[Prognostic factors in patients with non-ST-segment elevation acute coronary syndrome concurrent with type 2 diabetes mellitus (according to the results of the registry)]. / Faktory prognoza u patsientov s ostrym koronarnym sindromom bez pod''ema segmenta ST v sochetanii s sakharnym diabetom 2-go tipa (po rezul'tatam registra).

AIM: To investigate factors that influence annual prognosis in patients with non-ST-segment elevation acute coronary syndrome ((NSTEACS) concurrent with type 2 diabetes mellitus (DM2). SUBJECTS AND METHODS: The registry of patients with NSTEACS (non-ST-segment elevation myocardial infarction (NSTEMI), unstable angina) included 415 patients, of them 335 had no carbohydrate metabolic disorders, 80 had DM2. The follow-up period, during which the prognosis was evaluated in the patients, was one year after hospital discharge following the index NSTEACS event. Lipidogram readings and the serum levels of endothelin-1 (ET-1), sP-selectin, sE-selectin, and sPECAM were determined on day 10 after admission to hospital. All the patients underwent coronary angiography (CA), Doppler ultrasound of peripheral arteries during their hospital stay. RESULTS: The patients with DM2 versus those without diabetes proved to be significantly older and to have a higher body mass index; among them there were more women, they were noted to have more frequently hypertension and less frequently smoked. The presence of DM2 was associated with significantly increased intima-media thickness and higher GRACE scores (p=0.013) as compared to those in the patients with normal carbohydrate metabolism. There were significant differences in high-density lipoprotein levels that were lower, as well as in triglyceride levels and atherogenic index, which were higher in patients with DM2 than in those without this condition. In addition, there were significant differences in ET-1, sP-selectin, sE-selectin, and sPECAM levels that were significantly higher in the DM2 group. Moreover, the levels of ET-1 and sPECAM were above normal in both the DM and non-DM2 groups. Assessment of poor outcomes at one year of the observation established that cardiovascular mortality rates were significantly higher and coronary angiography was performed much less frequently in the DM2 group. The most significant prognostic factors associated with a poor prognosis were as follows: multifocal atherosclerosis, reduced left ventricular ejection fraction (LVEF) less than 51%, and increased ET-1 levels more than 0.87 fmol/ml. CONCLUSION: The register-based study has shown that the presence of DM2 statistically significantly increases cardiovascular mortality rates during a year after the index ACS event; the patients of this category are less commonly referred for CA for the estimation of the degree of coronary bed lesion. The most important factors of recurrent cardiovascular events in patients with DM2 within a year after prior ACS are multifocal atherosclerosis, reduced myocardial contractility (LVEF less than 51%), and increased vasospastic endothelial function (an increase in ET-1 levels more than 0.87 fmol/ml).

[C-REACTIVE PROTEIN AS AN INDICATOR OF RISK OF CARDIOVASCULAR COMPLICATIONS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS AND ITS CORRECTION].

The study included 74patients (22 men and 52 women) aged 48-75yr with type 2 diabetes mellitus (DM2). 62 (88,6%) of them had grade II hypertensive disease (grade II-III by the WHO/ISH-2010 classification), 46 (67%) presented with II- III class functional stable angina of effort, 7 patients survived myocardial infarction, two ones underwent coronary artery stenting. Patients of the main group (n=50) received oral hypoglycemic agents in combination with 1-exenatide (mimetic of glucagon-like peptide) in the form of two daily subcutaneous injections of 5 mcg for 1 month and 10 mcg during the next 5 months. Control patients (n=20) were given standard hypoglycemic therapy. Analysis of highly sensitive CRP demonstrated its increase to 3 mg/l and more in 72.8% of the patients that was responsible for the high risk of cardiovascular disorders. 22,8% of the patients had a CRP level 1,0-2,9 mg/l (moderate risk) and only in 4,2% it was lower than 1 mg/l (low risk). Six months of exenatide therapy resulted in normalization of glycemia, glycated hemoglobin and significant decrease of CRP level which suggested the improvement of the functional state of vascular endothelium due to reduction of chronic inflammation objectively reflected in the highly sensitive CRP level.

[THE RELATIONSHIP BETWEEN POLYMORPHISMS OF G-1082A AND C-592A LOCI OF THE IL10 GENE AND MULTIFOCAL ATHEROSCLEROSIS IN PATIENTS WITH ACUTE CORONARY SYNDROME WITHOUT SEGMENT ST ELEVATION].

