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Материалы конференции /Proceedings of the Conference/
lation of thyroid homeostasis caused by inhibition of thyroid hormones convertion in peripheral organs as a result of decreased deiodinases activity is called «euthyroid sick syndrome» (ESS). Humans and animals require selenium for the function of a number of selenium-dependent enzymes, also known as selenoproteins. Deiodinases also refer to selenoproteins. Selenium deficiency causes inhibition of deiodinases activity as well as increased cytokines expression in patients with metabolic syndrome (MS) and is the trigger factor of ESS development.
The aim of the study. To establish impact of selenium and on thyroid homeostasis parameters in patients with metabolic syndrome.
Material and methods. We have examined 42 patients with MS, 10 healthy individuals formed control group. We determined selenium level in blood plasma by atomic absorption method.
To study thyroid homeostasis characteristics we determined free thyroxine (fT4) and free triiodothyronine (fT3) levels and calculated fT3/fT4 ratio to estimate activity of peripheral convetion of thyroid hormones.
Examined patients were divided into two groups in order to assess the impact of sodium selenite on thyroid hormones metabolism: 20 people received sodium selenite at a dose equivalent to 50 ^g of selenium per day plus basic treatment of MS, 16 people received only basic therapy of MS and made control group.
Results. In previous studies we found increased fT4, decreased fT3 concentratoins and fT3/fT4 ratio in patients with MS compared to the control group.
Selenium level in the blood of patients with MS was by 16.7 % reliably lower than in control group (P < 0.05). Positive correlation between selenium level in blood and fT3 level, fT3/fT4 ratio was revealed. So selenium may have positive influence on thyroid hormones metabolism.
After patients have been divided into main and control group to assess the effectiveness of the treatment by sodium selenite, such changes remained significant in relation to control group without probable inter-group differences.
After sodium selenite administration fT4 level ba-came 32.2 % lower (P < 0.05), while in the control group it was only 5 % lower (P < 0.05), than before treatment. FT3 level became 33.9 % higher in main group after treatment (P < 0.05), whilst in control group it's changes weren't significant. Reliable increase of fT3/fT4 ratio in both groups after treatment has been obtained: by 39.2 % in main group and by 8.4 % in control group (P < 0.05).
Conclusions:
1. There is a direct correlation between selenium content and activity of peripheral conversion of thyroid hormones.
2. The results indicate the improvement of peripheral conversion of thyroid hormones activity after sodium selenite intake in patients with metabolic syndrome by deiodinases activity balancing.
UDC 616.12-008.46:616.379-008.64:615.22 PAVLYUKOVICH N.D., PAVLYUKOVICH O.V. Higher State Educational Establishment of Ukraine «Bukovinian State Medical University», Chernivtsi, Ukraine
IMPACT OF TELMISARTAN ON THE QUALITY OF LIFE ¡N PATIENTS WITH CHRONIC HEART FAILURE AND DIABETES MELLITUS TYPE 2
Diabetes mellitus (DM) — one of the leading medical-social problem of the modern society due to its high incidence, frequent comorbidity with concomitant pathology, increased mortality, high risk of chronic vessel complications. In Ukraine, same as in the world, the number of diabetic patients is continuously increasing mainly due to people with diabetes mellitus type 2, total number of which is around 90 % in the population of the patients with this disease (Pankiv V.I., 2010).
The aim of the study was to determine the impact of chronic heart failure and diabetes mellitus type 2 on the quality of life of elderly and senile patients.
Material and methods. A comprehensive survey of 108 patients with chronic heart failure (HF) of is-chemic origin and DM type 2, who were hospitalized to the cardiological department of the Chernivtsi Regional Hospital for War Veterans, was conducted. The average age of the patients was 76.00 ± 1.84 years. All examined patients according to their comorbidities were randomized into the following subgroups: I — patients with HF without DM type 2 (n = 32), II — patients with HF, complicated by concomitant DM type 2 (n = 76). The control group for comparative studies comprised 24 people without HF and DM type 2, whose age was not significantly different from the average age of the patients of the experimental groups. All patients received basic therapy of the main and concomitant diseases. Moreover, to achieve the objective of the investigation telmisartan was prescribed additionally. Therefore, patients with HF and DM type 2 were randomized into subgroups according to the prescribed treatment: IIA subgroup — patients, who received only basic therapy (26 people); IIB subgroup (30 patients) — those, for whom in the scheme of the standard treatment substitution of ACE inhibitor by angiotensin II receptor blocker telmisartan (MIKARDIS®, Boehringer Ingelheim) was conducted. Telmisartan was prescribed in a daily dose of 40 mg after meals. Duration of hospital treatment was 21—24 days, in addition, it was recommended to continue treatment with telmisartan up to 3 months. Quality of life was determined by the questionnaire J.E. Mez-zich, M. Cohen, N. Ruiperez et al., 1999.
