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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">uzspbgmu</journal-id><journal-title-group><journal-title xml:lang="ru">Учёные записки Первого Санкт-Петербургского государственного медицинского университета имени академика И. П. Павлова</journal-title><trans-title-group xml:lang="en"><trans-title>The Scientific Notes of the Pavlov University</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">1607-4181</issn><issn pub-type="epub">2541-8807</issn><publisher><publisher-name>Academician I.P. Pavlov First St. Petersburg State Medical University</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.24884/1607-4181-2026-33-1-94-107</article-id><article-id custom-type="elpub" pub-id-type="custom">uzspbgmu-1211</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ОРИГИНАЛЬНЫЕ РАБОТЫ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>ORIGINAL PAPERS</subject></subj-group></article-categories><title-group><article-title>Инсульты и факторы риска инсульта у пациентов с церебральной аутосомно-доминантной артериопатией с подкорковыми инфарктами и лейкоэнцефалопатией</article-title><trans-title-group xml:lang="en"><trans-title>Strokes and stroke risk factors in Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) patients</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-5601-5899</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Кирьянов</surname><given-names>Ю. М.</given-names></name><name name-style="western" xml:lang="en"><surname>Kyrianov</surname><given-names>Yu. M.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Кирьянов Юрий Михайлович, аспирант кафедры неврологии, Первый Санкт-Петербургский государственный медицинский университет им. акад. И. П. Павлова; врач – невролог и нейрореаниматолог, Военно-медицинская академия имени С. М. Кирова</p><p>197022, Санкт-Петербург, ул. Льва Толстого, д. 6-8</p><p>194044, Санкт-Петербург, ул. Академика Лебедева, д. 6</p></bio><bio xml:lang="en"><p>Kyrianov Yuriy M., Postgraduate Student of the Department of Neurology, Pavlov University; Neurologist and Neurointensivist, Military Medical Academy</p><p>6-8, L’va Tolstogo str., Saint Petersburg, 197022</p><p>6, Academica Lebedeva str., Saint Petersburg, 194044</p></bio><email xlink:type="simple">dontwritehere@gmail.com</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-9354-8790</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Назаров</surname><given-names>В. Д.</given-names></name><name name-style="western" xml:lang="en"><surname>Nazarov</surname><given-names>V. D.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Назаров Владимир Дмитриевич, кандидат медицинских наук, зав. лабораторией молекулярной диагностики НМЦ Минздрава России по молекулярной медицине</p><p>197022, Санкт-Петербург, ул. Льва Толстого, д. 6-8</p></bio><bio xml:lang="en"><p>Nazarov Vladimir D., Cand. of Sci. (Med.), Head of the Laboratory of Molecular Diagnostics of the SMC of the Ministry of Health of the Russian Federation for Molecular Medicine</p><p>6-8, L’va Tolstogo str., Saint Petersburg, 197022</p></bio><email xlink:type="simple">nazarov19932@mail.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-2115-8873</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Васильева</surname><given-names>Е. Ю.</given-names></name><name name-style="western" xml:lang="en"><surname>Vasilyeva</surname><given-names>E. Yu.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Васильева Елена Юрьевна, кандидат медицинских наук, зав. ЦКДЛ, доцент кафедры лабораторной медицины с клиникой</p><p>197341, Санкт-Петербург, ул. Аккуратова, д. 2</p></bio><bio xml:lang="en"><p>Vasilyeva Elena Yu., Cand. of Sci. (Med.), Head of the Centralized Clinical and Diagnostic Laboratory, Associate Professor of the Department of Laboratory Medicine with Clinic</p><p>2, Akkuratova str., Saint Petersburg, 197341</p></bio><email xlink:type="simple">vasilieva_ey@almazovcentre.ru</email><xref ref-type="aff" rid="aff-3"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Колегова</surname><given-names>М. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Kolegova</surname><given-names>M. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Колегова Марина Владимировна, врач клинической лабораторной диагностики ЦКДЛ</p><p>197341, Санкт-Петербург, ул. Аккуратова, д. 2</p></bio><bio xml:lang="en"><p>Kolegova Marina V., Doctor of Clinical Laboratory Diagnostics of Centralized Clinical and Diagnostic Laboratory</p><p>2, Akkuratova str., Saint Petersburg, 197341</p></bio><email xlink:type="simple">kolegova_mv@almazovcentre.ru</email><xref ref-type="aff" rid="aff-3"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-3594-1647</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Сироткина</surname><given-names>О. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Sirotkina</surname><given-names>O. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Сироткина Ольга Васильевна, доктор биологических наук, доцент, профессор кафедры лабораторной медицины с клиникой, Национальный медицинский исследовательский центр им. В. А. Алмазова; ведущий научный сотрудник лаборатории молекулярной генетики человека, Петербургский институт ядерной физики им. Б. П. Константинова Национального исследовательского центра «Курчатовский институт»</p><p>197341, Санкт-Петербург, ул. Аккуратова, д. 2</p><p>188300, Ленинградская область, г. Гатчина, микрорайон Орлова роща, д. 1</p></bio><bio xml:lang="en"><p>Sirotkina Olga V., Cand. of Sci. (Biol.), Associate Professor, Professor of the Department of Laboratory Medicine with Clinic, Almazov National Medical Research Centre; Leading Research Fellow of the Laboratory of Human Molecular Genetics, Petersburg Nuclear Physics Institute named by B. P. Konstantinov of National Research Centre «Kurchatov Institute»</p><p>2, Akkuratova str., Saint Petersburg, 197341</p><p>1, Orlova Roshcha Microdistrict, Gatchina, Leningrad Oblast,188300</p></bio><email xlink:type="simple">olga_sirotkina@mail.ru</email><xref ref-type="aff" rid="aff-4"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-4998-3699</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Лапин</surname><given-names>С. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Lapin</surname><given-names>S. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Лапин Сергей Владимирович, кандидат медицинских наук, зав. лабораторией диагностики аутоиммунных заболеваний Научно-методического центра Минздрава России по молекулярной медицине</p><p>197022, Санкт-Петербург, ул. Льва Толстого, д. 6-8</p></bio><bio xml:lang="en"><p>Lapin Sergei V., Cand. of Sci. (Med.), Head of the Laboratory for the Diagnosis of Autoimmune Diseases of the Scientific and Methodological Center of the Ministry of Health of the Russian Federation for Molecular Medicine</p><p>6-8, L’va Tolstogo str., Saint Petersburg, 197022</p></bio><email xlink:type="simple">svlapin@mail.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-6715-8203</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Тотолян</surname><given-names>Н. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Totolyan</surname><given-names>N. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Тотолян Наталья Агафоновна, доктор медицинских наук, профессор, профессор кафедры неврологии</p><p>197022, Санкт-Петербург, ул. Льва Толстого, д. 6-8</p></bio><bio xml:lang="en"><p>Totolyan Natalia A., Dr. of Sci. (Med.), Professor, Professor of the Department of Neurology</p><p>6-8, L’va Tolstogo str., Saint Petersburg, 197022</p></bio><email xlink:type="simple">ntotolyan@mail.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-1880-3122</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Шулешова</surname><given-names>Н. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Shuleshova</surname><given-names>N. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Шулешова Наталья Викторовна, доктор медицинских наук, профессор, профессор кафедры неврологии</p><p>197022, Санкт-Петербург, ул. Льва Толстого, д. 6-8</p></bio><bio xml:lang="en"><p>Shuleshova Natalya V., Dr. of Sci. (Med.), Professor, Professor of the Department of Neurology</p><p>6-8, L’va Tolstogo str., Saint Petersburg, 197022</p></bio><email xlink:type="simple">shuleshova@inbox.ru</email><xref ref-type="aff" rid="aff-2"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>Первый Санкт-Петербургский государственный медицинский университет имени академика И. П. Павлова; Военно-медицинская академия имени С. М. Кирова</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Pavlov University; Military Medical Academy</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>Первый Санкт-Петербургский государственный медицинский университет имени академика И. П. Павлова</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Pavlov University</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-3"><aff xml:lang="ru"><institution>Национальный медицинский исследовательский центр им. В. А. Алмазова</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Almazov National Medical Research Centre</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-4"><aff xml:lang="ru"><institution>Национальный медицинский исследовательский центр им. В. А. Алмазова; Петербургский институт ядерной физики им. Б. П. Константинова Национального исследовательского центра «Курчатовский институт»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Almazov National Medical Research Centre; Petersburg Nuclear Physics Institute named by B. P. Konstantinov of National Research Centre «Kurchatov Institute»</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2026</year></pub-date><pub-date pub-type="epub"><day>09</day><month>06</month><year>2026</year></pub-date><volume>33</volume><issue>1</issue><fpage>94</fpage><lpage>107</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Кирьянов Ю.М., Назаров В.Д., Васильева Е.Ю., Колегова М.В., Сироткина О.В., Лапин С.