THE SENSITIVITY OF VASCULAR ENDOTHELIUM AND ITS PREDICTORS IN PATIENTS WITH CARDIOVASCULAR PATHOLOGY

Aim. To estimate the role of endogenous metabolic factors in formation of vascular endothelium reactivity in patients with different genesis cardiovascular regulation disorders.

Materials and methods. The research included 30 patients with ischemic heart disease (IHD) with stable form of exertional angina (EA) of II–III severity class, 30 patients with I–II stage and 1st–2nd degree essential hypertension (EH), and 15 clinically healthy volunteers. We researched the signs of functional state of vascular endothelium before and after occlusion test. The parameters investigated included: adhesion of thrombocytes, spontaneous aggregation, prostacyclin activity of blood plasma, levels of antithrombine-III, of von Willebrand factor, contents of malonic aldehyde, of nitrites, of endothelin-1, of membrane-connected haemoglobin, of methaemoglobin in erythrocytes, activity of angiotensineconverting enzyme, level of sorption on the membrane of erythrocytes of nucleotides. Research of hemorheology was performed by viscosimetry method.

Results. In healthy volunteers high probability of endothelium sensitivity to transverse strain decrease (in 82%) was determined and 25% increase of activity of peroxide oxidation of lipids. In patients with exertional angina influence of dynamic changes of blood flow on endothelium occurred by 2% decrease of viscosity and more than 120% increase of production von Willebrand factor (in 87%). It was concluded that as higher the production of prostacyclin in response to mechanic stimuli (more than 50%) is, the higher is probability of blood flow dynamic changes influence on endothelium. In patients with essential hypertension 30% increase of level of antithrombine-III in 100% of cases caused increase of sensibility of vascular endothelium to transverse strain.

Conclusion. The most significant factors linked with sensibility of endothelium of vascular wall to dynamic blood flow changes in examined groups of patients were determined. In patients with exertional angina vascular reaction was mostly linked with rheological qualities and adhesive-aggregation characteristics of blood. In patients with essential hypertension the sensitivity of vascular endothelium was implied to be concordant with anticoagulant activity of blood plasma.

1. Dysfunction endoteliya. Reasons, mechanisms, pharmacological correction. Ed. Petrishchev NN. SPb.: Izd-vo SPbGMU 2003; 184 р. Russian (Дисфункция эндотелия. Причины, механизмы, фармакологическая коррекция. Ред. Петрищев Н. Н. СПб.: Изд-во СПбГМУ 2003; 184 с).

2. Andreeva EO, Kuril’skaia TE, Pivovarov JuI, et al. Dysfunction an endoteliya of a vascular wall at patients with coronary heart disease. Klinicheskaja medicina 2009; 87; 12: 23–7. Russian (Андреева Е. О., Курильская Т. Е., Пивоваров Ю. И. и др. Дисфункция эндотелия сосудистой стенки у больных ишемической болезнью сердца. Клиническая медицина 2009; 87; 12: 23–7).

3. Kirichuk VF. Dysfunction endoteliya. Saratov: Izd-vo SGU, 2008; 129 р. Russian (Киричук В. Ф. Дисфункция эндотелия. Саратов: Изд-во СГУ 2008; 129 с).

4. Bonetti P. Endothelial dysfunction — a marker of atherosclerotic risk. Arterioscler Thromb Vasc Biol 2003; 23 (2): 168–75.

5. Cooke JP, Flow, NO and atherogenesis. Proc Natl Acad Sci 2003; 100: 768–70.

6. Petrishchev NN. Pathogenetic value of dysfunction endoteliya. Omsk nauch vestn 2005; 1: 20–2. Russian (Петрищев Н. Н. Патогенетическое значение дисфункции эндотелия. Омск науч вестн 2005; 1: 20–2).

7. Petrishchev NN, Vasina LV. Typical forms of endothelial dysfunction. Kliniko-laboratornyi konsilium 2007; 18: 31–5. Russian (Петрищев Н. Н., Васина Л. В. Типовые формы дисфункции эндотелия. Клинико-лабораторный консилиум 2007; 18: 31–5).

8. Lupinskaja ZA, Zarif’jan AG, Gurovich TS, et al. Endotely function and dysfunction. Bishkek: KRSU, 2008; 273 р. Russian (Лупинская З. А., Зарифьян А. Г., Гурович Т.С Эндотелий функция и дисфункция. Бишкек: КРСУ, 2008; 273 с).

9. Vavilova TV. Hemostasiology in clinical practice. SPb.: Izd-vo SPbGMU 2005; 92 р. Russian (Вавилова Т. В. Гемостазиология в клинической практике. СПб.: Изд-во СПбГМУ 2005; 92 с).

10. Pervushin IuV, Rogova SSh, Kovalevich NI, et al. Laboratory methods of hemostasis and diagnostics of system of blood coagulation. The tutorial. Stavropol’-Moskva: Izd-vo M. 2009; 64 р. Russian (Первушин Ю. В., Рогова С. Ш., Ковалевич Н. И. и др. Лабораторные методы исследования системы гемостаза и диагностика нарушений системы гемокоагуляции. Учебное пособие. Ставрополь-Москва: Изд-во М. 2009; 64 с).

11. Reference laboratory research methods edited by Danilova LA. Moskva: Izd-vo M. 2003; 733 р. Russian (Справочник по лабораторным методам исследования под ред. Даниловой Л. А. Москва: Изд-во М. 2003; 733 с).

12. Pacher P, Beckman JS, Liaudet L. Nitric oxide and peroxynitrite in health and disease. Physiol. Rev 2007; 87 (1): 315–424.

13. Kuznik BI. Cellular and molecular mechanisms of regulation of hemostasis system in norm and pathology. Chita: Ekspress-izdatel’stvo 2010; 832 р. Russian (Кузник Б. И. Клеточные и молекулярные механизмы регуляции системы гемостаза в норме и патологии. Чита: Экспресс-издательство 2010; 832 c).

14. Endemann DH, Schiffrin EL. Endothelial dysfunction. J Am Soc Nephrol 2004; 15: 1983–92.

15. Turner NA, Nolasco L, Tooz, et al. Human Endothelial cell synthesize and Release ADAMTS-13. J Thromb Haemost 2006; 4: 1396–404.