48 research outputs found
Hypoglycemia in type 2 diabetes mellitus patients β cerebral, cognitive, psychosocial and clinical aspects
The review article describes modern approaches to hypoglycemia in diabetes mellitus (DM) patients, its clinical and laboratory diagnostics, and its current classification. Hypoglycemia has the highest impact on cardiovascular morbidity and mortality, including stroke. Cerebral damage in neuroglycopenia, as well as neurological aspects in this group of patients, are discussed. The authors describe glycopeniaβs influence on cerebral metabolism, counter-regulatory response, and impaired hypoglycemia recognition, as well as modern neuroimaging techniques that may enhance differential diagnostics in complex cases. The epidemiology of neurocognitive disorders in DM patients and their association with hypoglycemic conditions is outlined, together with psychosocial aspects of its consequences β both for the patient and relatives and for the medical professionals. The search for ways to reduce the burden of hypoglycemia from the standpoint of an effective and safe strategy for treating patients with type 2 diabetes does not lose its relevance, and therefore data on the prevalence of hypoglycemic conditions of varying severity when using certain classes of hypoglycemic drugs are presented. A therapeutic approach that maximizes metabolic control while reducing hypoglycemia to a minimum may determine further possibilities for personalized DM management
Acute ischemic stroke in the setting of essential thrombocytemia (clinical cases)
This article describes several clinical cases of acute ischemic stroke among patients suffering from essential thrombocytemia. Ambiguity of etiological factors of stroke is demonstrated among patients with this pathology. Thrombocytosis and high allele load in the Jak2 gene play an important role (even with normal platelet count) in progression of cerebrovascular disease. Also the question of effectiveness of preventive and etiological therapy is considered
MicroRNA detection in carotid atherosclerosis: prospects for clinical use
Carotid atherosclerosis is a significant cause of cerebrovascular disease. However, with many candidate markers, precise assessment of its development and progression risks is still limited. This paper reviews state-of-the-art concepts of microRNA as an atherogenesis biomarker throughout various stages including endothelial dysfunction, cholesterol/lipid metabolism, inflammation, oxidative stress, angiogenesis regulation, and proliferation and migration of vascular smooth muscle cells. Based on the available literature, we have described most significant microRNAs for each stage characterized in brief. We have visualized interactions between microRNAs and validated target genes with MIENTURNET and suggest and justify a set of microRNAs for further pilot studies of carotid atherosclerosis
