Background Of Metabolic Syndrome Research Articles

CORRELATIONS OF CARBOHYDRATE, LIPID METABOLISM AND THE IMMUNE SYSTEM INDICATORS IN ISCHEMIC HEART DISEASE AGAINST THE BACKGROUND OF THE METABOLIC SYNDROME

Introduction. Coronary heart disease (CHD) is the most common form of heart disease, which is one of the leading causes of death in the world.A combination of several factors has a special effect on the course of coronary heart disease, which significantly worsens the unfavorable prognosis.
 Purpose: to determine the correlations of the studied indicators in patients with coronary artery disease against the background of metabolic syndrome.
 Research methods. 60 patients had verified coronary heart disease without metabolic syndrome - group 1, the other 60 patients had verified coronary heart disease (CHD) complicated by metabolic syndrome (MS) - group 2. In order to identify correlations, the linear correlation coefficient |r|between all studied indicators.
 Results and discussion. In both groups of patients, the main interactions were found between glucose content and other indicators, as well as numerous correlations of lipid metabolism indicators with other studied indicators.In the group of patients with coronary artery disease, strong positive correlations were found between the creatinine clearance index and hemoglobin concentration; hematocrit; content of erythrocytes; a strong negative relationship with the age of patients. In the group of patients with MS, strong positive correlations were found between creatinine clearance and NT-proBNP, ST 2, and pro-inflammatory cytokines.
 Conclusion. When analyzing the obtained results, numerous correlations of lipid metabolism indicators with other studied indicators were found.In coronary heart disease against the background of metabolic syndrome, a direct pathogenetic connection of hyperglycemia with pro-inflammatory interleukin, which activates the cellular link of non-specific immunity (phagocytosis), is revealed. The depressing effect of hyperglycemia on other links of immune defense and indicators of lipid metabolism is also revealed.ST 2 positively correlates with NT-proBNP indicators in patients with coronary artery disease on the background of MS, which indicates the presence of ischemic and metabolic disorders in these patients.

The Intensity of Degradation and Synthesis of the Dermal Intercellular Matrix in Rats after Local Cold Injury against the Background of Metabolic Syndrome

The Intensity of Degradation and Synthesis of the Dermal Intercellular Matrix in Rats after Local Cold Injury against the Background of Metabolic Syndrome

PATHOGENESIS OF IMMUNE DYSFUNCTION IN THE SETTING OF METABOLIK SYNDROME IN CORONARY HEAT DISEASE. QUALIFYING SCENTIFYING WORK ON THE RIGHTS OF THE MANUSCRIPT

PATHOGENESIS OF IMMUNE DYSFUNCTION IN THE SETTING OF METABOLIK SYNDROME IN CORONARY HEAT DISEASE. QUALIFYING SCENTIFYING WORK ON THE RIGHTS OF THE MANUSCRIPT

MODERN VIEWS ON THE PATHOGENESIS OF IMMUNE DYSFUNCTION AGAINST THE BACKGROUND OF THE METABOLIC SYNDROME IN ISCHEMIC HEART DISEASE

Introduction. Today, the pathology of the cardiovascular system is one of the most common and fatal diseases. Cardiovascular diseases are the cause of disability among the younger and younger population. Taking into account the frequency of cardiovascular diseases, the severity of the course and their lethality, the study of this topic remains one of the most urgent problems of medicine, in particular cardiology.
 The aim of the study. Consider modern views on the pathogenesis of coronary heart disease against the background of metabolic syndrome and the role of the immune system.
 Conclusions. Ischemic heart disease is the leading cause of mortality in Ukraine and the world. In recent years, there has been convincing evidence of a significant prevalence of cardiovascular disease in patients with metabolic syndrome. The presence of concomitant metabolic syndrome in patients with coronary heart disease worsens the course of the underlying disease and has an unfavorable prognosis, and even fatal cases.
 Therefore, the detection of an increase in the level of body mass index, dyslipidemia, hyperglycemia, arterial hypertension in a patient strengthens the effects of each other, that is, they have a synergistic effect, and in general, the risk of developing CHD becomes quite high.
 IL-6 is one of the cytokines released by both macrophages and adipocytes and its levels have been shown to be increased in insulin resistance and obesity. In fact, IL-6 is known to regulate fat and glucose metabolism, mediating insulin resistance through various complex mechanisms. This cytokine acts on various tissues, leading to the metabolic effects of obesity. In the liver, IL-6 increases the production of acute phase reactants, including CRP. Several studies have demonstrated that high CRP levels have the strongest correlation with cardiac events, T2DM, and MS. IL-6 also contributes to a prothrombotic state by increasing the level of fibrinogen, another acute phase reactant. In addition, IL-6 targets other tissues, such as endothelial cells, to promote the expression of vascular cell adhesion molecules, leading to vascular wall atherosclerosis, inflammation, and dysfunction.
 These data support the role of IL-6 in the development of insulin resistance, but do not support the hypothesis that IL-6 is involved in β-cell failure.
 IL-18 is a pro-inflammatory cytokine associated with insulin resistance and T2DM risk. IL-18 stimulates the production of gamma interferon (IFN-γ), which, in turn, is probably involved in the pathogenesis of atherosclerosis. IL-18 is a cytokine that is a predictor of metabolic syndrome.
 TNFα is another cytokine produced in adipose tissue, mainly from local macrophages, and its production also varies with adipose tissue mass and correlates with insulin resistance, both hallmarks of MS. TNFα exerts its pathogenic effects by disrupting insulin signaling in adipocytes and hepatocytes through serine phosphorylation and inactivation of insulin receptors and downstream signaling molecules, leading to decreased metabolic effects of insulin. TNFα also contributes to insulin resistance by inducing hepatic lipolysis.

