CLINICAL AND PATHOGENETIC SIGNIFICANCE OF ENDOGENOUS INTOXICATION SYNDROME IN SYSTEMIC SCLEROSIS

• Main Authors: Ye. D. Iegudina, V. Ya. Mikuksts, O. Syniachenko
• Format: Article
• Language: Ukrainian
• Published: Ukrmedknyha Publishing House 2017-04-01
• Series: Vіsnik Naukovih Doslіdžen'
• Subjects: склеродермія системна; ендогенна інтоксикація; перебіг; патогенез.
• Online Access: https://ojs.tdmu.edu.ua/index.php/visnyk-nauk-dos/article/view/7338
• ISSN: 1681-276X; 2415-8798

Systemic autoimmune rheumatic diseases are accompanied by an endogenous intoxication syndrome (EIS), but its clinical and pathogenetic significance in systemic sclerosis (SSc) is unknown. The aim of the work – to evaluate the role of EIS in the frequency and severity of separate clinical signs in SSD, significance in the pathogenetic constructions of the disease, the selection of the most informative prognostic criteria. Materials and Methods. The study included 63 patients aged 16 to 67 years (mean age – 42 years), among whom there were 11 % men and 89 % women. In 43 % of cases there was a limited form of SSc, 57 % – diffuse, disease duration averaged 11 years,  I degree of activity of pathological process is set in 41 % of all patients, II – 38 %, III – 21 %. Positivity SSD by the presence in serum anti-topoisomerase antibodies (aScl70) installed in 78 % of cases, antibodies to native deoxyribonucleic acid (aDNA) in 64 % and antibodies to cardiolipin in 18 %. Results and Discussion. 12 blood parameters were studied (diene conjugates, malondialdehyde, xanthine oxidase, ammonia, urea, creatinine, uric acid, nitrite, the average mass of  different factions molecule. All parameters were evaluated at 1 point, in case of their parameters > M + SD (where M – the median, the SD – standard deviation) – were evaluated in 2 points, while > M + 2SD – in 3 points. The sum of balls divided by the number of investigated parameters, thereby obtaining an index of endogenous intoxication, and when it exceeded 1 indicates the presence of SEI. In addition, further defined integrated surfactant index according to the level of equilibrium (static) surface blood tension. EIS occurs in 70 % of SS patients, which was caused by increase in blood levels of aminopeptid, peptide, nucleotide and containing aromatic chromatophores fractions of middle compounds, nonprotein nitrogen and products of lipid peroxidation, involved in the pathogenesis of scleroderma cardiomyopathy and vascular encephalopathy. In turn, the EIS with SSc can cause damage of skin, lungs, heart, liver, kidneys and nervous system. The content of nitrogenous compounds such as EIS components has significant direct correlation with the level of aScl70 in blood and the index of the severity of the EIS – with aDNA. Conclusions: EIS develops in most patients with SSc and is involved in its pathogenesis, wherein hyperasotemia is the risk factor central nervous system lesion, the accumulation average molecular weight in the organism – the liver and heart, and a surfactant index bigger than 4 is prognosis negative criteria for cutaneous syndrome.