Method determining tactics of carrying out of medical actions at patients with metabolic syndrome against arterial hypertensia

FIELD: medicine; cardiology.

SUBSTANCE: scheme of examination and treatment of patients with a metabolic syndrome (MS) consists in the following. In the presence of AG with average degree of cardiovascular risk in a combination to visceral adiposity and: overweight<27 kg/m2, during 3-6 month prescribe non-medicament actions referred on treatment of adiposity, at achievement of AD target level after the specified term, non-medicament actions continue; with overweigth≥27 kg/m2 or combination of overweigth≥27 kg/m2 and hyperglycemias on an empty stomach, during 3-6 month, prescribe Orlistat and-or Metforminum, at achievement after the specified term of target level of a AD, continue the therapy; with combination overweigth≥27 kg/m2, hyperglycemias on an empty stomach and glucose tolerance during 3-6 month, prescribe acarbose or Orlistat and acarbose in a combination with Metforminum, at achievement after the specified term of target AD level, continue the therapy; in combination of overweight≥27 kg/m2, hyperglycemias on an empty stomach, glucose intolerance and lipidemia during 3-6 month, prescribe Orlistat in a combination with Metforminum or acarbose, at achievement of AD target level after the specified term, continue the therapy. In the presence of AG with high degree of cardiovascular risk in combination with visceral adiposity and: overweight<27 kg/m, prescribe non-medicament actions referred on treatment of obesity, and the antihypertensive combined therapy; overweight≥27 or combination of overweight≥27 kg/m2 and hyperglycemias on an empty stomach, prescribe Orlistat and-or Metforminum, and the antihypertensive combined therapy; with overweight≥27 kg/m2, hyperglycemias on an empty stomach and glucose intolerance, prescribe the antihypertensive combined therapy in a combination with acarbose or Orlistat and acarbose together with Metforminum; with overweight≥27 kg/m2, hyperglycemias on an empty stomach, glucose intolerance and lipidemia, prescribe the antihypertensive combined therapy in combination with Orlistat and Metforminum or acarbose; with lipidemia, glucose intolerance, prescribe the antihypertensive combined therapy in a combination with Orlistat or acarbose; SD 2, and also lipidemia, glucose intolerance, a plasma glucose on an empty stomach < 6,0 mmol/l, prescribe the antihypertensive combined therapy in a combination with orlistate or akarbose; SD 2, and also a lipidemia broken by tolerance to a glucose, plasmatic glucose on an empty stomach > 6,0 mmol/l, prescribe the antihypertensive combined therapy in a combination with preparations decreasing amount of sugar in blood. Affecting only on one of the MS components, it is possible to achieve appreciable improvement due to indemnification of changes in other links of its pathogenesis.

EFFECT: use of the offered algorithms of treatment of patients with a metabolic syndrome will allow optimising their treatment.

12 cl, 2 tbl, 2 ex

 

The invention relates to medicine, namely cardiology, and can be used when choosing tactics of medical interventions in patients with metabolic syndrome.

Obesity is recognized by the world health organization (who) non-infectious epidemic of our time because of its wide prevalence among populations at high risk for cardiovascular disease, early disability of patients and premature mortality.

According to who, about 30% of the inhabitants of the planet are overweight. Of them 16.8% of women and 14.9% were men. The number of people suffering from obesity, progressive increases every 10 years by 10%.

In individuals with obesity, the likelihood of development of arterial hypertension (AH) is 50% higher than in individuals with normal body weight. For every extra 4.5 kg systolic blood pressure (SBP) increased by 4.4 mm RT. senior men and 4.2 mm RT. senior women, as shown by Reminesce study. In General, the number of studies was found directly proportional relationship between body weight and total mortality. I degree obesity increases the risk of developing diabetes mellitus type 2 in 3 times, II degree - 5 times, and III - 10 times.

A particular danger is the Central type of obesity with preferential deposition of fat in the abdominal area. Frequent combination of viscer the high obesity disturbances in carbohydrate, lipid metabolism, breathing disorders during sleep and AG and the close pathogenetic link between them was the basis for separating them into self-syndrome - "metabolic". Who experts as follows assessed the situation on the prevalence of the metabolic syndrome: "We are faced with a new pandemic of the XXI century, covering the industrialized countries. This can be a demographic disaster for developing countries. Prevalence of the metabolic syndrome is twice the prevalence of diabetes in the next 25 years is expected to increase its growth rate by 50%".

Over the past 15 years, there have been more than 20 epidemiological studies on the prevalence of MS. Meta-analysis of large-scale research has shown that in the adult population of MS comes from 10% in China to 24% in the US. Most studies have identified common patterns that play an important role in the development of MS, such as age, postmenopausal status in women, behavioral factors (sedentary lifestyle, the prevalence carbohydrate diet), socio-economic status. Recently received the results of the first Russian studies conducted in a random sample of the adult population in the city of Cheboksary (Suwalska the Republic, Volga Federal district) with a population of 1800 people. It was shown that 20.6% of those aged 30-69 years have metabolic syndrome, and in women it occurs in 2.4 times more often, and with age, the number of patients increases. So, in the age range 30-39 years metabolic syndrome was diagnosed in 1%, 40-49 years at 3.6%in 50-59 years at 9%, and aged 60-69 years at 7% of respondents.

According to the Kuopio Ischaemic Heart Disease Risk Factors Study among patients with MS, the risk of developing coronary heart disease was 2.9-4.2 times above, mortality from coronary heart disease 2.6-3.0 times and all causes of death in the 1.9-2.1 times higher compared to patients without metabolic disorders. In another prospective study (ARIC study), it was shown that patients with metabolic syndrome (23% of the population) cases of development of ischemic stroke were 2 times more often in men, the risk was 1.9 and women of 1.52) compared with the control group.

The result of the meta-analysis of three prospective studies (IRAS, MCDC and SAHS), duration 5-7,5 years, in which he tracked incidents of diabetes in different groups with metabolic disorders, showed that patients with metabolic syndrome and impaired glucose tolerance is a risk of developing diabetes in the next 5 years is 40%, which is 2.5 times higher compared with the group of patients with impaired glucose tolerance without metabolic syndrome. In patients with is and With normal glucose tolerance is a risk of developing diabetes was almost 3 times higher in comparison with healthy people.

The selection of the metabolic syndrome (MS) is of great clinical importance, since on the one hand this condition is reversible, i.e. with appropriate treatment, you can achieve the disappearance or at least reduce the severity of its main manifestations, and on the other hand, it is preceded by the emergence of diseases such as diabetes mellitus type 2 and atherosclerosis diseases, which currently are the main reasons for increased mortality of the population.

Based on national studies, as well as Russian multicenter IVF programs, MINOTAUR and APRIL [Unibanco, Yeshatova, Webtycho. Multicenter randomized open study of the effectiveness of lifestyle changes and therapy of ACE inhibitor (quinapril) in patients with obesity and arterial hypertension (IVF)/hypertension 2003;9(6): 196 to 199; Chazov IE, Sliver V.B. have been Open, multicenter, conducting a randomized, scientific-practical program MINOTAUR: an interim analysis of results/cardiovascular treepie and prevention 2006; 2:81-88; Yeshatova, Vbbyte, Wielenga. The first results of the Russian program "April" (Effectiveness of acarbose in patients with impaired glucose tolerance and hypertension/ Obesity and metabolism, 2005; N1(3), p.13-21], taking into account m the world experience in this issue were identified priority areas of medical intervention.

Explore the possibilities of therapy aimed at the main pathogenetic links of MS: medical treatment of obesity, lipid-lowering therapy, hypoglycemic therapy drugs with different mechanisms of action and antihypertensive therapy with different classes of antihypertensive drugs has allowed to develop and to offer recommendations for the treatment of MS and AG with this syndrome.

