ANALYSIS OF ACTIVE MECHANISMS FOR MODULATING THE BLOOD FLOW OF THE MICROVASCULATURE IN PATIENTS WITH PERIODONTITIS ON THE BACKGROUND OF CORONARY HEART DISEASE COMPLICATED BY CHRONIC HEART FAILURE

Abstract

According to the World Health Organization (2015), the prevalence of periodontal disease among the population aged 33-44 is 65-98%. Damage to periodontal tissues is expressed by a combination of exogenous and endogenous factors and local tissue reactions. The development of the disease is associated with the simultaneous exposure to several factors, such as the existence of periodontopathogenic microbes, a high level of proinflammatory cytokines, a low level of matrix metalloproteinases (MMPs), and interleukin-10 (IL-10). In accordance with this concept, the equilibrium of cytokines determines the occurrence of destruction in periodontal tissues or the provision of homeostasis. The state of the microvasculature (ICR) is one of the main factors in trophic support of tissues and compensatory processes in the development of both inflammatory and ischemic lesions of periodontal tissues. The contractile apparatus of the arterioles is adapted to implement the wave regime of muscle contraction directed along the vessel, which allows for the injection of blood into the capillaries. It is proved that the total mass of the muscle layer of arterioles is comparable with the mass of the myocardium. It was revealed that in patients with generalized periodontitis in 97% of cases pathology of the internal organs is detected, which indicates the relationship of pathological processes in periodontal tissues with the general status of the body. One of the most common pathologies of high social significance is coronary heart disease (CHD), which, especially in combination with impaired carbohydrate metabolism, leads to the development of vascular catastrophes, including at the level of ICR. And the enhancement of lipid peroxidation (LP) processes plays a key role in the progression of IHD complications. The aim of the study was to study the state of microcirculation in the gum tissue using LDF in patients with chronic generalized periodontitis (CGP), which occurs against the background of coronary heart disease (CHD), complicated by chronic heart failure (CHF). Object and methods. The control group – patients aged 49.4 ± 1.2 years, receiving only standard therapy of heart failure (n = 8); the main group – individuals aged 52.3 ± 0.9 years with periodontitis in combination with coronary heart disease complicated by heart failure of functional class 2 and 3 (NY) according to NYHA (New York Heart Association) (n = 12), received standard treatment in complex treatment CHF therapy and locally – Chandelia ointment (Uzbekistan). The treatment was carried out for 15 days. The study of microcirculation was carried out using the apparatus “LAKK-02” (Russia). Laser Doppler flowmetry is based on the registration of blood flow in the microvasculature (arterioles, precapillaries, capillaries, venules) by analyzing the Doppler shift of laser radiation from moving red blood cells. Results and discussion. With generalized periodontitis in the presence of CHD complicated by heart failure, significant blood supply with slight fluctuations in blood flow is observed, which indicates venous congestion in the microvasculature and confirms an increase in myogenic tone (increased tonus of precapillaries that prevent blood from entering the capillaries, resulting in a decrease in the number of functioning capillaries). And also, an increase in myogenic tone and arterio-venular shunting can be regarded as a compensatory reaction of the microcirculatory bed to stagnation in the venous link. In this regard, an adequate correction of these disorders, as well as parallel therapy of the underlying disease, has led to the successful resolution of the pathological process as a whole.

Keywords

• chronic generalized periodontitis
• coronary heart disease
• chronic heart failure
• periodontal microcirculation
• laser doppler flowmetry.