Cerebral natriuretic peptide and systemic inflammation factors in the combined course of community-acquired pneumonia and gastroesophageal reflux disease

Objective: to determine the level of cerebral natriuretic peptide (CNP) and markers of systemic inflammation in the dynamics of treatment of CAP in patients with GERD. Materials and methods : 84 patients with CAP were studied at an average age (42.3±2.9) years, including 44 men and 40 women who were treated in a therapeutic hospital. All patients with VP had a mild course. Among patients with CAP, 48 were diagnosed with GERD (main group), 36 patients had no symptoms of GERD (comparison group 1). Comparison group 2 consisted of 36 patients with GERD without CAP. In addition to conventional examination methods, all patients with CAP and GERD were assessed for CRP, procalcitonin (PCT), BNP (by its stable fragment NTproBNP), interleukins (IL)-1, IL-6, IL-8 at the start of therapy and before discharge. Results: in all patients with CAP in combination with GERD, respiratory and dyspeptic symptoms were noted, along with symptoms of intoxication. Electrocardiography in patients with CAP in combination with GERD diagnosed low voltage voltage of QRS complexes, right ventricular extrasystoles, violations of the processes of repolarization of the left ventricle. During laboratory examination in patients with САP combined with GERD, a significant increase in the level of CRP, PCT, and proinflammatory cytokines was observed, which characterized a pronounced systemic inflammatory syndrome. At the same time, by discharge in patients with CAP combined with GERD, blood levels of CRP and IL-1, IL-6 and IL-8 remained elevated, despite clinical recovery from CAP. Positive correlations were found between CRP and proinflammatory cytokines, which weakened by discharge. In patients with CAP combined with GERD and with only CAP, at the beginning of treatment, the level of NTproBNP was within the reference values, and by discharge it increased by 1.2 times, more significantly in patients with CAP combined with GERD. Conclusions: the clinical course of САP in patients with GERD is characterized by respiratory and dyspeptic syndromes, as well as more frequent ECG changes in the form of extrasystole. In patients with САP combined with GERD, there is a pronounced systemic inflammatory syndrome with a significant increase in the concentration of CRP, PCT and proinflammatory cytokines in the blood compared with patients with САP without GERD. At the same time, by discharge in patients with САP combined with GERD, blood levels of CRP and IL-1, IL-6 and IL-8 remain elevated, despite clinical recovery from САP. An increase in the level of MNUP (according to a stable fragment of NTproBN) in patients with САP combined with GERD, which appeared during clinical recovery from САP, taking into account its pathogenetic role, should be considered as a risk factor for myocardial involvement in the preserved inflammatory process, which determines careful monitoring of the dynamics of CRP, MNUP (NTproBN), proinflammatory cytokines and the state of myocardial infarction in patients with GERD who underwent САP during the dispensary observation.