Vol 78, No 10 (2003)

Цель исследования. Изучение функционального состояния симпатико-адреналовой системы у больных сахарным диабетом (СД) на этапах формирования поздних осложнений. Материалы и методы. Обследован 81 больной СД: 24 - без признаков поздних осложнений и диабетической автономной нейропатии (ДАН), 20 больных с ДАН, у 8 из которых была непролиферативная ретинопатия и у 6 - нефропатия 1-2-й стадии, 23 больных с ДАН, диабетической ретинопатией и сенсорной полинейропатией, 14 больных с диабетической нефропатией 4-й стадии. Содержание адреналина, норадреналина, дофамина в крови определяли методом жидкостной хроматографии с электрохимической детекцией. Всем больным проведен спектральный анализ сердечного ритма с применением программы "Марс". Результаты. У больных прогрессирование СД сопровождалось дисбалансом автономной нервной системы: повышением тонуса симпатического отдела и снижением тонуса парасимпатического отдела, снижением характеристик мощности центрального регуляторного контура. Отмечена диссоциация между степенью гиперсимпатикотонии и снижением концентрации катехоламинов в крови, связанная со степенью тяжести оагожнений заболевания. Заключение. Диссоциация между повышенным тонусом симпатического отдела автономной нервной системы и снижением концентрации катехоламинов в крови прогностически неблагоприятна и является предиктором развития аритмии и асистолии. Повышение централизации систем управления автономной нервной системы отражает напряжение регуляторных систем и является предиктором срыва адаптации.

Aim. To study specific features of lipid plasm profile in patients with metabolic syndrome (MS) and manifest disorder of carbohydrate metabolism (CM) as well as their relationships with clinical symptoms of MS. Materials and methods. Contents of lipids and apolipoproteins of plasm was measured on an empty stomach in 30 patients (18 females and 12 males) with MS and manifest disorder of CM (diabetes mellitus type 2 at the stage of good and satisfactory compensation of CM without terminal complications). Results. The patients were found to have a subnormal level of HDLP cholesterol, high levels of total cholesterol, LDLP cholesterol and LPa. Hypertriglyceridemia occurred only in 31.4% patients (TG < 200 mg/dl). Mean TG level was 173.69 ± 27.52 mg/dl. TG and diastolic arterial pressure, fasting glycemia and waist circumference significantly correlated. If the WC/TC was 1.0 and higher, И. В. the antiatherogenic plasm factor ~ HDLP cholesterol - significantly lowered. Positive correlation existed between TG and total cholesterol, LDLP cholesterol, apoB, LDLP cholesterol/'HDLP cholester- ol, apoB/apoAl, while negative correlation was seen between TG and HDLP cholesterol levels. Patients with hypertriglyceridemia had significantly higher levels of total cholesterol, LDLP cholesterol, apoB, apoB/apoAl. Conclusion. Plasm levels of TG most significantly reflect severity of basic clinical manifestations of MS: abdominal obesity, arterial hypertension, CM compensation. The presence of hypertriglyceridemia in MS patients can be considered as an indicator of high atherogenic potential of plasm.

Aim. To study psychovegetative correlations and clinical course of ischemic heart disease (IHD) in men and women. Material and methods. Personality characteristics (MMPI test), reactive and personal anxiety (Spilberger's questionnaire), severity of depression (Back's questionnaire), vegetative status (vegetative disorders questionnaire), variability of cardiac rhythm (cardiovascular tests) were studied in 60 females and 62 males with IHD. Results. IHD females vs males were characterized by higher neurotization, personal accentuation, more serious anxiety, depression and vegetative disturbances, lower variability of heart rate. IHD in females is more frequent in postmenopause, is characterized by less severe hemodynamically significant coronary stenoses. Conclusion. Emotional disorders make a great contribution to a course of ischemic heart disease.

