urmjУральский медицинский журналUral Medical Journal2949-4389Ural State Medical University10.52420/umj.24.1.108ZSJFLRurmj-1729Research ArticleОригинальные статьи | Original articlesOriginal articlesКлинико-патогенетические факторы риска инсульта у пациентов с неуточненным (криптогенным) патогенетическим вариантом ишемического инсульта согласно критериям TOASTClinical and Genetic Risk Factors in Patients with an Unspecified (Cryptogenic) Pathogenetic Variant According to the TOAST Criteriahttps://orcid.org/0000-0001-7210-945XГалкинС. С.GalkinS. S.

Сергей Сергеевич Галкин — кандидат медицинских наук, ассистент кафедры неврологии, нейрохирургии и медицинской генетики, институт нейронаук и нейротехнологий;

невролог отделения для больных с острым нарушением мозгового кровообращения

Москва

Sergei S. Galkin — Candidate of Sciences (Medicine), Assistant of the Department of Neurology, Neurosurgery and Medical Genetics, Institute of Neuroscience and Neurotechnology;

Neurologist of the Department for Patients with Acute Cerebrovascular Accident

Moscow

ser.62@mail.ruhttps://orcid.org/0000-0002-4532-4434АнисимовК. В.AnisimovK. V.

Кирилл Владимирович Анисимов — кандидат медицинских наук, врач рентгенэндоваскулярных диагностики и лечения;

невролог, научный сотрудник института цереброваскулярной патологии и инсульта

Москва

Kirill V. Anisimov — Candidate of Sciences (Medicine), Endovascular Radiologist;

Neurologist, Researcher of the Institute of Cerebrovascular Pathology and Stroke

Moscow

anisimov.org@gmail.comhttps://orcid.org/0000-0003-3322-9357ГунченкоА. С.GunchenkoA. S.

Анастасия Сергеевна Гунченко — кандидат медицинских наук, невролог

Москва

Anastasia S. Gunchenko — Candidate of Sciences (Medicine), Neurologist

Moscow

dr.nevrolog@list.ruhttps://orcid.org/0000-0002-8434-5916ИконниковаА. Ю.IkonnikovaA. Yu.

Анна Юрьевна Иконникова — кандидат медицинских наук, ведущий инженер лаборатории биологических микрочипов

Москва

Anna Yu. Ikonnikova — Candidate of Sciences (Medicine), Leading Engineer of the Laboratory of Biological Microarrays

Moscow

anyuik@gmail.comhttps://orcid.org/0009-0007-6570-7786ШапкинМ. А.ShapkinM. A.

Михаил Алексеевич Шапкин — анестезиолог-реаниматолог, заведующий отделением реанимации и интенсивной терапии для больных с острым нарушением мозгового кровообращения, региональный сосудистый центр

Москва

Mikhail A. Shapkin — Anesthesiologist-Resuscitator, Head of the Intensive Care Unit for Patients with Acute Cerebrovascular Accident, Regional Vascular Center

Moscow

Mihailshapkin6230@gmail.comhttps://orcid.org/0000-0001-9209-9121АнисимоваА. В.AnisimovaA. V.

Анастасия Вячеславовна Анисимова — доктор медицинских наук, профессор, профессор кафедры неврологии, нейрохирургии и медицинской генетики, институт нейронаук и нейротехнологий;

невролог отделения реанимации и интенсивной терапии для больных с острым нарушением мозгового кровообращения, региональный сосудистый центр

Москва

Anastasia V. Anisimova — Doctor of Sciences (Medicine), Professor, Professor of the Department of Neurology, Neurosurgery and Medical Genetics, Institute of Neuroscience and Neurotechnology;

Neurologist Intensive Care Unit for Patients with Acute Cerebrovascular Accident, Regional Vascular Center

Moscow

gssh@mail.ruhttps://orcid.org/0000-0002-2642-4202НаседкинаТ. В.NasedkinaT. V.

Татьяна Васильевна Наседкина — доктор биологических наук, профессор, ведущий научный сотрудник лаборатории биологических микрочипов

Москва

Tatyana V. Nasedkina — Doctor of Sciences (Biology), Professor, Leading Researcher of the Laboratory of Biological Microarrays

