Prevalence of familial hypercholesterolemia and hyperlipoproteinemia(a) in patients with premature acute coronary syndrome

Aim. To evaluate the prevalence of familial hypercholesterolemia (FH) and hyperlipoproteinemia(a) (HLP(a)) in patients with premature acute coronary syndrome (ACS).Material and methods. The study included 120 patients with ACS up to 60 years (mean age, 53±7 years, 104 (87%) men) and 44 people from the comparison group without atherosclerotic cardiovascular diseases and dyslipidemia (mean age, 48±11 years, 19 (43%) men). All patients with ACS underwent coronary angiography. The lipid profile and lipoprotein(a) (Lp(a)) were determined in all patients.Results. The prevalence of HLP(a) in patients with premature manifestation of ACS was 41% (n=49), possible FH — 25% (n=30), combination of FH and HLP(a) — 13% (n=15). In the comparison group, an increased concentration of Lp(a) was detected in 14% (n=6). Based on the analysis of operating characteristic curves, Lp(a) ≥30 mg/dL had the maximum significance for ACS with a sensitivity of 40% and a specificity of 86% (area under the curve, 0,6; 95% confidence interval (CI), 0,5-0,7, p<0,05), and Lp(a) >15 mg/dl was associated with two or more coronary artery lesions with a sensitivity of 67% and a specificity of 65% (area under the curve, 0,7; 95% CI, 0,6-0,7, p<0,01). On logistic regression analysis, age (odds ratio (OR). 1,1; 95% CI, 1,0-1,2, p<0,05), smoking (OR, 7,5; 95% CI, 2,5-22,0, p<0,001) and Lp(a) ≥30 mg/dl (OR, 6,7; 95% CI, 1,1-39,7, p<0,05) are independently associated with premature ACS. Only Lp(a) ≥15 mg/dL was associated with multivessel coronary artery disease in these patients (OR, 3,8; 95% CI, 1,52-9,74, p<0,01).Conclusion. Every fourth patient with premature ACS has FH, while almost every second has HLP(a), and every eighth has a combination of FH and HLP(a). HLP(a) is associated with ACS up to 60 years of age and multivessel coronary artery disease in these patients

Association of various lipid parameters with premature coronary artery disease in men

Aim. To assess the relationship between premature coronary artery disease (CAD) and various lipid parameters.Material and methods. This retrospective longitudinal study included 166 men aged 57±9 years with coronary CAD with onset before age of 55. The control group consisted of 62 men (60±8 years old) who did not have CAD and peripheral arterial disease. In all patients, data on following lipid profile parameters were collected: total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), non-high-density lipoprotein cholesterol (non-HDL-C) and lipoprotein(a) (Lp(a)) at the time of CAD onset, while in control group patients — at the first visit to the A.L. Myasnikov Institute of Clinical Cardiology. These indicators were measured in blood plasma at the time of enrollment in all patients. In addition, the concentration of LDL-C corrected for Lp(a)-cholesterol (LDL-Ccorr) was calculated. Hypercholesterolemia was diagnosed with an initial level of TC >5 mmol/l, or LDL-C ≥3,0 mmol/l, or non-HDL-C ≥3,8 mmol/l, while hyperlipoproteinemia(a) (HLP(a)) — at the level of Lp(a) ≥30 mg/dl.Results. Lipid metabolism disorders were significantly more common in patients with premature CAD compared to the control group. Lp(a) concentration ≥30 mg/dl, along with elevated levels of non-HDL-C or LDL-Ccorr, were associated with premature CAD, regardless of heredity and smoking, in the general cohort of examined men. Kaplan-Meier survival analysis showed that any type of lipid metabolism disorder was associated with an increased risk of premature CAD. In addition, patients with isolated elevated Lp(a) concentrations lived to the CAD onset 8 years earlier — 47 vs 55 years, p<0,02. The probability of premature CAD was maximum when the elevated level of non-HDL-C and HLP(a) was combined (hazard ratio, 2,91 (95% CI 1,96-4,33), p<0,0001).Conclusion. HLP(a) is an independent factor of premature CAD, even with normolipidemia, which confirms the need for routine measurement of Lp(a) in clinical practice

Антигенное разнообразие вирусов гриппа А и В, выделенных от детей в г. Санкт-Петербурге в период с 2013 по 2015 г.

