cardiotomskСибирский журнал клинической и экспериментальной медициныSiberian Journal of Clinical and Experimental Medicine2713-29272713-265XTSU publishing10.29001/2073-8552-2023-39-2-14-22cardiotomsk-1782Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESРеперфузионное повреждение сердца. Роль микроваскулярной обструкцииReperfusion cardiac injury. The role of microvascular obstructionhttps://orcid.org/0000-0002-4358-7329РябовВ. В.RyabovV. V.

Рябов Вячеслав Валерьевич - д-р мед. наук, доцент, заместитель директора по научной и лечебной  работе, заведующий отделением неотложной  кардиологии

 634012, Российская Федерация, Томск, ул. Киевская, 111а 

Vyacheslav V. Ryabov - Dr. Sci. (Med.)., Deputy Director for Research and Clinical Services, Head of Department of Emergency Cardiology

 111a, Kievskaya str., Tomsk, 634012, Russian Federation 

rvvt@cardio-tomsk.ruhttps://orcid.org/0000-0002-1607-1482ПоповС. В.PopovS. V.

Попов Сергей Валентинович - д-р мед. наук, профессор, академик РАН, директор 

 634012, Российская Федерация, Томск, ул. Киевская, 111а 

 Sergey V. Popov - Dr. Sci. (Med.)., Academician of the Russian Academy of Sciences, Director 

 111a, Kievskaya str., Tomsk, 634012, Russian Federation 

press@cardio-tomsk.ruhttps://orcid.org/0000-0002-3699-4807ВышловЕ. В.VyshlovE. V.

Вышлов Евгений Викторович - д-р мед. наук, ведущий научный сотрудник, отделение неотложной кардиологии

 634012, Российская Федерация, Томск, ул. Киевская, 111а 

Evgeny V. Vyshlov - Dr. Sci. (Med.), Leading Research Scientist, Department of Emergency Cardiology 

 111a, Kievskaya str., Tomsk, 634012, Russian Federation 

evv@cardio-tomsk.ruhttps://orcid.org/0000-0002-4502-0836СиротинаМ.SirotinaM.

Сиротина Мария - аспирант, младший научный сотрудник, лаборатория экспериментальной кардиологии

 634012, Российская Федерация, Томск, ул. Киевская, 111а 

Maria Sirotina - Graduate Student, Junior Research Scientist, Laboratory of Experimental Cardiology 

 111a, Kievskaya str., Tomsk, 634012, Russian Federation 

sirotina_maria@mail.ruhttps://orcid.org/0000-0003-2264-1928НарыжнаяН. В.NaryzhnayaN. V.

Нарыжная Наталья Владимировна - д-р мед. наук, ведущий научный сотрудник, лаборатория экспериментальной кардиологии

 634012, Российская Федерация, Томск, ул. Киевская, 111а 

Natalia V. Naryzhnaya - Dr. Sci. (Med.)., Leading Research Scientist, Laboratory of Experimental Cardiology 

111a, Kievskaya str., Tomsk, 634012, Russian Federation 

natalynar@yandex.ruhttps://orcid.org/0000-0003-1808-556XМухомедзяновА. В.MukhomedzyanovA. V.

Мухомедзянов Александр Валерьевич - канд. мед. наук, научный сотрудник, лаборатория  экспериментальной кардиологии

 634012, Российская Федерация, Томск, ул. Киевская, 111а 

Alexander V. Mukhomedzyanov - Cand. Sci. (Med.), Research Scientist, Laboratory of Experimental Cardiology 

111a, Kievskaya str., Tomsk, 634012, Russian Federation 

sasha_m91@mail.ruhttps://orcid.org/0000-0003-1998-0873ДеркачевИ. А.DerkachevI. A.

