RU2703137C1 - Method for complex correction of comorbid pathology in perimenopausal women - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention refers to medicine, namely to rehabilitation, and can be used for complex treatment of metabolic syndrome in patients with accompanying climacteric, sideropenic and depressive perimenopausal syndromes. For 5 weeks, 10 sessions of 40 minutes are performed in the Spectra Color SPA System. One capsule of 50 mg of the Ferretab-comp preparation and 500 ml of freshly prepared dietary and phytotherapeutic smoothie is taken daily, with the following ratio of components, wt%: banana fruits (20 %), cocoa powder (5 %), defatted milk (70 %), hemp flour (2.7 %), flax flour (2 %), and finely ground powder of officinal herbal medicines – camomile blossom flowers (0.1 %), red clover grasses (0.1 %) and common St. John's wort herbs (0.1 %).EFFECT: method provides higher clinical effectiveness ensured by the complex administration of the preparation Ferretab-komp and smoothie and sessions in the rehabilitation chamber.1 cl, 2 ex

Description

In connection with the continuing tendency to increase life expectancy in modern society, there is growing interest in the health problems of women of the older age group. A modern woman spends almost a third of her life in a state of menopause (peri- and postmenopausal women), which is characterized by various pathological manifestations of an estrogen-deficient condition caused by an age-related decrease and then cessation of ovarian function, as well as other endocrine changes (Vikhlyaeva EM, 2000; Zaydieva Y.Z., 2017).

One of the frequent disorders in this age period is also metabolic syndrome (MS) - a combination of various disorders and / or diseases that are risk factors for the early development of atherosclerosis and its cardiovascular complications. (Dedov I.I., Melnichenko G.A., 2014). The main symptoms and manifestations of the metabolic syndrome are:

- abdominal-visceral obesity

- insulin resistance and hyperinsulinemia

- dyslipidemia

- arterial hypertension

- impaired glucose tolerance / type 2 diabetes

- early atherosclerosis / TBS

- hyperuricemia and gout

- microalbuminuria

- hyperandrogenemia

- liver steatosis

- Obstructive sleep apnea syndrome.

Combined with menopausal syndrome (CS), which occurs in women in the menopause during a neurohormonal restructuring, MS is an even more multifactorial disease, often comorbid to many other somatic and psychosomatic disorders. CS is observed in 30-60% of women aged 45-65 years, while the duration of CS up to 5 years is observed in 35% - 56% of patients, up to 15 years or more - in 26% - 40%, which is regarded as a prolonged course of CS (Tikhomirov A.L., Oleinik C.G., 2013).

It is in this age category that there is a high prevalence of all kinds of metabolic disorders, including type 2 diabetes mellitus (DM-2) and psychoemotional (non-psychotic anxiety-depressive) disorders (Dedov I.I., Shestakova M.V., 2010; Smulevich A.B., 2016). Currently, diabetes and non-psychotic depression are among the most common chronic non-infectious diseases in humans, and are included in the register of the most important medical and social problems addressed at the state level (Smulevich A.B., 2018).

WHO predicts that by 2030, 1.2 billion women in the world will be at the age of postmenopause (Tikhomirov A.L., Oleinik C.G., 2003). The search for new methods of treating diseases characteristic of this population group is an urgent task of medical science. Symptoms of CS are divided into three main groups: neuro-vegetative, metabolic-endocrine and psycho-emotional, and therefore all these symptom complexes must inevitably be treated comprehensively and polytherapeutically.

The proven incidence of anxiety-depressive disorders (MAD) in patients with CS is 65-100% (Bardenstein L.M., 2005; Popov A.A., 2009; Richardson T.A., Robinson RD, 2010; Schnatz PF, 2015 ; Torchinov AM et al., 2016). The presence of TDD in patients with CS and MS aggravates the manifestations of comorbid somatic pathology - cardiovascular diseases (Baturin K.A., 2016), various metabolic disorders (Wassertheil-Smoller S. et al., 2004), postmenopausal osteoporosis (Menczel J. , 2010), reduces the quality of life of patients (Bankowski BJ, 2012; Conde DM, 2016).

