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Nasyrova Zarina Akbarovna, Doctoral student of the Department of Internal Medicine № 2
Samarkand State Medical Institute E-mail: [email protected]
PERSONALIZED APPROACH TO THERAPY OF PATIENTS WITH UNSTABLE ANGINE CARDIACITY WITH ANXIETY-DEPRESSIVE DISORDER
Abstract. on the basis of the Samarkand branch of the Republican Scientific Center for Emergency Medicine from 2018 to 2019, 123 patients with a diagnosis of unstable angina were examined. The average age of patients with NS was 62.2 ± 14.08 years. To solve general clinical problems, patients were conditionally divided into 2 groups: group 1 patients in comorbidity with anxiety-depressive syndrome and group 2 patients without anxiety-depressive syndrome. There were more patients with anxiety-depressive syndrome than patients with NS without comorbid pathology, which amounted to 60.88% of patients. Studies have shown that anxiety-depressive syndrome in patients with unstable angina is an important prognostic factor for the progression of NS, which affects the prognosis and outcome of the disease. The inclusion of paroxetine in the standard therapy regimen reduces the level of pro-inflammatory cytokines, regulates the cytokine imbalance, increases the effectiveness of therapy, and reduces the rate of poor prognosis and outcome in patients with anxiety-depressive syndrome.
Keywords: coronary heart disease, unstable angina pectoris, pro-inflammatory cytokines, antiinflammatory cytokines, anxiety-depressive syndrome.
Introduction. To date, the attention of the sci- Research Kozolova S. N. and her co-authors
entific community has been drawn to the study of (2010) shows that when comparing markers of cy-
the relationship between cardiovascular diseases, tokine inflammation in patients with coronary artery
namely coronary heart disease (CHD), and patho- disease depending on the presence or absence of affec-
logical mood disorders such as anxiety and depres- tive disturbances in the anxiety-depressive spectrum,
sive disorders. according to experts of the World results were obtained that increased the level of pro-
Health Organization (WHO), by 2020, depression inflammatory cytokines IL-6 and TNFa in individu-
will occupy the second place, after IHD, among the als with comorbid pathology. Thanks to the data from
causes of disability in the world [2; 3; 5]. this study, we can explain the reason for the possible
Data from various studies show the prevalence of high mortality of patients with coronary artery disease
depression in the population ofolder age groups, which with the presence of affective disorders [2; 4].
ranges from 9 to 30% [1; 4; 8]. In particular, among pa- Thus, literary sources state the relevance of this
tients with coronary heart disease (CHD), depression work and the need for further study of the problem
is more common than in the population, making up, of anxiety-depressive syndrome in patients with cor-
according to various sources, 18-65% [8; 9]. Various onary artery disease. In addition, it is necessary to
studies highlight several important risk factors for the conduct early screening of patients with coronary ar-
development ofaffective disorders in somatic diseases. tery disease for the presence of depression for timely
treatment. A timely approach to the treatment of patients with NS will make it possible to predict the progression of the disease, which will improve the results of treatment of coronary heart disease and increase the quality of life of patients in this category.
Objective: To study the etiopathogenetic significance of the influence of anxiety-depressive syndrome on the progression of unstable angina and develop methods for diagnosing and predicting the development of cardiovascular complications.
Materials and research methods: 123 patients with a diagnosis of unstable angina were examined on the basis of the Samarkand branch of the Republican Scientific Center for Emergency Medicine from 2018 to 2019. The average age of patients with NS was 62.2 ± 14.08 years. To solve general clinical problems, patients were conditionally divided into 2 groups: group 1 patients in comorbidity with anxiety-depressive syndrome and group 2 patients without anxiety-depressive syndrome. There were more patients with anxiety-depressive syndrome than patients with NS without comorbid pathology, which amounted to 60.88% of patients.
During the study of patients with NS, it turned out that the male gender prevailed, and amounted to 57% of patients, which is consistent with many published data. When distributed by sex among patients with NS with anxiety-depressive syndrome, it turned out that 39.84% of women than men prevailed. When studying age-related characteristics, patients with NS are more likely to be between the ages of 50 and 59 years, which in general is 30.89% of the total number of patients, while 17.1% of the same age category were patients with NS with anxiety-depressive a syndrome.
When examining patients, the following were used: HADS Hospital Scale (The hospital Anxiety and Depression Scale Zigmond A. S., Snaith R. P., 1983). And also the Spielberger - Hanin scale
(State-Trait Anxiety Inventory-STAI, 1976), developed by Spielberger C. D. and adapted by Khanin
Yu. L. Wexler for the evaluation of cognitive functions (Wechler D., 1945).