Symptomatic and silent cerebral ischemia (detected on MRI) in patients with type 2 diabetes mellitus after carotid revascularization procedures
Background: Type 2 diabetes mellitus (T2DM) is a significant independent risk factor for ischaemic stroke. Carotid revascularisation procedures are an effective method of primary and secondary stroke prevention. However, patients developed postoperative acute ischaemic lesions (AILs), which were identified via magnetic resonance imaging (MRI) of the brains. Most of the patients with these AILs lack clinically overt symptoms. Aims: To assess the risk of ischaemic brain damage in patients with T2DM in the setting of carotid angioplasty with stenting (CAS) or carotid endarterectomy (CAE). Materials and methods: This open prospective study comprised of 164 patients with carotid atherosclerosis, who have undergone either CAS or CAE. Patients with T2DM were included in Group 1: 38 patients and 28 patients with CAE. Group 2 included patients without T2DM: 62 patients with CAS and 36 patients with CAE. All patients underwent a thorough neurological examination and diffusion-weighted brain MRI. In patients with T2DM, plasma glucose levels and glycated haemoglobin (HbA1c) were determined and their relationships to brain damage were evaluated. Results: In CAS, there were no statistically significant differences in the AIL frequency in patients with and without T2DM. AILs were found in 15 patients with T2DM (39.8%) and 29 patients without T2DM (46.8%, Ρ = 0.24); three patients without T2DM were diagnosed with stroke. Of the 28 patients with T2DM who underwent CAE, 13 had AIL (46.4%); three had stroke (10.7%). In patients without T2DM, AILs were less prevalent in seven cases (19.4%, Ρ = 0.012) and appeared asymptomatic. Following CAS, the baseline HbA1c levels were higher in patients with T2DM who developed AILs compared to those who did not develop AIL, 7.8% ± 1.4% vs 7.1 ± 1.1% (Ρ = 0.0469). Negative impact of hyperglycaemia on the risk of cerebral ischaemia was observed in patients who underwent CAE, the baseline fasting plasma glucose level was 8.5 ± 1.9 mmol/l vs 7.0 ± 1.5 mmol/l in patients without AIL (Ρ = 0.014). The baseline HbA1c levels in patients with and without AILs were 8.0% ± 1.7% and 6.9% ± 0.9% respectively (Ρ = 0.023). Conclusions: Carotid revascularisation procedure for patients with carotid atherosclerosis may be associated with risk of stroke and asymptomatic acute cerebral ischaemic lesions, which are more prevalent in patients with T2DM. Also, increased HbA1c levels is a risk factor for AIL