Purpose of the study: study of the circulation, isolation and antigenic analysis of influenza viruses A and B in St.-Petersburg in the children aged 0–18 in the seasons 2013–2015.Materials: nasal swabs from children-inpatients from Saint-Petersburg.Methods: virus isolation in MDCK cell culture and chicken embryos, antigenic analysis with the hemagglutination inhibition (HAI) test with the set of hyper-immune rat antisera to the epidemic and reference strains, antigenic cartography.Results: The epidemic seasons 2013–2015 were characterized by the co-circulation in children in St.-Petersburg of influenza sub-types А(H1N1)pdm09, A(H3N2), and B of Yamagata lineage (B yam). In the season 2014–2015 the low activity of epidemic process was observed with the predominant sub-type A(H3N2) and in the next season – 2014–2015 with the more pronounced epidemic activity – the pre-dominance of B yam viruses. Antigenic analysis of influenza viruses А(H1N1)pdm09 which circulated in children revealed their antigenic homogeneity and full correspondence with vaccine strain A/California/07/09. As for А(H3N2) viruses, two antigenic groups were established: strains similar to A/St.-Petersburg/80/14 (sub-clade 3C.2a) and strains similar to A/Switzerland/9715293/13 (sub-clade 3C.3a). А(Н3N2) strains of the season 2013-2014 were similar to the vaccine strain. However isolates of the season 2014-2015 did not fit to the vaccine strain because in the children were predominant strains similar to the evolution branch A/St.-Petersburg/80/14 while according the WHO recommendations the influenza vaccine contained the strain A/Texas/50/12. Antigenic analysis of influenza viruses B showed their homogeneity and all they were B/Phuket/3073/13-like. Influenza strains B also incompletely corresponded to the vaccine strain – B/Massachusetts/2/12 belonging to the different genetic sub-clade. That might be the reason of enhanced morbidity of children with influenza B in the last season.Conclusion: The obtained results stress the urgency for the wide coverage of human population with the epidemic studies, virus isolation in different time periods and geographic regions and their etiological studies with the modern techniques. Only in these conditions we can assure high efficiency of flu seasonal vaccines.Цель исследования: особенности циркуляции, выделение и антигенный анализ вирусов гриппа А и В в Санкт-Петербурге в 2013–2015 гг. от детей от 0 до 18 лет.Материалы исследования: назальные мазки от детей из стационаров и закрытых детских учреждений Санкт-Петербурга.Методы: выделение вирусов на культуре клеток MDCK и куриных эмбрионах, антигенный анализ методом реакции торможения гемагглютинации (РТГА) с набором гипериммунных крысиных антисывороток к эталонным и эпидемическим штаммам гриппа, антигенная картография.Результаты: в эпидемические сезоны 2013–2015 гг. в г. Санкт-Петербурге среди детей была выявлена совместная циркуляция вирусов гриппа А(H1N1)pdm09, A(H3N2), B Ямагатской линии (B yam), причем в сезоне 2013–2014 гг. при общей невысокой активности эпидемического процесса преобладали вирусы A(H3N2), а в следующем эпидемическом сезоне – 2014–2015 гг. – при более высокой интенсивности эпидемии – вирусы В yam. Антигенный анализ вирусов А(H1N1)pdm09, циркулировавших среди детей, выявил их антигенную однородность и полное соответствие вакцинному штамму А/Калифорния/07/09. Зафиксирован антигенный дрейф вирусов А(H3N2), выявлены 2 антигенные группы: вирусы, подобные А/Санкт-Петербург/80/14 (генетическая подгруппа 3С.2а) и вирусы, подобные А/Швейцария/9715293/13 (подгруппа 3С.3а). Вирусы А(Н3N2) сезона 2013–2014 гг. были подобны вакцинному штамму. В то же время изоляты сезона 2014–2015 гг. не соответствовали вакцинному штамму, поскольку среди детей в основном выявлены штаммы, подобные эволюционной ветви А/Санкт-Петербург/80/14, а в вакцину по рекомендации ВОЗ был включен штамм А/Техас/50/12. Антигенный анализ вирусов гриппа В yam показал их однородность, они были подобны эталонному вирусу В/Пхукет/3073/13. Вирусы В также антигенно не полностью соответствовали вакцинному компоненту, поскольку данные вирусы были подобны штамму В/Пхукет/3073/13, а в состав вакцины входил штамм В/Массачусетс/2/12, принадлежащий к другой генетической подгруппе, что могло привести к повышению заболеваемости детей гриппом типа В в данном сезоне. Заключение: для своевременного правильного выбора штаммов, входящих в состав сезонных противогриппозных вакцин, по-прежнему актуальной остается задача как можно более широкого охвата населения эпидемиологическими исследованиями, выделения вирусов в разные периоды эпидемического сезона и в разных географических регионах, их антигенный и генетический анализ современными методами

