emcardioНеотложная кардиология и кардиоваскулярные рискиEmergency Cardiology and Cardiovascular Risks journal2616-633XБелорусский государственный медицинский университет10.51922/2616-633X.2025.9.2.2560emcardio-315Research ArticleОригинальные научные публикацииOriginal Scientific ResearchГиперлипидемия, маркеры воспаления, структурно-механические свойства клеток крови у пациентов со стенозирующим атеросклерозом коронарных артерийHyperlipidemia, inflammatory markers, and structural-mechanical properties of blood cells in patients with stenosing atherosclerosis of coronary arteriesБируляА. А.BirulyaA. A.

Минск

Minsk

BiruliaAA@bsmu.byМельниковаГ. Б.MelnikovaG. B.

Минск

Minsk

ПетроваЕ. Б.PetrovaE. B.

Минск

Minsk

ТолстаяТ. Н.TolstayaT. N.

Минск

Minsk

РусскихИ. И.RusskihI. I.

Минск

Minsk

ГригоренкоЕ. А.GrigorenkoE. A.

Минск

Minsk

ЧижикС. А.ChizhikS. A.

Минск

Minsk

МитьковскаяН. П.MitkovskayaN. P.

Минск

Minsk

Учреждение образования «Белорусский государственный медицинский университет»; Республиканский научно-практический центр «Кардиология»Belarusian State Medical University; Scientific and practical centre «Cardiology»Государственное научное учреждение «Институт тепло- и массообмена имени А. В. Лыкова Национальной академии наук Беларуси»A. V. Lykov Heat and Mass Transfer Institute of the National Academy of Sciences of BelarusРеспубликанский научно-практический центр «Кардиология»Scientific and practical centre «Cardiology»Учреждение образования «Белорусский государственный медицинский университет»Belarusian State Medical University2025250120269225602570Copyright © Бируля А.А., Мельникова Г.Б., Петрова Е.Б., Толстая Т.Н., Русских И.И., Григоренко Е.А., Чижик С.А., Митьковская Н.П., 20262026Бируля А.А., Мельникова Г.Б., Петрова Е.Б., Толстая Т.Н., Русских И.И., Григоренко Е.А., Чижик С.А., Митьковская Н.П.Birulya A.A., Melnikova G.B., Petrova E.B., Tolstaya T.N., Russkih I.I., Grigorenko E.A., Chizhik S.A., Mitkovskaya N.P.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://emcardio.bsmu.by/jour/article/view/315

Основной причиной смертности во всем мире остается ишемическая болезнь сердца, несмотря на успехи профилактической медицины, связанные с эффективным воздействием на модифицируемые факторы риска болезней системы кровообращения (БСК).

Цель работы

Цель работы. Оценить характер липидемии, индексы системного воспаления (SIRI, AISI, SII, NLR, PLR, MLR), морфологические и локальные механические свойства клеток крови по данным атомно-силовой микроскопии у пациентов со стенозирующим атеросклерозом коронарных артерий.

Материалы и методы

Материалы и методы. В исследование включено 58 пациентов, имеющих инструментально поддтвержденный гемодинамически значимый стеноз коронарных артерий с технической невозможностью или отказом пациентов от реваскуляризации. Из них 72,4 % (n = 42) составили мужчины и 27,6 % (n = 16) – женщины в возрасте 59,1±4,4 лет. У всех пациентов определены показатели липидного спектра крови, выполнен общеклинический анализ крови с подсчетом лейкоцитарной формулы и расчетом индексов воспаления, проведена диагностика нарушений микрогемодинамики. У 10 лиц выполнено исследование структуры и локальных механических свойств фиксированных форменных элементов клеток (эритроцитов и тромбоцитов) на атомно-силовом микроскопе.

