Vol 87, No 10 (2015)

Editorial
The metabolic memory phenomenon in predicting a risk for vascular complications in diabetes mellitus
Dedov I.I., Shestakova M.V.
Abstract
The paper presents data on positive and negative metabolic memory phenomena in patients with type 1 and type 2 diabetes mellitus (DM) as exemplified by the long-term randomized trials DCCT, UKPDS, ACCORD, VADT, and ADVANCE. It discusses the role of metabolic memory in predicting a risk for vascular complications in DM. Ideas on the mechanisms of this phenomenon, which are based on the activation of oxidative stress, the production of irreversible glycation products, and epigenetic disorders, are given.
Terapevticheskii arkhiv. 2015;87(10):4-10
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Cardiovascular autonomic neuropathy in patients with type 2 diabetes mellitus and coronary artery disease: Diagnosis and severity assessment
Beshlieva D.D., Kalashnikov V.Y., Smirnova O.M.
Abstract
Aim. To study the nature and severity of heart rate variability (HRV) and heart rate turbulence (HRT) abnormalities in patients with coronary artery disease (CAD) and type 2 diabetes mellitus (T2DM) and to assess the prevalence of cardiovascular autonomic neuropathy (CAN) and its severity in patients with T2DM concurrent with CAD. Subjects and methods. A total of 185 patients with T2DM and/or CAD were examined and divided into 3 groups: 1) 92 patients with CAD and T2DM; 2) 43 patients with CAD without T2DM; 3) 49 patients with T2DM without CAD. All the patients underwent 24-hour ECG monitoring with HRV and HRT analysis. Results. CAN was identified and the severity of CAN was assessed based on the abnormal HRV and HRT parameters. CAN, especially severe one, was more common in Group 1 (the relative risk was 3.3 [95% CI 1.3—8.2]; p<0.05), than in Group 3. In Group 1, CAN was associated with the duration of T2DM and the level of glycated hemoglobin (p<0.05). The patients with severe CAN in Group 1 showed a 4-fold higher risk for multivessel coronary artery lesions than those without CAN (p<0.05). Conclusion. Glycemic control quality, T2DM duration, and obvious coronary atherosclerotic lesions were demonstrated to be associated with the presence and severity of CAN. The developed methods may be used in practice to detect and more accurately determine the severity of CAN and to predict cardiovascular risk in patients with T2DM and CAD.
Terapevticheskii arkhiv. 2015;87(10):11-18
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Risk factors and glycation end products in patients with different forms of coronary heart disease and type 2 diabetes mellitus
Ivannikova E.V., Kalashnikov V.Y., Smirnova O.M., Kononenko I.V., Kuznetsov A.B., Terekhin S.A.
Abstract
Aim. To determine the levels of growth factors and glycation end products in patients with different forms of coronary heart disease (CHD) and type 2 diabetes mellitus (T2DM). Subjects and methods. A total of 134 patients with CHD and T2DM, including 38 patients with non-ST-elevation acute coronary syndrome (ACS), were examined. The arterial and venous serum levels of basic fibroblast growth factor-β (FGF-β), transforming growth factor-β (TGF-β), placental growth factor (PlGF), advanced glycation end products (AGEs) and their receptors (RAGE) were estimated in all the patients. Results. A direct correlation was found between the degree of arterial stenosis and the level of growth factors and AGEs in the patients with T2DM; there was also a direct correlation of the examined factors with lipid metabolic parameters. There was a significant two-fold increase in FGF-β, PlGF, and RAGE levels in the patients with ACS. Conclusion. Hyperglycemia was found to negatively affect the progression of atherosclerotic changes in the vessel wall and on that of fibrotic processes.
Terapevticheskii arkhiv. 2015;87(10):19-25
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The state of the great arteries in type 2 diabetes mellitus patients with obstructive sleep apnea syndrome
Oleynikov V.E., Sergatskaya N.V., Gusakovskaya L.I., Khromova A.A.
