Darii I. Clinical and pathogenetic features of the mechanisms of chronic cerebral ischemia formation in patients with metabolic syndrome

Cerebrovascular diseases take one of the first places in mortality and disability of population in the world. More than 90% of the cerebrovascular diseases cases are chronic cerebral ischemia. One of the risk factors for developing chronic cerebral ischemia is the metabolic syndrome. The dissertation is devoted to the definition and improvement of diagnostic and therapeutic measures in patients with chronic cerebral ischemia and metabolic syndrome. The aim of the dissertation was to determine the clinical and pathogenetic mechanisms of chronic cerebral ischemia formation in patients with metabolic syndrome and to improve the tactics of their treatment. On the basis of clinical, instrumental and laboratory research the clinical and pathogenetic mechanisms of chronic cerebral ischemia formation in patients with metabolic syndrome are specified and supplemented. The author as a result of a comprehensive study of clinical and neurological, psychodiagnostic, neuroimaging, ultrasound, laboratory studies presented the features of the course of chronic cerebral ischemia with metabolic syndrome. In patients with chronic cerebral ischemia and metabolic syndrome, new scientific data on the frequency of clinical and neurological syndromes, on the features of structural changes in the extracranial segments of the common carotid artery have been updated. For the first time on the basis of the conducted researches it is established that at patients with chronic cerebral ischemia and metabolic syndrome the essential role in development of a disease development of increase of vasculoendothelial growth factor concentration and its diagnostic value is revealed. For the first time, the associated participation of the proinflammatory cytokine interleukin-6 and vasculoendothelial growth factor in the blood of patients with chronic cerebral ischemia and metabolic syndrome and their significant role in the implementation of this pathology was revealed. The gender difference in the concentration of interleukin-6 in patients with chronic cerebral ischemia and metabolic syndrome has been clarified. For the first time, some new correlations have been identified between anthropometric data, carbohydrate and lipid metabolism, pro- and anti-inflammatory cytokines, vasculoendothelial growth factor in patients with chronic cerebral ischemia depending on the presence of metabolic syndrome. Based on the definition of these complex changes, new methods of correction of detected disorders in patients with chronic cerebral ischemia and metabolic syndrome have been proposed. The results of the research allow to determine the complex and sequence of diagnostic and therapeutic measures in patients with chronic cerebral ischemia depending on the presence of metabolic syndrome at the stages of outpatient and inpatient treatment. The practical value of the obtained results is determined by the ability to optimize treatment in patients with chronic cerebral ischemia and metabolic syndrome by additional monitoring of vasculoendothelial growth factor and cognitive impairment. The use of indicators of cytokine and vasculoendothelial growth factor reactivity disorders for the most reliable assessment manifestations of pathological changes and inflammatory processes in patients with chronic cerebral ischemia and metabolic syndrome has been proposed and statistically substantiated. The principles of the differential approach to the definition of anti-inflammatory therapy in order to optimize the treatment of patients with chronic cerebral ischemia and metabolic syndrome are substantiated. The results and conclusions of the research can be implemented in the practice of neurological, therapeutic, endocrinological, cardiological departments, family physicians to implement measures to diagnose and optimize the treatment of patients with chronic cerebral ischemia and metabolic syndrome.