Interaction of Vascular Smooth Muscle Cells and Endothelial Cells in Atherosclerosis on the Background of Metabolic Syndrome

The objective: was to determine the interaction of vascular smooth muscle cells with endothelial cells in the process of atherogenesis in the presence of metabolic syndrome. Materials and methods. We studied the following groups: Group I – 50 patients who died as a result of complications associated with cerebral atherosclerosis in the setting of metabolic syndrome, Group II – 50 patients who died as a result of complications associated with cerebral atherosclerosis without a history metabolic syndrome and Group III (comparison group) – 50 patients who died from causes unrelated to MS and AS. For the study we used the following histological and histochemical methods: hematoxylin-eosin, Masson’s method, Van Gieson’s method, Weigert’s method, and immunohistochemical examination using monoclonal antibodies. For the identification of smooth muscle cells: immunocytochemical markers – Actin Smooth Muscle Ab-1 (Clone 1A4), Vimentin Ab-2 (Clone V9), Desmin (Muscle Cell Marker Ab-1 Clone D33), immunocompetent cells – CD4 (CD4 Ab-8), CD8 (SP-16), CD20 (CD20 Ab-1), CD68 (CD68/Macrophage Marker Ab-4) and to determine the endothelium state, immunocytochemical marker – CD31/PECAM-1 (Endothelial Cell Marker) Ab-1. Results. In atherosclerotic lesions of cerebral arteries with metabolic syndrome manifestations, in the arterial wall media a significantly higher expression of desmin was observed in smooth muscle cells (SMCs) compared to other study groups. It should be noted that the migration of smooth muscle cells from the media and their intensive proliferation is directly dependent on endothelial and fibroblast factors. The immunohistochemical reaction with vimentin revealed the presence of connective tissue components and severe arterial wall fibrosis. The expression of vimentin showed that vascular wall fibrosis increases with the progression of the underlying disease – metabolic syndrome. We observed migration and proliferation of SMCs, endocytosis, and synthesis of connective tissue components that actively contribute to intimae hypertrophy and atheromatous changes. As for the change in VSMCs phenotype, they demonstrate an extremely high degree of plasticity, and this affects the loss of expression of their contractile genes, including smooth muscle cell alpha-actin. We also noted potentiation of atherosclerotic changes resulted from formation of less differentiated forms of smooth muscle cells. Atherogenesis can be initiated by both certain substances, such as cholesterol and lipoproteins, and endothelial changes – activated and damaged endothelium can participate in atherogenesis. Endothelial activation is also accompanied by the production of cell growth factors (Sitia S. Et al., 2010). We observed monocyte adhesion to the arterial endothelium, the presence of monocytes under the endothelium their migration into the intimae with subsequent proliferation and formation of foam cells. This indicates their important role in the development of atherosclerosis by potentiating inflammation in the vascular wall and promoting the VSMCs phenotype transformation. Conclusions. Changes in the phenotype of arterial intimae SMCs are accompanied by increased proliferation, and modified SMCs, with their high activity of synthesis of extracellular connective tissue components (elastin, collagen and glycosaminoglycans), are responsible for the formation of the plaques fibrous base. The presence of lymphocytes in the atherosclerotic process involves interaction with macrophages, endothelial cells and SMCs. A decrease in the number of endothelial progenitor cells, which are actively involved in the process of endothelial regeneration, contributes to the development of atherosclerosis.

Influence of organism stimulation with bacterial lipopolysaccharide on nitric oxide production and metabolism in rat heart on the background of metabolic syndrome

