Vol 81, No 10 (2009)

Articles
The obstetric history of preeclampsia as a further maternal cardiovascular risk factor
Sukhikh G.T., Vikhlyaeva E.M., Kholin A.M., Sukhikh G.T., Vikhlyaeva E.M., Kholin A.M.
Abstract
The paper considers the late sequels of preeclampsia that is one of the main causes of poor perinatal outcomes. The idea that this gestational complication shows no noticeable impact on the female health status in the late postpartum periods has long been prevalent. At the same time, recent studies suggest that this cohort of women will have a high cardiovascular risk in future life, which requires the formulation of their management strategy. Epidemiological data are given on late female morbidity and mortality due to coronary heart disease, stroke, and renal failure.
Terapevticheskii arkhiv. 2009;81(10):5-9
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Pregnancy management and spontaneous labor in heart diseases: present-day solution to the dilemma
Mravyan S.R., Petrukhin V.A., Zarudskiy A.A., Pronina V.P., Mravyan S.R., Petrukhin V.A., Zaprudsky A.A., Pronina V.P.
Abstract
Aim: to study cardiac rhythm variability (CRV), to optimize pregnancy management tactics and to choose a delivery procedure. Subjects and methods. Ninety-six 19-to-37 year-old (mean age 28.3±9.4 years) women at 35-39 weeks gestational age were examined. All the women were diagnosed as having congenital or acquired (rheumatic) heart disease. Their hemodynamics and CRV were analyzed according to the type of hemodynamic overload, for which purpose three patient groups were formed: 1) volume overload; 2) pressure overload; and 3) combined overload. A control group comprised 40 healthy pregnant women. Before and 2-3 days after delivery, all the women underwent 24-hour Holter cardiac rhythm monitoring with the estimation of the temporary and spectral parameters of CRV. Results. In antepartum heart diseases accompanied by volume overload, there was a tendency for total CRV (SDNN 95.4 ± 15.8 msec versus 125.5 ± 17.8 msec in the controls) to decrease and for sympathetic activity to significantly increase (SDANN 65.7 ± 13.7 and 109.9 ± 14.7 msec, respectively; p < 0.05). When pressure overload (a moderate gradient) developed, the temporary parameters of total CRV, sympathetic and parasympathetic activities did not differ from those in the control group. Heart diseases attended by pressure overload and a high gradient were characterized by a significant reduction in total CRV (100.5 ± 24.6 msec; p < 0.05) as compared with those in patients having a moderate pressure gradient, with a declining trend for total spectrum power, Group 3 patients showed a reduction in all the indices reflecting the temporary and spectral characteristics, suggesting a considerable rise in sympathetic activity and a decrease in total autonomic spectrum power. Conclusion. Based on SRV studies, indications for prolonged pregnancy and spontaneous or, in some cases, surgical delivery can be assessed in pregnant women with heart diseases.
Terapevticheskii arkhiv. 2009;81(10):9-15
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Cardiovascular catastrophes in pregnancy
Tkacheva O.N., Sharashkina N.V., Novikova I.M., Torshkhoeva X.M., Tkacheva O.N., Sharashkina N.V., Novikova I.M., Torshkhoyeva K.M.
Abstract
Cardiovascular catastrophes (myocardial infarction and stroke occur relatively rarely during pregnancy, but they are menacing complications that frequently result in a fatal outcome. The global pattern of vascular catastrophes determines the need for applying an interdisciplinary approach to this problem and for combining the efforts of different specialists, such as obstetricians, gynecologists, cardiologists, neurologists, and therapists. To study the causes of gestational cardiovascular events and the mechanisms of their development, to devise methods for their diagnosis, prevention, and therapy are a topical problem in the present-day medical practice. The same etiological factors may cause both ischemic and hemorrhagic complications, as well as their coconcomitant forms.
Terapevticheskii arkhiv. 2009;81(10):15-20
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Current approaches to controlling type 2 diabetes
Ametov A.S., Karpova E.V., Ivanova E.V., Ametov A.S., Karpova E.V., Ivanova E.V.
Abstract
At present, about 250 million subjects suffer from type 2 diabetes (T2D) in the world. Scientists assume that this figure will amount to 380 million subjects by 2025. Macrovascular complications hold the lead in the structure of mortality in patients with T2D. Chronic hyperglycemia is known to be a cause of the development and progression of T2D. As for effective diabetes control, there is strong evidence suggesting that better glycemic control can considerably reduce a risk for both micro- and macroangiopathy. To what values glycosylated hemoglobin (HbA1c) should be reduced to prevent complications due to T2D, currently remains an urgent problem. Based on the largest studies dealing with this problem, recommendations have been formulated for different groups of patients: to achieve HbA1c levels of < 7% for all patients; < 6% for those at relatively low risk for hypoglycemia, and in the range from 7.5 to 8% for those at its high risk.
