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7. Urlea-Sch MI. Effectiveness and tolerability of Euphorbium comp SN for the symptomatic treatment of rhinitis in children aged 2-6 years. Eur JIntMed., 2018. 1: 236.
EFFICACY OF MOXONIDINE IN THERAPY OF ARTERIAL HYPERTENSION IN TYPE 2 DIABETES MELLITUS Yusupova Sh.K.1, Nishonova M.S.2, Shоkirova G.K.3, Urinboeva I.R.4 Email: Yusupova17164@scientifictext.ru
1Yusupova Shakhnoza Kodirzhonovna - Candidate of Medical Sciences, Docent, Head of the
Department; 2Nishonova Malika Sanzharovna - Assistant; 3Shokirova Gulnoza Kodirzhonovna - Assistant; 4Urinboeva Iroda Ravshanbek kizi - Assistant, DEPARTMENT OF HOSPITAL THERAPY AND ENDOCRINOLOGY, ANDIJAN STATE MEDICAL INSTITUTE, ANDIJAN, REPUBLIC OF UZBEKISTAN
Abstract: in patients with type 2 diabetes mellitus and arterial hypertension, the use of moxonidine and enalapril showed a more pronounced hypotensive effect compared to monotherapy with enalapril, which was associated with a decrease in sympathetic-adrenal activity in this category ofpatients; metabolic blood parameters also improved. Large clinical trials have shown that tight blood pressure control reduces the incidence of cardiovascular disease and mortality in people with type 2 diabetes. Keywords: moxonidine, enalaprile, arterial hypertension, type 2 diabetes.
МОКСОНИДИН В ТЕРАПИИ АРТЕРИАЛЬНОЙ ГИПЕРТОНИИ
ПРИ САХАРНОМ ДИАБЕТЕ 2 ТИПА Юсупова Ш.К.1, Нишонова М.С.2, Шокирова Г.К.3, Уринбоева И.Р.4
1Юсупова Шахноза Кодиржоновна - кандидат медицинских наук, доцент, заведующий
кафедрой;
2Нишонова Малика Санжаровна - ассистент; 3Шокирова Гулноза Кодиржоновна - ассистент; 4Уринбоева Ирода Равшанбек кизи - ассистент, кафедра госпитальной терапии и эндокринологии, Андижанский государственный медицинский институт, г. Андижан, Республика Узбекистан
Аннотация: у больных сахарным диабетом 2 типа и артериальной гипертонией применение моксонидина и эналаприла показало более выраженный гипотензивный эффект по сравнению с монотерапией эналаприлом, которое было связано со снижением симпатико-адреналовой активности у данной категории больных, также улучшились метаболические показатели крови.
В крупных клинических исследованиях было показано, что жесткий контроль артериального давления снижает частоту сердечно-сосудистых заболеваний и смертность лиц с сахарным диабетом 2 типа.
Ключевые слова: моксонидин, эналаприл, артериальная гипертония, сахарный диабет 2 типа.
UDC 616.12-008.331.1+616.37
Every year, the number of patients with type 2 diabetes mellitus (DM) is increasing all over the world. A large number of studies have demonstrated that type 2 diabetes mellitus (DM) is often combined with cardiovascular diseases, including arterial hypertension (AH). The development of diabetes and hypertension are interrelated diseases. Thus, in a study by T.W. Gress et al (2000) showed that over 6 years of follow-up, the incidence of type 2 diabetes in patients with hypertension was more than 2 times higher than in normotensive patients. On the other hand, an increase in the level of glycemia is also associated with an increase in the risk of developing hypertension [1, 2, 3, 5].
Large clinical trials have shown that tight blood pressure control reduces the incidence of cardiovascular disease and mortality in people with type 2 diabetes mellitus. Metabolic disorders of all types observed in diabetes, as well as dysregulation of the endocrine system, primarily significant changes in the level of counter-insular hormones, including catecholamines, are the reasons for an increase in blood pressure (BP), which not only aggravates the course of diabetes, but also serves as an additional factor contributing to the deterioration of the function of the cardiovascular and other systems [5].
Purpose. The aim of this study is to evaluate the effectiveness of the use of combination therapy of moxonidine with an ACE inhibitor (enalapril) on the functional state of the sympathoadrenal system (SAS), the activity of the key enzyme of oxidative deamination of catecholamines (CA) - monoamine oxidase (MAO) in patients with type 2 diabetes with hypertension.