Π€ΠΎΡΠΌΠ°Π»ΠΈΠ·ΠΎΠ²Π°Π½Π½Π°Ρ ΠΎΡΠ΅Π½ΠΊΠ° ΡΠΈΡΡΠ΅ΠΌΠ½ΠΎΠΉ ΡΡΠΎΠΌΠ±ΠΎΠ³Π΅Π½Π½ΠΎΡΡΠΈ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΈΡΠ΅ΠΌΠΈΡΠ΅ΡΠΊΠΈΠΌ ΠΈΠ½ΡΡΠ»ΡΡΠΎΠΌ, ΡΠ°Π·Π²ΠΈΠ²ΡΠΈΠΌΡΡ Π½Π° ΡΠΎΠ½Π΅ ΠΈΡΡΠΈΠ½Π½ΠΎΠΉ ΠΏΠΎΠ»ΠΈΡΠΈΡΠ΅ΠΌΠΈΠΈ
Introduction. Thrombosis diagnosis and prevention in patients with Polycythemia vera (PV) suffered an ischemic stroke (IS) are still open. The aim was to find the reasons for systemic thrombogenicity and to compare the applicability of the main scales assessing thrombosis risk in patients with PV suffered IS.Materials and methods. We followed up 127 people (42-75 y.o.), of which 68 were patients with PV suffered IS (group I) and 59 non-PV-patients with ischemic stroke (group II). Clinical study included common blood analysis, rheological properties of erythrocytes, coagulation and endothelial parameters, cytokines, inflammation markers, angiogenesis markers, and testing for the V617F mutation in the JAK2 gene. The follow up included common and neurological examinations as well, and the assesment of thrombosis risk factors with both Caprini scale and CHA2DS2-VASc scale. All patients were examined twice as in the acute period of IS as well as in 16-18 months.Results. Between the groups no significant differences were found for the NIHSS average score and for Bartel index as well.The Caprini score belonged to the βvery high riskβ (score > 6) in both groups in the acute period of IS. At the same time, the score β8-10 pointsβ prevailed in group II (68%) whereas the score β11-12 pointsβ prevailed in group I.In the acute time of IS the CHA2DS2-VASc score revealed 12% of patients from both groups who had a score of β3-4 pointsβ (moderate risk of thrombosis).In group I thrombotic complications rate correlated significantly with the JAK2V617F gene allelicloading (r = 0.236; p < 0.05), and the development of recurrence cerebrovascular disorders correlated significantly with Caprini score (r = 0.241; p < 0.05), but not with CHA2DS2-VASc score.Aiming to predict thrombotic complications in PV-patients the threshold (cut off) points were established for those markers as factor VIII, factor VII, red blood cell deformability, thrombin activated fibrinolysis inhibitor (TAFI), red blood cell count, white blood cell count, t-PA, VEGF-A, p-thrombomodulin, and