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13ограничения во времени, отведенного на такие важные разделы обследования пациента, как опрос с детальным изучением жалоб больного, оценкой его функционального статуса, изучением факторов риска и т.д. Все это обусловливает необходимость применения дополнительных технических средств.
Мы предполагаем, что именно дефицит информации, необходимой для принятия врачебного решения, при консультациях без предварительного интерактивного опроса, определял частыми такие результаты удаленного консультирования ЕИСЗ ПК, как «подтверждение диагноза без коррекции лечения» и необходимость выезда специалиста в направляющую МО и наоборот, редкими - «изменение диагноза с коррекцией лечения».
Выводы
Предварительное интерактивное анкетирование с помощью компьютерной программы «Электронная поликлиника» позволяет повысить эффективность консультаций в удаленном доступе, помогая врачу избежать диагностических ошибок в условиях дефицита времени и недостаточного объема необходимой клинической информации для принятия врачебного решения.
Литература
1. Чучалин А.Г., Бобков Е.В. Основы клинической диагностики. Издание 2- е, перераб. и доп. М.: ГЭОТАР-Медиа, 2008. 584 а
2. Приказ Минздравсоцразвития России от 28.04.2011. N 364 (ред. от 12.04.2012) "Об утверждении Концепции создания единой государственной информационной системы в сфере здравоохранения".
3. Приказ Министерства здравоохранения и социального развития РФ от 12.04.2012 № 348 "О внесении изменений в Концепцию создания информационной системы в сфере здравоохранения, утвержденную приказом Минздравсоцразвития России от 28 апреля 2011 г. № 364" «Об утверждении концепции создания единой государственной
информационной системы в сфере здравоохранения». М. 2012.
4. Омельянчук С.Ю., Никонова Е.З. Анализ функциональных возможностей специализированных корпоративных мессенджеров // International Journal of Advanced Studies. 2018. Т. 8. № 2-2. С. 1923.
5. Свидетельство о государственной регистрации программы для ЭВМ "Электронная поликлиника" № 2012614202, дата регистрации 12.05.12. Авторы: Мишланов Я.В., Мишланов В.Ю., Мишланова И.В., Мишланова С.Л.
6. Кочетов А.Г., Лянг О.В., Масенко В.П., Жиров И.В., Наконечников С.Н., Терещенко С.Н. Методы статистической обработки медицинских данных: Методические рекомендации для ординаторов и аспирантов медицинских учебных заведений, научных работников. М.: РКНПК, 2012. 42 с.
7. Тишков А.В., Хромов-Борисов Н.Н., Ко-машня А.В., Марченкова Ф.Ю., Семенова Е.М., Эюбова Н.И., Делакова Е.А., Быхова А.В. Статистический анализ таблиц 2*2 в диагностических исследованиях. СПб.: Издательство СПбГМУ, 2013. 20 с.
8. Борисов Д.Н., Иванов В.В. Организационная медицина // Врач и информационные технологии. 2017. №3. С. 112-120.
9. Владзимирский А.В. Эффективность телемедицинских консультаций «пациент-врач»: status praesens // Журнал телемедицины и электронного здравоохранения. Выпуск №3. 2018. URL: http://jtelemed.ru/article/effektivnost-telemedicinskih-konsultacij-pacient-vrach-status-praesens (дата обращения: 25.07.2019).
10. Бразовский К.С., Демкин В.П., Пеккер Я.С., Рязанцева Н.В. Технологии телемедицины -инструмент оптимизации ресурсов в здравоохранении // Вестник науки Сибири. 2012. № 2 (3). С. 117122.
ALTERNATIVE CHANGES OF LIPIDES OF BLOOD AND SALIVA IN PATIENTS WITH GENERALIZED PERIODONTITIS WITH OBESITY BACKGROUND
Maiborodina D.