Material and methods of research: 107 men aged 35 to 65 years (mean age 55.82 ± 1.3 years) were studied with a diagnosis of type 2 diabetes with hypertension, which was established in accordance with the WHO criteria (1999) and VNOK. The control group consisted of 20 apparently healthy men aged 30-55 years. Patients with type 2 diabetes with AH by the method of random sampling after the survey were divided into 2 subgroups, which were comparable in terms of age, duration of arterial hypertension and diabetes mellitus, office systolic and diastolic blood pressure.
Patients of subgroup - A - 67 people received traditional treatment, consisting of a diet (table No. 9), antihypertensive therapy, antihypertensive therapy (enalapril at a dose of 10 mg per day); Subgroup - B - 40 patients who also received traditional treatment, consisting of a diet (table No. 9), antihypertensive therapy, in addition to antihypertensive therapy (enalapril at a dose of 10 mg per day) received moxonidine (physiotens) in doses of 0.2-0, 6 mg.
To judge the functional state of the SAS, the daily urinary excretion of adrenaline (A), norepinephrine (HA), dopamine (DA) and DOPA was determined by the fluorometric method modified by E.Sh. Matlina. In the blood serum, the MAO activity was determined by the colorimetric method of A.V. Balakleevsky. Determination of lipid peroxidation (LPO) products by the level of malondialdehyde (MDA) in blood serum was carried out according to the method of V.B. Gavrilova, A.R. Gavrilova and A.M. Mazhul, determined by reaction with 2-thiobarbituric acid.
The arithmetic mean values for the compared groups and their mean errors (M ± m) were calculated by the method of variation statistics, the reliability of the difference between the compared values was determined using the Student's t-test.
Research results. After the treatment, after 12 weeks in patients of subgroup A, there was a positive dynamics of blood pressure levels, so the levels of SBP and DBP decreased by 15.0% and 9.7%, respectively, and in subgroup B these indicators decreased by 16.8% and 11,% respectively.
From the data in Table 2, it follows that both drugs are comparable in terms of the hypotensive effect on office SBP and DBP, while Physiotens reduced the magnitude and rate of the morning rise in blood pressure, which makes it a promising drug for the prevention of cerebral and cardiac complications of hypertension.
When analyzing the activity of the sympathoadrenal system after treatment (Table 3) in subgroup A, we observed a statistically significant decrease in the daily excretion of CA and DOPA, in relation to the initial values. Thus, the excretion of total A decreased by 12.8% (1.13 times) (P <0.05), HA - by 13.6% (1.14 times) (P <0.02), YES - by 6.4% (1.1 times) (P <0.001), DOPA - by 25.0% (1.25 times) (P <0.001). Also, the indicators of the coefficient ratios of CA, their precursors and metabolites were normalized. In subgroup B, after treatment with moxonidine, we observed a more pronounced statistically significant decrease in the daily excretion of CA and DOPA, and the values of these parameters approached those of the control group. Thus, the excretion of total A decreased by 20.4% (1.2 times), AN by 25.6% (1.3 times), YES - by 8.9% (1.1 times), DOPA - by 45.4% (1.25 times) (P <0.01-0.001). Also, the indicators of the coefficient ratios of CA, their precursors and metabolites were normalized. Assessment of monoamine oxidase activity of blood in patients with type 2 diabetes with AH revealed a statistically significant decrease in MAO activity (Table 4). After active therapy with antioxidants, we noted a significant increase in enzyme activity by 20.9% (1.3 times) (P <0.001), which is higher than the initial level.
Discussion. Currently, diabetes is considered not only as a syndrome of hyperglycemia, but also as a systemic metabolic disorder, which is often combined with chronic activation of the sympathoadrenal system. Moxonidine, which selectively binds to imidazoline receptors, reduces SAS activity and produces a hypotensive effect due to a decrease in peripheral vascular tone, catecholamine secretion, renin and aldosterone activity [7], which is also confirmed by our data. Our studies have shown that a significant change in the LPO system immediately affects the SAS activity, which was expressed by a decrease in the daily excretion of adrenaline, norepinephrine, dopamine and DOPA, an increase in the level and improvement of the catalytic activity of MAO. In the HOT study, it was shown that target blood pressure levels are very rarely achieved with the use of a single antihypertensive drug [8].
Output. The results of this study indicate that when moxonidine is added to the first-line antihypertensive drug, along with an increase in the hypotensive effect, it also has a beneficial effect on the normalization of metabolic processes, which reduces the risk of cardiovascular complications in type 2 diabetes with hypertension. Thus, the combined antihypertensive therapy of enalapril with moxonidine in patients with type 2 diabetes with hypertension effectively reduces both systolic and diastolic blood pressure, suppressing the activity of the sympathoadrenal system, and also favorably affects the parameters of carbohydrate metabolism.
