires further anticoagulation therapy. However, patients at high risk of bleeding have traditionally become a group requiring a personalized approach and, in many cases, the guidance of a multidisciplinary team of specialists of various profiles. In this clinical case, it is noteworthy that the 72-year-old patient underwent a full amount of preoperative preparation, and no contraindications to surgical treatment were identified. During esophagogastroduodenoscopy, an endoscopic picture of non-erosive reflux esophagitis, grade M (Minimal), was determined against the background of cardia insufficiency. After surgical treatment, on the background of anticoagulant therapy, vomiting of \"coffee grounds\" and melena were noted. According to the esophagogastroduodenoscopy data, multiple erosive and ulcerative defects of the stomach and duodenum were revealed, and combined endoscopic hemostasis was performed. The patient was prescribed anti-ulcer eradication therapy. The purpose of this clinical case is to emphasize the importance of a personalized approach to the treatment of this group of patients, who often require consultation with a gastroenterologist.</p>","PeriodicalId":22209,"journal":{"name":"Terapevticheskii Arkhiv","volume":"98 2","pages":"115-118"},"PeriodicalIF":0.3,"publicationDate":"2026-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147378593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Dynamics of lipid metabolism parameters following the change of targeted therapy for hypercholesterolemia after acute coronary syndrome].","authors":"A A Nekrasov, E S Timoshchenko, S G Erofeeva, E S Kuzyakina, T A Nekrasova","doi":"10.26442/00403660.2026.02.203601","DOIUrl":"https://doi.org/10.26442/00403660.2026.02.203601","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate lipid metabolism dynamics by switch from inclisiran to alirocumab in the setting of lipid-lowering therapy (LLT) after acute coronary syndrome (ACS).</p><p><strong>Materials and methods: </strong>26 patients survived ACS with low-density lipoprotein cholesterol (LDL-C) ≥ 4.0 mmol/L during hospitalization were included. All patients were prescribed inclisiran within 6 months after ACS. Each patient received it at least twice. All patients were expected to undergo an unplanned switch from inclisiran to alirocumab due to logistical reasons. All patients gave consent to participate in the study. Eight visits were conducted to assess LDL-C levels: 3 and 1 month before the end of inclisiran therapy, on the day of the first alirocumab injection and 1, 2, 3, 4, and 5 months after the start of alirocumab therapy.</p><p><strong>Results: </strong>LDL-C values (<i>Me</i> [<i>Q1</i>; <i>Q3</i>]) during the inclisiran treatment period (visits 1-3) were 1.34 [0.55; 1.41], 1.44 [0.53; 2.00], 1.67 [1.08; 1.96] mmol/l and during alirocumab treatment (visits 4-8) - 1.10 [0.61; 1.55], 0.95 [0.69; 1.40], 1.01 [0.86; 1.55], 0.88 [0.71; 1.53], 0.87 [0.70; 1.22] mmol/l (<i>p</i> = 0.002). The first administration of alirocumab at visit 3 was associated with the greatest reduction in LDL-C over the month (-34.1%; <i>p</i> = 0.001).</p><p><strong>Conclusion: </strong>The switch from inclisiran to alirocumab in post-ACS patients resulted in a rapid LDL-C reduction without any adverse events.</p>","PeriodicalId":22209,"journal":{"name":"Terapevticheskii Arkhiv","volume":"98 2","pages":"105-109"},"PeriodicalIF":0.3,"publicationDate":"2026-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147378612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Gastrointestinal complications of dual antiplatelet therapy in patients with ischemic heart disease: risk stratification, current management tactics. A review].","authors":"E S Deeva, M A Isaikina, O I Trushina, V V Fomin, A V Pogonin, M K Tamkaeva","doi":"10.26442/00403660.2026.02.203532","DOIUrl":"https://doi.org/10.26442/00403660.2026.02.203532","url":null,"abstract":"<p><p>Coronary heart disease is one of the leading causes of death worldwide, and antiaggregant therapy is crucial for both its prevention and treatment. The review article presents the data of clinical trials that allow to determine the tactics of management of patients