RU2344814C1 - Method of blood platelet normalisation under metabolic syndrome - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: for platelet aggregation normalisation under metabolic syndrome a complex therapt is performed for 2 months, including individual hypocaloric diet calculated by a formula with account of patient's age and sex, rated static and dynamic exertion, and introduction of 80 mg of telmisartan each morning.

EFFECT: efficient correction of intravascular thrombocyte activity of patients with metabolic syndrome due to therapeutic effect potentiation of several complex therapy component components.

1 ex, 2 tbl

Description

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

The closest analogue of the proposed method for normalizing blood platelet aggregation in the metabolic syndrome (MS) is a method for normalizing platelet aggregation in the metabolic syndrome by using an individually selected hypocaloric diet calculated according to a formula identical to the stated dosage of physical activity, as well as the administration of Siofor (RU 2239426 C1, November 10, 2004).

The claimed method differs from the known one in that an angiotensin receptor blocker telmisartan is administered as a drug therapy in a specified dose.

This embodiment of the method allows you to adjust platelet aggregation in patients with metabolic syndrome within 2 months.

For the correction of arterial hypertension, which is an essential component of the metabolic syndrome, the group of angiotensin receptor blockers is most shown. In a large number of people with metabolic syndrome, the combined use of a hypocaloric diet and dosed physical activity is also justified. Therefore, in preparing this application, the task was to develop a method for normalizing the functional activity of platelets in patients with metabolic syndrome who need treatment with a low-calorie diet, dosed physical exertion and a hypotensive agent from the class of angiotensin receptor blockers, which would solve the problem of correcting arterial hypertension while normalizing functional platelet activity and thereby prevention in a wide range of patients with metabolic skim syndrome of heart attacks and strokes.

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 p.) And reducing the degree of abdominal obesity, which is its component with the help of recommendations that are 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 for obesity. Alma-Ata: Kazakhstan, 1990) or physical training (Moshkov V.N. Physical education for obesity. M: Medicine, 1976. - 56 s).

Telmisartan is used to correct blood pressure in the metabolic syndrome.

However, never before has a treatment complex consisting of an individually selected hypocaloric diet, dosed physical activity, and telmisartan been used in patients with metabolic syndrome to normalize platelet aggregation (with ADP, collagen, thrombin, adrenaline and combinations of inducers - ADP + adrenaline, ADP + collagen, adrenaline + collagen, ADP + adrenaline + collagen, ADP + adrenaline + thrombin).

The aim of the invention is to increase the efficiency of correction of platelet aggregation disorders in patients with metabolic syndrome.

The essence of the proposed method lies in the fact that for the correction of platelet aggregation, patients with metabolic syndrome are prescribed for a long time an individually selected hypocaloric diet, dosed physical activity, and telmisartan 80 mg once daily in the morning for 2 months.

The method allows to adjust platelet aggregation, determined by A. Shitikova. (Visual micromethod of platelet aggregation studies. In the book: Hemostasis. Physiological mechanisms, principles for the diagnosis of the main forms of hemorrhagic diseases. St. Petersburg, 1999. - pp. 49-52.) In patients with MS for two months, translating it to the level, close to that for healthy people. If you follow the recommendations of the proposed method, it is possible to maintain platelet aggregation in an optimal mode of operation, which will significantly reduce the risk of thrombotic complications, reduce the number of cases of temporary disability, speed up and improve the quality of inpatient care, reduce disability, and also extend the life and reduce mortality of patients with MS from a heart attack and stroke.

The inventive method is as follows. Evaluation of AT is carried out in the following way (A. Shitikova In the book: Hemostasis. Physiological mechanisms, principles of diagnosis of the main forms of hemorrhagic diseases. Edited by N. N. Petrishchev, L. P. Papayan. St. Petersburg, 1999. P. 49 -52).

Blood is taken with sodium citrate 3.8% in a 9: 1 ratio, centrifuged for 5 minutes at 1000 rpm to obtain platelet-rich plasma (BTP). Part of the plasma is taken, and the remaining centrifuged at 3000 rpm for 20 min, receiving platelet-poor plasma (BeTP). BTP is standardized by the number of platelets by diluting the original BTP with an autologous BeTP sample (up to 200 · 10 ⁹ / L). The concentration of blood platelets in the initial BTP is calculated in the Goryaev's chamber (in 50 large squares). The volumes of mixed BTP and BeTP are determined by the formula:

V _BeTP = V _BTP · [(N / 200000) -1],

V _BeTP - volume of platelet-poor plasma,

V _BTP - the volume of platelet-rich plasma,

N is the counted platelet concentration in the original BTP (cells / μl).

