RU2342934C1 - Method of optimisation of protein c activity at metabolic syndrome - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method includes application of individually chosen hypohigh-calorie diet, the dosed out physical activities and introduction of Pyoglitazone 30 mg once a day and Valsartane 80 mg, 1 time at the same time of the day. The combined application of a hypohigh-calorie diet, physical activities and Pyoglitazone and Valsartane preparations in the specified dosages allows normalising activity of protein C within three months at patients with metabolic syndrome.

EFFECT: optimisation of activity of protein C at patients with metabolic syndrome.

1 ex, 1 tbl

Description

The invention relates to medicine, namely to hematology, cardiology and endocrinology.

Analogues of the proposed method for optimizing protein C activity in patients with metabolic syndrome (MS) do not exist.

There are recommendations in the literature on the appointment of a low-calorie diet and physical training for metabolic correction in the metabolic syndrome (Almazov V.A., Blagosklonnaya Y. V., Shlyakhto E.V., Krasilnikova E.I. Metabolic cardiovascular syndrome. St. Petersburg. : Publishing House of St. Petersburg State Medical University. 1999. - 208 pp.) And reducing the degree of abdominal obesity, which is its component with the help of recommendations more focused on the use of a low-calorie diet (Savelyeva L. Modern approaches to the treatment of obesity. // Doctor, 2000, No. 12, - p. 12-14; Kadyrova R.Kh. , Salkhanov B.A. Nutrition in obesity. Alma-Ata "Kazakhstan", 1990) or physical training (Moshkov V.N. Physical education in obesity. M., "Medicine", 1976. 56 pp.).

Patients with MS may be prescribed pioglitazone in order to correct insulin resistance.

Angiotensin receptor blockers, one of which is valsartan, are used to correct blood pressure in the metabolic syndrome.

However, never before a treatment complex consisting of an individually selected hypocaloric diet, dosed physical activity and drugs - pioglitazone and valsartan was not used in patients with arterial hypertension with metabolic syndrome in order to optimize the activity of protein C.

The aim of the invention is to increase the efficiency of correction of disorders of protein C activity in patients with metabolic syndrome.

Protein C is a vitamin K-dependent glycoprotein synthesized in hepatocytes that circulates in the blood as a proenzyme. Under the action of the thrombin-thrombomodulin complex (or an activator from snake venom), protein C activates and acts as an anticoagulant, causing proteolysis of factors Va and VIIIa in the presence of its cofactor - protein S and phospholipids. With thrombophilia, including in MS, disorders in the hemostatic system may be due to a deficiency of protein C.

The essence of the proposed method is that to optimize the activity of protein C, patients with metabolic syndrome are prescribed a long-term individually selected hypocaloric diet, dosed physical activity and drugs - pioglitazone 30 mg once a day and valsartan at a dose of 80 mg once a day.

The method allows to optimize the activity of protein C in patients with MS for three months, translating it to a level close to that for healthy people. If you follow the recommendations of the proposed method, it is possible to maintain the activity of protein C in optimal condition, which will allow people with MS to significantly reduce the risk of thrombotic complications, reduce the number of cases of temporary disability, speed up and improve the quality of treatment, reduce disability, and also extend life and reduce mortality patients with MS from heart attack and stroke.

The inventive method is as follows.

For the diagnosis in patients with MS of a violation of the level of protein C in the blood, it is evaluated according to the following procedure (Barkagan Z.S., Momot A.P. Fundamentals of the diagnosis of hemostasis disorders. M., 1999. - pp. 118-120).

Protein C in the samples of the studied plasma is activated by a specific activator from the muzzle poison - Agkistrodon contortrix. When activated with this protein C causes proteolysis of factors Va and VIIIa in a protein C deficient plasma. The latter leads to an increase in clotting time, which is used to evaluate the activity of protein C in the test sample. Protein C activity, expressed as a percentage of normal, is found from a previously constructed calibration curve.

Reagents are used: 1. Protein activator, lyophilized, diluted with 3 ml of distilled water. 2. Plasma deficient in protein C, lyophilized, is diluted in 1 ml of distilled water. 3. Neothromtin, lyophilized - an analogue of the kaolin-cephalic reagent, containing instead of kaolin ellagic acid and phospholipids, 3 ml of distilled water is diluted.

In addition, a medial buffer (pH 7.6) is required, which is used to dilute the samples of the test and standard plasma and a solution of calcium chloride (0.025 M). To construct a calibration curve, a standard branded or control normal plasma with a known protein C activity or a pooled plasma (taken from no less than 10 healthy people), the protein C activity in which is taken as 100%, is also required.