For the first time in Russia the algorithm integrated approach to the treatment of the metabolic syndrome.

It is known that therapeutic measures in the treatment of patients with MS should be directed to the basic pathogenesis of this syndrome.

The main pathogenesis of MS and its complications are obesity, insulin resistance, carbohydrate metabolism, dyslipidemia and hypertension. This syndrome may be associated with the prevalence of violations of a particular type of currency, which ultimately determines the priority directions of its treatment in a particular case.

The cornerstone in the treatment of MS are non-drug activities aimed at reducing body weight, changing eating habits, giving up bad habits such as Smoking and alcohol abuse, increasing physical activity, i.e. the formation of so-called healthy lifestyle. Joining me is kamentsky treatment methods does not exclude non-drug activities, and should be conducted in parallel. These activities should be conducted for life because obesity refers to chronic diseases.

Non-pharmacological treatment of MS includes dietary changes and exercise, which should be a decrease in the severity of obesity. Reduction of body weight and, especially, mass, visceral fat contributes to the correction of metabolic disorders, increasing the sensitivity of tissues to insulin and reduction of blood pressure, greatly reducing and eliminating the risk of complications. The lack of effectiveness of non-pharmacological methods of treatment or the presence of certain indications arises the need for medication or even surgical correction of body weight, but these activities should be carried out only with the continued non-pharmacological interventions. Determining the medical treatment of obesity should be aware of the high degree of cardiovascular risk in patients with MS and to consider the influence of drugs.

In the case of predominance of changes in carbohydrate metabolism, which consists in the violation of carbohydrate tolerance, the lack of effect of non-pharmacological interventions and high risk of development of diabetes or atherosclerosis, shows the accession of drugs affecting tissue sensitivity to and Sulina and carbohydrate metabolism peripheral actions.

The predominant clinical picture of MS dyslipidemia can serve as the basis for appointment of lipid-lowering therapy. Indications for use of this form of therapy is determined by the degree of cardiovascular risk and the critical level of the main indicators of lipid metabolism. An important condition for therapy, aimed at the improvement of carbohydrate and lipid metabolism, is the achievement of target levels of glucose and lipids, which reduces the risk of development of diabetes, atherosclerosis and cardiovascular disease and increases the life expectancy of patients MILLISECONDS.

Treatment of hypertension refers to the pathogenetic therapy of MS, because as mentioned earlier, it can contribute to the formation and progression of this syndrome. It is necessary to consider the influence of one or another antihypertensive drug on carbohydrate and lipid metabolism. Advantage should use drugs, at least, neutral acting on metabolic processes, even better if they would have properties to reduce IL and improve carbohydrate and lipid obmana. Unacceptable use of drugs with known negative impact on R & d and metabolic processes. One of the important conditions of antihypertensive therapy is to achieve target levels of blood pressure less than 140 /9 mm RT. senior (and for patients with diabetes is less than 130/80 mm RT. century), as it is subject to achievement of these levels there is the least number of cardiovascular complications.

Non-pharmacological TREATMENT of OBESITY

To improve the clinical status of patients with hypertension and obesity does not necessarily reduce the weight to an "ideal" performance. Enough to reduce it by 5-10% from the original. Quick weight loss, on the contrary, may be a certain stress to the body and can have dire consequences.

Non-pharmacological interventions for weight loss include:

a moderately low-calorie diet

- teaching patients the proper lifestyle changes in eating habits,

the food diary,

- physical exercises.

DRUG TREATMENT of OBESITY

A low-calorie diet and increased physical activity are the basis of the program of weight loss, however, is often only when their application is difficult to achieve the desired result. Even more difficult, reducing weight, maintain it at that level. Therefore, in some cases it is necessary to non-pharmacological therapies for obesity add drugs that reduce weight.

The indication for their use is available:

- BMI ≥30 kg/m2or

- BMI ≥27 kg/m2in combination with abdominal obesity, hereditary pre is a disposition to type 2 diabetes and the presence of risk factors for cardiovascular disease (dyslipidemia, Hypertension and diabetes mellitus type 2).

The drug of choice for treatment of obesity in patients with MS is orlistat - medication with non-system effect. It inhibits the absorption of fat food in the gastrointestinal tract (GIT) by inhibiting gastrointestinal lipase is a key enzyme involved in the hydrolysis of triglycerides of food, releasing fatty acids and monoglycerides. This leads to the fact that about 30% of triglycerides of food is not digested and absorbed, which allows you to create additional caloric deficit compared with the use of only low-calorie diet. After discontinuation of orlistat lipase activity is quickly restored. Orlistat no effect on other enzymes of the gastrointestinal tract, even when doses exceed 100 times srednestatisticheskiy. Orlistat does not affect the absorption of carbohydrates, proteins and phospholipids. The drug has its own additional lipid-lowering effect, because by inhibiting gastrointestinal lipase, it reduces the amount of free fatty acids in the intestine and thereby reduces the solubility and absorption of cholesterol. As has been shown in several studies, orlistat reduces the cholesterol to a greater extent than one would expect only from a reduction in body weight against the background of its application. Taking orlistat and poor diet with restriction of fat in PI is e can cause diarrhoeal disorders in patients. Orlistat (xenical) take 120 mg 3 times a day during meal.

DRUGS AFFECTING insulin resistance

One manifestation of MS is hyperglycemia on an empty stomach and/or IGT. The results of a large international research DECODE and UKPDS convincingly demonstrated the important role of hyperglycemia, especially postprandial, in the development of cardiovascular disease and premature mortality in patients with IGT. On the other hand, adequate control of blood glucose was significantly reduced in these patients cardiovascular risk [DECODE Study Group. Glucose tolerance and mortality: comparison of WHO and American Diabetes Association diagnostic criteria. The DECODE study group. European Diabetes Epidemiology Group. Diabetes Epidemiology: Collaborative analysis Of Diagnostic criteria in Europe. Lancet. 1999;354:617-621, UK Prospective Diabetes Study Group. UK Prospective Diabetes Study 16. Overview of 6 years' therapy of type II diabetes: a progressive disease. Diabetes. 1995; 44:1249-1258].

In the case of dominance of carbohydrate metabolism disorders as disorders of carbohydrate tolerance or hyperglycemia on an empty stomach, the lack of effect of non-pharmacological interventions and high risk of development of diabetes or atherosclerosis shows the accession of drugs that affect carbohydrate metabolism (biguanide preparations, thiazolidinediones, inhibitors of alpha-glucosidase).

HbAl%
Table 1.

Target levels of blood glucose:
OrganizationGlucose on an empty stomachPostprandial glucose
EDF-Europe≤6.5≤6.0≤7.5
IDF-Europe - Interbational Diabetes Federation

Biguanides.

Their main properties are the ability to reduce gluconeogenesis and reduce the production of glucose by the liver, inhibit glucose absorption in the small intestine, reduce R & d and to improve insulin secretion. Currently applies only drug in this class - Metformin, as it has been proven that it has a minimal risk of lactic acidosis.

Metformin does not affect insulin secretion, and this is due to the absence of hypoglycemic episodes in his appointment. This applies not only to the patients of diabetes, but also to patients with normoglycemia. Increasing the sensitivity of tissues to insulin therapy Metformin reduces GI, helps to reduce body weight, blood pressure and improves the function of vascular endothelium in patients with obesity and hypertension.

Along with the action of Metformin on carbohydrate metabolism, and it has a favorable effect on lipid metabolism. Restoring the sensitivity of hepatocytes to insulin leads to lower production in the liver VLDL cholesterol, resulting in a reduction in triglycerides.