ADAMTS-13.This pattern of parameters showed the odds ratio of thrombotic complications 10.3 (95% CI 7.6-13.8) in PV-patients in thelong-term period.At the end of the follow up the Caprini score showed a trend towards a decreasing in total while the CHA2DS2-VASc score remained virtually unchanged.Conclusion. We assume the accurate assessment of thrombotic risk in patients with Polycythemia vera suffered an ischemic stroke requires a proposed pattern of parameters including the test for JAK2V617F allelicloading and the calculation of Caprini score but not CHA2DS2-VASc score. Final results may provoke to change standard antithrombotic therapy in those patients towards its intensification due to pathogenetic featues of cancer-associated thrombosis.Π¦Π΅Π»Ρ. Π¦Π΅Π»ΡΡ Π½Π°ΡΠ΅Π³ΠΎ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ Π±ΡΠ»ΠΎ Π²ΡΡΠ²Π»Π΅Π½ΠΈΠ΅ ΠΏΡΠΈΡΠΈΠ½ ΡΠΈΡΡΠ΅ΠΌΠ½ΠΎΠΉ ΡΡΠΎΠΌΠ±ΠΎΠ³Π΅Π½Π½ΠΎΡΡΠΈ ΠΈ ΡΡΠ°Π²Π½ΠΈΡΠ΅Π»ΡΠ½ΡΠΉ Π°Π½Π°Π»ΠΈΠ· ΠΏΡΠΈΠΌΠ΅Π½ΠΈΠΌΠΎΡΡΠΈ ΠΎΡΠ½ΠΎΠ²Π½ΡΡ
ΡΠΊΠ°Π» ΠΎΡΠ΅Π½ΠΊΠΈ ΡΡΠ΅ΠΏΠ΅Π½ΠΈ ΡΠΈΡΠΊΠ° ΡΠ°Π·Π²ΠΈΡΠΈΡ ΡΡΠΎΠΌΠ±ΠΎΠ·ΠΎΠ² Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΈΡΡΠΈΠ½Π½ΠΎΠΉ ΠΏΠΎΠ»ΠΈΡΠΈΡΠ΅ΠΌΠΈΠ΅ΠΉ, ΠΏΠ΅ΡΠ΅Π½Π΅ΡΡΠΈΡ
ΠΈΡΠ΅ΠΌΠΈΡΠ΅ΡΠΊΠΈΠΉ ΠΈΠ½ΡΡΠ»ΡΡ.ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. ΠΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΎ 127 ΡΠ΅Π»ΠΎΠ²Π΅ΠΊ (Π²ΠΎΠ·ΡΠ°ΡΡ ΠΎΡ 42 Π΄ΠΎ 75 Π»Π΅Ρ), ΠΈΠ· ΠΊΠΎΡΠΎΡΡΡ
68 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΏΠ΅ΡΠ΅Π½Π΅ΡΠ»ΠΈ ΠΈΡΠ΅ΠΌΠΈΡΠ΅ΡΠΊΠΈΠΉ ΠΈΠ½ΡΡΠ»ΡΡ (ΠΠ) Π½Π° ΡΠΎΠ½Π΅ ΠΠ (I Π³ΡΡΠΏΠΏΠ°), ΠΈ 59 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΏΠ΅ΡΠ΅Π½Π΅ΡΠ»ΠΈ ΠΈΡΠ΅ΠΌΠΈΡΠ΅ΡΠΊΠΈΠΉ ΠΈΠ½ΡΡΠ»ΡΡ, Π½ΠΎ Π½Π΅ ΠΈΠΌΠ΅Π»ΠΈ ΠΠ (II Π³ΡΡΠΏΠΏΠ°). ΠΠ»ΠΈΠ½ΠΈΠΊΠΎΠ»Π°Π±ΠΎΡΠ°ΡΠΎΡΠ½ΠΎΠ΅ ΠΎΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π²ΠΊΠ»ΡΡΠ°Π»ΠΎ ΠΎΠ±ΡΠΈΠΉ Π°Π½Π°Π»ΠΈΠ· ΠΊΡΠΎΠ²ΠΈ, ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ ΡΠ΅ΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΡΡΠΈΠΊ ΡΡΠΈΡΡΠΎΡΠΈΡΠΎΠ², ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΠΎΠ² ΡΠΈΡΡΠ΅ΠΌΡ Π³Π΅ΠΌΠΎΡΡΠ°Π·Π° ΠΈ ΡΡΠ½ΠΊΡΠΈΠΈ ΡΠ½Π΄ΠΎΡΠ΅Π»ΠΈΡ, ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΠ΅ ΡΠΈΡΠΎΠΊΠΈΠ½ΠΎΠ², ΠΌΠ°ΡΠΊΠ΅ΡΠΎΠ² Π²ΠΎΡΠΏΠ°Π»Π΅Π½ΠΈΡ Π°ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ Π°Π½Π³ΠΈΠΎΠ³Π΅Π½Π΅Π·Π°, Π° ΡΠ°ΠΊΠΆΠ΅ ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎΠ΅ ΠΌΠΎΠ»Π΅ΠΊΡΠ»ΡΡΠ½ΠΎ-Π³Π΅Π½Π΅ΡΠΈΡΠ΅ΡΠΊΠΎΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ ΠΌΡΡΠ°ΡΠΈΠΈ V617F Π² Π³Π΅Π½Π΅ JAK2. ΠΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠ΅ ΠΎΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π²ΠΊΠ»ΡΡΠ°Π»ΠΎ ΠΎΠ±ΡΠΈΠΉ ΠΈ Π½Π΅Π²ΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠΉ ΠΎΡΠΌΠΎΡΡΡ, ΡΡΠΎΡΠ½Π΅Π½ΠΈΠ΅ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΠ°ΠΊΡΠΎΡΠΎΠ² ΡΠΈΡΠΊΠ°, ΡΠ±ΠΎΡ Π°Π½Π°ΠΌΠ½Π΅Π·Π°, Π° ΡΠ°ΠΊΠΆΠ΅ ΠΎΡΠ΅Π½ΠΊΡ ΡΠΈΡΠΊΠ° ΡΠ°Π·Π²ΠΈΡΠΈΡ Π²Π΅Π½ΠΎΠ·Π½ΡΡ