Abstract
Aim. To evaluate the impact of hyperglycemia concurrent with obstructive sleep apnea syndrome (OSAS) on endothelial function (EF) and vessel remodeling in patients with Grade 1—2 hypertension. Subjects and methods. A total of 101 patients with Grade 1—2 hypertension were examined. A study group (SG) consisted of 74 hypertensive patients with type 2 diabetes mellitus (T2DM). A control group (CG) comprised 27 persons with isolated blood pressure (BP) elevation. The patients with T2DM underwent cardiorespiratory sleep monitoring, the readings of which were used to divide SG into 2 subgroups: 1) patients with an apnea-hypopnea index of <30 episodes/h (SG-1); 2) those with an index of >30 episodes/h (SG-2). 24-hour BP and vascular stiffness monitoring was made; EF was evaluated; common carotid artery diameter (CCAD) and intima-media thickness (IMT) were determined. Results. The diabetic patients showed lower central diastolic BP and higher aortic pulse BP. Unlike the comparison group, the diabetic patients with severe OSAS were found to have the highest central pulse wave propagation velocity at night. There was a preponderance of an average nocturnal arterial rigidity index, average daily and average nocturnal BP rising rates, and shorter reflected wave propagation time in the diabetic patients. The mean level of flow-mediated vasodilation was significantly reduced in SG-2. The diabetic patients, unlike the controls, were ascertained to have decreased absolute responsiveness index values. There were increases in IMT and CCAD in SG-2. Conclusion. OSAS worsens EF and vessel rigidity in patients with T2DM concurrent with hypertension.
Terapevticheskii arkhiv. 2015;87(10):26-30
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Markers of visceral adipose tissue metabolic abnormalities in patients with coronary atherosclerosis in relation to the presence of type 2 diabetes mellitus
Gavrilova N.E., Metelskaya V.A., Boytsov S.A., Gumanova N.G., Yarovaya E.B.
Abstract
Aim. To assess the specific features of visceral adipose tissue metabolism in patients with coronary atherosclerosis, complicated or uncomplicated type 2 diabetes mellitus (T2DM). Subjects and methods. A cohort of 429 patients (325 men and 104 women; mean age, 61.3±9.4 years) with coronary atherosclerosis who had been admitted to the National Research Centre for Preventive Medicine, Ministry of Health of Russia, to undergo coronarography (CG) and to receive high-tech treatments and met the criteria for being included in and excluded from this investigation, was examined. The Gensini scoring scale was used to estimate the magnitude of coronary atherosclerosis from CG results. Carotid artery duplex ultrasound scanning estimating the intima-media thickness was performed in 48% of the patients. DM was diagnosed from examination results (fasting plasma glucose ≥7.0 mmol/l and glycated hemoglobin >6.5%) and an endocrinologist’s report. 94% of the patients took statins. Results. Overall, 18% of the examinees had DM that was 2.5 times more common in the women than in the men (32.7 and 13.2%, respectively (p=0.000). The diabetic and non-diabetic patients showed no significant differences in age: 62.9±8.3 and 60.9±9.6 years, respectively (p=0.105). There were statistically significant differences in the magnitude of coronary artery atherosclerosis according to the Gensini scale in relation to the presence of T2DM; thus, the median Gensini score was 48 in the diabetic patients and 46 in the persons with no signs of the disease (Mann-Whitney test; p=0.03). Analysis of adipokine levels showed that the median leptin level was significantly higher than that in the male patients with T2DM than in the persons with no signs of the disease. In the patients with T2DM, the median adiponectin level turned out to be significantly lower in both men and women. Conclusion. The coronary atherosclerosis severity rated using the Gensini scale is shown to increase in the presence of T2DM. The probability of detecting obvious (>45%) carotid artery lesion is associated with the presence of DM in both men and women. The male patients with T2DM concurrent with coronary atherosclerosis are noted to have an elevated leptin level, but a lower adiponectin concentration was found in both the men and women.
Terapevticheskii arkhiv. 2015;87(10):31-36
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Leptin, resistin, and hormonal and metabolic parameters in women with type 2 diabetes and in those with its concurrence with asthma
Verbovoy A.F., Kosareva O.V., Akhmerova R.I.