Деркачев Иван Андреевич - аспирант, младший научный сотрудник, лаборатория экспериментальной кардиологии

634012, Российская Федерация, Томск, ул. Киевская, 111а 

Ivan A. Derkachev - Graduate Student, Junior Research Scientist, Laboratory of Experimental Cardiology 

111a, Kievskaya str., Tomsk, 634012, Russian Federation 

vanya.derkachev@mail.ruhttps://orcid.org/0000-0001-9603-822XКурбатовБ. К.KurbatovB. K.

Курбатов Борис Константинович - младший научный сотрудник, лаборатория экспериментальной кардиологии 

 634012, Российская Федерация, Томск, ул. Киевская, 111а 

Boris K. Kurbatov - Junior Research Scientist, Laboratory of ExperimentalCardiology 

111a, Kievskaya str., Tomsk, 634012, Russian Federation 

bobersanker@gmail.comhttps://orcid.org/0000-0003-1281-3714ГомбожаповаА. Е.GombozhapovaA. E.

Гомбожапова Александра Энхэевна - канд. мед. наук, научный сотрудник, отделение неотложной кардиологии

 634012, Российская Федерация, Томск, ул. Киевская, 111а 

Aleksandra E. Gombozhapova - Cand. Sci. (Med.), Research Scientist, Department of Emergency Cardiology 

111a, Kievskaya str., Tomsk, 634012, Russian Federation 

gombozhapova@gmail.comhttps://orcid.org/0000-0003-3692-5892ДильС. В.DilS. V.

 Диль Станислав Викторович - врач отделения неотложной кардиологии

 634012, Российская Федерация, Томск, ул. Киевская, 111а 

Stanislav V. Dil - Junior Research Scientist, Cardiologist, Department of Emergency Cardiology 

 111a, Kievskaya str., Tomsk, 634012, Russian Federation 

dil.stanislav@mail.ruhttps://orcid.org/0000-0001-7545-7388СамойловаЮ. О.SamoylovaJ. O.

Самойлова Юлия Олеговна - младший научный сотрудник, отделение неотложной кардиологии 

 634012, Российская Федерация, Томск, ул. Киевская, 111а 

Julia O. Samoylova - Junior Research Scientist, Department of Emergency Cardiology 

 111a, Kievskaya str., Tomsk, 634012, Russian Federation 

samoylova.ssmu@yandex.ruhttps://orcid.org/0000-0003-1291-0661СуфиановаГ. З.SufianovaG. Z.

Суфианова Галина Зиновьевна - д-р мед. наук, профессор, заведующий кафедрой фармакологии

 625023, Российская Федерация, Тюмень, ул. Одесская, 54 

Galina Z. Sufianova - Dr. Sci. (Med.), Professor, Head of the Department of Pharmacology

 54, Odessa str., Tyumen, 625023, Russian Federation 

sufarm@mail.ruhttps://orcid.org/0000-0002-5966-8916ХлёсткинаМ. С.KhlеstkinaM. S.

Хлёсткина Мария Сергеевна - ассистент кафедры фармакологии

 625023, Российская Федерация, Тюмень, ул. Одесская, 54 

 Maria S. Khlеstkina - Assistant, Department of Pharmacology 

 54, Odessa str., Tyumen, 625023, Russian Federation 

kh_m_s@mail.ruhttps://orcid.org/0000-0002-6020-1598МасловЛ. Н.MaslovL. N.

Маслов Леонид Николаевич - д-р мед. наук, профессор, заведующий лабораторией экспериментальной кардиологии 

 634012, Российская Федерация, Томск, ул. Киевская, 111а 

Leonid N. Maslov - Dr. Sci. (Med.), Professor, Head of the Laboratory of Experimental Cardiology 

