DIAGNOSTIC CRITERIA FOR UNDIFFERENTIATED CONNECTIVE TISSUE DYSPLASIA IN PATIENTS WITH ARTERIAL HYPERTENSION

Authors

  • Ye. H. Zaremba Danylo Halytsky Lviv National Medical University
  • N. O. Rak Danylo Halytsky Lviv National Medical University
  • O. V. Zaremba Danylo Halytsky Lviv National Medical University
  • O. V. Zaremba-Fedchyshyn Danylo Halytsky Lviv National Medical University
  • M. M. Virna Danylo Halytsky Lviv National Medical University
  • L. O. Odnorih Danylo Halytsky Lviv National Medical University

DOI:

https://doi.org/10.11603/1811-2471.2020.v.i2.11303

Keywords:

hypertension, undifferentiated connective tissue dysplasia, research methods (determination of IL-1, IL-6, TNF-, free and general blood oxyproline levels)

Abstract

The aim – to improve the diagnosis efficiency of patients with arterial hypertension (AH) combined with undifferentiated connective tissue dysplasia (UCTD) based on the study of clinical course, the severity of UCTD external and internal symptoms with determining the levels of IL-1, IL-6, TNF-a, free and general blood oxyproline.

Material and Methods. The study implied examination of 90 patients (52 women and 38 men) with AH of stage 2 from first to third degrees with manifestations of UCTD, who were on inpatient treatment in the Cardiology Department of the Lviv City Communal Clinical Emergency Hospital. The mean age of patients was (61.14±2.58) years. Patients were divided into 3 groups depending on the stage and degree of hypertension. Group I (n=16) included patients with hypertension of the first degree, group II (n=35) – with AH of the second degree, group III (n=39) – with AH of the third degree. The control group consisted of 20 patients with hypertension without manifestations of CTD.

Patients underwent clinical (checkup, palpation, percussion, auscultation), laboratory (determination of IL-1, IL-6, TNF-a, free and general oxyprolin blood levels) and instrumental studies (ECG, echocardiography, DBPM, ultrasound examination of internal organs and vessels of the lower extremities, ultrasound duplex examination of the carotid and vertebral arteries, radiological examination of the osteoarticular system), consultations of an ophthalmologist, neurologist, traumatologist and dentist.

Results. As a result of the study, in the group I of patients (n=16) UCTD of slight degree of severity was revealed in 13 (81 %), of medium degree – in 3 (19 %) persons. In the group II of patients (n=35), UCTD of moderate severity was found in 30 (86 %), severe – in 5 patients (14 %). In the group III of patients (n=39), UCTD of moderate severity was found in 32 patients (82 %), severe – in 7 (18 %). In the study of the level of TNF-a, an increase compared to the control group was detected, particularly, in the group I of patients its level exceeded in 37.4 times, in the group II – in 39.6 times, in the group III – in 46.2 times (p<0.001). IL-1b increased by 2.6-fold (р<0.05) in the group I of patients compared to the control group, 3.1-fold (р<0.01) – in the group II, and by 3.7-fold, that was the foremost (р<0.001), in patients of the group III. In turn, IL-6 in the group I of patients exceeded the indicators of the control group by 4.3 times (p<0.001), in the group II – 4.8 times (p<0.001), in the group III – 5.7 times (р<0.001). The study of the level of free oxyproline revealed its increase in comparison with the control group, namely in the group I of patients exceeded in 6.12 times, in the group II – in 6.81 times, in the group III – by 7.56 times (р<0.01). The study of the general of bound oxyproline revealed its increase in comparison with the control group, namely in the group I of patients exceeded by 6.98 times, in the group II – by 7.79 times, in the group III – by 9.42 times (p<0.01), which indicates an increase in fibrillogenesis and more pronounced destructive and inflammatory processes in connective tissue.

Conclusions. Patients with AH of the stage 2 from first to third degrees with manifestations of UCTD have increased levels of IL-1, IL-6 and TNF-a, which are not only sensitive markers of inflammation, but also play an important role in the pathogenesis and progression of vascular lesions, occurrence and destabilization of atherosclerotic plaques and thrombotic vessels occlusion. The determination of blood oxyprolin in patients with hypertension combined with UCTD confirms the presence of CTD, namely the decay of collagen is more pronounced in patients with severe dysplasia.

References

(2016). Vserossiyskoye nauchnoye obshchestvo terapevtov. Natsionalnyye rekomendatsii rossiyskogo nauchnogo meditsinskogo obshchestva terapevtov po diagnostike, lecheniyu i reabilitatsii patsiyentov s displaziyami soyedinitelnoy tkani [National recommendations of the Russian scientific medical society of therapists for the diagnosis, treatment and rehabilitation of patients with connective tissue dysplasia]. Medical Journal of the North Caucasus, 11 (1), 2-76 [in Russian].

