Цитомегаловирусная инфекция и функция эндотелия у пациентов с острым инфарктом миокарда

Цель исследования. Изучение связи активной цитомегаловирусной (ЦМВ) инфекции с дисфункцией эндотелия у пациентов с острым инфарктом миокарда (ОИМ). Материалы и методы. В исследование вошли 42 добровольца без ишемической болезни сердца (ИБС) и 63 пациента с ОИМ. У пациентов до коронарографии и у добровольцев при поступлении брали образцы крови для анализа дезоксирибонуклеиновой кислоты (ДНК) ЦМВ в плазме методом полимеразной цепной реакции в реальном времени. Кроме того, у пациентов с ОИМ и добровольцев без ИБС анализировали функцию эндотелия с помощью теста эндотелийзависимой вазодилатации (ЭЗВД) плечевой артерии. Результаты. Мы показали, что у пациентов с ОИМ при поступлении статистически значимо повышена концентрация ДНК ЦМВ в плазме крови по сравнению с таковой у добровольцев без ИБС, что отражает активную ЦМВ-инфекцию - 1185,7 (0; 3003,0) против 0 (0;910,8) копий ДНК/мл плазмы (p=0,011). При этом по сравнению с добровольцами без ИБС у пациентов с ОИМ также выявлена дисфункция эндотелия - 11,5 (7,5; 15,2) % против 4,4 (0; 9,6) % случаев (p<0,0001), которая достоверно коррелировала с активностью продукции ЦМВ (R= -0,35; p=0,002). Обсуждение. У пациентов с ОИМ помимо нарушения функции эндотелия в острую фазу заболевания также выявляется повышенная продукция цитомегаловирусной ДНК. В настоящей работе мы впервые выявили отрицательную корреляцию между активностью цитомегаловирусной инфекции и эндотелийзависимой вазодилатацией не только у здоровых добровольцев, но и у пациентов с ОИМ. Выявленная нами взаимосвязь между активацией ЦМВ и нарушением функции эндотелия может объяснять роль цитомегаловируса в развитии осложнений атеросклероза за счет активации и повреждения инфицированных им клеток эндотелия. Выводы. В настоящей работе мы подтвердили наличие дисфункции эндотелия и активной ЦМВ-инфекции у пациентов с ОИМ. Мы выявили отрицательную корреляцию между активностью ЦМВ-инфекции и ЭЗВД у добровольцев без ИБС и пациентов с ОИМ.

острый инфаркт миокарда, вирус герпеса, цитомегаловирус, функция эндотелия, acute myocardial infarction, herpes virus, cytomegalovirus, endothelial function

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