Abstract
Aim. To investigate the relationship between resistin, adiponectin, leptin, and hormonal and metabolic parameters in patients with type 2 diabetes mellitus (T2DM) and in those with its concurrence with asthma. Subjects and methods. Twenty-seven patients with T2DM and 26 patients with T2DM concurrent with asthma were examined. The examination data of 23 apparently healthy women served as a control. Anthropometric measurements, carbohydrate and lipid metabolic parameters, and leptin, resistin, adiponectin, interleukin (IL)-6 and IL-10 levels were studied. Results. Hyperleptinemia, hyperresistinemia, and lower adiponectin concentrations were found in the patients with T2DM and in those with its concurrence with asthma. These changes in the patients from these groups occurred in the presence of subclinical inflammation. Obvious insulin resistance (IR) accompanied by compensatory hyperinsulinemia was identified in the examined women. The detected atherogenic dyslipidemia appeared as increases in the levels of total cholesterol (C), triglycerides, low-density lipoprotein C, and atherogenic index and as a decrease in those of high-density lipoprotein C. The women with the concurrence of the diseases showed a positive correlation of the level of resistin with insulin and the HOMA index. Conclusion. The patients with T2DM and those with its concurrence with asthma exhibited obvious IR accompanied by compensatory hyperinsulinemia. Hyperresistinemia plays a role in the development of IR in the concurrence of these diseases. The patients with T2DM and those with its concurrence with asthma were found to have hyperleptinemia, hyperresistinemia, and a trend for decreasing adiponectin values in the presence of subclinical inflammation.
Terapevticheskii arkhiv. 2015;87(10):37-41
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Use of human insulin analogues in young patients with type 1 diabetes mellitus: Results of the RESULT observational program on the use of insulin glargine (Lantus) in combination with insulin glulisine (Apidra) as a basal-bolus regimen
Efremova N.V., Bolotskaya L.L., Atarshchikov D.S., Bondarenko O.N., Ilyin A.V., Shestakova M.V.
Abstract
Aim. To implement in 2009—2012 the RESULT observational program on the use of insulin glargine (Lantus) in combination with insulin glulisine (Apidra) as a basal-bolus regimen in patients with type 1 diabetes mellitus (DM) to evaluate the efficiency and safety of therapy with human insulin analogues. Subjects and methods. The program covered 100 patients aged 19 to 25 years from 7 regions of the Russian Federation, who had had DM onset at the age of 9—13 years, were using human recombinant insulins as continuous insulin therapy, and had glycated hemoglobin (HbA1c) levels of 7 to 9%. The main inclusion criterion was switching to insulin therapy with the human insulin analogues Lantus and Apidra. Results. A total 41 men and 59 women were followed up. Their mean baseline HbA1c level was 8.3±0.7%. After 24 months of therapy, HbA1c was significantly decreased to 7.7±0.7%; its change compared with that at Visit 1 was –0.6±0.6% (p<0.001). There was a significant reduction in fasting and postprandial blood glucose levels at 3 months of a follow-up. The number of symptomatic and asymptomatic glycemic episodes declined. No nocturnal or severe hypoglycemic episodes were recorded at 24 months of therapy. Microvascular complications did not progress during the follow-up. Conclusion. The use of human insulin analogues is effective and safe in treating young diabetic patients, improves their quality of life and confers no risk of asymptomatic or nocturnal hypoglycemic states.
Terapevticheskii arkhiv. 2015;87(10):42-49
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Intercurrent and autoimmune processes in type 1 diabetes mellitus
Derevyanko O.S., Nikonova T.V., Smirnova O.M., Dedov I.I.
Abstract
Aim. To estimate the prevalence of autoantibodies pathognomonic for autoimmune diseases of connective tissue and liver in patients with type 1 diabetes mellitus (DM1) and to study their clinical features in patients positive for these indicators. Subjects and methods. A total of 84 patients (39 men and 45 women) with DM1 divided into 2 groups were examined. Biochemical, immunological, and instrumental examinations were performed. Results. There was a high prevalence of markers of autoimmune diseases of connective tissue and liver in patients with DM1 and that of autoantibodies in those without its clinical symptoms or signs according to instrumental findings. Conclusion. The findings may suggest that patients with DM1 have a higher risk of concomitant autoimmune diseases with a probability of their asymptomatic course.
Terapevticheskii arkhiv. 2015;87(10):50-53
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Nonglycemic effects of incretins in patients with long-term type 1 diabetes mellitus and chronic kidney disease
Arutyunova M.S., Glazunova A.M., Mikhaleva O.V., Zuraeva Z.T., Martynov S.A., Klefortova I.I., Manchenko O.V., Ulyanova I.N., Ilyin A.V., Shamkhalova M.S., Shestakova M.V.
