Molotiahin D. Diagnostic significance of pentraxin-3 as a marker of inflammation in patients with coronary artery disease and type 2 diabetes

The dissertation contains theoretical substantiation and proposals for practical solution of the scientific problem – optimization of diagnosis and treatment of coronary artery disease in patients with concomitant type 2 diabetes mellitus based on determining the pathogenetic role of pentraxin-3 in the formation of metabolic, cardiohemodynamic and immunoinflammatory disorders. Based on the goals and objectives of the study, after obtaining written consent for the survey in accordance with the principles of the Declaration of Helsinki, the Council of Europe Convention on Human Rights and Biomedicine and relevant laws of Ukraine, in a randomized manner with prior stratification, we conducted a comprehensive survey of 110 patients with coronary artery disease and type 2 diabetes mellitus, who were treated in the cardiology department of the Municipal Non-Profit Enterprise «City Clinical Hospital №27» of the Kharkiv City Council, which is the basic medical institution of the Department of Internal medicine №2 and clinical immunology and allergology named after academician L.T. Malaya of the Kharkiv National Medical University of the Ministry of Health of Ukraine. Patients were divided into groups depending on the presence of type 2 diabetes: the first group (n=75) included patients with stable coronary artery disease and type 2 diabetes, the comparison group consisted of 35 patients with coronary artery disease without diabetes. The control group included 25 healthy individuals. The scientific novelty of the work is that the pathogenetic significance of the marker of systemic inflammation of pentraxin-3 in the formation of metabolic and structural-functional changes of the heart, features of clinical manifestations in the case of comorbidity of coronary artery disease and type 2 diabetes, depending on the level of pentraxin -3. The relationship between the rate of immune inflammation of pentraxin-3 and disorders of carbohydrate and lipid metabolism in patients with comorbid coronary artery disease with concomitant type 2 diabetes mellitus was established for the first time. The influence of increased concentration of pentraxin-3 on the development of structural and functional reorganization of the left ventricular myocardium has been demonstrated. It has been proven that the activity of pentraxin-3 in patients with coronary artery disease and type 2 diabetes is interrelated with lesions of the left branch of the coronary artery. The effectiveness of valsartan and telmisartan in combination therapy was determined on the basis of studying the effect on carbohydrate and lipid metabolism, aseptic inflammation, cardiohemodynamics, which additionally pathogenetically justifies the choice of treatment regimens in patients with coronary artery disease with concomitant type 2 diabetes mellitus. Based on the obtained data, the expediency of determining the plasma level of pentraxin-3 as a marker of cardiometabolic disorders in patients with coronary artery disease and type 2 diabetes mellitus is substantiated. The proposed method of determining the options for the clinical course of coronary artery disease and type 2 diabetes can be used by institutions of practical health care to improve diagnosis. 10 The expediency of using various therapeutic regimens with the inclusion of valsartan or telmisartan in health care institutions is substantiated on the basis of a positive effect on glucometabolic and cardiohemodynamic parameters to improve the treatment of this cohort of patients. Based on the results of the study, a new method for assessing metabolic disorders in patients with coronary artery disease in combination with type 2 diabetes mellitus by the level of pentraxin-3 (Pat. №132550) was developed and introduced into practice, as well as a new method for determining the clinical course of coronary artery disease in in combination with type 2 diabetes mellitus (Pat. №143491), which aim to increase the efficiency of diagnosis of coronary artery disease in patients with comorbid type 2 diabetes mellitus, which will improve the quality of diagnosis and treatment of such patients.