RU2617182C1 - Method for metabolic syndrome prediction in the ii trimester of pregnancy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: placenta preferential location side is determined for a pregnant woman in the second trimester by two-dimensional ultrasound scanning. In case of left hand lateralization, the nature of the lateral behavioral profile of asymmetries is further determined. If the right lateral behavioral asymmetries profile is detected, metabolic syndrome development is predicted for women in later stages of pregnancy.

EFFECT: improved accuracy of metabolic syndrome prediction in the early stages of gestation.

3 ex

Description

The invention relates to clinical medicine and can be used in obstetrics to identify a predisposition to metabolic syndrome at an early stage of the examination, when the patient has not yet become ill.

One of the possible predictors of the reproductive system pathology, according to domestic and foreign medical sources, is today recognized as metabolic syndrome (MS), in which a complex of hormonal, metabolic and clinical disorders is formed, which develops as a result of a decrease in the sensitivity of peripheral tissues to insulin. It is believed that it is insulin resistance (IR) and compensating hyperinsulinism (GI) that are the main pathogenetic link in the development of metabolic syndrome. To date, the problem of metabolic syndrome is extremely relevant throughout the world. The prevalence of metabolic syndrome continues to increase and currently ranges from 5 to 20% (Innes K.E., Wimsatt J.H., 2001; Alessi M.R. et al., 2004; Kahn et al., 2005).

In the vast majority of literature, MS is defined as a complex of metabolic, hormonal and clinical disorders, which are based on insulin resistance and compensatory hyperinsulinemia (GI) [Nesto R.W. The relation of insulin resistance syndromes to risk of cardiovascular disease // Rev. Cardiovasc. Med. - 2003. - Vol. 4, N. 6. - P. S11-S18; Prevalence of insulin resistance in metabolic disorders: the Bruneck Study / Bonora E., Kiech S., Willeit J. et al. // Diabetes. - 1998. - Vol. 47, No. 10. - P. 1643-1649.].

A cardinal sign of MS in non-pregnant women is a violation of menstrual and generative functions against the background of a progressive increase in body weight (MT). The main complaints of patients are: menstrual irregularities, miscarriage, infertility, excessive body hair, obesity and a variety of diencephalic complaints. With a carefully collected history, you can detect the presence of increased appetite and inadequate attitude to the number of calories consumed. This is due to impaired function of the centers of eating behavior, which are located in the hypothalamus. Of the past diseases, there is a high frequency of acute respiratory viral infections, various extragenital pathologies (Zanko SN // Metabolic syndrome from the perspective of a gynecologist. - Protection of motherhood and childhood. - No. 2 (10), - 2007. - P. 86-88).

However, in pregnant women, these alarming signs are erased, which complicates the diagnosis, and even more so the prediction of the occurrence of MS.

Isolation of metabolic syndrome (MS) is of great clinical importance, since on the one hand this condition is reversible, i.e. with appropriate treatment, it is possible to achieve the disappearance or at least reduce the severity of its main manifestations, and on the other hand, it precedes the occurrence of diseases such as type 2 diabetes and atherosclerosis - diseases that are currently the main causes of increased mortality.

It should be noted that, based on the available data, the metabolic syndrome and insulin resistance forming it, trigger a cascade of pathophysiological reactions in the body of a pregnant woman, the result of which is organ failure formed in the mother-placenta-fetus system and the relevance of this problem becomes apparent . Hormonal studies are not critical in the diagnosis of MS, since they are very variable.

However, in the modern literature, data on the course of pregnancy against the background of MS are very limited and there are no clear data on the criteria for the formation, prediction and prevention of obstetric pathology against the background of metabolic changes, which determined the purpose and objectives of our study.

Despite the large number of publications on the problem of MS, currently in medicine there are no clear criteria for determining the risk of MS in pregnant women.

In the presence of such uncertainty, it was important to establish factors reliably related and affecting the development of MS. The revealed regularities and criteria developed on their basis give practical healthcare doctors a “tool” for assessing the risk of developing MS, which will allow to remove or reduce the pathological load on the body in a timely manner.