ΡΡΠΎΠΌΠ±ΠΎΡΠΌΠ±ΠΎΠ»ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ (ΠΠ’ΠΠ) ΠΏΠΎ ΡΠΊΠ°Π»Π°ΠΌ Caprini ΠΈ CHA2DS2-VASc. ΠΡΠ΅ ΠΏΠ°ΡΠΈΠ΅Π½ΡΡ Π±ΡΠ»ΠΈ ΠΎΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½Ρ Π² ΠΎΡΡΡΠ΅ΠΉΡΠ΅ΠΌ ΠΏΠ΅ΡΠΈΠΎΠ΄Π΅ ΠΠ ΠΈ ΡΠΏΡΡΡΡ 16-18 ΠΌΠ΅Ρ.Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. ΠΡΠΈ ΠΎΡΠ΅Π½ΠΊΠ΅ Π½Π΅Π²ΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΠΈΠΌΠΏΡΠΎΠΌΠΎΠ² Π² ΠΎΡΡΡΠΎΠΌ ΠΏΠ΅ΡΠΈΠΎΠ΄Π΅ ΠΠ Π² ΠΎΠ±Π΅ΠΈΡ
Π³ΡΡΠΏΠΏΠ°Ρ
ΡΡΠ΅Π΄Π½ΡΡ ΠΎΡΠ΅Π½ΠΊΠ° ΠΏΠΎ ΡΠΊΠ°Π»Π΅ NIHSS ΠΈ ΠΏΠΎ ΠΈΠ½Π΄Π΅ΠΊΡΡ ΠΠ°ΡΡΠ΅Π»Ρ ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈ Π·Π½Π°ΡΠΈΠΌΠΎ Π½Π΅ ΡΠ°Π·Π»ΠΈΡΠ°Π»ΠΈΡΡ ΠΌΠ΅ΠΆΠ΄Ρ Π³ΡΡΠΏΠΏΠ°ΠΌΠΈ. ΠΡΠ΅Π½ΠΊΠ° ΠΏΠΎ ΡΠΊΠ°Π»Π΅ Caprini Π² ΠΎΡΡΡΠΎΠΌ ΠΏΠ΅ΡΠΈΠΎΠ΄Π΅ ΠΠ Π±ΡΠ»Π° Π² ΠΊΠ°ΡΠ΅Π³ΠΎΡΠΈΠΈ Β«ΠΎΡΠ΅Π½Ρ Π²ΡΡΠΎΠΊΠΈΠΉ ΡΠΈΡΠΊΒ» (ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²ΠΎ Π±Π°Π»Π»ΠΎΠ² > 6) Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΎΠ±Π΅ΠΈΡ
Π³ΡΡΠΏΠΏ. ΠΡΠΈ ΡΡΠΎΠΌ Π²ΠΎ II Π³ΡΡΠΏΠΏΠ΅ ΠΏΡΠ΅ΠΎΠ±Π»Π°Π΄Π°Π»Π° ΠΎΡΠ΅Π½ΠΊΠ° Β«8-10 Π±Π°Π»Π»ΠΎΠ²Β» (68%), ΡΠΎΠ³Π΄Π° ΠΊΠ°ΠΊ Π² I Π³ΡΡΠΏΠΏΠ΅ Π±ΠΎΠ»ΡΠ½ΡΡ
ΠΏΡΠ΅ΠΎΠ±Π»Π°Π΄Π°Π»Π° ΠΎΡΠ΅Π½ΠΊΠ° Β«11-12 Π±Π°Π»Π»ΠΎΠ²Β». ΠΡΠ΅Π½ΠΊΠ° ΠΏΠΎ ΡΠΊΠ°Π»Π΅ CHA2DS2-VASc Π² ΠΎΡΡΡΠΎΠΌ ΠΏΠ΅ΡΠΈΠΎΠ΄Π΅ ΠΠ Π²ΡΡΠ²ΠΈΠ»Π° Π² ΠΎΠ±Π΅ΠΈΡ
Π³ΡΡΠΏΠΏΠ°Ρ
ΠΏΠΎ 12% ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΎΡΠ΅Π½ΠΊΠΎΠΉ Β«3-4 Π±Π°Π»Π»Π°Β» (ΡΠΌΠ΅ΡΠ΅Π½Π½ΡΠΉ ΡΠΈΡΠΊ ΡΡΠΎΠΌΠ±ΠΎΠ·Π°). Π I Π³ΡΡΠΏΠΏΠ΅ ΡΠ°ΡΡΠΎΡΠ° ΡΡΠΎΠΌΠ±ΠΎΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ Π΄ΠΎΡΡΠΎΠ²Π΅ΡΠ½ΠΎ ΠΊΠΎΡΡΠ΅Π»ΠΈΡΠΎΠ²Π°Π»Π° Ρ Π²Π΅Π»ΠΈΡΠΈΠ½ΠΎΠΉ Π°Π»Π»Π΅Π»ΡΠ½ΠΎΠΉ Π½Π°Π³ΡΡΠ·ΠΊΠΈ Π³Π΅Π½Π° JAK2V617F (r = 0,236; p < 0,05), Π° Π²ΠΎΠ·Π½ΠΈΠΊΠ½ΠΎΠ²Π΅Π½ΠΈΠ΅ ΠΏΠΎΠ²ΡΠΎΡΠ½ΡΡ
Π½Π°ΡΡΡΠ΅Π½ΠΈΠΉ ΠΌΠΎΠ·Π³ΠΎΠ²ΠΎΠ³ΠΎ ΠΊΡΠΎΠ²ΠΎΠΎΠ±ΡΠ°ΡΠ΅Π½ΠΈΡ Ρ ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²ΠΎΠΌ Π±Π°Π»Π»ΠΎΠ² ΠΏΠΎ ΡΠΊΠ°Π»Π΅ Caprini (r = 0,241; p < 0,05), Π½ΠΎ Π½Π΅ ΠΏΠΎ ΡΠΊΠ°Π»Π΅ CHA2DS2-VASc. ΠΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΠ΅ ROC-Π°Π½Π°Π»ΠΈΠ·Π° Π΄Π»Ρ ΠΏΡΠΎΠ³Π½ΠΎΠ·Π° ΡΡΠΎΠΌΠ±ΠΎΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² I Π³ΡΡΠΏΠΏΡ ΠΏΠΎΠ·Π²ΠΎΠ»ΠΈΠ»ΠΎ ΡΡΡΠ°Π½ΠΎΠ²ΠΈΡΡ ΠΏΠΎΡΠΎΠ³ΠΎΠ²ΡΠ΅ Π·Π½Π°ΡΠ΅Π½ΠΈΡ Π½Π°ΠΈΠ±ΠΎΠ»Π΅Π΅ ΠΈΠ½ΡΠΎΡΠΌΠ°ΡΠΈΠ²Π½ΡΡ
Π»Π°Π±ΠΎΡΠ°ΡΠΎΡΠ½ΡΡ