AIM: To study the relationship between polymorphous G-1082A (rs3024491) and C-592A (rs1800872) variants of the IL10 gene and multifocal atherosclerosis (MFA) in patients with acute coronary syndrome (ACS) without segment ST elevation. MATERIALS AND METHODS: Genotypes of polymorphous G-1082A (rs3024491) and C-592A (rs1800872) variants of the IL10 gene were determined in 178 patients. Interleukin-10 (IL-10) level was measured in 93 of them using solid-phase immunoenzymatic assay. All patients underwent visualization of coronary and peripheral arteries. RESULTS: C-592A (rs1800872) polymorphism ofthe IL10 gene tended to be associated with type 2 diabetes mellitus in the carriers of the CC (gg) genotype and with elevated concentration of high density lipoproteins and reduced intima-media thickness in the carriers of the AA (tt) genotype. The frequency of MFA in the carriers of different genotypes of rs1800872 polymorphism was practically identical while the CA(gt) genotype was associated with more severe manifestations of atherosclerosis and AA(tt) genotype with lower frequency of peripheral artery stenosis. Patients with AA(tt) genotype of rs1800872 polymorphism had higher IL-10 levels. No relationship between rs3024491 polymorphism of IL10 gene, blood IL-10 level, clinical risk factors, and MFA was documented. CONCLUSION: CC (gg) genotype of C-592A (rs1800872) polymorphism of the IL10 gene in patients with acute coronary syndrome (ACS) without segment ST elevation was associated with type 2 diabetes mellitus while the AA(tt) genotype of the same polymorphism with elevated concentration of high density lipoproteins, reduced intima-media thickness, low frequency of peripheral artery stenosis, and increased IL-10 production. CA (gt) genotype of rs1800872 polymorphism of the IL10 gene was associated with MFA.

[Hyperglycemia as a risk factor of complicated acute myocardial infarction in patients of elderly and senile age].

AIM: To study clinical manifestations and functional state of myocardium in diabetic patients and in patients of elderly and senile age with myocardial infarction (MI) free of type 2 diabetes mellitus (DM) with transient hyperglycemia (HG). MATERIALS AND METHODS: The study included 170 patients with acute macrofocal and transmural MI (with Q-wave). They were divided into group 1 comprised of diabetic patients with MI (n = 60; 36 men and 24 women; age median 78.0 (72.5-83.0 years)), group 2 with MI and TH (n = 60, 38 men, 22 women having no diabetes or disturbances of carbohydrate metabolism in the history; age median 77 (67.0-81.0 years)), and group 3 (n = 50, 28 men, 22 women with MI and normal glycemia in the acute period; age median 73.5 (66.0-83.0 years)). RESULTS: Diabetic patients with TH more frequently than normoglycemic ones showed complicated acute Iaccompanied by acute left ventricular insufficiency, arrhythmia, and lethal outcome. Decrease of their left ventricular systolic function was more pronounced than in controls. Patients with MIIand DM and those with MI and TH had a higher frequency of mitral regurgitation. CCONCLUSION:Hvyerglycemia is significant for the evaluation clinical course and outcome of Ml.

[Vegetative status in pregnant and perimenopausal women with hypertension].

We observed 137 patients, 72 of whom (53%) had hypertension in II trimester of pregnancy, and 65 patients (47%) who had hypertension in perimenopausal period. The comprehensive clinical and instrumental examination was carried out in all patients, including simultaneous 24-hour ambulatory blood pressure (BP) recording (with BP pattern), assessment of vegetative tone using the vegetative index (index Kerdo). Sympathetic/adrenergic activity (SAA) was quantified as ß-receptor binding (ß-RB). Hypertension in pregnant women is associated with increased activity of the sympathetic-adrenal system, as evidenced by high values of ß-ARM, the Kerdo index and the presence of correlation between these parameters. Parasympathicotonia in perimenopausal women prevails.

[Microcirculatory parameters in patients with myocardial infarction].

AIM: To estimate the prognostic value of the parameters of the microcirculatory bed for the assessment of risk for in-hospital death and cardiovascular events in patients with myocardial infarction (MI). SUBJECTS AND METHODS: Thirty (62.5%) and 18 (37.5%) of 48 patients (mean age 63.5 +/- 10.2 years) admitted to an intensive care unit for acute coronary syndrome subsequently developed MI in the anterior and lower walls of the left ventricle (LV), respectively. RESULTS: According to the GRACE scale, 28 (58.3%), 7 (14.6%), and 13 (18.1%) patients had high, low, and moderate risks for in-hospital death, respectively. Uncomplicated MI was noted in 18 (37.5%) of the patients; acute LV aneurysm was formed in 12 (25%); 14 (29.1%) had cardiac arrhythmias as frequent ventricular and supraventricular premature beats, paroxysms of ventricular fibrillation, ventricular tachycardia, atrial fibrillation and flutter. Early post-infarction angina pectoris was noted in 2 (4.2%) patients, Killip Class I and II heart failure in 36 (75%) and 12 (25%), respectively; 3 patients died (2 from myocardial rupture and 1 from ventricular fibrillation). According to GRACE scores, complicated MI was significantly more frequently encountered in patients at high risk for in-hospital death (75% versus 28.5% in those at low risk; p = 0.03). Analysis of the microcirculatory bed revealed substantial changes in microcirculation (MC), which reflected its hypereremic type and characterized high perfusion and high MC flow index. Moreover, the coefficient of variation (CV) was significantly higher than that in the control; on days 4 and 20 it did not virtually differ from that in the control on day 2. CONCLUSION: The found changes in MC parameters (MC value and CV) may suggest the higher influence of active mechanisms for regulation of vascular tone as a response to myocardial necrosis. The role of the autonomic nervous system in the regulation of vascular tone is supported by the significant change in the normalized amplitudes of low- and high-frequency oscillations while the intravascular resistance index remained considerably higher at all follow-up stages, which may suggest that central hemodynamics is unstable in patients with MI and necessitates monitoring of their clinical status.

