Liudmyla Ivanovna Vakulenko
@dmu.edu.ua
Dnipro State Medical University
RESEARCH, TEACHING, or OTHER INTERESTS
Pediatrics, Perinatology and Child Health, Nephrology
Scopus Publications
Scholar Citations
Scholar h-index
Scholar i10-index
Scopus Publications
T. Borysova, S. Samsonenko, and L. Vakulenko
Higher State Educational Establishment of Ukraine Bukovinian State Medical University
The course of juvenile idiopathic arthritis (JIA) is associated with a long-term infl ammatory process and the use of nonsteroidal anti-infl ammatory drugs (NSAIDs), which can cause nephrotoxicity with fi brotic kidney damage in patients with JIA. Regardless of the etiology of joint damage, prolonged infl ammation promotes the progression of fi brosis, and renal fi brosis is the fi nal common stage of chronic kidney disease (CKD). Kidney biopsy, which is invasive, risky and underutilized, is generally considered the only clinical method to detect fi brosis. Over the past decade, some progress has been made in the search for minimally invasive biomarkers of early kidney fi brosis, with transforming growth factor-β1 (TGF-β1) playing a key role in the progression of kidney fi brosis, but the signifi cance of TGF-β1 in children with JIA is unknown.Material and Methods: 80 children with JIA were examined. Urinary TGF-β1 levels were determined using a TGF-β1 ELISA kit(DRG International, Inc., Germany, EIA-1864) according to the manufacturer’s instructions. Methods of variation statistics were used. Informed consent was obtained from all patients. The study has a positive conclusion of the Commission on Biomedical Ethics of Dnipro State Medical University (Minutes of the meeting of the Commission No. 12 dated December 19, 2002), which decided that the scientifi c research can be considered in accordance with generally accepted moral standards, the requirements of respecting the rights, interests and personal dignity of study participants, bioethical standards for work with pediatric patients. There is no risk to the research subjects in the performance of the work. The legal representatives of the children involved in the research are informed about all aspects related to the purpose, objectives, methods and expected benefi ts of the research. Laboratory and instrumental research methods are generally accepted; the drugs to be used are approved for use. No human experiments were performed.Methods of variation statistics were used. Statistical analysis was performed using the STATISTICA 6.1 software package(StatSoft Inc., serial no. AGAR909E415822FA). The work was carried out as part of the research work of the Department of Propaedeutic of Childhood Diseases and Pediatrics 2 of the Dnipro State Medical University «Development of criteria for early diagnosis and prediction of comorbid kidney damage in children with somatic and infectious diseases» (state registration No. 0119U100932, implementation period 01.2019-12.2023).Results. The mean TGF-β1 level in our study was 20.26±16.34 (14.02, 12.5-17.98) pg/ml. Polyarthritis almost quadrupledthe probability of pathological changes in TGF-β1. The overwhelming majority of children with elevated TGF-β1 suff ered from polyarthritis (80.0 %) – one and a half times more often than those with relatively normal TGF-β1 concentration, p<0.04.If the active stage of the disease lasted at least 4 years, the probability of elevated TGF-β1 increased more than sixfold. Thetendency of signifi cant nephrotoxic eff ect of prolonged active JIA was confi rmed by the results of correlation analysis, according to which, in general, the duration of active JIA was directly related to the increase of TGF-β1 (ρ=0.38, p<0.001), and the duration of remission and the total duration of JIA had no signifi cant correlation with it (ρ= –0.19 and ρ=0.18, respectively, p>0.05). The direct dependence of elevated urinary TGF-β1 levels on clinical features such as polyarthritis and the duration of the active phase of JIA has been demonstrated. These clinical features in children with JIA can be considered as risk factors for the development of early renal fi brosis. Against the background of elevated TGF-β1, a reduced GFR according to the Hoek formula (<90 ml/min/1.73 m2) was found in 95 % of cases, i. e. the estimates of the functional state of the kidneys obtained by two diff erent methods were quite clearly the same. In the sample with TGF-β1<17.98 pg/ml, 22.76 % of children received immunobiologic therapy, while in the sample to increase TGF-β1 – only 14.76 %. Immunobiological therapy reduced the risk of increasing this urinary marker by 5.5 times.Conclusions. Elevated levels of the TGF-β1 biomarker were found in 25 % of children with JIA. An association of early renalfi brosis with duration of active phase of JIA ≥ 4 years, increased ESR, polyarthritis, arterial hypertension, and dental carieswas observed. Elevated urinary TGF-β1 levels are associated with reduced eGFR and are observed in almost all children witheGFR<90 ml/min/1.73 m2, confi rming the importance of early renal fi brosis in the development of renal dysfunction.