The results of the research the DPP (Diabetes Prevention Program) involving 3234 patients with a high risk of developing diabetes mellitus type 2 set, that Metformin reduced the incidence of diabetes mellitus type 2 by 31% compared with placebo. [Knowler WC, Barrett-Connor E, Fowler SE, Hamman RP, Lachin JM, Walker EA, Nathan DM; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393-403]

Among the side effects of Metformin, such as diarrhoea and other diarrheal disorders, the most dangerous is the development of lactic acidosis, but when using Metformin risk of lactic acidosis minimum is 20 times less in comparison with other biguanides used previously. You must consider all contraindications to the use of Metformin. These include hypoxic condition: cardiac, coronary, respiratory, renal, hepatic insufficiency, alcohol abuse.

Metformin take 500-850 mg 1-3 times a day under the control of blood glucose.

ACARBOSE

One of the safest drugs that affect postprandial glucose and IL, is acarbose is representative of a class of inhibitors of alpha-glucosidase. A study of STOP-NIDDM demonstrated high efficiency of acarbose in the prevention of diabetes type 2 in patients with IGT [Chiasson JL, Josse RG, Gomis R, et al, for the STOP-NIDDM Trial Research Group. Acarbose treatment and the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance: the STOP-NIDDM Trial. JAMA 2003;290:486-494]. The main outcome of the study STOP - NIDDM was that patients who were on the active treatment with acarbose, the relative risk of developing diabetes mellitus type 2 was 36% less than in the placebo group Relative risk of new cases of hypertension on the background of active treatment decreased by 34%, myocardial infarction by 91%, and any recorded cardiovascular events by 49%. The results of Russian research APRIL showed that acarbose positively affects the main factors of cardiovascular risk - overweight, postprandial hyperglycemia, and hypertension [Yeshatova, Vbbyte, Unibanco. The main results of the programme APRIL/Consilum medicum 2005, Appendix 2:18-22].

Usually the first 10-15 days take acarbose 50 mg 3 times a day immediately before or during meals, then gradually increase the dose to 100 mg 3 times a day with portability in mind. This tactic destination acarbose allows predotvratite or decrease gastrointestinal symptoms such as flatulence and diarrhea. Disorders of the intestine caused by taking the drug, it is necessary to strictly follow a diet with restriction of carbohydrates and reduce its dose. Contraindications to the appointment of acarbose are diseases of the bowel, accompanied by malabsorption, gastric ulcer, diverticulum, cracks, stenosis. The acarbose should not be administered to individuals younger than 18 years, pregnancy and lactation.

LIPID-lowering THERAPY MS

Dislipidemia the (DLP) is one of the main symptoms of MS and the risk factors for the early development of atherosclerosis. It can be both a consequence and one of the reasons for the development of IL due to the reduction of insulin-dependent glucose transport. To the appointment of lipid-lowering therapy for patients with MS should be treated individually, taking into account not only the levels of cholesterol and triglycerides, but also the presence or absence of CHD or other major risk factors. Patients with IL preferable to use all the possibilities for primary prevention of atherosclerosis, as based only on the principles of secondary prevention, when there is already CHD, it is impossible to achieve great success in increasing the survival rate of such patients. Patients with MS due to the high risk of CHD need the same level decrease HLPP as patients with a diagnosis of coronary artery disease.

Statins

Currently hypolipidemic drugs of choice in primary and secondary prevention of cardiovascular disease in patients with MS are statins. Their widespread use in the treatment of dyslipidemia in these patients is justified by the fact that they have the most pronounced and powerful cholesterol-lowering effect, have the least number of side effects and good tolerability. They do not affect the carbohydrate metabolism and do not interact with hypoglycemic drugs. In addition, as shown by several studies and is torvastatin and rosuvastatin can increase the sensitivity of peripheral tissues to insulin [Vbbyte, Yeshatova. Effect of antihypertensive therapy on insulin resistance in patients with metabolic syndrome/Consilium medicum 2004; Appendix 1:16-18].

Treatment with statins prescribed small doses, gradually citrua the dose to achieve target levels of lipid metabolism. Statins are well tolerated, but may cause diarrhoea disorders in the form of constipation, flatulence, abdominal pain. 0.5-1.5% of cases has increased liver enzymes in the blood. Exceeding the upper limit of normal in 3 times at least one of the liver enzymes is grounds for termination of treatment. After some time, when the enzymes will decrease to normal values, treatment can be resumed using a lower dose, or to assign a different statin. 0.1 to 0.5% of statin-treated patients observed myopathy and myalgia. The most dangerous oslozhnenem when taking statins is rhabdomyolysis or muscle tissue, which is accompanied by increased CPK more than 10 times and darkening of urine color because mioglobinurii. If you suspect the development of rhabdomyolysis statins should be stopped immediately.

ANTIHYPERTENSIVE THERAPY

AH when MS is not only a symptom of the disease, but also one of the most important links of the pathogenesis of this symptom along with hyperinsulinemia. According to the "Rivers is the recommendations for the diagnosis, prevention and treatment of hypertension", developed by experts of GFCF (2004) (these recommendations used in the proposed method as the closest analogue) target levels of HELL for all categories of patients with hypertension are values not exceeding 140/90 mm RT. Art., if DM is less than 130/80 mm RT. Art.

Pathogenesis of hypertension in MS define indications and contraindications to the appointment of those or other classes of antihypertensive drugs or their representatives (table 2).

Table 2.

Antihypertensive therapy in patients with MS.
The basic mechanisms of AG at MSNecessary medications
↑ activity SNAβ-blockers, calamus
↑ the activity of the RAASand ACE, ARA
Delay Na, N2AboutDiuretics
Violation of transmembrane CA-channelsAntagonists of CA2+

DIURETICS

One of the main mechanisms for development of hypertension when MS is gipervolemia resulting from increased reabsorption of sodium and water in the proximal renal tubules in the background of hyperinsulinemia. So, of course, diuretics JW is Auda one of the major classes of antihypertensive drugs, used in this pathology.

Unfortunately, the obvious advantages of these antihypertensive drugs are balanced such unpleasant side effects when they are set as fiber, carbohydrate, lipid and purine exchanges, lower potency.

According to the results of clinical observations all thiazide diuretics in one way or another affect carbohydrate metabolism, especially in high doses, or in individuals with a genetic predisposition to diabetes. Diabetogenic effect of thiazide diuretics is expressed in the increase of blood glucose taken on an empty stomach, glycated hemoglobin, the deterioration of glucose tolerance, the appearance of clinical symptoms of diabetes and even acetoneiso hyperosmolar coma. The higher the initial level of blood glucose, the more he rises in the background of the use of thiazide diuretics. On the severity of disorders of carbohydrate metabolism in the application of this class of diuretics drugs also affect the duration of their use and the age of patients. Initial changes in the indices of carbohydrate metabolism manifested in the appointment of hydrochlorothiazide dose of 25 mg per day. In young patients, impaired glucose tolerance detected, on average, after 5 years of continuous receiving thiazide diuretics drugs, and in patients over 65 years of age - for whom the first 1-2 years of treatment. In patients with diabetes the glycemic deteriorate within a few days from initiation of thiazide diuretics, while patsientov with hypertension without concomitant diabetes through 2-6 years of continuous administration of the drug. Thiazide diuretics in addition to adverse effects on carbohydrate metabolism can have a negative effect on lipid metabolism in the form of elevated blood total cholesterol and triglycerides.

Loop diuretics (furosemide, ethacrynic acid, etc. can also cause impaired glucose tolerance, glycosuria and development acetoneiso coma.

Effect of potassium-sparing diuretics on carbohydrate and lipid metabolism poorly understood and to date there is no conclusive information about their adverse metabolic effects. However, the use of this class of diuretics drugs is restricted for use in patients with diabetes because of the high risk of hyperpotassemia.

Casinobuddy diuretic chlorthalidone, as has been shown in several studies, can cause impaired glucose tolerance and development acetoneiso hyperosmolar coma in patients with and without DM.