Aim. The aim of the study was to establish the changes in nitric oxide production and metabolism in rat heart during combined influence of organism stimulation with bacterial lipopolysaccharide (LPS) and modeling of metabolic syndrome (MetS).
 Materials and methods. The study was conducted on 24 mature male Wistar rats weighing 200–260 g. Experiment lasted 60 days. The animals were divided into 4 groups of 6 animals each: control group, MetS group, LPS stimulation group, LPS + MetS group. MetS was reproduced by using a 20 % fructose solution as the only source of drinking water. LPS of Salmonella typhi was administered at a dose of 0.4 μg/kg intraperitoneally. Animals from LPS + MetS group received a 20 % fructose solution as the only source of drinking water and were administered LPS. In 10 % tissue homogenate of rat heart we studied: total activity of NO-synthases (NOS), activity of constitutive (cNOS) and inducible (iNOS) isoforms, activity of nitrate (NaR) and nitrite (NiR) reductases, concentration of peroxynitrites (ONOO-), nitrites, nitrosothiols and hydrogen sulfide.
 Results. Combination of MetS and stimulation of organism with LPS led to increase in total NOS activity by 32.72 % compared to control group. Activity of cNOS did not change compared to control group. Activity of iNOS increased by 33.76 %. Arginase activity decreased by 23.53 %. NaR activity and NiR activity were increased by 86.67 % and by 149.29 %, respectively. Combination of MetS and stimulation of organism with LPS led to decrease in nitrite and nitrosothiols concentration by 38.73 % and by 54.79 %, respectively. Under these conditions concentration of ONOOelevated by 398.0 % compared to control group. Concentration of H S decreased by 27.56 %.
 Conclusions. Combination of metabolic syndrome and stimulation of organism with bacterial lipopolysaccharide leads to prevalence of peroxynitrite formation during increased nitric oxide production NO-synthase-dependent and nitrate-nitrite-NO pathways in rat heart.

Pathogenetic and clinical rationale for syntropic pathology based on metabolic syndrome, coronary heart disease and type 2 diabetes mellitus

Pathogenetic and clinical rationale for syntropic pathology based on metabolic syndrome, coronary heart disease and type 2 diabetes mellitus

STATE OF HUMORAL IMMUNITY IN DIABETIC RETINOPATHY AGAINST THE BACKGROUND OF THE METABOLIC SYNDROME

Introduction. The most common cause of vision loss in case of diabetes is retinal pathology (diabetic retinopathy). The study of blood pressure levels in blood serum in patients with nonproliferative diabetic retinopathy in type 2 diabetes is a promising direction of research with the aim of studying the links of the pathogenesis of the development of this pathology, diagnosis, and possible prognosis of the disease
 The aim of the study: to find out the peculiarities of humoral immune dysfunction in patients with diabetic retinopathy against the background of metabolic syndrome
 Results and discussion. PSA increases in patients with decompensated diabetes (by 1.2 times compared to the control group). We found a statistically significant increase in the level of Ig A in patients of group 2 by 2.5 times compared to the control group and by 1.5 times compared to group 1. The content of Ig M exceeds the control indicator by 2.3 times and in group 1 by 1.7 times. The level of Ig G increased compared to the control indicator by 1.4 times, and did not differ from the indicator in group 1. The content of CIC in group 2 exceeded the indicators in the control group by 1.4 times and by 2 times the indicators in group 1, which indicates a higher probability of occurrence of III-type hypersensitivity reactions in the group of non-insulin-dependent patients with DR.
 Probable strong correlations of the concentration of immunoglobulins with other indicators in group 2 were revealed, which may indicate the preservation of relationships between immune indicators in compensated diabetes.
 The analysis of the ratio of the indicators implies the predominant activation of a specific link of humoral immunity and suggests the chronicity of the process, in the group of non-insulin-dependent patients there is a pronounced activation of humoral protection on the mucous membranes, as well as a predominant activation of early humoral immune mechanisms.
 Conclusion. Determination of the content of humoral factors of immunity in blood serum often does not reveal a probable difference. Therefore, it is advisable to determine the ratio of indicators. The obtained data indicate more pronounced changes in indicators of specific humoral immunity - immunoglobulins in patients with diabetic retinopathy, compared to the indicator of systemic inflammation - SRP.

Характеристика харчування українських підлітків з ознаками метаболічного синдрому

One of the most important issues of modern medical science is the metabolic syndrome, the origins of which begin in childhood and adolescence. Purpose: To study the dietary peculiarities of Ukrainian adolescents with obesity and to identify the eating dis-orders on the background of metabolic syndrome. A survey on the nutrition of Ukrainian adolescents was conducted on the base of Institute of Children and Adolescents Health Care of the National Academy of Medical Sciences of Ukraine. As a result, a sample of 200 adolescents with obesity (age 14 – 18 years: 100 boys and 100 girls) was formed. Thus, irregular and unbalanced diet naturally causes digestive disorders, abnormalities in eating behavior and contributes to the formation of comorbid pathologies such as obesity and metabolic syndrome. Adolescents with obesity experienced sig-nificant zinc and magnesium deficiency in the body.

THE POLYMORPHISM -308 G/A OF THE TNF GENE AND METABOLIC IMBALANCE IN PATIENTS WITH TYPE 2 DIABETES MELLITUS AND NON-ALCOHOLIC FATTY LIVER DISEASE, TAKING INTO ACCOUNT CARDIOVASCULAR COMPLICATIONS