L.I. Vakulenko, , A.V. Riznyk, and
Group of Companies Med Expert, LLC
Purpose - to present a clinical case of a particular complication of post-COVID multisystem inflammatory syndrome (MIS) - pulmonary embolism (PE) which developed due to primary hereditary thrombophilia in a child for better understanding of the MIS evolution and prognosis in children (MIS-C). Case report. In an 11-year-old boy who previously had no hemorrhagic manifestations, the first symptoms of the disease occurred in the form of fever and a hemorrhagic rash on the lower extremities. Later, he developed signs of respiratory failure, his condition worsened, and bilateral community-acquired viral pneumonia caused by COVID-19 was diagnosed. The child presented with post-COVID MIS manifested as PE, which caused further genetic examinations for hereditary thrombophilia. Primary thrombophilia was detected (F2 gene - prothrombin (20210 G>A) D68.5). Concomitant hereditary pathology was probably the reason for a severe course of the infection and the development of a complication in the form of PE requiring intensive and long-term anticoagulant therapy. Conclusions. In case of PE detection, especially in young patients, examinations to confirm or rule out hereditary or acquired thrombophilia are required, that defines recurrent venous thromboembolism prevention programs. This clinical case report is a contribution to the study on the issues of MIS-C, defining links between pulmonary complications (transient or persistent) and serious sequelae in the future. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.
O. Obolonska, T. Mavropulo, L. Vakulenko, T. Borysova, and O. Obolonskyi
Higher State Educational Establishment of Ukraine Bukovinian State Medical University
Acute kidney injury (AKI) is a common complication with high mortality rates among preterm infants at neonatal intensivecare units. Identifi cation of preterm newborns who are at risk for developing AKI is essential not only for early diagnosis andtreatment, but also for prevention since AKI signifi cantly worsens an outcome of any disease. Studying the information contentof additional non-invasive markers for AKI, in particular, parameters of regional renal oxygen saturation (RrSO2) and Dopplerestimation of blood fl ow in the main renal vessels is interesting.The aim of the study was to evaluate the diagnostic performance of additional markers (measurements of RrSO2 andblood fl ow in the main renal vessels using Doppler ultrasonography) in diagnosing of AKI and its degree of severity in pretermnewborns with patent ductus arteriosus (PDA).Material and methods. A single- center, open, prospective cohort study examined 66 preterm infants born at 29-36 weeksof gestational age (GA) undergoing treatment at the Department of Anesthesiology and Intensive Care for newborns. Inclusioncriteria: preterm newborns born between 29-36 week’s gestation with hemodynamically signifi cant PDA (hsPDA), a writteninformed consent to participate in this study provided by parents. Exclusion criteria: congenital malformations, grades III-IVintracerebral or intraventricular hemorrhages, neonatal sepsis, severe perinatal asphyxia, skin diseases, fetal growth restriction.Clinical examination and treatment of children was carried out according to current guidelines. The modifi ed neonatal KDIGOcriteria were used to diagnose and characterize the severity of AKI.Doppler ultrasound measurements were done to reveal the presence, size, and hemodynamic signifi cance of PDA. ColorDoppler ultrasonography was performed to evaluate intrarenal hemodynamics upon hospital admission of children prior toprescribing ibuprofen, and in the case of hsPDA detection – on the 3rd and 10th days of life. Blood fl ow in the area from the main renal artery to the interlobar renal artery of the right kidney was measured including peak systolic velocity (PSV), end diastolic velocity (EDV), and the resistive index (RI) was calculated. RrSO2 values were recorded using near-infrared spectroscopy (NIRS) and renal fractional tissue oxygen extraction (rFTOE) was estimated within 24 hours on the 1st, 3rd and 10th days of life.The study received a positive conclusion of the Biomedical Ethics Commission of Dnipro State Medical University (minutesof the Commission meeting No. 8 