ΠΌΠ°ΡΠΊΠ΅ΡΠΎΠ²: ΡΠ°ΠΊΡΠΎΡ VIII, ΡΠ°ΠΊΡΠΎΡ VII, Π΄Π΅ΡΠΎΡΠΌΠΈΡΡΠ΅ΠΌΠΎΡΡΡ ΡΡΠΈΡΡΠΎΡΠΈΡΠΎΠ², Π°ΠΊΡΠΈΠ²ΠΈΡΡΠ΅ΠΌΡΠΉ ΡΡΠΎΠΌΠ±ΠΈΠ½ΠΎΠΌ ΠΈΠ½Π³ΠΈΠ±ΠΈΡΠΎΡ ΡΠΈΠ±ΡΠΈΠ½ΠΎΠ»ΠΈΠ·Π° (TAFI), ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²ΠΎ ΡΡΠΈΡΡΠΎΡΠΈΡΠΎΠ², ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²ΠΎ Π»Π΅ΠΉΠΊΠΎΡΠΈΡΠΎΠ², ΠΊΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠΈΡ t-PA, ΠΊΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠΈΡ VEGF-Π, ΠΊΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠΈΡ p-ΡΡΠΎΠΌΠ±ΠΎΠΌΠΎΠ΄ΡΠ»ΠΈΠ½Π° ΠΈ ΠΊΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠΈΡ ADAMTS-13. ΠΡΠΈ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠΈ ΡΡΠΎΠΉ ΠΏΠ°Π½Π΅Π»ΠΈ ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΠΎΠ² ΠΎΡΠ½ΠΎΡΠ΅Π½ΠΈΠ΅ ΡΠ°Π½ΡΠΎΠ² Π²ΠΎΠ·Π½ΠΈΠΊΠ½ΠΎΠ²Π΅Π½ΠΈΡ ΡΡΠΎΠΌΠ±ΠΎΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ Π² ΠΎΡΠ΄Π°Π»Π΅Π½Π½ΠΎΠΌ ΠΏΠ΅ΡΠΈΠΎΠ΄Π΅ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² I Π³ΡΡΠΏΠΏΡ ΡΠΎΡΡΠ°Π²ΠΈΠ»ΠΎ 10,3 ΡΠ°Π·Π° (95% ΠΠ 7,6-13,8). Π ΠΊΠΎΠ½ΡΠ΅ ΠΏΠ΅ΡΠΈΠΎΠ΄Π° Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΡ ΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΎ, ΡΡΠΎ ΠΏΠΎ ΡΠΊΠ°Π»Π΅ Caprini ΠΎΡΠΌΠ΅ΡΠ΅Π½Π° ΡΠ΅Π½Π΄Π΅Π½ΡΠΈΡ ΠΊ ΠΎΠ±ΡΠ΅ΠΌΡ ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΡ ΡΡΠΌΠΌΠ°ΡΠ½ΠΎΠ³ΠΎ Π±Π°Π»Π»Π°, ΡΠΎΠ³Π΄Π° ΠΊΠ°ΠΊ ΠΎΡΠ΅Π½ΠΊΠ° ΠΏΠΎ ΡΠΊΠ°Π»Π΅ CHA2DS2-VASc ΠΏΡΠ°ΠΊΡΠΈΡΠ΅ΡΠΊΠΈ Π½Π΅ ΠΈΠ·ΠΌΠ΅Π½ΠΈΠ»Π°ΡΡ.ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. Π£ΡΠΈΡΡΠ²Π°Ρ ΡΠΎΠ»Ρ ΠΠ Π² ΡΠΎΡΠΌΠΈΡΠΎΠ²Π°Π½ΠΈΠΈ ΡΠΈΡΡΠ΅ΠΌΠ½ΠΎΠΉ ΡΡΠΎΠΌΠ±ΠΎΠ³Π΅Π½Π½ΠΎΡΡΠΈ ΠΈ, ΠΊΠ°ΠΊ ΡΠ»Π΅Π΄ΡΡΠ²ΠΈΠ΅, Π² Π²Π΅Π»ΠΈΡΠΈΠ½Π΅ ΡΠΈΡΠΊΠ° ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΠ’ΠΠ, Π΄Π»Ρ Π±ΠΎΠ»Π΅Π΅ ΡΠΎΡΠ½ΠΎΠΉ Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΡΡΠΈΠΊΠΈ Π³ΡΡΠΏΠΏ ΡΠΈΡΠΊΠ° ΡΠΌΠ΅ΡΡΠ½ΠΎ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°ΡΡ ΡΠΊΠ°Π»Ρ Caprini, Π° ΡΠ°ΠΊΠΆΠ΅ ΠΏΠ°ΡΡΠ΅ΡΠ½ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΉ, Π²ΠΊΠ»ΡΡΠ°ΡΡΠΈΠΉ Π²Π΅Π»ΠΈΡΠΈΠ½Ρ Π°Π»Π»Π΅Π»ΡΠ½ΠΎΠΉ Π½Π°Π³ΡΡΠ·ΠΊΠΈ JAK2V617F ΠΈ ΠΎΠ±ΡΠ΅Π΄ΠΈΠ½Π΅Π½Π½ΡΡ ΠΏΡΠ΅Π΄ΠΈΠΊΡΠΈΠ²Π½ΡΡ ΠΏΠ°Π½Π΅Π»Ρ Π»Π°Π±ΠΎΡΠ°ΡΠΎΡΠ½ΡΡ
ΠΌΠ°ΡΠΊΠ΅ΡΠΎΠ². Π’Π΅ΠΌ ΡΠ°ΠΌΡΠΌ ΡΡΠΎ ΠΌΠΎΠΆΠ΅Ρ ΡΠ²ΠΈΡΡΡΡ ΠΎΠ±ΠΎΡΠ½ΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ Π΄Π»Ρ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡ ΡΡ
Π΅ΠΌ ΡΡΠ°Π½Π΄Π°ΡΡΠ½ΠΎΠΉ Π°Π½ΡΠΈΡΡΠΎΠΌΠ±ΠΎΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Ρ ΡΠ°ΠΊΠΈΡ
Π±ΠΎΠ»ΡΠ½ΡΡ
Π² ΡΡΠΎΡΠΎΠ½Ρ Π΅Π΅ ΡΡΠΈΠ»Π΅Π½ΠΈΡ ΠΈ Ρ ΡΡΠ΅ΡΠΎΠΌ ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΠ΅ΠΉ ΠΏΠ°ΡΠΎΠ³Π΅Π½Π΅Π·Π° ΡΠ°ΠΊ-Π°ΡΡΠΎΡΠΈΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠ³ΠΎ ΡΡΠΎΠΌΠ±ΠΎΠ·Π°
Assessment of Biomarker Profile in Patients Post Carotid Angioplasty and Stenting