A known method for detecting MS, including the study of anthropometric and biochemical parameters of patients [Perova N.V., Metelskaya V.A., Mamedov M.N., Oganov R.G. Methods for the early detection and correction of metabolic syndrome // Disease Prevention and Health Promotion - 2001. - 4 (1). - S. 18-31]. According to this method, the presence of MS is diagnosed when at least one of the three combination options is detected:

- overweight, hypertension and isolated moderate hyperlipidemia;

- overweight, hypertension and combined dyslipoproteinemia;

- Type 2 diabetes mellitus or impaired glucose tolerance (NTG) and abdominal obesity.

The mandatory examination complex for each of the patients with early MS markers includes blood pressure monitoring, analysis of blood serum for total cholesterol (GC), triglycerides (TG), high density lipoprotein cholesterol (HDL cholesterol), glucose tolerance test and assessment of the total risk of coronary heart disease. Moreover, for the standards of early markers of the presence of MS take the following:

1) blood pressure> 140/90 mm Hg;

2) overweight, with a Ketle index> 25 kg / m2 and <30 kg / m2 or abdominal obesity (Ketle index 30 kg / m2) with a waist circumference of 94 cm in men and 80 cm in women;

3) hypertriglyceridemia (TG 1.7 mmol / L);

4) hypo-alpha-cholesterolemia (HDL cholesterol 1.0 mmol / l in men and 1.3 mmol / l in women);

5) hyperglycemia (serum sugar level of 6.1 mmol / l) or an impaired glucose tolerance test.

The disadvantages of the criteria for this separation is that they do not adequately reflect the ability to predict metabolic disorders.

A known method for a comprehensive assessment of the severity of hemodynamic and metabolic disorders in women in the perimenopausal period (RF patent No. 2251971, 05/20/2005), which includes the determination of informatively significant signs of the condition, characterized in that as the informatively significant signs of the condition reveal the presence or absence of hypertension and extirpation of the uterus with appendages, an indicator of body mass index, the prevalence of disorders by the modified menopausal index (MMI) of vegetative, metabolic-endocrine or psychoemotics onal, the type of metabolic structures of blood serum, echocardiographically determine the stroke volume of the heart, cardiac index and total peripheral vascular resistance (OPSS), ultrasound reveals the maximum linear blood flow velocity (LSC maximum) in the middle cerebral artery and changes in the thyroid gland, rheovasographically reveal the specific blood flow (UK) of the legs, when studying laser Doppler flowmetry, the microcirculation indicator is determined, the beta-ad indicator is biochemically determined enoreactivity, cholesterol and B-lipoproteins, crystalloscopically - the presence of crystals of serotonin and dopamine, by the method of enzyme-linked immunosorbent assay determine the level of thyroid-stimulating hormone, the obtained indicators are assigned the values in Table 1 and then, after obtaining the values of the diagnostic coefficients of each indicator, summarize them and obtain a diagnostic index (CI ), with a value of less than 10, determine the absence of violations, with a value of CI - 10 ÷ 10 - the state is uncertain, with a value of 11-20 determine 1 step the severity of violations, with a value of 21-30 - 2 the severity of violations, and with a value of CI 31 and higher determine the 3 severity of violations.

A known method for the diagnosis of stages of the metabolic syndrome, including the determination of its classical components (RF patent No. 2321354, 04/10/2008), characterized in that it is further determined glycosylated hemoglobin (HBAic) by low pressure cation exchange chromatography on an automatic analyzer and in the presence of clinical and / or laboratory components of the metabolic syndrome, not more than two, and the normal level of glycosylated hemoglobin is diagnosed with stage I metabolic syndrome; with a combination of clinical and laboratory signs of metabolic syndrome and a level of glycosylated hemoglobin of more than 6.1%, stage II metabolic syndrome is diagnosed with a pathogenetically significant violation of insulin receptor binding, compensatory hyperinsulinemia; in the presence of three or more clinical and laboratory components of the metabolic syndrome, according to WHO criteria, with type 2 diabetes mellitus, stage III of the metabolic syndrome is diagnosed.

