The aim of the study was to evaluate the incidence of high residual platelet reactivity (HRPR) in patients with non-Q myocardial infarction (non-Q-MI), depending on age and characteristics of therapy at different periods after the onset of MI. Methods. The study included 78 patients with acute non-Q-MI, who were divided into 3 subgroups (SG) depending on their age: SG1 (31-44 years) – 5 persons (6.4%), SG2 (45-59 years) – 36 individuals (46.2%), SG3 (60-74 years) – 37 individuals (47.4%). 34 people (43.6%) were treated conservatively, 44 people (56.4%) underwent primary percutaneous coronary intervention (PCI). Platelet aggregation was assessed using a Multiplate impedance aggregometer (Germany) with several aggregation inducers on admission, 12-14 days and 28-30 days after the onset of MI. Results. The analysis of aggregatograms in patients with non-Q-MI revealed the following indicators: 1ASPI-test 17.0 [10.0; 25.5] U, 2ASPI-test 25.0 [17.0; 36.0] U, 3ASPI-test 21.0 [15.0; 26.5] U (Friedman's test 22.2; p=0.00002); 1ADP-test 27.0 [19.0; 43.5] U, 2ADP-test 32.0 [22.0; 47.5] U, 3ADP-test 28.0 [19.0; 49.0] U (Friedman's test 4.9; р=0.09); 1TRAP-test 72.0 [59.5; 93.0] U, 2TRAP-test 88.0 [72.5; 111.0] U, 3TRAP-test 90.0 [71.5; 102.0] U (Friedman's test 19.7; р=0.00005). HRPR, indicating an insufficient response to antiplatelet therapy, was detected initially in 14 patients (17.9%) according to the ASPI-test, in 13 patients (16.6%) according to the ADP-test, in 5 patients (6.4%) according to the ASPI-test + ADP-test. On re-examination HRPR was revealed in 28 patients (35.9%) according to the ASPI-test (p<0.05), in 15 patients (19.2%) according to the ADP-test, in 9 patients (11.5%) according to the ASPI-test + ADP-test. On the third examination HRPR was detected in 15 patients (19.2%) according to the ASPI-test (p<0.05), in 17 patients (21.7%) according to ADP-test, in 10 patients (12.8%) according to the ASPI-test+ADP-test. The dynamics of changes of the aggregatogram and HRPR in age subgroups and in subgroups with different therapy was of a similar nature. Conclusion. A high percentage of patients with non-Q-MI associated with insufficient response to acetylsalicylic acid and clopidogrel was revealed at different times after the onset of MI. There were no differences in the aggregation parameters depending on the age of the patients, the type of therapy (conservative or PCI) or the type of implanted stents.

The aim of the study was to assess the clinical and genetic factors associated with the risk of recurrent ischemic events in patients with stable stenocardia (SS). Materials and methods. A total of 100 patients with SS were examined and followed-up for 15.3±8.3 months. The patients were divided into subgroups (SG): SG1 (n=51) – persons without events, SG2 (n=49) persons with recurrent ischemic events (hospitalization due to the development of pain syndrome, re-stenting due to stent restenosis, myocardial infarction, cerebral infarction and death from cardiovascular causes), SGB (n=11) – persons with «major» recurrent ischemic events (re-stenting due to stent restenosis, myocardial infarction, cerebral infarction and death from cardiovascular causes) , SGG (n=89) – persons without «major» events. The obtained survey data (general clinical, aggregometry, polymor  phism of genes of platelet fibrinogen receptor ITGB3 (T1565C), platelet collagen receptor ITGA2 (C807T), ADP platelet receptor P2RY12, H1/H2 (T744C)) were analyzed using the STATISTICA 10.0 software. Results. In SG2, men predominated (χ2 =9.2; p<0.01), past MI was more common (χ2 =4.8; p<0.05), more stents were implanted (2.4±1.9 versus 1.7±1.1, p<0.05), TRAP-test values were higher (p<0.05) compared to SG1. In SGB, greater number of stents were implanted (3.1±2.2 versus 1.61±1.57, p<0.05), the carriage of the TC genotype of the ITGB3 gene was more common, (p<0.05), a combination of gene mutations ITGB3 and P2RY12 was more common, (p<0.05) compared to SGG. A logistic regression equation was constructed, including the presence of diabetes mellitus, the number of platelets in the blood test, the ASPI-test values, the carriage of the 1565C allele of the ITGB3 gene, the number of stents implanted, which makes it possible to determine the likelihood of developing «major» recurrent ischemic events with a cut-off threshold LP₀=0.0965, with sensitivity – 81.82 %, specificity – 78.48 %, overall accuracy – 78.89 %. Conclusions. The factors associated with the development of recurrent ischemic events are: male sex, previous MI, a greater number of implanted stents, and high TRAP-test values. The factors associated with the development of recurrent «major» ischemic events are: a greater number of implanted stents, carriage of the TC genotype of the ITGB3 gene, carriage of a combination of mutations of the H1/H2 polymorphic locus of the P2RY12 gene and the T1565C polymorphic locus of the ITGB3 gene, diabetes mellitus, the number of platelets in blood test, ASPI-test values.

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Ю. Я. Шелкович (lazarilin@mail.ru), В. И. Шишко (vshyshko@mail.ru), А. В. Копыцкий (andrey_cop@mail.ru) УО «Гродненский государственный медицинский университет», Гродно, Беларусь Введение. Поиск биомаркеров эрозивного поражения пищевода у пациентов с гастроэзофагеальной рефлюксной болезнью (ГЭРБ) представляет собой научный и клинический интерес.Цель исследования -оценить содержание коллагена IV типа в плазме крови пациентов с ГЭРБ в зависимости от характера поражения слизистой оболочки пищевода.Материалы и методы. Обследованы 90 пациентов, из которых 64 человека -с ГЭРБ, 26 человек -группа сравнения. Пациентам выполнялась эзофагогастродуоденоскопия с биопсией нижней трети пищевода, у 51 человека выполнено определение коллагена IV типа в плазме крови методом иммуноферментного анализа. С целью определения порогового уровня коллагена IV типа, указывающего на наличие эрозивного поражения пищевода у пациентов с ГЭРБ, была построена математическая модель и выполнен ROC-анализ.Результаты. Пациенты с эрозивной ГЭРБ характеризуются более высокими показателями концентрации коллагена IV типа в плазме крови при сопоставлении с пациентами с неэрозивной ГЭРБ и группой сравнения. Согласно уравнению логистической регрессии и ROC-анализу, пациенты с плазменной концентрацией коллагена IV типа, равной или выше 6,08 нг/мл, имеют эрозивный эзофагит с чувствительностью 90,91%, специфичностью 92,31%, точностью 91,89%. Заключение. Коллаген IV типа может рассматриваться в качестве биомаркера эрозивного поражения пищевода при ГЭРБ. Плазменный может указывать на наличие эрозивного поражения пищевода у пациента с ГЭРБ.Ключевые слова: гастроэзофагеальная рефлюксная болезнь, коллаген IV типа, эрозивное поражение пищевода, биомаркер, желудочно-кишечный тракт.

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