Introduction. Cardiovascular diseases are predominantly caused by atherosclerosis as a multifactorial chronic condition. Alterations in the hematological system and the blood vessel wall are considered as highly significant for onset and development of cerebrovascular disorders associated with atherosclerosis. Biomarkers as measurable indicators are to verify abnormal activity.
Objective: to assess atherogenesis biomarkers in patients after carotid angioplasty and stenting (CAS) as associated with development of cerebrovascular disease.
Materials and methods. We evaluated 50 individuals (50% men, 50% women; average age 65.4 6.4 years) with established cerebrovascular disease associated with brain atherosclerosis. All of them had hemodynamically significant abnormalities in the internal carotid artery (ICA) with both symptomatic (stenosis 60% and more) and asymptomatic (stenosis 70% and more) stenoses confirmed by duplex scanning of the brachiocephalic arteries. All patients underwent CAS as indicated. Before and 1 year after the intervention, we performed clinical and neurological examinations, brain magnetic resonance imaging, and laboratory tests of atherogenesis biomarkers.
Results. At baseline, all the individuals demonstrated a pro-atherogenic shift in the assessed indicators, predominantly markers of extracellular matrix degradation, inflammation and atherogenesis (including osteoprotegerin and chromogranin Π). Additionally, we established a direct correlation between osteoprotegerin levels and the characteristics of mostly hyperechoic atherosclerotic plaques (r = 0.29; p 0.05). A year later, no signs of restenosis were shown in follow-up ultrasound assessment of stented arteries in any patient.
In 1 year post CAS, we found significant changes in the levels of osteoprotegerin (decrease to 1.765 pg/mL [1.592; 1.937]; p 0.05) and chromogranin Π (elevation to 31.3 g/L [13.9; 90.7]; p 0.05). Re-assessment demonstrated association between changes in the pattern of the nitrogen oxide system, which tends to improve (NO elevation to 38.23 mol/L [32.95; 43.51]; p 0.001), and atheroprotective shift in the morphology of atherosclerotic plaques and biomarker profile.
Conclusion. Prospective, 1-year long observation for patients who underwent CAS for symptomatic/asymptomatic hemodynamically significant ICA stenoses revealed favourable atheroprotective shift in both ultrasound and hematological atherogenesis biomarker ratio. This shift contributed to the absence of cerebral atherosclerosis progression during the follow-up. The process may be mediated by chromogranin Π and osteoprotegerin, and their further research is needed from perspective of atherogenesis