Non-alcoholic fatty liver disease (NAFLD), the most common form of liver disease, is now recognized as a major public health problem worldwide. Tumor necrosis factor alfa (TNF-α), a member of the TNF/TNFR cytokine family, is an intercellular transmission molecule that has been reported in a wide range of human noninfection diseases. The aim of the study was to determine the circulating levels of TNF-α and the nature of its relationships with the components of insulin resistance, both metabolic and hormonal, in patients with type 2 diabetes; and establishing the nature of cardiovascular complications (taking into account TNF-α gene polymorphism) in the presence and absence of NAFLD. Materials and methods. Case-control study included information about 50 practically healthy people from the city of Kharkiv and the region. The examined population (except control subjects) consisted exclusively of patients with type 2 diabetes mellitus with a long-term existence of the disease against the background of metabolic syndrome, with varying degrees of glycemic control and violations of liver homeostasis in the absence of renal failure. 117 people were selected for analysis: 63 of them with type 2 diabetes in the presence of NAFLD and 54 patients with type 2 diabetes without NAFLD. Genotyping for single nucleotide polymorphism -308 G>A of the TNF-α was performed by the method of polymerase chain reaction with appropriate primers and NcoI endonuclease. Testing of statistical hypotheses was carried out using the odds ratio and χ2 criteria at the significance level of P≤0.05. Results. The contribution of the genetic component to the formation of the predisposition to the development of type 2 diabetes mellitus based on the single-nucleotide polymorphism -308 G>A of the TNFα gene was determined, which makes it possible to consider the carrier of the A allele as a factor of increased risk for the development of type 2 diabetes mellitus. No association of the studied polymorphism with the risk of developing NAFLD was found. The obtained data make it possible to assume that the studied polymorphism -308 G>A of the TNFα gene is more associated with the risk of developing type 2 diabetes, and the occurrence or progression of NAFLD primarily depends on metabolic imbalance, and not on the contribution of the studied polymorphism. Conclusions. Non-alcoholic fatty liver disease is closely related to hormonal and metabolic risk factors and markers of cardiovascular disease and type 2 diabetes and may increase the risk of developing and progressing cardiovascular complications. The contribution of the genetic component to the formation of the predisposition to the development of type 2 diabetes mellitus based on the single-nucleotide polymorphism -308 G>A of the TNFα gene was determined, which makes it possible to consider the carrier of the A allele as a factor of increased risk for the development of type 2 diabetes mellitus.

Changes in metabolic parameters in ischemic heart disease against the background of metabolic syndrome

For many years, and to this day, cardiovascular disease has been and remains the leading cause of death worldwide. Cardiovascular diseases mainly affect people in countries with middle and low living standards.
 The aim of the study was to find out the peculiarities of lipid, carbohydrate, and hormonal changes in patients with coronary heart disease against the background of metabolic syndrome.
 Materials and methods: 120 patients with verified coronary heart disease were examined, including 60 patients with coronary heart disease without metabolic syndrome and 60 patients with coronary heart disease with metabolic syndrome. The control group consisted of 30 practically healthy individuals of appropriate age and sex. The content of HbA1c, glucositol C-peptide, triacylglycerols, total cholesterol, leptin, HDL-cholesterol, and LDL-cholesterol in blood serum was determined by modern methods.
 Results: The analysis of the results of laboratory tests of patients' blood revealed more pronounced changes in carbohydrate and lipid metabolism in patients with coronary artery disease against the background of metabolic syndrome, which indicates the severity of the clinical course in such patients. The results obtained indicate that in coronary heart disease with metabolic syndrome, there are more pronounced dysmetabolic changes: hyperleptinemia, glucosemia, elevated HbA1c, and decreased C-peptide content. Studies have shown that obesity is accompanied by high levels of leptin, which exacerbates insulin resistance and is a trigger for the development of coronary heart disease.
 Conclusions: 1. Leptin resistance is a potential cause of insulin resistance and, consequently, obesity, which ultimately leads to metabolic syndrome and the development of coronary heart disease. The data obtained indicate a greater tendency to obesity in women with coronary heart disease complicated by metabolic syndrome.
 
 The data obtained may indicate a latent disorder of carbohydrate metabolism in patients with coronary artery disease without metabolic syndrome.
 The detected deviations in lipid metabolism indicate the presence of type II dyslipoproteinemia in patients of group 1 and type IV dyslipoproteinemia in patients of group 2

Increasing the efficiency of hypolipidemic therapy with the combined use of quercetin in patients with non-alcoholic fatty liver disease on the background of the metabolic syndrome

The article analyzes the results of a set of biochemical indicators in the course of treatment with the combined use of rosuvastatin with quercetin in patients with metabolic syndrome (MS) combined with non-alcoholic fatty liver disease. Changes in blood biochemical parameters have been identified and presented with MS, essential for revealing generalbiological mechanisms development and interrelationship between the components of MS and non-alcoholic fatty liver. The effect of an increase in free cholesterol and triglycerides and activation of freeradical oxidation of lipids followed by theaccumulation of oxidative stress products was noted. In the course of long-term hypolipidemic therapy (90 days), 86 patients with non-alcoholic fatty liver disease on the background of metabolic syndrome were previously divided into 2 groups: a comparison group (45 patients), who weretreated with basic therapy – only rosuvastatin, the main group (41 patients) received quercetin together with rosuvastatin –40 mg 3 times a day, clinical and laboratory-instrumental examinations were carried out. On the 90th day of treatment, positive results in the functional state of the liver and lipid spectrum of the blood wereregistered in all patients. A more significant advantage of the therapeutic combination of rosuvastatin with quercetin was proved. The inclusion of quercetin contributed to reducing the intensity of oxidative stress and enhancing antioxidant protection activity, resultingin a decrease in apoptosis of hepatocytes (cytokeratin-18 level was 1.27 times decreased). The studies have shown the feasibility of combined use of quercetin with rosuvastatin for the prevention of the development and progression of metabolic disorders associated with non-alcoholic fatty liver disease.

