The dissertation in candidacy for the degree of the Candidate of Medical Sciences (doctor of philosophy) in the specialization 14.01.15 "Nervous diseases". – State Institution of Higher Education "Uzhhorod National University", Ministry of Education and Science of Ukraine, Uzhhorod, 2021.
The dissertation is devoted to the study of the links between groups of clinical-neurological, anamnestic and genetic markers of ischemic stroke. It is also the scientific basis for creating a method of mass screening of the population to prevent ischemic stroke.
The study involved 150 people, who were divided into two equal groups (75 people in each one): group I － people who had a case of ischemic stroke (the main study group, which consisted of randomly selected patients of Mukachevo central department hospital) and group II - individuals who had no history of any type of stroke (a control study group that was formed by random selection from a database of 9 family physicians.
From the group of clinical-neurological risk factors, 8 of them were selected: arterial hypertension, obesity, hypodynamia, smoking, atherosclerosis, diabetes, excessive alcohol consumption and atrial fibrillation, but only 4 of them were able to overcome the RR (relative risk) barrier and be statistically significant: arterial hypertension (RR – 2.31); atherosclerosis (RR – 1.29); diabetes mellitus (RR – 1.34) and atrial fibrillation (RR – 1.51). Among the anamnestic risk factors, only the presence of 1st and 2nd generation relatives, who had any type of stroke (RR – 1.94 and 3.37, accordingly) were representative. Among the genetic markers, 3 genes were selected: SERPINE-1, INTEGRIN-β-3 and factor II coagulation gene (F-II), but only the SERPINE-1 gene was statistically significant (RR – 3.01).
The next step was a double comparison of all remaining clinical-neurological, genealogical and genetic risk factors. After calculations, it turned out that 8 double connections are statistically significant. The final step of the scientific work was a triple comparison of factors from each group. For easier understanding, 4 connections were created:
1. Connection A – arterial hypertension + the presence of first-generation relatives who had a stroke + the presence of a pathological alleles of the gene of plasminogen activator inhibitor-1 (PAI-1 / IAP-1) or SERPINE-1
2. Communication B – arterial hypertension + the presence of second-generation relatives who had a stroke + the presence of a pathological alleles of the gene of plasminogen activator inhibitor-1 (plasminogen activator inhibitor-1) (PAI-1 / IAP-1) or SERPINE-1
3. Connection C – atherosclerosis + the presence of first-generation relatives who had a stroke + the presence of a pathological alleles of the gene of plasminogen activator inhibitor-1 (PAI-1 / IAP-1) or SERPINE-1
4. Connection D – atherosclerosis + the presence of second-generation relatives who had a stroke + the presence of a pathological alleles of the gene of plasminogen activator inhibitor-1 (plasminogen activator inhibitor-1) (PAI-1 / IAP-1) or SERPINE-1
However, only two connections were statistically significant: A (BP - 2.83) and B (BP - 1.67).
Thus, the results of this dissertation suggest that the combination of arterial hypertension, the presence of first or second generation relatives who had a stroke and a pathological alleles of the gene of plasminogen activator inhibitor-1 (PAI-1 / IAP-1) is significant risk factors for ischemic stroke. Thus, a scientific basis for the formation of a method of mass screening of the population with the possibility of further primary prevention of ischemic stroke was created.