Known methods of mathematical modeling in predicting the development of MS: in women after articulated abortion [Zavalko AF The use of mathematical modeling in predicting the development of MS in women after induced abortion // Bulletin of new medical technologies. - 211. T. XVIII, 1. - S. 25-26]; predicting the development of MS in adolescence [Trushkina IV, Filipov GP, Leontiev IV Prediction of the development of MS in adolescence // Pediatrics. - 2010. - T. 89, 5. - S. 33-36].

A known method for predicting the risk of developing metabolic syndrome in women of perimenopausal age (patent No. 2396912, 08/20/2010). The presence of thyroid pathology, a violation of carbohydrate metabolism, heredity for obesity, hypertension and diabetes mellitus, the cause of menopause are revealed. The value of the body mass index is determined and its dynamics in the perimenopausal period is evaluated. Then calculate the prognostic index (PI). If PI is greater than zero, then an increased risk of metabolic syndrome is predicted over the next five years, and if less than zero, then the absence of this risk is judged. The method allows predicting the risk of developing metabolic syndrome in women aged 45-55, depending on the state of the thyroid gland and the causes of menopause, based on a combination of informative clinical signs.

A known method for predicting the risk of developing a metabolic syndrome in a patient with abdominal obesity in the Russian population (RF patent No. 2471193, 12/27/2012). Lymphocyte DNA is isolated from peripheral blood and T45G polymorphism of the adiponectin gene is then identified by polymerase chain reaction followed by restriction analysis. If the T45T genotype of the adiponectin gene is detected, the risk of developing a metabolic syndrome is predicted.

A known method for the diagnosis of predisposition to metabolic syndrome (2480154, 04/27/2013). They scan both palms of the patient, process the data and identify the parameters of the dermatoglyphic picture. Such characteristics are evaluated as: finger, total and total crest count, the nature of the pattern on the fingers and in the palmar region of the tenar, hypotenar and interdigital fields, the presence and location of palmar triradiuses, palmar crest count, direction of end of the main palmar lines A, B, C , D. Based on the revealed characteristics of the parameters of the dermatoglyphic picture, it is concluded that there is a predisposition to the metabolic syndrome.

A known method for predicting the risk of metabolic syndrome (RF patent No. 2530770, 10/10/2014), including the determination of diagnostic indicators by clinical, laboratory and functional methods, followed by calculation of the prognostic index in a patient, the following diagnostic parameters are determined in the complex: anthropometric - Quetelet index (IR), lipid metabolism - the apoprotein atherogenic coefficient (apoB / apoAl), the functional state of the liver - alanine aminotransferase (ALT), lipoperoxidation - the ratio of malondialdehyde antioxidant activity (MDA / AOA), indicators of central hemodynamics - systolic blood pressure (SBP) and cardiac index (SI), and as a prognostic indicator that determines the severity of metabolic disorders, use the prognostic index (y) as the total value of certain clinical laboratory and functional methods of the values of diagnostic indicators, which is determined by the formula: y = -0.6 + X1⋅0.04 + X2⋅0.65 + X3⋅0.18-X4⋅1.4 + X5⋅0.015-X6- 0.09, when y is less than 2.50, the absence is predicted lawsuit for the development of metabolic syndrome, when obtaining a value of y ranging from 2.51 to 2.99, a low risk of developing a metabolic syndrome is predicted, when obtaining a value of y equal to or greater than 3.00-3.24, the average risk of developing metabolic syndrome is predicted, when a value of greater than 3.25 is obtained, a high risk of developing metabolic syndrome is predicted.

A common drawback of all known methods for predicting and diagnosing MS is the complexity and inability to use them in women during pregnancy.

While physiological pregnancy is also characterized by the formation of insulin resistance (IR). Carbohydrate metabolism changes, “diabetogenic” properties of pregnancy appear, lipid metabolism changes, the level of fatty acids increases, which along with glucose participate in energy metabolism, which further contributes to the accumulation of the mother’s energy resources to realize her trophic function in relation to the fetus. In fact, pregnancy is a model of MS. If pregnancy is not accompanied by complications, metabolic changes self-destruct in the postpartum period (Butrova S.A., 2001).