The high frequency of metabolic, climacteric and depressive disorders in women of transitional age, in the prime of their professional activities, as well as the multivariance and polymorbidity of clinical symptoms, significantly worsen the health and well-being of women, reduce their quality of life, which determines enormous not only social, but also economic importance.

In addition, with the combination of the above nosology with sideropenic syndrome, there is an even greater need for comprehensive treatment and rehabilitation. Sideropenic syndrome is characterized by symptoms such as:

1. dry skin;

2. hair change (dullness, brittleness, excision, loss);

3. change of nails (thinning, brittleness, koilonychia); cheilosis (angular stomatitis, "jams");

4. sideropenic glossitis;

5. sideropenic dysphagia;

6. hypo- or anacid gastritis; tendency to caries;

7. increased fatigue; muscle weakness; delayed physical and psychological development; headache; hepatosplenomegaly; perversion of taste and smell; blue sclera; nocturnal enuresis, urinary incontinence.

8. addiction to spicy, salty, sour, spicy food;

9. perversion of smell - addiction to smells that are perceived by most people as unpleasant (gasoline, acetone, the smell of varnishes, paints, shoe polish, etc.);

10. severe muscle weakness and fatigue, muscle atrophy and decreased muscle strength due to a deficiency of myoglobin and tissue respiration enzymes;

11. dystrophic changes in the skin and its appendages (dryness, peeling, tendency to quickly form cracks on the skin; dullness, brittleness, loss, early graying of hair; thinning, brittleness, transverse striation, dullness of the nails; symptom of koilonychia - spoon-shaped concavity of the nails);

12. angular stomatitis - cracks, “seizures” in the corners of the mouth (found in 10-15% of patients);

13. glossitis (in 10% of patients) - characterized by a sensation of pain and bursting in the tongue, redness of its tip, and later atrophy of the papillae (“varnished” tongue); often there is a tendency to periodontal disease and caries;

14. atrophic changes in the mucous membrane of the gastrointestinal tract - manifested by dryness of the mucous membrane of the esophagus and difficulties, and sometimes pain when swallowing food, especially dry (sideropenic dysphagia); the development of atrophic gastritis and enteritis;

15. the symptom of “blue sclera” - is characterized by a bluish color or pronounced blueness of the sclera;

16. peremptory urge to urinate, inability to retain urine when laughing, coughing, sneezing, even night-time urinary incontinence is possible, which is due to weakness of the sphincter of the bladder;

17. "sideropenic subfebrile condition" - characterized by a prolonged increase in temperature to subfebrile values;

18. pronounced predisposition to acute respiratory viral and other infectious and inflammatory processes, chronic infections, due to a violation of the phagocytic function of leukocytes and weakening of the immune system;

19. reduction of reparative processes in the skin, mucous membranes.

The modern introduction into clinical practice of various medications, including hormone replacement therapy, timoleptics and iron preparations, over the past decade, has effectively influenced the severity of the manifestations of menopause, metabolic, depressive and sideropenic syndromes, as well as the prevention of medium-term and late metabolic disorders, however, this drug treatment often causes side effects (Grigoryan O.R., Antsifirov M.V., 2013; Krasnov V.N., 2016). This necessitates the search for effective and safe methods for the non-drug correction of menopausal disorders in women with depression and sideropenia, for example, with diabetes mellitus, which, together with compensation for carbohydrate metabolism, should lead to the prevention of severe metabolic disorders and significantly improve the quality of life of postmenopausal patients.

We have used a new rehabilitation method, the SPA capsule, for the treatment of all four combined disorders and nosology, which occupies a special place among the latest achievements of domestic regenerative medicine in the field of complex treatment and rehabilitation of comorbid chronic diseases. The practical solution of this medical and technical task for the rehabilitation of women has become possible thanks to innovative developments in correction methods applicable in this physiotherapy unit.

Studies on patent and scientific and technical information sources have shown that the proposed correction method for these comorbid disorders is not known, has not yet been applied for all these diagnoses and should not be explicitly studied from the prior art, meets the criteria of “novelty” and “inventive” level".