Terapevticheskii arkhiv. 2009;81(10):20-27
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Acute coronary syndrome in patients with carbohydrate metabolic disturbances (A REVIEW)
Kremneva L.V., Shalaev S.V., Kremneva L.V., Shalayev S.V.
Abstract
The review gives the results of large clinical studies of the prognostic value of hyperglycemia in patients with acute coronary syndrome and discusses the basic mechanisms determining the increased cardiovascular risk. The advantages of invasive treatment policy are also described in diabetic patients with an exacerbation of coronary heart disease.
Terapevticheskii arkhiv. 2009;81(10):27-34
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Influence of age and body weight on plasma glucose levels during an oral glucose tolerance test in subjects without carbohydrate metabolic disturbances
Dreval' A.V., Misnikova I.V., Barsukov I.A., Dreval A.V., Misnikova I.V., Barsukov I.A.
Abstract
Aim. To evaluate the influence of age and body mass index (BMI) on fasting and postprandial (2 hours after glucose load) plasma glucose (FPG and PPG) levels in males and females. Subjects and methods. A screening for carbohydrate metabolic disturbances (by using an oral glucose tolerance test) was made in the stratified adult sample from two municipal districts of the Moscow Region. The data were statistically processed by the computer program SPSS 11.0. Results. The mean FPG level in normoglycemic subjects was 5.26 ± 0.43 mmol/l. There was a significant (p < 0.001) positive correlation between age and FPG: r = 0.11 in men and r = 0.17 in women. The mean PPG was 6.15 ± 1.35 mmol/l; in males it was significantly lower than that in females. There was a significant correlation between age and PPG: r = 0.30 in males and r = 0.13 in females. A weak, but statistically significant correlation was found between FPG and body mass index (BMI) in women: r = 0.02. There was no significant correlation between FPG and BMI in men. No significant correlation was found between PPG and BMI in both males and females. A lower PPG level was 2 times more frequently observed in men than that in women (37.70 and 17.57%, respectively). Conclusion. Fasting and postprandial (2 hours after glucose load) plasma glucose levels increase with age in subjects without carbohydrate metabolic disturbances. A predictable plasma glucose level increase depending on age is described by the cubic regression model equation.
Terapevticheskii arkhiv. 2009;81(10):34-38
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Antithyroid antibodies of varying specificity in the pathogenesis and diagnosis of autoimmune thyroid diseases
Ivanova E.V., Bogatyreva Z.I., Isaeva M.A., Suchkova E.N., Baysugurov M.A., Andreeva A.V., Korotkova A.A., Notkins A., Pal'tsev M.A., Suchkov S.V., Ivanova E.V., Bogatyreva Z.I., Isayeva M.A., Suchkova E.N., Baisugurov M.A., Andreyeva A.V., Korotkova A.A., Notkins A., Paltsev M.A., Suchkov S.V.
Abstract
Aim. To compare the possible pathogenetic and clinicodiagnostic value of antithyroid autoantibodies (autoAB) different in specificity, such as monospecific ones to thyroglobulin and thyroid peroxidase (anti-TG and anti-TPO autoAB) and bispecific ones to thyroglobulin and thyroid peroxidase simultaneously (anti-TGPO autoAB), in patients with autoimmune thyroid diseases. Materials and methods. The sera from 240 patients with autoimmune thyroiditis (AIT) and from 124 with diffuse toxic goiter (DTG) were examined. The sera from 40 healthy donors served as a control. The sera were screened for anti-TG and anti-TPO autoAB, anti-TGPO autoAB, by employing enzyme immunoassay and/or radioimmunoassay. The results were statistically processed using the variation statistics-based programs. Results. The specific features of an autoantigenic component to thyroid tissues were found in the sera of patients with AIT and DTG. An association was established between the progression of disease and the phasic change of autoAB populations or their combinations. Conclusion. The procedure for evaluating seropositivity for antithyroid autoAB, which is referred to as non-invasive studies, can be considered as a criterion test in the diagnosis and prediction of the course of AIT and DTG.
Terapevticheskii arkhiv. 2009;81(10):39-45
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Relationship between the intima-media complex thickness, the risk factors of cardiovascular diseases, and the level of C-reactive protein in gouty patients
Il'ina A.E., Varfolomeeva E.I., Volkov A.V., Mach E.S., Aleksandrova E.N., Novikov A.A., Il'inykh E.V., Barskova V.G., Nasonov E.L., Ilyina A.E., Varfolomeyeva E.I., Volkov A.V., Mach E.S., Aleksandrova E.N., Novikov A.A., Ilyinykh E.V., Barskova V.G., Nasonov E.L.