В., Тотолян Н.А., Шулешова Н.В., 2026</copyright-statement><copyright-year>2026</copyright-year><copyright-holder xml:lang="ru">Кирьянов Ю.М., Назаров В.Д., Васильева Е.Ю., Колегова М.В., Сироткина О.В., Лапин С.В., Тотолян Н.А., Шулешова Н.В.</copyright-holder><copyright-holder xml:lang="en">Kyrianov Y.M., Nazarov V.D., Vasilyeva E.Y., Kolegova M.V., Sirotkina O.V., Lapin S.V., Totolyan N.A., Shuleshova N.V.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.sci-notes.ru/jour/article/view/1211">https://www.sci-notes.ru/jour/article/view/1211</self-uri><abstract><p>Церебральная аутосомно-доминантная артериопатия с подкорковыми инфарктами и лейкоэнцефалопатией (ЦАДАСИЛ) выделена из группы заболеваний с поражением мелких церебральных сосудов, и основной ее особенностью считается развитие инсульта в отсутствие общеизвестных сердечно-сосудистых факторов риска инсульта. Тем не менее, у пациентов с ЦАДАСИЛ такие факторы риска могут встречаться как коморбидные состояния. Исследован 71 пациент с генетически подтвержденным диагнозом ЦАДАСИЛ, 31 из них выполнено клиническое, лабораторное, молекулярно-генетическое, инструментальное и нейровизуализационное обследование и у 60 исследованы варианты полиморфизмов в тромбофилических генах для определения их возможной значимости в развитии церебральных сосудистых событий. Исследование генов тромбофилии также выполнено в группах сравнения, включивших 45 пациентов с лакунарными или малыми инсультами и/или церебральной микроангиопатией и в референтной группе, которую составили 309 человек, направленных в лабораторию генетических исследований для обследования на тромбофилии. Результаты исследования продемонстрировали наличие у пациентов с ЦАДАСИЛ сопутствующих факторов риска инсульта: артериальной гипертензии (61,3 %), дислипидемии (64,5 %), ожирения (22,6 %), сахарного диабета (12,9 %), курения (35,5 %). Другие коморбидные состояния включали сердечно-сосудистые нарушения, включая расстройства сердечной проводимости (81,8 %), признаки дисплазии соединительной ткани (церебральных сосудов) (50,0 %), мигрень (74,2 %); аутоиммунный тиреоидит (22,6 %). Анализ вариантов полиморфизмов в протромботических генах не выявил значимых различий в группах обследованных (p&gt;0,05). У 78,3 % пациентов с ЦАДАСИЛ выявлено одновременное наличие 2–4 патологических аллелей, а также более часто встречался патологический вариант 103 G&gt;T в гене активированного фактора свертывания XIII F13A (p&lt;0,05), кодирующего фибриназу, по сравнению с референтной группой, что требует дальнейшего изучения в качестве дополнительных немодифицируемых факторов риска инсульта у пациентов с ЦАДАСИЛ.</p></abstract><trans-abstract xml:lang="en"><p>Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is pointed out from the group of small vessel diseases and its main feature is considered to be the development of stroke in the absence of well-known cardiovascular stroke risk factors. Nevertheless, such comorbid factors can be present in CADASIL patients. 71 genetically confirmed CADASIL patients were observed, in 31 of whom, a complex investigation including clinical, laboratory, molecular genetic, instrumental and neurovisualization data was performed, and 60 were tested for the presence of variants of polymorphisms in thrombophilic genes to detect their possible significance in development of a cerebral vascular accident. Thrombophilic gene’s testing was also performed in comparison groups including 45 patients with lacunar or small strokes and/or cerebral microangiopathy, and 309 persons who underwent laboratory genetic testing to exclude thrombophilia of a reference group. The results showed presence in CADASIL patients such coexisting stroke risk factors as arterial hypertension in 61.3 %, dyslipidemia in 64.5 %, obesity in 22.6 %, diabetes mellitus in 12.9 %, and smoking in 35.5 %. Other comorbidities included cardiovascular dysfunction presented mainly by cardiac conductive disability in 81.8 %, the signs of connective tissue dysplasia in 50.0 %, migraine in 74.2 %, and autoimmune thyroiditis in 22.6 %. In 78.3% of CADASIL patients, the simultaneous presence of 2-4 pathological alleles was revealed, and the pathological variant 103 G&gt;T in the activated coagulation factor XIII (F13A) (p&lt;0.05) encoding fibrinase was more common compared to the the reference group, which requires further studies as additional non modifiable stroke risk factors in CADASIL patients.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>церебральная аутосомно-доминантная артериопатия с подкорковыми инфарктами и лейкоэнцефалопатией</kwd><kwd>факторы риска инсульта</kwd><kwd>гены тромбофилии</kwd></kwd-group><kwd-group xml:lang="en"><kwd>cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy</kwd><kwd>stroke risk factors</kwd><kwd>thrombophilia genes</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Joutel A., Corpechot C., Ducros A. et al. 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