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1 , /....:.. -, : - /....: -, Anan'ev BG. Selected psychological works. In 2 volumes. Pod red. Bodaleva AA, Lomova VF. 1980;2: Zeygarnik BV. Psychopathology: A manual for schools. 1986; Kon IS. In search of self: personality and its identity. 1984; Kritskaya VP, Meleshko K, Polyakov YF. The pathology of mental activity. Schizophrenia: motivation, communication, cognition. 1991; Kurek NS. The study of mental decline in activity patients with schizophrenia on the material processes of goal formation and tseledostizheniya. Avtoref. kand. dis; Leont'ev DA. Psychology of meaning: the nature, structure and dynamics sense of reality. 1999; Leont'ev DA. Test life orientations (LSS). 2000; Maslou A. Psychology of Being; Overall psychodiagnostics. Pod red. Bodaleva AA, Stolina VV. 1987; Pantileev SR, Stolin VV. Method of research the self. Practicum in psycho-diagnostics. Specific psychodiagnostic methods. 1989; REFERENCES /.. // -. :.. /...,.. -..:, Yur'yeva LM, Filipov VM, Demura NO, Kushnir NG, Kolomoyets NY. Psychological peculiarities of life sense orientations and self-relation of schizophrenic patients who have committed socially hazardous actions. Perspective medical, 2008;13(2): Frankl V. Man in search of ultimate meaning. Humanistic Psychology: The 3x volumes. V.1. Humanistic approaches in the western psychology XX; Kholmogorova AB. Violation reflective regulation cognitive functions in patients with schizophrenia. Avtoref. kand. dis; Chesnokova II. The problem of identity in psychology. 1987; Yur' eva LN. Rehabilitation of patients with schizophrenia who have committed socially dangerous deyaniya. 1996; Yur' eva LN. Schizophrenia: Clinical guidelines for the doctors. 2010; Yadov VA. On the regulation of social behavior dispositional personality. In.: Social Psychology. Reader: Study manual for students. Sost. Belinskaya EP, Tikhomandritskaya OA. 1999; : : ( ).., 96,, 49074, SI Institute of Gastroenterology of NAMS of Ukraine "Pravda" av., 96, Dnipropetrovsk, 49074, Ukraine tboyko@inbox.ru :,, Key words: anemia, chronic inflammatory bowel diseases, iron deficiency...., 2, 1/3., 70

2 ( ), %. ( ),,.. (,,, ), ( ) ,. stfr/log : 44% ( ), 34 % ( ) 22 %. -25,.,. Abstract. Iron metabolism and diagnostic of iron deficiency in inflammatory bowel diseases. Boyko T. According to WHO data about 2 billion people in the world suffer from anemia, that is 1/3 of the whole population of the planet. Causes of anemic states are varied and often they complement each other, iron deficiency anemia (IDA) which occurs in 75-80% of cases is of the greatest significance among anemias of different origins. Anaemia is a frequent systemic manifestation of inflammatory bowel diseases (IBD) which significantly worsens quality of life, it is associated with disease severity and resistance to therapy. The article highlights pathogenesis and diagnosis of anaemia in IBD patients based on current understanding of iron homeostasis in chronic inflammation. 69 anemic patients with IBD compared to with 30 patients with normal Hb level were under investigation. The control group consisted of 15 healthy individuals. The examination included total blood count, parameters of iron metabolism (serum iron, unsaturated and total iron binding capacity, trasferrin saturation, ferritin), as well as hepcidin-25 level and erythropoetin in serum. Depending on stfr/log ferritin index the patients were divided into groups: 44% with IDA, 34 % anemia of chronic disease (ACD) and 22 % combination of IDA and ACD. A significant decrease of hepcidine-25 level in serum of IDA patients and increase of that one against inflammatory process in patients with ACD and ACD+IDA was found being. An increase of erythropoetin production was established in anemic patients, less expressed on ACD background. -., 2, 7 - [12]. ( ) : 120 / 130 / [20]., - ( ), % [19]. (Fe),,,,. Fe - -. Fe, -,,, - [5]. 13/ XV I / 3 -.,. - 0,6. 1,3., -, Fe,, Fe,, -.,,. Fe,, - ( - ( ) ( )). -,,,., 71

3 [4, 5] ( ), -, -. -,., %, -. F - -., '. [6]., (TfR), -.,, - ( +3 +2). -,. TfR, (stfr) [15]. TfR,, stfr. -. TfR,. 80 % TfR -. TfR -.. TfR, [14].,,.. (MCV), - ( ) ( ), (MCHC), - RDW -. -,. -. ( ),,,, -., - ( ), - [1].,, -. - stfr stfr/log,. - <1, >2 >3. - 2,,,, - [17]. -, [2, 3]. -, 25 -,,, Fe, 72

