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6CURRENT TRENDS IN THE TREATMENT OF CHRONIC DISTURBANCE OF CEREBRAL CIRCULATION IN PATIENTS WITH TYPE 2 DIABETES MELLITUS
Begimbekova L.M.
PhD, docent, head of department of obstetrics, gynecology and pediatrics Shymkent Medical Institute, Kh. A. Yassavi International Kazakh Turkish University, Kazakhstan Bekenov N.N. PhD, teacher of department of obstetrics, gynecology and pediatrics Shymkent Medical Institute, Kh. A. Yassavi International Kazakh Turkish University, Kazakhstan Utepova R.Y.
teacher of department of obstetrics, gynaecology and pediatrics Shymkent Medical
Institute, Kh. A. Yassavi International Kazakh Turkish University, Kazakhstan Muhankyzy G.M.
teacher of department of obstetrics, gynaecology and pediatrics Shymkent Medical
Institute, Kh. A. Yassavi International Kazakh Turkish University, Kazakhstan
ABSTRACT
Peculiar diabetic complications are a major cause of early disability and mortality of patients with diabetes mellitus. One of these complications is slowly progressive cerebrovascular insufficiency leading to the development of many piecemeal necroses of the brain tissue, and brain dysfunctions. As a result, patients with type 2 diabetes often tend to have both central and peripheral nervous system damage. According to the data from WHO, the most frequent manifestations of cardiovascular disease in diabetes are acute and chronic disturbances of cerebral circulation. Many investigations have found that the incidence of stroke, particularly ischemic stroke, in patients with diabetes mellitus is 2-3 times higher compared to this figure in the general population. Key words: diabetes, nervous system, blood circulation, syndrome, pathology
Introduction. Peculiar diabetic complications are a major cause of early disability and mortality of patients with diabetes mellitus. One of these complications is slowly progressive cerebrovascular insufficiency leading to the development of many piecemeal necrosis of the brain tissue, and brain dysfunctions. As a result, patients with type 2 diabetes often tend to have both central and peripheral nervous system damage. According to the data from WHO, the most frequent manifestations of cardiovascular disease in diabetes are acute and chronic disturbances of cerebral circulation. Many investigations have found that the incidence of stroke, particularly ischemic stroke, in patients with diabetes mellitus is 2-3 times higher compared to this figure in the general population [1, 2].
Frequent chronic disturbances of cerebral circulation in patients with diabetes mellitus cause the formation of a chronic cerebrovascular insufficiency syndrome. The disturbances of blood circulation in the brain vessels promote the development of diabetic central neuropathy and encephalopathy with impaired functioning of the central nervous system (CNS) in patients with diabetes mellitus. Due to this fact, there is an angiopathic form of diabetic encephalopathy, reacting to the damage of brain vessels. The involvement of any arteries occur at type 2 diabetes mellitus.
The involvement of a vascular bed is initiated at the stage of insulin resistance in the absence of carbohydrate metabolism disorder, which is clinically evident by early vascular
complications of type 2 diabetes mellitus. The involvement of main arteriae encephali, primarily internal carotid arteries, are especially definitive. Afterwards, the formation of hemo dynamically relevant stenosis of the arteries with an increased risk of mural thrombosis and threateningly complete vascular occlusion may occur. The risk of cerebral infarction is increased at incomplete functioning of anastomoses, particularly the inferiority vascular circle of Willis. Extensive damage of the arterial system of the brain is accompanied by a decrease in vascular reactivity, which also adversely affects the state of the cerebral circulation. Systemic fluctuations in blood pressure (BP) in these conditions can be a determinant factor of occurrence of both acute and chronic cerebral ischemia [3, 4, 5].
The involvement of arterioles with the development of microangiopathy occur in patients with type 2 diabetes mellitus. The risk of cerebral circulation disorders increases in these patients in the presence of microvascular complications, especially at relatively long duration of the disease. The risk of "silent" strokes - small infarctions located in the deep parts of the white matter of the cerebral hemispheres increases due to the involvement of arterioles in patients with type 2 diabetes mellitus. Microcirculation disturbances play a particularly important role in the pathogenesis of cerebrovascular accident in patients with type 2 diabetes mellitus. The mechanisms of their formation are diverse, including dysfunction of thrombocytes, endothelial dysfunction, and procoagulant
promotion of the blood system [6, 7].
The involvement of cerebral vessels in patients with type 2 diabetes mellitus are evident as disorders of cerebrovascular regulation, decreasing adequate response of cerebral blood flow to appropriate stimuli. This can significantly limit the compensatory-adaptive possibilities of cerebral circulation and make a difference in the development of the syndrome of chronic disturbance of cerebral circulation.
In view of the above, it is urgent to use effective methods of treatment for chronic disturbance of cerebral circulation in patients with type 2 diabetes [8, 9].
The aim of the research is to study the effectiveness of the medication Sermion (nicergoline) produced by Pfizer HC Corporation Pi Company in the treatment for chronic disturbance of cerebral circulation in patients with type 2 diabetes mellitus followed by hypertension.
This drug preparation is a derivative of lysergic acid. Sirmione activity is due to its inhibitory effect on a-adrenergic receptors of the vessels, so that the drug has a pronounced vasodilating effect. Sermion improves metabolism in the brain at ischemia and hypoxia, which leads to an increase in imbibition and utilization of glucose by the brain tissue and oxygen utilization by the cells, the content of adenosine
Division of Pat:
triphosphate and adenylate cyclase activity, as well as activation of protein synthesis and of the nucleic acids. An additional positive effect of the drug preparation is a vasodilator effect on the blood vessels of the lower limbs, as this lesion often occurs develops at diabetes.