at high risk of gastrointestinal complications on the background of dual antiaggregant therapy. The main risk factors for complications are described, such as: acetylsalicylic acid dose, ulcer or bleeding from the upper GI tract in anamnesis, advanced age, concomitant use of anticoagulants, non-aspirin non-steroidal anti-inflammatory drugs, including COX-2-selective non-steroidal anti-inflammatory drugs, <i>Helicobacter pylori</i> infection. The mechanism of action of antiaggregant drugs and pathogenesis of their damaging effect on the GI mucosa, the use of gastroprotective therapy for the prevention and treatment of existing damage to the GI mucosa are considered.</p>","PeriodicalId":22209,"journal":{"name":"Terapevticheskii Arkhiv","volume":"98 2","pages":"125-130"},"PeriodicalIF":0.3,"publicationDate":"2026-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147378636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Justification for the use of a FODMAP diet in patients with irritable bowel syndrome: focus on small intestinal disaccharidase activity].","authors":"S V Bykova, S R Dbar, E A Sabelnikova, N I Belostotsky, A I Parfenov","doi":"10.26442/00403660.2026.02.203542","DOIUrl":"https://doi.org/10.26442/00403660.2026.02.203542","url":null,"abstract":"<p><strong>Background: </strong>The current study hypothesized that gastrointestinal symptoms would improve following a low-FODMAP diet in patients with irritable bowel syndrome (IBS) due to reduced load on enzyme systems and normalization of the activity of disaccharidases involved in the final assimilation of carbohydrates.</p><p><strong>Aim: </strong>To evaluate the effect of a low-FODMAP diet on the dynamics of disaccharidase activity in patients with IBS who have symptoms of food intolerance.</p><p><strong>Materials and methods: </strong>The study included 20 patients with IBS aged 18 to 50 years: median 32.0 years, <i>Q1</i> = 27.0, <i>Q3</i> = 38.0, <i>p</i>-value (Shapiro-Wilk) < 0.05. Complaints were collected from patients, dietary history was analyzed with an emphasis on intolerance to FODMAP products and the occurrence/intensification of clinical symptoms when eating dairy products. All patients underwent esophagogastroduodenoscopy with a biopsy from the subbulb of the duodenum to determine the activity of four intestinal carbohydrates: lactase, sucrase, maltase and glucoamylase according to the Dahlquist method as modified by N.I. Belostotsky. The control group consisted of 30 apparently healthy people, comparable in age and gender to the examined IBS patients. Among them were 10 men and 20 women (average age - 31.2 ± 9.2 years). The activity of intestinal enzymes in this group was within the reference values. Statistical processing of data was carried out using the computer program Statistica 8.0 (StatSoft Inc, USA).</p><p><strong>Results: </strong>The analysis of enzymatic activity showed that initially the level of intestinal carbohydrates in patients with IBS was reduced compared to the control group. 2 months after following the low-FODMAP diet, the activity of all enzymes studied increased, but a statistically significant increase was noted only for lactase and sucrase (<i>p</i> < 0.05). Clinical improvement was observed with adherence to the low-FODMAP diet, decrease in the number of patients with complaints of pain, bloating, rumbling in the abdomen, nausea and diarrhea syndrome, however, a statistical difference was found only for bloating and diarrhea (<i>p</i> < 0.05).</p><p><strong>Conclusion: </strong>Reducing the substrate load on the enzyme systems of the small intestinal mucosa can help improve clinical symptoms in patients with IBS with symptoms of intolerance to foods containing FODMAPs and have a positive effect on the activity of intestinal enzymes.