The material for the study is a citrate platelet-poor plasma.

Before the analysis, the studied plasma is diluted with a medial buffer 10 times.

0.1 ml of diluted (1:10) plasma, 0.1 ml of protein C deficient in protein C, 0.1 ml of activator are preheated at the same temperature in a test tube (or coagulometer cuvette), heated to + 37 ° C. protein C and 0.1 ml of the kaolin-mullet analogue reagent. The mixture is kept in a water bath at + 37 ° C for 4 minutes. Then, 0.1 ml of a solution of calcium chloride, preheated to 37 ° C, is added to the mixture, a stopwatch or a coagulometer timer are turned on and coagulation time is recorded.

Results are measured by a calibration curve.

Construction of a calibration curve. Prepare a series of dilutions of the control plasma pool or standard branded plasma using a medial buffer (table).

Table. Scheme for preparing a plasma dilution for constructing a calibration curve when determining the activity of protein C No. Protein C,% Breeding Getting dilutions one 200 1: 5 0.2 ml of plasma + 0.8 ml of buffer 2 one hundred 1:10 0.1 ml of plasma + 0.9 ml of buffer 3 fifty 1:20 0.1 ml of plasma + 1.9 ml of buffer four twenty 1:50 0.1 ml of dilution No. 1 + 0.9 ml of buffer 5 10 1: 100 0.1 ml of dilution No. 2 + 0.9 ml of buffer

With each of the samples of the diluted plasma, the clotting time is determined by the above procedure. When constructing a calibration curve on the logarithmic axis of ordinates, the clotting time in seconds is postponed, on the logarithmic axis of abscissa, protein C activity in% in accordance with the dilutions indicated in the table.

Normally, protein C activity is 70-140%.

When establishing a decrease in protein C activity, MS patients should be prescribed the following treatment complex.

To create a negative energy balance in the body of patients, they are recommended an individually selected hypocaloric diet.

The calorie content of the daily diet is calculated in kcal individually for each patient with MS according to the formula:

for women 18-30 years old (0.0621 × body weight, kg + 2.0357) × 240,

31 years-60 years (0.0342 × body weight, kg + 3.5377) × 240,

over 60 years old (0.0377 × body weight, kg + 2.7545) × 240,

for men 18-30 years old (0.0630 × body weight, kg + 2.8957) × 240,

31 years-60 years (0.0484 × body weight, kg + 3.6534) × 240,

over 60 years old (0.0491 × body weight, kg + 2.4587) × 240.

The obtained value remains unchanged with minimal physical activity, multiplied by a coefficient of 1.3 for moderate and 1.5 - for high physical activity (as a rule, in patients with MS the level of physical activity is low).

3 main meals and 2 intermediate meals are recommended. The following daily calorie distribution is recommended: breakfast - 25%, 2nd breakfast - 10%, lunch - 35%, afternoon tea - 10%, dinner - 20%.

To compile the patient’s menu, special tables are used that indicate the chemical composition and calorie content of the products, given that the main sources of energy are proteins (1 g contains 4 kcal), fats (9 kcal), carbohydrates (4 kcal) and alcohol (7 kcal).

The second component of the proposed method is feasible regular physical training.

In real life conditions, it is possible to carry out three forms of physical activity: 1) morning hygienic gymnastics (exercise); 2) therapeutic and preventive gymnastics; 3) fractional physical exercises throughout the day.

1. Morning hygienic gymnastics (exercise)

Morning exercises should be done after sleep before breakfast in a ventilated room. Under the influence of classes, the body is freed from the state of inhibition of physiological processes that occurs during sleep.

The sequence of exercises involves alternating the load on various muscle groups (arms, legs, body). Exercises are performed with a gradually increasing excursion of breathing, stretching, limited use of force conditions. The breathing during exercises should be free, rhythmic, without delay, mainly through the nose; the exhalation should be longer than the inhalation (inhalation 2-3 s, exhalation 3-5 s).

With good health, the load can be strengthened by the number of repetitions, speeding up the pace, increasing the amplitude of movements and reducing pauses between exercises.

With fatigue, you should reduce the load, increase the duration of pauses between exercises, fill them with calm breathing.

After gymnastics, you need to go to a wipe or take a shower.

Morning exercises should cause a sense of vitality, increased activity, better health and performance.

