Прокоагулянтная готовность у пациентов с артериальной гипертензией и мультифокальным атеросклерозом

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

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. 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. 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. 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.

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