Study of alpha defensin in coronary artery disease and type 2 diabetes mellitus on the background of metabolic syndrome

Background. The prevalence of metabolic syndrome (MS), a cluster of risk factors for type 2 diabetes mellitus (DM) and coronary artery disease (CAD), is increasing annually. MS is associated with an almost 2-fold increase in the risk of cardiovascular complications and 1.5-fold increase in all-cause mortality. Systemic inflammation is considered to be one of the pathogenetic links in the development of MS. The study of alpha defensins as inducers of inflammation with antimicrobial properties in patients with MS is increasing. However, changes in the serum level of alpha defensin in MS, with or without type 2 DM and CAD, remain insufficiently studied that determines the feasibility of conducting this study. The objective: to evaluate serum levels of alpha defensin in individuals with metabolic syndrome, type2 diabetes mellitus and coronary artery disease. Materials and methods. Fifty-four patients (27 women, 27 men) with MS, type 2 DM and CAD were examined. The research was carried out at the Lviv Regional State Clinical Medical and Diagnostic Endocrinology Center and Lviv Territorial Medical Association “Clinical Hospital of Planned Treatment, Rehabilitation and Palliative Care”, Lviv City Clinical Hospital 5. Patients with MS were divided into 3 subgroups, depending on the presence of type 2 DM and CAD. The first subgroup included 18 individuals with MS without type 2 DM and CAD, the second— 18 people with MS and type 2 DM, the third— 18 patients with MS, type 2 DM and CAD. The control group consisted of 16 healthy people (8 men, 8 women), the employees of the Lviv Territorial Medical Association “Clinical Hospital of Planned Treatment, Rehabilitation and Palliative Care”, Lviv City Clinical Hospital 5. In patients, the level of alpha defensin was determined, as well as blood lipids (high-density lipoproteins (HDL), very low-density lipoproteins (VLDL)), and the correlations between the above values were investigated. Results. The level of alpha defensin and blood lipids were examined in patients with MS, type 2 DM and CAD. The content of alpha defensin in all participants with MS, both with and without type 2 DM and CAD (18.40±0.89, 24.4±1.2, and 29.1±1.1ng/ml), was significantly increased and exceeded the control indicators (3.72±0.36 ng/ml) by 4.95, 6.56, 7.82 times (p<0.05). The highest parameters of alpha defensin were detected in MS combined with type 2 DM and CAD— 29.1±1.1ng/ml that significantly exceeded the parameters in patients with MS and type 2 DM (24.4±1.2 ng/ml) and group of MS without type 2 DM and CAD (18.40±0.89 ng/ml; p<0.05). Values of HDL cholesterol in patients with MS (1.12±0.08 ng/ml), MS and type 2 DM (1.01±0.07 ng/ml), MS, type 2 DM and CAD (0.95±0.05ng/ml) significantly reduced compared to those in the group of healthy individuals (1.40±0.14 ng/ml; р<0.05), but no significant difference was found between individual subgroups (p>0.5). The parameters of VLDL cholesterol were highest in patients with combination of MS, type 2 DM and CAD (1.32±0.05 ng/ml), and significantly exceeded those in patients both with MS and type 2 DM (0.87±0.10 ng/ml), and with MS (0.73±0.06 ng/ml; p>0.05). Comparative analysis was carried out for alpha defensin and blood lipids. A direct strong correlation (r=0.72; р<0.5) was found between alpha defensin and VLDL cholesterol in MS patients. In people with MS, type 2 DM and CAD, a direct strong correlation was also found between alpha defensin and VLDL cholesterol (r=0.65; р<0.5). In the group of MS and type 2 DM, a weak correlation was revealed (r=0.1; р<0.5). Only weak correlations were found between the levels of alpha defensin and HDL cholesterol (r=–0.15, r=–0.11, r=–0.16; р<0.5). Conclusions. A significant increase in the level of alpha defensin was detected in patients with metabolic syndrome, type 2 diabetes mellitus and coronary artery disease. HDL cholesterol values are significantly reduced in all patients with metabolic syndrome, regardless of the presence or absence of type 2 diabetes mellitus and coronary artery disease. VLDL cholesterol parameters, depending on combined pathology, were highest in patients with metabolic syndrome, type 2 diabetes mellitus, and coronary artery disease, and significantly exceeded the levels of VLDL cholesterol in patients with both MS and type 2 diabetes mellitus, and with metabolic syndrome. Correlations were found between alpha defensin indicators and VLDL cholesterol, they were especially expressed in the presence of coronary artery disease and metabolic syndrome.