Laboratory examination included: determination of lipid profile, cardiospecific enzymes, interleu-kin-1, interleukin-4, interleukin-10, tumor necrosis factor-a serum. Blood samples were taken from the ulnar vein in the morning, from 8.00 to 11.00, on an empty stomach. In the course of the study, a comorbid state was found in 60.88% of patients with NS. Of these groups of patients using the HADS hospital scale, it was found that, in 59.39% of patients, sub-clinically expressed anxiety / depression, in 40.60% of patients, clinically expressed anxiety / depression. In addition, the Spielberger - Khanin scale showed us that 40.60% of patients with NS suffer from situational anxiety, while 33.83% of patients have even personal anxiety.
The results of the study showed that in patients with NS in comorbidity with anxiety-depressive syndrome, LDL and OH were higher by 19.5% and 38.2%, respectively, while HDL and PTI were 12.1% and 7.0% lower level of control, which indicates a violation of lipid metabolism in patients with NS in comorbidity with anxiety-depressive syndrome. in patients with NS in comorbidity with anxiety-depressive syndrome, changes in the level of cardiospecific blood enzymes of MV CPK were associated with the presence of anxiety-depressive disorder. So, in patients with no anxiety-depressive disorder, the activity of CPK and MV CPK exceeded the control by 21.8 and 15.2% (P < 0.05 and P > 0.05), and in patients with anxiety-depressive disorder - by 36.8 and 83.3%. In patients with NS in comorbidity with anxiety - depressive disorder, lower levels of echocardiography are noted. So LVEF amounted to 42.8 ± 1.20%, CDI - 65.5 ± 2.42 ml/m2, CSI - 33.6 ± 2.21 ml/m2. Accordingly, in patients with anxiety-depressive disorder, the incidence of elevation and / or depression of the ST segment is 18.9% higher than the incidence of T wave inversion by 14.7%.
When studying the cytokine status, a contrast difference was revealed between patients with NS in
comorbidity with anxiety-depressive syndrome and patients with NS without comorbid pathology. The level of pro-inflammatory cytokines IL-1^ exceeded
21.6 ± 0.04 pg/ml and TNFa by 30.8 ± 0.12 pg/ml. In contrast, anti-inflammatory IL-4 and IL-10 decreased by 5.7 ± 0.65 pg/ml and 6.6 ± 0.04 pg/ml, respectively.
Patients with NS with anxiety-depressive syndrome by random sampling were divided into 2 groups. Group 1 consisted of 40 (54.05%) patients with unstable angina with anxiety-depressive syndrome who received conventional conventional therapy (CT). The 2nd group included 34 (45.95%) patients who, in addition to traditional therapy, received the drug paroxetine at a dose of 0.04-0.08 g/day. The follow-up was 2 months.
Conventional therapy included intravenous nitrate infusion for 12-24 hours, followed by sustained-release nitrates, antiplatelet agents, anticoagulants, cardioprotectors, beta-blockers, ACE inhibitors or ARA. drugs, as well as statins.
Studies have shown that after 2-month traditional therapy (1st gr.) And treatment with the inclusion of paroxetine (2nd gr.) Unidirectional changes in biochemical parameters in the blood ofpatients with NS were recorded. In this case, the most noticeable changes occurred in patients of the 2nd group. In patients of the 1st group, at the end of treatment, the content of total cholesterol, LDL, VLDL and TG, as well as the cytokine status did not change significantly.
In patients of the 2nd group, the level of total cholesterol, LDL, VLDL and TG decreased by 14.8, 16.3,
11.07 and 12.9% (P < 0.05). The indicators of cytokine status improved significantly in patients of the second group, they reached those values that were in patients with NS before the attack. The indicators of pro-inflammatory cytokines (IL-1^, TNFa) in the
2nd group almost 2 times after the use of paroxetine decreased to the level of control.
It should be emphasized that in patients of the 1st group, all indicators of nitrogen-carbohydrate-cholesterol metabolism after 2 months of therapy practically did not differ from the initial figures. In patients of the 2nd group, practically all indicators significantly differed. At the same time, in the 2nd group, most indicators of nitrogen-carbohydrate and cholesterol metabolism of blood serum, as well as in the membranes of red blood cells, had significant differences from the data of the patients of the 1st group and practically did not differ from the control.
Therefore, there is a definite relationship between prognostic indicators and anxiety-depressive syndrome. In the 2nd group, by the end of the 2-month therapy, a significant decrease in the frequency of anginal attacks was noted, which contributes to a lower intake of nitrates. In patients of the 1st group who received only traditional therapy, angina attacks practically did not decrease.
Conclusions: thus, studies have shown that anxiety-depressive syndrome in patients with unstable angina is an important prognostic factor for the progression of NS, which affects the prognosis and outcome of the disease. The inclusion of paroxetine in the standard therapy regimen reduces the level of pro-inflammatory cytokines, regulates the cytokine imbalance, increases the effectiveness of therapy, and reduces the rate of poor prognosis and outcome in patients with anxiety-depressive syndrome.
This allows us to recommend including them in the standard therapy regimen to correct the psychological state of patients with unstable angina pectoris, as well as to resolve the cytokine imbalance, which will help increase the effectiveness of treatment, improve the prognosis and quality of life of patients.
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