RU2337660C1 - Method for metabolic disorders correction in postmenopausal women - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: woman is placed in pressure chamber and barometric pressure is decreased; she stays some time in such regimen, then the barometric pressure is returned to normal. The barometric pressure decrease being effected at rate 3-4 m/sec, and normalisation at rate 1-2 m/sec; period of staying in pressure chamber is 2.5 hour, the first séance altitude is 1000 m above sea level.

EFFECT: safe, effective, more fast and apparent metabolic disorders correction in postmenopausal women.

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Description

The invention relates to medicine and may find application as an effective non-drug method for the correction of metabolic disorders in women with menopausal syndrome.

A modern woman spends about a third of her life in a postmenopausal state and it is for this age category that there is a fairly high prevalence of type 2 diabetes and obesity. An increase in body weight in menopause leads to the formation of menopausal metabolic syndrome (MMS), the main manifestations of which are abdominal obesity, dyslipidemia and impaired carbohydrate metabolism, arterial hypertension (Smetnik V.P., Shestakova I.G., 2005; Prilepskaya V.N. , 2005; Antsifirov M.B., 2000). One of the links in the pathogenesis of obesity in menopausal metabolic syndrome is a slowdown in metabolism due to a deficiency of sex hormones (Poehlman E.T., Tchemof A, 1998). Insulin resistance developing in postmenopausal women is a persistent and independent factor that increases the risk of developing atherosclerosis and coronary heart disease, thereby making a certain contribution to the overall mortality rate (Bugrova S.A., 2000).

When treating women with MMS, one of the main principles is the use of non-drug correction methods: rational nutrition with limited fat and carbohydrate intake, increased physical activity, reduced alcohol consumption, and smoking cessation. Drug pathogenetic therapy is aimed at reducing the mass of abdominal-visceral adipose tissue, increasing the sensitivity of peripheral tissues to insulin, normalizing indicators of carbohydrate and lipid metabolism and blood pressure (Ametov A.S., Kochergina I.I., Demidova T.Yu., 2000; Bugrova S.A., 2001; Grigoryan O.R., 2005). Currently, drugs that have a therapeutic effect on insulin resistance are used in the treatment of metabolic syndrome. These include biguanides, the mechanism of action of which is associated with increased glucose uptake by skeletal muscle due to a decrease in peripheral insulin resistance, suppression of hepatic gluconeogenesis and appetite, and a decrease in the amount of visceral adipose tissue. Another class of drugs that affect insulin resistance include thiazolidinediones. Their effect has not been sufficiently studied, but it is known that they do not positively affect the body mass index, blood pressure level, total cholesterol, and also have a toxic effect on the liver (Grigoryan O.R., 2005). Most of these drugs cause adverse side effects: nausea, diarrhea, anorexia, or can aggravate a number of other manifestations of menopausal syndrome.

The use of hormone replacement therapy was a breakthrough in solving the problem of improving the quality and increasing the average life expectancy of a postmenopausal woman (Smetnik V.P., 2005). However, this therapy does not completely solve the problem of “age-related insulin resistance” and, of course, does not affect many parts of the MMS as well as physiological aging in general (Grigoryan OR, 2005). In addition, there are a number of contraindications to the use of hormone replacement therapy drugs, and most women with menopausal metabolic syndrome are afraid of their use due to the risk of proliferative processes in the uterus and mammary glands

Thus, we can conclude that the problem of safe and effective correction of metabolic disorders in women with menopausal syndrome remains unresolved.

At the same time, numerous experimental studies convincingly demonstrate the possibility of correcting metabolic parameters by using hypoxic therapy (Starkova NT, Ehrenburg IV, Davydov AL, Tkatchouk EN Effects of interval hypoxic therapy (IHT) on insulin resistance and vibration sensitivity in non-insulin dependent diabetes mellitus patients // Hyp.Med. J. 2001. V.9. N 3. P.49 .; Ehrenburg IV, Starkova NT, Davydov AL, Tkatchouk EN Effects of interval hypoxic therapy in non-insulin-dependent diabetes mellitus (NIDDM ). Double blind placebo controlled study. // High Altitude Medicine & Biology, Spring 2001. V.2. N 1.1). 105 .; Sokolov E.I., Mushinskaya K.V., Davydov A.L., Starkova N.T., Ehrenburg I.V., Tkatchouk E.N. Effects of the interval hypoxic training on lipid peroxidation in non-insulin-dependent diaabetes mellitus // Hyp. Med. J. 1999. N 3-4. 37-40).

