RU2343917C1 - Method of correction of intravascular activity of thrombocytes at patients with metabolic syndrome - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: within 2 months carry out the complex therapy including individually picked up hypohigh-calorie diet, calculated under the formula considering age and a floor of the patient, the dosed out static and dynamic loads, and also Kandesartane in a dose of 8 mg in the morning.

EFFECT: effective correction of intravascular activity of thrombocytes at patients with MS at the expense of potentiation of therapeutic effect of separate components of complex therapy.

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Description

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

The closest analogue of the proposed method for the correction of intravascular platelet activity in patients with metabolic syndrome (MS) can be considered the method RU 2272628 C1, 03/27/2006.

This method allows you to level platelet dysfunction in metabolic syndrome and the appointment of a low-calorie diet, as well as the introduction of calcium channel blocker amlodipine and metformin. The technical result of the known method coincides with the declared when achieving the result within a 2-month course of treatment.

The claimed method differs from the known one in that as a drug therapy, a candesartan angiotensin receptor blocker is administered at a dose of 8 mg in the morning, and metered exercise is also used. Moreover, the technical result of the claimed method coincides with the known one.

The scientific search that led to the creation of the claimed method was dictated by the fact that amlodipine used in the prototype can be used by far not every patient with metabolic syndrome due to both possible individual intolerance of the drug and its economic inaccessibility to a significant part of patients. In addition, among patients with metabolic syndrome, a high proportion of people are in need of combined antihypertensive therapy with a calcium antagonist and angiotensin receptor blocker. The drug metformin also has its contraindications and cannot be used in a large number of patients with metabolic syndrome, while dosed physical activity is indicated to the vast majority of people with this pathology, providing a comprehensive healing effect on the body. In this regard, the task was set - to develop a more accessible method for the correction of thrombocytopathy for a wide range of people with metabolic syndrome using approaches that are more widely used in patients with metabolic syndrome - a low-calorie diet, dosed physical activity, and angiotensin receptor blocker as a hypotensive agent.

Moreover, never before has a treatment complex consisting of an individually selected hypocaloric diet, dosed physical activity, and candesartan been used in patients with metabolic syndrome to normalize the intravascular activity of platelets (BAT).

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

The essence of the proposed method lies in the fact that for the correction of BAT, patients with metabolic syndrome are assigned an individually selected hypocaloric diet, dosed physical activity and candesartan in a dose of 8 mg in the morning.

The method allows to correct BAT in patients with MS for two months, translating it to a level close to that for healthy people. Subject to the subsequent recommendations of the proposed method, it is possible to maintain BAT in the 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 heart attack and stroke.

The inventive method is as follows.

Evaluation of BAT is carried out in the following way (A. Shitikova et al. Method for determining intravascular platelet activity and its significance in clinical practice. // Clinical Laboratory Diagnostics, 1997, No. 2.- P.23-35). From a needle inserted into the ulnar vein, 2-3 ml of blood is drained onto cotton and the next 2 ml is poured into a silicone centrifuge tube with 8 ml of a solution of 0.125% glutaraldehyde. This tube is filled first to all other samples recruited to study the hemostatic system. The resulting blood is immediately centrifuged for 6 minutes at 1000 rpm. In case of incomplete deposition of red blood cells (pink supernatant), 2 ml of supernatant are collected in another tube and centrifuged in the same mode for 1 min. The supernatant was diluted four times with a solution of glutaraldehyde (0.1 ml + 0.3 ml of solution), mixed with a pipette and filled in the Goryaev chamber, which was placed for 20 min in a humidified Petri dish.

In order to determine the absolute platelet content in 10 ⁹ / l of blood in the filled Goryaev’s chamber, the number of all single blood platelets, regardless of their shape, is counted in five large squares. The obtained value for calculating the platelet content in 10 ⁹ / l of blood needs to be multiplied by 5 × 4 × 10 × 5 × 10 ⁶ = 1 × 10 ⁹ , where the first two digits are the corrections made during the blood dilution study, the second two digits are the corrections associated with the height of Goryaev’s chamber (0.1 mm) and the area on which blood plates were counted (5 large squares = 1/5 mm ² ), 10 ⁶ - conversion factor 1 mm ³ into 1 liter. Having determined the absolute platelet content in the test blood, the relative values of the individual platelet forms (in%) are converted to their absolute content of 10 ⁹ / L. blood. Absolute values in pathology can more adequately reflect changes in the determined distribution of forms.

In the same preparation, the number of aggregates of different sizes (i.e., containing 2, 3, 4, 5, etc. blood plates) per 500 free platelets is counted. The result is evaluated by the distribution of aggregates of different sizes per 100 free platelets. To facilitate the analysis of the distribution aggregatogram, the results can be summarized in the form of two quantities: 1) the number of small aggregates containing 2-3 platelets, and 2) the number of medium and large aggregates containing 4 or more platelets. A change in these values under pathological conditions more clearly reveals an increase in the process of intravascular activation of blood platelets.

The degree of aggregation is also assessed by the relative number of all platelets involved in the aggregation reaction. The latter can be detected by the percentage of the number of aggregated platelets to their total number in the preparation (i.e., to the sum of free-lying cells and involved in aggregation) according to the formula

where x, y, z, etc. - the number of aggregates of the appropriate size per 500 free platelets. This formula cannot be applied if the preparation contains irreversible, optically homogeneous aggregates or so large that it is impossible to calculate the number of cells in them. In this case, they are limited to data on the distribution of aggregates of different sizes.

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 coefficient obtained 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. Strives 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; 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 classes, it is possible to use the following set of exercises.

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 candesartan 8 mg in the morning.

Example. Patient T., 53 years old, with a body weight of 80.0 kg, a body mass index of 29.2 kg / m ² , suffering from metabolic syndrome for 9 years, examination revealed an increase in intravascular platelet activity (discocytes - 62%, disc echinocytes - 21%, spherocytes - 14.0%, sphero-echinocytes - 2.9%, biopolar forms - 0%, the sum of active forms - 38%, the number of platelets in aggregates - 3.0%, the number of small aggregates - 20 per 100 free platelets, the number of medium and large aggregates is 12 per 100 free platelets).

The patient was prescribed an individually selected hypocaloric diet (1953, 1 kcal), candesartan 8 mg in the morning. The patient was examined 2, 4 and 8 weeks after the start of treatment. Simultaneously with the examination, a BAT study was performed.

By the 8th week of treatment, the patient began to decrease body weight (76.0 kg) and complete normalization of the intravascular activity of platelets was achieved (discocytes - 86%, disco-echinocytes - 7.8%, spherocytes - 3.5%, sphero-echinocytes - 2.2%, biopolar forms - 0.5%, the sum of the active forms - 14%, the number of platelets in aggregates - 5.0%, the number of small aggregates - 6 per 100 free-lying platelets, the number of medium and large aggregates - 0.4 per 100 free platelets).

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

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

Claims (1)

A method for correcting intravascular platelet activity in patients with metabolic syndrome, including the use of 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 loads and candesartan 8 mg in the morning for 2 months.