The prototype of the invention is the patent RU 2226381 C1 “METHOD OF RESTORING THE HUMAN BODY'S OPERATIONALITY AND TREATMENT OF THE CHRONIC FATIGUE SYNDROME” (patent holders: Closed Joint-Stock Company “Tsarskoye Selo Plant-Sofia”, which provides for rehabilitation of the Center for Psychosomatics), Posositic Improvement) the health of the human body and the treatment of chronic fatigue. Using a rehabilitation capsule, vibromassage, ultraviolet irradiation, aromatherapy, thermotherapy, as well as directing ionized air to the face area and visual impact with color and music are carried out in it, while the brain structures are additionally stimulated with electric pulses, acting by a pulsed bipolar current of 1-5 mA s with a stimulation frequency of 66-80 Hz and a pulse duration of 3.5-4.0 ms by applying electrodes to the frontal and occipital regions of the head. In addition, if it is necessary to enhance the effect, they additionally massage the cervical-collar zone and act on reflexogenic points, and in the case of an increased labile psychoemotional status, they perform a psycho-corrective effect on the human body using breathing, the rhythm of which is determined from the inspiration-expiration ratio as one to two and forming a relaxing visual image.

The disadvantages of this invention are the lack of effectiveness of the methods used to treat comorbid metabolic and sideropenic syndromes in patients with CS, as well as the developed methodology for this combined pathology.

An analogue of the invention is also the method of "HORMONAL CORRECTION OF CLIMACTERIC DISORDERS IN PATIENTS WITH METABOLIC SYNDROME" (authors: Berikhanova PP, Minenko PP Journal of the Bulletin of new medical technologies. Electronic edition. 2015. No. 2. Publication 2-21. URL: http: http: // 21. /www.medtsu.tula.ru/VNMT/Bulletin/E2015-2/5200.pdf (accessed: 06/30/2015), which uses the method of complex non-hormonal correction of menopausal disorders in women with metabolic syndrome, or rather, non-drug complex ( diet therapy, psychotherapy, physiotherapy, lay down physical culture) and oral extract of dry red clover (Trifoliumpratense), standardized to 40% isoflavones at a dose of 160 mg - 1 capsule per day.This method has been shown to be effective according to the Cooperman index, transvaginal echography, cytography of cervical scrapings (PAP- test) and mammological research.

The disadvantage of this method is the lack of effectiveness of the methods used for the treatment of comorbid depressive and sideropenic syndromes in patients with MS and CS.

A close analogue of the invention is patent US 5645578 A “TOTAL THERAPY SAUNA BED SYSTEM” (Copyright: VISIBELLE DERMA INSTITUTE Inc.), which also uses complex correction with the physiotherapeutic Spectra Color SPA System (Sybaritic Inc., USA) for relaxation ), giving the effect of therapeutic factors: aromatherapy, music therapy, color therapy, vibrotherapy, ion therapy.

The disadvantages of this method are the lack of proven effectiveness in the combined metabolic, climacteric, anxiety-depressive and sideropenic syndrome in perimenopausal patients, as well as the extremely low systematic nature of the recipe for using this method with the above pathology.

Also an analogue of the proposed solution is a description of the use of the Spectra Color SPA System apparatus (Sybaritic Inc., USA), set forth on the web resource https://web.archive.org/web/20190407175536/https://loza.ru / spectra_color_spa_system (content retention date: 04/07/2019), which describes that this rehabilitation capsule is used in many areas of medicine, especially in balneology, physiotherapy, neurology, narcology, nutrition, cosmetology, sports medicine and is effective in the treatment of psychosomatic diseases and for : relaxation, stress relief, stimulation of immunity, withdrawal elimination of toxins (detoxification), activation of metabolic processes, improvement of microcirculation, lymphatic drainage, cellulite prophylaxis, body shaping, stimulation of sweating, remineralization, removal of muscle fatigue, skin cleansing (rejuvenation), calorie burning, weight regulation, contributing to: increase mood, energy, concentration , reduce tension, restore daily biorhythms.