In the Russian multicenter program MINOTAUR with the participation of 619 patients with MS and AG indapamide-retard (arifona-retard) manifested itself as a product that can not only effectively reduce the level of HELL, but also positively influence nepokazatelen carbohydrate, lipid and purine metabolism [Vbbyte, Yeshatova Russian evidence-based medicine program MINOTAUR: benefits retardee form of indapamide in the treatment of metabolic syndrome/Consilium medicum 2006; 8(5):46-50]. Identified during the program MINOTAUR additional positive metabolic effects arifona-retard in patients with MS along with its antihypertensive efficacy and known from literary sources expressed cardio and nephroprotective action make it the drug of choice from a group of diuretics for the treatment of patients with obesity and disturbances in carbohydrate, lipid and purine metabolism.

The effective concentration of indapamide-retard 1.5 mg is maintained 24 hours and provides long-lasting antihypertensive effect during the day when taking 1 pill a day.

However, it is often necessary for patients with MS and diabetes mellitus type 2 to assign a thiazide or loop diuretics. To eliminate the negative metabolic effects, it is recommended to combine them with ACE inhibitors.

BETA-BLOCKERS

Participation in the pathogenesis of hypertension in MS increased activity of the SNA requires the application of the β-blockers in the treatment of hypertension in these patients.

Non-selective β-blockers adversely affect carbohydrate and lipid metabolism. In addition, many selective β1 -blockers lose their selectivity at high doses, and their antagonism is manifested in relation to β2-adrenergic receptors. Such β-blockers have the potential to prolong hypoglycemic state and mask the symptoms of hypoglycemia. In some cases they lead to hyperglycemia and even hyperglycemic coma, blocking β-adrenergic receptors in the pancreas and, thus, slowing the release of insulin. Adversely affecting lipid metabolism nonselective β-blockers lead to increased haemoglobin.

In recent years we have created highly selective β1-blockers, which are virtually devoid of the adverse side effects that limit widespread use of this class of drugs in patients with impaired uglevodnogo lipid metabolism.

Such drugs are currently the nebivolol, bisoprolol, metoprolol and some other drugs. An important feature of nebivolol to talk about it as one of the priority medicines for the treatment of patients with diabetes mellitus type 2 and MS, is the effect on NO production is one of the main endogenous vasodilators whose production is impaired in these patients. This is probably due to the improvement in carbohydrate metabolism, reduction in triglycerides and improve perfusion of the head m is ZGA in patients with MS, taking nebivolol.

A special place among drugs with β-blocking action takes carvedilol, which unlike β1-selective blockers, in addition to β1-adrenergic receptors, blocks β2and α-adrenergic receptors. Effects of combined alpha and beta blockade resulting in lower General and peripheral vascular resistance. This leads to increased peripheral blood flow, improved renal perfusion and increase glomerular filtration rate, increasing the sensitivity of peripheral tissues to insulin. Typical beta-blockers adverse effects on glucose metabolism and lipids are reduced by using α1-blockade.

CALCIUM CHANNEL BLOCKERS

Calcium antagonists (AK) - a large group of drugs, the main feature of which is the ability to reversibly inhibit the calcium current through the so-called slow calcium channels. From a clinical point of view AK can be divided into:

Dihydropyridine (nifedipine, amlodipine, lacidipine and others), which primarily acting on the smooth muscles of the peripheral arteries, i.e. are typical peripheral vasodilators. Due to this, they reduce blood pressure (BP) and reflex can increase the heart rate (HR), for the as well as increasing the pulse AK;

Netheroriginally (verapamil and diltiazem) are significantly less pronounced peripheral vasodilatory effect than dihydropyridine calcium antagonists. In their effect dominates the negative effect on sinus node automaticity (due to this, they can reduce the heart rate and are called reducing pulse with calcium antagonists), the ability to slow atrioventricular conduction, to have a negative inotropic effect due to the effect on the contractility of the myocardium. These properties bring together verapamil and diltiazem with b-blockers.

Hypotensive purpose widely used AK with prolonged action. In a large number of randomized trials confirmed not only high antihypertensive efficacy and safety AK prolonged action. In studies, INVEST, INSIGHT, NORDIL, HOT demonstrated a positive impact of AK on mortality, the risk of developing cardiovascular complications, and INVEST in research observed a reduction in the number of new cases of diabetes in the treatment of AK. The security application AK on the metabolic level demonstrated in large studies [Gress TW, Nieto FJ, Shahar E et al. Hypertension and antihypertensive therapy as risk factors for type 2 diabetes mellitus. N Engi J Med 2000; 342:13:905-912]. AK have the ability to reduce left ventricular hypertrophy (TOMS), and also have anti-sclerotic effect (VHAS).

ACE INHIBITORS

The drugs of choice for treatment of hypertension in patients with MS are angiotensin converting enzyme inhibitors (ACEI) with proven metabolically neutral and organoprotective action. The advantage of ACEI is their neutral effect on carbohydrate and lipid metabolism. The results of a large multicenter studies ASCOT and HOPE has established the reduction in the incidence of DM in patients receiving ACEI. In addition, some representatives of this class, such as perindopril, thanks to solid and high epinasty to ACE plasma and tissues is able to reduce insulin resistance. This was demonstrated by the results of studies in which therapy with perindopril along with a good antihypertensive effect has led to an increased sensitivity of peripheral tissues to insulin, the improvement in carbohydrate and lipid metabolism in patients with MS and diabetes mellitus type 2 [Yeshatova, Vbbyte, Rot, Imidogen, WebService Cerebrovascular complications in patients with arterial hypertension: primary and secondary prevention/Consilium medicum 2003;5(2):61-64]. In addition, decreased myocardial hypertrophy of the left ventricle and improve the microcirculation of the brain vessels

Nephroprotective the effect of ACEI due to the fact that, lock the I formation of angiotensin II, they provide extension of the efferent arterioles of the glomeruli, thereby reducing vnutriklubovskoe hydrostatic pressure. The study of the effects of inhibitors on endothelial function was discovered another possible mechanism of their angioprotective actions. It is known that angiotensin II inhibits the secretion of endothelium nitric oxide and stimulates the secretion of endothelin I. ACEI, blocking the synthesis of angiotensin II, restore the balance of endothelial vasoactive factors contributing to the normalization of vascular tone.

ANTAGONISTS of ANGIOTENSIN II RECEPTORS

The mechanism of antihypertensive action of antagonists of angiotensin II receptors of the first type (ARA) is a selective blockade of angiotensin II receptors of the first type. It is believed that such effects on the RAAS allows you to achieve the most specific and, therefore, a complete blockade of this system.

One of the differences ARA from ACE inhibitors is that they do not affect bradykininase system, so for them devoid of side effects such as dry cough and angioedema, the occurrence of which is associated with increased levels of bradykinin.

Since the action of this class of drugs is associated with suppression of activity of the RAAS, as well as with ACE inhibitors, indications and protivopokazaniya to their destination the same.

ARA have the pronounced nephroprotective effect. In patients with DM-2 ARA improve kidney function, reducing proteinuria and improving renal hemodynamics. In relation to lipid metabolism ARA neutral.

Some lipophilic ARA have the additional property to improve tissue sensitivity to insulin, carbohydrate and lipid metabolism. These medications include telmisartan, irbesartan [Sliver V.B. have been, mamyrbaeva K.M., Masenko VP, Sergienko V.B. have been, Chazova I.E. the Possibility of antihypertensive therapy with irbesartan in correction of insulin resistance and cerebral blood flow in patients with metabolic syndrome./Consilium medicum 2006; 8 (11):25-30]. The study ALPIN prescription of candesartan in patients with hypertension compared with terapia beta-blocker-atenolol was metabolically neutral and significantly less likely to have led to the emergence of MS and diabetes. In studies of LIFE, VALUE, CHARM and other purpose ARA was significantly reduced risk of developing diabetes mellitus type 2.

