Object of the study: different forms of the acute coronary syndrome (ACS): unstable angina (UA), ST elevation in ACS (STEACS) and no ST elevation in ACS (NSTEACS). Purpose of the study: an increase in the efficacy of early diagnosis and treatment of ACS in patients with coronary disease (CD) by studying the role of neopterin and immunoinflammatory markers (interleukin-6 [IL-6], interleukin-8 [IL-8], interleukin-10 [IL-10], C-reactive protein [CRP] as early prognosticating agents for the course severity, development of complications, the substantiation of the expediency to use statins in ACS, as well as the choice of their doses from the position of pleotropic anti-inflammatory effects and the dynamics of the above indices against a background of treatment with statins. Methods of the investigation: general clinical, immunoenzyme, instrumental studies, statistical methods. Theoretical and practical results: the necessity of revealing the levels of neopterin, pro- and anti-inflammatory cytokines in ACS patients was substantiated in order to improve the quality of diagnosis. The study of changes in the concentrations of neopterin, IL-6, IL-8, IL-10 and СRP make it possible to improve the assessment of the ACS course severity and early diagnosis of the development of complications in the course of ACS. The revealing of immunity indices in patients with ACS makes it possible to control the state of the immune system under the influence of dose-dependent therapy with atorvaststin, to optimally choose the dose and terms of administration in patients with ACS. Atorvaststin therapy at a dose of 40 mg/day produced a positive effect on the immunological indices of the patients, contributed to a higher efficacy of the treatment and a reduced term of recovery, as well as to the prevention of the development of complications in ACS cases, thereby proving the expediency of early administration of statins in patients with ACS for the development of pleotrophic effects. Novelty: for the first time, it was shown that ACS, caused by the process of CD destabilization, was accompanied by changes in the mechanisms of the monocyte-macrophage activation together with an activation of immune-inflammation markers, whose manifestations were directly related to a clinical variant of ACS and the severity of its course. It was found out that the level of neopterin increased in all ACS cases proportionally to the severity of its complications. It was demonstrated that the activation of proinflammatory cytokine processes was characterized by higher blood content of IL-6, IL-8 and CRP, which increased from UA to STEACS. A compensatory increase in the activity of proinflammatory cytokin mechanisms, shown by a higher blood level of IL-10, occurred in UA, NSTEACS and was replaced by their inhibition in cases of STEACS and severe complications. It was grounded that an imbalance between intensified proinflammatory processes and a reduced activity of anti-inflammatory ones, taking place in STEACS and its complicated variants, described a relation between the intensity of the immune-inflammation mechanisms and ACS severity. For the first time, it was suggested to determine the levels of neopterin and CRP as an early marker for the appearance of cardiac insufficiency in ACS patients. By the results of the research, a declaration patent of Ukraine was received on the invention “A process of cardiac insufficiency prognostication in patients with different clinical forms of the acute coronary syndrome” (No. 26793 UA, МПК (2006) А61В 8/02; G01N30/00; G01 N33/49). It was revealed that a correction of immune-inflammation disorders in ACS patients was achieved by the administration of atorvastatin at doses of 20 and 40 mg/day, as it was demonstrated by lower levels of neopterin, proinflammatory cytokines and CRP, an increase of anti-inflammatory IL-10. The obtained results enriched the available data about the expediency of an early administration of atorvaststin in ACS at the optimum dose of 40 mg/day in order to correct immune-inflammation disorders. It was revealed that a pleotrophic immunomodulating effect developed after 28 days of atorvastatin therapy. Degree of introduction: results of the researches were introduced into the practical work of the Resuscitation Department of Malaya Therapy Institute of the Academy of Medical Sciences of Ukraine, cardiological and therapeutic departments of the City of Kharkiv, Dergachi Central District Hospital. Sphere of application: medicine, cardiology.