Abstract
Aim. To estimate a relationship between the intima-media thickness (TIM), cardiovascular risk (CVR) factors, and the level of C-reactive protein (CRP) in gouty patients. Subjects and methods. Eighty-nine patients at an interattack interval were examined. The patients' mean age was 46.0 ± 11.4 years; the duration of the disease was 5.2 (3.0; 8.9) years. The traditional CVR factors were analyzed. Carotid ultrasound scanning was performed to detect vascular atherosclerotic lesion. The serum CRP concentration was measured by a highly sensitive immunonefelometric assay. Results. According to the TIM, the patients were divided into 2 groups: 1) 37 patients with signs of carotid atherosclerotic lesion (TIM l 0.9 mm); 2) 52 patients with a TIM of less than 0.9 mm. The ages at the moment of examination and at the onset of the disease, the duration of the disease, as well as systolic blood pressure, and the risk of myocardial ischemia were greater in Group 1 than those in Group 2. In patients with atherosclerosis, the concentration of CRP was statistically significantly higher than that in patients without this condition. Conclusion. By complementing the classical CVR factors, CRP may be a predictor of cardiovaskular diseases and their complications in patients with gout at an interattack interval.
Terapevticheskii arkhiv. 2009;81(10):45-49
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Neutrophil bactericidal and absorptive function in gout
Khitrik N.M., Didkovskiy N.A., Malashenkova I.K., Tsurko V.V., Egorov I.V., Khitrik N.M., Didkovsky N.A., Malashenkova I.K., Tsurko V.V., Egorov I.V.
Abstract
Aim. To study neutrophil bacterial and absorptive functions and the specific features of their impairments in gout. Subjects and methods. The study included 48 male patients with a valid diagnosis of gout (mean age, 59.7 ± 10.3 years; duration of the disease, 9.2 ± 2.1 years; blood uric acid (UA), 520 ± 80 μmol) (Group 1); 25 apparently healthy volunteers (mean age 55.1 ± 6.2 years; blood UA, 350 μmol/l) (Group 2). Neutrophil functional activity was estimated from the phagocytic-nitroblue tetrazolium reduction (NBT test) and myeloperoxidase (MPO) activity, the determination of non-enzyme cationic proteins (CP) and their spontaneous and induced indices. Neutrophil phagocytic function was also studied. Results. In Group 1, the content of active oxygen forms (AOF) was increased, on average, to 113.3 ± 8.65 conventional units (CI) versus 88.22 ± 5.23 CI in Group 2; p < 0.05). In 34 (70.8%) of the 48 male patients with gout, spontaneous MPO activity was significantly reduced as compared with that in Group 2: 348.4 ± 13.6 and 509.2 ± 12.2 CI, respectively (p < 0.01). In Group 1, the level of CP was noticeably decreased to 60.1 ± 2.06 CI whereas in Group 2, it was 84.91 ± 5.36 CI (p < 0.05). In gouty patients, the CP stimulation index averaged 0.70 ± 0.13; in Group 2, it was significantly higher - 1.2 ± 0.05 (p < 0.05). Conclusion. In the majority of gouty patients, neutrophil functional activity suffers due to its lower phagocytic function, which suppresses the body's antioxidant defense and contributes to the chronic pattern of an inflammatory process.
Terapevticheskii arkhiv. 2009;81(10):49-52
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Bol' v nizhney chasti spiny u molodykh - novyy podkhod k terapii
Shostak N.A., Pravdyuk N.G., Koryakina I.N., Shostak N.A., Pravdyuk N.G., Koryakina I.N.
Abstract
Aim. To evaluate the efficiency and safety of arthrofoon versus sublingual nimesulide in patients with degenerative disc disease (DDD) in two parallel groups. Subjects and methods. Fifty patients (males and females) aged 18-35 years who had acute and chronic low back pain (LBP) (visual analog scale (VAS), > 40 mm) associated with DDD were enrolled in the study. Therapeutic efficiency was evaluated from the intensity of pain (VAS), spinal function (Schober's test and Tomayer's test), the severity of disease (VAS), assessed by a physician and a patient, and the frequency of recurrent pain episodes. Results. The evaluation of the efficacy of arthrofoon showed a statistically significant positive change in pain (VAS), which corresponded to that in the indices of the pain syndrome during nimesulide administration. There was a statistically significant reduction in the frequency of recurrences in patients with chronic intermittent LBP treated with arthrofoon (p < 0.01). Arthrofoon used alone and in combination with paracetamol demonstrated a good safety profile. Conclusion. In DDD-associated LBP, the use of arthrofoon is effective and safe in young patients with both the acute (in combination with nonsteroidal anti-inflammatory drugs as a short course) and chronic (requiring long-term anti-inflammatory therapy) types of the disease.
