The dissertation is devoted to the improvement of the diagnostic protocol for the
diagnosis of coronary heart disease before surgery and to the improvement of the
results of surgical intervention among patients with coronary heart disease by drug
treatment of disorders of vitamin D and homocysteine metabolism.
The dissertation was based on the results of own clinical, instrumental and
laboratory - biochemical methods of research and observation as for surgical treatment
of patients.
The results of diagnosis and treatment of 133 patients with coronary heart disease
were analyzed.
The age of patients ranged from 27 to 74 years, the average age - (59.34 ± 8.37)
years. There was a statistically significant predominance of men - 117 (87.96 %) over
women - 16 (12.03 %), p > 0.05.
Patients included in the study, depending on the blood tests for homocysteine and
vitamin D (25 OH) were divided into three groups:
91st group - 25 patients with normal level of hyperhomocysteinemia (up to 10
mcmol / l) and vitamin D (more than 30 ng /ml): average age - (58.16 ± 7.32). Men -
22 (88 %), women - 3 (12 %).
2nd group - 71 patients with hyperhomocysteinemia (from 10.9 to 40.08 mcmol/l)
and normal vitamin D level (more than 30 ng /ml): average age (59.73 ± 7.8). Men -
62 (87.32 %), women - 9 (12.67 %).
3rd group - 37 patients with hyperhomocysteinemia (more than 10.38 mcmol /l)
and vitamin D deficiency (less than 30 ng /ml): average age - (59.16 ± 8.24). Men - 33
(89.1 %), women - 4 (10.8 %).
About 70 % of the examined patients had elevated level of homocysteine in their
blood more than 15 mcmol \l. The correlation of the plasma hyperhomocysteinemia
level with age (r = 0.20) and with the level of vitamin D (r = -0.191) was revealed.
We also revealed a correlation between glycated hemoglobin and homocysteine
level (r = 0.38) and vitamin D level (r = 0.32), which may indicate a direct involvement
of carbohydrate metabolism disorders among patients with impaired homocysteine
and vitamin D metabolism in patients with more visible atherosclerosis.
The morphological picture of aorta fragments and great saphenous vein in patients
with different levels of homocysteine and vitamin D in plasma was studied. Samples
were obtained during coronary artery bypass graft surgery. In each observation, the
10 inner layer (intima) was examined and attention was paid to the endothelium,
subendothelial layer and middle layer (media). Patients from the 1st group of the study
had in 78.5 % of cases a histological picture within the norm with the preservation
concerning the structure of the venous wall, from the 2nd group - in 6 (22.2 %)
patients, and from the 3rd group - 1 (7, 69 %) of the case, the structure of the venous
wall remained unchanged. It was also seen that in patients of the 3rd group of the study
inflammatory infiltration of the vein wall was more obvious. In the majority of patients of the 2nd group of the study (51.85 %) more severe
morphological changes of the vascular wall were seen, as well as inflammatory
infiltration was detected - on average 3-4 small lymphocytes per 10 fields of vision.
Patients of the 3rd group of the study showed severe inflammatory infiltration, on
average up to 5-7 small lymphocytes and up to 4-6 neutrophils per 10 fields of vision,
as well as more severe sclerosis of the middle layer, with areas of hemorrhage and
rupture of the inner elastic membrane. During the analysis we confirmed the relationship between the levels of
hyperhomocysteine and vitamin D with qualitative changes in atherosclerotic plaque,
such as ruptures, hemorrhages - in patients of the 2 nd and 3rd groups of the study with
hyperhomocysteinemia, the relationship was P = 0.47 and P = 0.54) and calcification
(P = 0.52 and P = 0.44) of plaque. All calcined plaques from the coronary arteries were
found in individuals with homocysteine level higher than 15.3 mcmol/l.
In our study, a positive correlation was set between the concentration of
hyperhomocysteinemia (= 0.92) and the degree of inflammatory reaction of
atherosclerotic plaque. A negative correlation was also found between the level of
vitamin D (= -0,81) and the degree of inflammation of the atherosclerotic plaque.