Abstract
Aim. To investigate the nonglycemic effects of incretins in patients with type 1 diabetes mellitus (DM1) of long duration (for more than 20 years) and chronic kidney disease. Subjects and methods. Seventy-five patients with varying degrees of diabetic nephropathy (DN) and without this condition, including patients receiving renal replacement therapy with programmed hemodialysis and those who had undergone kidney transplantation were examined. The levels of phosphorus-calcium metabolic indicators (calcium, phosphorus, parathyroid hormone, vitamin D, and fibroblast growth factor 23 (FGF-23)), the cardiac damage marker atrial natriuretic peptide, the proinflammatory markers monocyte chemoattractant protein 1 (MCP-1) and C-reactive protein (CRP) and the fibrotic marker transforming growth factor-β, as well as those of glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP) were estimated in addition to conventional examination methods. All the patients underwent cardiac multislice spiral computed tomography, by calculating the Agatston index (calcium index (CI)) reflecting the degree of coronary artery calcification. Results. The investigation revealed no relationship of GLP-1 and GIP levels to the presence and degree of DN in the patients of the study groups. GLP-1 was noted to be inversely related to patient age, indicating the diminished secretion of this peptide in older people. There was evidence that GLP-1 positively affected blood lipid composition (total cholesterol: r=–0,320; p<0.05) and the magnitude of coronary artery calcification (CI: r=–0.308; p<0.05). GIP showed a differently directed effect on the proinflammatory factors: fibrinogen (r=–0.264; p<0.05), CRP (r=–0.626; p<0.05), and FGF-23 (r=–0.341; p<0.05). Conclusion. The investigation has demonstrated the nonglycemic effects of incretins that favorably affect the pathogenetic processes underlying the late complications of DM1. The findings point to the potential efficacy of incretin-based drugs in preventing and treating the late complications of DM, which necessitates the conduction of larger investigations.
Terapevticheskii arkhiv. 2015;87(10):54-61
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Urinary excretion of markers for podocyte injury in patients with diabetes mellitus
Shchukina A.A., Bobkova I.N., Shestakova M.V., Vikulova O.K., Zuraeva Z.T., Mikhaleva O.V.
Abstract
Aim. To estimate the urinary excretion of markers for podocyte injury, to specify their value for the early diagnosis of diabetic nephropathy (DN), and to access the risk of its progression in patients with diabetes mellitus (DM) with varying degrees of albuminuria/proteinuria. Subject and methods. Seventy-four diabetic patients (30 with type 1 DM and 44 with type 2 DM) were examined and divided into 3 groups according to the urinary concentration in one urinary portion: 1) 41 patients with normal albuminuria (NAU) (<20 mg/l); 2) 13 patients with microalbuminuria (MAU) (20—200 mg/l); 3) 20 patients with proteinuria (PU) (>200 mg/l). A control group included 10 healthy individuals. The urinary levels of the podocyte structural proteins nephrin and podocin were determined by enzyme immunoassay. Results. Nephrinuria (NU) was detected in 63, 77, and 80% of the patients with NAU, MAU, and PU, respectively. Podocinuria (PDU) was found in 78, 54, and 83% of those with NAU, MAU, and PU, respectively. NU in DN with PU was significantly higher than that in DM with NAU. In the NAU, MAU, and PU subgroups, podocin excretion was equally higher and did not differ between the types of DM. There was a direct correlation of NU with albuminuria, which was stronger in the MAU subgroup. In the patients with DM with varying degrees of albuminuria, the values of NU and PDU correlated directly to serum creatinine levels and inversely with glomerular filtration rate. NU directly correlated with glycated hemoglobin levels in the patients with types 1 and 2 DM of less than 5 years’ duration and a direct significant correlation of systolic blood pressure with NU was found in those with type 2 DM. Conclusion. Determination of urinary nephrin and podocin levels may be used for the early preclinical diagnosis of DN and the monitoring of the glomerular apparatus in DM.