IDIOPATHIC PULMONARY FIBROSIS. CORRECTION OF ERRORS

Substantial changes have been recently made in the concept of the diagnosis of idiopathic pulmonary fibrosis. The concept of disease pathogenesis and the pathomorphologic criteria for diagnosing usual interstitial pneumonia have been revised. All idiopathic pulmonary fibrosis treatments that existed prior to 2011 have been found to be ineffective. This article analyzes the currently existing computer tomographic criteria for the diagnosis and differential diagnosis of idiopathic pulmonary fibrosis and considers the common causes of errors and the possibilities of improving the existing X-ray criteria

EFFECTS OF AN EIGHT-WEEK ATORVASTATIN TREATMENT ON SPONTANEOUS CYTOKINE PRODUCTION BY THE BLOOD MONONUCLEAR LEUKOCYTES IN METABOLIC SYNDROME

The aim of this study was to assess effects of the eight-week course of atorvastatin therapy upon the levels of spontaneous cytokine production by mononuclear blood leukocytes (MNBC) in metabolic syndrome. An open-label prospective study included 36 patients with stage II hypertension (blood pressure < 180/110 mm Hg.) accomplished by metabolic syndrome. Along with clinical surveys performed at a specialized cardiological clinics, we assessed spontaneous cytokine production by MNBC during treatment with atorvastatin. It was shown that the 8-week treatment of these patients with atorvaststin, at individually matched daily doses (20to 40 mg) was associated with reduced serum concentration of acute phase proteins (C-reactive protein and neopterin), as well as decreased spontaneous production of proinflammatory cytokines (IL-1β, IL-6 and TNFα) by MNBCs. The latter finding is of great importance for pathogenesis of metabolic syndrome

SUBPOPULATIONS AND METABOLIC ACTIVITY OF BLOOD MONONUCLEAR CELLS IN METABOLIC SYNDROME

Aim of study: to examine the features of expression of CD-markers of blood mononuclear leukocytes and their functional activity in the metabolic syndrome. Conducted a cross-sectional (transverse) study of 76 patients with essential hypertension (EH) II stage (BP <180/110 mm Hg.) [10] in conjunction with the metabolic syndrome and 20 people, formed the control group. Along with a complete clinical, laboratory and instrumental examination taken in a specialized cardiological clinic was conducted determination of surface markers of lymphocytes CD4+, CD8+ and monocytes CD36+ and assessment of the level of spontaneous production of reactive oxygen blood mononuclear leukocytes. Found that in patients with the metabolic syndrome compared with the control group the proportion of CD4+ lymphocytes and the level of spontaneous ROS production by mononuclear leukocytes significantly higher. The positive correlated interconnection between these indicators and the number of CD36+ monocytes with the majority of clinical and metabolic markers of MS confirmes their participation in mechanism of immune inflammation and oxidative stress in this pathological process