Клінічна хірургія (Dec 2022)
The intestinal sutures insufficiency: factors of risk and prognostication, based on genetic investigations
Abstract
Objective. To improve the results of treatment in patients, suffering insufficiency of sutures of intestinal anastomoses, using analysis of rate in the genes polymorphous variants of the matrix metalloproteinase Type 2 (C-1306 →T) and the tissue inhibitor of the matrix metalloproteinase Type 2 (G303 →A), as well as the result of elaboration of genetic diagnosis and prognostication of such complication. Materials and methods. In 32 patients, suffering insufficiency of intestinal sutures, which were treated in Shalimov National Institute of Surgery and Transplantology during 2016 - 2021 yrs, there were conducted the laboratory, genetic, immunohistochemical and statistical investigations. Results. Genetic and statistical analysis for the genes polymorphism of the matrix metalloproteinase Type 2 (C-1306 →T) and the tissue inhibitor of the matrix metalloproteinase Type 2 (G303 →A) have permitted to determine the genotypes variants, associated with risk for the sutures insufficiency occurrence in the hollow gut organs anastomoses. Basing on the data obtained, the prognostication method was elaborated for the sutures insufficiency occurrence in intestinal anastomoses. Such complications are occurred in 1,36 times more frequently in carriers of homozygous СС genotype in gene of the matrix metalloproteinase Type 2 and in two times lesser (5.9%) in carriers the minor homozygotes ТТ, than in the control - 10% (p>0.05). Among the patients with the sutures insufficiency of intestinal anastomoses a statistically significant in 1,6 times more frequent rate of carriers of the homozygous GG gene variant the tissue inhibitor of the matrix metalloproteinase Type 2 was revealed. Carriers of the minor homozygotes АА among the patients with the sutures insufficiency in intestinal anastomoses were absent, while the same genotype was revealed in the control with the 10% (p<0.05) rate. With objective to study the occurrence risk for the sutures insufficiency in intestinal anastomoses in presence of association in the studied genotypes we have analyzed several clinic-laboratory indices. There was revealed the pathogenetic significance of alleles of the genes polymorphic variants of the matrix metalloproteinase Type 2 and the tissue inhibitor of the matrix metalloproteinase Type 2, which were accompanied by hypoproteinemia, high indices of biochemical markers of collagen biodegradation and lowered expression of monoclonal antibodies for α-гладкоmuscular actin and collagen IV, and, finally. have evolved as the risk factors for development of the sutures insufficiency in intestinal anastomoses. Conclusion. The method proposed consists of genetic investigation of the genes polymorphism of the matrix metalloproteinase Type 2 (C-1306 →T) and of the tissue inhibitor of the matrix metalloproteinase Type 2 (G303 →A). It permits to prognosticate the probability of the sutures insufficiency development in intestinal anastomoses, and, basing on this, to improve the choice of the patients’ treatment tactic.
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