If you feel unwell, develop shortness of breath or pain in the heart and behind the sternum, you should temporarily interrupt classes and consult a doctor.

During the day, patients with MS are recommended preventive gymnastics. Depending on the initial training, it is possible to use at the beginning of a lightened version of physical activity, and subsequently a strengthened version.

2. Complexes of therapeutic and preventive gymnastics for persons suffering from MS.

2.1. Lightweight version of therapeutic gymnastics

Exercise 1. Standing. Walking is calm with a gradual acceleration and deceleration of 1-2 minutes. When performing the exercise, a gradual deepening of breathing.

Exercise 2. Circular movements in the shoulder joints. When breeding - inhale, while mixing - exhale with a slight tilt of the body and retraction of the abdominal wall - 6-8 times. Fingers touch shoulders, elbows pressed to the body.

Exercise 3. Standing, hands on the belt. Alternately transferring the severity of the body from one leg to the other with slight bending of the legs in the knee joint, without taking the feet off the floor. Do the exercise 10-16 times with muscle tension in the legs.

Exercise 4. Standing, legs spaced shoulder width apart, hands on the belt. Torso forward, touch left sock with your right hand. 4-6 times alternately. When the position is straightened, inhale; when tilted, exhale. Looking forward.

Exercise 5. Standing, arms along the torso. At the same time, take straight arms and one leg to the sides with alternating leg abductions. 4-6 times in each direction alternately. A wave of arms and legs, breathing free, do not hold.

Exercise 6. Standing, legs to the sides, hands in front of the chest, palms down. With the turn of the body, spread your arms to the sides with the turn of the palms up - inhale. Return to the starting position with a slight tilt of the body forward - exhale. 3-5 times in each direction alternately. Coordinate breathing with the movement of the body and hands. By the end of the exhalation, retract the wall of the abdomen.

Exercise 7. Standing, hands free. Walking freely - 1 min, then with high flexion of the hips - 10-20 movements, followed by a transition to a quiet walk - 1-2 minutes. Rhythmic breathing, medium depth.

Exercise 8. Sitting on the edge of the chair, hands on the waist. Bending back and bending forward of the body. Repeat 6-10 times. Do not hold your breath.

Exercise 9. Sitting on the edge of the chair, focus with tassels on the edge of the chair, and with your feet somewhat in front of the chair. Squats with an emphasis on the edge of the chair - 4-6 times. When squatting, exhale.

Exercise 10. Standing sideways to the back of the chair, hold on to it with one hand. Swing your free straight arm with your legs back. Return to starting position. Repeat 4-6 times with each hand and foot. Do not hold your breath.

Exercise 11. Standing, legs apart, arms at the waist. Turns the body to the right and left - 6-10 times alternately. Do not turn your head, look forward.

Exercise 12. Standing, legs together, arms down. To spread your arms to the sides - inhale, bend your leg at the knee and press your hands to your stomach - exhale. 3-5 times each leg in turn. Strive to maintain balance; as you exhale, draw in your stomach.

Exercise 13. Standing, legs together, hands down. Lateral tilts of the body with bending of the opposite arm ("pump").

Do not hold your breath, strive for a greater excursion of movement.

Exercise 14. Standing. Walking is calm with uniform breathing of medium depth. 1-2 minutes

Exercise 15. Lying on a rug with a pillow placed under the head. Go to the half-sitting position and hug the bent hips - exhale, return to the starting position - inhale. Do not hold your breath. Strive in a half-sitting position to maintain balance. Run 4-6 times.

Exercise 16. Lying, arms to the sides, legs apart. Semicircular movements with the right straight leg to the left with the turn of the pelvis - exhale - return to the starting position - inhale. 3-5 times in each direction. Alternately left and right with the greatest possible excursion of the leg movement, while maintaining the emphasis of the hands on the floor.

Exercise 17. Sitting on the floor; a) get on all fours; b) move to a kneeling position; c) raise your hands up - inhale, tilt the body, and take your hands back - exhale. When tilting, belly retract. Repeat 4-6 times; e) move to a standing position, and the son-in-law to a lying position; e) self-massage of the abdomen with small semicircular movements in a clockwise direction -1-2 min. Rest 2 min; g) calm breathing; h) exercise in protruding (calm) and retracting (active) the abdominal wall. Combine abdominal retraction with expiration through the mouth. Repeat 4-6 times.

Exercise 18. Standing, arms bent. Vigorous walking on the spot or in a room with high flexion of the hips and waved arms - 20-30 steps. Do not hold your breath.

