Endogenous Intoxication in Patients with Coronary Heart Disease on the Background of Different Gallbladder Condition

Abstract

The endogenous intoxication syndrome (EIS) is one of the leading syndromes of many pathological processes. EIS is a result of the accumulation of harmful substances. This accumulation depends on formation and excretion of bile, and gallbladder (GB) condition, because intrahepatic and intraductal bile stasis, provoked by cholelithiasis, strictures and deformations of bile ducts, cellular and enzymatic dysfunctions, worsens the detoxifying function of bile system. Together with this, persistent inflammation increases the amount of proinflammatory mediators.The objective: was to estimate EIS activity according to hematological indexes in patients with coronary heart disease (CHD), namely, non-stable angina pectoris, with various GB condition.Material and methods. We analyzed the data of 116 patients, which were divided into groups according to GB condition: intact GB; sludge, cholesterosis and GB polyps; GB body deformations; GB neck deformations and cholecystitis in anamnesis; cholelithiasis; cholecystectomy in anamnesis. According to blood analysis, we counted the cellular indexes of EIS: index of neutrophils’ reactive answer, leucocytic index of intoxication in modification of B.A. Reys, hematologic index of intoxication, intoxication marker. Results were processed by variation statistics methods. Data were considered significant if р<0,05.Results. Groups with different GB conditions were significantly different according to absolute levels of index of neutrophils’ reactive answer and both leucocytic indexes of intoxication. GB neck deformations, cholecystitis and cholelithiasis (both at the moment or in anamnesis) in patients with CHD were accompanied by activation of EIS. This tendency continued after cholecystectomy.Conclusion. Hematologic markers of intoxication directly correlated with biochemical parameters of inflammation, intoxication, lipid metabolism, and cytolysis. Increase of the former was associated with distension of mitral and aortic valves, and systolic dysfunction. In case of minimal EIS its markers did not correlate with inflammatory parameters. The biggest amount of correlations was revealed in case of present of past cholecystitis.