PROSPECTS FOR CORRECTION OF ENDOTHELIAL DYSFUNCTION IN PATIENTS WITH PANCREATIC CANCER
The subject of the research is the functional indicators of the vascular endothelium in patients with pancreatic cancer.
Purpose of the study. Determining the results of the correction of disorders of the vascular endothelium in patients with pancreatic cancer after surgery.
Materials and methods. Study design: A prospective, randomized clinical trial. 95 patients with pancreatic head cancer (T3N0M0 (2a), T1-3N1M0 (2b) or T4N1M0) were examined, including 52 men and 43 women, the average age in the group was 61.7 ± 2.1 years. For the correction of the state of the vascular endothelium in 44 patients, L-arginine per os was used in a daily dose of 3-6 g, depending on the patient's body weight, and a drug from the group of ACE inhibitors (enalapril maleate) 5 mg per day once. The comparison group included 51 patients.
The determination of circulating (desquamated) endotheliocytes in the blood has been carried out; blood levels of von Willebrand factor; endothelium-dependent vasodilation in a Doppler echocardiographic test with reactive hyperemia on the brachial artery. Statistical methods - an analysis of the significance of differences according to Mann-Whitney, in dynamics - according to Wilcoxon.
Main results. In the examined patients, violations of the state of the vascular endothelium were revealed, which are reflected in an increase in the content of circulating endotheliocytes in the blood, the concentration of von Willebrand factor and a decrease in the endothelium-dependent vasodilation rate. After surgery, a significant increase in the degree of impairment was observed. A protective effect of endothelial dysfunction medical correction in the perioperative period on the degree of endothelial damage and its functional parameters was revealed. In particular, a significant decrease in the content of circulating endotheliocytes and an increase in the degree of endothelium-dependent vasodilation were determined.
Conclusion. In patients with pancreatic cancer, a systemic response of the endothelium to the neoplasm and surgical treatment, expressed by the development of endothelial dysfunction, is observed. The use of a combination of L-arginine and an angiotensin-converting enzyme inhibitor in the perioperative period can reduce the degree of endothelial dysfunction in patients with pancreatic cancer.
Sayakhat T. Olzhayev
Almaty Regional Oncological Clinic, Almaty, Republic of Kazakhstan
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