Annals of the Russian academy of medical sciencesAnnals of the Russian academy of medical sciencesВестник Российской академии медицинских наук0869-60472414-3545"Paediatrician" Publishers LLC16210.15690/vramn.v68i7.706CARDIOLOGY AND CARDIOVASCULAR SURGERY: CURRENT ISSUESАКТУАЛЬНЫЕ ВОПРОСЫ КАРДИОЛОГИИ И СЕРДЕЧНО-СОСУДИСТОЙ ХИРУРГИИLipid, Adipokine аnd Ghrelin Concentrations in Myocardial Infarction Patients with Insulin ResistanceСОДЕРЖАНИЕ ЛИПИДОВ, АДИПОКИНОВ И ГРЕЛИНА ПРИ РАЗВИТИИ ИНСУЛИНОРЕЗИСТЕНТНОСТИ У ПАЦИЕНТОВ С ИНФАРКТОМ МИОКАРДАGruzdevaO. V.ГруздеваО. В.
Russian Federation

PhD, Department of Diagnostics of Cardiovascular Diseases, Research Institute for Complex Issues of Cardiovascular Diseases SB RAMS Address: 650002, Kemerovo, Sosnovy Blvd., 6; tel.: (3842) 64-05-53

gruzov@cardio.kem.ruKaretnikovaV. N.КаретниковаВ. Н.
Russian Federation

PhD, Head of the Laboratory of Blood Circulation Pathology of Multifocal Atherosclerosis, Department of Multifocal Atherosclerosis Research Institute for Complex Issues of Cardiovascular Diseases SB RAMS, Professor, Department of Cardiology and Cardiovascular Surgery, Kemerovo State Medical Address: 650002, Kemerovo, Sosnovy Blvd., 6; tel.: (3842) 64-05-53

tori1071@mail.ruAkbashevaO. Е.АкбашеваО. Е.
Russian Federation

PhD, Associate Professor, Department of Biochemistry, Siberian State Medical University Address: 634050, Tomsk, Moscow path, 6; tel.: (3822) 42-09-22

akbashoe@yandex.ruFedorovaT. S.ФедороваТ. С.
Russian Federation

PhD, Associate Professor, Department of Biochemistry, Siberian State Medical University. Address: 634050, Tomsk, Moscow path, 6; tel.: (3822) 42-09-22

akbashoe@yandex.ruBelikE. V.БеликЕ. В.
Russian Federation

Junior Research Worker, Department of Diagnostics of Cardiovascular Diseases, Research Institute for Complex Issues of Cardiovascular Diseases SB RAMS Address: 650002, Kemerovo, Sosnovy Blvd., 6; tel.: (3842) 64-05-53

sionina.ev@mail.ruPalichevaE. I.ПаличеваЕ. И.
Russian Federation

PhD, Senior Research Worker, Department of Diagnostics of Cardiovascular Diseases, Research Institute for Complex Issues of Cardiovascular Diseases SB RAMS, Associate Professor, Department of Biochemistry, Kemerovo State Medical Academy Address: 650002, Kemerovo, Sosnovy Blvd., 6; tel.: (3842) 64-05-53

palichevaelena@rambler.ruUchasovaE. G.УчасоваЕ. Г.
Russian Federation

PhD, Senior Research Worker, Department of Diagnostics of Cardiovascular Diseases, Research Institute for Complex Issues of Cardiovascular Diseases SB RAMS Address: 650002, Kemerovo, Sosnovy Blvd., 6; tel.: (3842) 64-05-53

uchaeg@cardio.kem.ruDylevaYu. A.ДылеваЮ. Д.
Russian Federation

Junior Research Worker, Department of Diagnostics of Cardiovascular Diseases, Research Institute for Complex Issues of Cardiovascular Diseases SB RAMS Address: 650002, Kemerovo, Sosnovy Blvd., 6; tel.: (3842) 64-05-53

dileya@cardio.kem.ruBrazovskayaN. G.БразовскаяН. Г.
Russian Federation

PhD, Senior Lecturer, Department of Medical and Biological Cybernetics, Siberian State Medical University Address: 634050, Tomsk, Moscow path, 6; tel.: (3822) 42-09-22

