Zaikina T. S.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

The new markers sCD40-ligand and sVE-cadherin reflect the presence and degree of endothelial dysfunction manifestation. In spite of the high interest to the search of new criteria for predicting the AMI course, the role of sCD40L, sVE-cadherin has not been studied enough. The aim of study was to elaborate the prediction model of hospital mortality in the patients with acute myocardial infarction and type 2 diabetes mellitus. Materials and methods: The study included 60 patients with AMI and type 2 DM (among them 33 (55%) women and 27 (45%) men). The patients were divided into two groups depending on the outcome of acute period of myocardial infarction: group 1 ‒ 7 patients died during the acute period of myocardial infarction; group 2 ‒ 53 patients, survives during acute period of myocardial infarction. sVE-cadherin blood serum level and sCD40L level were determined with commercial enzyme linked immunosorbent assay ELISA kit, and all these were performed with Automated EIA Analyzer «LabLine-90» (Austria). Levels of total cholesterol, LDL, VLDL, HDL and TG were measured biochemically. QUICKI index was measured mathematically. The data were processed statistically with Microsoft Office Excel software: the mean arithmetial value (М) and standard error of the mean (m) were calculated, for estimated probability and validity of the obtained data, Student’s t-test (р) was done. For risk stratification modeling, stepwise logistic regression SPSS method was used. Results and discussion. To evaluate the risk of hospital mortality within acute period of myocardial infarction in the patients with type 2 DM a prediction model was built by stepwise logistic regression SPSS method. This model allows to divide all patients into the groups of high and low risk of fatal outcome by means of L calculation (logit, i. e., combination of values of predictive indices with coefficients which have the most predictive effect. L= -286.5+16.9*A+887.1*B+1.25*C, i.e. Y= 1/(1+EXP(286.5+16.9*A+887.1*B+1.25*C)), where Y ‒ the group of hospital death risk in AMI patients with DM2; А ‒ LDL level, mmol/L; B ‒ QUICKI; C ‒ correlation between sCD40L-ligand level at day 1 of AMI and sCD40L-ligand level, determined at day 10 of AMI, %. Diagnostic efficiency of the above mentioned model (percentage of right predictions) was 96.7%. Conclusions. With the aim to predict cardiovascular death within the acute period of myocardial infarction, the model of risk group stratification of the patients with concurrent type 2 diabetes mellitus was developed that will allow to increase survival and widen the possibilities of the treatment tactics for the patient management in this category.

acute myocardial infarction, diabetes mellitus, hospital mortality, short-term prognosis, endothelial dysfunction

