Возможности комплексной терапии пациентов c метаболическим синдромом на ранних стадиях его развития

Abstract

This paper deals with the combination therapy of patients in the early stages of development of the metabolic syndrome (MS) according to the results of the survey and the 6-month treatment of 54 patients aged 20 to 55 years with a BMI ≥25 kg / m2 and signs of abdominal obesity. In the control group 15 of the surveyed persons with a BMI < 25,0 kg/m2 at age 20 to 50 years were included . According to the classification proposed in the recommendations of the experts of GFCF for the diagnosis and treatment of MS (2009), MS source in the group of patients with a BMI ≥ 25 kg/m2 was determined in 94.2% of cases. In this study the authors used laboratory examination, including general and biochemical blood tests to determine the level of glycated hemoglobin (Hb A1c), the concentration of magnesium and malondialdehyde (MDA) in serum levels of C-peptide immuno-reactive insulin (IRI) to the calculation of indices: HOMO IR, characterizing insulin resistance (IR) and Caro, which characterizes the degree of impairment of glucose uptake. The instrumental methods were measurement of blood pressure by auscultatory method, ECG, echocardiography, ultrasound of the abdomen, CGMS-monitoring of blood glucose levels. According to the obtained data in the studied group of patients with a BMI of 25 kg/m2 statistically significant increase in blood pressure, severe insulin resistance with compensatory hyper-insulinemia, elevated levels of Hb A1c were identified. It is established that the formation of overweight in 68.5% of cases is accompanied by hypomagnesemia and activation of oxidative stress". It was confirmed by statistically significant increase in MDA content. Number of newly diagnosed diseases - hypertension, ischemic heart disease, diabetes type 2, NAFLD, patients with a BMI ≥ 25 kg/m2 was significantly higher than the con-trol, which confirms the dominant influence of overweight as a risk factor for CVD formation with impaired metabolism of glucose and lipids. To study the stages of development of MS in both groups of patients oral glu-cose tolerance test (PGT) was conducted. According to the obtained results, the patients of the studied group were divided into 3 subgroups (without carbohydrate metabolism, with IGT, with newly diagnosed type 2 diabe-tes). In the 1st subgroup concentrations of insulin and C-peptide at 30 min of the test was higher than in other subgroups and the control group, but this concentration was decreased to 120 minute test. In the 2nd subgroup of these indicators for 30 minutes were significantly lower and grew to 120 minute test. In the subgroup with newly diagnosed type 2 diabetes, this concentration of insulin and C-peptide at 30 min of the test was lower than in the control group, but the concentration was increased to 120 minute test. Monitoring blood glucose lev-els using the CGMS system helped to identify: in the 1st subgroup intermittent episodes of hyperglycemia to 5.5% daily time; significant episodes of hyperglycemia in the 3rd subgroup – 19% of the time during the day. Therefore, the first stage of correction of hyper-insulinemia and IR were: changing the receiving regime of low-calorie food and incretin mimetics appointment - exenatide. At the same time, the patients in the treatment group received drugs magnesium – Magnesium Orotate (if hypomagnesemia) and antioxidants – coenzyme Q10 and vitamin E. After 24 weeks of therapy, clinical examination demonstrated the effectiveness of treat-ment: BMI statistically significantly decreased by 8.5%, IL by 43.3%, normalization of the level of glycated hemoglobin and reduced levels of atherogenic lipids, as well as the achievement of target values of blood pressure on average for the study group were identified. Restoring the sensitivity of insulin receptors was accompanied by an increase in the level of magnesium in the blood by 47.5% and a simultaneous decrease in activity of oxidative system by 42.7%. The obtained results suggest the usefulness of the use of incretin mimetics drugs with antioxidant activity and therapy by preparations of magnesium in the prevention and treatment of MS in the early stages of development.