ЛЕЙКОЦИТАРНЫЕ ПОКАЗАТЕЛИ ВОСПАЛЕНИЯ У ПАЦИЕНТОВ С ОСТРЫМ ИНФАРКТОМ МИОКАРДА И САХАРНЫМ ДИАБЕТОМ 2 ТИПА

Abstract

Introduction. Acute myocardial infarction is accompanied by an intense inflammatory response. On the other hand, the severity of inflammation is a marker of the risk of poor prognosis. Type 2 diabetes mellitus (DM2) is associated with the development of chronic inflammation and oxidative stress. Objective: To conduct a comparative analysis of leukocyte indicators of inflammation and highly sensitive C-reactive protein (hsCRP) in patients with ST-segment elevation acute myocardial infarction (STEMI) with and without DM 2. Materials and methods. Inclusion criteria: men and women with STEMI with or without type 2 diabetes, age over 45 years, primary percutaneous coronary intervention (PCI). Exclusion criteria: cases of hospital mortality, acute heart failure according to Killip 3-4 at admission. The study included 30 patients with STEMI in combination with type 2 diabetes and 30 patients with STEMI without type 2 diabetes. The groups were matched by sex (15 men and 15 women in each group) and age (64.2 vs 63.8 years, p= 0.8049). In both groups, we compared leukocyte indicators of inflammation (the number of leukocytes, neutrophils, lymphocytes, neutrophil-lymphocyte ratio (NLO) and hsCRP before pcCI, as well as their dynamics on days 5–7 after pcCI. The study of the cellular composition of blood was performed on a hematological analyzer BC- 6800Plus, Mindray, China.HsCRP was determined by the method of biochemical analysis of blood on the analyzer BS-200, Mindray, China.Data are presented as mean (M) and standard deviation (SD).The distribution of variables was normal, therefore, to compare quantitative indicators in independent and in paired samples, Student's t-test was used, and Pearson's chi-square, 2 test was used to compare lesion locations in study groups. Results. Body mass index was higher in the STEMI group with type 2 diabetes (30.2 kg/m2 and 26.6 kg/m2, p = 0.001). Groups of patients with and without type 2 diabetes did not differ in the incidence of anterior STEMI (43.3% and 56.6%; p2 =0.302), left ventricular ejection fraction 46.4% and 47.3%, p=0.399) . In the study groups with STEMI and DM 2 and without DM 2, such indicators as leukocytes (14.66±2.07×109/l vs 10.19±1.08×109/l, p<0.001) and (13, 92±1.73×109/L vs 9.81±1.77×109/L, p<0.001), neutrophils (8.64±1.2×109/L vs 5.36±0.97×109 /l, p<0.001) and (7.99±0.76×109/l vs 5.01±0.75×109/l, p<0.001), UFO (5.34±1.34 vs 2, 92±0.81, p<0.001) and (4.71±0.89 vs 2.75±0.96, p<0.001) and hsCRP (27.97±6.87 mg/l vs 13.23± 3.57 mg/l, p<0.001) and (29.86±5.91 mg/l vs 11.63±3.48 mg/l, p<0.001) decreased statistically significantly on days 5–7 of treatment in both groups, respectively. Lymphocytes (1.68±0.33×109/L vs 1.92±0.42×109/L, p<0.001) and (1.74±0.29×109/L vs 1.95±0, 45×109/l, p<0.001) in dynamics significantly increased in both groups, respectively. An intergroup comparative analysis showed that the degree of change in UFO at admission (5.34±1.34 vs 4.71±0.89, p=0.038) was statistically greater in the group with STEMI and DM 2. HsCRP decreased over time to a greater extent in the group with STEMI without DM 2 (-14.74±5.33 mg/l vs -18.23±5.25 mg/l, p=0.013). Upon admission, neutrophils (8.64±1.20×109/L vs 7.99±0.76×109/L, p=0.015) and UFOs (5.34±1.34 vs 4.71±0.89 , p=0.038) was statistically higher in the STEMI group with DM 2 than in the STEMI group without DM 2, respectively. Conclusions: In both groups, all studied leukocyte indicators of inflammation, with the exception of monocytes, decreased by 5-7 days from the moment of admission. In patients with STEMI and type 2 DM, there was a significant increase in the level of neutrophils and UFO at admission and a slower dynamics of the decrease in hsCRP, compared with the group of patients with STEMI and without type 2 DM, which indicates a more pronounced inflammatory response associated with acute infarction in type 2 DM myocardium.