• 1. Аметов А. С. Сердечно-сосудистые осложнения при сахарном диабете: патогенез и пути коррекции / А. С. Аметов, О. Л. Соловьева // Российский медицинский журнал. ‒ 2011. ‒ № 26. ‒ С. 1694.
• 2. Бернс С. А. Маркеры дисфункции эндотелия у больных острым коронарным синдромом без подъема сегмента ST с различной локализацией атеросклеротического поражения / С. А. Бернс, Е. А. Шмидт, Е. С. Юхно, Е. С. Киприна, О. Л. Барбараш // Российский кардиологический журнал. ‒ 2013. ‒ № 6. ‒ С. 17-22.
• 3. Гандзюк В. А. Аналіз захворюваності на ішемічну хворобу серця в Україні / В. А. Гандзюк // Український кардіологічний журнал. ‒ 2014. ‒ № 3. ‒ С. 45-52.
• 4. Коваленко В. М. Регіональні медико-соціальні проблеми хвороб системи кровообігу. Динаміка та аналіз. / В. М. Коваленко, В. М. Корнацький. ‒ К., 2013. ‒ 239 с.
• 5. Мальцева О. В. Прогностическая мощность различных моделей в определении уровня коронарного риска у больных с острым коронарным синдромом без стойких подъемов сегмента ST / О. В. Мальцева, З. М. Сафиуллина, С. В. Шалаев // Кардиология. ‒ 2012. ‒ № 4. ‒ С. 4-9.
• 6. Пархоменко О. М. Шкала оцінки ризику несприятливих віддалених наслідків інфаркту міокарда / О. М. Пархоменко, О. С. Гурєва, О. І. Іркін, С. П. Кушнір, О. В. Шумаков, С. М. Кожухов, О. А. Скаржевський // Серце і судини. – 2008. – № 4. – С. 73-76.
• 7. All-cause and cardiovascular mortality in middle-aged people with type 2 diabetes compared with people without diabetes in a large U.K. primary care data base / K. S. Taylor, C. J. Heneghan, A. J. Farmer [et al.] // Diabetes Care. ‒ 2013. ‒Vol. 36, № 8. ‒ P. 2366-2371.
• 8. B-cells regulate expression of CD40 ligand on activated T-cells by lowering the mRNA level and through the release of soluble CD40 / C. Van Kooten, C. Gaillard, J. P. Galizzi [et al.] // Eur. J. of Immunol. ‒ 1994. ‒ Vol. 24. ‒ P. 787-792.
• 9. Cardiovascular event rates in diabetic and nondiabetic individuals with and without established atherothrombosis (REACH Registry) / Michel Krempf, Klaus G. Parhofer, Gabriel Steg, Deepak L. Bhatt [et al.] // American Journal of Cardiology. ‒ 2009. ‒ Vol. 4, № 6. ‒ P. 1420-1425.
• 10. CD40 ligand+ microparticles from human atherosclerotic plaques stimulate endothelial proliferation and angiogenesis a potential mechanism for intraplaque neovascularization / A. S. Leroyer, P. E. Rautou, J. S. Silvestre [et al.] // J. Am. Coll. Cardiol. ‒ 2008. ‒ Vol. 52, № 16. ‒ P. 1302-1311.
• 11. Cell adhesion dynamics at endothelial junctions: VE-cadherin as a major player / D. Vestweber, M. Winderlich, G. Cagna [et al.] // Trends Cell Biol. ‒ 2009. ‒ Vol. 19, № 1. ‒ P. 8-15.
• 12. Elevated concentration of soluble vascular endothelial cadherin is associated with coronary atherosclerosis / T. Soeki, Y. Tamura, H. Shinohara [et al.] // Circ. J. – 2009. ‒ Vol. 68. ‒ P. 1-5.
• 13. Increased levels of endothelial microparticles CD 144 (VE-Cadherin) positives in type 2 diabetic patients with coronary noncalcified plaques evaluated by multidetector computed tomography (MDCT) / S. Bernard, R. Loffroy, A. Sérusclat [et al.] // Atherosclerosis. – 2009. ‒ Vol. 203, № 2. ‒ P. 429-435.
• 14. Rautou P. E. Micriparticles, vascular function and atherothrombosis / P. E. Rautou, A. C. Vion, N. Amabile // Circ. Res. ‒ 2011. ‒ Vol. 109, № 5. ‒ P. 593-606.
• 15. Risk of cardiovascular disease and all cause mortality among patients with type 2 diabetes prescribed oral antidiabetes drugs: retrospective cohort study using UK general practice research database / I. Tzoulaki, M. Molokhia, V. Curcin [et al.] // British medical J. ‒ 2009. ‒ Vol. 339. ‒ P. 4731.
• 16. Soluble CD40 ligand is associated with angiographic severity of coronary artery disease in patients with acute coronary syndrome / W. Zhao, F. Zhang, Z. Li [et al.] // Chin. Med. J. ‒ 2014. ‒ Vol. 127, № 12. ‒ P. 2218-2221.
• 17. Steg G. for the GRACE Investigators. Baseline Characteristics, management practices, and in-hospital outcomes of patients hospitalized with acute coronary syndromes in the Global Registry of Acute Coronary Events (GRACE) / G. Steg, R. J. Goldberg, J. M. Gore [et al.] // Am. J. Cardiol. – 2002. – Vol. 90. – P. 358-363.

«Bulletin of problems biology and medicine» Issue 1 part 1 (126), 2016 year, 167-170 pages, index UDK [616.127‒005.8‒036.11+616.379‒008.64]‒036.88‒037