Оптимізація діагностики розвитку ускладнень стабільних форм ішемічної хвороби серця у хворих із супутнім ожирінням

Abstract

Сегодня сердечно-сосудистая патология остается ведущей причиной заболеваемости и смертности населения Украины. Целью данного исследования было определить динамику неоптерина у больных со стабильной стенокардией и ожирением в зависимости от степени стеноза коронарных сосудов на основе данных коронарографии. Было обследовано 110 пациентов со стабильной стенокардией II – III функционального класса. Все боль- ные со стабильной стенокардией были разделены на 2 группы: первую группу составили пациенты со ста- бильной стенокардией и сопутствующим ожирения (n = 80), вторая группа включала пациентов со стабиль- ной стенокардией без ожирения (n = 30). Уровень неоптерина определяли иммуноферментыми методиками на иммуноферментном анализаторе «LabLine-90». 39 пациентам была выполнена коронарография. При увеличении стеноза за счет атеросклеротической бляшки установленного в соответствии с дан- ными коронарографии, наблюдалось значительное увеличение уровня неоптерина, что указывает на вза- имосвязь степени выраженности и распространенности атеросклеротического поражения сосудов и уров- нем неоптерина, это в свою очередь позволяет рассматривать нарастание неоптерина, как маркера риска развития осложнений стабильных форм ишемической болезни сердца, о чем свидетельствуют полученные корреляции. Today cardiovascular pathology remains the leading cause of morbidity and mortality of population. However, it is necessary to emphasis that in majority of European countries starting from the sixties of the last century mortality due to cardiovascular diseases (CVD) was reduced more than by 60 %, but in our country – it increased by 40 % and has a tendency for further growth. In the structure of mortality of population from CVD the first place is occupied by ischemic heart disease (IHD) and its most frequent sign is stable angina, which is reported in 48 % of cases. The aim of the study was to determine the dynamics of neopterin in patients with stable angina and obesity depending on the degree of stenosis of coronary vessels on the basis of the coronarography. Material and Methods. We examined 110 patients suffering from stable angina of II – III functional classes (FC) with concomitant obesity. The average age of the patients was 63,45 ± 1,09 years. 65 males (60,72 %) and 45 females (39,28 %) were examined. The control group was composed of 20 practically healthy people. Patients suffering from stable angina with concomitant acute or chronic inflammatory diseases, renal insufficiency, oncologic diseases and insulin-dependent diabetes mellitus were not involved in the investigation. All patients underwent comprehensive examination in conformity with the decree № 436 of MoH of Ukraine “Protocols on delivery of medical care to the patients with IHD – stable angina”. Anthropometric measurement included measuring of height, body mass, waist circumference and hips circumference. Obesity was determined by IDF classification. Neopterin level was assessed by immunoenzyme methods using immunoenzyme analyzer «LabLine-90». 39 patients with diagnosed stable angina and concomitant obesity was performed coronarography. The statistical processing of results was performed with the help of software package «Statistika» (StaSoftInc, USA). The values calculated: the average (M), dispersion, standard deviation, the median (m), accuracy and level of significance (p). The standard programme of correlation analysis with calculation of average arithmetic means was used: M+m, σ, and level of accuracy (p). Pearson correlation coefficient was applied to evaluate the interaction stage between the samples (r). Conclusion. As the growth of stable angina functional class was noted a significant increase of neopterin, indicating the activation of cellular immune responses and can be regarded neopterin as a marker of development and progression of stable angina, due to the development of immune inflammation. Increasing stenosis due to atherosclerotic plaque installed according to coronary angiography, there was a significant increase of neopterin, indicating the degree of correlation of expression and prevalence of atherosclerotic vascular lesions and neopterin levels, which in turn allows us to consider increased neopterin as a marker of risk factor of development of complications of coronary artery disease, as evidenced by the obtained correlation