Adaptation to periodic hyperbaric hypoxia (APBG) is used to treat cardiovascular diseases, in particular with hypertension (Aleshin I.A., 1993). The multi-seat medical vacuum unit Ural-1 is used, the effect on the body in which is carried out by artificially lowering the barometric pressure and, as a result of this, reducing the partial pressure of oxygen in the surrounding air, that is, the high-altitude effect is created. During treatment, the following adaptation mode was used: the course consisted of 22 sessions, the ascent rate was 5-7 m / s, the descent was 2-5 m / s, the patients were at “height” for 3 hours. The first session in adults was carried out at a “height” of 1,500 m, each next increase by 500 m until reaching 3,500 m (460 mm Hg). This method is taken as a prototype.

The technical result is a non-pharmacological correction of metabolic disorders in postmenopausal women.

The technical problem is solved in that in a method for correcting metabolic disorders in postmenopausal women, including: placing women in a pressure chamber, lowering barometric pressure, staying in this mode in a pressure chamber, normalizing barometric pressure, lowering barometric pressure is carried out at a speed of 3-4 m / s , and the normalization of barometric pressure - with a speed of 1-2 m / s, and the stay in the pressure chamber is 2.5 hours and the height of the first session is 1000 m.

New in the claimed method is that the speed of lowering the barometric pressure of 3-4 m / s was used, and the normalization speed of 1-2 m / s, the height of the first session corresponded to 1000 m above sea level for a more smooth adaptation to the change in barometric pressure, which allows you to reduce possible unpleasant sensations ("laying" of ears) during a change in barometric pressure. The effect of intermittent hyperbaric hypobaric hypoxia is carried out for 22 sessions of 2.5 hours each.

We examined 93 women with menopausal metabolic syndrome, which were divided into 3 equal groups. Patients of the first group (average age 51.1 ± 0.92 years) underwent treatment in the Ural-1 pressure chamber in accordance with the recommendations for the treatment of hypertension using adaptation to intermittent hypobaric hypoxia (Aleshin I.A., 1993): 22 three-hour session, lowering the barometric pressure was carried out at a speed of 5-7 m / s, "descent" 2-5 m / s, the height of the first session 1500 m

The second group, the main group, included patients whose average age was 50.6 ± 0.86 years. Patients of this group underwent an adaptation to periodic hyperbaric hypoxia in the Ural-1 hyperbaric chamber according to the following methodology: the main adaptation course consisted of 22 sessions at an “altitude” of 3,500 m (460 mm Hg) conducted daily for 2.5 hours, except for three days off and two technical days, the first sessions were carried out with a gradual increase in height, starting from 1000 m and further, adding 500 m daily to reach the maximum "height" (3500 m). The decrease in barometric pressure was carried out at a speed of 3; 3.5 and 4 m / s, and the normalization of barometric pressure - at a speed of 1; 1.5 and 2 m / s.

The third group was the control, the average age of patients of which was 49.9 ± 1.27 years. Patients in this group received hormone replacement therapy drug “femoston 1/5” (Solvey pharma).

Monitoring of patients was carried out during the entire period of treatment. Before the use of barotherapy and hormone replacement therapy in the control group, as well as after completion of treatment, an in-depth medical examination was carried out, including the determination of the modified Kopperman-Uvarova menopausal index, body weight measurement, hormonal background studies (estradiol, luteinizing hormone, follicle-stimulating hormone, dehydroepiandrosterone sulfate , insulin, C-peptide, leptin), blood lipid spectrum and serum glucose level.

When conducting a hyperbaric hypoxic training, the beginning of positive changes in the well-being of women with menopausal metabolic syndrome manifested no earlier than 10 sessions (“height” 3,500 meters), which became more pronounced as the adaptation time increased. At the same time, a number of patients had a later clinical effect - from the 18-19th session. At the end of the course of adaptation therapy, the clinical effect of the treatment was observed in 97% of patients.

The clinical effectiveness of hypoxytherapy in the subjects was determined by a decrease or disappearance of certain complaints caused by menopausal syndrome, which was manifested by a 54% decrease in the index of neuro-vegetative disorders of Kupperman-Uvarova. Patients in the control group (86%) began to notice improvement in well-being only after 3 weeks of treatment, which was manifested by a decrease in the index of neuro-vegetative disorders by Kupperman-Uvarova one month after the start of hormone replacement therapy by 33%.