Aim. To study efficacy and safety ofpirazidol administration in depressive patients with ischemic heart disease (1HD). Material and methods. Pirazidol was given in a dose 0.15-0.3 g/day for 4 weeks to 30 IHD patients aged 21-65 years. 21 of them had nosogenic depression, 9 patients had dysthymia. The efficacy of the antidepressive action was assessed by the Hamilton scale. Results. The trend to a decrease in Hamilton scale scores was manifest by the end of the treatment week 2. To the end of the study the overall score median lowered from 17 to 9, most of the patients had the score sum under 11. Side effects were insignificant. In pirazidol combination with beta-blockers, blockers of calcium channels, antiaggregant, diuretic drugs, nitrates and other cardio- and angiotropic drugs unfavorable interactions were not registered. Conclusion. Pirazidol can be effectively used in the treatment of psychosomatic disorders in patients with cardiovascular diseases.

Aim. To assess efficacy of different methods of iodine prophylaxis in pregnant women living in conditions of goiter endemia. Material and methods. Standard clinical, laboratory and device tests for iodine deficiency according to WHO criteria were made in 156 pregnant women living in the territory affected by goiter endemia. Of them, 121 examinees had no thyroid pathology, 35 ones had diffuse euthyroid goiter. All of them received different kinds of iodine prophylaxis. Results. The occurrence of neonatal TTH values over 5 iU/l in neonates born by mothers free of thyroid pathology on potassium iodide prophylaxis when pregnant was 9.1%. This is much lower than in conventional iodine prophylaxis - 17.24% (p < 0.01). A comparative analysis of the efficacy of potassium iodide-200 in pregnant women with diffuse euthyroid goiter and its combination with L-thy roxin has shown that by the effect on lessening frequency of neonatal ТТЯ over 5 Ш/l the above schemes do not differ significantly, thyroid reduction is more prominent in pregnant women on thyroxine with potassium iodide. Conclusion. The index of neonatal TTH is an objective criterium to control efficacy of different methods of iodine prophylaxis in pregnancy.

Aim. Analysis of associations between idiopathic disturbances of cardiac conduction (DCC) and polymorphism of mitochondrial genome. Material and methods. A family examination was performed in 431 probands with various DCC and 1347 relatives of the first, second and third degree of kinship (the study group). All the examinees were divided into four subgroups. These included 158 probands with atrioventricular block (A VB) of various degree and their 518 relatives (subgroup 1); 50 probands with a complete right bundle-branch block (BBB) and their 161 relatives (subgroup 2); 108 probands with a complete left BBB and left anterior branch of the His bundle and their 152 relatives (subgroup 3); 115 probands with sick sinus syndrome (SSS) and their 327 relatives (subgroup 4). The control group consisted of 104 probands without clinical ECG manifestations of cardiac diseases and their 321 relatives. All the examinees have undergone ECG, atropin test, echocardioscopy, electrophysiological examination of the heart and mitochondrial DNA (mDNA). Results. Comparison of the incidence of mDNA D-loop restriction sites in the group of patients with idiopathic DCC and controls has found higher frequency of the Hae III 16517 site in the group of the patients (p = 0.0480). By location of the blocks (atrioventricular and intraventricular), the site occurred more frequently in patients with AVB (86.36%). The variant "+" by the site of Hae III 16517 mDNA was found to associate with disturbances of cardiac conduction, more closely in AVB. Conclusion. Variability of mDNA may be an etiological factor of idiopathic DCC pathogenesis.

Aim. To elaborate an innovating computer learning system allowing experienced doctors to share their knowledge with beginning physicians; to apply a computer expert system in teaching interns to detect pulmonary artery thromboembolism (PAT) with emphasis on PAT risk factors and symptoms, on fixation of diagnostic skills. Material and methods. The latest achievements in the field of artificial intellect served the basis for design of OSTELA educational computer system which operates with decisive rules of a highly skilled cardiologist. In this system interns study PAT diagnosis without a direct contact of the teacher with a learner. The computer system and its operation are described. Results. Skills of PAT diagnosis were taught to 48 interns. The number of correct answers to the control test increased by 30%, on the average. Conclusion. The proposed computer learning system OSTELA was successfully tried in clinics (pilot trials) and is recommended for postgraduate education of physicians.