ANALY SIS OF CHANGES IN CHOLI NERGIC AND ADRENERGIC REGUL ATION OF BRONCHI AL TONE AND BILI ARY TRACT DU E TO COMORBIDI TY OF BRONCHI AL ASTHMA AND CHRONIC CHOLECYSTITIS

Abstract

Objective. To investigate the changes in cholinergic and adrenergic regulation of bronchial and biliary tract tone in patients with comorbid bronchial asthma and chronic non-calculous cholecystitis, as well as to determine their relationship with pulmonary function parameters and neuroendocrine homeostasis. Materials and Methods. The study involved 92 patients divided into four groups: 30 patients with mild to moderate persistent bronchial asthma (Group I), 30 patients with bronchial asthma combined with chronic non-calculous cholecystitis in the exacerbation phase (Group II), 32 patients with chronic non-calculous cholecystitis (Group III), and 30 apparently healthy individuals (control group). Pulmonary function was assessed using computer-based spirometry with analysis of the flow–volume curve and bronchodilator testing with salbutamol. The morphofunctional state of the hepatobiliary system was evaluated by ultrasound examination. Cholinergic system activity was assessed by measuring serum acetylcholinesterase activity, while the state of the sympathoadrenal system was evaluated based on the catecholamine-depositing function of erythrocytes. Serum cortisol concentration was determined using immunoassay methods. Statistical analysis included correlation analysis. Results and Discussion. All patients with bronchial asthma, chronic non-calculous cholecystitis, and their combined course demonstrated a predominance of parasympathetic regulation, manifested by a significant decrease in acetylcholinesterase activity, most pronounced in patients with comorbid pathology. A marked reduction in the catecholamine-depositing function of erythrocytes was observed in patients with bronchial asthma, which was significantly more pronounced in the presence of concomitant chronic non-calculous cholecystitis, indicating the development of adrenergic imbalance. A significant decrease in serum cortisol levels was detected in all patient groups, correlating with the severity of bronchial asthma and forced expiratory volume in one second. Correlation analysis revealed strong direct relationships between pulmonary function parameters, acetylcholinesterase activity, catecholamine-depositing function of erythrocytes, and serum cortisol levels, as well as their association with disorders of gallbladder motility and sphincter of Oddi dysfunction. These changes create pathogenetic prerequisites for the progression of both bronchial asthma and chronic cholecystitis. Conclusions. The comorbid course of bronchial asthma and chronic non-calculous cholecystitis is accompanied by pronounced cholinergic and adrenergic imbalance, characterized by decreased acetylcholinesterase activity, reduced catecholamine-depositing function of erythrocytes, and lower serum cortisol concentration. These neuroendocrine disturbances correlate with the degree of bronchial obstruction, hypokinetic gallbladder dysfunction, and hypertensive sphincter of Oddi dysfunction, substantiating the need to consider comorbid pathology when selecting therapeutic strategies and predicting disease course