Assistant of the Department of Dentistry Bohomolets National Medical University, Kiev, Ukraine
ABSTRACT
The article analyzes changes in the composition of fatty acids (linoleic, arachidonic, palmitic) in patients with generalized periodontitis with obesity background. The conducted researches allow to conclude that in the serum and saliva of patients with generalized periodontitis on the background of excess body weight and obesity there are significant disorders of lipid metabolism.
Such an imbalance, by altering the physicochemical properties of cell membranes, may initiate the production of proinflammatory cytokines and promote the progression of periodontal disease in such patients.
Keywords: fatty acids, saliva, serum, periodontitis, obesity, body mass index.
Topicality. In recent years, according to WHO, over 1.9 billion people over the age of 18 are overweight, of whom over 650 million suffer from obesity, with an upward trend in these indicators. At present, 3536% of men, 41% of women and 15-16% of children
have obesity or overweight in Ukraine, while the tendency to increase of these indicators remains [1]. Obesity leads to a number of medical and social problems, in particular, metabolic disorders (type 2 diabetes, insulin resistance, metabolic syndrome), cardiovascular
pathology (arterial hypertension, heart failure, stroke), respiratory system pathology, and respiratory system pathology functions. In addition, obesity is an independent predictor of risk of death.
Studies in recent decades have noted that in young obese patients with generalized periodontitis, there are abnormalities in protein, fat and carbohydrate metabolism, which contributes to the early destruction of the periodontal tissue complex and rapid tooth loss [2, 3, 4, 5, 6]. At a young age, obese people experience chronic stress, which leads to depletion of the body's antioxi-dant systems and the development of oxidative stress [7]. In turn, this pathological condition maintains a state of chronic inflammation in the macro organism, which negatively affects the periodontium and the severity of major dental diseases [8].
Under the influence of hypoxia, processes of free radical oxidation and immunological changes in the body, fatty acid imbalance occurs at the level of membrane structures, which can be pathogenetic in development pathological conditions [2]. As a structural component of membranes, fatty acids have an effect on the electrophysiological properties of biomembranes, the function of membrane proteins and the activity of cellular receptors. Persistent lipid imbalance arising from prolonged pathogenicity can impair cell specific functions and cause chronic disease [3].
Since polyunsaturated fatty acids (PUFAs) are a link that links lipid peroxidation processes, synthesis of proinflammatory cytokines and cell membrane status, determination of fatty acid composition of blood lipids and saliva makes it possible to study the pathogenesis of disease on the membrane-cell level of the disease, and evaluate the effectiveness of treatment.
Aim of the study: to investigate changes in the fatty acid composition of serum and saliva lipids in patients with generalized periodontitis on the background of obesity.
Materials and methods: 94 people aged 19 to 35 participated in the study. Among them: 32 patients with generalized periodontitis on the background of excess body weight (19 men and 13 women) - 1 group, 40 patients with generalized periodontitis and obesity (21 men and 19 women) - 2 group, and the control group -22 practically healthy individuals of the same age category. In the diagnosis of periodontal lesions used standard algorithm of clinical and radiological examination and classification Danilevsky (1994). The studies were conducted with informed consent in accordance with the requirements of the Bioethical Examination Commission. All patients were familiarized with the aims and objectives of the study and voluntarily signed informed consent.
The criteria for inclusion in the study were: age (19-35 years), patients with excess body mass (body mass index > 25 kg/m2) and obesity (body mass index > 30 kg/m2).
Exclusion criteria were acute inflammatory disease and exacerbation of chronic inflammatory disease at the time studies, severe somatic diseases that interfere with the examination (acute myocardial infarction, acute cerebral circulation, malignancies, etc.), and the formal absence of diagnosed affective disorders.
Lipid disorders in patients of the study groups included studies of fatty acid composition of serum and saliva lipids by gas-liquid chromatography and determination of palmitic, linoleic and arachidonic fatty acids in serum and saliva lipids compared with controls.
Statistical analysis of the study results was performed using Microsoft Excel using Student's t-test.
Results and Discussion.
These studies of the content of fatty acids in serum lipids are shown in table 1.
