Serdobinska-Kanivets E. Activity of proteinases and their inhibitors in patients with chronic heart failure, induced by ischemic heart disease associated with diabetes mellitus.

The dissertation is dedicated to the problem of the enhancing of the efficacy of the treatment of chronic heart failure (HF) in patients with coronary artery disease associated with type 2 diabetes mellitus. Also, the investigation of proteinases (chymase, tonin) and their inhibitors (?-1-proteinases inhibitor (?-1-PI), ?-2-macroglobulin (?-2-MG)) was done. Their role in the pathogenic mechanism of the development and progression of this pathology was studied. It was established, that congestive HF, particularly in diabetes mellitus, characterized by significant increase of proteinase activity and its initial manifestations associated directly with tonin elevation, progression - with chymase elevation. Decrease of ?-2-MG activity and cholesterol of high density lipoproteins and elevation of total cholesterol level promoted chymase activation in patients with congestive HF not only with diabetes mellitus but also without it. Moreover, chymase activity associated with tumor necrosis factor-? (TNF-?) level elevation in both groups. Decrease of high density lipoproteins cholesterol and elevation of total cholesterol level promoted tonin activation. It was detected that hyperglycemia is accessory factor of the proteinases activation only in diabetes mellitus patients. Standard therapy of congestive HF and diabetes mellitus three month duration in the mean therapeutic dosages, promoted significant ?-1-PI inhibitor elevation, but did not affect proteinases activity and TNF-? level. Additional mast cell membrane stabilization in patients with congestive HF in chymase activity > 3,55 Е?10-3 (without diabetes mellitus) and > 5,22 Е?10-3 (with diabetes mellitus) induces TNF-? level decrease and balances improvement in the proteinase - proteinase inhibitors system.