These disadvantages are eliminated in the claimed invention.

The objective of the invention is the development of a new method for predicting MS in pregnant women in the 2nd trimester, taking into account placental lateralization, which allows taking preventive measures to prevent complications in the subsequent stages of pregnancy.

The problem is solved in that in a method for predicting a metabolic syndrome in a pregnant woman in the second trimester of pregnancy, the ultrasound region of the placenta is preliminarily identified using ultrasound and, with its left-sided lateralization, the character of the lateral behavioral profile of asymmetries is additionally determined, and the development of metabolic syndrome is predicted to develop syndrome in subsequent stages of pregnancy.

The technical result obtained by using this method in clinical practice is to increase the accuracy of prediction of the metabolic syndrome in pregnant women at the early stages of the gestational process as early as 13-14 weeks of pregnancy using simple, affordable techniques that allow timely prevention, reduce the number of complications, reduce the frequency and duration of hospitalization, as well as the drug load on the mother and fetus.

It is known that hyperinsulinemia is characterized by an increase in the activity of the sympathoadrenal system, sympathetic hyperactivity leads to an increase in the release of sympathetic neurotransmitters - noradrenaline (HA), adenosine triphosphate (ATP) and neuropeptide Y (NP-Y). All three sympathetic transmitters are capable of causing vasoconstriction and stimulating proliferative processes (Christian R.L., 2001). The prevailing regulatory effect on the body of the sympathoadrenal system leads to the development of persistent vasoconstriction, and, as is known, the morphogenesis of the placental “tree” and the growing needs of the fetus require two interrelated processes of vasodilation and angiogenesis (neovascularization from previous blood vessels in response to hypoxia), which is impaired in MS patients (Kingdom J. et al., 2000; Tse JY et al., 2001; De Marco CS, Caniggia I., 2002).

For the normal course of pregnancy, coordinated growth and differentiation of the placenta, the development of a functional vasculature are important. R.M. Popovici et al. (2001) indicate that an important family of cell growth modulators that stimulate cell proliferation and differentiation is the family of insulin-like growth factors (IPFRs): IPFR-1, IPFR-2, the proteins that bind them. IPFR-2 plays an important role in the process of early embryogenesis, having mitotic activity and metabolic influence. These growth factors often characterize induced factors as hypoxia (V. Krasnopolsky et al., 2008). Optimal placental perfusion requires, according to Orlov V.I. et al. (2009), controlled invasion of trophoblast and its deep penetration into the proximal sections of the spiral arteries of the uterus. The decrease in oxygen tension in the blood, which occurs against the background of uncontrolled vasodilation in patients with MS, causes an increase in the expression of hypoxia-induced growth factor, which leads to surface invasion of the trophoblast (Penzhoyan G.A., 2003; Ordinsky V.F., 2005; Goldman- Wohl D., Yagel S., 2002; Ness RB et al., 2006). As a result of the inferior reconstruction of the spiral arteries, the invasion of trophoblast villi is limited to their decidual segment and the spiral arteries retain their high resistance (Krivoruchko A.Yu., 2000; Kiselev S.M., 2003). The emerging hypoxic dysregulation of placental angiogenesis, due to metabolic endotheliopathy, leads to various complications (threatened abortion, often fetal malnutrition, pregnancy, gestosis, up to severe eclampsia and fetal death) and, as a result, reproductive losses (A. Orlov. , 2006; Orlov V.I. et al., 2007).

According to modern concepts, autonomous control of the placental-fetal blood flow is ensured by the competing influence of vasodilators and vasoconstrictors - special biosubstances produced locally in the placenta. The most significant vasodilators according to E. Svedas et al. (2002) are: endothelial natriuretic peptide - a radical of nitric oxide (NO) and prostacyclin - a product of cyclooxygenase metabolism of arachidonic acid; both agents are produced by endothelial cells. Among the vasoconstrictors of greatest importance are: thromboxane A2, produced by platelets in the lumen of the umbilical vessels; angiotensin II synthesized in fetal kidneys; and endothelin-1, produced locally in the placenta. This physiological mechanism in patients with metabolic syndrome is known to be disorganized and shifted towards an increase in the production of vasoconstrictors, which is also associated with the activating effect of sympathoadrenal nervous regulation in this contingent, which leads to a complication of the gravidary period (Manukhin I.B. et al. , 2001; Moiseeva O.M. et al., 2003; Petrishcheva N.N., 2003).).