From the selected volume of standardized plasma, 0.02 ml of plasma is applied to a glass slide and 0.02 ml of inductor solution are used with different pipettes. As agonists, it is possible to use ADP, collagen, thrombin, adrenaline in conventional concentrations, as well as a combination of inducers (ADP + collagen, collagen + adrenaline, ADP + adrenaline, ADP + collagen + adrenaline, ADP + adrenaline + thrombin) in concentrations below the generally accepted ADP - 10 ^-6 M, collagen - dilution with the main suspension 1: 4, thrombin - 0.09 units / ml, adrenaline 2.5 × 10 ^-7 M), but sufficient for platelet aggregation to occur when the inducers are mutually potent. Plasma is mixed with inducers with a glass rod and the stopwatch is turned on. The mixture is stirred so that the liquid occupies a circle with a diameter of about 2 cm.

Shaking the glass in a circular motion in the transmitted light of the illuminator, on a black background they monitor the occurrence of aggregates through a magnifying glass. When distinct aggregates appear, the solution becomes clear and some of the aggregates adhere to the glass, the stopwatch is turned off, fixing the time of platelet aggregation.

The reaction is repeated 2-3 times with each inductor, finding the arithmetic mean value.

With the development of platelet aggregation before the normative values (Tables 1, 2), it is necessary to prescribe treatment according to the proposed method.

Table 1 The time of development of platelet aggregation in healthy people and patients with arterial hypertension with metabolic syndrome with the use of a single inducer in standard concentrations. Examined Category Platelet aggregation development time under the influence of a single inducer ADP, s Collagen s Thrombin with Adrenaline, with Healthy people, n = 28 32-60 42.0 ± 0.40 27-37 33.0 ± 0.13 47-61 55.0 ± 0.40 81-106 94.0 ± 0.37 Sick people, n = 127 19-30 24.2 ± 0.16 17-26 20.2 ± 0.17 34-47 38.6 ± 0.17 60-76 67.6 ± 0.16

table 2 The time of development of platelet aggregation in healthy people and patients with arterial hypertension with metabolic syndrome when using a combination of inducers in mutually potent concentrations. Examined Category The time of development of platelet aggregation under the influence of a combination
inductors ADP + adrenaline, s ADP + collagen, s Adrenaline + collagen, s. ADP + collagen + adrenaline, s ADP + adrenaline + thrombin with Healthy people, n = 28 30-42 35.0 ± 0.3 22-30 26.0 ± 0.15 24-35 29.0 ± 0.14 21-26 23.0 ± 0.20 21-24 23.0 ± 0.11 Sick people, n = 127 12-25 19.6 ± 0.16 12-20 15.4 ± 0.14 7-15 11.8 ± 0.11 8-12 9.0 ± 0.14 8-12 10.0 ± 0.20

A method for the treatment of hypertension patients with MS includes the following.

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

The caloric content of the daily diet individually for each patient with MS is calculated in kcal 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 resulting coefficient remains unchanged with minimal physical activity, multiplied by 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. With the regular skipping of one of the main meals, the frequency of obesity increases significantly, a positive correlation between obesity and skipping breakfast is also revealed. 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. A 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 then to a prone position; f) self-massage of the abdomen with small semicircular movements in a clockwise direction - 1-2 minutes. 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 movements of the hands with the 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 telmisartan 80 mg 1 time per day in the morning.

Example. In patient C, 47 years old, with a body weight of 83.0 kg, a body mass index of 29.7 kg / m ² , suffering from metabolic syndrome for 11 years, the examination revealed thrombocytopathy with increased aggregation activity (with ADP - 25 s, with collagen - 23 s, with thrombin - 42 s, with adrenaline 68 s, with ADP + adrenaline - 20 s, with ADP + collagen - 18 s, with adrenaline + collagen - 14 s, ADP + adrenaline + collagen - 11 s, ADP + adrenaline + thrombin - 12 s).

The patient was prescribed an individually selected hypocaloric diet (2389.9 kcal), dosed static and dynamic loads, and telmisartan 80 mg once daily in the morning. The patient was examined 2, 4 and 8 weeks after the start of treatment. At the same time as examination, platelet aggregation was studied.

By the 8th week of treatment, the patient's body weight began to decrease (74.0 kg) and platelet aggregation with ADP was completely normalized for 48 s, collagen for 36 s, thrombin for 60 s, adrenaline for 98 s and combinations of inductors ADP + adrenaline - 32 s, ADP + collagen - 24 s, adrenaline + collagen - 26 s, ADP + adrenaline + thrombin - 22 s, ADP + adrenaline + collagen - 23 s.

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

Using the proposed method for the correction of platelet disorders 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, reduce the duration of hospitalization, reduce disability and mortality.

Claims (1)

A method of normalizing platelet aggregation in metabolic syndrome, characterized in using an individually selected hypocaloric diet calculated in kcal according to the formula
for women: 18-30 years old - (0.0621 · body weight, kg + 2.0357) · 240;
31-60 years old - (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;
31-60 years old - (0.0484 · body weight, kg + 3.6534) · 240; over 60 years old (0.0491 · body weight, kg + 2.4587) · 240,
dosed static and dynamic physical activity and telmisartan 80 mg 1 time in the morning for 2 months.