AGONISTS IMIDAZOLINE RECEPTORS

From the group of drugs Central action currently widely used recently created activators I2-imidazoline receptors (air), which do not cause the syndrome, and numerous other side effects of his predecessors, such as clonidine, hydrochlorothiazide methyldopa. Patients with metabolic disorders this group of drugs is shown also in connection with their property to improve the tissue sensitivity to insulin and carbohydrate metabolism. In addition, they have a pronounced cardioprotective effect, the ability to reduce left ventricular hypertrophy, inferior only ACEI. In the Russian multicenter study of DIAMOND in patients with MS moxonidine therapy resulted in significant improvement in most indicators of lipid and carbohydrate metabolism, increasing the sensitivity of tissues to insulin, comparable to Metformin therapy, reduction of body weight and leptin levels in the blood along with a good anti-hypertensive effect and improves the function of vascular endothelium.

ALPHA BLOCKERS

Alpha-blockers have a number of advantages for the treatment of hypertension in patients with MC. They have the ability to reduce IL, improve carbohydrate and lipid metabolism. However, the use of alpha blockers can cause postural hypotension, and therefore it is advisable to combine them with taking beta-blockers.

COMBINED ANTIHYPERTENSIVE THERAPY IN PATIENTS WITH MS

The benefits of COMBINATION THERAPY IN PATIENTS WITH MS

One of the groups of patients with hypertension, which can be a combination antihypertensive therapy immediately after the establishment of high blood pressure, are patients with MS and diabetes mellitus type 2. It is known that the course of hypertension in this cohort of patients has a large "refractory" to the ongoing antihypertensive therapy and earlier lesions - targets, and assign only one antihypertensive agents in these patients rarely allows to achieve the desired result.

Often "refractory" patients with MS and AG may be associated with disorders of breathing during sleep, and therefore requires a comprehensive treatment of these patients with the use of CPAP therapy, and combination antihypertensive therapy.

Thus, the rational combination therapy helps to achieve good hypotensive effect which is combined with excellent portability and absolute safety of the treatment.

RATIONAL COMBINATIONS FOR PATIENTS WITH MS:

- ACE inhibitor + calcium antagonist

- ACE inhibitor + air

- ACE inhibitor + diuretic

- ARA + AK

- ARA + diuretic

- β- + α-blockers

AK dihydropyridine + β-blocker

It should be noted that patients with MS and diabetes mellitus type 2 from all of the above most preferred combinations are combinations of ACE inhibitors or ARA with calcium antagonists, since they have the most pronounced positive effect on the state of carbohydrate and lipid metabolism in these patients. At the same time, patients with hypertension and the presence of metabolic abnormalities, if possible, should be avoided combination β-blocker and diuretic, since both PR is parathas, included in it, adverse effect on glucose metabolism and lipids, with the exception of nebivolol and carvedilola in combination with Indapamid.

One of the most popular and pathogenetic combinations for the treatment of patients with MS is a combination of diuretics and ACE inhibitors. ACE inhibitors are able to some extent to offset the negative effects of diuretic drugs. The most successful such a combination for the treatment of patients with MS is a fixed form - noliprel combining ACE inhibitor - perindopril and metabolically neutral casinobuddy diuretic - indapamide.

Summarizing the above, in the inventive method, a new algorithm is proposed for the treatment of patients with MS.

Considering all the above, we propose the following scheme for the management and treatment of patients with MS.

1. In the presence of AG with an average degree of cardiovascular risk in combination with visceral obesity and:

BMI < 27 kg/m2within 3-6 months appoint non-pharmacological interventions aimed at the treatment of obesity, upon reaching the expiration of the specified term target BP levels of non-medical activities continue;

BMI≥27 kg/m2or the combination of BMI≥27 and hyperglycemia on an empty stomach, for a period of 3-6 months is prescribed orlistat and/or Metformin, upon reaching the expiration of the specified term target is equal HELL therapy continue;

the combination of BMI≥27 kg/m2, prandial hyperglycemia and impaired glucose tolerance within 3-6 months prescribed acarbose or orlistat and acarbose in combination with Metformin, when reached by the expiration of the specified term target level of blood pressure therapy continue;

the combination of BMI≥27 kg/m, prandial hyperglycemia, impaired glucose tolerance and hyperlipidemia within 3-6 months prescribed orlistat in combination with Metformin or acarbose, upon reaching the expiration of the specified term target level of blood pressure therapy continue.

2. In the presence of AG with a high degree of cardiovascular risk in combination with visceral obesity and:

BMI < 27 kg/m2appoint non-pharmacological interventions aimed at the treatment of obesity, and antihypertensive combination therapy;

BMI≥27 kg/m2or the combination of BMI≥27 kg/m2and hyperglycemia fasting is prescribed orlistat and/or Metformin and antihypertensive combination therapy;

BMI≥27 kg/m2, prandial hyperglycemia and impaired glucose tolerance prescribed antihypertensive combination therapy in combination with the appointment of acarbose or orlistat and acarbose together with Metformin;

BMI≥27 kg/m2, prandial hyperglycemia, impaired glucose tolerance and hyperlipidemia prescribe anti-Christ. ipertensione combination therapy in combination with orlistat and Metformin or acarbose;

hyperlipidemia, impaired glucose tolerance prescribed antihypertensive combination therapy in combination with orlistat or acarbose;

Type 2 and hyperlipidemia, impaired glucose tolerance, fasting plasma glucose < 6.0 mmol/l, prescribed antihypertensive combination therapy in combination with orlistat or acarbose;

Type 2 and hyperlipidemia, impaired glucose tolerance, fasting plasma glucose >6.0 mmol/l, prescribed antihypertensive combination therapy in combination with glucose-lowering drugs.

In that case, if the intake of orlistat and/or Metformin, with AG with an average degree of cardiovascular risk in combination with visceral obesity not achieve target glucose levels after 3-6 months, prescribe acarbose.

In that case, if the intake of orlistat and/or Metformin, with AG with an average degree of cardiovascular risk in combination with visceral obesity is not achieved target lipid levels, prescribed statins.

In that case, if AG with an average degree of cardiovascular risk in combination with visceral obesity, target BP in therapeutic activities aimed at the treatment of obesity and correction of metabolic disorders in 3-6 not reach the prescribed anticipates the main monotherapy and when not achieving target BP levels prescribed antihypertensive combination therapy.

In that case, if AG with a high degree of cardiovascular risk in combination with visceral obesity due to intake of orlistat and/or Metformin is not achieved target lipid levels, prescribed statins.

In that case, if the intake of orlistat, angiography with a high degree of cardiovascular risk in combination with visceral obesity will not achieve target glucose levels, prescribe acarbose.

In case if while taking orlistat or acarbose, angiography with a high degree of cardiovascular risk in combination with visceral obesity, is not achieved target lipid levels, prescribed statins.

In that case, if the intake of antihypertensive combination therapy in combination with glucose-lowering drugs, hypertension with a high degree of cardiovascular risk in combination with visceral obesity, is not achieved target lipid levels, prescribed statins.

In that case, if the intake of antihypertensive combination therapy in combination with glucose-lowering drugs, hypertension with a high degree of cardiovascular risk in combination with visceral obesity, no weight loss, prescribe orlistat.

In that case, if the intake of antihypertensive combination therapy in combination with glucose-lowering drugs, hypertension high with what epent cardiovascular risk in combination with visceral obesity, not achieve target glucose levels, prescribed antihypertensive combination therapy in combination with glucose-lowering drugs.

As antihypertensive monotherapy using drugs from the group of angiotensin converting enzyme inhibitors and receptor antagonists to angiotensin II.