brand@mail.ruBarbarashO. L.БарбарашО. Л.
Russian Federation

PhD, Professor, Director of the Research Institute for Complex Issues of Cardiovascular Diseases SB RAMS, Head of Multifocal Atherosclerosis Department Research Institute for Complex Issues of Cardiovascular Diseases SB RAMS, Head of the Department of Cardiology and Cardiovascular Surgery, Kemerovo State Medical Academy Address: 650002, Kemerovo, Sosnovy Blvd., 6; tel.: (3842) 64-33-08

barbol@cardio.kem.ruResearch Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian FederationНИИ комплексных проблем сердечно-сосудистых заболеваний СО РАМН, Кемерово, Российская ФедерацияResearch Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation Kemerovo State Medical Academy, Russian FederationНИИ комплексных проблем сердечно-сосудистых заболеваний СО РАМН, Кемерово, Российская Федерация Кемеровская государственная медицинская академия, Российская ФедерацияSiberian State Medical University, Tomsk, Russian FederationСибирский государственный медицинский университет, Томск, Российская Федерация19072013687Vestnik Rossiiskoi akademii medetsinskikh nauk / Annals of the Russian academy of medical sciencesВестник Российской академии медицинских наук131907082015Copyright ©; 1970, "Paediatrician" Publishers LLCCopyright ©; 1970, Издательство "Педиатръ"1970"Paediatrician" Publishers LLCИздательство "Педиатръ"https://vestnikramn.spr-journal.ru/jour/about/submissionshttps://vestnikramn.spr-journal.ru/jour/article/view/162

Aim. The estimate insulin resistance in myocardial infarction. Patients and methods. The study involved 200 patients with myocardial infarction, in which on the 1st and 12th day of hospitalization measured glucose, insulin, insulin resistance index (IR), lipid profile, the concentration of adipokines and ghrelin. Results. IR was detected in 77% of patients and was associated with a history of factors of cardiovascular risk, adverse clinical course of the disease, lipid disorders. The most important marker was the level of free fatty acids. High risk associated with increased in 9 times the concentration of free fatty acids in blood plasma. Patients with IR observed increased concentrations of leptin, resistin, and reduced the protective effect of adiponectin. The high specificity and sensitivity characteristic of the concentration of ghrelin: its reduction by 4 times in the acute phase of myocardial infarction increases the risk of MI by 78%. Conclusions. Significant risk factors for MI myocardial infarction, along with insulinemia and glycemia, is to increase the concentration of free fatty acids and the disbalance in the system adipokines against deficiency of ghrelin in acute and early recovery periods of the disease. Free fatty acids and ghrelin are promising markers to stratify the risk of insulin resistance in patients with myocardial infarction.

Цель исследования: оценка инсулинорезистентности при инфаркте миокарда. Пациенты и методы: в исследование включено 200 пациентов с инфарктом миокарда, у которых на 1-е и 12-е сут госпитализации определяли содержание глюкозы, инсулина, индекс инсулинорезистентности (ИР), показатели липидного профиля, концентрацию адипокинов и грелина. Результаты: ИР была выявлена у 77% больных и ассоциировалась с наличием в анамнезе факторов сердечно-сосудистого риска, неблагоприятным клиническим течением заболевания, нарушением липидного обмена. Наиболее информативным маркером оказался уровень свободных жирных кислот. Высокий риск развития ИР связан с возрастанием в 9 раз концентрации свободных жирных кислот в плазме крови. У больных с ИР наблюдается увеличение концентрации лептина, резистина, и снижение защитного действия адипонектина. Высокая специфичность и чувствительность характерна для концентрации грелина: ее снижение в 4 раза в остром периоде инфаркта миокарда повышает риск развития ИР на 78%.Выводы: значимыми факторами риска ИР при инфаркте миокарда, наряду с инсулинемией и гликемией, является увеличение концентрации свободных жирных кислот и дисбаланс в системе адипокинов на фоне дефицита грелина в остром и раннем восстановительном периодах заболевания. Свободные жирные кислоты и грелин являются перспективными маркерами для стратификации риска развития инсулинорезистентности у больных с инфарктом миокарда.

