Государственное бюджетное учреждение «Санкт-Петербургский научно-исследовательский институт скорой помощи им И. И. Джанелидзе», Санкт-Петербург, Россия «Национальный медицинский исследовательский центр им. В.А. Алмазова» Минздрава России, Санкт-Петербург, Россия Резюме Целью данного исследования явилось оценить клиническое течение инфаркта миокарда (ИМ) у больных с острым повреждением почек (ОПП) на госпитальном этапе в зависимости от наличия полиморфизма генов: Leu28Pro APOE, G681A CYP2C19, Trp212Ter CYP2C19, Val174Ala SLCO1B1, C786T NOS3. В исследование включены 86 пациентов, лечившихся в ГБУ СПб НИИ скорой помощи им. И.И. Джанелидзе в 2016 году по поводу ИМ. Все пациенты были разделены на 2 группы. В первую (I) вошли 34 больных с ИМ и ОПП. Во вторую (II)-52 человека с ИМ, но без ОПП. Всем пациентам производился забор венозной крови, для выявления полиморфных вариантов генов. Метод основывался на анализе геномной ДНК человека, выделенной из лейкоцитов крови, методом полимеразной цепной реакции. Произведено сопоставление полученных лабораторных данных и клинической картины заболевания между группами. Репрезентативность и достоверность различий между параметрами в выборках оценены с использованием углового преобразования Фишера, t-критерия Cтьюдентa, проведен однофакторный анализ. Было доказано, что у больных с ИМ и ОПП достоверно чаще выявляются мутации в генетических вариантах: G681A CYP2C19, C786T NOS3, Val174Ala SLCO1B1, на фоне чего отмечалось ухудшение течения ИМ в госпитальном периоде и увеличение случаев летальных исходов. Ключевые слова: полиморфизм генов, инфаркт миокарда, острое повреждение почек.

Background. At present close attention is paid to the study of genetic mutations and markers of systemic inflammatory response (SIR) in patients with cardiorenal syndrome. Aim. To evaluate the effect of NOS3 gene t786c polymorphism and SVR on the clinical course of hospital and long-term periods in patients with myocardial infarction (MI) and acute kidney injury (AKI). Materials and methods. 108 patients treated for MI were examined. All patients were divided into 2 groups: the first — 56 patients with IM and AKI, the second — 52 patients with IM but without AKI. Results. In patients with MI and AKI, heterozygote and homozygote by allele С with NOS3 gene polymorphism Т786С, as well as leukocytosis and elevated C-reactive protein (CRP) in the blood were significantly more frequently detected. In the hospital period there was a large percentage of relapses of acute coronary syndrome (ACS), which led to high mortality. In the long-term period recurrent ACS and stent thromboses were also significantly more frequent, as well as high mortality rate. The conclusion. Patients with IM and AKI revealed high frequency of allele C inheritance with polymorphism t786c gene NOS3, which in combination with the induction of SVR, being manifested by leukocytosis and increase in the content of CRP in the blood, was associated with the severity of the clinical picture, both in hospital and in the long-term periods.

Lymphocyte-to-platelet adhesion during hypoxia, tissue damage, activation of inflammation and coagulation is associated with expression of ICAM-1 membrane molecules by blood and tissue cells. At the same time, the platelet adhesion receptors determine their adherence to endothelium and recruited lymphocytes. Moreover, the role of platelets in pathogenesis of ischemic cardiovascular diseases comprises their ability to modulate both hemostasis and inflammatory reactions, which are accompanied by secretion of inflammatory mediators and some factors that promote recruitment of leukocytes to tissue damage sites. Creatine kinase activity is a sensitive marker of tissue damage and tissue ischemia. The purpose of the present study was to assess the effect of anti-inflammatory therapy with dexamethasone upon the intensity of inflammation and adhesive properties of lymphocytes, number of platelets in peripheral blood of the patients with acute lower limb ischemia (ALLI), as well as to evaluate the effectiveness of treatment. To study the effect of anti-inflammatory therapy, a group of 32 patients treated with dexamethasone was selected; the control group was represented by 71 patients with basic therapy, the comparison group consisted of 15 volunteers. After revascularization, all patients received antiplatelet and anticoagulant therapy. Dexamethasone infusions were carried out as a course of 4 to 6 days after reconstructive surgery. In all patients, the content of C-reactive protein in blood, the activity of creatine kinase, the content of platelets and, especially, of enlarged platelets were determined. The numbers of lymphocytes expressing ICAM-1 (CD54+) adhesion molecules were counted using immunocytochemical technique. The studies were performed before surgery and 1, 3, 5, 7, 10 days after surgery. During exacerbation of the limb ischemia and damage to endothelium, the accumulation of cytolysis products was noted. Expression of adhesion molecules was increased both on endotheliocytes and on inflammation effector cells, i.e., leukocytes and platelets. The adhesion molecules transmit the activating signal inside the cell, thus promoting adhesion of leukocytes and platelets to endothelium, lymphocytic-platelet adhesion, formation of parietal thrombi, and possible occlusion of damaged vessels. Increased expression of adhesion molecules is associated with activation of metabolism, inflammation, coagulation and oxidative stress. It may stimulate all hematopoietic lineages, including platelets. The involvement level of cellular reactions in pathogenesis of the disease affects effectiveness and duration of treatment, risk of recurrent thrombosis and lethal outcome. Anti-inflammatory therapy with dexamethasone contributed to earlier remission, it was associated with lower frequency of infectious and thrombotic complications, decreased mortality, and reduced duration of treatment. Inflammation, adhesiveness of effector cells and thrombosis are important factors in pathogenesis of acute lower limb ischemia. Additional anti-inflammatory therapy with dexamethasone contributes to earlier remission, decreased proportion of infectious and thrombotic complications, lower frequency of deaths, and reduced duration of treatment.

Jellyfish, as representatives of marine fauna, contain toxic chemicals in their bodies and, if they come into contact with humans, can pose a threat to their health and safety. The article describes a clinical observation of a patient who received a chemical injury as a result of contact of the right upper limb with a venomous jellyfish (Medusa kornerot) and was hospitalized for 35 days with acute poisoning with animal toxin, chemical burns, toxic-allergic dermatitis, epidermolysis, soft tissue necrosis and compression-ischemic neuropathy. Laboratory results confirmed the presence of an inflammatory process, but without allergic and autoimmune components (leukocytosis 16,7 x 109/l, acceleration of ESR to 21 mm/h), revealed an increase in the level of transaminases upon admission: alanine aminotransferase 138.3 u/l (norm 0-31 u/l), aspartate aminotransferase 94,8 u/l (norm 0-31 u/l), gamma-glutamyltransferase 97 u/l (norm 0-32 units/l). Previous drug therapy, including the introduction of tetanus serum (once), antihistamines (chloropyramine), hormonal (prednisone), anticoagulants (heparin sodium), antispasmodics (Metamizole sodium, pitofenone hydrochloride, fenpiverinium bromide), antiplatelet agents (pentoxifylline, nicotinic acid), calcium gluconate, multivitamins in therapeutic doses, the application of bandages «gelonet», «fibrotul Argentum», was not effective enough. Complex therapy with cellular metabolism regulators, antihypoxants, cholinesterase inhibitors using hyperbaric oxygenation and membrane plasmapheresis allowed to achieve a lasting effect: to stop the pain syndrome, normalize the disturbed functions of internal organs and the affected limb, avoid surgery, and fully restore working capacity. This complex of therapeutic measures should be used in the treatment of patients with this pathology