[Effect of acetylsalicylic acid on the indicators of thrombocytic hemostasis in patients with myocardial infarction]. / Vliianie atsetilsalitsilovoi kisloty na pokazateli trombotsitarnogo gemostaza u bol'nykh infarktom miokarda.

The examination of 50 patients with acute myocardial infarction indicated that enhanced platelet functional activity was a prognostically unfavourable sign and associated with a higher risk for myocardial infarction complications. The application of aspirin, 250 mg daily, in patients with high platelet functional activity in the acute period of the disease failed to produce a beneficial antiaggregatory effect.

[Somatotropin, prolactin and thyrotropin levels of the plasma during the thyroliberin test in patients with non-insulin-dependent diabetes mellitus]. / Uroven' somatotropina, prolaktina i tireotropina v plazme krovi pri provedenii proby s tiroliberinom u bol'nykh insulin-nezavisimym sakharnym diabetom.

The paper is concerned with the assessment of hypophyseal somatotropic, prolactotropic and thyrotropic functions during the TRH test in patients with non-insulin-dependent diabetes mellitus with noticeable signs of diabetic retinopathy. No changes in hypophyseal somatotropic, prolactotropic and thyrotropic functions during the TRH test were noted in patients with non-insulin-dependent diabetes mellitus without diabetic microangiopathies.

[Levels of various pituitary and pancreatic hormones in the blood of patients with non-insulin-dependent diabetes mellitus]. / Uroven' nekotorykh gormonov gipofiza i podzheludochnoi zhelezy v krovi bol'nykh insulinonezavisimym sakharnym diabetom.

The level of pituitary hormones (somatotropin and prolactin) and pancreatic hormones (insulin and glucagon) was measured by radioimmunoassay in blood of patients with insulin-independent diabetes mellitus with and without diabetic microangiopathies, in the state of decompensation and during treatment. Forty-four patients aged 26 to 60 years were examined. Some patients with insulin-independent diabetes with and without diabetic microangiopathies demonstrated an elevation of blood insulin and glucagon. The blood somatotropin level was found to be increased in patients with insulin-independent diabetes mellitus with diabetic microangiopathies in the state of decompensation. No correlations were established between prolactin and insulin levels, somatotropin and insulin levels in the blood of patients with insulin-independent diabetes mellitus. During treatment, one could see a decrease in the somatotropin content and a tendency toward elevation in the insulin content and reduction in the glucagon level in patients with insulin-independent diabetes with diabetic microangiopathies.

[Somatotropin and prolactin levels in patients with insulin-dependent diabetes mellitus]. / Somatotropnyi gormon i prolaktin u bol'nykh insulinozavisimym sakharnym diabetom.

Radioimmunoassay was used to measure the content of somatotropic hormone and prolactin in the blood of patients with insulin-dependent diabetes in relation to the duration and degree of diabetic complications in a state of decompensation and during compensation. To have a more descriptive idea of the interrelation between prolactin and somatotrophic hormone (STH), the prolactin/STH index was introduced (the ratio of prolactin indicators to those of STH). Altogether 66 patients aged from 16 to 50 years were examined. A direct relationship was disclosed between an increase in the STH content and the degree of diabetic complications. The prolactin level was found to be elevated only in content was recorded in patients with a more long-term disease. During compensation, the patients with insulin-depended diabetes manifested a reduction in the STH level and an increase in the prolactin/STH index.

[Effect of thyroliberin on the prolactin and thyrotropic and somatotropic hormone content of the blood plasma in insulin-dependent diabetes mellitus]. / Vliianie tiroliberina na soderzhanie prolaktina, tireotropnogo somatotropnogo gormonov v plazme krovi u bol'nykh insulinzavisimym sakharnym diabetom.

Twelve men, aged 17 to 43 years, with insulin-depending diabetes mellitus were examined during the decompensation stage. The patients were divided into 2 groups, depending on the disease duration. The stage of the hypothalamic-hypophyseal system was evaluated according to the blood plasma STH, TTH and prolactin levels and after intravenous injection of the Soviet thyroliberin (TRH). A significant increase in the basal prolactin level is seen in the group of patients with prolonged insulin-depending diabetes during the decompensation stage. The blood plasma STH content rises in this group of patients after intravenous STH injection. The data obtained testify that the changes in somatotropic and prolactotropic hypophyseal functions occur in the patients with prolonged insulin-depending diabetes mellitus within the decompensation stage.