In the main group, after completion of the course of adaptation to periodic hyperbaric hypoxia, a decrease in body weight in 98% of patients from 2 to 7 kg was noted. In the control group, there were no significant changes in body weight one month after the start of hormone replacement therapy.

When comparing the hormonal spectrum of the blood, a decrease in the level of luteinizing and follicle-stimulating hormones and an increase in the level of estradiol were revealed. However, in the group of patients who received treatment in the pressure chamber, there was a more pronounced dynamics of the level of these hormones (table). Also, in patients of the main group, as a result of a course of hypoxytherapy, an increase in the level of dehydroepiandrosterone-sulfate by 7% was revealed.

When studying the indicators of carbohydrate metabolism as a result of hypoxytherapy according to the claimed method, a decrease in initially elevated glucose levels by 17.7%, insulin by 17.4% and C-peptide by 17% was observed, which indicates an improvement in the sensitivity of peripheral tissues to insulin as a result of hypoxic stimulation. In the control group, there were no statistically significant changes in these indicators a month after the start of treatment (table).

Adaptation to periodic hyperbaric chamber hypoxia in women with menopausal metabolic syndrome contributed to a decrease in total cholesterol by 17% and an increase in HDL cholesterol by 12% (table).

In comparison with the group of patients who underwent a course of hypoxic therapy according to the prototype method, the claimed method showed better tolerance of the sessions, the absence of unpleasant symptoms during the “up” and “down”, more pronounced positive dynamics of laboratory parameters (table).

Comparative characteristics of the effect of treatment methods on laboratory parameters in women with menopausal metabolic syndrome (M ± m). Indicators Prototype method (n = 31) Control Group (n = 31) The claimed method (n-31): lowering the barometric pressure - V ₁ , the normalization of barometric pressure - V ₂ Initial data After adatation Initial data After 1 month Initial data After adaptation V ₁ = 3 m / s; V ₂ = 1 m / s V ₁ = 3.5 m / s; V ₂ = 1.5 m / s V ₁ = 4 m / s; V ₂ = 2 m / s Glucose, mmol \ p 6.21 ± 1.1 5.5 ± 0.67 * 6.14 ± 1.21 6.03 ± 1.19 6.32 ± 1.04 5.3 ± 0.76 * 5.2 ± 0.56 * 5.26 ± 0.65 * Insulin μme \ ml 15.9 ± 0.88 14.5 ± 1.1 * 15.8 ± 0.92 15.6 ± 1.11 17.2 ± 1.23 14.1 ± 1.13 * 14.2 ± 1.21 * 14.2 ± 1.23 * C-peptide, ng \ ml 1.94 ± 0.29 1.76 ± 0.32 * 1.84 ± 0.31 1.8 ± 0.42 1.93 ± 0.22 1.65 ± 0.23 * 1.63 ± 0.26 * 1.67 ± 0.31 * Leptin, pg \ ml 48.9 ± 4.9 54.3 ± 5.1 * 46.2 ± 5.6 47.6 ± 6.3 49.6 ± 4.8 54.8 ± 2.9 * 56.4 ± 3.2 * 57.3 ± 3.6 * Estradiol, PG \ ml 19.9 ± 4.1 24.9 ± 3.9 * 20.5 ± 3.2 26.8 ± 3.8 * 19.6 ± 3.8 25.9 ± 3.1 * 25.4 ± 3.2 * 24.6 ± 3.6 * Lukeimizing hormone, ME \ ml 55.7 ± 6.1 49.7 ± 6.4 * 56.2 ± 5.6 48.4 ± 5.1 * 54.3 ± 4.8 45.9 ± 4.1 * 46.3 ± 4.6 * 46.1 ± 4.3 * Follicle stimulating fever, ME \ ml 81.4 ± 8.8 70.4 ± 9.2 * 83.6 ± 9.4 72.4 ± 8.9 * 82.3 ± 8.6 b5.8 ± 3.9 * 68.4 ± 4.2 * 66.8 ± 4.3 * Dehydroepiandro sterone sulfate, μg \ dl 67.9 ± 6.9 77.3 ± 7.1 * 66.7 ± 6.8 67.9 ± 5.2 70.2 ± 5.9 77.3 ± 4.9 * 78.4 ± 5.2 * 79.3 ± 5.1 * Total cholesterol 6.17 ± 0.89 5.7 ± 1.1 * 6.1 ± 0.96 6.0 ± 0.92 6.2 ± 0.95 5.71 ± 0.94 * 5.62 ± 0.92 * 5.68 ± 1.01 * mmol \ l HS-HDL, mmol \ l 1.19 ± 0.31 1.26 ± 0.29 * 1.2 ± 0.21 1.2 ± 0.32 1.16 ± 0.26 1.28 ± 0.27 * 1.32 ± 0.28 * 1.31 ± 0.31 * Note: * - the differences are significant compared with the initial data (p <0.05).