</p>","PeriodicalId":22209,"journal":{"name":"Terapevticheskii Arkhiv","volume":"98 2","pages":"99-104"},"PeriodicalIF":0.3,"publicationDate":"2026-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147378664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[From the history of pancreatology and pancreatitis classification].","authors":"E A Dubtsova, L V Vinokurova","doi":"10.26442/00403660.2026.02.203527","DOIUrl":"https://doi.org/10.26442/00403660.2026.02.203527","url":null,"abstract":"<p><p>The retrogastric location, small size and soft consistency of the pancreas were the reason for the late discovery of the physiology of this organ. The first information about the anatomy and physiology of the pancreas appeared only in the 16th-17th centuries. The role of the pancreas in digestion was studied in the 18th-19th centuries, its participation in carbohydrate metabolism - in the 19th century, and insulin was discovered in the first half of the 20th century. Clinical signs of pancreatitis were first described in the early 19th century, but diagnosis of this disease still presents certain difficulties. The same can be said about the classification of pancreatitis. Due to the variety of etiological factors and clinical manifestations of acute and, especially, chronic pancreatitis, a single universal classification of pancreatitis has not yet been created, despite repeated attempts and existing classifications.</p>","PeriodicalId":22209,"journal":{"name":"Terapevticheskii Arkhiv","volume":"98 2","pages":"131-136"},"PeriodicalIF":0.3,"publicationDate":"2026-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147378632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Characteristics and 5-year outcomes in patients with chronic lymphocytic leukemia receiving ibrutinib (a real-world study)].","authors":"U P Ergasheva, E P Panchenko, C G Chernyshenko, E A Dmitrieva, M I Kislova, Y A Fedotkina, E B Yarovaya, E V Rimashevskaya, V V Ptushkin, E A Nikitin","doi":"10.26442/00403660.2026.01.203492","DOIUrl":"https://doi.org/10.26442/00403660.2026.01.203492","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate major cardiovascular complications in chronic lymphocytic leukaemia (CLL) patients receiving ibrutinib, and to characterise those with new-onset atrial fibrillation (AF) during ibrutinib therapy, examining their outcomes in a real-world clinical setting.</p><p><strong>Materials and methods: </strong>A retrospective analysis of the medical records of 641 patients diagnosed with CLL who were treated with ibrutinib at the haematology centre of the Botkin Moscow Multidisciplinary Scientific and Clinical Center from 2013 to 2024 was conducted. The primary endpoint of the study was the occurrence of atrial fibrillation during ibrutinib therapy. The secondary endpoint of the study was thrombotic and haemorrhagic complications. To assess the impact of AF on patient outcomes, a comparison was made between patients with AF and those without AF based on sex and age. A composite endpoint was used to evaluate outcomes, which included cardiovascular death and fatal bleeding.</p><p><strong>Results: </strong>The incidence of new-onset AF in patients receiving ibrutinib therapy during the five-year was 15%. Patients with AF occurring during ibrutinib therapy were found to be older and characterised by the presence of standard risk factors for AF. No significant differences were observed in the characteristics of CLL and its treatment. The occurrence of AF during ibrutinib therapy was associated with a fourfold increased risk of thrombotic complications (OR 4.071, 95% CI 1.837-9.024; <i>p</i> < 0.001), including an increased incidence of fatal pulmonary embolism (<i>p</i> = 0.035) with a comparable incidence of fatal bleeding.</p><p><strong>Conclusion: </strong>The incidence of AF in patients with CLL receiving ibrutinib is significantly higher than the incidence of AF in elderly patients without CLL. The occurrence of new-onset AF during ibrutinib therapy has been observed to be associated with an increased incidence of thrombotic complications, including fatal thrombotic complications. The incidence of fatal haemorrhagic complications has been noted to be comparable.</p>","PeriodicalId":22209,"journal":{"name":"Terapevticheskii Arkhiv","volume":"98 1","pages":"56-65"},"PeriodicalIF":0.3,"publicationDate":"2026-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146228805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[A study of clinical blood test parameters as potential predictors of atrial fibrillation].","authors":"A G Plisyuk, P P Poletskov, E A Zhdanova, I A Orlova","doi":"10.26442/00403660.2026.01.203498","DOIUrl":"https://doi.org/10.26442/00403660.2026.01.203498","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the relationship of inflammatory parameters and calculated inflammatory indices obtained from clinical blood test with the presence of atrial fibrillation (AF) in patients.