References / Список литературы
1. Babenko A. Yu. The role of hypoglycemic drugs in blood pressure control in patients with type 2 diabetes. Arterial hypertension. 21 (4), 2015. 334-348.
2. Izzo R., de Simone G., Trimarco V. еt al. Hypertensive target organ damage predicts incident diabetes mellitus. Eur Heart J. epub 27. June, 2013.
3. Gress T.W., Nieto F.J., Shahar E., Wofford M.R., Brancati F.L. / Hypertension and antihypertensive therapy as risk factors for type 2 diabetes mellitus. N Engl. J Med., 2000; 342 (13): 905-912.doi: 10.1056 / NEJM200008243430813.
4. Solomaa V.V., Strandberg T.E., Vanhanem H., Naukkarinen V., Sarna S., Mietlinen T.A. Glucose tolerance and blood pressure: long term follow up in middle aged men BMJ, 1991; 302 (6775): 493-496.
5. PrichardB., Owens C, Gracham B. Pharmacology and clinical use of moxonidinc, a new centrally acting sympatholytic antihypenensive agent. J. Hum. Hypenens., 1997. 11 (Suppl. 1). S. 20-45.
6. Tolkacheva V.V., Villevalde S.V., Kobalava Zh.D. The state of carbohydrate metabolism and the transformation of prediabetes into type 2 diabetes mellitus depending on the diagnostic method in patients with high cardiovascular risk arterial hypertension without a history of diabetes mellitus. Arterial hypertension. Volume 18. № 2, 2012. Р. 83.
MODERN FEATURES OF PCOS TREATMENT IN WOMEN WITH
CHRONIC IOD DEFICIENCY
1 2 Ahmedova N.M. , Abdullazhonova S.A.
Email: Ahmedova17164@scientifictext.ru
1Ahmedova Nilufar Mahmudovna - Candidate of Medical Sciences, Associate Professor; 2Abdullazhonova Sayyora Azimzhonovna - Master's degree in Obstetrics and Gynecology, DEPARTMENT № 1 OF OBSTETRICS AND GYNECOLOGY, ANDIJAN STATE MEDICAL INSTITUTE, ANDIJAN, REPUBLIC OF UZBEKISTAN
Abstract: polycystic ovary syndrome is a clinical syndrome characterized by moderate obesity, irregular periods or amenorrhea, and signs of androgen excess (eg, hirsutism, acne). Most patients have multiple ovarian cysts.
The developing hypercholesterolemia in hypothyroidism and polycystic ovary syndrome leads to the progression of atherosclerotic changes in the vessels and the occurrence of cardiovascular diseases.Diagnosis is based on pregnancy test results, hormone measurements, and imaging to rule out a virilizing tumor. Treatment is symptomatic. Keywords: polycystic ovary syndrome, infertility, ovaries, iodine deficiency, ovulation.
СОВРЕМЕННЫЕ ОСОБЕННОСТИ ЛЕЧЕНИЯ СПКЯ У ЖЕНЩИН С ХРОНИЧЕСКОМ ДЕФИЦИТОМ ЙОДА Ахмедова Н.М.1,Абдуллажонова С.А.2
1Ахмедова Нилуфар Махмудовна - кандидат медицинских наук, доцент; 2Абдуллажонова Сайёра Азимжоновна - магистр акушерства и гинекологии, кафедра № 1 акушерства и гинекологии, Андижанский государственный медицинский институт, г. Андижан, Республика Узбекистан
Аннотация: синдром поликистозных яичников - клинический синдром, характеризующийся умеренным ожирением, нерегулярными менструациями или аменореей и признаками избытка андрогенов (например, гирсутизм, угри). Большинство пациентов имеют множественные кисты яичников. Развивающаяся гиперхолестеринемия при гипотиреозе и синдроме поликистозных яичников приводит к прогрессированию атеросклеротических изменений в сосудах и возникновению сердечно-сосудистых заболеваний. Диагноз ставится на основании результатов теста на беременность, измерения уровней гормонов и визуальных методов исследования для исключения вирилизирующей опухоли. Лечение является симптоматическим.
Ключевые слова: синдром поликистозных яичников, бесплодие, яичники, йододефицит, овуляция.
УДК 618.11-006.31-07-08
Relevance. Determination of the frequency of PCOS depends on the diagnostic criteria used and the characteristics of the population sample [2, 6]. Among patients with
