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TO STUDY THE ROLE AND FUNCTION OF LEUKOCYTES IN PATIENTS WITH
ACUTE MYOCARDIAL INFARCTION Mukhtarov S.A.1, Usmanova D.N.2
1Mukhtarov Saidorifkhon Abdukodirkhuja ugli - Master of Cardiology 3rd level; 2Usmanova Dilorom Nematyanovna - Candidate of Medical Sciences, Associate Professor, DEPARTMENT OF FACULTY THERAPY, ANDIJAN STATE MEDICAL INSTITUTE, ANDIJAN, REPUBLIC OF UZBEKISTAN
Abstract: the literature data on the prevalence of leukocytosis in myocardial infarction are summarized. Its pathophysiological mechanisms, influence on the course and outcomes of the disease depending on the treatment tactics are highlighted. The role of leukocytosis in myocardial infarction as a marker for risk stratification is assessed.
This article is based on a study of the literature on this situation. All information presented in the article was carefully analyzed during the study of the literature.
Keywords: myocardial infarction, leukocytosis, prognosis, risk stratification.
ИЗУЧИТЬ РОЛЬ И ФУНКЦИЮ ЛЕЙКОЦИТОВ У ПАЦИЕНТОВ С ОСТРЫМ
ИНФАРКТОМ МИОКАРДА Мухтаров С.А.1,Усманова Д.Н.2
1Мухтаров Саидорифхон Абдукодирхуджа угли - магистр кардиологии 3-й ступени; 2Усманова Дилором Нематьяновна - кандидат медицинских наук, доцент, кафедра факультетской терапии, Андижанский государственный медицинский институт, г. Андижан, Республика Узбекистан
Аннотация: обобщены данные литературы о распространенности лейкоцитоза при инфаркте миокарда. Освещены его патофизиологические механизмы, влияние на течение и исходы заболевания в зависимости от тактики лечения. Дана оценка роли лейкоцитоза при инфаркте миокарда как маркера для риск-стратификации.
Данная статья основана на изучении литературы по данной ситуации. Вся информация, представленная в статье, была тщательно проанализирована в ходе изучения литературы. Ключевые слова: инфаркт миокарда, лейкоцитоз, прогноз, риск-стратификация.
UDC 616.127-005.8: 616.155.391-07
Relevance. According to statistics, the number of acute myocardial infarctions (MI) in the world from 1988 to 2002 increased by 80% [4]. Despite the significant progress made in the treatment of acute MI over the past decades, this disease continues to be one of the main causes of cardiac death, including sudden death, in all developed countries of the world.
Patients who have had MI have a high risk of recurrent vascular events: 18% of men and 35% of women experience acute MI again over the next 6 years [6]. Therefore, the issue of predicting cardiac death, both sudden (SCS) and non-sudden (SCS), as well as recurrent MI (MI) remains very relevant. Moreover, the most important results on this topic were obtained in the 80-90s of the last century and in most cases were based on data from foreign multicenter clinical trials, which, as you know, have a number of limitations: a specific sample of patients, certain inclusion and exclusion criteria, and etc. It should also not be forgotten that the population of patients with myocardial infarction in our country has its own characteristics: younger age, the presence of a combination of risk factors, complicated course, and less frequent use of myocardial revascularization methods. Therefore, it is obvious that when assessing the prognosis of the disease, it is impossible to fully extrapolate foreign data to our patient population. In addition, if the predictors of VCS have always been studied quite extensively, then what specific factors contribute to the development of NVCS and PIM and whether they are of the same type remains unclear.
