Острая ишемия миокарда у больных с интактными или малоизмененными венечными сосудами занимает особое место в структуре сердечно-сосудистой патологии. Диагноз инфаркта миокарда без обструктивного атеросклероза коронарных артерий (ИМБОКА) выставляется при наличии критериев инфаркта миокарда согласно 4-му универсальному определению, отсутствии обструкции венечных сосудов по данным коронарной ангиографии (стеноз КА<50%) и исключении другой доказанной причины острого повреждения миокарда. В настоящее время распространенность данной патологии варьирует от 1% до 25%. ИМБОКА рассматривается как рабочий диагноз и требует от врача выполнения дополнительного обследования с целью установления причины, лежащей в основе данной патологии. Предложено множество этиопатогенетических механизмов развития ИМБОКА: повреждение «молодых» атеросклеротических бляшек КА, эрозия бляшки с сохранением фиброзной капсулы, спонтанная диссекция венечных артерий, коронароспазм, тромбоз и эмболия, эндотелиальная дисфункция. Определение патогенетического варианта является крайне важным, поскольку в дальнейшем позволяет индивидуализировать диагностическую и терапевтическую стратегии, однако до сих пор многие вопросы остаются до конца неизученными и дискуссионными. В данном литературном обзоре представлены современные диагностические критерии ИМБОКА, проанализированы и обобщены данные отечественной и зарубежной литературы о распространенности и основных патогенетических механизмах развития данной патологии. Ключевые слова: инфаркт миокарда, инфаркт миокарда без обструктивного атеросклероза коронарных артерий, ИМБОКА, атеросклероз, коронароспазм.

Objectives Radioactive iodine therapy is considered for patients with certain clinicopathological factors that predict a significant risk of recurrence, distant metastases of thyroid cancer or disease-specific mortality. The aim of the study was to investigate the association between polymorphisms of genes, products of which are involved in the processes of DNA damage response and autophagy, and the adverse reactions of radioiodine therapy in thyroid cancer patients. Methods The study included 181 patients (37 men, 144 women; median age 56 [41; 66.3] years) with histologically confirmed thyroid cancer and a history of thyroidectomy who received radioiodine therapy. NFKB1, ATM, ATG16L2, ATG10, TGFB1, and TNF polymorphisms were determined by allele-specific realtime-PCR. Results The frequency of adverse reactions was the following: gastrointestinal symptoms – 57.9 %, local symptoms – 65.8 %, cerebral symptoms – 46.8 %, fatigue – 54.4 %; signs of sialoadenitis six months after radioiodine therapy – 25.2 %. TT genotype carriers of ATG10 rs1864183 had higher frequency of gastrointestinal symptoms (vs. CC+CT), the CC genotype carriers of ATG10 rs10514231 had significantly more frequent cerebral symptoms (vs. CT+TT), as well as AA genotype carriers of TGFB1 rs1800469 (vs. AG+GG). CC genotype of ATG10 rs10514231 increased the incidence of radioiodine-induced fatigue, whereas GA genotype of the ATM rs11212570 had a protective role against fatigue. TGFB1 rs1800469 was associated with signs of sialoadenitis six months after radioiodine therapy. Conclusions Genetic factors may contribute to the occurrence of adverse reactions of radioiodine therapy in thyroid cancer patients.

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Objectives Development of the secondary to ACEI cough leads to discontinuation of the drugs of this group. Assessing the safety of the ACEIs with further development of customized approaches for their administration is a major scientific and practical problem. The objective of this study was to assess the association of the genetic markers with the development of the adverse drug reaction in the form of secondary to enalapril dry cough in the patients with essential arterial hypertension. Methods Study involved 113 patients with the secondary to enalapril cough and 104 patients without development of the secondary to enalapril adverse drug reaction. Results The patients carriers of the genotype AA rs2306283 of gene SLCO1B1 had 2-fold higher odds of developing the dry cough than those with the genotypes AG and GG (ОR=2.01, 95%CI=1.10–3.66, р=0.023). Similarly, the patients heterozygous for rs8176746 of gene АВО had 2.3-fold higher odds of developing the ADR in the form of dry cough than the carriers of the genotypes GG and TT (ОR=2.30, 95%CI=1.24–4.29, р=0.008). Conclusions Statistically significant association between the development of the ADR in the form of secondary to enalapril dry cough and polymorphisms rs2306283 of gene SLCO1B1 and rs8176746 of gene ABO was revealed.

Identification of factors determining both of favorable and unfavorable outcome of IVF will increase the effectiveness of this method and optimize infertility treatment. The aim of the research is to analyze the correlation between serum IL-1α concentration, its gene rs1800587 (C/T) genotype carrier and thyroid-stimulating hormone (TSH), thyroid hormones (triiodothyronine (T3) and tetraiodothyronine (T4)), and evaluate the prognostic significance of their combinations in women with tube-peritoneal infertility under the IVF program. 120 patients with tube-peritoneal infertility who applied for an IVF program were examined. Depending on the outcome of the procedure, 2 groups of patients were allocated: 1 group - 40 women who had a pregnancy after IVF, 2 group - 80 patients who did not have a pregnancy. The content of IL-1α, TSH, T3, T4 was determined in blood by ELISA. Genotyping was performed on the rs1800587 (C/T) polymorphic marker of the IL-1α gene. TSH, T3, T4 were within the norm for both groups. In our study, women with a TSH concentration of 0.23 to 1.7 nmol/L had a chance of a favorable IVF outcome 1.4 times higher than with other TSH levels (p = 0.042901); with a T3 level of 1.0 to 1.8 nmol/L had a chance of becoming pregnant 5.7 times higher than with other levels of T3 (p = 0.00002). For T4 concentration, the confidence test was not achieved (p = 0.068505). The individual indicators of IL-1α, TSH, T3 and carrier of the genotype of the gene IL-1α at the preconceptive stage have lower diagnostic value than their combined combination. Three combinations have maximum predictive value: a combination of the T/T genotype of the IL-1α gene and the TSH level of 0.23 to 1.7 nmol/l - OR = 8.1 (p = 0.000048); combination of IL-1α of 28.7 to 85.1 pg/ml, T/T gene genotype IL-1α and TSH level of 0.23 to 1.7 nmol/l - OR = 8.1 (p = 0.000048); combination of IL-1α of 28.7 to 85.1 pg/ml, T/T gene genotype IL-1α, TSH level of 0.23 to 1.7 nmol/l and T3 level of 1.0 to 1.8 nmol/l - OR = 8.1 (p = 0.000146). Thus, proposed new prognostic markers of IVF program effectiveness.