dated 04.26.2023), which considered the scientifi c study as being consisted with generallyaccepted norms of morality, human rights requirements, interests and personal dignity of the study participants, bioethicalstandards of work with pediatric patients. There was no risk for study participants when performing examinations. Legalguardians of the children enrolled in the study were informed about all aspects related to the purpose, tasks, methods and expected benefi ts of the study. Laboratory and instrumental methods of examinations were generally adopted, medicines planned to be prescribed were licensed for use. Experiments with human subjects were not carried out.Statistical processing of the results was realized using a software product STATISTICA 6.1® (StatSoft Inc., serial numberAGAR909E415822FA). A set of statistical analysis methods based on parametric and non-parametric criteria was used forsolving the tasks of testing a hypothesis on diff erences between mean values, methods of assessing the eff ect with an alternative form of a reaction result, correlation analysis (Spearman’s rank correlation), cluster analysis.The study was conducted within the bounds of complex research activities at the Department of Propaedeutics of Children’sDiseases and Pediatrics No. 2 of Dnipro State Medical University “Development of criteria for early diagnosis and predictionof comorbid kidney damage in children with somatic and infectious diseases” (state registration number 0119U100836), thestudy period 09.2019-12.2023.Results. Group 1 (with moderate renal impairment) included 43 patients with a GA of 33.27±0.43 weeks. AKI was detectedin 12 patients (27.9%), of those, 10 (23.3%) children developed stage 1 AKI according to the modifi ed neonatal KDIGO criteria,and stage 2 AKI were classifi ed in 2 (4.7%) patients. Group 2 was composed of 5 patients (infants with severe renal impairment)with a GA of 31.60±0.75 weeks. All the children in this group had diff erent stages of AKI (stages 1-3), which progressed to acuterenal failure after 7 days. Mortality in this group was 60%. Group 3 consisted of 18 patients (infants with mild renal impairment)with a GA of 32.86±0.29 weeks. AKI stage 1 was diagnosed in 2 (11.1%) patients, and AKI was not detected in 16 (88.9%) ofthem. On the 1st day of life, the PSV and EDV values of the interlobar artery in children of the group with mild renal impairmentwere higher than those in children with a severe course of the disease (p<0.05). This trend regarding PSV continued on the 3rdday. Doppler parameters of renal blood fl ow, namely a decrease in EDV of the interlobar artery to 1.96 ± 2.22 cm/s and PSV to8.14 ± 2.71 cm/s on the 1st day of life, as well as a decrease in PSV to 17,60 ±3.82 cm/s, EDV to 3.40±0.82 cm/s and increased RI up to 0.80±0.04 of the main renal artery were found to be early non-invasive predictors of severe AKI in preterm newbornson day of life 1 (p<0.05). Non-invasive monitoring of RrSO2 and calculation of rFTOE revealed a decrease in renal oxygenationby NIRS in preterm infants with PDA on the 1st day of life to 53.60 ± 1.11%, as well as rFTOE values of 0.45 ± 0.01, that wasprognostically unfavorable with regard to the course of AKI (p<0.05). The highest value of RrSO2 on day 10 (91.8±0.81%) andthe lowest rFTOE value (0.05 ± 0.01) (р<0.05) might indicate irreversible changes associated with reduced oxygen utilizationdue to destruction of cells and be used as a screening tool to detect and assess ductal steal phenomenon caused by hsPDA andthe development of AKI.Conclusions. A decrease in the rate of diuresis within the fi rst 5 days of life as well as a two fold increase in the level ofserum creatinine on postnatal days 3 and 10 were the main, but late markers for the development of severe kidney impairment in preterm newborns. Doppler parameters of renal blood fl ow, namely decreased EDV and PSV in the interlobar artery on the 1st day of life, and decreased PSV, EDV and increased RI in the main renal artery has been found to be early non-invasive predictors of severe AKI in preterm newborns on the 1st day of life. Non-invasive monitoring of RrSO2 and calculation of rFTOE can serve as screening tools for detection and assessment of hsPDA-related ductal steal phenomenon and the development of AKI.
