Імунне запалення, клітинний і гуморальний імунітет у хворих з раннім розвитком ішемічної хвороби серця
Authors: Lomakovsky O. M. 
Published: July 2021

The aim – to identify a possible relationship between the early development of coronary artery disease and the level of cellular and humoral indicators of adaptive and innate immunity, immune inflammation in order to clarify the effect of the immune system on the early development of atherosclerosis.Materials and methods. IHD patients with stable angina pectoris were divided into two groups: the first group (n=112) included patients with the development of clinical manifestations of IHD after 60 years (65.7±4.3 years), the second group (n=108) – patients with the development of clinical manifestations of coronary artery disease before 45 years (43.7±4.8 years). The material for the immunological study was peripheral venous blood. To determine the parameters of cellular and humoral innate and adaptive immunity in blood serum and supernatants of mononuclear cells, enzyme immunoassay was used.Results and discussion. Comparative characteristics of patients with the development of clinical manifestations of ischemic heart disease up to 45 years compared with patients with their development after 60 years showed: clinical manifestations of dynamic coronary stenosis – in 33 versus 14 % of patients (p=0.046) (R=–0.21; p=0.046), the presence of heredity of ischemic heart disease – in 45 versus 15 % of patients (p=0.030) (R=–0.31; p=0.029), the level of specific antibodies to the damaged aorta is 10 (10–20) versus 5 (0–10) cu (р=0.033) (R=–0.31; p=0.01), the number of activated B cells with a CD40 index was 9.5 (7.0–11.9) versus 7.1 (5.6–9.9) % (p=0.019) (R=–0.32; p=0.018), free radical oxidation of proteins – 5.2 (4.0–6.6) versus 4.2 (1.7–5.7) cu (p=0.006) (R=–0.19; p=0.005), stable metabolite of blood nitric oxide NO2 – 0.95 (0.58–1.06) and 1.04 (0.70–1.54) mg/ml (p=0.036) (R=0.17; p=0.036), IL-2 in mononuclear cells – 18.7 (15.5–21.3) versus 14.5 (11.4–15.7) pg/ml (p=0.019) (R=–0.43; p=0.016). According to factor analysis, the main independent variables were identified: IL-6 (factor 1), functional and metabolic activity of monocytes (factor 2), antibodies to arterial components (factor 3) and CRP (factor 4). Analysis of multivariate linear regression showed the total relationship of the studied factors with the early development of clinical manifestations of coronary artery disease (R=0.30; F=2.5; p=0.048) with the dominant influence of inflammatory CRP (B=0.19; p=0.046) and activity monocytes (B=0.20; p=0.045). A step-by-step analysis of linear regression found a total relationship between the early development of IHD (R=0.41; F=3.7; p=0.017) with CRP (B=0.21; p=0.10), monocyte activity (B=0.22; p=0.08) and antibodies to arterial components (B=0.21; p=0.11).Conclusions. The early development of clinical manifestations of coronary artery disease (up to 45 years) compared with their development after 60 years is associated with a high level of activated B-lymphocytes and antibodies to the tissues of the vascular wall, active synthesis of pro-inflammatory IL-2, and a low level of anti-inflammatory IL-10. A simultaneous increase in the level of CRP, antibodies to arterial components and functional and metabolic activity of monocytes is directly related to the early development of clinical manifestations of coronary artery disease. The early development of ischemic heart disease is accompanied by the presence of heredity of ischemic heart disease, high activity of free-radical oxidation of proteins and expressive impairment of endothelial function.