Imbalance of the protease-antiprotease system against the background of chronic obstructive pulmonary disease in combination with ischemic heart disease

Abstract

The aim of the study: to evaluate the clinical value of the violation of the expression level of MMP-9 and TIMP against the background of chronic obstructive pulmonary disease (COPD) in combination with ischemic heart disease (IHD). Materials and methods. In accordance with the set goal of the study, 26 people with COPD + IHD and 22 practically healthy people were under observation. The average age of patients was 56.68 ± 1.21 years; 76.92 % were men. In the control group, the average age was 54.37 ± 1.84 years, 72.73 % were men. The object of the study was ischemic heart disease: angina pectoris. Research methods: external respiration function study, six minute walk test, determination of heart rate variability, the concentration of MMP-9 and TIMP in blood serum was determined by the method of solid-phase enzyme immunoassay. Results. The analysis of the level of expression of proteases and its inhibitor shows that patients with comorbid IHD on the background of COPD demonstrated 8.11 times higher activity of MMP-9 (p < 0.05) compared to a cohort of practically healthy people. Indicators of TIMP activity in patients with IHD on the background of COPD are 1.46 ± 0.03 μg/ml, which is statistically significantly lower by 53.21 % (p < 0.05) compared to healthy people (3.12 ± 0.01 μg/ml). The presence of reliable correlations between the MMP-9 level and the FEV1 indicator (r = -0.67, p < 0.05), the LF/HF parameter (r = -0.74, p < 0.05) indicates, that when the level of expression of MMP-9 is elevated, there is a more pronounced violation of the function of external respiration and a shift in the sympatho-parasympathetic balance in the direction of sympathetic activation and a decrease in vagal tone in heart rate modulation. The analysis of the meeting frequency with the analysis of conjugation tables showed that in persons in the upper quartile of MMP-9, prognostically negative parameters of the function of external breathing – an isolated decrease in the Tifno index (χ2 = 5.2 at p = 0.03), as well as the expressiveness of shortness of breath – were recorded more often ≥6 points on the Borg scale when assessing exercise tolerance during the 6-minute walk test (χ2 = 7.3 at p = 0.02). Conclusions. The obtained data demonstrate that patients with IHD on the background of COPD have a pronounced proteolytic imbalance and disruption of fibrotic processes compared to practically healthy individuals.