Kicha N. Factors of cardiovascular risk and their modification in patients with chronic cholecystitis in an outpatient setting.

Українська версія

Thesis for the degree of Candidate of Sciences (CSc)

State registration number

0413U007535

Applicant for

Specialization

  • 14.01.38 - Загальна практика - сімейна медицина

22-11-2013

Specialized Academic Board

Д 29.600.01

Essay

It was found that persons with gall bladder dysfunction (GBD) in chronic cholecystitis cardiovascular risk associated (?2 = 14,7) to the functional state gall bladder (GB): hypokinetic type - cardiovascular risk (CVR) threefold higher than in the hyperkinetic, and determined the influence of complex factors. Determined that the most informative constitutional-biological factors CVR at GBD are: the index figure "waist / hip" (2.324 bits), height - weight Ketle index (1.168 bits) and burdened; among psychosomatic and behavioral factors - the level of everyday activity (2,010 bits), duration and intensity of smoking (1.120 bits), personal characterological factors. Therefore, forecasting CVR in patients with chronic cholecystitis possible by combining a patient following factors: the index figure "waist/hip" (?2=24,0 %; p<0.05), prolonged and intensive smoking (?2 = 20,0 %, p<0.05), heredity (?2=14,0 %; p<0.05), increased growth-weighted index Ketle (?2=12,0 %; p<0.05), in the top of factors CVR prognostic significance are psychosomatic characteristics of patients. Revealed high level of atherogenic lipid profile in 57.5 % of men and 47.9 % of women with chronic cholecystitis, with the heightened CVR correlated with atherogenic lipid profile (rXY=+0,810; p<0.05) and high density lipoproteins content (rXY=- 0.485, p<0.05). With increased CVR discovered sexual difference in terms of content and very low density lipoproteins and triglycerides, manifested significantly (p?0,05) higher content of their men. Hypercholesterolemia occurs in (34,7±3,7)% of patients and recorded significantly higher in men than in women (p?0,05). Hypertriglyceridemia diagnosed among (47,4±5,1)% of patients with chronic cholecystitis; combined types of dyslipidemia found with equal frequency: type III - in (26,3±4,5)%, and type IIB - in (16,8±3,8)% of patients. It is shown that hypertriglyceridemia fairly frequently detected in hypokinetic than hyperkinetic type GBD and does not depend on gender patients, additional CVR was significantly (p?0,05) higher in hypokinetic type GBD. Defined clinical typological variants regulating systemic blood pressure. Found that patients with chronic cholecystitis, depending on the functional state of the gall bladder, characterized by different variants regulating systemic blood pressure: disadaptive variant of regulation - in (89,5±7,0)% of patients with hypokinetic type and (40,0±11,1)% of patients with hyperkinetic type GBD, indicating a significantly (p?0,001) greater frequency disturbances with such patients. According to the daily monitoring found significantly (p?0,05) more frequent "non-dipper" options is in hypokinetic type GBD in patients with chronic cholecystitis. The place of artichoke leaf extract in the treatment of wounds tended to a certain category of patients is justified systematic set of preventive, diagnostic and therapeutic measures to reduce CVR in ambulatory monitoring. Grounded: CVR stratification with regard to the kinetic state GB, individual factors determining the current CVR, type dyslipidemiy diagnosis, assessment of systemic blood pressure regulation and excluding medical and psychological characteristics of patients at the primary level of care.

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