urmjУральский медицинский журналUral Medical Journal2949-4389Ural State Medical University10.52420/umj.23.3.36DPNWPQurmj-1533Research ArticleОригинальные статьи | Original articlesOriginal articlesПрокоагулянтная готовность у пациентов с артериальной гипертензией и мультифокальным атеросклерозомPro‑coagulant Considerations in Patients with Arterial Hypertension and Multifocal Atherosclerosishttps://orcid.org/0000-0001-5219-9216ВеденскаяС. С.VedenskayaS. S.

Светлана Сергеевна Веденская  — кандидат медицинских наук, доцент кафедры факультетской терапии, эндокринологии, аллергологии и иммунологии

Екатеринбург

Svetlana S. Vedenskaya — Candidate of Sciences (Medicine), Associate Professor of the Department of Faculty Therapy, Endocrinology, Allergology and Immunology

Ekaterinburg

ssveden@yandex.ruhttps://orcid.org/0000-0002-0705-6651СмоленскаяО. Г.SmolenskayaO. G.

Ольга Георгиевна Смоленская — доктор медицинских наук, профессор, заведующий кафедрой факультетской терапии, эндокринологии, аллергологии и иммунологии

Екатеринбург

Olga G. Smolenskaya — Doctor of Sciences (Medicine), Professor, Head of the Department of Faculty Therapy, Endocrinology, Allergology and Immunology

Ekaterinburg

o.smolenskaya@mail.ruhttps://orcid.org/0000-0001-9397-4063ГрачёвВ. Г.GrachevV. G.

Вадим Геннадьевич Грачёв — кандидат медицинских наук, доцент кафедры факультетской терапии, эндокринологии, аллергологии и иммунологии

Екатеринбург

Vadim G. Grachev — Candidate of Sciences (Medicine), Associate Professor of the Department of Faculty Therapy, Endocrinology, Allergology and Immunology

Ekaterinburg

grach_vad@mail.ruhttps://orcid.org/0000-0001-5063-5571КлячинаЕ. С.KlyachinaE. S.

Екатерина Сергеевна Клячина — ассистент кафедры факультетской терапии, эндокринологии, аллергологии и иммунологии

Екатеринбург

Ekaterina S. Klyachina — Assistant of the Department of Faculty Therapy, Endocrinology, Allergology and Immunology

Ekaterinburg

katrina.s.sharm@mail.comhttps://orcid.org/0009-0008-1817-1250ШиробоковаК. В.ShirobokovaK. V.

Ксения Владимировна Широбокова — заведующий клинико-диагностической лабораторие

Екатеринбург

Ksenia V. Shirobokova — Head of the Clinical Diagnostics Laboratory

Ekaterinburg

ksenia.kirillova@citilab.ruУральский государственный медицинский университетРоссияUral State Medical UniversityRussian FederationСитилаб-УралРоссияSitilab-UralRussian Federation2024110720242333645Copyright © Веденская С.С., Смоленская О.Г., Грачёв В.Г., Клячина Е.С., Широбокова К.В., 20242024Веденская С.С., Смоленская О.Г., Грачёв В.Г., Клячина Е.С., Широбокова К.В.Vedenskaya S.S., Smolenskaya O.G., Grachev V.G., Klyachina E.S., Shirobokova K.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.umjusmu.ru/jour/article/view/1533

Цель работы — установить особенности гемостаза и реологии крови у пациентов с артериальной гипертензией (АГ) и мультифокальным атеросклеротическим поражением (МФАП).

Материалы и методы

Материалы и методы. В исследование включены мужчины и женщины в возрасте 40–70 лет, из них 59 пациентов с контролируемой АГ I–II стадий, имеющие мультифокальное поражение сосудистого русла (1 группа), и 42 пациента с контролируемой АГ III стадии, перенесших ишемический инсульт и имеющих мультифокальное поражение сосудистого русла (2 группа). Для выявления нарушений гемостаза проводили тест на анализаторе «Регистратор тромбодинамики Т-2» (ООО «ГемаКор», Москва, Россия).

Результаты

Результаты. Пациенты с АГ и МФА имеют нарушения в системе коагуляционного гемостаза (увеличение средней и начальной скоростей роста сгустка, размера сгустка, а также наличие спонтанных сгустков), что приводит к высокому остаточному риску развития церебральных осложнений, несмотря на снижение АД до целевых цифр и контроль липидного спектра.

Обсуждение

Обсуждение. Повышенное артериальное давление у пациентов с МФА приводит к дисфункции эндотелия, что сопровождается активацией путей коагуляции и фибринолиза. Эти изменения приводят к нарушению микроциркуляторного гемостаза в головном мозге, развитию и прогрессированию церебральной ишемии, а в последующем и возникновению инсульта, как первого, так и повторного.

Заключение

Заключение. Важным результатом настоящей работы является впервые выявленное изменение коагуляционного звена гемостаза у пациентов 40–70 лет с АГ и МФАП, которое можно рассматривать как дополнительный предиктор развития инсульта.

The aim of the work to determine the features of hemostasis and blood rheology in patients with arterial hypertension (HTN) and multifocal atherosclerosis (MFA).

Materials and methods

Materials and methods. The study enrolled male and female patients aged from 40 to 70 years, including 59 patients with controlled stage I–II hypertension and multifocal vascular lesions (Group 1) and 42 patients with controlled stage III hypertension, who have suffered an ischemic stroke and have multifocal vascular lesions (Group 2). A test using the Thrombodynamics analyser system T-2 (GemaKor, LLC, Moscow, Russia) was performed to detect the impairment of hemostasis.

Results

Results. Patients with HTN and MFA have an impaired coagulation hemostasis system (an increase in the initial and stationary clot growth rate and the size of the clot, as well as the presence of spontaneous clots), which leads to a high residual risk of cerebral complications, despite BP lowering to target figures and control of lipid profile.

Discussion

Discussion. Elevated blood pressure in patients with MFA leads to endothelial dysfunction, which is accompanied by activation of coagulation and fibrinolysis pathways. These changes lead to a violation of microcirculatory hemostasis in the brain, the development and progression of cerebral ischemia, and subsequently the occurrence of stroke, both the first and repeated.

Conclusion

Conclusion. An important result of this study is the first registered change in the coagulation link of hemostasis in patients with HTN and MFA aged from 40 to 70 years, which can be considered an additional criterion for stroke prediction.

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The authors declare that there are no conflicts of interest present.