4 -6. - Fe (SLC40A1). () Fe, - - (TNF- ), ()., - -., - Fe Fe,. Fe,,, [10, 13]. ( ),, -,,,,, - - [9, 11]. -,, ( ), 54 15, 38,97±1,47., - (H ) 120 /. - ( ) 30,. 15., i Sysmex ( ), - (Fe), ( Fe), - ( ), - ( ) «- -». ( ) - - ( ); - (stfr) ( - Bio Vendor, ); ( - -, ), ( LISA epcidin-25 (bioactiv) DRG ( ). - Stat Fax 303 Plus ( )., Statistica for Windows 6.0., ( ) - - (MCH, MCHC, RDW), (. 1). (M±m) 1 (n=69) (n=30) HB, / 94,43±1,94 135,57±1,57 <0,001, / 4,12±0,07 4,41±0,06 <0,01, % 32,06±0,61 41,00±0,20 <0,001 V, 77,41±1,31 80,11±1,32 >0,05 MCH, 23,37±0,52 28,72±1,10 <0,001 MCHC, / 29,83±0,30 43,95±2,50 <0,001 RDW-CV, % 17,60±0,46 14,75±0,50 <0,01 13/ XV I / 3 73

5 - - (Fe) - (HT Fe), (. 2). (p<0,001), -. -,,. 5,0 872,6 /, 28,2 69,1 /, -,. 2 (n=69) (n=30) (n=15) Fe, / 8,63±0,51 19,66±1,71 17,20±1,53, / 60,60±1,72 61,99±1,72 74,35±3,25, / 52,02±1,81 43,40±2,20 55,11±5,83 Fe, % 15,15±1,07 31,48±2,87 33,70±5,41, / 55,52±13,48 40,85±3,68 116,00±10,10 TfR, / 3,30±0,35 1,14±0,06 0,86±0,17, / 84,12±11,92 16,58±0,87 14,73±2,04 1 <0,001 1 >0,05 3 <0,001 1 <0,01 p 2 >0,05 1 <0,001 1 >0,05 3 <0,001 1 <0,001 1 <0,001, / 16,44±2,68 22,81±2,76 7,20±1,10 : 1 ; 2 ; 3. 1 >0,05 p 2 <0,01 3 <0,001 ( Fe) -,. - (stfr),, -, -. stfr, Fe, [18]. - stfr - (p<0,001), - stfr 0,55 9,25 /, -. -, stfr/log, <1, >1, >2., :, +, (. 3). 74

6 , 44%, stfr/log >2, 34% ( <1) 22% stfr/log 1 2. (M±m) 3 (n=30) + (n=15) (n=24) n=15 Hb, / 82,77 ± 3,57 95,58 ± 4,53 102,79 ± 3,11 >120 p1<0,05 p2<0,001 Fe, / 7,06 ± 0,90 7,95 ± 0,72 9,58 ± 1,30 17,20 ± 1,53 >0,05 Fe, % 11,9 ± 1,63 16,09 ± 1,99 18,87 ± 3,29 33,70 ± 5,41 >0,05, / 14,37 ± 3,05 56,26 ± 16,07 144, 79 ± 54,36 116,0 10,10 TfR, / 5,40 ± 0,54 2,56 ± 0,26 1,30 ± 0,23 0,86 ±0,17 p1<0,05 p2<0,05 p1<0,001 p2<0,001 TfR/log 5,4 1,76 0,8, / 3,95 ± 0,89 18,26 ± 2,99 31,32 ± 6,07 7,2±1,1 p1<0,001 p2<0,001 E, / 140,84± 21,00 56,95 ± 16,95 35,21 ± 8,07 14,73±2,04 : 1 + ; 2. p1<0,001 p2<0, (P 2 <0,01, 3 <0,001).,.,, - -,. ( ) (3,95 ± 0,89) /. - 4,6 8. -, - - IL- 6,,, - 13/ XV I / 3, -, stfr [16], (.3). ( ) - ( 6 ), (. 2). - : r= -0,768, p<0,001.,, [7]. - (. 3),, - -, IL-1, IL-6, TNF- IFN-, -. 75