Terapevticheskii arkhiv. 2015;87(10):62-66
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Association of CTLA4 and TNF gene polymorphisms with endocrine ophthalmopathy in ethnic Russian patients with Graves’ disease
Martirosian N.S., Burdennyi A.M., Trukhina L.V., Panteleeva O.G., Saakyan S.V., Petunina N.A., Nosikov V.V.
Abstract
Aim. To analyze the associations of the rs3087243 CTLA4 polymorphism and the rs1800629 TNF polymorphism with endocrine ophthalmopathy (EOP) in ethnic Russian patients with Graves’ disease (GD). Subjects and methods. The case-control study enrolled 205 patients with GD. The distribution of alleles and genotypes of the rs3087243 CTLA4 and rs1800629 TNF polymorphisms was studied in 141 patients with GD and EOP (a GD+EOP group) and 64 patients with GD without EOP (a GD-EOP group). The polymorphic alleles were identified by polymerase chain reaction-restriction fragment length analysis. Results. The patients with GD in their history and EOP had significantly higher frequencies of A allele and AA genotype and a lower proportion of G allele and GG genotype of the rs3087243 CTLA4 polymorphism. Comparative analysis revealed no significant differences in the frequency of the alleles and genotypes of the rs1800629 TNF polymorphism. Conclusion. The rs3087243 CTLA4 polymorphism is associated with the risk of EOP in ethnic Russian patients with GD.
Terapevticheskii arkhiv. 2015;87(10):67-71
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Impact of the local application of collagen on the activity of reparative processes in the lower extremity soft tissue of patients with diabetic foot syndrome
Tokmakova A.Y., Zaytseva E.L., Doronina L.P., Molchkov R.V., Voronkova I.A.
Abstract
Aim. To estimate of the rate of reparative processes in the lower extremity (LE) soft tissues of patients with diabetic foot (DF) syndrome in the local application of collagen-containing dressings (CCD) versus standard medical therapy. Subjects and methods. The clinical (sizes, tissue oxygenation), histological, and immunohistochemical markers of reparative processes in LE soft tissues were analyzed in patients with diabetes mellitus during the local application of collagen-containing wound dressings versus standard treatment. Forty-two patients with postrevascularization neuropathic and neuroischemic DF syndrome were examined after standard surgical wound treatment. In the perioperative period, 21 patients received local treatment using CCD and 21 patients had standard treatment. Results. In the patients using CCD, the area and depth of wound defects could be decreased by 26.4±17.2 and 30.4±25.6%, respectively (p=0.002 vs baseline). In the control group, those were 17.0±19.4 and 16.6±21.6%, respectively (p=0.002). Percutaneous oximetry assessment indicated significantly higher local microhemodynamics in the local collagen treatment group (p<0.05). According to the data of histological examination of wound defect tissues, after 10-day treatment, Group 1 showed a 80% reduction in edema (p<0.05), a 90% disappearance of inflammatory infiltrates (p<0.05), and formation of mature granulation tissue (p<0.05). Immunohistochemical examination revealed a more pronounced rise in the count of macrophages in the derma (p<0.05). When CCD was applied, the level of matrix metalloproteinase tended to more markedly decrease as compared to that in the control group. Conclusion. The findings suggest that the activity of reparative processes in LE soft tissues is enhanced in diabetic patients receiving local collagen therapy versus those having standard treatment. This manifests itself as a decrease in both the area and depth of wounds, enhancement of local tissue perfusion, a reduction of inflammation and a rapider wound transfer from proliferation to the epithelialization phase, as supported by histological and immunohistochemical findings.
Terapevticheskii arkhiv. 2015;87(10):72-79
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Adipokines and a risk for metabolic disturbances in different types of female obesity
Selyatitskaya V.G., Pinkhasov B.B., Karapetyan A.R., Kuzminova O.I.
