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Section 5. Medical science
destruction [7; 8]. The modern anti-cancer therapy is based on the targeted therapy or the new generation Immuno drugs that may enhance the anti-tumor immune response. The results show that the polymorphism rs231775 CTLA4 gene not found significant differences in the distribution of genotypes and allele frequencies between the main group and the control group. However, there is
a slight tendency to increase the number of heterozygous A/G and A allele of rs231775 * in the control group compared to patients (50.0 % and 41.2 %, respectively) that requires confirmation on larger sample of patients. Also, the study of interactive regulation of systemic inflammation cytokines to create new approaches treat hematological diseases.
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A/A A/G G/G
Fig. 1. The frequency of alleles and genotypes distribution of polymorphism A49G gene CTLA 4 in the groups of patients
References:
Боголюбова А. В., Ефимов Г. А., Друцкая М. С., Недоспасов С. А. Иммунотерапия опухолей, основанная на блокировке иммунологических контрольных точек//Медицинская иммунология. - 2015. - Т. 17, № 5. - С. 395-406.
Howard T. A., Rochelle J. M., Seldin M. F. CD28 and CTLA-4, two related members of the Ig supergene family, are tightly linked on proximal mouse chromosome//Immunogenetics. - 1991. - Vol. 33, no. 1. - Р. 74-76.
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Kamilova Umida,
Republican Specialized Scientific-Practical Medical Center of Therapy and Medical Rehabilitation JSC, Prof Uzbekistan E-mail: umida_kamilova@mail.ru Usupov Donyor,
Fergana Branch of the Republican Emergency Care Research Center
Evaluation of endpoints in patients with myocardial infarction
Abstract: the aim of the study of evaluation of endpoints in patients with myocardial infarction. Determination of early predictors ofpoor prognosis in patients with myocardial infarction identifies patients at high cardiovascular risk and poor prognosis. Keywords: myocardial infarction, prognosis, endpoints.
Evaluation of endpoints in patients with myocardial infarction
High mortality of patients, as well as the fact that a significant part of them subsequently developed heart failure, cardiac arrhythmias, reinfarction, renewed angina, which degrade the quality of life and limit disabled patients [1; 2] is determined by the social significance of suffering a acute myocardial infarction (AMI). Such a high medical and social significance of myocardial infarction (MI) requires further improvement of its methods of early diagnosis, effective treatment and secondary prevention [3]. The ability to predict the nature of the adverse postinfarction LV remodeling is tantamount to identify opportunities in the early period of myocardial infarction at high risk for cardiovascular events and cardiac death in long-term period. There are a number of indicators that show a high probability of poor prognosis after myocardial infarction: patient's age, the presence of myocardial infarction, disturbance of systolic and diastolic function of the left ventricle (LV), ventricular arrhythmias in the history of ventricular fibrillation, the front or anterior-inferior myocardial infarction, unstable angina, the progression of heart failure. Several multicenter clinical and retrospective studies have demonstrated the diversity and complexity of the factors determining the prognosis of AMI [4; 5].
Purpose of research was to study of evaluation of endpoints in patients with myocardial infarction.
Material and methods
The study included 76 male patients with primary Q-wave MI, not older than 10 days between the ages of 29 to 60 years. Diagnosis is based on the WHO criteria for the presence of the following symptoms: typical anginal pain attack or its equivalent for at least 30 minutes; appearance of pathological Qwaves or QS in two or more ECG leads. The stationary phase of AMI treatment was carried out in accordance with recommendations for management of patients with myocardial infarction with elevation segment ST (ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation; 2012) and included thrombolytic therapy if indicated, early administration of
20 n 18,4
beta-blockers, antiplatelet agents, anticoagulants, as well as nitrates (including intravenously), statins, ACE inhibitors, diuretics. According to the study plan, the final analysis included data of patients who within one year from the start of them to develop meaningful clinical outcomes: death, recurrent nonfatal MI; occurrence or progression of heart failure or coronary artery disease destabilization that required hospitalization. All patients were informed about the protocol and agreed to participate in the study. Exclusion criteria included: age over 60 years; permanent form of atrial fibrillation; hypotension (blood pressure < 100/60 mm. Hg.); comorbidities that can independently affect the prognosis of life or remodeling of the left ventricle (heart defects, severe and malignant hypertension, cancer, lung disease, liver and kidney dysfunction of these organs; severe or decompensated diabetes, the effects of acute stroke; symptoms of circulatory failure in history).
Results and Discussion
We have evaluated the forecast in the studied groups ofpatients. The analysis showed that in 1 years offollow-noted development reinfarction in 14 (18.4 %) cases, including 5 (6.6 %) fatal and nonfatal — 9 (11.8 %), and 6 (7.9 %) cases of sudden death (Fig. 1). Depending on the development ofreinfarction analysis on various factors showed that recurrent MI was significantly more likely to develop at the rear location of the primary IM (x2 = 13.25; P = 0.001), and the statistical significance of this distribution is preserved as in the case of a fatal (x2 = 20.1; P = 0.0001), and nonfatal MI (x2 = 18.366; P = 0.001).
Availability initially cardiac arrhythmia also significantly influences the development of reinfarction: in the group with cardiac arrhythmia in 10.5 % of cases developed reinfarction (P < 0.001). Analysis of prognostic parameters showed that patients who developed adverse outcomes for extended surveillance had a greater number of heart rate, lower left ventricular ejection fraction less than 40 %.
Conclusion. Determination of early predictors of poor prognosis in patients with myocardial infarction identifies patients at high cardiovascular risk.
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a Rate of re hos. BRNFMI hRFMI sSD
Fig. 1. The endpoints after 1 years References:
Dorresteijn J. A., Visseren F. L., Wassink A. M. et al. Development and validation of a prediction rule for recurrent vascular events based on a cohort study of patients with arterial disease: the SMART risk score//Heart. - 2013. - 99: 866-872.
Puymirat E., Simon T., Steg P. G. et al. Association of changes in clinical characteristics and management with improvement in survival among patients with ST-elevation myocardial infarction//JAMA. - 2012. - 308(10): 998-1006.
Brieger D., Fox K. A., Fitzgerald G. et al. Predicting freedom from clinical events in non-ST-elevation acute coronary syndromes: the Global Registry of Acute Coronary Events//Heart. - 2009. - 95: 888-894.
Dunlay S. M., Weston S. A., Killian J. M. et al. Thirty-day rehospitalizations after acute myocardial infarction: a cohort study//Ann Intern Med. - 2012. - 157(1): 11-18.
ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation; 2012//European Heart Journal. - 2012. - 33: 2569-2619.
