1. P010 HEART, VESSELS & DIABETES – THE EUROPEAN CONFERENCE, LISBON CONGESS CENTRE, DECEMBER ISOLATED ISCHEMIA OF MYOCARDIUM OR COMBINED WITH PANCREAS, FEATURES INFLAMMATORY SYNDROME IN PATIENTS WITH CORONARY HEART DISEASE COMBINED WITH DIABETES MELLITUS Authors: Kulishov S., Mandryka Ya. Higher State Educational Institution of Ukraine "Ukrainian Medical Stomatological Academy", Poltava, Ukraine
Background: Background. It is known that acute coronary heart disease (ACHD) causes varying degrees of myocardial and pancreas (more rarely) ischemia. The aim of the study was determination the triggers of inflammation syndrome, myocardial and pancreas ischemia in patients with ACHD and violations in carbohydrate metabolism.
Methods: The study included 28 patients with nonstable angina pectoris (NAP) with violations in carbohydrate metabolism, including 25 with diabetes mellitus (DM) 2-th type; 3 with DM and dissecting aneurysm of the abdominal aorta. We measured the concentrations of antibodies to human heat shock protein 60 (anti-Hsp 60), interleukine -10 (IL-10), C-reactive protein (CRP) in 25 patients with NAP and DM 2-th type {64,52 years old (М) ±1,82 (SEM); 9,08 (SD); (CІ - 95% : 60,77~68,27); 63,0 (Меd); (Q : 57,5~71,0). М – mean, SEM – standard error of mean; SD – standard deviation, 95% CІ - 95% Confidence Interval for Mean – Lower Bound and Upper Bound; Меd – median; Q – Lower and Upper Quartiles}. Clinical characteristics of these patients: in 6 (24%) from 25 patients were diagnosed concomitant essential hypertension of the second stage, in 18 (72%) - third stage. Chronic heart failure II functional class by New York Cardiology Association (NYHA, 1964) was diagnosed at 12 (40%) of 30 patients; III-rd functional class by NYHA - in 2 (6%) of 30. Age of 3 patients with NAP, DM and the abdominal aorta dissecting aneurysm are 47, 78, 84 years, respectively. 15 healthy subjects years old consist control group. Statistical analysis included t Student criterion (st) for 2 independent samples; nonparametric Mann-Whitney U test (MW) (program SPSS for Windows Release 13.00, SPSS Inc., ( ).
Results: Level of C-reactive protein (CRP) was significantly higher in patients with NAP and DM {Med; Q: 14,6 mg/l (11,35~14,95); P mw=0,0001} than in the control group {Med; Q: 0,65 mg/l (0,23~1,53) – fig. 1.
Fig. 1. Level of C-reactive protein in the control group, in the patients with NAP and DM. 1 – level of C-reactive protein (mg/l)
Level of part from the division of anti-Hsp 60 on the result of multiplying the IL-10 and CRP was lower in patients with NAP and DM {Med; Q: 0,61 conditional units - c.un. (0,04~1,68); P mw=0,003} than in the control group {Med; Q: 11,17 c.un. (0,80~35,82)} – fig. 2.
Fig. 2. Level of part from the division of chaperone autoantibodies on the result of multiplying the interleukin-10 and C-reactive protein in the control group, in patients with NAP and DM. 1 – level of part from the division of chaperone autoantibodies on the result of multiplying the interleukin-10 and C-reactive protein (conditional units).
Level of part from the division of anti-Hsp 60 on CRP was lower in patients with NAP and DM {M SEM; SD; 95% СI; Med; Q: 14,27 c.un. ±5,64;28.19;(2,63~25,91); 5,07 (2,69~8,36); P mw=0,0001} than in the control group {307,59 c.un.±94,73; 328,14; (99,09~516,08); Pst=0,01} – fig. 3.
Fig. 3. Level of part from the division of chaperone autoantibodies on C-reactive protein in the control group, in patients with NAP and DM. 1 – level of part from the division of chaperone autoantibodies on C-reactive protein (conditional units).
Ischemic pancreatitis was presented by the appearance of pain in the upper abdomen, strengthening after meals, high levels of diastase, glucose of blood and urine. The degree of increasing in diastase, glucose of blood, urine, the presence of an aneurysm of the abdominal aorta and its branches with impaired hemodynamics in the pancreas by visualization methods allowed assessing the extent of the pancreas damage.
Conclusions: Activation both inflammatory and anti-inflammatory activity causes depressing effect on chaperones, autoimmune activities at the patients with NAP and DM.
Atherosclerotic lesions of an aorta and its branches are risk factors for initiation and potentiation of carbohydrate metabolism disturbances due to formation of ischemia of pancreas, ischemic pancreatitis. Imaging methods (ultrasound research of the aorta, a CT scan with contrast of abdominal aorta and its branches), research of diastase, blood glucose, urine may help for the differentiation of ischemia pancreas and ischemic pancreatitis.
Authors:
1.Sergii Kulishov, professor, Ph.D., D.Med. Sci. Higher state educational institution of Ukraine (HSEIU) “Ukrainian Medical Stomatological Academy”, Poltava, Ukraine, department of internal medicine No 1,
2.Iaroslav Mandrikas, graduate of internal medicine No 1 department, HSEIU “Ukrainian Medical Stomatological Academy”,