Cerebrovascular pathology and metabolic disorders are problems of modern health care, which are of colossal medical and social significance. A high percentage of not only mortality, but also disability determines the extreme urgency of studying their various aspects, and the presence of combined pathology requires the development of a personalized approach to the tactics of managing such patients. The aim of our study is to predict the development of IS based on indicators of the structural and functional state of the heart and cerebral vessels and heart rate variability in patients with cerebral atherosclerosis (CA) and DM2. Materials and methods. The complex clinical and instrumental study involved 229 patients with CA 1–3 degrees. Study design: simple, prospective, non-randomized, sequential enrollment. All patients underwent instrumental examinations: transthoracic echocardiography, electrocardiography ECG, ultrasound Doppler of the vessels of the head and neck, MRI of the brain. All patients took antihypertensive and antidiabetic drugs, antiplatelet agents, statins. Results: Patients were divided into 2 groups: I - with CA 1–2 degrees, II - with CA 3 degrees (after ischemic atherothrombotic stroke (IS)). Average age = 65.1 ± 10.5 and 65.4 ± 9.1 years, respectively. The share of men was 21.2% in the 1st and 52% in the 2nd groups. The number of patients with type 2 diabetes, mean fasting glucose and glycosylated hemoglobin levels were comparable in both groups. At the time of examination, all patients achieved the target BP and T2DM compensation. In our study, for patients with CA, a negative relationship between ischemic stroke and end-diastolic size index and a positive relationship with the thickness of the interventricular septum and male sex was established, which logically explains the important role of LV geometry in the development of ischemic stroke. For patients with T2DM, a negative relationship was found between ischemic stroke and LV diastolic function and positive - with fasting glucose and IM thickness. Conclusion: Based on multivariate regression analysis, in patients with cerebral atherosclerosis with the development of ischemic stroke, the presence of a relationship between the thickness of the interventricular septum, end-systolic size index, end-diastolic size index and the male sex was revealed (AUC = 0.94 (CI 0.91 - 0.97), but in patients with DM2 and CA - fasting glucose level, interventricular septum thickness, intima-media complex thickness and E/A AUC = 0.99 (95% CI 0.94 - 1.00).
Цель работы — комплексная оценка влияния кверцетина на функциональное состояние центральной нервной и сердечно-сосудистой систем у больных ишемическим инсультом (ИИ) и сахарным диабетом 2-го типа (СД2) в восстановительный период. Материал и методы. В клинике ГУ «Институт геронтологии им. Д.Ф. Чеботарева НАМН Украины» проведено открытое пилотное когортное проспективное клиническое исследование, которое включало 30 больных, перенесших атеротромботический ишемический инсульт в каротидном бассейне (19 женщин и 11 мужчин), в возрасте от 55 до 75 лет (средний возраст 64,3±7,5 года), треть из них имели в анамнезе СД2. До и после курсового приема препарата кверцетин больным проводили комплексное клинико-неврологическое и нейропсихологическое обследование, исследование мозгового кровотока методом ультразвукового дуплексного сканирования экстра- и интракраниальных отделов магистральных артерий головы и шеи, электрокардиографию с оценкой вариабельности ритма сердца. Все больные получали кверцетин (лиофилизат для приготовления раствора для инъекций (комплекс кверцетина с повидоном) в дозе 0,5 г в сутки в течение 10 дней. Для приготовления раствора для внутривенного введения препарат растворяли в 100 мл изотонического раствора NaCl и вводили внутривенно капельно в течение 15-20 минут 1 раз в день. Результаты. У больных с левополушарным инсультом кверцетин оказывал более выраженное влияние на структуру биоэлектрической активности головного мозга и церебральную гемодинамику, чем у больных с правополушарной локализацией ИИ. У больных, перенесших ИИ, кверцетин улучшалпсихоэмоциональные и мнестические функции за счет положительной реорганизации биоэлектрической активности головного мозга, улучшения церебральной гемодинамики и гармонизации симпатического и парасимпатического звеньев вегетативной нервной системы. Выводы. Корригирующее влияние кверцетина на функциональное состояние мозга и сердца дает основание рекомендовать применение препарата в системе реабилитации больных, перенесших ишемический инсульт.
Objective — to establish the peculiarities and relationship of spectral indicators of heart rate variability (HRV), fasting glucose level and lipid profile indicators in practically healthy persons and in elderly patients with dyscirculatory atherosclerotic encephalopathy (DEP). Materials and methods. The study involved 77 subjects of various age, who were divided into two groups: group 1 consisted of apparently healthy persons (19 subjects of middle age and 27 elderly subjects) and group 2 that included patients with DAP manifestations (15 subjects of middle age and 16 elderly persons). In the groups of elderly persons, the subgroups were extracted based on the fasting glucose levels: lower than 6.1 mmol/l and 6.1 mmol/l. The measurements of systolic and diastolic blood pressure were performed in a sitting position after at least 10 min of rest. Plasma glucose levels were determined by a standard glucoseoxidase method, lipid profile was determined by using the automatic analyzer. To assess the risk of cardiovascular disease development, calculations were performed for the indices of the cardiovascular risk: Castelli index and Boizel index. All patients with DEP manifestations underwent 24‑hour Holter ECG monitoring, and healthy people underwent 5 min ECG. Results. The incidence of fasting hyperglycemia in patients with 1 — 2 stage DEP manifestations was in 3.4 times higher (p < 0.05) vs healthy subjects of the same age. The significant correlation has been reveled between age and HDL‑C (r = 0.47, р < 0.05), atherogenic index (r = –0.40, р < 0.05), heart rate (r = –0.45, р < 0.05), Castelli index (r = –0.40, р < 0.05), Boizel index (r = –0.31, р < 0.05), heart rate (r = –0.45, р < 0.05). Moreover, correlation has been established between Boizel index and heart rate (r = +0.44, р < 0.05), heart rate and LF/HF (r = +0.57, р < 0.05), between TG and heart rate (r = +0.43, р < 0.05), LF/HF (r = +0.53, р < 0.05) and between levels of very low density lipoprotein cholesterol and heart rate (r = +0.44 р < 0.05), LF/HF (r = +0.53, р < 0. 05). It has been established that hyperglycemia and dyslipidemia significantly affected spectral heart rate variability indices in patients with encephalopathy manifestations. Conclusions. With ageing, the frequency of fasting hyperglycemia in patients with 1 — 2 stage DEP manifestations was significantly higher in 3.4 times in comparison with practically healthy individuals of the same age. In the group of practically healthy persons over 60 years old, the tendency has been revealed towards a decrease in the spectral parameters of HRV LF and HF, which indicates HRV decrease. With the development of 1 — 2 stages DEP, even in the middle age, a significant decrease in the value of HF (parasympathetic influence) and a significant increase in the value of LF (sympathetic activity) were revealed. In elderly people with signs of 1 — 2 stage DEP with normoglycemia and fasting hyperglycemia against the background of dyslipidemia, the sympathetic link of the autonomic nervous system is activated, accompanied by an increase in the index of vascular complications. In patients with 1 — 2 stages DEP and fasting hyperglycemia, this tendency was even more pronounced. This fact can serve as confirmation that in the development of pre‑diabetic disorders (fasting hyperglycemia) one of the pathogenic mechanisms is the violation of the central regulatory mechanisms, which in turn leads to the violation of the autonomic balance with the prevalence of sympathicotonia, and a decrease in the parasympathetic effect on the heart, which leads to development of autonomous cardiac neuropathy.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.