Exercise 19. Sitting on a chair, legs apart, hands on the waist or rest against the edge of the chair. Circular movements of the pelvis with retraction of the abdomen when the pelvis is brought back. 4-6 times in each direction.

Exercise 20. Standing. Calm walking with breathing of an average depth of 2-3 minutes.

With the initial sufficient training or exercise tolerance arising during the classes, the following set of exercises can be used.

2.2. A reinforced version of therapeutic gymnastics.

Exercise 1. Standing. Walking calm with rubbing the palms of the chest, abdomen, lower back. It takes 1-2 minutes.

Exercise 2. Standing, arms down. Simultaneous bending with tension and free “throwing” of arms forward, to the sides and upwards 12-16 times. When bending, exhale, while leveling, inhale.

Exercise 3. Standing, arms at the waist, legs shoulder width apart. Lateral movements of the pelvis to the right and left, back and forth. It is performed 6-10 times alternately. Breathing is free.

Exercise 4. Standing, feet shoulder width apart, arms down. Circular movements of straight arms in the shoulder joints, 6-10 times with maximum excursion, do not hold your breath.

Exercise 5. Standing, arms in front of the chest, bent at the elbows. Walking with high flexion of the hips, with the touch of hands. 6-10 times each leg in turn. The movements are vigorous, while flexing the thigh - exhale through the mouth.

Exercise 6. Walking calm 1-2 minutes.

Exercise 7. Sitting on the edge of the chair, hands on the waist. Bending and bending of the body. The exercise is performed 8-10 times. The movements are energetic. When straightening, inhale; when bent, exhale.

Exercise 8. Standing sideways to a chair, hold on to the back, the other hand at the waist. Alternating swings with a straight leg forward with the greatest possible excursion. Leg sweep combined with exhalation. It is carried out 4-6 times.

Exercise 9. Standing, legs apart, arms to the sides. Tilts the body forward with a touch of the right brush of the left toe of the foot, the other hand is pulled up. Return to starting position. Combine the slope with the exhale, while straightening, inhale 4-6 times.

Exercise 10. Walking calm with breathing of medium depth. 1-2 minutes

Exercise 11. Standing, hands in a fist and lowered: a) bending the arms at the elbows with force and unbending them with the back, with the greatest possible straightening and tension and a delay in tension for 2-3 seconds. Standing, hands on the waist; b) half-squats, followed by lifting on toes and straining the legs. The exercise is performed 4-6 times with the greatest possible rectification and tension, and a delay in the stress state for 2-3 seconds.

Exercise 12. Sitting on the edge of a chair. In the position of the leg raised and bent at the knee joint, alternately shake the tibia and thigh muscles with the hands. Reduce muscle tension. 1-2 minutes

Exercise 13. Sitting on the edge of the chair, straight legs divorced. Breeding and mixing straight arms and legs. When breeding, inhale, while mixing, exhale. It is carried out 4-8 times.

Exercise 14. Standing. Walking is calm with the transition to a rhythmic calm run (jogging) in place or with movement.

If tired, go for a walk with moderate breathing. 2-5 minutes

Exercise 15. Lying on the mat. Simultaneous lifting of the body and legs as you exhale. 4-6 times. Arms and legs straightened, keep balance.

Exercise 16. Lying on the mat, emphasis with brushes on the floor. Cross movement with straight legs - “scissors.” 4-8 times. Do not hold your breath.

Exercise 17. With a quick straightening of the legs, move to a sitting position, then lie down. You can help with a wave, 4-6 times.

Exercise 18. Lying on your back, legs bent. Calm breath 4-6 times.

Exercise 19. Lying on your back, arms spread apart with the emphasis of the hands on the floor. With the turn of the pelvis to the left, bend the legs, turn the pelvis with the legs crossed to the right and stretch the legs. Repeat such circular movements with legs 3-6 times in each direction alternately. Do not tear your hands off the floor. Do not hold your breath.

Exercise 20. Lying on your back, arms and legs apart. Alternate turns of the body to the right and left with the laying of one hand on the other. Do not move your legs. With arms apart, inhale, while turning, exhale. It is carried out 3-6 times.

Exercise 21. Lying on your back, arms along the body: a) turn on your left side; b) turn on the right side; c) go to the supine position; d) get on your knees; e) move to a standing position; f) walking in a place with high hip flexion and arm movement - 20-30 steps; g) sit on the mat; h) lie on your back, calm breathing. Repeat the whole complex 3-4 times.

