SYSTEMIC INFLAMMATORY RESPONSE IN THE DEVELOPMENT OF ENDOTHELIAL DYSFUNCTION AND HYPERCOAGULATION SYNDROME IN PATIENTS WITH STENOTIC-OCCLUSIVE DISEASES
DOI:
https://doi.org/10.11603/2414-4533.2024.1.14642Keywords:
endothelial dysfunction, chronic arterial ischemia, thrombotic complicationsAbstract
The aim of the work: to study the influence of the level of the systemic inflammatory response on the development of endothelial dysfunction and the frequency of the development of the postoperative thrombotic process in patients with chronic limb-threatening ischemia.
Materials and Methods. The study included 121 patients with stenotic-occlusive atherosclerotic lesions of the infrainguinal arterial channel. Patients were divided into 2 groups, so group 1 included 74 % patients with stenotic-occlusive atherosclerotic lesions of the infrainguinal arterial bed, group II made up 47 % patients with stenotic-occlusive atherosclerotic lesions of the infrainguinal arterial bed with accompanying diabetes.
The level of activity of the systemic inflammatory response was determined by the level of C-reactive protein (CRP), interleukin 1 (IL1), interleukin 6 (IL6) and tumor necrosis factor α (TNF α); the level of endogenous intoxication was determined by the level of leukogram indicators and hematological indices of intoxication.
Results and Discussion.
The development of chronic arterial ischemia, which threatens the limb, is accompanied by an increase in the level of indicators of the systemic inflammatory response. The latter manifests itself in an increase in the level of CRP.
Violation of the function of the endothelium, especially in patients of group 2, was accompanied by the development of hypercoagulation syndrome even in the preoperative period and was manifested by an increase in the level of fibrinogen, FSF, TA and CRP, respectively by 22.2 % (Р < 0.05), 19.2 % (Р < 0.05), 8.7 % (Р < 0.05), 9.2 % (Р < 0.05).
In the postoperative period, the highest activity of indicators of the coagulation system was established in patients of group 2 at 12 o'clock after surgery with a slight decrease in the activity of the latter for 24 hours of the postoperative period. Identical changes in the activity of the coagulation system were also found in patients of group 1.
Based on the obtained results, the frequency of thrombotic complications, which occur much more often in patients with acute surgical processes, becomes clear. Yes, in patients of group 1 the frequency of postoperative DVT was 1 (2.0 %) case, and in group 2 patients – 4 (10.5 %) cases.
Conclusions. In patients with stenotic-occlusive lesions of the peripheral arterial bed, an increase in the activity of indicators of the systemic inflammatory response with an increase in the level of endogenous intoxication, accompanied by the development of endothelial dysfunction of the hypercoagulation syndrome, was established. These changes are more pronounced in patients with concomitant diabetes. These changes contribute to the development of the thrombotic process in the postoperative period.
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