L. Vakulenko, O. Obolonska, O. Nekhanevych, V. Golyk, and T. Obolonska
Publishing House Zaslavsky
Background. The adverse social situation in Ukraine and an increase in the number of injured children lead to a burden on trauma departments and rehabilitation centers. Looking for simple methods to help detect violations of compensatory mechanisms, one of which is the centralization of blood circulation, and impaired perfusion at the microcirculatory periphery level is of great current relevance. Materials and methods. A comprehensive clinical and functional examinations were applied to 44 children aged 10–15 years, 21 of them had home-related upper extremity fractures (main group), 23 otherwise healthy children served as the control group. All the children underwent the Box and Block Test (BBT), and the perfusion index (PI) from the extremities was recorded. Results. The BBT performance was characterized by a 1.6-fold decrease (p < 0.05) in the affected extremity of children aged 10–15 years under the rehabilitation treatment compared to that of the non-dominant extremity in healthy children and a 1.3-fold decrease (p < 0.05) in the healthy extremity compared to the dominant one. PI decreased to 2.52 ± 0.58 at rest in the main group children who underwent upper extremity rehabilitation treatment for injuries compared to 3.49 ± 0.34 (p < 0.05) in healthy children. PI reduced to 1.57 ± 0.56 in injured children at exercise loads versus 2.93 ± 0.91 (p < 0.05) in healthy children. The dynamics of recovery also differed and amounted to 2.82 ± 0.45 in the main group versus 4.00 ± 0.64 in the control group. Children with PI up to 1.5 ± 0.4 had significantly lower BBT scores at the beginning of exercise training. PI reduction to less than 1.5 allowed predicting a decrease in muscle functions, delayed wound healing, and the need for analgesia. With an increase in PI to 2.40 ± 0.54 during exercise training, children performed BBT better, while those who had a decrease in perfusion up to 0.98 ± 0.20 performed it twice as slowly (p < 0.05). As a study result, an association between the physical exercise load, changes in PI and BBT has been revealed. Conclusions. BBT scores were characterized by a 1.6-, 2.0- and 1.8-fold (p < 0.05) reduction during the first, second and third measurements, respectively, compared to those of healthy children. Characteristic feature of perfusion index was a statistically significant decrease before and during exercise training as well as slow dynamics of recovery. The correlations between perfusion index and BBT have proven the association of the rehabilitation processes and blood flow restoration.