Material and methods. The study was conducted on the basis of the clinical department at A. Kh. Yassavi IKTU, city polyclinic №6 in Shymkent. We prescribed Sermion to 50 patients with insulin dependent diabetes mellitus. The patients were between the ages 35-55 with the disease duration from 5 to 15 years. The patients of the main group were divided into two subgroups: the first subgroup between the ages 3545; the second subgroup between the ages 45-55, (see Tab.1). The study included the patients with clinical signs of chronic disturbance of cerebral circulation, which was confirmed by the presence of the signs of morphological changes of medullary substance according to neuroimaging (MRI, ultrasonography, rheoencephalography, EEG, ophthalmoscopic examination of ocular fundus, cholesterol, blood glucose). All patients with symptoms of chronic ischemic attacks had conducted on them neuropsychological tests according to the Mini-Mental State Examination (MMSE), (see Tab.2).
Tab.1
nts into Subgroups
The age of patients between the ages 35 - 45 between the ages 45 - 55
The first subgroup 23 patients -
The second subgroup - 27 patients
The medication was taken in a dose of 30 mg per os 2 times in a dose of 10 mg 2 times a day during 60 days. a day during 30 days. Further, there was a maintenance therapy
Tab.2
Neurological Symptoms in the Patients from the both Subgroups with the Signs of Chronic Disturbance of Cerebral Circulation before the Therapy with Sermion (P±m%)
№ Neurological symptoms first subgroup second subgroup P
1 Headaches 12(52%±14.52) 16(59%±15.37) <0.05
2 Dizziness 10(43%±13.81) 14(52%±14.46) <0.05
3 Sensory disorders 7(30%±12.76) 10(37%±14.21) <0.05
4 Oculomotor disturbances 4(17%±10.43) 8(30%±12.39) <0.05
5 Balance disorder 5(22%±11.72) 9(33%±12.84) <0.05
6 Somnipathy 14(60%±13.24) 15(55%±14.56) <0.05
7 Hearing disorders 2(9%±7.65) 3(11%±8.23) <0.05
8 Cognitive deteriorations 11(48%±12.44) 14(52%±13.38) <0.05
Nota: P - accuracy index of a distinction between groups
Good clinical tolerance of the patients to drug preparation experienced a significant improvement in well-being, sleep, Sermion at high doses was evident in acute stress and after hearing and others, followed by a decrease in headaches and treatment. After a course of treatment, most of the patients dizziness (see Tab.3).
Tab.3
Neurological Symptoms in the Patients from the both Subgroups with the Signs of Chronic Disturbance of Cerebral Circulation after the Therapy with Sermion (P±m%)
№ Neurological symptoms first subgroup second subgroup P
1 Headaches 7(30%±10.63) 14(52%±12.84) <0.05
2 Dizziness 6(26%±11.27) 11(40%±12.97) <0.05
3 Sensory disorders 4(17%±9.61) 8(30%±10.37) <0.05
4 Oculomotor disturbances 3(13%±9.52) 7(26%±11.21) <0.05
5 Balance disorder 3(13%±10.45) 6(22%±9.54) <0.05
6 Somnipathy 9(39%±12.13) 12(44%±11.89) <0.05
7 Hearing disorders 1(4%±6.48) 2(7%±7.65) <0.05
8 Cognitive deteriorations 8(35%±11.51) 10(37%±11.14) <0.05
Nota: P - accuracy index of a distinction between groups
Results. According to the indicators of Tab. 3, we noticed that a significant regression of neurological symptoms compared with those of Tab. 2 was in patients with symptoms of chronic ischemic attacks. Furthermore, it was revealed that in the first subgroup a decrease in clinical neurological symptoms was much lower than in the second subgroup treated with Sermion. Cognitive impairments in the patients from the first subgroup were lower in comparison with those of the second subgroup. The coefficient of reliability of P was determined according to the table of Student. Differences were considered accurate at P <0.05.
Conclusion. Thus, we have found that the drug preparation Sermion effectively improves the clinical condition of the patients in terms of a decrease in headaches and dizziness, improvement in memory and attention, as well as a reduction in depression and anxiety.
It is advisable to use drug preparation Sermion during the period 3-6 months to maintain reduction in and treatment of the syndrome of cognitive mnemonic and cerebral functions in the polyclinic conditions.
References:
1. Starkova N.T. Clinical Endocrinology // St. Petersburg, 2002, str.213-280.
2. Dedov I.I., Melnychenko G.A., Fadeiev V.V.
Endocrynonology. Manual.- 2nd publ. - M.: Media, 2009. -430pp.
3. Kozlov S.G., Liakishev A.A. Treatment of ishemic heart disease in patients with type 2 diabetes // BC. - 2003. - V. 11. - № 9. - S. 53-56.
4. Medical Management of Hyperglycemia in Type 2 Diabetes: A consensus Algorithm for the Initiation and Adjustment of therapy. Diabetes Care. 2009; 32 (1): 1-9.
5. Stegmayr B., Asplund K. (1995) Diabetes as a risk factor for stroke. A population perspective. Diabetologia, 38: 1061-1068.
6. The Action to Control Cardiovascular Risk in Diabetes Studt Group: Effect of intensive glucose lovering in type 2 diabetes. N. Engl. J. Med. 2008; 358: 2545-2559.
7. Prikhozhan V.M. Classification of diabetic neuropathy. Problems of Endocrinology, 1987, №3 - pp. 79-85.
8. Dedov I.I., Shestakova M.V., Maximova M.A. the Federal having a special purpose program "The Diabetes mellitus": methodical recommendations. M.: 2002.
9. Charles M., Clark J. Oral therapy in type 2 diabetes: Pharmacological properties and clinical use of currently available agents. Diabetes spectrum. 1998; 4 (11): 211-221.
