INTERRELATION OF CHANGES IN THE PROTEOLY TIC AND FIBRINOLY TIC SYSTEMS AND THEIR IMPACT ON ENDOTHELI AL FUNCTION IN THE COMBINED COURSE OF CHRONIC PANCREATITIS AND CHRONIC OBSTRUCTIVE PUL MONARY DI SEASE
DOI:
https://doi.org/10.32689/2663-0672-2025-4-5Keywords:
chronic pancreatitis, chronic obstructive pulmonary disease, plasma proteolysis, fibrinolysis, endotheliumAbstract
Chronic pancreatitis (CP) and chronic obstructive pulmonary disease (COPD), when occurring independently, are characterized by opposite disruptions in hemostasis. Exacerbation of CP with hyperenzymemia syndrome typically manifests as proteolysis activation and hypocoagulation, while COPD exacerbation is marked by a predisposition to hypercoagulation. This amplifies the impact of hypoxia on various organs, including the pancreas. It is possible that the comorbid course of CP and COPD exacerbates the clinical presentation of both conditions and increases the frequency of pathological process recurrences due to changes in the hemostatic system. Materials and methods. A prospective cohort study was conducted, analyzing the medical records of 305 hospitalized patients. Participants were divided into three groups: Group I included 96 patients with isolated CP; Group II consisted of 116 patients with CP and comorbid COPD; and Group III comprised 93 patients with isolated COPD. A control group included 30 practically healthy individuals (PHI). Results. The analysis revealed that patients with CP, both in isolation and when comorbid with COPD, exhibited increased proteolytic activity. Azocolytic activity in Groups I and II was 1.8 times higher (p<0.05) compared to PHIs, while in Group III, it was 1.3 times higher (p<0.05). Collagen lysis intensity was observed at levels 1.9 times higher for Groups I and II (p<0.05) than PHIs, while in Group III it was 1.5 times higher (p<0.05). The total plasma activity in Groups II and III was 1.2 times lower than in PHIs (p<0.05), whereas this parameter in Group I showed only a tendency toward a decrease (p<0.05). Plasma enzymatic activity in Group I was 1.3 times lower than PHIs (p<0.05), while it was decreased by 1.7 times in Group II and by 2.1 times in Group III (p<0.05). At the same time, there was compensatory growth in plasma non-enzymatic activity: in Groups I and II, this increased 1.5 times compared to PHIs (p<0.05), while in Group III, it increased by 1.6 times (p<0.05). Patients in Group I experienced a 1.4- fold reduction (p<0.05) in stable blood NO metabolites compared to PHIs, while Groups II and III showed a significant increase in blood nitrites/nitrates – 1.6 times and 1.5 times, respectively (p<0.05). The endothelin-1 blood content exceeded PHI levels by 2.2 times in Group I (p<0.05), 3.1 times in Group II (p<0.05), and 2.8 times in Group III (p<0.05). Analysis of circulating endothelial cells revealed their significant increase across all patient groups: in Groups I, II, and III, their count rose by 1.7, 1.9, and 1.5 times, respectively (p<0.05). Conclusions. Patients with CP and comorbid COPD demonstrated reduced fibrinolytic potential of plasma, intensified proteolysis of low- and high-molecular-weight proteins, inhibited collagenolysis, marked endothelial dysfunction, hyperproduction of NO with activation of nitrosative stress, increased levels of endothelin-1, and a significant rise in circulating endothelial cells. These changes create conditions for the development of hypercoagulation syndrome on one hand, while on the other they exacerbate the damaging impact on acinar epithelium and vascular endothelium
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