Terapevticheskii arkhiv. 2009;81(10):52-56
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Current approaches to the diagnosis and treatment of postmenopausal osteoporosis
Baranova I.A., Baranova I.A.
Abstract
Postmenopausal osteoporosis (OP) is a disease afflicting every three women above 50 years of age. The sociomedical significance of OP is determined by the development of fracture in minimal injuries resulting in disability and, occasionally, death. The review presents a new management strategy described in the European and Russian guidelines. Particular emphasis is laid on the early identification and treatment of patients at high risk for fractures. The current requirements for drugs used to treat OP are described, by using as an example strontium ranelate, one of the first-line agents for the treatment of postmenopausal OP.
Terapevticheskii arkhiv. 2009;81(10):56-60
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Current views on the pathogenesis of depression and approaches to antidepressive therapy (in case of coaxil)
Tyuvina N.A., Tyuvina N.A.
Abstract
The review considers the current theories of depression and its clinical manifestations, as well as the factors that determine the likelihood of depression. It presents information on cerebral structural and functional changes observed in depression. There are data on the tactics of antidepressive therapy as a whole and on the use of coaxil in particular.
Terapevticheskii arkhiv. 2009;81(10):60-64
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Essential hypertension, dementia, and antihypertensive therapy in geriatric patients
Kobalava Z.D., Kotovskaya Y.V., Tyul'kina E.E., Kobalava Z.D., Kotovskaya Y.V., Tyulkina E.E.
Abstract
The review summarizes the current views on the pathogenesis of dementia and the significance of blood pressure levels for its development. The present status of the prevention of cognitive disorders and dementia is detailed in the use of antihypertensive therapy: there are the data of prospective cohort studies of the impact of antihypertensive therapy on the risk of dementia, the results of placebo-controlled studies in the groups of elderly and senile patients with a history of cerebrovascular complications, and the data of meta-analyses of studies. As for cognitive function, the effects of different classes of the currently available antihypertensive agents, such as diuretics, calcium antagonists, angiotensin-converting enzyme inhibitors, and angiotensin II type 1 receptor antagonists, are analyzed.
Terapevticheskii arkhiv. 2009;81(10):64-70
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Influence of regular use of vardenafil on endothelial and erectile functions in patients with arteriogenic erectile dysfunction
Gamidov S.I., Shcherbakov D.V., Tkhagapsoeva R.A., Koroteev R.V., Gamidov S.I., Shcherbakov D.V., Tkhagapsoyeva R.A., Koroteyev R.V.
Abstract
Aim. To study the influence of long-term of vardenafil use on endothelial and erectile functions in patients with arteriogenic erectile dysfunction (ED) Subjects and methods. The study included 74 arteriogenic ED patients (mean age 57.4 ± 4.7 years). In addition to a comprehensive andrological examination, all the patients underwent the estimation of the endothelial function of cavernous arteries, the indicator of which is the percentage increase in the diameter of cavernous arteries. The patients were divided into 3 groups: 1) 24 patients receiving vardenafil on demand in a dose of 10 mg; 2) 26 patients taking the drug on demand in a dose of 20 mg; and 3) 24 patients regularly using the agent in a dose of 10 mg every other day. Endothelial and erective functions were re-estimated 1, 3, and 6 months after the initiation of vardenafil therapy and a month following its discontinuation. Results. Erectile function improvement was noted just a month after the initiation of vardenafil therapy and achieved the maximum values by month 6. The highest erectile function parameters were observed in Group 3. There was a significant endothelial function improvement only in Group 3; the peak effect was achieved by month 6 of treatment. Conclusion. The long-term use of vardenafil contributes to the improvement of both erectile and endothelial functions in patients with arteriogenic ED.
Terapevticheskii arkhiv. 2009;81(10):70-73
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Inflammation as a factor of the pathogenesis of insulin resistance and type 2 diabetes
Shvarts V., Schwarz V.
Abstract
Insulin resistance (IR) is a leading factor of type 2 diabetes (T2D), the central and governing component of the metabolic syndrome (MS), that also appears as obesity, glucose intolerance, dyslipidemia, and essential hypertension. Recent experimental studies have indicated that proinflammatory cytokines, adipocytokines, and transcription factors are implicated in the pathogenesis of IR, as evidenced by a number of clinical observations in patients with MS and T2D, in whom IR correlates with the status of chronic mild inflammation. Based on the results of these studies, a search for methods for exposure of IR has been initiated, by controlling inflammation. The first results encourage and suggest that anti-inflammatory agents improve tissue susceptibility to insulin and they are promising for the treatment of MS and T2D.
Terapevticheskii arkhiv. 2009;81(10):74-80
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