Abstract
Aim. To investigate the effects of adiponectin and leptin on the development of metabolic disturbances in women with android and gynoid fat distribution. Subjects and methods. A total of 101 women aged 40 to 65 years were examined. Anthropometric measurements were made; overweight and obese women with a waist/hip (W/H) ratio of less than 0.83 were referred to as a gynoid fat distribution (GFD) group; and those with a W/H ratio of 0.83 or more were to an android fat distribution (AFD) group. The serum concentrations of triglycerides, high-density lipoprotein cholesterol, and glucose were measured; the levels of insulin, leptin, and adiponectin were determined by enzyme immunoassay. Insulin resistance (IR), HOMA IR, and visceral obesity index (VOI) were calculated. Results. With the same excess adipose tissue accumulation, the women with GFD had a less magnitude of hormonal and metabolic disturbances than those with AFD, whose HOMA-IR also pointed to the presence of IR. VOI was insignificantly higher in the women with GFD and 2.4-fold greater than that in normal weight (NW) women. In the women with GFD and AFD, the concentration of leptin was higher than that in the NW women, which was characteristic of obesity, but the concentration of adiponectin proved to be significantly lower in the patients with AFD and to be unchanged in those with GFD as compared with that in the NW women. Conclusion. The women with AFD are typified by a high VOI, hypoadiponectinemia, IR, and metabolic disturbances, which determine a high risk for cardiovascular events and type 2 diabetes mellitus. In the women with GFD, obesity is associated with normal adiponectinemia and a low VOI and, in terms of hormonal and metabolic characteristics, may be characterized as metabolically healthy obesity.
Terapevticheskii arkhiv. 2015;87(10):80-84
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Association of adiponectin gene G276T polymorphism with the development of metabolic syndrome in ethnic Kyrgyz patients
Isakova J.T., Lunegova O.S., Talaibekova E.T., Asambaeva D.A., Kerimkulova A.S., Aldashev A.A.
Abstract
Aim. To study the association of adiponectin gene G276Т (ADIPOQ) polymorphism with the development of metabolic syndrome (MS) in ethnic Kyrgyz patients. Subjects and methods. A total of 171 patients with MS (a study group) and 117 patients without MS (a comparison group) were examined. MS was defined on the basis of the modified ATP III criteria. The genotypes of the G276T polymorphism in the adiponectin gene were determined by polymerase chain reaction-restriction fragment length polymorphism analysis. Results. Dividing the MS and control groups by gender revealed statistically significant differences in the distribution of alleles and genotypes only among the women. There was a higher frequency of GT+TT genotypes (53% vs 34%; χ2=5.942; р=0.014) and T allele (30% vs 19%; χ2=4.489; р=0.0341) in the women with MS than in those without MS. Iin the ethnic Kyrgyz women, the T allele at the G276Т polymorphic locus in the ADIPOQ gene was associated with the development of MS (odds ratio (OR)=1.82; 95% confidence interval (CI) 1.04—3.19) and type 2 diabetes mellitus (T2DM) (OR=2.63; 95% CI, 1.05—6.56 ) with the high levels of leptin (p<0.05), glucose (p<0.05), triglycerides (OR=3.06; 95% CI, 1.05—8.93), low-density lipoprotein cholesterol (OR=2.80; 95% CI, 1,07—7.31) and with the lower level of high-density lipoprotein cholesterol (OR=2.9; 95% CI, 1.15—7.24). Conclusion. The risk for MS, T2DM, hyperglycemia, and dyslipidemia is related to the carriage of the T allele of the G276Т polymorphism in the ADIPOQ gene in ethnic Kyrgyz women.
Terapevticheskii arkhiv. 2015;87(10):85-90
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Motor-evacuatory function of the gastrointestinal tract in metabolic syndrome
Vakhrushev Y.M., Lyapina M.V.
Abstract
Aim. To investigate the motor-evacuatory function of the gastrointestinal tract (GIT) in metabolic syndrome (MS). Subjects and methods. Fifty-eight patients with MS were examined. In addition to clinical findings, an integrated study of GIT motor function by peripheral electrogastroenterocolography was used. The specific features of lipid metabolism and hormonal and autonomic status were studied in patients with MS. Results. The local and systemic clinical signs of small bowel lesions were noted in 82.9% of the patients with MS. There were elevated blood lipid levels in the presence of hypomotor dyskinesia of the upper GIT portions in the postprandial period. New pathogenetic trends in the role of hormones and hypersympatheticotonia in impairing the motor function of the small bowel were found in MS. Conclusion. The results of our investigations suggest that the found changes in GIT motor function are an important component of the complex pathogenesis of MS.