The disadvantage of this description of the effect of the technique is the lack of development and techniques for the treatment of comorbid menopause, depressive and sideropenic syndromes in patients with MS. In addition, the described method in our invention is used in much more detail and accuracy.

Also known is the treatment method described in the dissertation of Samsonova OS “APPLICATION OF TRANSCRANIAL MAGNETOTHERAPY IN COMBINATION WITH PHYTESTROGENS IN CORRECTION OF METABOLIC DISORDERS IN WOMEN WITH CLIMACTERIC SYNDROME” (2017), in which transcranial magnetotherapy in combination with the use of the patient with the treatment of menopause and phytogenesis was used, it was used starting from a frequency of 1 Hz with a duration of 7 minutes, the field strength is 10-30 mT, then the frequency and duration of the procedure are gradually increased to 1 0 Hz and 12 min. accordingly, with the aim of adapting to this physical factor and eliminating individual intolerance. And the patient’s phytoestrogen drug Klimadinon took 1 tablet 2 times a day at the same time of day (day and evening) and the course of treatment was 30 days.

The disadvantages of this method is the lack of effectiveness of the methods used by the author for the treatment of comorbid depressive and sideropenic syndromes in patients with CS and MS.

Also known is the patent “METHOD FOR TREATING CLIMACTERIC SYNDROME IN WOMEN OF THE PREVIOUS-PAUSAL PERIOD” RU No. 2564088 C1 (patent holder: Federal State Budgetary Institution “Rostov Research Institute of Obstetrics and Pediatrics” of the Ministry of Health of the Russian Federation), in which case law enforcement is carried out a set of physical exercises - aerobic and anaerobic loads of a cyclic nature lasting in a ratio of 1: 2. When identifying the left lateral profile - cyclic aerobic loads in combination with breathing exercises lasting in a ratio of 2: 1. When revealing the ambidextral profile, only cyclic aerobic loads are included in the complex of physical exercises.

The disadvantages of this method is the lack of effectiveness of the methods used by the author for the treatment of comorbid metabolic, depressive and sideropenic syndromes with CS and a longer rehabilitation period.

An analogue of the claimed invention is also patent RU 2376026 C1 on “MEDICINAL PRODUCT FOR PREVENTION AND TREATMENT OF PATHOLOGICAL MANIFESTATIONS OF CLIMACTERIC SYNDROME” (copyright: GOU VPO SibGMU ROSZDRAVA, Poluektova T.V. which for the prevention and treatment of the manifestations of the menopause uses a medicinal product based on plant collection containing licorice roots, rhizomes and roots of calamus swamp, chamomile flowers, meadow clover grass, hop cones, horsetail grass left, taken in equal parts by weight or made in the form of granules, wherein the granules contain 10% dense extract collecting and 90% lactose. These compositions have estrogen-like, anti-inflammatory and antimicrobial effects in the pathological course of menopause

The disadvantage of this invention is the study of effectiveness only in laboratory animals - mice and rats, as well as the impossibility of obtaining an effect with combined pathology, as in the present method.

The technical result of the claimed invention is to increase the effectiveness of the treatment of metabolic syndrome, in combination with menopause, depression and sideropenic, by reducing the duration of the entire amount of procedures. The method allows to prevent the development of MS, CS, DS and mild sideropenic syndrome with its timely use.

The method is as follows.

The combination of rehabilitation procedures is carried out taking into account their compatibility in accordance with the appendix “The list of necessary medical services and procedures dispensed in specialized sanatoriums to the patient according to the profile of his disease. Guidelines ”(approved by the Ministry of Health of the Russian Federation on December 22, 1999, No. 99/229).

The patients simultaneously underwent a comprehensive healing effect with the help of the Spectra Color SPA System (Sybaritic Inc.) rehabilitation facility, USA, registration certificate of the Ministry of Health of the Russian Federation No. 97/532 of 05.22.1997).

When drawing up the procedures, exact dosing of each influencing factor was carried out according to the degree of intensity and time of exposure according to a certain program.

