Abstract
Introduction: Chronic cerebral ischemia (CCI) accounts for 60-75% of all cerebrovascular diseases in Russia and around the world. The problem: the issues concerning the role of immunity in the pathogenesis of CCI depending on the main etiologic factor and stage of the disease are hardly elaborated, which makes the main pharmacological correction impossible. The objective of the study is to establish the immune disorder patterns in patients with CCI I-II associated with arterial hypertension and to develop differentiated pharmacological methods for their correction.
 Material and methods: The results of treatment of 104 patients of Kursk Regional Clinical Hospital with CCI associated with II-stage arterial hypertension were analyzed: 52 patients were with CCI I stage (2th-4th groups of 12-14 patients) and 52 patients were with CCI II stage (5th -7th groups of 12-14 patients), aged 50±5, who received the basic pharmacological therapy (enalapril and vinpocetine). The patients of the 2nd and 5th groups additionally received ceraxon and mexicor, those of the 3rd and the 6th groups additionally received immunomodulator glutoxim, and those from the 4th and 7th groups received polyoxidonium. Twenty-two healthy donors were in the control group. Immune disorders were assessed by the parameters of the functional activity of neutrophils, levels of cytokines in plasma, components of the complement and inhibitors.
 Results and discussion: In the case of CCI I and II stages similar proinflamatory immune disorders were detected, which is indicative of immune inflammation. The inclusion of glutoxime and polyoxidonium in a complex pharmacotherapy helps reduce the severity of immune and neuropsychic status indicators, which are more evident in case of stage II.
 Conclusions: In case of CCI I stage, the medications used can be arranged according to their clinico-immunological efficacy in ascending order: ceraxon+mexicore ® ceraxon+mexicor+glutoxim ® ceraxon+mexicor+polyoxidonium, and in case of CCI II stage: ceraxon+mexicor ® ceraxon+mexicor+polyoxidonium = ceraxon+mexicor+glutoxim.
Highlights
Chronic cerebral ischemia (CCI) accounts for 60-75% of all cerebrovascular diseases in Russia and around the world
An increasing number of facts have been accumulated about an important role of the immune system in cerebrovascular pathology, for example, in the pathogenesis of atherosclerosis and arterial hypertension, which are essential for emergence and progression of CCI, the key role is played by the immuno-inflammatory mechanisms
Given that one of the main causes of the immune inflammatory reaction, which is of a metabolic nature, is hypoxia, an increase, that was detected, of the content of pro-inflammatory cytokines and chemokines (TNFα, IL IL-6, IL-6, IL-8, IL-17, IL-18) with a compensatory increase in the concentration of anti-inflammatory cytokines (IL-10, IL-1RA, IL-4) in the systemic circulation of patients with CCI-I and CCI-II reflects the reaction of resident and recruited cells of innate immunity and epithelium to molecular patterns associated with a damage (Zurochka et al 2013, Yarilin 2010, Loktionov et al 2015, Pigarevskyy et al 2014, Lukens et al 2012, Spenceret al. 2014)
Summary
Chronic cerebral ischemia (CCI) accounts for 60-75% of all cerebrovascular diseases in Russia and around the world. The objective of the study is to establish the immune disorder patterns in patients with CCI I-II associated with arterial hypertension and to develop differentiated pharmacological methods for their correction. Among the various neurological symptoms observed in this category of patients, of crucial importance are cognitive dysfunctions, as it is their appearance that largely determines a decrease in the quality of patients’ life. According to their clinical manifestations, vascular cognitive disorders are quite heterogeneous, which can be explained, on the one hand, by different localization of brain damaged areas, and, on the other hand, by differences in developing cognitive deficit. A strong trend of the last 10-15 years has been that the contingent of patients with various types of cerebrovascular diseases has become much younger, which results from a constant increase in the impact of unfavorable external factors and low effectiveness of programs to prevent socially significant diseases, primarily atherosclerosis and arterial hypertension (AH) (Zakharova et al 2014, Skvortsova et al 2008, Kadykov et al 2014, Mitra et al 2011)
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