Патофизиология нарушения коронарной микроциркуляции
DOI:
https://doi.org/10.52692/1857-0011.2025.1-81.08Ключевые слова:
нарушение коронарной микроциркуляции, эндотелиальная дисфункция, микровазоспазм, микротромбоз, прогностические маркёрыАннотация
Нарушение коронарной микроциркуляции (НКМ) - это совокупность функциональноструктурных изменений, приводящих к снижению кровотока в артериолокапиллярном русле миокарда. Выделяют три паттерна: (1) снижение коронарной вазодилатации, (2) преобладание вазоконстрикции и (3) диффузные микротромбозы. НКМ выступает как до и послеинфарктный патогенетический фактор при STEMI/NSTEMI, объясняет ишемию/ангину без стенозов эпикардиальных артерий (INOCA/ANOCA, MINOCA) и утяжеляет прогноз при сердечной недостаточности с сохранённой ФВ, фибрилляции предсердий и внезапной сердечной смерти. Цель исследования - охарактеризовать ключевые механизмы (эндотелиальная дисфункция с дефицитом NO, гипертрофическое ремоделирование артериол, активация Rhoкиназы, тромбовоспалительный дисбаланс) и их клинические особенности при разных фенотипах заболевания. Понимание этих звеньев обосновывает применение функциональных инвазивных тестов(FFR, IMR, пробы с ацетилхолином/аденозином) в сочетании с мультимаркерной панелью (NO, ET1, GDF15, PCSK9, Lp(a) и др.) и открывает возможности для таргетной терапии.
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