A program was used that included the combined effects of melotherapy, aromatherapy, full-spectrum and selective chromotherapy, and aeroionotherapy. Using a stereo sound system with a CD player, passive (receptive) music therapy was carried out using advertising melodies for 30 minutes. Aromatic oils were sprayed through the four-channel system inside the capsule: lavender (Lavandula officinalis), common fennel (Foeniculum vulgare). The duration of aromatherapy was 40 minutes.

The effect of light on the patients was carried out through the skin and the visual analyzer. The rehabilitation installation includes six built-in full-spectrum fluorescent lamps with a total luminous power of 9000 lux and twelve monochrome light sources. The full range reproduces the effect of solar radiation, is pure white and includes red, orange, yellow, green, blue and violet colors. Full-spectrum chromotherapy was carried out for 40 minutes, the wavelength from 760 to 400 nm. At the same time, selective chromotherapy was used (green light for 30 minutes, wavelength 530 nm), aimed at stress relief, activation of photochemical processes. It was carried out simultaneously blowing face ionized cool air with the predominance of negative ions for 40 minutes. A special individual comfortable microclimate was created inside the capsule. The temperature regime was 30-35 ° C. A contour bed with supporting pads made it possible to take the most comfortable and relaxing pose. Sessions in the conditions of the Spectra Color SPA System)) rehabilitation facility were conducted twice a week for 40 minutes, a course of 10 sessions, for 5 weeks.

All patients with comorbid sideropenic syndrome in our method of treating comorbid disorders also took Ferretab Comp, consisting of 163.56 mg iron fumarate and 0.54 mg folic acid, for 5 weeks. The action was determined by the properties of its active ingredients. Iron fumarate is a salt of iron, a trace element necessary for the synthesis of hemoglobin. When using iron in the form of salts, it quickly replenishes its deficiency in the body, which leads to a gradual regression of clinical (weakness, fatigue, dizziness, tachycardia, soreness and dryness of the skin) and laboratory symptoms of anemia. Folic acid is necessary for the normal maturation of megaloblasts and the formation of normoblasts. It stimulates erythropoiesis, participates in the synthesis of amino acids, nucleic acids, purines and pyrimidines, in the exchange of choline.

Patients took the drug by mouth, 1 capsule per day on an empty stomach, washed down with liquid.

Also, all patients for 5 weeks ate smoothies from plant components, medicinal herbs and milk, 500 ml each day, at any time of the day, at one time.

Freshly prepared dietary and phytotherapy smoothie was used independently prepared by patients from the recommended components according to a specially developed recipe (ratio of components, wt.%): Banana fruit (20%), cocoa powder (5%), skim milk (70%), hemp flour ( 2.7%), flax flour (2%) and finely ground powder of officinal herbs - chamomile flowers (0.1%), meadow clover grass (0.1%) and St. John's wort perforated (0.1%).

The treatment of these comorbid disorders according to the proposed method favorably affected the general condition of the patients. Complications and deterioration of health are not registered. The method allows for an individual approach to each patient, taking into account the severity of her condition.

After 5 weeks of treatment, a maximum decrease in the total modified menopausal index (MMI) was observed - from the initial level of 37.4 ± 0.17 points to 25.6 ± 0.15 points (by 31.6%), which corresponded to a mild climacteric syndrome ( p <0.05). The psychoemotional component of MMI regressed from the initial level of 6.4 ± 0.1 points after 5 weeks of treatment to 4.8 ± 0.1 points (25.0%) (p <0.05). A marked regression of neurovegetative manifestations was noted: this MMI component significantly decreased from 19.4 ± 0.15 points to 11.4 ± 0.17 points (by 41.2%) (p <0.05). Endocrine and metabolic disorders decreased from 11.2 ± 0.15 points to 9.4 ± 0.12 points (p <0.05).

The reactive anxiety index from the initial level of 48.6 ± 0.4 points after 5 weeks of treatment decreased to 43.4 ± 0.2 points (by 10.8%), reaching a level of moderate anxiety. The indicator of personal anxiety from the initial level of 49.1 ± 0.3 points after 5 weeks of treatment regressed to the level of moderate anxiety - 43.4 ± 0.2 points (12.5%) (p <0.05).