O.Yu. Obolonska, L.I. Vakulenko, L.P. Badogina, O.I. Obolonskyi, I.A. Likhachova, and O.V. Kovryga
Publishing House Zaslavsky
Background. Retinopathy of prematurity is one of the disabling conditions in premature babies. Despite the fact that the main predictors for the development of retinopathy of prematurity are known, the factors that can potentially cause it require further study. The purpose was to determine risk factors for the development of retinopathy in premature newborns for better control. Materials and methods. A retrospective analysis of 50 medical records of inpatient premature babies with a gestational age of 28–34 weeks and the medical charts of their mothers was carried out. Two groups were distinguished: the first one — 29 children with retinopathy, the second one — 21 patient without retinopathy. Results. The vast majority of children — 38 (76.0 %) were born at a gestational age of 28–31 weeks. Differences between groups were not significant. The analysis showed that 14 (48.3 %) premature children were diagnosed with stage I retinopathy, 6 (20.7 %) — with stage II, 5 (17.2 %) — with stage ІІІ and 4 (13.8 %) — with stage IV. The most influential risk factors for the development of retinopathy of prematurity were identified. The presence of retinopathy significantly correlated with gestational age of less than 34 weeks (ρ = 0.64, p < 0.001), need for oxygen subsidy ≥ 40 % (ρ = 0.59, р < 0.001), development of bronchopulmonary dysplasia (ρ = 0.34, р < 0.01), sepsis (ρ = 0.59, р < 0.001), intraventricular hemorrhages (ρ = 0.56, р < 0.001). It was also found that the presence of a burdened maternal history in the form of chronic foci of infection and chorioamnionitis is a significant risk factor for the development of retinopathy (ρ = 0.56, р < 0.001). Moreover, the presence of an infection in the mother increased the risk of retinopathy stage III–IV in a child by 3.8 times (p < 0.05), and stage I–II retinopathy — by 5 times. With a combination of chorioamnionitis and chronic foci of infection, the risk of developing severe retinopathy was almost 95 % (р < 0.007). Conclusions. Burdened maternal history in the form of chronic foci of infection and/or choriamnionitis is an important risk factor for the development of retinopathy in children. Chorioamnionitis is a predictor of severe retinopathy. Treatment of chronic foci of infection in pregnant women should be considered as a mandatory measure to prevent retinopathy in premature newborns.
O. Obolonska, T. Borysova, V. Vakulenko, and O. Obolonsky
Higher State Educational Establishment of Ukraine Bukovinian State Medical University
SummaryTimely diagnosis of acute kidney injury (AKI) is problematic due to difficulties in using the “Kidney Disease: Improving Global Outcomes (KDIGO) guideline” modified for neonates, requiring the search for non-invasive markers and their diagnostic capacity assessment. Preterm infants with hemodynamically significant patent ductus arteriosus (HSPDA) are highly vulnerable to developing AKI. Renal biomarker neutrophil gelatinase-associated lipocalin (NGAL) in urine enables diagnosis of AKI, although literature data on the possibility of its use are somewhat contradictory.The aim of this study was to identify diagnostic capacity of the renal biomarker NGAL in urine for the early diagnosis of AKI in preterm infants with HSPDA. Materials and methods A total of 29 preterm infants (gestational age 29-36 weeks) with HSPDA were examined at the Department of Anesthesiology and Neonatal Intensive Care on the first, third and tenth day. The patients were assigned to groups depending on the development of AKI: the AKI group with any degree of severity - 14 children, and the group without AKI - 15 children. To determine the influence of HSPDA size on the level of urine NGAL, the children were further divided based on ductal size: HSPDA diameter ≥ 2 mm - 11 children, and HSPDA diameter ≤ 2 mm - 18 children. The urine NGAL level was quantitatively measured using sandwich enzyme-linked immunosorbent assay according to the manufacturer's