Optimization of early markers for the diagnosis of preeclampsia on the background of metabolic syndrome

Annotation. Preeclampsia remains a mysterious puzzle for clinicians and researchers who have been uncovering it for decades. The search for new modern diagnostic markers for the possibility of early prevention of this complication will facilitate the course of pregnancy and childbirth. Preeclampsia can affect 2-8% of all pregnancies. The study of angiogenic biomarkers to stratify the risk of disease is the aim of our study. Patients are divided into groups due to the severity of preeclampsia. Group I included 26 pregnant women with moderate preeclampsia, diastolic blood pressure was up to 90 m Hg, to group II – 20 pregnant women with moderate preeclampsia, the level of diastolic pressure was up to 99 m Hg. The third group included pregnant women in whom the physiological course of pregnancy without complications and concomitant extragenital pathology. Inhibin A levels were determined using a Beckmann Coulter analyzer and test system (Germany); ELISA Testkit, Access-Inhibin A Kit by Beckmann Coulter, the concentration of vitamin D in the serum of patients was determined using an analyzer and test system Immulite (Siemens AG, Germany). Statistical analysis of the obtained results was performed minus the mean value (M) and the standard error of the mean value (m). Qualitative indicators are presented in the form of %. Comparison of quantitative indicators with normal distribution was performed by Student’s t test (p<0.05), and with abnormal distribution in unrelated samples – using Mann-Whitney test (U test), comparison of relative values – using χ2 (chi) -square). A significant relationship (p=0.041) was found between inhibin A levels and the occurrence of preeclampsia. Vitamin D deficiency (24.5±1.01 ng/ml) was also found in women in the study groups. The level of placental growth factor in all women in the first trimester of pregnancy was 45.93±11.74 pg/ml, which corresponds to normal values. The mean level of insulin-like growth factor was reduced (120.87±4.12 ng/ml) compared with the control group (224.1±6.24 ng/ml). Thus, increased inhibin A, decreased IGF, and vitamin D deficiency may be a marker for a patient at risk for preeclampsia.

Дослідження цитокінового спектру ротової рідини хворих із генералізованим пародонтитом на тлі метаболічного синдрому

The purpose of the study was to study the state of cytokine regulation of oral fluid in patients with generalized periodontitis and metabolic syndrome. Materials and methods. For this study, 3 groups of surveys were formed. The main group included 30 people with generalized periodontitis on the background of metabolic syndrome; 30 people with generalized periodontitis, without somatic pathology, formed a comparison group. The obtained results were compared with the data of 20 practically healthy individuals with intact periodontium who were included in the control group. The content of pro-inflammatory cytokines IL-1β, IL-6, TNF-α and anti-inflammatory cytokines IL-4, TGF-β1 in the oral fluid of the study groups was determined by solid-phase enzyme-linked immunosorbent assay. Results and discussion. According to the research, on average, the highest levels of pro-inflammatory cytokines (IL-1β, IL-6, TNF-α) were observed in patients with periodontal disease on the background of metabolic syndrome. We investigated increase in the concentration of proinflammatory IL-1β. The average value of IL-6 in the oral fluid of patients with metabolic syndrome exceeded this figure in persons not burdened with somatic pathology by 1.3 times, the difference with healthy individuals was more significant: the indicators differed by 2 times. That can be considered an immune response to the inflammatory process in periodontal tissues. The next stage is the beginning of the cytokine cascade, which is characterized by increased production of IL-6 and TNF-α – inducers of acute phase protein synthesis. TNF-α causes an increase in the number of free radicals and can lead to intensification of apoptosis. Due to the fact that anti-inflammatory IL-4 blocks the induced expression of pro-inflammatory IL-6 and TNF-α, a decrease in its level in oral fluid can be considered an unfavorable factor in the course of inflammatory-dystrophic periodontal lesions in patients with syndrome X. Given that TGF-β1 is an immunosuppressive factor, a decrease in its concentration indicates a deficiency of local factors of immune protection in patients with periodontal disease on the background of metabolic syndrome. Conclusion. Patients with metabolic syndrome and periodontal disease have significant disorders of cytokine regulation, which are complicated by age: expression of proinflammatory IL-1β, IL-6, TNF-α on the background of reduced anti-inflammatory cytokines IL-4 and TGF-β1. Such changes in cytokine homeostasis indicate chronic inflammation, insufficient efficiency of regenerative processes in tooth-retaining tissues, and, as a consequence, lead to a more severe course of periodontal disease in people with metabolic syndrome

Diagnostic significance of leptin in patients with ischemic heart disease on the basis of metabolic syndrome

