Chekalina N. Coronary heart disease: a clinical and pathogenetic rationale for diagnosis and treatment in conditions of autoimmune inflammation.

The thesis presents the theoretical substantiation and solution of the actual problem of modern medicine - the determination of the peculiarities of the inflammation process in stable coronary heart disease and under the influence of autoimmune thyroiditis according to the characteristics of the cytokine profile, indices of inflammatory activation of the endothelium and transcriptional activity of the nuclear factor kappa B, the effect of chronic systemic inflammation on the condition of central hemodynamics, myocardial ischemia and arterial bloodstream of thyroid gland, determination of the predictors of the violation of cardiac hemodynamics and coronary changes, evaluation of the effectiveness of differentiated anti-inflammatory therapy with the use of polyphenols, resveratrol and quercetin. The results show there is a close pathogenetic relationship between chronic systemic inflammation, dyslipidemia and inflammatory endothelial activation in patients with coronary heart disease, while the degree of inflammatory vascular endothelial damage is significantly higher in conditions of a combination of stable coronary heart disease with autoimmune thyroiditis. The action of resveratrol and quercetin on the mechanism of blockade of signal transduction with the participation of nuclear factor kappa B in coronary heart disease and under the influence of autoimmune thyroiditis has been determined. It has been found out that the increase of the velocity of thyroid blood flow is an early marker of autoimmune thyroiditis even in the stage of euthyroidism, and it does not depend on systemic arterial pressure and the presence of non-stenotic atherosclerosis of the carotid arteries. By the determination of independent predictors it has been established that in chronic coronary heart disease in combination with autoimmune thyroiditis chronic systemic inflammation plays a leading role in the development and progression of ischemia, electrical instability of the myocardium and disturbance of central hemodynamics. The expediency of the use of resveratrol and quercetin in the combination therapy for patients with stable coronary heart disease due to the proven anti-inflammatory effect and the positive effect on the clinical condition of patients, the indices of central hemodynamics and myocardial ischemia with a predominance of resveratrol has been determined. The effectiveness of resveratrol in patients with stable coronary heart disease under the influence of autoimmune thyroiditis has been substantiated in connection with the revealed anti-inflammatory, endothelioprotective, cardioprotective and thyrotoprotective action.