Genetic aspects of predicting the results of treatment of patients with atherosclerosis of the arteries of the lower extremities

Abstract

Relevance. The reasons for the unsatisfactory results of treatment of atherosclerotic diseases of the arteries of the lower extremities are associated not only with the limited possibilities of conservative and operative methods of treatment, but also with the lack of objective criteria that allow predicting the course of this pathology and the effectiveness of planned therapeutic measures. The purpose of the study. Improving the results of treatment of patients with atherosclerosis of the arteries of the lower extremities on the basis of predicting the effectiveness of conservative and surgical treatment, taking into account genetic polymorphism. Materials and methods. The results of treatment and specially conducted studies were analyzed in 226 patients with atherosclerosis of the arteries of the lower extremities aged 40 to 89 years. The median age was 66.7 years. There were 157 males (69.5%) and 69 females (30.5%). Standard research methods were aimed at determining the biochemical status and assessing the state of arterial blood flow of patients. Genetic studies of 17 genes in the blood serum of patients were carried out using the polymerase chain reaction method. Results. It was revealed that the genes encoding elements of the renin-angiotensin-aldosterone system (angiotensinogen genes AGT:704 and AGT:521, angiotensin II receptor AGTR1:1166 and AGTR2:1675, aldosterone synthetase CYP11B2) have clinical significance; genes regulating intracellular ion homeostasis (G protein beta-3 subunit GNB3, alpha-adductin ADD1:1378); genes determining the structure of endothelial NO synthase (NOS3:894 and NOS3:786); hemostasis genes (F5 Leiden factor, prothrombin F2, plasminogen activator inhibitor PAI-1, platelet receptor fibrinogen GPIIIA, fibrinogen FGB); cytochrome P-450 CYP2D6 and CYP2C9 genes; genes of glycoprotein P MDR1. The dependence of gene polymorphism on the level of occlusion and the stage of the disease has been established. In order to determine the possibilities of predicting the effectiveness of therapeutic measures, a comparative assessment of the indicators of genetic testing was carried out, depending on the result of conservative therapy and surgical treatment. Conclusions. Genetic polymorphism determines the progression of obliterating atherosclerosis of the arteries of the lower extremities and is associated with the effectiveness of conservative and surgical therapeutic measures. The use of genetic testing using methods of multidimensional statistics makes it possible to predict the effectiveness of reconstructive operations in patients with chronic lower limb ischemia, taking into account not only clinical, laboratory and instrumental data, but also on the basis of changes in gene polymorphism.