Summary. This article presents changes in leptin, carbohydrate and lipid metabolism in patients with coronary heart disease and complicated by metabolic syndrome (MS). Obesity is positively correlated with loss of health and reduced life expectancy, as it contributes to a high risk of many pathological processes, such as coronary heart disease, stroke, liver cirrhosis, type 2 diabetes and a number of different cancers. Obesity and insulin resistance are major components of the metabolic syndrome and major risk factors for cardiovascular disease. High leptin levels are positively associated with systemic markers of inflammation. The aim of the study – to research the levels of leptin, glucose, triacylglycerols (TG), glycated hemoglobin (HbA1c) in the blood of patients with coronary heart disease and patients with coronary heart disease on the background of metabolic syndrome. Materials аnd Methods. 120 patients with verified coronary heart disease were examined, including 60 patients with coronary heart disease without MS (30 men, 30 women) and 60 patients with coronary heart disease on the background of MS (29 men, 31 women). The mean age of patients was (50±5) years. Control group – 30 healthy people of appropriate age and sex. Results. Studies have shown that obesity is accompanied by high levels of leptin, which deepens insulin resistance and is a trigger for coronary heart disease. Also, more pronounced changes in carbohydrate and lipid metabolism in patients with coronary heart disease on the background of metabolic syndrome, which indicates the severity of the clinical course of coronary heart disease on the background of MS. Conclusions. Studies have shown that leptin resistance can be a potential cause of insulin resistance and therefore obesity, which ultimately leads to metabolic syndrome and the development of coronary heart disease. The data indicate a greater tendency to obesity in women with coronary heart disease complicated by MS

Тривожно-когнітивні розлади у пацієнтів з метаболічним синдромом: клініко-нейровізуалізаційна діагностика, лікування

Мета дослідження: вивчити когнітивний, психоемоційний стан та нейровізуалізаційні показники головного мозку в пацієнтів середнього віку з хронічними формами цереброваскулярних захворювань на фоні метаболічного синдрому; вивчити клінічну ефективність, безпечність, вплив на когнітивні показники, тривогу вітчизняного препарату Вітаксон® у пацієнтів з хронічними формами цереброваскулярних захворювань на фоні метаболічного синдрому. Матеріали і методи. У відкритому контрольованому дослідженні взяли участь 60 пацієнтів віком від 42 до 61 року (Ме = 52 [Q1 = 54; Q3 = 60]) з метаболічним синдромом. Пацієнтам основної групи (n = 30) до базисної терапії додавався препарат Вітаксон®. У контрольній групі (n = 30) пацієнти отримували лише базисну терапію. Критерієм включення в дослідження була наявність тривожно-когнітивних розладів у пацієнтів з дисциркуляторною енцефалопатією І–ІІ ст. на фоні метаболічного синдрому. Проводили клініко-лабораторне обстеження та нейропсихологічне тестування за шкалами: МоСА; Спілбергера; Бека; таблицями Шульте. За допомогою методу волюметрії на МРТ-сканері Toshiba Vantage Titan 1,5 оцінено стан головного мозку в 41 пацієнта. Проводили кореляційний аналіз показників об’єму кори й білої речовини скроневої й лобної часток та когнітивно-тривожних порушень в пацієнтів з метаболічним синдромом та без нього. Результати. Після 24-денного курсу лікування відбулось покращення когнітивних функцій за шкалою МоСА в обох групах (в основній групі — на 1,5 бали; у контрольній — на 0,5 балів), у групі, у якій пацієнти приймали Вітаксон®, відмінності були вірогідними (р < 0,05). Показники реактивної тривожності за шкалою Спілбергера покращились в основній групі (42,4 ± 3,4 бала до лікування та 24,6 ± 2,8 бала на 24-ту добу), у контрольній відповідні показники суттєво не відрізнялись (41,2 ± 3,2 бала та 39,1 ± 2,1 бала відповідно). Аналіз результатів тестування за таблицями Шульте показав вірогідне зменшення показників виконання завдань після лікування в групі, що приймала Вітаксон® (р < 0,05). Показники депресії за шкалою HADS після лікування покращились в обох групах, але ступеня статистичної вірогідності не було досягнуто. Аналіз волюметричних досліджень показав погіршення когнітивних функцій за шкалою МоСА при зменшенні об’єму кори в лобній і скроневій частках. Визначався кореляційний зв’язок між показниками об’єму кори лобної і скроневої часток і результатами когнітивних функцій за шкалою МоСА. Індекс кореляції r = 0,49 для показників скроневої частки та r = 0,43 — для лобних часток. Модулі коефіцієнтів кореляції були середньої сили. Висновки. У пацієнтів з МС визначалось зменшення об’ємів сірої речовини в скроневих і лобних частках, що корелювало з когнітивним дефіцитом за шкалою МоСА. Ці дані свідчать більшою мірою про змішаний характер когнітивних порушень — судинно-дегенеративний. Проведення волюметричного дослідження в поєднанні з нейропсихологічним дозволяє на стадії помірних когнітивних порушень прогнозувати подальший розвиток захворювання. Наявність позитивного нейротропного ефекту на когнітивно-тривожні прояви та відсутність значимих побічних явищ у препарату Вітаксон® дозволяють рекомендувати його для лікування хронічних форм цереброваскулярних захворювань у пацієнтів з метаболічним синдромом.