licensed instructions (ELISA Kit, 96, USA). The study has a positive conclusion of the biomedical ethics commission of the Dnipro State Medical University (protocol of the commission meeting No. 2 dated October 19, 2022)/ A set of statistical research methods was used to solve the tasks and check the initial assumptions, namely: for independent samples - the Mann-Whitney test, for dynamic assessment - the Wilcoxon signed rank test. The test for the normality of the distribution of quantitative samples was carried out using the Kolmogorov-Smirnov test. Statistical processing of the results was carried out using the software product STATISTICA 6.1® (StatSoft Inc., serial number AGAR909E415822FA). The work was carried out within the scope of complex research works of the Department of Propaedeutics of Children's Diseases and Pediatrics 2 of the Dnipro State Medical University "Development of criteria for early diagnosis and prediction of comorbid kidney damage in children with somatic and infectious diseases" (state registration number 0119U100836) execution 09.2019-12.2023.Results. In the group of children with AKI, the significant increase in the urine NGAL level was observed from the first to the tenth day. For example, the urine NGAL level was 2.2 times (p<0.002) and 2.4 times (p<0.001) increased on the third and tenth day, respectively, as compared to that on the first day, while in the group without AKI, urine NGAL level was 1.3 times (p<0.04) increased on the third day compared to that on the first day. On the tenth day, in the group without AKI, the urine NGAL level was increased by 1.6 times (p<0.007) compared to that on the first day and by 1.2 times (p<0.04) as compared to that on the third day. The data obtained were confirmed by the clear correlation between the urine NGAL level and the development of AKI. For instance, the urine NGAL level at the first day was significantly correlated with AKI on the third and on the fifth day: ρ=0.72, p<0.001 and ρ=0.75, p<0.001, respectively. On the third day, the urine NGAL level was also significantly correlated with AKI on the third and on the fifth day: ρ=0.65, p<0.001 and ρ=0.73, p<0.001, respectively. It was particularly important that the urine NGAL level on the first day was significantly correlated with the maximum stage of AKI: ρ=0.76, p<0.001.In preterm infants with HSPDA size > 2 mm, the urine NGAL level on the first day of life was 1.7 times higher than that in children with HSPDA ≤ 2 mm (p < 0.002). It was also observed on the third day as in preterm infants with HSPDA size > 2 mm, the urine NGAL level was 2.3 times higher than that in children with HSPDA ≤ 2 mm (p < 0.001). On the tenth day, there was a 2.3-fold higher urine NGAL level in the group with ductal diameter > 2 mm as compared to the group with ductal diameter ≤ 2 mm (p < 0.003). The correlation between the urine NGAL level and the size of HSPDA has been found to be quite revealing. Notably, on the first day, urine NGAL level was significantly correlated with the HSPDA size: ρ=0.66, p<0.001, and on the 10th day, it was significantly correlated with the ductal size on the first day: ρ=0.70, p<0.001. In addition, the urine NGAL level on the first day was significantly correlated with the HSPDA size on the third day: ρ=0.49, p<0.015. The significant correlation between the urine NGAL level on the third day with the ductal size on the third day has also been revealed: ρ=0.47, p<0.019. Finally, on the 10th day, the urine NGAL level was significantly correlated with the HSPDA size on the third day: ρ = 0.46, p < 0.022.Conclusions. The elevated urine NGAL level has been found to be a reliable marker of the AKI development in preterm infants with HSPDA: it was 1.7 times (p<0.001), 2.8 times (p<0.001) and 2.6 times (p<0.001) increased on day one, three and ten, respectively, in children with AKI in comparison with those examined without AKI. In preterm infants with HSPDA diameter of > 2 mm on the first day, the urine level of NGAL was significantly increased on the first, third and tenth day.