Example No. 1. Patient M., 52 years old, was admitted for a course of adaptation to periodic hyperbaric hypoxia with a diagnosis of

Menopausal metabolic syndrome. Surgical menopause (3 years). Arterial hypertension 1 tbsp. Obesity 2 tbsp.

Prior to treatment, she noted hot flashes up to 10 times a day, sweating, palpitations, weakness, tearfulness, sleep disturbances. Weight gain of 10 kg and a periodic increase in blood pressure over the past 3 years after surgery hysterectomy with appendages due to purulent-inflammatory formations of the uterine appendages.

Previously, the patient did not receive treatment. During the course of adaptation, the exit to the “plateau” was well tolerated, which was confirmed both subjectively and by the data of active monitoring of the patient while in the pressure chamber. Starting from the 12th session, I began to notice a decrease and relief of tolerance of hot flashes, normalization of night sleep, increased working capacity, and improved mood. After completing the adaptation course, there was a decrease in the Kupperman-Uvarova index by 47%, a decrease in body weight by 5 kg, an initially elevated glucose level was normalized, the level of insulin decreased by 16% and C-peptide by 15%, the level of estradiol increased by 23%, and dehydroepiandrosterone sulfate by 14% and leptin by 21%, the levels of luteinizing and follicle-stimulating hormones decreased by 14% and 18%, respectively.

Example No. 2. Patient S., 46 years old, was admitted for treatment in a pressure chamber with a diagnosis of Menopausal metabolic syndrome. Premature menopause (5 years). Obesity 3 tbsp. Arterial hypertension 1 tbsp.

Prior to treatment, there were hot flashes up to 8 times a day, decreased performance, headaches, a periodic increase in blood pressure to 160 \ 100 mm Hg, stitching pains in the heart, palpitations. Weight gain and increased blood pressure has been noted since 42 years, when premature menopause has occurred. She took beta-blockers in moderate therapeutic doses. The adaptation course was well tolerated. Starting from the 14th session, a decrease in the severity and frequency of hot flushes, an improvement in night sleep, and a decrease in blood pressure were noted, which made it possible to reduce the beta-blocker dose by 1.5 times. By the end of the adaptation course, she lost 6 kg, a decrease in glucose by 14%, insulin and C-peptide by 13%, LH by 12%, FSH by 16%, an increase in estradiol by 15% and DHEA sulfate by 12%.

Thus, the presented data convincingly demonstrate that our proposed method for the correction of metabolic disorders in women with menopausal syndrome has significant advantages compared with the prototype. These benefits include:

1) Safety and the absence of adverse side effects of the non-drug treatment used.

2) A faster and more pronounced clinical effect, a decrease in the index of neuro-vegetative disorders Kupperman-Uvarova, a decrease in body weight and blood pressure.

3) Significantly significant decrease in glucose level, decrease in hyperinsulinemia and insulin resistance due to increased sensitivity of peripheral tissues to insulin during hypoxic stimulation.

4) Increased estrogen saturation, decreased levels of gonadotropic hormones, and increased levels of dehydroepiandrosterone sulfate.

5) An increase in the level of leptin, which due to exposure to the hypothalamic receptors leads to suppression of appetite and weight loss.

6) Reducing the speed of "rise" to 3-4 m / s and "descent" to 1-2 m / s allows you to reduce possible discomfort ("laying" of the ears) when changing barometric pressure and improve the quality of the portability of the session.

In this regard, the proposed method of treatment can be recommended for the correction of metabolic disorders in women with menopausal syndrome.

Claims (1)

A method for correcting metabolic disorders in postmenopausal women, including placing women in a pressure chamber, lowering the barometric pressure, staying in this mode in the pressure chamber, normalizing the barometric pressure, characterized in that the lowering of the barometric pressure is carried out at a speed of 3-4 m / s, and the normalization of the barometric pressure - at a speed of 1-2 m / s, and the stay in the pressure chamber is 2.5 hours and the height of the first session is 1000 m.