FREQUENCY AND VARIANTS OF MENSTRUAL DISORDERS IN ADOLESCENTS WITH METABOLIC SYNDROME

The problem of the correlation between reproductive disorders and metabolic syndrome (MS) is well known, but data on the frequency and nature of these disorders among adolescents are extremely limited. The aim of the study: is to determine and analyze the frequency and structure of menstrual disorders in adolescent girls on the background of metabolic syndrome, as well as to study the correlation of these disorders with possible reproductive health disorders in the future. Materials and methods. To achieve this goal, a retrospective analysis of randomly selected 2,000 outpatient medical records (primary registration form № 025/o) of girls aged 10 to 18 years was performed at the Sumy Regional Clinical Perinatal Center from 2011 to 2021. The menstrual cycle was assessed according to the FIGO 2018 classification. Pathological menarche was defined as early (up to 10 years) or late (after 15 years) onset of menstrual function. Polycystic ovarian syndrome (РCOS) was diagnosed according to the Rotterdam criteria (2003): oligo‑ or anovulation (≤ 6 menstrual periods per year); clinical or laboratory hyperandrogenism (hirsutism/acne) and/or hyperandrogenemia (increased levels of free testosterone in the blood); polycystic ovaries during transvaginal ultrasound (≥ 15 follicles 2–9 mm in size in each ovary). Results. The results showed that in adolescent girls with overweight and MS, the frequency of menstrual dysfunction was observed in 71.1% of cases. Moreover, the most common variant of menstrual disorders in this category of patients was oligomenorrhea (60.0%), and the frequency of its manifestations was directly dependent on overweight degree. It was found that almost 82% of girls with confirmed MS had a high risk of developing polycystic ovarian syndrome (PCOS) in the future. Conclusion. It was found that the incidence of obesity in children and adolescents in the population was 27.1%, and the incidence of menstrual syndrome among children and adolescents with obesity was 41.5%. A significant proportion of adolescents with menstrual syndrome had menstrual irregularities – 71.1%, which was significantly higher than in healthy girls – 19%. Among menstrual disorders in girls with menstrual syndrome and obesity, oligomenorrhea prevailed (60.0% and 52%, respectively). Moreover, the frequency of oligomenorrhea was significantly affected by the degree of obesity. Almost 82% of girls with confirmed menstrual syndrome had at least two of the three criteria, which put them at high risk for developing polycystic ovarian syndrome in the future.

Comorbidity: non-alcoholic fatty liver disease and psoriasis

Non-alcoholic fatty liver disease (NAFLD), being a marker of significant changes in the hepatobiliary system against the background of metabolic syndrome and other endocrine pathologies, has a significant impact on the course of psoriatic disease. The presence of common mechanisms in the pathogenesis of these diseases suggests a very close relationship between them. This requires a multidisciplinary approach to studying the mechanisms of the pathogenesis of psoriasis and NAFLD, which will improve the methods of diagnosis and treatment of both diseases.

Influence of endotoxemy on development of non-alcoholic fatty liver disease

Objective — to investigate endotoxin levels and to assess the relationship between endotoxemia and metabolic parameters and the degree of steatosis and fibrosis in patients with non‑alcoholic fatty liver disease (NAFLD) against the background of metabolic syndrome (MS).
 Materials and methods. The study included 68 patients with NAFLD with metabolic disorders and 20 people of the control group. Women prevailed in both investigational groups, the mean age was 49.34 ± 10.8 years. All patients underwent evaluation of their anthropometric parameters, investigation of body composition with determination of the percentage of visceral adipose tissue (VAT). To reveal VAT dysfunction, visceral adiposity index (VAI) was calculated with M. C. Amato method. Steatometry was performed by determining the wave attenuation coefficient and carrying out shear wave elastography. Endotoxin levels in blood serum were determined using a set of reagents «LAL Chromogenic Endpoint Assay» manufactured by «Hycult Biotech» (Netherlands).
 Results. Bacterial endotoxin levels in peripheral blood in the examined patients were almost three times higher in comparison with the control group (p < 0.05). Patients with overweight and obesity had significantly higher endotoxin levels compared with the control group (p < 0.05). The significant increase in endotoxin levels has been defined in obese NAFLD patients compared to the NAFLD patients with normal weight (p < 0.05). The direct correlation was found between endotoxin parameters and parameters of abdominal and visceral obesity. In the group of patients with high VAT activity, the maximal values of this indicator were observed, which significantly differed from the corresponding indicator in patients with low and medium VAI (p < 0.05). There was a direct correlation between moderate endotoxin and insulin resistance, a direct weak relationship between endotoxin and lipid profile parameters. In patients with grade 2 and 3 steatosis, significant differences in the level of endotoxemia were observed compared with the control group (p < 0.05) and patients with grade 1 steatosis (p < 0.05). At high grades of liver fibrosis (F3F4) there was a tendency to reduce endotoxemia compared with the low‑grade fibrosis (p < 0.05).
 Conclusions. The revealed relationships between endotoxemia level and metabolic factors of NAFLD development indicate the pathogenetic role of bacterial endotoxemia in triggering a cascade of metabolic reactions with the subsequent accumulation of lipids in the liver tissue and the progression of steatosis and fibrosis.