Since it has been established that with metabolic syndrome, there is a violation of hemostasis and a prothrombotic status develops (predisposition to thrombosis and an increased level of PAI-1), there are certain difficulties in the management of these pregnant women, since the level of PAI-1 plays an important role in the process of implantation of the ovum, and, in addition, it is an independent factor in thrombophilia (Bitsadze O.D., 2003; Makatsaria A.D. et al., 2007; Chichester M., 2005; Lopez Jaramillo P. et al., 2001).

In women with the presence of metabolic syndrome, complications of the course of pregnancy may develop: a worsening of metabolic processes; increased risk of fetal pathology and death. In this case, the following may develop: the threat of termination of pregnancy (miscarriage, premature birth); preeclampsia (a complication of the course of pregnancy, characterized by a disorder of a number of organs and systems of the body); severe arterial hypertension; diabetes; the development of a large fetus, which creates difficulties in childbirth for the mother and child. During pregnancy, MS leads to placental abruption, the formation of placental insufficiency, fetal hypoxia and hypotrophy, and intrauterine growth retardation syndrome. Changes also occur in hemorheological parameters in pregnant women with MS, which is manifested by increased coagulation, decreased antithrombotic potential of the vascular wall and increased coagulating activity of the blood coagulation system. In this connection, many researchers attribute obstetric complications in this category of patients to the pathology of the hemostatic system, which leads to massive obstetric bleeding (Kan N.I. et al., 2007; Schweikhart G. et al., 1986; Shigemura N. et al ., 2004). In some cases, patients with MS during pregnancy for the first time manifest latently current somatic pathology (chronic pyelonephritis, neurocirculatory dystonia, type II diabetes mellitus) (Abramchenko V.V., 2007). Postpartum complications include heavy bleeding and childbirth mortality.

Morphofunctional asymmetry is the most important property of all living creatures without exception, which has reached maximum severity and complexity in humans. In the phenotype of each person, only his inherent lateral neuropsychic and somatovisceral signs are traced. In this regard, the lateral phenotype is the most important factor in the constitution, closely related and largely determines the level of reactivity, resistance, adaptability, type of nervous system, features of metabolism, etc. The individual characteristics of the lateral behavioral profile of asymmetries are associated with a predisposition to many chronic diseases (Chuprikov A.P., 1994; Berdichevskaya E.M., 2004). All this dictates the urgent need to take into account the lateral behavioral profile of asymmetries and, above all, the severity and orientation of the functional asymmetry of the cerebral hemispheres in predicting many diseases (Botasheva T.L., 2015; Chernositov A.V., 2015).

When pregnancy occurs, in the process of implantation of the ovum and subsequent formation of the uteroplacental complex, mainly in the right or left parts of the uterus, a dominant focus, called the gestational dominant, is formed in the contralateral to the placenta of the brain, which determines the effectiveness of afferent-efferent connections and the quality pregnancy (Poroshenko A.B., 1985; Chernositov A.V., 2000; Orlov V.I., 2004; Botasheva T.L., 2015). Not only the course of pregnancy, but also the outcome of childbirth depends on the ratio of the initial asymmetries of the female body, formalized in terms of the lateral behavioral profile of asymmetries and gestational asymmetries in the form of placental lateralization (Frolov A.A., 2016).