Terapevticheskii arkhiv. 2015;87(10):91-97
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Carbohydrate metabolism in patients with acromegaly and Itsenko—Cushing disease
Matchekhina L.V., Belaya Z.E., Melnichenko G.A., Shestakova M.V.
Abstract
The relevance of investigating carbohydrate metabolism (CM) in patients with acromegaly and Itsenko—Cushing disease is attributable to frequent glucose metabolic disturbances, on the one hand, and to difficulties in choosing sugar-lowering therapy in these categories of patients, on the other. The efficiency of hyperglycemia treatment in these patients may be reduced due to problems in achieving remission/cure of the underlying disease and to specific therapy favoring hyperglycemia. The top-priority tasks are to search for ways of reducing the frequency of CM abnormalities in patients with neuroendocrine diseases and to elaborate sugar-lowering therapy regimens. There is a growing interest in studies of the role of the incretin system in the pathogenesis of secondary hyperglycemias associated with neuroendocrine diseases. Nevertheless, few works have been published on this subject matter because of its novelty. There is a need for a further closer study of the specific features of incretin system function and the pharmacodynamics of incretin mimetics that are potential candidates as first-line drugs to treat secondary hyperglycemias. This paper attempts to summarize the available data obtained from studies into CM in neuroendocrine diseases.
Terapevticheskii arkhiv. 2015;87(10):98-104
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The concurrence of diabetes mellitus and gallstone disease
Tereshchenko I.V., Kamenskikh Y.A., Kayushev P.E.
Abstract
The article presents an update on the concurrence of diabetes mellitus (DM) and gallstone disease (GSD), on the mechanisms for the development of GSD in patients with type 2 DM (T2DM), on the risk factors of DM in GSD. The role of diabetic autonomic neuropathy of the gallbladder in the development of cholelithiasis is assessed in patients with T2DM. The impact of impaired secretion of neurohormones in the gastrointestinal tract in the development of DM in GSD is analyzed.
Terapevticheskii arkhiv. 2015;87(10):105-109
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Asthma and metabolic syndrome: Clinical and pathogenetic relationships
Budnevsky A.V., Malysh E.Y., Ovsyannikov E.S., Drobysheva E.S.
Abstract
Asthma and metabolic syndrome (MS) are common and social diseases. External and internal factors influencing the development and manifestations of asthma are identified; among which there is obesity that is a major risk factor for MS. Accordingly, the concurrence of asthma and MS and to study their clinical and pathogenetic relationships are a topical problem. There is a tendency to identify a particular asthma phenotype that is characterized by later-onset disease in the presence of obesity; the low prevalence of atopy, low serum level of IgE, and a poorly-controlled course with a trend of standard therapy resistance. It is necessary to understand the essence of asthma cause-effect relationships in the presence of obesity for defining management tactics for this group of patients.
Terapevticheskii arkhiv. 2015;87(10):110-114
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Hereditary pheochromocytoma-associated syndromes. Part 2
Yukina M.Y., Troshina E.A., Beltsevich D.G.
Abstract
Pheochromocytoma (PCC)/paraganglioma is a catecholamine-secreting tumor of the paraganglion. The hereditary variants of PCC have been previously considered to occur in 10% of cases. The latest researches have clearly demonstrated that the hereditary cause of chromaffin tumors is revealed in a much larger number of patients. There have been the most investigated NF, RET, VHL, SDHD, SDHC, and SDHB gene mutations. New EGLN1/PHD2, KIF1В, SDH5/SDHAF2, IDH1, TMEM127, SDHA, MAX, and HIF2А gene mutations have been recently discovered. This review describes the most common PCC-associated syndromes in detail and considers the specific features of new mutations.
Terapevticheskii arkhiv. 2015;87(10):115-119
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Some issues of the diagnosis and treatment of gastroesophageal reflux disease
Avdeev V.G.
Abstract
The clinical inefficacy of proton pump inhibitors (PPIs) is very frequently encountered in nonerosive gastroesophageal reflux disease (NERD) in particular. Postprandial acid pocket, weak-acid or alkaline reflux, etc. are one of the causes of resistance to antisecretory drugs. Alginates serve as a good alternative to PPIs in treating NERD and gastroesophageal reflux in children and pregnant women. The alginate test may help diagnose NERD.
Terapevticheskii arkhiv. 2015;87(10):120-124
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