Table 1
Fatty acid content in serum lipids in patients with generalized periodontitis with concomitant excess body weight (group 1), in patients with generalized periodontitis with obesity (group 2) and in the control group
Name of fatty acids
Content of fatty acids (%, M ± m) in the serum
I group (n=32)
II group (n=40)
Control group (n=22)
C 16:0 (palmitic)
31,5+1,5
2,8+0,5
40,0+1,0
C 18:2 (linoleic)
36,0+1,5
64,8+1,5
16,0+1,0
C 20:4 (arachidonic)
29,0+1,5
33,0+1,5
31,0+1,0
According to the data in table 1, the content of serum fatty acids of patients with generalized periodonti-tis with excess body weight and obesity is significantly different from the control parameters. Thus, in group I there was a decrease of palmitic acid content by 20% compared to the control indicators, and in group II a decrease in palmitic acid content was reduced in comparison with the control group by 93%, which indicates a deeper disruption of lipid metabolism in patients with generalized periodontitis on obesity. Such changes in palmitic acid content indicate impaired serum phospho-lipid fraction of blood lipids in patients with generalized periodontitis with overweight and obesity, which may be an additional sign of the presence of metabolic syndrome in such patients.
The content of linoleic acid in the serum of patients in group I was reduced compared to the control group by 20%. And the content of linoleic acid in the serum of patients in group II was reduced compared to the control group by 39%. The results obtained indicate a violation of lipid metabolism in such patients.
Arachidonic acid content was not significantly different from controls for both groups.
The results obtained may indicate impaired metabolism of PUFAs in the liver with excess body weight and obesity.
Indicators of the content of linoleic, palmitic and arachidonic fatty acids in saliva of the studied patients are presented in table 2.
Table 2
Fatty acid content of saliva lipids in patients with generalized periodontitis with concomitant excess body weight
(group 1), in patients with generalized periodontitis on the background of obesity (group 2) and in the control __group_
Content of fatty acids (%, M ± m) in the saliva
Name of fatty acids I group II group Control group
(n=32) (n=40) (n=22)
С 16:0 (palmitic) 39,2+1,0 9,8+0,7 34,0+1,4
С 18:2 (linoleic) 14,4+1,1 49,0+1,5 17,9+1,0
С 20:4 ^chidon^) 11,2+0,6 1,8+0,3 3,8+0,5
As follows from table 2, the content of fatty acids of saliva of patients with excess body weight and obesity is significantly different from the control parameters. Thus, for group I, palmitic acid content increased significantly by 15% compared to the control group. For group 2, the content of the same acid was reduced by 70% compared to the control group. This indicates a violation of the phospholipid fraction of saliva and may contribute to the development of periodontitis in patients.
Changes in palmitic acid content in saliva lipids were detected by us in both study groups. Palmitic acid content was reduced by 20% for group I and 72% for group II subjects compared to the control group. Such significant changes in palmitic acid content in salivary lipids are a clear sign of disorders of lipid metabolism and may contribute to the progression of periodontal diseases for overweight and obese patients.
The content of arachidonic acid in salivary lipids for both groups of subjects was significantly different from the control group. For group I, an increase of ara-chidonic acid content was found 2-fold, and for group II - 3-fold. Such a change in its saliva characterizes (with increasing) inflammatory process and may contribute to the development of periodontitis for the I and II group of patients. However, changes in the content of this fatty acid in patients with obesity were more pronounced, indicating a correlative relationship of disorders of lipid metabolism with the severity of changes in body mass index.
Disruption of arachidonic acid content in saliva lipids can have a significant effect on salivary lipid metabolism and may be related to the degree of periodontitis.
Conclusions: the conducted studies allow to conclude that in the serum and saliva of patients with generalized periodontitis on the background of excess body weight and obesity there are significant disorders of lipid metabolism. These disorders are more pronounced in patients with generalized periodontitis on the background of obesity. Such an imbalance, by altering the physicochemical properties of cell membranes, may initiate the production of proinflammatory cytokines and contribute to the progression of periodontal disease in such patients.
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