In women with a right lateral behavioral profile, asymmetries initially dominate the left hemisphere. In the case of the left-sided location of the placenta, a gestational dominant is formed in the contralateral right hemisphere. That is, a situation of competitive management of peripheral processes is being formed: a situation of the type of “two owners in one house”. It is this option of "competition in the center" is accompanied by neurovegetative and endocrine-metabolic disorders. The situation is also aggravated by the fact that the right hemisphere is responsible for controlling metabolic, hormonal and psycho-emotional processes, namely, it starts to receive a pool of afferent signals from the placenta site in case of its left-side location. “Competition in the center” and gestational dominant in the right hemisphere parts of the brain are highly likely to cause metabolic disturbances. Thus, when identifying the right lateral behavioral profile of asymmetries, the development of the metabolic syndrome in this pregnant woman is predicted.

A detailed description of the method and examples of its clinical application.

Fetometry was carried out using a two-dimensional ultrasonic research method on a Toshiba (Essose) SSA-340 ultrasound device (Japan), 3.5 MHz, with color Doppler mapping (FS registration certificate No. 2005/1686).

In a pregnant woman of 2 trimesters, the area of preferential localization of the placenta relative to the midline is determined previously by the method of two-dimensional ultrasound scanning according to the generally accepted technique. All studies are performed on an ultrasonic device "Toshiba (Essose) SSA-340" (Japan), 3.5 MHz, with color Doppler mapping (registration certificate FS No. 2005/1686). Ultrasound examination is carried out in a horizontal position of the pregnant woman on her back. A special gel is applied to the surface of the skin of the abdomen and the side of fixation of the placenta is determined.

When identifying the left-sided lateralization of the pregnant placenta, the character of the lateral behavioral profile of asymmetries is additionally determined.

A lateral behavioral phenotype is determined using tests: asymmetry of sensorimotor signs, comparing the width of the nail bed of the little finger, leading legs. To determine the initial lateral behavioral phenotype, a modified Annette test is used (Bragina N.N., Dobrokhotova T.A., 1988), which allows one to determine sensorimotor asymmetries, which are a marker of behavioral skills associated with simple emotionally colored movements, which are fixed in early ontogenesis (Kinsbourn M., 1978). Judging by the literature, they have a significant relationship with the functional state of the female reproductive system (Poroshenko AB, 1985). Researchers are offered the following questions:

- Test “interweaving of fingers”;

- Test "crossing arms on the chest";

- Test "applause";

- A test to determine the leading leg;

- Test to determine the jogging leg;

- Test "foot to foot";

- Test with a phone to identify the leading ear;

- Test with a sink to determine the leading ear;

- Test "keyhole" to determine the leading eye;

- Aiming test to determine the leading eye.

The detection of mismatch of the sides of the sensorimotor, visual and auditory signs / sensorimotor asymmetries / is recorded during the tests for the “leading eye” and “leading ear”. To this end, the woman is asked to answer the following questions and demonstrate: “with which ear do you listen to the telephone?”, “Which ear do you put the shell on?”, “With which eye do you aim?” And “with what eye do you look into the keyhole?”. In the presence of one of the right signs according to the "leading eye" and the left sign of the test according to the "leading ear" (or vice versa), a conclusion is made that the motor-sensory visual and auditory signs are counter-directed.

Morphological inequality of the hands is determined by measuring the width of the nail beds of the little fingers with a ruler. The test attribute is considered to be right or left on the side of prevailing width of the nail bed. Equality of indicators allows us to consider the sign of ambilateral.

The methods for determining the asymmetry of the legs are constructed so that their inequality is revealed:

1. to determine the leading leg: a woman must push with her foot an object lying on the floor / ball /. The leg she manipulates is the lead;

2. to determine the jogging leg: a woman must cross an imaginary barrier / pit, strip, object /. That leg with which a woman pushes off when overcoming an obstacle is the lead.

The prevalence of right signs in all the proposed tests (except for the “jerk leg”; this indicator should be left) in the patient determines the right lateral asymmetry behavioral profile (LPAA). In the case of a predominance of left signs (under the condition of the right push leg), the left LPPA is established in the subjects. Combined versions of the test results for the levels of “leading eye”, “leading ear”, “leading hand” and “leading leg” indicate ambidextral LPPA, with ambi-right ones included in the group of patients with a right-oriented profile, and ambi-left ones in a group of patients with a left-oriented profile.