</p><p><strong>Materials and methods: </strong>A retrospective analysis of the data of 5,041 patients aged 18 to 99 years was conducted. A group of 470 patients without AF, comparable in age, gender, and presence of cardiovascular diseases to a group of 470 patients with AF, was selected using propensity score matching. The groups were compared by key parameters of clinical blood test and calculated inflammatory indices. For the parameters that showed significant differences when comparing groups, optimal thresholds were determined using ROC analysis. To assess the predictive ability of inflammatory parameters, a logistic regression analysis with the calculation of the odds ratio of the presence of AF was applied.</p><p><strong>Results: </strong>When comparing the groups, the following parameters showed significant differences: the number of neutrophils, monocytes, immature granulocytes, and most inflammatory indices were significantly higher, while the number of lymphocytes and the LMR index were significantly lower in the AF group. The most significant predictors were SIRI values of more than 1.3 and LMR values of more than 4.84 (the odds of AF according to multivariate logistic analysis increased by 2.13 times and decreased by 2.27 times, respectively).</p><p><strong>Conclusion: </strong>Biomarkers of chronic systemic inflammation were associated with the presence of AF regardless of gender, age, and concomitant diseases. Thus, markers of systemic inflammation detected in routine blood tests have the potential to be used as predictors of the presence of AF.</p>","PeriodicalId":22209,"journal":{"name":"Terapevticheskii Arkhiv","volume":"98 1","pages":"66-72"},"PeriodicalIF":0.3,"publicationDate":"2026-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146228741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Prevalence and predictors of suboptimal peak inspiratory flow values with metered-dose dry powder inhalers in patients with asthma and chronic obstructive pulmonary disease].","authors":"B B Lavginova, N V Trushenko, G V Nekludova, O S Belkina, S N Avdeev","doi":"10.26442/00403660.2026.01.203558","DOIUrl":"https://doi.org/10.26442/00403660.2026.01.203558","url":null,"abstract":"<p><strong>Background: </strong>A key requirement for effective dry powder inhaler (DPI) use is adequate patient inspiratory effort, measurable through peak inspiratory flow (PIF).</p><p><strong>Aim: </strong>To assess the prevalence of suboptimal PIF values, and identify factors significantly affecting PIF in pulmonary disease (COPD) and asthma outpatients.</p><p><strong>Materials and methods: </strong>The study enrolled asthma and COPD patients using DPIs for maintenance therapy. PIF was measured using In-Check DIAL G16^® at resistance levels matching each patient's DPI, both before and after proper inhalation technique training. Clinical and functional parameters were evaluated to identify predictors of suboptimal PIF.</p><p><strong>Results: </strong>The study included 61 asthma and 30 COPD patients. Baseline suboptimal PIF rates were 34% (asthma) and 63% (COPD). After training, these decreased significantly to 10% (asthma) and 23% (COPD); <i>p</i> < 0.0001. Key limiting factors for achieving optimal PIF were age ≥ 60 years, FVC ≤ 70% predicted, and FEV1 ≤ 45% predicted.</p><p><strong>Conclusion: </strong>Many patients had insufficient inspiratory flow for effective DPI use due to technique errors or age/functional limitations. Pre-prescription PIF measurement objectively evaluates DPI suitability and enhances treatment efficacy.</p>","PeriodicalId":22209,"journal":{"name":"Terapevticheskii Arkhiv","volume":"98 1","pages":"35-42"},"PeriodicalIF":0.3,"publicationDate":"2026-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146228736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}