7 , -.,, - Fe,, -, : -,, ( ) /.. // (92) /..,..,.. // /..,..,.. [.] // , /..,..,.. [.]..:, : /... [.]..:, /..,.. // " - " (43)..: 7. : /..,..,.. - [.]..:, Ganz T: Hepcidin, a key regulator of iron metabolism and mediator of anemia of inflammation / T. Ganz // Blood Vol P Gomollon F. Anemia and inflammatory bowel diseases / F. Gomollon, J. Gisbert // World J. Gastroenterol Vol. 15, N 37. P Intestinal DMT1 cotransporter is down regulated by hepcidin via proteasome internalization and degradation / C. Brasse-Lagnel, Z. Rarim, P. Letteron [et al.] // Gastroenterol Vol. 140, N 4. P Iron, anaemia, and inflammatory bowel diseases / C. Gasche, M.C. Lomer, I. Cavill [et al.] // Gut Vol. 53, N 8. P Milman N. Anemia still a major health problem in many parts of the world! / N. Milman // Ann. Hematol Vol. 90. P Nemeth E. The role of hepcidin in iron metabolism / E. Nemeth, T. Ganz // Acta Hematol Vol. 122, N 2-3. P Serum soluble transferrin receptor reflects erythropoiesis but not iron availability in erythropoietintreated chronic hemodialysis patients / W.C. Chiang, T.J. Tsai, Y.M. Chen [et al.] // Clin. Nephrol Vol. 58. P Skikne B.S. Serum transferring receptor / B.S. Skikne // Am. J. Hematol Vol. 83, N 11. P Stin J. Diagnosis and management of iron deficiency anemia in patients with IBD / J. Stin, F. Hartmann, A.U. Dignas // Nature Revue Gastroent. Hepatol Vol. 7, N 11. P The ratio of serum transferring receptor and serum ferritin in the diagnosis of iron status / B.I. Malope, A.P. MacPhail, M. Alberts [et al.] // Br. J. Haematol Vol.115. P Wish J.B. Assessing Iron Status: Beyond Serum Ferritin and Tanserrin Saturation / J.B. Wish // Clin. J. Amer. Cociety Nephrology Vol. 1, Suppl. 1. S4-S World Health Organization. Assessing the iron status of populations. Geneva, WHO : World Health Organization.Worldwide prevalence of anaemia WHO Global Database on Anaemia. Geneva: WHO, REFERENCES 1. Vygovska Ya. Anemia of chronic diseases: pathogenesis, diagnosis, treatment (lecture). Ukr Med Chasopys. 2012;6(92): Vidiborets SV, Sergienko AV, Popovich YuYu. Hepcidine as a central regulator of iron metabolism. Ukr J Hematol Transfusiol. 2011;2: Levina AA, Kazyukova TV, Tsvetaeva NV. Hepcidine as a regulator of iron homeostasis. Pediatry. 2008;87(1): Svintsitskiy AS, Guseva SA, Skripnichenko SV. Diagnostic and treatment of blood system diseases. Kyi'v: Medkniga. 2010: Guseva SA. Iron deficiency condition. Kyi'v: Logos. 2005: Kolocheva TI, Reshetnikov SS. Ferritin in laboratory diagnostic of different human diseases. Vector-Best News; 2007:1(43). 76

8 7. Guseva SA, Goncharov YaP, Kurshchuk V. Recombinant erythropoietin: use in clinic practice. Kyi'v: Logos. 2007: Ganz T. Hepcidin, a key regulator of iron metabolism and mediator of anemia of inflammation. Blood. 2003;102: Gomollon F, Gisbert J. Anemia and inflammatory bowel diseases. World J. Gastroenterol. 2009;15 (37): Brasse-Lagnel C, Rarim Z, Letteron P. Intestinal DMT1 cotransporter is down regulated by hepcidin via proteasome internalization and degradation. Gastroenterol. 2011;140(4): Gasche C, Lomer MC, Cavill I. Iron, anaemia, and inflammatory bowel diseases. Gut. 2004;53(8): Milman N. Anemia still a major health problem in many parts of the world! Ann. Hematol. 2011;90: Nemeth E, Ganz T. The role of hepcidin in iron metabolism. Acta Hematol. 2009;122(2-3): Chiang WC, Tsai TJ, Chen YM. Serum soluble transferrin receptor reflects erythropoiesis but not iron availability in erythropoietin-treated chronic hemodialysis patients. Clin. Nephrol. 2002;58: Skikne BS. Serum transferring receptor. Am. J. Hematol. 2008;83(11): Stin J, Hartmann F, Dignas AU. Diagnosis and management of iron deficiency anemia in patients with IBD. Nature Revue Gastroent. Hepatol. 2010;7(11): Malope BI, MacPhail AP, Alberts M. The ratio of serum transferring receptor and serum ferritin in the diagnosis of iron status. Br. J. Haematol. 2001;115: Wish JB. Assessing Iron Status: Beyond Serum Ferritin and Tanserrin Saturation. Clin. J. of the American Cociety of Nephrology. 2006;1(Suppl.1): World Health Organization. Assessing the iron status of populations. Geneva, WHO World Health Organization.Worldwide prevalence of anaemia WHO Global Database on Anaemia. Geneva, WHO /.67: : : , 9,, 49600, SE "Dnipropetrovsk medical academy Ministry of Health of Ukraine" Dzerzhinsky Str., 9, Dnipropetrovsk, 49044, Ukraine dosia@ua.fm :,,,, Key words: children, children's homes, local immunity, mucosal microflora of the nose and throat, seasonal prophylaxis of ARVI ,, 13/ XV I / 3 77