Moscow

tanased06@rambler.ruРоссийский национальный исследовательский медицинский университет имени Н. И. Пирогова; Городская клиническая больница имени И. В. ДавыдовскогоРоссияPirogov Russian National Research Medical University; I. V. Davydovsky City Clinical HospitalRussian FederationГородская клиническая больница имени И. В. Давыдовского; Федеральный центр мозга и нейротехнологийРоссияI. V. Davydovsky City Clinical Hospital; Federal Center for Brain and NeurotechnologyRussian FederationГлавное бюро медико-социальной экспертизы по г. МосквеРоссияMain Bureau of Medical and Social Expertise in MoscowRussian FederationИнститут молекулярной биологии имени В. А. Энгельгардта Российской академии наукРоссияEngelhardt Institute of Molecular Biology, Russian Academy of SciencesRussian FederationГородская клиническая больница № 1 имени Н. И. ПироговаРоссияPirogov City Clinical Hospital No. 1Russian FederationРоссийский национальный исследовательский медицинский университет имени Н. И. Пирогова; Городская клиническая больница № 1 имени Н. И. ПироговаРоссияPirogov Russian National Research Medical University; Pirogov City Clinical Hospital No. 1Russian Federation202503032025241108–122Copyright © Галкин С.С., Анисимов К.В., Гунченко А.С., Иконникова А.Ю., Шапкин М.А., Анисимова А.В., Наседкина Т.В., 20252025Галкин С.С., Анисимов К.В., Гунченко А.С., Иконникова А.Ю., Шапкин М.А., Анисимова А.В., Наседкина Т.В.Galkin S.S., Anisimov K.V., Gunchenko A.S., Ikonnikova A.Y., Shapkin M.A., Anisimova A.V., Nasedkina T.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/1729

Обоснование. Как показывают последни е научные исследования, для криптогенного ишемического инсульта (ИИ) характерна гетерогенность этиопатогенетических механизмов, что указывает на актуальность поиска потенциальных факторов риска развития криптогенного ИИ, в т. ч. клинико-генетических.Цель исследования — исследовать ассоциации генетических маркеров, влияющих на спонтанную и индуцированную агрегацию тромбоцитов (АТ), клинико-лабораторных показателей у пациентов с неуточненным характером ИИ согласно критериям TOAST для выявления потенциальных клинико-генетических факторов риска и более глубокого понимания патогенетических механизмов заболевания.Материалы и методы. В исследование включено 196 пациентов с неуточненным патогенетическим вариантом ИИ. Исследованы ассоциации полиморфизмов генов ITGB3, GPIba, TBXA2R, ITGA2, PLA2G7, HMOX1, PTGS1, PTGS2, ADRA2A, ABCB1, PEAR1 и межгенной области 9p21.3 с клинико-лабораторными параметрами.Результаты. Носительство генотипа G/G rs1062535 ITGA2 ассоциировалось с достоверно более низкими показателями спонтанной АТ по сравнению с пациентами с генотипами G/A+A/A. У пациентов с генотипом С/С PLA2G7 уровень спонтанной АТ (ОП %) являлся значимо (p = 0,041) более низким по сравнению с пациентами с генотипами T/C+T/T. У пациентов с генотипом С/С rs4523 TBXA2R определялся достоверно (p < 0,050) ниже показатель АТ, инду цированной аденозиндифосфатом, по сравнению с пациентами с генотипами C/T+T/T. У пациентов с генотипом С/С rs5918 ITGB3 достоверно более низкий показатель АТ, индуцированной адреналином, по сравнению с пациентами с генотипами T/T+T/C. У пациентов с генотипом A/A rs1062535 ITGA2 уровень АТ, индуцированной ристомицином, достоверно (p < 0,050) выше по сравнению с пациентами с генотипами G/G+G/A.Заключение. Носительство генотипов G/A+A/A ITGA2, T/C+T/T PLA2G7, C/T+T/T TBXA2R, A/A ITGA2 может быть использовано как потенциальный маркер течения ИИ неуточненного патогенетического варианта.

Background. Recent studies emphasize the heterogeneity of cryptogenic ischemic stroke (IS), highlighting the importance of identifying clinical and genetic risk factors.Objective. This study explores the associations between genetic markers affecting spontaneous and induced platelet aggregation (PA) and clinical parameters in patients with unspecified IS according to TOAST criteria, aiming to uncover potential risk factors and understand the disease’s pathogenetic mechanisms.Materials and methods. The study included 196 patients diagnosed with unspecified ischemic stroke. We examined the associations of various gene polymorphisms (ITGB3, GPIba, TBXA2R, ITGA2, PLA2G7, HMOX1, PTGS1, PTGS2, ADRA2A, ABCB1, PEAR1) with clinical and laboratory parameters.Results. The G/G rs1062535 ITGA2 genotype was linked to significantly lower spontaneous aggregation rates than the G/A+A/A genotypes. Patients with the C/C PLA2G7 genotype had a significantly lower spontaneous aggregation level (SA %) compared to T/C+T/T genotypes (p = 0.041). The C/C genotype rs4523 TBXA2R showed a significantly lower ADP-induced PA rate compared to C/T+T/T (p < 0.050). Similarly, those with the C/C genotype rs5918 ITGB3 had significantly lower adrenaline-induced PA rates compared to T/T+T/C. Conversely, patients with the A/A genotype rs1062535 ITGA2 exhibited significantly higher ristomycin-induced AT rates than G/G+G/A genotypes.Conclusion. The G/A+A/A ITGA2, T/C+T/T PLA2G7, C/T+T/T TBXA2R, and A/A ITGA2 genotypes may serve as potential markers for the course of unspecified ischemic stroke.

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