Exercise 22. Standing. Walking calm with breathing of medium depth - 1-2 minutes.

Exercise 23. Standing, legs spaced the width of the foot, hands on the waist. Circular motion of the pelvis, right and left 6-8 times. Do not hold your breath.

Exercise 24. Standing with legs wide apart, hands in front of the chest. Alternately bending the leg with the transfer of body weight to it with stretching the arms to the toe of the bent leg. 4-6 times in each direction. The other leg is straight. When straightening - inhale, while tilting - exhale.

Exercise 25. Standing, legs spaced shoulder width apart, arms at the waist. Circular head movements 4-10 times in each direction.

Exercise 26. Standing, legs spaced shoulder-width apart, arms at the waist. Tilt the body to the right, pulling the left hand up - inhale. Return to starting position - exhale. 4-6 times alternately.

Exercise 27. The same, arms to shoulders. Circular movement of the hands with a maximum excursion in the shoulder joints, when breeding - inhale, while reducing and retracting the walls of the abdomen - exhale. The breath is deep.

Exercise 28. Standing. Calm walking and breathing of medium depth. Reduced overall load. 1-2 minutes

3. Fractional exercise throughout the day.

A patient with MS is a patient with a number of concomitant disorders and, above all, the cardiovascular system. This circumstance limits the simultaneous use of great physical activity in the process of morning gymnastics, as well as in the main occupation of therapeutic and prophylactic gymnastics. That is why an increase in the physical activity of people suffering from MS should be carried out by distributing physical activity in small doses throughout the day. This method of increasing the physical activity of patients with MS should be considered as a fractional load method.

Depending on the real-life conditions of patients with MS suffering from various degrees of abdominal obesity, various exemplary fractional exercise options can be recommended to increase physical (motor) activity throughout the day.

Option 1.

Exercise 1. Sitting - spread your elbows to the sides - inhale, stretch your arms forward with tension - exhale, 4-6 times.

Exercise 2. Sitting - stand up with the deflection of the body and sit down - 8-10 times.

Exercise 3. Sitting - an imitation of the movements of a boxer with a possibly large rotation of the body - 10-12 times.

Option 2

Exercise 1. Standing - walking with high flexion of the hips - 16-30 times.

Exercise 2. Standing - circular movements of the head to the right and left - 3-8 times in each direction.

Exercise 3. Standing - legs spread apart - imitation of the movement of the pigtail - 10-12 times.

Exercise 4. Sitting - transition to a standing position - 10-12 times.

Option 3

Exercise 1. Walking is calm - 1 min.

Exercise 2. Walking accelerated - 1 min.

Exercise 3. Walking with a high flexion of the hips and alternate wave of hands 20-30 times.

Exercise 4. Walking calm with breathing - 1-2 minutes; the run is calm on the spot or with movement around the room - 2-5 minutes.

Option 4

Walking walk of various extent.

Option 5

Physical labor in various versions and of various durations depending on the conditions (cleaning the premises, home maintenance, work on cleaning the territory, garden works, etc.).

The third component of the proposed method is the appointment of pioglitazone 30 mg 1 time per day, the fourth component is valsartan 80 mg 1 time at the same time of the day.

Example. Patient Sh., 57 years old, with a body weight of 83.0 kg, a body mass index of 31.5 kg / m ² , suffering from metabolic syndrome for 12 years, the examination revealed a decrease in the activity of protein C - 60%. The patient was prescribed an individually selected hypocaloric diet (1989, 4 kcal), dosed physical training, pioglitazone 30 mg 1 time per day, and valsartan 80 mg 1 time per day. The patient was examined 4.8 and 12 weeks after the start of treatment. At the same time as the inspection, protein C activity was evaluated.

By the 12th week of treatment, the patient's body weight decreased (74.0 kg) and body mass index (28.1 kg / m ² ), complete normalization of protein C activity (110%) was achieved.

The patient was asked to follow the recommendations given to her in the future.

Using the proposed method for optimizing the activity of protein C in hematology, cardiology and endocrinology will help to avoid many vascular complications in patients with metabolic syndrome, reduce the number of cases of temporary disability in them, reduce the duration of hospitalization, reduce disability and mortality.

Claims (1)

A method for optimizing the activity of protein C in patients with metabolic syndrome, including the use of an individually selected hypocaloric diet, dosed physical activity, pioglitazone 30 mg 1 time per day and valsartan 80 mg 1 time at the same time of day.