As an antihypertensive combination therapy using the following combination of drugs: angiotensin-converting enzyme inhibitor and calcium antagonist or an angiotensin-converting enzyme inhibitor and activator I2-imidazoline receptors, or angiotensin-converting enzyme inhibitor and a diuretic, or an antagonist of angiotensin II receptors of the first type and a calcium antagonist or antagonist of angiotensin II receptors of the first type and a diuretic, or β- and α- blockers, or calcium antagonist of the dihydropyridine and β-blocker.

Clinical example 1.

Patient K., 43, diagnosis: obesity 2 tbsp., visceral type, arterial hypertension 1 tbsp., risk 2 (moderate), impaired glucose tolerance.

Examination: height - 168 cm, weighs 103 kg, BMI=36.8 kg/m2the shape giperstenichesky, FROM=102 cm, AD=of 145/90 mm RT. Art.

Lab. data: fasting glucose - 5.1 mmol/l, glucose 2 hours after load - 9.5 mmol/l, OHL - 4.7 mmol/l, TG - 1.8 mmol/L.

Treatment: 1. nemedi amantadne measures for weight reduction;

2. orlistat 120 mg 1 tab. 3 R/d during the meal.

Visit 3 months:

Examination: height - 168 cm, weight - 96 kg, BMI=34,3 kg/m2FROM=95 cm, AD=125/80 mm RT. Art.

Lab. data: fasting glucose - to 4.8 mmol/l, glucose 2 hours after load - 7.9 mmol/l, OHL - 4.9 mmol/l, TG - 1.8 mmol/L.

Treatment: 1. non-pharmacological interventions for weight loss;

2. orlistat 120 mg 1 tab. 3 R/d during the meal;

3. acarbose 50 mg 1 tab. 3 R/d before eating.

Visit after 1 month:

Examination: height - 168 cm, weight is 93 kg, FROM=94 cm, BMI=33,2 kg/m2AD=120/80 mm RT. Art.

Lab. data: fasting glucose - to 4.8 mmol/l, glucose 2 hours after load - 6,9 mmol/l, OHL - 4.6 mmol/l, TG - 1.7 mmol/l

The results of treatment testify adequately selected medical events.

Clinical example 2.

Patient M., 39 years old, diagnosis: obesity 3 tbsp., visceral type, arterial hypertension 1 tbsp., risk 2 (moderate), IIB hyperlipidemia type.

Examination: height - 165 cm, weight 127 kg, BMI=47 kg/m2the shape giperstenichesky, FROM=113 cm, AD=150/85 mm RT. Art.

Lab. data: OHL - 6.4 mmol/l, TG - 2.8 mmol/l, LDL - 4.9 mmol/l, HDL cholesterol - 0.9 mmol/L.

Treatment: 1. non-pharmacological interventions for weight loss;

2. orlistat 120 mg 1 tab. 3 R/d during the meal.

Visit 3 months:

Examination: height - 168 cm, weight 121 kg, BMI=43 kg/m2FROM=108 cm, AD=140/80 mm RT. Art.

the lab. data: OHL - 6.1 mmol/l, TG - 2.5 mmol/l, LDL - 4.5 mmol/l, HDL cholesterol - 0.95 mmol/l

Treatment: 1. non-pharmacological interventions for weight loss;

2. orlistat 120 mg 1 tab. 3 R/d during the meal;

3. rosuvastatin 10 mg 1 tab. 1 R/d after dinner;

4. Prestarium 4 mg 1 tab. 1 R/d in the morning.

Visit after 1 month:

Examination: height - 168 cm, weight 119 kg, BMI=42,5 kg/m2FROM=107 cm, AD=125/70 mm RT. Art.

Lab. data: OHL - 4.2 mmol/l, TG - 1.3 mmol/l, LDL - 3.4 mmol/l, HDL cholesterol - 1.1 mmol/l

The results of treatment testify adequately selected medical events.

Using the proposed algorithms for the treatment of patients with MS will optimize their treatment. Affecting only one of the components of MS, can be remarkably improved by compensating changes in other parts of its pathogenesis. For example, the weight reduction will cause a reduction of blood pressure and normalization of metabolic disorders, and hypoglycemic therapy along with compensation of carbohydrate metabolism will lead to reduction of blood pressure and improve lipid metabolism. Lipid-lowering therapy may enhance the sensitivity of tissues to insulin and improvement of carbohydrate metabolism. Properly selected antihypertensive therapy in addition to the main action are often improves carbohydrate and lipid metabolism and increases h is stateliest tissues to insulin. The effectiveness of the treatment depends on a deep understanding of the physician of the nature of MS and knowledge of the basic and additional mechanisms of action of the drugs used for its treatment.

1. The method of choosing tactics of medical interventions in patients with metabolic syndrome on the background of arterial hypertension (AH), including the determination of the degree of cardiovascular risk, body mass index (BMI), blood pressure (BP), lipids, glucose, fasting plasma glucose, detection of visceral adiposity, hyperglycemia on an empty stomach, impaired glucose tolerance, hyperlipidemia, diabetes mellitus type 2 (DM 2), and in the presence of AG with an average degree of cardiovascular risk in combination with visceral obesity: BMI < 27 kg/m2within 3-6 months appoint non-pharmacological interventions aimed at the treatment of obesity, upon reaching the expiration of the specified term target BP levels, non-pharmacological interventions continue; BMI≥27 kg/m2or the combination of BMI≥27 and hyperglycemia on an empty stomach, for a period of 3-6 months is prescribed orlistat and/or Metformin, upon reaching the expiration of the specified term target level of blood pressure therapy continue; the combination of BMI≥27 kg/m2, prandial hyperglycemia and impaired glucose tolerance within 3-6 months prescribed acarbose or Orly is tat and acarbose in combination with Metformin, upon reaching the expiration of the specified term target level of blood pressure therapy continue; the combination of BMI≥27 kg/m2, prandial hyperglycemia, impaired glucose tolerance and hyperlipidemia within 3-6 months prescribed orlistat in combination with Metformin or acarbose, upon reaching the expiration of the specified term target level of blood pressure therapy continue; in the presence of AG with a high degree of cardiovascular risk in combination with visceral obesity: BMI < 27 kg/m2appoint non-pharmacological interventions aimed at the treatment of obesity, and antihypertensive combination therapy; BMI≥27 kg/m2or the combination of BMI≥27 kg/m2and hyperglycemia fasting is prescribed orlistat and/or Metformin, and antihypertensive combination therapy; BMI≥27 kg/m, prandial hyperglycemia and impaired glucose tolerance prescribed antihypertensive combination therapy in combination with the appointment of acarbose or orlistat and acarbose together with Metformin; BMI≥27 kg/m2, prandial hyperglycemia, impaired glucose tolerance and hyperlipidemia prescribed antihypertensive combination therapy in combination with orlistat and Metformin or acarbose; hyperlipidemia, impaired glucose tolerance prescribed antihypertensive combination therapy in combination the years with orlistat or acarbose; Type 2 and hyperlipidemia, impaired glucose tolerance, fasting plasma glucose < 6.0 mmol/l, prescribed antihypertensive combination therapy in combination with orlistat or acarbose; type 2 and hyperlipidemia, impaired glucose tolerance, fasting plasma glucose >6.0 mmol/l, prescribed antihypertensive combination therapy in combination with glucose-lowering drugs.

2. The method according to claim 1, characterized in that, if the intake of orlistat and/or Metformin, with AG with an average degree of cardiovascular risk in combination with visceral obesity will not achieve target glucose levels after 3-6 months, prescribe acarbose.

3. The method according to claim 1, characterized in that, if the intake of orlistat and/or Metformin, with AG with an average degree of cardiovascular risk in combination with visceral obesity, is not achieved target lipid levels, prescribed statins.

4. The method according to claim 1, characterized in that, if AG with an average degree of cardiovascular risk in combination with visceral obesity, target BP in therapeutic activities aimed at the treatment of obesity and correction of metabolic disorders in 3-6 months is not reached, prescribed antihypertensive monotherapy and when not achieving target BP levels prescribed antihypertensive whom inrevenue therapy.