During treatment, the number of patients with a positive Kerdo index decreased after 5 weeks of treatment by 19.5% of the original. Frequent psychoemotional and neurovegetative disorders in the examined women were heat flashes of varying severity, sleep disturbance. After 5 weeks of treatment, the frequency of complaints of hot flashes more than 10 times a day significantly decreased. After 5 weeks of treatment, the number of patients with complaints of hot flashes decreased by 56.3% of the initial value. Typical complaints of sleep disturbance in the examined patients were difficulty falling asleep, frequent waking up at night, early waking up, inability to fall asleep again, shallow sleep, excessive daytime sleepiness. A significant regression of the frequency of dissomnia during treatment was noted after 5 weeks of treatment -18.7%.

The most significant change in indicators across all scales of the SF-36 questionnaire was noted. The maximum positive trends were identified on the scales of physical functioning (PF) and role-playing physical functioning (RP). Physical functioning (PF) during treatment was statistically significantly improved after 5 weeks of treatment from the initial level of 47.5 ± 0.16 points to 67.4 ± 0.12 points, i.e. 41.7%. Role physical functioning (RP) significantly increased after 5 weeks of treatment from the initial level of 48.7 ± 0.12 points to 68.8 ± 0.11 points, i.e. 41.7%.

Against the background of the measures taken, after 5 weeks, the hemoglobin level increased by 15.3%, the hemoglobin content in the erythrocyte (MSN) increased, the iron content increased 2.4 times, and the serum ferritin increased 2.1 times .

During treatment, a maximum decrease in the total MMI was observed after 5 weeks - from the initial level of 45.4 ± 3.8 points to 25.6 ± 2.7 points (by 43.6%), which corresponded to a mild degree of menopausal syndrome (p <0 , 05).

The maximum significant decrease in the psychoemotional component of MMI was noted during therapy after 5 weeks - by 51.6%, after 6 months - by 67.9% of the initial values (p <0.05 when compared with the indicator before treatment). Psycho-emotional symptoms after 5 weeks of therapy significantly decreased by 32.3%.

Indicators of situational (reactive) and personal anxiety, obtained as a result of dynamic testing according to the Spilberger-Khanin technique, significantly decreased, approaching a low level after 5 weeks of treatment. The indicator of reactive anxiety decreased by 19.6%, the indicator of personal anxiety decreased after 5 weeks of treatment by 20.4% (p <0.05 when compared with indicators before treatment).

The Hamilton Depression Rating Scale (HDRS-21) initially showed mild to moderate depressive disorders. A marked decrease in the level of depressive disorders after treatment from an average baseline of 17.8 ± 0.9 points was observed after 5 weeks of therapy to 8.2 ± 0.6 points, that is, by 53.9% (p <0.05 when compared with indicators before treatment). During therapy, the number of patients with depressive disorders decreased: after 5 weeks - by 11.7%.

The number of patients with complaints of hot flashes more than 10 times a day decreased by 43.3% of the initial value (p <0.05 when compared with the indicator in the group before treatment). The frequency of complaints of hot flashes more than 10 times a day decreased after 5 weeks of treatment by 30.4% (p <0.05 when compared with the indicator in the group before treatment).

During treatment, the frequency of complaints of heart palpitations after 5 weeks decreased by 30.1% (p <0.05 when compared with the indicator before treatment).

One of the most frequent complaints examined was a complaint of sweating. Against the background of the comprehensive measures taken, the frequency of hyperhidrosis decreased after 5 weeks by 28.5% (p <0.05 when compared with the indicator before treatment).

Against the background of ongoing therapeutic measures, there was also a decrease in the frequency of complaints of irritability after 5 weeks by 20.1% (p <0.05 when compared with the indicator before treatment).

Typical complaints of sleep disturbance in the examined patients were difficulty falling asleep, frequent waking up at night, early waking up, inability to fall asleep again, shallow sleep, excessive daytime sleepiness. The regression of the frequency of dissomnia during treatment - through within 5 weeks - by 30.1% (p <0.05 when compared with the indicator before treatment.

