CC BY
79
UDC 616.12-008.331.1:616.15-07 doi.org:10.31684/2541-8475.2019.1(13).43-45
PROGNOSTIC IMPORTANCE OF INFLAMMATION MARKERS (C-REACTIVE PROTEIN AND INTERLEUKIN-6) IN PATIENTS WITH ARTERIAL HYPERTENSION
Altai State Medical University, Barnaul
N.V. Vostrikova, D.V. Fyodorov, E.E. Klimova, K.M. Bishevsky
The article describes the results of the research of 54 patients aged from 34 to 86 years having essential arterial hypertension. The results obtained reveal the increase of C-reactive protein and interleukin-6 in such patients. High frequency of revealing of abovementioned acute phase indices is noted as well, which may be of prognostic importance concerning the development and course of cardiovascular pathologies. Key words: arterial hypertension, acute phase indices.
Arterial hypertension (AH) is the leading risk factor for atherosclerosis and its complications being the cause of the apoplectic attack and myocardial infarction [1, 2, 3]. According to the modern concept of atherogenesis, atherosclerosis is a prolonged sluggish chronic inflammation in the intima of the vessel [4]. This concept allows to see the connection between the mediators of inflammation and the risk factors of atherosclerosis. Low-active sluggish inflammation prospectively determines the risk of development of these complications. Previously, there was evidence that neutrophils generalize endothelium inflammatory changes, and this activation of pro-inflammatory factors can be witnessed in the systemic circulation [5]. Therefore, the study of the content of the main inflammation markers - interleukin-6 (IL-6) and C-reactive protein (CRP) - in patients with AH can provide information on the progression of the atherosclerotic process.
The research objective is to study the content of the most important inflammation reaction markers, that is CRP and IL-6, in patients with essential arterial hypertension.
Materials and methods
We examined 54 patients (12 men and 42 women) aged 34-86 (the mean age is 65.5±1.6). The mean duration of the AH amounted to 17±1.0 years. 22 patients had a high risk of the target organs damage and cardiovascular complications. A very high risk of cardiovascular complications was established in 31 patients by the presence of associated diseases, including 15 patients with arterial hypertension in anamnesis having the episodes of atherothrombosis (acute myocardial infarction, acute cerebral circulation disorder).
The study did not include people with a malignant form of the arterial hypertension, symptomatic hypertension, acute inflammatory processes and chronic ones at the stage of the recrudescence, renal and hepatic pathology, hematological diseases, oncological diseases,
alcoholism, drug addiction, diffuse connective tissue diseases, mental diseases, chronic heart failure of the III-IV functional classes of the New York Heart Association, and the presence of hemodynamically significant heart defects. The control group consisted of 49 practically healthy people under the age of 40.
The content of IL-6 and CRP in the blood serum was analyzed with the immunoenzymatic method. The studies were carried out on the Uniplan device with the help of the set of reagents Human IL-6 ELISA produced by the Bender MedSystems, Austria and the set of Hs-CRP ELISA produced by the Biomerica, USA.
To assess the risk of the cardiovascular disease progression, the level of CRP was used [6]. A group with a high risk of the cardiovascular disease progression was formed among patients with arterial hypertension with a concentration of CRP being over 3.0 mg/l.
The statistical analysis of the results was carried out using the SPSS 9 software package for Windows. Results are presented in the form of: arithmetic mean (X) ± error of mean (m). The statistical significance of differences in the samples was assessed at p<0.05. Linear correlation analysis was used to assess the severity of the correlation of indicators.
Results and discussion
The world literature compiles the great material, on the basis of which the unfavourable prognostic role of CRP in relation to the development and course of the cardiovascular pathology is recognized [6, 7, 8, 9, 10]. That is why we considered it necessary to determine the mean values and frequency of increase of these indicators in patients with arterial hypertension. The study of 54 patients with arterial hypertension revealed the increase of the CRP level - 8.66±0.88 mg/l (p<0.001) compared to the similar indicators in the control group — 1.74±0.11 mg/l. The data obtained comply with the results of studies of other authors which
described the increase of the CRP level in patients with cardiovascular system diseases, including arterial hypertension [11, 12, 13].
Among the patients surveyed, only 4 people had normal CRP values. We found a moderate increase in the CRP level in 11 patients. We discovered a high risk of cardiovascular disease progression (the content of CRP was over 3.0 mg/l) in 39 patients (72%) with arterial hypertension. The high frequency of increase of CRP indicates the significant role of this marker in the pathogenesis of arterial hypertension.
The concentration of interleukin-6 in patients with AH was also reliably higher than in patients of the control group and averaged 5.8±0.6 pg/ml and 1.3±0.08 pg/mg respectively (p<0.001).
Since interleukin-6 is a pro-inflammatory cytokine involved in the implementation of the immune response in an inflammatory reaction, it seems that a reliable increase of this indicator is the reflection of the inflammatory process occurring in the arterial wall in patients with arterial hypertension.