When identifying the right lateral behavioral profile of asymmetries in patients with left-sided lateralization of the placenta, the development of the metabolic syndrome in this pregnant woman in the subsequent period of pregnancy is predicted.

The performance of the proposed method is confirmed by clinical examples.

Example 1

Patient E-va A.V., 29 years old, 14 weeks of pregnancy.

By the method of two-dimensional ultrasound scanning, the side of the placenta is located - left-sided. When determining the indicators of the lateral behavioral profile of asymmetries in a woman, the left lateral behavioral profile of asymmetries is established.

According to our method, this pregnant woman should not develop MS.

In a laboratory study of blood samples taken from peripheral veins on an empty stomach at 24 and 32 weeks of pregnancy, in vitro quantification was performed: levels of IRI, C-peptide by ELISA using DRG kits, Germany; glycosylated HB (HBA1c) by latex inhibition of agglutination, glucose by glucose oxidative method, Randox kits, UK, lipid profile.

At 24 weeks, revealed: HELL 120/70 mm Hg on both hands; IRI - 2.7 mcED / ml; C-peptide - 1.2 ng / ml; fasting plasma glucose concentration - 4.1 mmol / l; plasma glucose concentration in 1 hour after glucose loading - 5.2 mmol / l; plasma glucose concentration after 2 hours after glucose loading - 4.6 mmol / l (impaired glucose tolerance was detected); HvA1s - 4.0%; lipid spectrum (cholesterol - 3.8 mmol / L; LDL - 2.17 mmol / L; HDL - 1.23 mmol / L; TG - 0.59 mmol / L; KA - 2.09). Over the past 4 weeks, the increase in body weight was 1150.0 g.

At 32 weeks revealed: HELL 125/80 mm Hg on both hands; IRI - 3.5 mcED / ml; C-peptide - 1.8 ng / ml; fasting plasma glucose concentration - 4.6 mmol / l; plasma glucose concentration in 1 hour after glucose loading - 5.7 mmol / l; plasma glucose concentration 2 hours after glucose loading - 5.0 mmol / l (glucose tolerance disorders were not detected); HvA1s - 5.1%; lipid spectrum (cholesterol - 4.9 mmol / l; LDL - 2.18 mmol / l; HDL - 1.27 mmol / l; TG - 0.70 mmol / l; CA - 2.8). Over the past 4 weeks, weight gain was 1370.0 g. No metabolic syndrome was detected.

Thus, this clinical example shows the efficiency of the proposed method.

Example 2

Patient I-va V.V., 26 years old, 14 weeks pregnant.

By the method of two-dimensional ultrasound scanning, the side of the placenta location is determined - left-sided.

When determining the indicators of the lateral behavioral profile of asymmetries in a woman, the right lateral behavioral profile is established.

According to our method, a pregnant woman should develop MS.

In a laboratory study of blood samples taken from peripheral veins on an empty stomach at 24 and 32 weeks of pregnancy, a quantitative determination was made in vitro: levels of IRI, C-peptide by ELISA using DRG kits, Germany; glycosylated HB (HBA1c) by latex inhibition of agglutination, glucose by glucose oxidative method, Randox kits, UK, lipid profile.

At 24 weeks, revealed: HELL 130/80 mm Hg on the right hand; 135/80 mmHg on the left hand; IRI - 2.2 mkU / ml; C-peptide - 2.7 ng / ml; fasting plasma glucose concentration - 5.2 mmol / l; plasma glucose concentration after 1 hour after glucose loading - 5.9 mmol / l; plasma glucose concentration in 2 hours after glucose loading - 5.6 mmol / l (glucose tolerance disorders were not detected); HvA1s - 4.0%; lipid spectrum (cholesterol - 5.0 mmol / l; LDL - 2.8 mmol / l; HDL - 1.05 mmol / l; TG - 1.64 mmol / l; CA - 3.8). Over the past 4 weeks, weight gain was 2180.0 g. No metabolic disorders were detected.