The treatment of these comorbid disorders according to the proposed method favorably affected the general condition of the patients. Complications and deterioration of health are not registered. The method allows for an individual approach to each patient, taking into account the severity of her condition.

The claimed method of treatment of the combined metabolic, menopause, depressive and sideropenic syndromes is highly effective, requires minimal staff costs, is simple and affordable to use, can reduce the drug load on the woman’s body, can be used as in primary health care (outpatient or inpatient), and in spa facilities.

With this comorbid pathology, by optimizing the combination of factors of rehabilitation procedures, the drug Ferretab-comp and diet smoothie, the method provides an increase in the effectiveness of treatment with the synergistic effect of the treatment components.

We give clinical examples:

Example No. 1.

Patient M., 50 years old, postmenopausal 1 year, complained of general weakness, increased fatigue, sweating, sleep disturbances (insomnia at night, drowsiness during the day), hot flashes up to 20 times a day, headaches, palpitations at rest, increased irritability, irritability. The above complaints are noted within 10 months. Metabolic syndrome suffers for about 6 years. Conducted a comprehensive clinical and laboratory examination.

Diagnosis: basic: (according to ICD E 66.9.) Obesity 2 tbsp. Dyslipidemia. Impaired glucose tolerance. (Metabolic syndrome). Background: Menopausal syndrome of moderate severity (with a predominance of neurovegetative disorders). Latent iron deficiency.

Examination results: Height 162 cm, body weight 96 kg, BMI 36.6; HELL 145/95 mm RT; Kerdo autonomic index 19. Mild depressive disorder (12 points) was found on the Hamilton Depression Rating Scale (HDRS-21); the indicator of reactive anxiety 47 points, the indicator of personal anxiety 48 points; total MMI 54 points (neuro-vegetative component of MMI 29 points, psychoemotional component of MMI 12 points, metabolic symptoms 13 points); Hemoglobin (Hb) 110 G / l, hemoglobin content in erythrocyte (MCH) 22.4 pg, iron serum 8.6 μmol / l; ferritin 8.7 ng / ml; serum glucose 6.1 mmol / L, HOMA-IR 4.7 insulin resistance index; total cholesterol 7.4 mmol / l, triglycerides 2.2 mmol / l, atherogenic coefficient 4.3.

Was prescribed treatment according to the claimed method. After 2 weeks of treatment, a positive trend was observed: an improvement in overall well-being, sleep, a decrease in headaches, palpitations, sweating, irritability, a decrease in the frequency of hot flashes up to 10 times a day, blood pressure decreased to 135/85 mm Hg. After 5 weeks of treatment, body weight decreased to 83.0 kg (13.5% of the original); BMI - regressed to 31.6 (13.7%); headaches, palpitations stopped, hot flashes became rare (up to 1-3 times a day), mild, increased working capacity, normalized sleep, the patient noted the absence of weakness, increased fatigue, irritability, irritability; HELL stabilized at 125/85 mm Hg

According to laboratory tests, there was a positive dynamics of carbohydrate and fat metabolism: serum glucose decreased to 5.6 mmol / l, HOMA-IR insulin resistance index to 2.4; total cholesterol decreased to 5.7 mmol / l, triglycerides to 1.4 mmol / l, atherogenic coefficient to 3.1. Iron metabolism indices also improved: the hemoglobin level increased to 125 g / l, the erythrocyte hemoglobin content (MCH) increased to 27.9 pg, the iron content increased to 16.6 mmol / l; ferritin - up to 30.9 ng / ml.

According to the Hamilton Depression Rating Scale, 6 points is the norm, reactive and personal anxiety indicators reached moderate anxiety levels - 41 points and 42 points, respectively. The total MMI was 19 points (the neuro-vegetative component of the MMI was 9 points, the psychoemotional component of the MMI was 6 points, metabolic symptoms were 4 points), which corresponded to a mild degree of CS.

With a dynamic assessment of quality of life indicators according to the SF-36 questionnaire, there was a positive dynamics on all scales. The most significantly improved indicators were physical functioning (PF) and role-playing physical functioning (RP): physical functioning (PF) after 5 weeks of treatment was 65 points (initially 44 points), role-playing physical functioning (PF) 67 points (initially 43 points) .