The increased content of interleukin-6 (79.6%) was found in 43 patients with arterial hypertension.
Earlier it was shown that IL-6 is able to activate the liver production of the protein of the acute phase of the C-reactive protein inflammation, fibrinogen, complement components, etc. That is why we conducted a correlation analysis between IL-6 and CRP levels in patients with arterial hypertension. As a result, a weak positive correlation relationship was revealed (r=0.34; р=0.011), which confirms earlier information that interleukin-6 controls the CRP synthesis. The presence of a relationship between the CRP and interleukin-6 levels in patients surveyed suggests a significant role of these inflammation markers in the pathogenesis of arterial hypertension.
Conclusions
1. A high level of acute phase indicators reveals in patients with arterial hypertension: CRP in 72% of cases, interleukin-6 in 79.6% of cases.
2. There is a positive correlation relationship between the interleukin-6 and CRP levels in patients with arterial hypertension.
Conflict of interest. The authors declare that there is no conflict of interest.
References:
1. Burmistrova A.L., Shmunk I.V., Suslova T.A., Grigoricheva E.A. HLA and cytokines in patients with essential arterial hypertension. Allergology and Immunology.. 2006; 7(3): 343-344.
2. Vaulin N.A. Endothelium disfunction in arterial hypertension: focus on nebivolol. Systemic Hypertensions. 2009; 1: 11-14.
3. Guideline for arterial hypertension. Ed. E.I. Chazov, I.E. Chazova. M., 2005: 734.
4. Gogin E.E. Hypertensive disease and associated diseases of the circulatory system: basics of pathogen-esis, diagnostics and choosing of treatment. M., 2006: 254.
5. Koryakina L.B., Pivovarov Yu.I., Kurilska-ya T.E. et al. Vessel endothelium disfunction in arterial hypertension and ischemic heart disease (literature overview). Bulletin VSNC SO RAMN. 2013. 2-1 (90): 165-170.
6. Gusev D.E., Ponomar' E.G. Role of C-reac-tive protein and other markers of acute inflammation phase. Clinical Medicine. 2006; 3: 25-30.
7. Dmitriev V.A., Oshchepkova E.V., Titov V.N. C-reactive protein and arterial hypertension: is there a connection? Therapeutic archive. 2006; 5: 86-89.
8. Titov V.N. C-reactive protein: physical and chemical features, methods for determination and diagnostic value. Clinical laboratory diagnostics. 2004; 4: 3-9.
9. Antonova A.B., Shevchenko A.O., Ko-chetova E.V. Diagnostic value of PAPP-A and inflammation markers in acute coronary syndrome. Bulletin of RSMU. 2005; 42: 3-5.
10. Zadionchenko V.S, Adasheva T.V., San-domirskaya A.P. Endothelium disfunction and arterial hypertension: therapeutic possibilities. Russian Medical Journal. 2002; 10(1): 11-15.
11. Fichtlscherer S, Rosenberger G, Walter DH. et al. Elevated C-Reactive Protein Levels and Impaired Endotelial Vasoreactivity in Patients With Coronary Artery Disease. Circulation. 2000; 102(9): 1000-1006.
12. Shilkina N.P., Yunonin I.E., Stolyarova S.A., Mikhailova E.V. Arterial hypertension and systemic inflammatory process: modern state of problem. Therapeutic archive. 2008; 5: 91-96.
13. Danesh J, Whiter JG, Hirshfeld GM. et al. C-Reactive Protein and Other Markers of Inflammation in the Prediction of Coronary Heart Disease. N Engl J M. 2004; 350(14):1387-1397.
Contacts
Corresponding author: Vostrikova Natalya Vladimirovna, Candidate of Medical Sciences, Associate Professor of the Department of Nursing, Altai State Medical University, Barnaul. 656038, Barnaul, Lenina Prospekt, 40. Tel.: 8 (913) 0969323. E-mail: [email protected]
Author information
Fyodorov Dmitry Vladimirovich, Doctor of Medical Sciences, Professor, Head of the Department of Nursing, Altai State Medical University, Barnaul. 656050, Barnaul, ul. Malakhova, 53a. Tel.: (3852) 402147. E-mail: [email protected]
Klimova Elena Evgenyevna, Candidate of Medical Sciences, Assistant of the Department of Nursing, Altai State Medical University, Barnaul. 656038, Barnaul, Lenina Prospekt, 40. Tel.: (3852) 366128. E-mail: [email protected]
Bishevsky Konstantin Mikhailovich, Candidate
of Medical Sciences, Associate Professor of the
Department of Nursing, Altai State Medical
University, Barnaul.
656038, Barnaul, Lenina Prospekt, 40.
Tel.: (3852) 366128.
E-mail: [email protected]
