Demyanets S. Role of cytokines aggression and nitric oxide in the pathogenesis of acute coronary syndrome.

Object of the study: patients with acute coronary syndrome. Purpose of the study: improvement of the diagnostics methods of the acute coronary syndrome's different clinical forms and development of the course and complications' prognostic criteria of the unstable angina and acute myocardial infarction by the analysis of activities and dynamics of the biological markers of inflammation - pro-inflammatory, anti-inflammatory cytokines and C-reactive protein, and stage of the endothelium-dependent vasodilatation for prove of the differentiation methods of treatment of the patients with acute coronary syndrome's different clinical forms. Methods of research: General clinical-laboratorial, instrumental methods of examination and specific enzyme-linked immunoassays were used. In order to examine heart's morpho-functional parameters the echocardiography in A- and I-regimens was used. Concentrations of pro-inflammatory cytokine interleukine-6, anti-inflammatory cytokine interleukine-10 and nitric oxide stable metabolites were measured by the specific enzyme-linked immune sorbent assays (ELISA). C-reactive protein was revealed by the method of agglutination. Obtained results were analyzed with the package of statistical software SPSS 10.0. Theoretical and practical results: Obtained results may allow the development of the prognostic criteria of the acute coronary syndrome unfavorable course (recurrent ischemia and death) on the base of increased pro-inflammatory cytokines IL-6, acute-phase protein CRP concentrations. It is recommended to implicate the differentiation methods for coronary artery disease acute clinical forms diagnostics on the base of the levels of both pro- and anti-inflammatory (IL-10) immune system mediators. Inadequate decrease or increase of nitric oxide, one of the most important regulators of the endothelium and myocardium functions, may allow to reveal the patients with disturbed endothelium-dependent vessel dilatation as well as worseness of the left ventricular systolic function. Decreasedof the IL-6 levels in dynamics after thrombolitic therapy confirmed the positive effects of the active methods of occluded vessel recanalization at the patients with acute MI. It is recommended to screen the markers of the immune system activation and regulation of the endothelium and myocardium functions that may allow to improve the detection of the persons with increased risk of development of acute cardiovascular events. Novelty: In the dissertation were investigated in complex the levels of pro-inflammatory (IL-6) and anti-inflammatory (IL-10) cytokines, acute-phase reaction component CRP, and end-stage metabolism products of the nitric oxide at the patients with acute coronary syndrome. At the patients with acute myocardial infarction were examined the changes of immunological mediators in dynamics. Multivariate analysis of the components concentrations was made during different course and complications development of acute coronary syndrome. The influence of the thrombolitic therapy on the immune system mediators was analyzed at the patients with acute myocardial infarction. Degree of introduction: the findings of research are implicated in the clinical practice of Institute of Therapy of Academy of Medical Science of Ukraine, Kharkiv, hospitals №27 and №11, Kharkiv. Sphere of application: Medicine, cardiology.