Kovalyova Yu. O.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

Coronary heart disease (CHD) is wides pread among cardiovascular diseases (22,4% of the total incidence) and it’s a major cause of disability (32%) and mortality in Ukraine and economically prosperous countries. Angina pectoris is the most common form of CHD. The purpose of the research – to define violations of inflammation markers and leptin in patients with angina pectoris with obesity. Methods and objects of research. The study conducted at the Kharkov city clinical hospital № 27 with enrolled 46 patients. Diagnosis was stable angina (SA) II and III functional class (FC). Patients were at age 48 – 69 years (avg. age — 58,6 ± 8,7 years) with disease duration from 1 to 15 years (avg. duration — 7,8 ± 4,7 years). In 18 patients from comparison group with SA was normal body mass (NBM) and in 28 patients — obesity 1-stg. Duration of obesity was 11,2 ± 3,6 years. The control group consisted of 20 people (8 — men and 12 — women, whose average age was 54,26 ± 4,2 years) and who met the age and sex of patients examined. Deep examination, including instrumental and biochemical blood tests, didn’t found signs of the SA and obesity. Body weight was assessed by body mass index, recommended by the WHO. The optimal BMI is in the range 18,5 – 24,9 units. The criterion of overweight was a BMI of 25 – 29,9 units and obesity — more than 30,0 units. In addition to body weight and height were taken into account the waist-to-hip ratio (WHR), set the type of fat distribution: central type considered in women with WHR ± 0,85; men WHR ± 1,0. Results and Discussion. The content of tumor necrosis factor-α (TNF-α) has been studied in 44 patients, 16 of whom patients had SA case with NBM, 28 patients had SA with obesity. TNF-α content varied from 27,19 pg/ml to 96,43 pg/ml in patients with SA and was elevated in 97,9% of patients with SA and obesity, and almost all remaining patients had TNF-α level on the upper range of normal, and was significantly higher than the average level of TNF-α in patients with NBM (61,67 ± 5,04 pg/ml) in 1,2 times (p < 0,05) and in comparison with the control group in 1,79 times (p < 0,05 ). The level of anti-inflammatory interleukin-4 (IL-4) was reduced in all patients and was in the range from 2,13 pg/ml to 25,04 pg/ml and average level was 8,66 ± 1,97 pg/ml in patients with obesity. It was significantly lower in comparison with patients with NBM (12,25 ± 1,78 pg/ml ) in 0,71 times (p > 0,1) and in 2,11 times — in comparison with the control group (p < 0,05). Recently, special interest and discussions of researchers is devoted to nonspecific mediator of inflammation — C-reactive protein (C-RP). It is believed that, its level helps predict the degree of cardiovascular risk the same extent as total cholesterol content. C-RP level were investigated in 46 patients, 20 of them were with SA and NBM, and 26 had obesity. C-RP was elevated in 92,7% of patients with obesity and SA and its values was from of 2,5 mg/l to 8,0 mg/l with average 5,25 ± 0,45 mg/l. It was greater than in patients with NBM in 1,14 times (4,6 ± 0,45 mg/l) (p > 0,1) and in 2,1 times — in comparison with the control group (p < 0,05). Direct correlation between body mass index (BMI) and blood leptin levels was proved. Reducing body weight by 10% lead to 53% reduction of plasma leptin, one-two-day hunger strike – lead to 64-72% reduction, longterm – sharply reduces its critical level, and vice versa weight gain of 10% increases leptin level in 300%. The study of physiological and pathophysiological functions of leptin expands our knowledge of the mechanisms that regulate neuroendocrine function, body weight value and exchange energy. Understanding these mechanisms will contribute to the finding of new approaches to treatment and prevention of obesity. Leptin blood levels was measured in 44 patients with SA, and 22 patients with obesity were examined for comparison. In addition, comparative analysis was performed with regard to gender. For patients with NBM leptin levels in men (3,61 ± 0,31) ng/ml and women (7,28 ± 0,21 ng/ml) did not differ (p > 0,1) of the control group men 3,84 ± 0,71 ng/ml and women 7,36 ± 0,78 ng/ml. The highest value was in obesity males (5,43 ± 0,34 ng/ml), which was significantly more than 1,5 times from patients with NBM (p < 0,05) and in 1,41 times higher compared with the control group (p < 0,05). Women have seen similar patterns. The level of leptin in the blood of patients with SA and obesity (10,18 ± 0,31 ng/ml) was significantly (p < 0,05) 1,4 times higher than the figure for patients with NBM (7,28 ± 0,21 ng/ml) and in 1,38 times higher than the control group (p < 0,05). These trends were kept in general, in all examined groups. Conclusions: 1. It is shown increasing of the content of tumor necrosis factor-α and C-reactive protein in patients with stable angina with obesity and a significant decrease in patients with normal-weight patients, and it was a reduction of anti-IL-4 for obesity and increasing in patients from comparison group. 2. Increased level of fat hormone leptin was estimated in the blood serum of both sexes in stable angina patients with different body weight, especially in patients with obesity. Perspectives of further research is based on further study of the nature of the interrelationship between inflammatory mediators indices, hormones of adipose tissue in different variants of stable angina courses.

stable angina, obesity, leptin, C-reactive protein, tumor necrosis factor – alpha, interleukin-4

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