Nechaeva, G.I., & Martynov, A.I. (2017). Displaziya soyedinitelnoy tkani: serdechno-sosudistyye izmeneniya, sovremennyye podkhody k diagnostike i lecheniyu [Dysplasia of connective tissue: cardiovascular changes, modern approaches to diagnosis and treatment]. Moscow: Publishing House Medical Information Agency [in Russian].

Kadurina, T.I., & Gorbunova, V.N. (2009). Displaziya soyedinitelnoy tkani [Dysplasia of connective tissue]. Saint-Petersburg: ALBI [in Russian].

(2013). Razrabotany komitetom ekspertov Rossiyskogo kardiologicheskogo obshchestva. Nasledstvennyye narusheniya soyedinitelnoy tkani v kardiologii. Diagnostika i lecheniye. Rossiyskiye rekomendatsii (1-y peresmotr) [Hereditary connective tissue disorders in cardiology. Diagnosis and treatment. Russian Recommendations (1st revision)]. Russkiy kardiol. Zhirn. – Russian Cardiology Journal, 1, 2 [in Russian].

Zaremba, Ye.H., Rak, N.O., & Zaremba-Fedchishin, O.V. (2017). Osoblyvosti perebihu arterialnoi hipertenzii poiednanoi z dysplaziieiu spoluchnoi tkanyny v praktytsi simeinoho likaria [Features of the course of arterial hypertension combined with connective tissue dysplasia in the practice of a family doctor]. Hromadske zdorovia – Public Health, 3-4 (6), 20-27 [in Ukrainian].

Geister, B.P., Egan, B.M., & Cohen, J.T. (2012). Cost-effectiveness and clinical effectiveness of catheter-based renal denervation for resistant hypertension. J. American College Cardiologists., 60 (14), 1550-1551.

Yakovlev, V.M., Nechaeva, G.I., Martynov, A.I., & Viktorova, I.A. (2016.) Displaziya soyedinitelnoy tkani v praktike vrachey pervichnogo zvena zdravookhraneniya [Dysplasia of connective tissue in the practice of primary care physicians]. Moscow: KST Interforum [in Russian].

Zaremba, Ye.H., Rak, N.O., & Shevchun-Pudlik, O.M. (2017). Vozrastnyye razlichiya proyavleniy nedifferentsirovannoy displazii soyedinitelnoy tkani u patsiyentov s arterialnoy gipertenziyey: prognoz [Age differences in manifestations of undifferentiated connective tissue dysplasia in patients with hypertension: a prognosis]. Med. Delo – Medical Business, 5 (57), 26-28 [in Russian].

Sklyarov, E.Y., & Bochar, O.M. (2016). Riven interleykinu-6 u patsiientiv z esentsiinoiu hipertenziieiu u poiednanni z ozhyrinniam pry pryznachenni telmisartanu abo olmesartanu v kompleksnii terapii z atorvastatynom [The level of interleukin-6 in patients with essential hypertension in combination with obesity when given telmisartan or olmesartan in complex therapy with atorvastatin]. Bukovyn. med. Visn. – Bukovyna Medical Bulletin, 2, 162-165 [in Ukrainian].

Stadnik, S.M., Lafarenko, V.A., & Pylypiuk, V.A. (2016). Rol systemnoho zapalennia u morfohenezi urazhennia arterialnoi systemy [The role of systemic inflammation in the morphogenesis of lesions of the arterial system]. Liky Ukrainy – Medicines of Ukraine, 3, 11-15 [in Ukrainian].

Kravchun, P.G., Shelest, O.M., Kovaleva, Yu.O., & Shelest, B.A. (2014). Tsytokinovyi profil v dynamitsi likuvannia arterialnoi hipertenzii [Cytokine profile in the dynamics of treatment of hypertension]. Hipertenziia – Hypertension, 2, 152-155 [in Ukrainian].

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Published

2020-08-14

How to Cite

Zaremba, Y. H., Rak, N. O. ., Zaremba, O. V., Zaremba-Fedchyshyn, O. V., Virna, M. M., & Odnorih, L. O. (2020). DIAGNOSTIC CRITERIA FOR UNDIFFERENTIATED CONNECTIVE TISSUE DYSPLASIA IN PATIENTS WITH ARTERIAL HYPERTENSION. Achievements of Clinical and Experimental Medicine, (2), 49–54. https://doi.org/10.11603/1811-2471.2020.v.i2.11303

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Оригінальні дослідження