5. The method according to claim 1, characterized in that, if AG with a high degree of cardiovascular risk in combination with visceral obesity due to intake of orlistat and/or Metformin is not achieved target lipid levels, prescribed statins.

6. The method according to claim 1, characterized in that, if in patients receiving orlistat, angiography with a high degree of cardiovascular risk in combination with visceral obesity not achieve target glucose levels, prescribe acarbose.

7. The method according to claim 1, characterized in that, if while taking orlistat or acarbose, angiography with a high degree of cardiovascular risk in combination with visceral obesity, is not achieved target lipid levels, prescribed statins.

8. The method according to claim 1, characterized in that, if the intake of antihypertensive combination therapy in combination with glucose-lowering drugs, hypertension with a high degree of cardiovascular risk in combination with visceral obesity is not achieved target lipid levels, prescribed statins.

9. The method according to claim 1, characterized in that, if the intake of antihypertensive combination therapy in combination with glucose-lowering drugs, hypertension with a high degree of cardiovascular risk in combination with visceral obesity no weight loss, prescribe orlistat.

10. The method according to claim 1, distinguished by the different topics what in patients receiving antihypertensive combination therapy in combination with glucose-lowering drugs, hypertension with a high degree of cardiovascular risk in combination with visceral obesity not achieve target glucose levels, prescribed antihypertensive combination therapy in combination with glucose-lowering drugs.

11. The method according to claim 4, characterized in that as an antihypertensive monotherapy using drugs from the group of angiotensin converting enzyme inhibitors and receptor antagonists to angiotensin II.

12. The method according to claim 1 or 4 or 10, characterized in that as an antihypertensive combination therapy using the following combination of drugs: angiotensin-converting enzyme inhibitor and calcium antagonist or an angiotensin-converting enzyme inhibitor and activator 12-imidazoline receptors, or angiotensin-converting enzyme inhibitor and a diuretic, or an antagonist of angiotensin II receptors of the first type and a calcium antagonist or antagonist of angiotensin II receptors of the first type and a diuretic, or β- and α-blockers, or calcium antagonist of the dihydropyridine and β-blocker.



 

Same patents:

FIELD: medicine.

SUBSTANCE: invention is referred to medicine area, namely to surgery and intensive care, and can be used for treatment of disorders of peroxide oxidation (POX) and antioxidatic activity (AOA) at patients at stress-reaction after operations on a thyroid gland. The method provides early correction of postoperative disorders of POX and AOA (in an hour after an operation). Define indicators of peroxide oxidation of lipids - diethenoid conjugates and hydroperoxides of lipids and antioxidatic activity of plasma - a hepatocuprein in blood serum of patients 1 hour prior to operation and in 1 hour after operation and at rising of the content of products POX in 1 hour after operation in 1.5 times and more, and also hepatocuprein depression in 1.5 times and more in comparison with preoperational level, perform medicamental correction by the continued intravenous infusion of 1% emoxipine solution of 20 ml with a dosing syringe with rate of 0.1-0.15 mg/minutes within 24 hours, in 24 hours after operation and after the emoxipine infusion termination perform control analyses for an effect estimation of antioxidant therapy and in the event that POX indicators are above initial level in 1.5 times, AOA below initial level in 1.5 times, repeat emoxipine infusion within next days in the same dose.

EFFECT: provision of early correction of postoperative disturbances of POX and AOA.

3 ex

FIELD: medicine.

SUBSTANCE: invention is referred to medicine, in particular to experimental pharmacology. For realisation of risk prediction method of ulceration of gastroduodenal zone tissues, determine lipide structure of a blood plasma. Thus, the high risk of ulceration is defined at level of phospholipids 23.18±1.30% cholesterol 15.53±0.87%, and ethers of cholesterol 39.71±1.38%. The low risk of ulceration is defined at level of phospholipids 28.03±1.58%, cholesterol 22.36±1.22%, and ethers of cholesterol 33.04±2.33%. Tests of preparations with counter-ulcerogenic activity are recommended to be spent on the rats predisposed to an ulceration that allows estimating more objectively counter-ulcerogenic activity of tested preparations.

EFFECT: obtaining an effective way of risk predicition of gastroduodenal zone tissues ulceration.

7 tbl, 2 ex

FIELD: medicine.

SUBSTANCE: diagnostics of metabolic syndrome includes determination of main symptom: central (abdominal) type of adipositas - waist circumference (WC) is more than 80 cm for women and more than 94 cm for men, as well as additional criteria: hypertension (arterial pressure ≥140/90 mm hg), increase of triglyceride level (≥1.7 gram-mol/l), decrease of high density lipoprotein cholesterol level (<1.0 gram-mol/l for men; <1.2 gram-mol/l for women), increase of low density lipoprotein cholesterol level >3.0 gram-mol/l, fasting hyperglycemia (glucose in the blood plasma on empty stomach ≥6.1 gram-mol/l), glucose tolerance distress (glucose in blood plasma in two hours after glucose loading within the limits of ≥7.8 and ≤11.1 gram-mol/l), obstructive respiration disturbances during sleep. Presence of adipositas and two of above additional criteria is the ground to diagnose metabolic syndrome. Developed and proposed algorithm and criteria of metabolic syndrome diagnostics taking into account all the types of Russian health system will allow increasing metabolic syndrome detection rate among the population. If timely and adequate therapy is provided it will lead to significant reduction of risk associated with development of cardio-vascular complications, diabetes mellitus of type 2 and improvement of patients' life quality.

EFFECT: reduction of risk associated with development of cardio-vascular complications and improvement of patients' life quality.

1 tbl, 1 ex

FIELD: medicine; gastroenterology.

SUBSTANCE: total cholesterol and low density lipoprotein cholesterol (LDL CH) are determined in serum, conjugated bile acids in gallbladder fraction of duodenal bile, body mass index and patient's age are determined. If the total cholesterol is increased more than 1.4 times, LDL CH - more than 1.4 times, conjugated bile acids are increased more than 2.8 times, body mass index is 26 and more, and patient's age is 29 year old and more, the cholelithiasis is predicted.

EFFECT: increased precision of cholelithiasis prediction is provided.

2 ex

FIELD: medicine, therapy of infectious diseases, hepatology.

SUBSTANCE: it is necessary to carry out clinical survey, moreover, in patients with mechanical jaundice one should determine the percentage of sphingomyelin fraction in phospholipid spectrum of blood serum and at its values ranged 7-15% it is possible to diagnose mechanical jaundice at the background of oncological diseases, and 20-28% - mechanical jaundice at the background of choledocholithiasis.

EFFECT: higher accuracy of differential diagnostics.

3 ex

FIELD: medicine.

SUBSTANCE: method involves determining superficial lipid skin film and blood plasma lipid composition (phospholipids, cholesterol, fatty acids, triacyl glycerides, cholesterol ethers). The obtained values in skin and blood plasma are estimated in scores. The score values are summed. The sum being equal to 10-14, mild severity degree is diagnosed; the value being equal to 15-20, severe atopic dermatitis is diagnosed.

EFFECT: high accuracy and objectivity of evaluation method.

2 tbl

FIELD: medicine.

SUBSTANCE: method involves determining lipid peroxidation values like diene conjugates and lipid hydroperoxides and plasma antioxidant activity values like ceruloplasmin in patient blood serum 1 h before operation and 1 h after operation. Lipid peroxidation products concentration being 1.5 times as high or higher 1h later after operation and ceruloplasmin concentration being 1.5 times as low or lower, when compared to preoperative level, marked lipid peroxidation and antioxidant activity changes are diagnosed as those requiring antioxidant therapy.

EFFECT: accelerated diagnosis procedure.

FIELD: medicine.