Vasyl I. Popovych, Halyna V. Beketova, Ivana V. Koshel, Olha A. Tsodikova, Tetiana A. Kriuchko, Aleksandr E. Abaturov, Liudmyla I. Vakulenko, and Iurii V. Gavrylenko
Elsevier BV
О.Ye. Abaturov, , L.I. Vakulenko, and
Group of Companies Med Expert, LLC
Актуальність. Визначення факторів, що спричиняють формування і прогресування хронічного пієлонефриту (ХПН) в дітей, забезпечує своєчасне проведення відповідних лікувальних та профілактичних заходів, які дають змогу уповільнити прогресування хронічної хвороби нирок і поліпшити прогноз захворювання. Мета — визначити прогностичні фактори розвитку ХПН у дітей для проведення ранньої діагностики та своєчасного лікування. Пацієнти та методи. Проаналізовано 176 випадків ХПН у дітей віком від 1 до 18 років. Групу порівняння становили 74 дитини з гострим пієлонефри& том, які одужали. Для виявлення провідних прогностичних факторів ризику розвитку ХПН у дітей та визначення найбільш інформативних показників застосовано теорему Баєса і послідовний (секвенційний) аналіз Вальда з оцінкою інформативності ознак за розрахованою мірою Кульбака (І). Інфор& мативною вважали ознаку з коефіцієнтом І більше 0,5. Результати. Високу прогностичну інформативність для розвитку ХПН у дітей мають 11 клініко&лабораторних факторів ризику: аномалії розвитку сечової системи, порушення уродинаміки (міхурово&сечовідний рефлюкс), затяжний перебіг першого епізоду пієлонефриту або рецидив протягом 3 місяців; наявність більше 5 стигм дизембріогенезу; урогенітальний мікоплазмоз у дівчаток; артеріальна гіпертензія; нормохромна анемія в дебюті захворювання; нейрогенний сечовий міхур / енурез; оксалатна дисметаболічна нефропатія з екскрецією оксалату кальцію більше 1,5 мг/кг/добу; гідронефроз; супутні хронічні вогнища інфекції. Для найбільш інформативних прогностичних ознак ХПН розраховано діагностичні коефіцієнти, підсумовуючи які накопичують діагностичну інформацію. Підставляючи отримані під час обстеження хворого діагностичні симптоми в таблицю, розраховують суму відповідних їм діагностичних коефіцієнтів. При сумі діагностичних коефіцієнтів (+13) прогнозують імовірний розвиток ХПН із вірогідністю помилки <5% (p<0,05); при сумі діагностичних коефіцієнтів (+20) імовірність прогнозу становить 99% (p<0,01), при сумі діагностичних коефіцієнтів менше (+13) і більше (&13) роблять висновок про недостатність інформації для прийняття рішення про ймовірний розвиток ХПН із зада& ним рівнем помилки (негативну відповідь). Висновки. Розроблена прогностична таблиця може бути використана для визначення ймовірності розвитку ХПН у дітей віком від 1 до 18 років. Ключові слова: діти, хронічний пієлонефрит, хронічна хвороба нирок, фактори ризику, прогнозування.
L.I. Vakulenko
Publishing House Zaslavsky
Актуальность. Исследование вегетативного гомеостаза у детей является одной из составляющих оценки адаптационных механизмов организма в условиях хронической патологии. Цель. Оценка вегетативного гомеостаза для определения его влияния на формирование и выраженность адаптационных механизмов у детей и подростков с хроническим пиелонефритом. Материалы и методы. Обследованы 115 детей в возрасте 6–17 лет (53 мальчика, 62 девочки) вне обострения хронического пиелонефрита. Контрольную группу составили 60 условно здоровых детей аналогичного возраста. Состояние вегетативной нервной системы оценивали по данным исходного вегетативного тонуса, вегетативной реактивности, вегетативного обеспечения деятельности, полученных с помощью метода кардиоинтервалографии в сочетании с клиноортостатической пробой. Результаты. Исходный вегетативный тонус у больных хроническим пиелонефритом характеризовался повышением активности симпатического отдела и угнетением парасимпатического тонуса. Индекс напряжения, отражающий степень напряжения регуляторных механизмов, достоверно превышал нормативные показатели у больных со II–III стадией хронической болезни почек всех возрастных групп. По мере прогрессирования хронической болезни почек гиперсимпатикотонический вариант вегетативной реактивности сменялся асимпатикотоническим. Для вегетативного обеспечения сердечной деятельности больных с хроническим пиелонефритом характерно преобладание патологических вариантов, свидетельствующих о прогрессирующей недостаточности и истощении адаптационных ресурсов организма. Выводы. Изменения вегетативного гомеостаза у больных с хроническим пиелонефритом демонстрируют напряжение механизмов адаптации сердечно-сосудистой системы и значительное снижение уровня адаптационно-приспособительного потенциала.