According to modern concepts, an important risk factor for VCS in patients after MI is systolic dysfunction of the left ventricular (LV) myocardium, determined mainly by a reduced ejection fraction (LV EF) [3, 7]. At the same time, it is generally accepted that with an LV EF of less than 20%, the frequency of VCS is lower than with its higher values [2]. Therefore, in addition to LV EF, other factors are also unfavorable. So, in recent years, the influence of other indicators characterizing the contractile function of the LV has been studied: LV size, impaired local contractility, as well as diastolic dysfunction (DD), left ventricular hypertrophy (LVH), etc. However, the question of the prognostic value of all these parameters in patients survivors of MI remains the subject of debate. Currently, there is an increase in the number of scientific papers devoted to the study of inflammatory blood markers, including cytokines, as well as apoptosis and the functional activity of various classes of leukocytes in heart pathology. But the severity and significance of these indicators in MI have been little studied and are presented mainly by experimental data [1, 5]. There is no consensus on the level of expression of CD95 on lymphocytes and
CD 14 on monocytes in acute myocardial infarction, the relationship of these indicators with the prognosis in this group of patients has not been studied.
The current interest in the problem of prognosis in MI is associated not only with a high mortality rate, but also with the introduction of new approaches to the treatment of MI, which, of course, influenced the course of the postinfarction period. Modern studies have shown that the active use of thrombolytic therapy and early myocardial revascularization, as well as Also, adequate drug therapy for MI can reduce both total and sudden mortality [2], which is reflected in the latest domestic and foreign recommendations for the treatment of patients with MI. However, how these recommendations are practically implemented in our country in clinical practice, and whether the range of factors affecting the prognosis of patients who have had MI has changed as a result, remains unclear.
Thus, patients who have undergone myocardial infarction constitute a group of increased risk of developing lethal outcomes and recurrent cardiovascular accidents, which forces researchers to continue the search for prognostic factors and build models based on a combination of features that would best predict the likelihood of cardiac death, including sudden, as well as repeated MI.
Purpose of the study. To identify clinical and functional indicators and inflammatory blood markers that affect the prognosis in patients with myocardial infarction.
Materials and research methods. We selected patients with in-depth white blood cell counts and conducted clinical trials on them, including blood tests and myocardial infarction, to achieve our goal.
Results of the study. The most important and independent factors for predicting sudden cardiac death in patients with MI are end-diastolic size, ejection fraction, left ventricular akinesia zones, as well as acute heart failure III-IV according to Killip; for non-sudden cardiac death, age, ejection fraction, and left ventricular aneurysm; for recurrent myocardial infarction - an increase in cholesterol levels of more than 6.5 mmol / l and a previous MI.
The relationship between the risk of sudden cardiac death and such ECHO cardiographic indicators as the restrictive type of diastolic dysfunction and left ventricular hypertrophy was revealed.
Leukocytes and their classes, pro-inflammatory cytokines (IL-1(3, IL-2, IL-6 and TNF-a), as well as CD95 expression on lymphocytes and CD 14 monocytes do not have independent prognostic value in acute myocardial infarction.
The prognostic value of inflammatory blood changes lies in their influence on the development of such complications as acute and chronic heart failure, ventricular arrhythmias, left ventricular aneurysm, which is mediated by the development of postinfarction remodeling processes.
The frequency of recurrent myocardial infarction (5.8%), cardiac mortality, both sudden (5.3%) and non-sudden (2.4%) in patients with myocardial infarction, is highest in the first year. By the age of 4-6, there was a gradual decrease in mortality, as well as the frequency of recurrent myocardial infarctions, followed by an increase by the 7th year of observation.
In the dynamics of observation (1998-2006), there was an improvement in the quality of therapy and adherence to treatment of patients who had myocardial infarction, which led to a decrease in sudden cardiac death.
Output. An increased level of blood leukocytes (more than 10 * 109/L) in STEMI patients is associated with a significant increase in the relative risk of developing cardiogenic shock (RR 5.2 [95%; CI 1.7-15.8] p=0.001), ventricular fibrillation ( RR 8.5 [95%; CI 1.9-38.3] p=0.001) and death during hospitalization (RR 2.47 [95%; CI 1.87-38.4] p=0.03) .
The level of blood leukocytes at admission to the hospital can be used as one of the additional risk stratification factors in patients with STEMI during hospitalization.
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