Example No. 2.

Patient R., 48 years old, complained of general weakness, fatigue, hot flashes up to 12 times a day, headaches, shortness of breath, increased psychoemotional lability. The above complaints are noted within 6 months. Conducted a comprehensive clinical and laboratory examination.

Diagnosis: primary: Obesity 2 tbsp. Dyslipidemia. Impaired glucose tolerance. (Metabolic syndrome). Background: Menopausal syndrome of moderate severity (with a predominance of psychoemotional disorders). Latent iron deficiency.

Survey results: Height 160 cm, body weight 95 kg, BMI 37.1; HELL 140/90 mm Hg; Kerdo vegetative index 20. Mild depressive disorder (13 points) was found on the Hamilton Depression Rating Scale (HDRS-21); the indicator of reactive anxiety 48 points, the indicator of personal anxiety 49 points; total MMI 46 points (neuro-vegetative component of MMI 25 points, psychoemotional component of MMI 12 points, metabolic symptoms 9 points); Hemoglobin (Hb) 112 G / l, hemoglobin content in erythrocyte (MCH) 23.1 pg, iron serum 9.1 µmol / l; ferritin 12.7 ng / ml; serum glucose 6.2 mmol / L, insulin resistance index HOMA-IR 4.3; total cholesterol 6.8 mmol / l, triglycerides -1.9 mmol / l, atherogenic coefficient 3.9.

Was prescribed treatment according to the claimed method. After 2 weeks of treatment, there was a positive trend: an improvement in overall well-being, sleep, a decrease in headaches, a decrease in the frequency of hot flashes up to 5 times a day, blood pressure decreased to 130/80 mm Hg. After 5 weeks of treatment, body weight decreased to 84.0 kg (11.6% of the original); BMI - regressed to 32.8 (13.6%); headaches ceased, hot flashes became rare (up to 1-2 times a day), mild, increased efficiency, the patient noted the absence of weakness, increased fatigue; Blood pressure stabilized at 120/80 mm Hg. The indicators of carbohydrate and fat metabolism improved: serum glucose decreased to 5.5 mmol / l, the HOMA-IR insulin resistance index to 2.3; total cholesterol decreased from 5.8 mmol / l, triglycerides to 1.5 mmol / l, atherogenic coefficient to 2.6. Against the background of the measures taken, after 5 weeks the following laboratory indicators improved: the hemoglobin level increased to 127 g / l, the hemoglobin content in the erythrocyte (MCH) increased to 28.7 pg, the iron content increased to 17.8 μmol / l; ferritin - up to 35.2 ng / ml.

According to the Hamilton Depression Rating Scale, 6 points is the norm; the reactive anxiety index decreased to 43 points, reaching a level of moderate anxiety; personal anxiety indicator also regressed to the level of moderate anxiety - 43 points; the total MMI was 17 points (the neuro-vegetative component of the MMI was 9 points, the psychoemotional component of the MMI was 4 points, metabolic symptoms were 3 points).

Significant improvement in quality of life indicators was noted on all scales according to the SF-36 questionnaire. The most significantly improved indicators were physical functioning (PF) and role-playing physical functioning (RP) according to the scales of the SF-36 questionnaire: physical functioning (PF) after 5 weeks of treatment was 68 points (initial 48 points), role physical functioning 69 points (initial 47 points).

Claims (1)

Method for correction of metabolic syndrome in perimenopausal patients, combining comorbid with climacteric, emotional disorders and sideropenia, characterized in that for 5 weeks 10 sessions of 40 minutes are carried out in a Spectra Color SPA System rehabilitation chamber, 1 capsule 50 is taken daily mg of the drug Ferretab-comp and 500 ml of freshly prepared dietary and phytotherapeutic smoothie in the following ratio of components, wt. %: banana fruits (20%), cocoa powder (5%), skim milk (70%), hemp flour (2.7%), flax flour (2%) and finely ground powder of officinal herbs - chamomile flowers ( 0.1%), meadow clover grass (0.1%) and St. John's wort grass perforated (0.1%).