insulin resistancemyocardial infarctionfree fatty acidsadipokinesghrelinинсулинорезистентностьинфаркт миокардасвободные жирные кислотыадипокиныгрелин1. Lazzeri C., Sori A., Chiostri M., Gensini GF, Valente S. Prognostic role of insulin resistance as assessed by homeostatic model assessment index in the acute phase of myocardial infarction in nondiabetic patients submitted to percutaneous coronary intervention. Eur. J. Anaesthesiol. 2009; 26: 856–862.2. Katz A., Nambi S.S., Mather K., Baron A.D., Follmann D.A., Sullivan G., Quon M.L. Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans. J. Clin. Endocrinol. Metab. 2000; 85: 2402–2410.3. Gruzdeva O., Uchasova E., Dyleva Y., Belik E., Kashtalap V., Barbarash O. Relationship between free fatty acids, insulin resistance markers, and oxidized lipoproteins in myocardial infarction and acute left ventricular failure. Diabetes, Metabol. Syndr. & Obesity: Targets & Therapy. 2013; 6: 103–111.4. Rask-Madsen C., Kahn C. Tissue-specific insulin signaling, metabolic syndrome, and cardiovascular disease. Arterioscler. Thromb. Vasc. Biol. 2012; 32: 2052–2059.5. Dunmore S., Brown J. The role of adipokines in β-cell failure of type 2 diabetes. J. Endocrinol. 2013; 216: 37–45.6. Varela L., Va´zquez M., Cordido F., Nogueiras R, Vidal-Puig A., Die´guez C., Lo´pez M. Ghrelin and lipid metabolism: key partners in energy balance. J. Mol. Endocrinol. 2011; 46: 43–63.7. Stubbs P., Nishio K., Shigemitsu M., Kusuyama T., Fukui T., Kawamura K., Itoh S., Konno N., Katagiri T. Insulin resistance in nondiabetic patients with acute myocardial infarction. Cardiovasc. Revasc. Med. 2006; 7 (2): 54–60.8. Leclercq I., Da Silva Morais A., Schroyen B., Van Hul N., Geerts A. Insulin resistance in hepatocytes and sinusoidal liver cells: mechanisms and consequences. J. Hepatol. 2007; 47: 142–156.9. Deng Y., Scherer P. Adipokines as novel biomarkers and regulators of the metabolic syndrome. Ann. N.Y. Acad. Sci. 2010; 1212: 1–19.10. Koh K., Park S., Quon M. Leptin and cardiovascular disease: response to therapeutic interventions. Circulation. 2008; 117: 3238–3249.11. Opie L. Metabolic management of acute myocardial infarction comes to the fore and extends beyond control of hyperglycemia. Circulation. 2008; 117: 2172–2177.12. Рichi S. Resistin down-regulates insulin-mediated glucose uptake by target tissues. Endocr. Res. 2010; 23: 132–137.13. Kadowaki T., Yamauchi T., Kubota N., Hara K., Ueki K., Tobe K. Adiponectin and adiponectin receptors in insulin resistance, diabetes, and the metabolic syndrome. J. Clin. Invest. 2006; 116: 1784–1792.14. Lee H., Wang G., Englander E., Kojima M., Greeley G. Ghrelin, a new gastrointestinal endocrine peptide that stimulates insulin secretion: Enteric distribution, ontogeny, influence of endocrine, and dietary manipulations. Endocrinology. 2002; 143: 185–190.15. Pacifico L., Poggiogalle E., Costantino F., Anania C., Ferraro F., Chiarelli F., Chiesa C. Acylated and nonacylated ghrelin levels and their associations with insulin resistance in obese and normal weight children with metabolic syndrome. Eur. J. Endocrinol. 2009; 161: 861–870.16. Doogue M., Begg E., Moore M., Lunt H., Pemberton C. et al. Metformin increases plasma ghrelin in Type 2 diabetes. Brit. J. Clin. Pharmacol. 2009; 68: 875–882.17. Granata R., Isgaard J., Alloatti G., Ghigo E. Cardiovascular actions of the ghrelin gene-derived peptides and growth hormone-releasing hormone. Exp. Biol. Med. 2011; 236: 505–514.18. Dixit V., Schaffer E., Pyle R. Ghrelin ingibits leptin and activation induced proinflammatory cytokine expression by human monocytes and T-cells. J. Clin. Invest. 2004; 114: 57–66.