79
Volume 04 Issue 01-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
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SSUE
01
Pages:
79-83
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
OCLC
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1121105510
METADATA
IF
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7.569
Publisher:
The USA Journals
ABSTRACT
The medical and social significance of type 1 diabetes mellitus (DM) throughout the world is due to early disability and
high mortality in patients due to the development of complications, including those from the cardiovascular system.
The increase in the life expectancy of patients with diabetes has highlighted the problem of late complications of the
disease, the number of which increases with the progression of the disease. The leading cause of death in diabetic
patients is cardiovascular accidents. At the same time, it was found that patients with diabetes under the age of 30
years quite often develop coronary heart disease. In addition, the progression of diabetes leads to the development
of cardiomyopathy (myocardial dystrophy), myocardiosclerosis, heart failure, life-threatening cardiac arrhythmias,
and sudden cardiac death.
Interest in the study of diabetic cardiomyopathy (PrEP) is due to a true increase in the frequency of its occurrence in
common pathology of social significance and the emergence of new instrumental research methods (Doppler
Research Article
ASSESSMENT OF THE EFFECTIVENESS OF CARDIOPROTECTIVE
DRUGS IN TREATMENT OF CHILDREN WITH DIABETIC
CARDIOMYOPATHY
Submission Date:
January 10, 2022,
Accepted Date:
January 20, 2022,
Published Date:
January 30, 2022 |
Crossref doi:
https://doi.org/10.37547/TAJMSPR/Volume04Issue01-09
Negmatova Gulzoda Shukhratovna
Assistant, Department of Endocrinology, Samarkand State Medical Institute, Samarkand, Republic of
Uzbekistan
Togaeva Gulnora Siddiqovna
Assistant, Department of Endocrinology, Samarkand State Medical Institute, Samarkand, Republic of
Uzbekistan
Davranova Aziza Davranovna
Assistant, Department of Endocrinology, Samarkand State Medical Institute, Samarkand, Republic of
Uzbekistan
Azimbegova Sitora Nodirovna
Assistant, Department of Endocrinology, Samarkand State Medical Institute, Samarkand, Republic of
Uzbekistan
Journal
Website:
https://theamericanjou
rnals.com/index.php/ta
jmspr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
80
Volume 04 Issue 01-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
I
SSUE
01
Pages:
79-83
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
echocardiography, 24-hour monitoring of heart rate and blood pressure), which significantly improved diagnostic
capabilities.
One of the drugs used in cardiology for metabolic purposes is Nikavit Cardio, the mechanism of action of which is
associated with the direct inhibition of fatty acid oxidation. The latter is accompanied by a significant increase in the
intensity of oxidative phosphorylation and a decrease in acidosis in the cardiomyocyte. A number of clinical studies
have shown the high efficiency of Nikavit Cardio, the effectiveness and safety of the use of Nikavit Cardio, due to its
cytoprotective mechanism of action, which makes it possible to prescribe it to patients with diabetes mellitus.
KEYWORDS
Diabetes mellitus, cardiomyopathy, cytoprotector, nikavit cardio.
INTRODUCTION
Objective
:
Methods
for
correcting
diabetic
cardiopathy in children with type 1 diabetes mellitus.
MATERIALS AND METHODS OF RESEARCH
A total of 40 children with diabetes mellitus, aged from
3 to 15 years old (average age 10.3 ± 3.4 years), 27 boys
and 13 girls were examined, 15 of them were residents
of the region's districts, 25 urban. For each child, an
information card was compiled, including information
from the anamnesis, clinic, electrocardiography (ECG)
and Echo-Doppler (Echo-KG) and laboratory methods
[2]. All patients were divided into groups depending on
the degree of compensation and the duration of
diabetes at the time of examination.
The first group consisted of 14 children (mean age 10.1
± 3.2 years) with newly diagnosed diabetes mellitus [1],
(fasting glycemia more than 8.0 mmol / l, fluctuations
during the day more than 5.0 mmol / l, nocturnal
hyperglycemia, episodes of hypoglycemia, HbA1c
level> 7%). Disease duration at the time of examination
ranged from 0 to 4 months (on average, 1 month ± 12.5
days). In this group, the drug Preductal (trimetazidine)
was used in a daily dose of 60 mg for 2.5 months.
Preductal slows down fatty acid oxidation by
selectively inhibiting long-chain 3-ketoacetyl-CoA
thiolase, which leads to an increase in glucose
oxidation and restoration of conjugation between
glycolysis and oxidative decarboxylation and protects
the myocardium from ischemia. Switching fatty acid
oxidation to glucose oxidation underlies the
antianginal action of preductal [3].
The second group included 13 children (mean age 12.4
± 3.5 years) who were in a state of diabetes
decompensation at the time of examination (fasting
glycemia more than 10.0 mmol / l, fluctuations during
the day more than 6.0 mmol / l, nocturnal
hyperglycemia, episodes of hypoglycemia, HbA1c
level> 8%). The duration of diabetes was up to 5 years
(3.17 + 0.98 years). In this group, the drug L-carnitine
chloride (Elcar) 20% solution for oral administration
was used at a daily dose of 20 mg / kg for 2.5 months.
