The comorbidity of chronic pancreatitis (CP) and hypertensive disease (HD), which are often combined with each other, can be considered as predictor states of the complication formation. This is due to the intersection of individual pathogenic links, which are enhanced by their combination. As such a complication, it is possible to consider osteoporotic conditions, leading to metabolic disturbances of bone tissue with quantitative and qualitative changes. The emergence of secondary osteoporosis (SO) is not only phenotypically but also genetically conditioned, which is the basis for studying the gene aberrations of “osteopenically directed genes” and determining the content of SO biochemical markers.
Aim of study: to establish the features of the comorbid course of CP and hypertension, to optimize the diagnosis of osteoporotic conditions by studying the content of biochemical markers of OP (total acid phosphatase (TAP) and tartrate-resistant acid phosphatise (TRAP)) and polymorphism of the vitamin D receptor genes (VDR).
Materials and methods of research. To solve this problem, 110 patients with CP were examined and further divided into 2 groups: treatment group — 70 persons with CP and hypertensive disease (HD), and the comparison group — 40 patients with isolated CP. These groups were representative by age and sex. The condition of bone tissue was studied in assessing the content of indicators of total acid phosphatase (TAP) and non-prostatic acid phosphatase (TRAP) in blood serum. At the same time, VDR was determined.
Results. It was found that the vast majority of patients in the treatment group (84.3%) had an unfavourable B-allele; against the comparison group — 77.5% of events. Changes in the VDR gene polymorphism affected the incidence of the osteoarticular system (CCP, χ2 = 20.81, p <0.01) and had a statistically significant relationship in the distribution of alleles between groups (CCP, χ2 = 30.08, p <0.01). The parameters of TAP and TRAP in patients with combined course of HP and CP were 8.7 ± 2.3 U/L and 5.1 ± 2.3 U/L, respectively, and in the comparison group — 6.9 ± 3.0 U/L and 3.5 ± 2.1 U/L. Thus, the content of TAP and TRAP exceeded the control in the treatment group by 2.5 (TAP) and 1.9 (TRAP) times (p<0.01) and in the comparison group by 2.0 (TAP) and 1.3 TRAP) times (p<0.01), which allowed us to state the development of osteopenic conditions. The distribution of alleles of the VDR gene was characterized by the predominance of the B-allele and was “supported” by changes in the biochemical markers of osteoporosis, which led to the development of osteopenicconditions in such individuals. Thus, the combination of HP and CP is an unfavourable factor in the development of osteoporosis and the basis for early detection of osteoporetic changes.
Conclusions. In the combined course of CP and arterial hypertension, there is an increase in the number of persons with the B-allele of the VDR gene (84.3% of cases), the carriers of which have a high risk of osteopenia. With the comorbidity of CP and HD, there are fluctuations in the content of TAP and TRAP, correlating with VDR. Increase in the content of TAP and TRAP in patients with CP and HD often occurs against the background of an unfavourable B-allele of the VDR gene. Combined course of CP and HD is the basis for early diagnosis of osteoporotic complications.
2. Коваль В. Ю. Особливості хронічних панкреатитів на Закарпатті / В. Ю. Коваль, Е. Й. Архій, О. О. Болдіжар // Гастроентерологія. – 2013. – № 3 (49). – С. 120–122.
3. Остеодефіцит і вплив супутньої патології на його глибину при хронічному панкреатиті / Л. С. Бабінець, О. С. Квасніцька, Л. М. Мігенько, О. Я. Пінкевич // Буковинський медичний вісник. – 2011. – Т. 15, № 2(58). – С. 183–185.
4. Філіппов Ю. А. Сучасні уявлення про патогенетичні аспекти хронічного панкреатиту (огляд літератури) / Ю. О. Філіппов, О. О. Крилова // Журнал АМН України. – 2008. – Т. 14, № 4. – С. 651–664.
5. Caughey G. E. Multimorbidity research challenges: where to go from here? / G. E. Caughey, Е. Е. Roughead // Journal of Comorbidity. – 2011. – Vol. 1. – P. 8–10.
6. Cortet B. Assessment of pain in osteoarthritis and osteoporosis: similarities and differences / B. Cortet // Osteoporosis Int. – 2013. – Vol. 24, No 1. – S71.
7. The effect of coffee on blood pressure and cardiovascular disease in hypertensive individuals : a systematic review and meta-analysis / A. E. Mesas, L. M. Leon-Muñoz, F. Rodriguez-Artalejo, E. Lopez-Garcia // Am. J. Clin. Nutr. – 2011. – Vol. 94. – P. 1113–1126.
8. Genetic variants in novel pathways influence blood pressure and cardiovascular disease risk / The International Consortium for Blood Pressure Genome-Wide Association Studies // Nature. – 2011. – Vol. 478. – P. 103–109.
9. He F. J. A comprehensive review on salt and health and current experience of worldwide salt reduction programmes / F. J. He, G. A. MacGregor // Journal of human hypertension. – 2009. – Vol. 23, No 6. – P. 363–384.
10. Nobili A. Review Multiple diseases and polypharmacy in the elderly: challenges for the internist of the third millennium / A. Nobili, S. Garattini, P. M. Mannucci // Journal of Comorbidity. – 2011. – Vol. 1. – P. 28–44.
11. Occurrence of metabolic osteopathy in patients with chronic pancreatitis / H. Dujsikova, P. Dite, J. Tomandl [et al.] // Pancreatology. – 2008. – Vol. 8, No 6. – P. 583–586.
12. Park W. G. Election year fever? Voting on EUS criteria for chronic pancreatitis / W. G. Park // Gastrointest. Endosc. – 2009. – Vol. 69, No 7. – P. 1262–1263.
13. Vaidya A. Vitamin D and hypertension: current evidence and future directions / A. Vaidya, J. P. Forman // Hypertension. – 2010. – Vol. 56, No 5. – P. 774–779.