Результаты

Результаты. У пациентов со стенозирующим многососудистым поражением коронарных артерий удельный вес лиц с превышением референсного интервала по нейтрофильно-лимфоцитарному индексу (NLR) составил 22,4%, индексу системного воспалительного ответа (SIRI) – 58,6%, индексу системного воспаления (SII) – 29,3%. Установлена прямая, средней силы корреляционная взаимосвязь между SIRI и значениями прогностически неблагоприятного ХС-ЛПНП (r = 0,49; р < 0,05), признаками атеросклеротического (r = 0,58; р < 0,05) многососудистого (r = 0,43; р < 0,05) поражения коронарных артерий, обратная средней силы взаимосвязь между антиатерогенным ХС-ЛПВП и масштабами атеросклеротического поражения коронарного бассейна (r = –0,41; р < 0,05).

Заключение

Заключение. Полученные взаимосвязи между антии атерогенными характеристиками липидограммы, степенью тяжести коронарного атеросклероза, SIRI указывают на вклад вторичной гиперлипидемии и воспаления в патогенез атеросклеротического ремоделирования. По результатам атомно-силовой микроскопии биоматериала пациентов со стенозирующим атеросклерозом коронарных артерий установлено, что изменение эластичности мембраны клеток крови (эритроцитов и тромбоцитов) связано с ростом индексов SIRI, SII и AISI. Данный предварительный вывод сделан на ограниченной выборке, результаты последующих исследований будут проанализированы и представлены после завершения набора пациентов.

Despite the successes of preventive medicine associated with the effective impact on modifiable risk factors for diseases of the circulatory system (DCS), the leading cause of mortality worldwide remains ischemic heart disease. Results from clinical studies indicate the varying prognostic value of inflammatory markers in the development and progression of the atherosclerotic process.

Study Objective

Study Objective. To assess the nature of lipidemia, systemic inflammation indices (SIRI, AISI, SII, NLR, PLR, MLR), and the morphological and local mechanical properties of blood cells using atomic force microscopy in patients with stenotic atherosclerosis of the coronary arteries.

Materials and Methods

Materials and Methods. The study included 58 patients with instrumentally confirmed hemodynamically significant stenosis of the coronary arteries, where revascularization was either technically impossible or rejected by the patients. Of these, 72.4% (n = 42) were men and 27.6% (n = 16) were women. The mean age was (59.1 ± 4.4) years. All patients had their blood lipid profile determined, a complete blood count with leukocyte formula and calculation of inflammatory indices performed, and diagnostics of microhemodynamic disorders conducted. In 10 subjects, the structure and local mechanical properties of fixed formed blood elements (erythrocytes and platelets) were examined using an atomic force microscope.

Results

Results. Among patients with stenotic multi-vessel coronary artery disease, the proportion of individuals with values exceeding the reference range for the neutrophil-to-lymphocyte ratio (NLR) was 22.4%, for the systemic inflammation response index (SIRI) – 58.6%, and for the systemic inflammation index (SII) – 29.3%. A direct, moderate-strength correlation was established between SIRI and the levels of prognostically unfavorable LDL-C (r = 0.49; p < 0.05), signs of atherosclerotic (r = 0.58; p < 0.05) multi-vessel (r = 0.43; p < 0.05) coronary artery lesions. A moderate-strength inverse correlation was found between anti-atherogenic HDL-C and the extent of atherosclerotic involvement of the coronary basin (r = –0.41; p < 0.05).

Conclusion

Conclusion. The identified correlations between the antiand atherogenic characteristics of the lipid profile, the severity of coronary atherosclerosis, and SIRI indicate the contribution of secondary hyperlipidemia and inflammation to the pathogenesis of atherosclerotic remodeling. According to atomic force microscopy of biomaterial from patients with stenosing atherosclerosis of the coronary arteries, it was found that a change in the elasticity of blood cell membranes (erythrocytes and platelets) is associated with an increase in the SIRI, SII, and AISI indices. This preliminary conclusion is based on a limited sample; the results of subsequent studies will be analyzed and presented upon completion of patient enrollment.

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The authors declare that there are no conflicts of interest present.