Elkar is involved in metabolism as a carrier of fatty acids
81
Volume 04 Issue 01-2022
The American Journal of Medical Sciences and Pharmaceutical Research
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VOLUME
04
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Pages:
79-83
SJIF
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(2020:
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OCLC
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METADATA
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7.569
Publisher:
The USA Journals
across cell membranes from the cytoplasm to
mitochondria, where these acids are oxidized (beta
oxidation process) with the formation of a large
amount of metabolic energy (in the form of ATP) [4].
The third group included 13 children (mean age 11.7 ±
2.5 years) with diabetes for more than 5 years (fasting
glycemia more than 15.0 mmol / l, fluctuations during
the day more than 7.0 mmol / l, nocturnal
hyperglycemia, episodes of hypoglycemia, HbA1c
level> 9%). In this group, Nikovit Cardio was used in a
daily dose of 200 mg 2 times a day for 3 months. The
drug is a cardiometabolic complex that normalizes the
metabolism of potassium and magnesium, activates
cytoplasmic enzymes, regulates intracellular osmotic
pressure, protein synthesis, amino acid transport,
conduction of nerve impulses, improves skeletal
muscle
contractions
in
muscular
dystrophy,
myasthenia gravis. Coenzyme Q10 is a coenzyme of
various enzymes involved in myocardial metabolism.
Promotes the normalization of lipid metabolism [5].
Clinical and instrumental signs of damage to the
cardiovascular system in 40 patients with diabetic
cardiomyopathy (DC) [3].
In the third group, compared with the first group 1,
there was a statistically significant decrease in
pathological changes in the terminal part of the
ventricular complex. Thus, the frequency of
registration of negative T waves decreased to 5.0%,
flattened T waves - to 15.0%, ST segment depression -
to 0%. Low QRS voltage after treatment was noted in
only one child. The manifestations of tachycardia in the
first group after the course of preductal were 70.0%
(with an initial frequency of 95.0%), which can be
explained by an improvement in the metabolism of
autonomic nerve fibers of the heart. Against the
background of therapy with nikavit cardiovitis in the
third group, after physical exertion, a significant
decrease in the percentage of pathological ECG
changes was also observed. There was no ST segment
depression in any patient, flattening of the T waves
was detected in only two children (10.0%), and the
appearance of negative T waves after exercise was
noted in only one child (5%). (27.3%) children with a
relatively short duration of diabetes (4.0 ± 0.6 years) at
rest showed normal indicators of myocardial
metabolism. myocardium.
After treatment with nikavit cardio in children with DC,
the parameters of diastolic transmitral blood flow
normalized, which remained 3 months after the drug
was discontinued. So, in comparison with the
indicators before treatment and with group 1, the
speed of the peak E increased (p <0.05) to 0.79 + 0.03
m / s, the ratio E / A to 1.41 + 0.1 units, the temporal
indicators tended to to decrease. 6 months after the
end of the course of nikavit cardio therapy, some
indicators returned to the pre-treatment level. EDV
decreased to 74.86 + 2.48 ml, HR - to 10.14 + 1.61 cm / s,
although there were differences with the comparison
group [6]. The values of EF, Vcf, AS level reached
significant differences from the baseline level, and the
characteristics of the transmitral diastolic blood flow
did not make significant differences either with the
parameters before treatment or with the values of the
previous observation period. It should be noted that
among the examined patients in 7 children with a
longer diabetes mellitus (> 5 years) complicated by
diabetic cardiomyopathy, the most pronounced
positive changes in hemodynamic parameters were
achieved with the help of nikavit cardio. Thus, the drug
nikavit cardio should be used with initial deviations of
the indicators of diastolic heart function from the age
norm. This is justified from the point of view of
normalization of metabolic processes in the heart
muscle, hemodynamic unloading of the heart, and
finally, the possible prevention of the development of
82
Volume 04 Issue 01-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
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2689-1026)
VOLUME
04
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Pages:
79-83
SJIF
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(2020:
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(2021:
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64
)
OCLC
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1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
cardiosclerosis and heart failure. Under the influence
of nikavit cardio, EDV, HR, as well as EF, AS, Vcf
significantly increase, which indicates a decrease in
diastolic rigidity of the myocardium and an increase in
LV contractility.
CONCLUSIONS
1.
In children with type 1 diabetes mellitus
complicated by diabetic cardiopathy, a negative T
wave ECG showed a decrease and flattening of T,
depression of the ST segment of low QRS voltage
on Echo-KG, a decrease in diastolic rigidity of the
myocardium and an increase in LV contractility.
2.
With a decrease in diastolic rigidity of the
myocardium and an increase in LV contractility, it is
recommended to improve metabolism and systole
- diastolic function of the myocardium, stabilize the
basic functional indicators of cardiac activity in
children and adolescents, the drug Nikovit Cardio
in a daily dosage for a period of 30 to 90 days.
3.
To restore myocardial function, the most effective
use of drugs that improve metabolism Coenzyme
Q10 is a coenzyme of various enzymes involved in
myocardial
metabolism.
Promotes
the
normalization of lipid metabolism.
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The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
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VOLUME
04
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SSUE
01
Pages:
79-83
SJIF
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(2020:
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OCLC
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The USA Journals
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