At 32 weeks revealed: HELL 140/90 mm Hg on the right hand; 145/90 mmHg on the left hand (there are periodic rises in blood pressure over the last 2 weeks); IRI - 4.3 mcED / ml; C-peptide - 4.8 ng / ml; fasting plasma glucose concentration of 6.2 mmol / l; plasma glucose concentration 1 hour after glucose loading - 10.4 mmol / l; plasma glucose concentration in 2 hours after glucose loading - 8.7 mmol / l; HBA1c - 6.7%; lipid spectrum (cholesterol - 6.3 mmol / l; LDL - 3.2 mmol / l; HDL - 1.06 mmol / l; TG - 2.1 mmol / l; CA - 4.9). Over the past 4 weeks, weight gain was 1940.0 g. A pregnant woman revealed metabolic syndrome in the third trimester of pregnancy.

Thus, this clinical example shows the efficiency of the proposed method.

Example 3

Patient N.V.A.A., 25 years old, 14 weeks pregnant.

By the method of two-dimensional ultrasound scanning, the side of the placenta location is determined - left-sided.

When determining the indicators of the lateral behavioral profile of asymmetries in a woman, the right lateral behavioral profile is established.

According to our method, a pregnant woman should develop MS.

In a laboratory study of blood samples taken from peripheral veins on an empty stomach at 14 and 24 weeks of pregnancy, in vitro quantification was performed: levels of IRI, C-peptide by ELISA using DRG kits, Germany; Glycosylated HB (HBA1c) by latex inhibition of agglutination, glucose by the glucose oxidative method, Randox kits, UK, lipid profile.

At 14 weeks revealed: HELL 110/70 mm Hg on both hands; IRI - 2.1 mcED / ml; C-peptide - 0.75 ng / ml; fasting plasma glucose concentration - 4.3 mmol / l; plasma glucose concentration in 1 hour after glucose loading - 5.2 mmol / l; plasma glucose concentration after 2 hours after glucose loading - 4.6 mmol / l (impaired glucose tolerance was detected); HvA1s - 4.0%; lipid spectrum (cholesterol - 3.9 mmol / L; LDL - 2.48 mmol / L; HDL - 1.65 mmol / L; TG - 1.56 mmol / L; CA - 1.4). Over the past 4 weeks, weight gain was 900.0 g. No metabolic syndrome was detected.

At 24 weeks, revealed: HELL 140/90 mm Hg on both hands (there are periodic rises in blood pressure over the last 2-3 weeks to 160/100); IRI - 12.5 mcED / ml; C-peptide - 4.0 ng / ml; fasting plasma glucose concentration of 6.1 mmol / l; plasma glucose concentration 1 hour after glucose loading - 10.3 mmol / l; plasma glucose concentration 2 hours after glucose loading - 8.8 mmol / l; HBA1s - 6.6%; lipid spectrum (cholesterol - 6.4 mmol / l; LDL - 3.3 mmol / l; HDL - 1.05 mmol / l; TG - 2.2 mmol / l; CA - 5.1). Over the past 4 weeks, the increase in body weight was 3050.0 g. A pregnant woman revealed a metabolic syndrome in the second trimester of pregnancy.

Thus, this clinical example shows the efficiency of the proposed method.

The claimed invention will allow to assess the severity of metabolic, vascular disorders, which will contribute to the timely prevention, correction of treatment of MS, reducing labor and time costs for treatment.

The method will allow to form a risk group for the development of MS in a timely manner and start preventive measures in this category of patients, make it possible to objectively judge the effectiveness of preventive measures and make an informed decision about the time for the start of preventive therapy, which is consistent with the principles of evidence-based medicine.

Claims (1)

A method for predicting the metabolic syndrome in the second trimester of pregnancy, including ultrasound, characterized in that the pregnant woman in the second trimester preliminarily determines the side of the placenta by the method of two-dimensional ultrasound scanning, and with its left-sided lateralization, the nature of the lateral behavioral profile of asymmetries is additionally determined, and if the right asymmetrical lateral behavioral profile predict the development of metabolic syndrome ma at this woman in the later stages of pregnancy.