SUBSTANCE: method involves studying blood serum lipid spectrum with phospholipid and fatty acid composition being determined in venous blood erythrocyte lipids and lipid peroxidation values in blood serum. Membrane-stabilizing therapy, absorbing lipid-correcting therapy and complex lipid-correcting and membrane-acting therapy are administered depending on factor values under study.

EFFECT: enhanced effectiveness of individual therapy selection.

1 tbl

FIELD: medicine, hepatology.

SUBSTANCE: it is necessary to carry out biochemical study of blood serum, moreover, one should determine relative content of the fractions of total phospholipids and free cholesterol to calculate their ratio by the following formula: TPL/FC, where TPL - relative content of total phospholipids, FC - relative content of free cholesterol and at its values ranged 1.4-1.9 one should diagnose chronic viral hepatitis, and at values ranged 0.2-1.0 - mechanical jaundice.

EFFECT: higher accuracy of diagnostics.

4 ex

FIELD: medicine, pediatrics, cardiorheumatology.

SUBSTANCE: it is necessary to detect the level of triglycerides (TG), the level of Willebrand's factor (WF), variability of systolic arterial pressure per a day (STD SAP) daily index of systolic arterial pressure (DI SAP) to calculate the probability of developing arterial hypertension by the following formula: P=eF/(1+eF), where P - the probability of developing essential arterial hypertension, e - ( the basis of natural logarithm)=2.718, F - the separating function which should be determined according to the following formula: F=-8.3565+(2.4617*TG)+(0.0210*WF)+(0.4824*STD SAP)+(-0.2762*DI SAP). At P being above 0.5 the probability for developing essential arterial hypertension is considered to be high, and at P being below or equal to 0.5 the probability of developing essential arterial hypertension is considered to be low. The innovation enables to efficiently diagnose essential arterial hypertension and prescribe adequate prophylactic therapy in due time.

EFFECT: higher accuracy of detection.

2 ex, 3 tbl

FIELD: medicine.

SUBSTANCE: diagnostics of metabolic syndrome includes determination of main symptom: central (abdominal) type of adipositas - waist circumference (WC) is more than 80 cm for women and more than 94 cm for men, as well as additional criteria: hypertension (arterial pressure ≥140/90 mm hg), increase of triglyceride level (≥1.7 gram-mol/l), decrease of high density lipoprotein cholesterol level (<1.0 gram-mol/l for men; <1.2 gram-mol/l for women), increase of low density lipoprotein cholesterol level >3.0 gram-mol/l, fasting hyperglycemia (glucose in the blood plasma on empty stomach ≥6.1 gram-mol/l), glucose tolerance distress (glucose in blood plasma in two hours after glucose loading within the limits of ≥7.8 and ≤11.1 gram-mol/l), obstructive respiration disturbances during sleep. Presence of adipositas and two of above additional criteria is the ground to diagnose metabolic syndrome. Developed and proposed algorithm and criteria of metabolic syndrome diagnostics taking into account all the types of Russian health system will allow increasing metabolic syndrome detection rate among the population. If timely and adequate therapy is provided it will lead to significant reduction of risk associated with development of cardio-vascular complications, diabetes mellitus of type 2 and improvement of patients' life quality.

EFFECT: reduction of risk associated with development of cardio-vascular complications and improvement of patients' life quality.

1 tbl, 1 ex

FIELD: chemistry.

SUBSTANCE: invention relates to biotechnology. Version of solvable dependent on pyrroloquinolinquinone (PQQ) glucosodehydrogenase (s-GDH), containing insertion of amino acid residual between positions 428 and 429, which correspond to amino acid sequence of wild type known for Acinetobacter calcoaceticus and can contain one or several additional amino acid substitutions, is described. Represented is polynucleotide, coding described s-GDH version. Expression vector is described. It containes represented polynucleotide. Host-cell E.coli, containing described vector is described. Method of obtaining said s-GDH version, including cultivation of host-cell E.coli in conditions, suitable for obtaining enzyme version is described. Method of detection is described. It determines or measuring glucose in sample by means of described s-GDH version, which includes bringing sample in contact with said version.

EFFECT: obtaining possibility to determine concentration of sugars, especially glucose in sample efficiently.

20 cl, 8 ex, 4 dwg, 1 tbl

FIELD: medicine.

SUBSTANCE: it is necessary to detect the risk factors, that is: a patient's affected critics to his own state and increased ESR levels and those of blood glucose for 3 d being above critical values, that is: 50 mm/h for ESR and 8 mM/l for glucose, correspondingly. In case of detecting, at least, two risk factors in a patient it is possible to conclude upon the development of purulent meningitis. The innovation enables to shorten the terms of the research and provides the chance for earlier indication of therapy.

EFFECT: higher accuracy of prediction.

4 ex

FIELD: medicine.

SUBSTANCE: the present innovation deals with predicting the diseases of operated stomach manifested with a dumping syndrome. One should detect the alterations in concentration of adenosine triphosphoric acid in peripheral blood erythrocytes against initial one as a response to peroral intake of 150 ml 50%-glucose solution, and in case of increased concentration (2-fold or more) it is possible to detect dumping syndrome. The innovation increases the significance of detection.

EFFECT: higher accuracy of detection.

2 dwg, 2 ex

FIELD: medicine.

SUBSTANCE: method involves measuring rectal temperature and glucose concentration in blood. Coefficient of rectal temperature to blood glucose concentration is calculated. The value being less than 15 conditional units, favorable clinical course is to be predicted. The value being greater than 15 conditional units, unfavorable clinical course is to be predicted.

EFFECT: high accuracy of prognosis.

2 tbl

FIELD: medicine.

SUBSTANCE: method involves measuring arterial blood glucose concentration and venous blood glucose concentration in blood sample taken from jugular vein. Glucose consumption value determined from arteriovenous difference is expressed in percents of initial reference value of 1.447 mmole/l ([Gl stand]). Initial oxygen consumption (UO2M(init))xΔGl, where Gl =[ Gmes]/[Gl stand]. Difference between the initial glucose consumption value and the current one is interpreted in terms of metabolic and functional brain reserve value.

EFFECT: high accuracy in estimating brain oxygen consumption.

1 tbl

The invention relates to medicine, in particular for laboratory diagnosis
The invention relates to the field of medicine, particularly cardiology

The invention relates to medicine, in particular for laboratory diagnosis

The invention relates to medicine, in particular for laboratory diagnosis

FIELD: medicine, pharmaceutics.

SUBSTANCE: group of inventions concerns a composition of the prolonged release for peroral administering of a reductase inhibitor HMG-CoA. The composition which contains a solid dispersing agent including reductase inhibitor HMG-CoA, the dissolving agent and the stabilising agent is offered; the compound carrier of the prolonged release; and the accelerator of gel hydration where the compound carrier of the prolonged release is an admixture of sodium alginate and xanthic gum, and the accelerator of gel hydration is an admixture of a compound propylene glycol ether alginate and hypromellose. The method of obtaining of the specified composition, including stages is offered: the mixing of a reductase inhibitor HMG-CoA, a dissolving the agent and stabilising agent in a dissolvent with obtaining of a solid dispersing agent; homogeneous mixing of the compound carrier of the prolonged release and the accelerator of gel hydration with the solid dispersing agent with obtaining of the first admixture; additions of pharmaceutically comprehensible additives to the first admixture with obtaining of the second admixture; and dry mixing and drawing up of the second admixture in a solid composition. The composition due to the present invention can be easily and effectively received and be capable to maintain constant level of a medical product in blood by means of slow release of inhibitor HMG-CoA of a reductase with homogeneous rate within 24 hours. Accordingly the composition of the prolonged release under the present invention can be effectively used for decrease of cholesterol and triglycerides level in blood.

EFFECT: depression of cholesterol and triglycerides level in blood.

15 cl, 6 tbl, 6 ex, 6 dwg

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