Results. The level of physical welfare was highest in the patients of the control group (6.20 ± 0.56 points) dominating over the corresponding figure in the group of patients with chronic HF up to 1.37 times (4.50 ± 0.48 points, P < 0.05), and up to 2.82 times (2.20 ± 0.11 points, P < 0.05) — in patients with chronic HF and DM
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Международный эндокринологический журнал, ISSN 2224-0721
№ 2(74) • 2016
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Материалы конференции /Proceedings of the Conference/
type 2. Value of the index of psychological and emotional welfare in the patients of the control group was 57 % more than in the patients with HF, its lowest value was determined in the patients of II group — 2.10 ± 0.25 points, which differs significantly from the patients of the control group (P < 0.05) and the patients of the I group (P < 0.05). The lowest level of self-service and independence of activity was detected in the patients with chronic HF and DM type 2 (4.10 ± 0.14 points), being significantly different from the corresponding value in the group of patients with HF of ischemic origin (6.30 ± 1.11 points, P < 0.05), and the control group (9.40 ± 0.62 points, P < 0.05). Work ability index was higher in patients of both experimental groups, than in the patients of the control group. Thus, in the patients with isolated HF as well as in the patients with combined course of chronic HF and DM type 2 the difference between the corresponding values was statistically significant, same as comparing to the patients with control group (2.5 ± 0.6 points and 3.80 ± 0.09 points to 5.40 ± 1.08 points correspondingly, P < 0.05). The level of interpersonal interaction and socio-emotional support was statistically significantly lower in comparison with the control group only in the patients of II experimental group. The lower value of this figure in the patients with chronic HF was statistically improbable comparing with patients of control group. The level of public support in the patients of I experimental group was statistically improbably lower, than in the control group (6.40 ± 1.03 against 8.60 ± 0.65 points, P > 0.05). In the patients with chronic HF and DM type 2 the following figure was 4.60 ± 0.32 points, being statistically significantly different from the patients of the control group (P < 0.05). Figure of the personal implementation was the highest in the patients of control group (7.40 ± 0.64 points). Due to the chronic HF of ischemic origin its decreasing to 5.67 ± 0.52 points was determined, though we found no statistically significant difference comparing to the control group (p > 0.05). The lowest level of personal implementation was detected in the experimental II group of patients with HF and DM type 2 (2.8 ± 0.4 points, P < 0.05 comparing with both control and I group). Index of religious implementation was almost equal in all investigated groups. Comparing with the control group overall perception of quality of life in patients with chronic HF was lower by 23 %, and in patients with HF and DM type 2 — by 42 % respectively (P < 0.05 in both cases).
In the IIA experimental group during treatment we managed to achieve significant increasing of the figure of physical welfare by 59 % comparing with one before treatment (P < 0.001), psychological and emotional welfare — by 130 % (P < 0.001), workability — by 27 % (P < 0.02), overall perception of quality of life — by 13 % respectively (P < 0.02). At the same time, the inclusion of telmisartan to the scheme of the complex treatment resulted in the statistically significant improvement of the overall perception of the quality of life by 1.74 times
(P < 0.001), particularly accompanied by improvement of physical welfare by 2.78 times against corresponding value before treatment (P < 0.001), psychological and emotional welfare — by 3.09 times (P < 0.001) and workability — by 1.56 times (P < 0.001), interpersonal interaction — by 1.33 times respectively (P < 0.02). In addition, in the patients of IIB group we have noted the improvement of the values of socio-emotional support by 67 % (P < 0.001), public support — by 24 % (P < 0.02) and personal realization — by 103 % (P < 0.001).
Conclusions. Inclusion of telmisartan to the scheme of complex treatment of the patients with chronic heart failure and diabetes mellitus type 2 results in the improvement of the patients' quality of life as well as its main components.
UDC 616.379-008.64:616.891.4:616.12 SHUPER V.A., SHUPER S.V.
Higher State Educational Establishment of Ukraine «Bukovinian State Medical University», Chernivtsi, Ukraine
COMPARATIVE ANALYSES OF THE CARDIAC AUTONOMIC NEUROPATHY IN PATIENTS WITH DIABETES MELLITUS TYPE 1 AND 2
Cardiac autonomic neuropathy (CAN) is a very common diabetes-related complication that has a major effect on mortality and morbidity in patients with diabetes mellitus (DM). Based on the CAN Subcommittee of the Toronto Consensus Panel on Diabetic Neuropathy, CAN is defined as the impairment of cardiovascular autonomic control in patients with established DM following the exclusion of other causes. The prevalence of CAN varies between 1—90 % in patients with type 1 DM (DM 1) and 20-73 % in patients with type 2 DM (DM 2). Careful and timely testing of CAN with easy standard bedside tests in patients with DM 1 and 2 is critically important for early diagnoses and prophylaxes of further cardio-vascular complications.
The aim of the study was to establish and compare the clinical and diagnostic characteristic of CAN among the DM 1 and DM 2 patients.
Material and methods. 75 patients with DM (DM 1 — 30 patients, DM 2 — 45 patients) were examined in the endocrinology department while they had been hospitalized for treatment. All patients were investigated routinely — complains, anamnestic data, objective examination, additional examination (blood test, sugar test, GTT, HbA1, urine test, ECG, other standard tests). For defining of CAN following five classical tests were done (cardiac autonomic reflex testing (CART)): Evaluating of the Resting tachycardia; Heart rate response to deep breathing; Valsalva maneuver; Systolic blood pressure response to standing; Diastolic blood pressure response to sustained handgrip with calculation of the score.
№ 2(74) • 2016
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