 111a, Kievskaya str., Tomsk, 634012, Russian Federation 

maslov@cardio-tomsk.ruНаучно-исследовательский институт кардиологии, Томский национальный исследовательский медицинский центр Российской академии наукРоссияCardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of SciencesRussian FederationТюменский государственный медицинский университет Министерства здравоохранения Российской ФедерацииРоссияTyumen State Medical UniversityRussian FederationНаучно-исследовательский институт кардиологии, Томский национальный исследовательский медицинский центр Российской академии наукРоссияCardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of SciencesRussian Federation2023030720233821422Copyright © Рябов В.В., Попов С.В., Вышлов Е.В., Сиротина М., Нарыжная Н.В., Мухомедзянов А.В., Деркачев И.А., Курбатов Б.К., Гомбожапова А.Е., Диль С.В., Самойлова Ю.О., Суфианова Г.З., Хлёсткина М.С., Маслов Л.Н., 20232023Рябов В.В., Попов С.В., Вышлов Е.В., Сиротина М., Нарыжная Н.В., Мухомедзянов А.В., Деркачев И.А., Курбатов Б.К., Гомбожапова А.Е., Диль С.В., Самойлова Ю.О., Суфианова Г.З., Хлёсткина М.С., Маслов Л.Н.Ryabov V.V., Popov S.V., Vyshlov E.V., Sirotina M., Naryzhnaya N.V., Mukhomedzyanov A.V., Derkachev I.A., Kurbatov B.K., Gombozhapova A.E., Dil S.V., Samoylova J.O., Sufianova G.Z., Khlеstkina M.S., Maslov L.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.sibjcem.ru/jour/article/view/1782

Микроваскулярная обструкция (МВО) коронарных артерий способствует увеличению смертности и неблагоприятных сердечно-сосудистых событий у пациентов с острым инфарктом миокарда (ОИМ) и чрескожным коронарным вмешательством (ЧКВ). Были получены предварительные данные, свидетельствующие о том, что в патогенез МВО могут быть вовлечены тромбоциты, воспаление, Са2+-перегрузка, нейропептид Y и эндотелин-1. Многие вопросы, связанные с патогенезом МВО, остаются без ответа. Неизвестна роль повреждения эндотелиальных клеток в формировании МВО у пациентов с ОИМ и ЧКВ. Неясно, снижается ли продукция оксида азота (NO), или же снижается чувствительность гладкомышечных клеток коронарных артерий к NO у пациентов с МВО. Получены лишь косвенные данные об участии воспаления в развитии МВО. Роль активных форм кислорода в патогенезе МВО не изучена. Роль некроптоза и пироптоза в патогенезе МВО у больных с ОИМ и ЧКВ также не изучена. Значение тромбоксана А, вазопрессина, ангиотензина II и простациклина в формировании МВО до сих пор неизвестно. Не было получено убедительных данных об участии спазма коронарных артерий в развитии МВО. Не проводился корреляционный анализ уровней нейропептида Y, эндотелина-1 и размера МВО у больных с ОИМ и ЧКВ. Неясно, усугубляет ли эндогенный адреналин МВО или, напротив, предупреждает МВО.

Microvascular obstruction (MVO) of coronary arteries increases the mortality rate and major adverse cardiac events in patients with acute myocardial infarction (AMI) and percutaneous coronary intervention (PCI). According to preliminary data platelets, inflammation, Ca2+ overload, neuropeptide Y, and endothelin-1 could be involved in the pathogenesis of MVO. Many questions related to the pathogenesis of MVO remain unanswered. The role of endothelial cell damage in the formation of MVO in patients with AMI and PCI is unknown. It is unclear whether nitric oxide (NO) production reduces or decreases sensitivity of smooth muscle cells of coronary arteries to NO in patients with MVO. It was obtained only indirect evidence on the involvement of inflammation in the development of MVO. The role of ROS in the pathogenesis of MVO is not studied. The role of necroptosis and pyroptosis in the pathogenesis of MVO in patients with AMI and PCI is also not studied.The significance of thromboxane A, vasopressin, angiotensin II, and prostacyclin in the formation of MVO is unknown before. It was not obtained conclusive evidence on the involvement of coronary artery spasm in the development of MVO. Correlation analysis of the neuropeptide Y, endothelin-1 levels and the MVO size in patients with AMI and PCI was not performed. It is not clear whether endogenous adrenaline exacerbates MVO or, conversely, prevents MVO.

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