Медицина / 4. Терапия

O. O. Kalmykov

Kharkiv National Medical University, Kharkiv, Ukraine

Сardiorespiratory pathology development and course determination using surfactant C gene polymorphism evaluation

Background. Chronic respiratory and cardiovascular pathology occupy the leading positions in general morbidity, oftenly combining in one and the same patient and demonstrate a constant growth of incidence, invalidizationand mortality all over the world [1, 2]. The significance of patient organism’s indivilual peculiarities in the development of either respiratory or cardiovascular diseases is wellknown [3]. The role of surfactant, its genetic polymorphism, in predisposition to pulmonary emphysema formation, irreversible obstruction development was studied well before [4, 5]. While, the relation of surfactant protein C genetic polymorphism to the state of cardiovascular system in patients with comorbid pathology was not clear till now.

Aim of the study was to improve the diagnostic an prophylactic measures in comorbid respiratory and cardiovascular pathology by surfactant protein C genetic polymorphism estimation in relation to vascular remodeling, endothelium dysfunction, hemodynamic and metabolic disturbances, and also systemic inflammation.

Materials and methods. In the prospective randomized study conducted by “case-control” design 76 male patients of slavic ethnic group aged 37–68 with respiratory pathology (chronic bronchitis, chronic obstructive pulmonary disease, pneumoconioses) and in half of cases — accompanying cardiovascular diseases (arterial hypertension, ischemic heart disease, heart failure, chronic cor pumonale) were examined. Genotypes А138С (АА, АС, СС) and А186G (AA, AG, GG) of surfactant protein С were studied in blood leukocytes and buccal epitheliocytes by polymerase chain reaction with further mass-spectrometry analysis; hemodynamic parameters by doppler-echocardiography; N-terminal prohormone of brain natriuretic peptide, interleukines 6, 10, 17 by immunoessay method; oxidative stress and “intima-media” complex characteristics.

Results and discussion. The association of А138С and А186G gene polymorphisms with more expressed structural, functional and metabolic changes of heart and endothelium, oxydative stress systemic inflammation were detected. The prognostic algorhythm for evaluation of cardiorespiratory pathology course was elaborated taking into account clinical and pathogenical parameters. It was assumed that two revealed “pathologic” allels of the gene show the highest prognostic potential and their combined presence surely points on high risk of cardiopulmonological disturbances. Becides this, a high predicting rate was revealed for the right ventricle’s front wall thickness (is above 6 mm), complex “intima-media” of carotid artery thikness to its diameter ratio (if above 0.10) and the duration of cardiovascular anamnesis (if exceeds 10 years).

Conclusion. Surfactant protein C genetic polymorphism evaluation is reasonable to conduct together with standard diagnostic and prophylactic measures in patients with combined course of respiratory and cardiovascular pathology for prognosis evaluation and risk groups formation. The developed prognostic algorhythm may be used for cardiorespiratory pathology complex evaluaton of development or progression risk. The perspective of further investigations is a clinical trial of prophylactic potential of surfactant protein C genetic polymorphism evaluation and implication of elaborated prognostic algorhythm in relation to cardiorespiratory morbidity decrease and also further search for prognostically significant clinico-genetical and other pathogenic markers of this pathology’s risk of development.

Key words: chronic bronchitis, chronic obstructive pulmonary disease, pneumoconiosis, atherosclerosis, arterial hypertension, cor pulmonale, heart failure

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