Advantage of modern protocols

Advantage of modern CLL chemotherapy protocols (FC, FCR, FCM, etc.) when using which appeared the possibility of achieving complete remission, besides a significant reduction in the tumor mass, is an improvement in microcirculation in the vessels of the bronchopulmonary system. The restoration of microhemocirculatory blood flow contributes to the improvement of tissue trophism and, accordingly, to a decrease in the incidence of AML in CLL patients in remission.

Note: P 1 – significance of differences compared with control; P 2 – the significance of the difference between the indices of LDF, before and after achieving remission.

Thus, the study of endobronchial microhemocirculation can help predict the occurrence of inflammatory diseases of the bronchopulmonary system in patients with CLL. The informativity of the endobronchial LDF method is highly informative in diagnosing vascular and intravascular disorders of the microcirculatory bed of the bronchial mucosa, in identifying early signs of microhemocirculation disorders. The use of this method allows the assessment of the dynamics of microcirculatory disorders in the mucosa of the proximal bronchi during the treatment of CLL.

In the study of general and zonal ventilation of the lungs using the rheography method in patients of group I, no significant changes were found, compared with the control. In group II, there was a decrease in the eographical index of the respiratory volume (DOR) and the eographical indicator of the minute ventilation volume (MVD) of the middle and lower zones of both light, and an increase in the DOF and MVR of the upper zones. The total value of the MPR from all zones of the lungs was reduced by 25.9% (P <0.05) as compared with the control. The greatest changes in regional ventilation were found in patients of group III, they showed a significant decrease in dose rates and MOP in each zone of the lungs, a decrease in the total indicator of MOV from all zones of the lung, compared with controls , by 43.8% (P <0.001) . In patients with groups II and III, there was a redistribution of ventilation from the lower and middle zones to the upper zones of both lung, as can be seen from the increase in the MOVr ratio of the upper zones / MOVr of the lower zones of the lungs .

Indicators of eographically minute minute pulsatory blood flow (MCR) from each of 6 light zones in group I did not significantly differ from those of control. In patients of group II, there was a decrease in perfusion in the middle and lower zones of both lungs and its increase in the upper zones (since areas with increased ventilation are supplied with blood), the overall intensity of MPKr from all zones of the lungs is reduced by 17.4% (P <0.05). In group III, a significant decrease in perfusion was noted in the middle and lower zones of both lungs, in the upper zones, the perfusion indices did not significantly differ from the control, the total intensity of MPCr from all lung zones was reduced by 34.3% (P <0.001). In patients with groups II and III, there was a redistribution of pulmonary blood flow from the lower and middle zones to the upper zones of both lungs. . Redistribution of blood flow to the upper zones was achieved by increasing vascular resistance in the lower and middle zones of both lungs, as evidenced by a decrease in the average blood filling rate (SSC) and lengthening the a-Q interval in these zones . An important rheographic sign indicating the state of venous resistance in the pulmonary circulation is the diastolic-systolic coefficient (DSC), the highest coefficient values ​​were recorded in patients of groups II and III in the middle and lower zones of the lungs.

The development and progression of hypoxemia is associated with an increase in pressure in the pulmonary artery (LA) system. In Group I, the SrDLA indicator (14.7 ± 0.7 mm. Hg. Art.) Did not have significant differences compared with the control group (14.99 ± 0.61 mm Hg. Art.). Patients II (18.2 ± 1.08 mm. Hg. Art.) And III (22.16 ± 1.6 mm. Hg. Art.) Groups showed a significant increase in SrDLA compared with control (P <0 , 05 and Р <0.001, respectively).

EHOKG and IDKG were performed on 54 CLL patients aged from 40 to 70 years, without concomitant COPD (13 out of I, 26 out of II and 15 out of III groups). Patients with heart defects, atrial fibrillation, high blood pressure and other diseases accompanied by primary lesions of the left heart areas were excluded from the study, since this pathology has a significant impact on intracardiac hemodynamics [149, 170, 254]. In 34 patients (63%) SrD-LA indices in conditions of rest did not exceed 20 mm. Hg Art. Of these, 28 people (52%) had SrDLA values ​​within 9–16 mm. Hg Art., in 6 patients (11%) – 17 – 20 mm. Hg Art. Pulmonary hypertension (PH) was detected in 20 (37%) people. Indicators SrDL were within 21 – 32 mm. Hg St, on average – 22.5 ± 0.7 mm. Hg Art. These are patients from groups II and III, of whom 3 had progressive, 9 had tumor and 8 had splenic CLL. The highest rates of SrDLA were found in patients with splenic and neoplastic forms of CLL in the later stages of tumor progression, with a significant increase in the liver and spleen. Progressive hemoblastosis was noted in all patients with high rates of SrDLA, 6 patients were diagnosed with terminal stage of the disease.

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