The examined patients (104) with compressive neuropathy (CN) of peripheral nerves (PN) (PNCN) of the upper limb (UL), chronic pancreatitis (CP) and obesity were divided into two clinical groups depending on the disorders of the carbohydrate metabolism: group I included 58 patients with PNCN of the UL, CP and obesity in combination with type 2 diabetes mellitus (DM); group II included 46 patients with PNCN of the UL, CP and obesity who had insulin resistance (IR). In accordance with the goal and objectives of the scientific study, patients in both groups were divided into 2 subgroups depending on the form of PNCN: subgroup 1.1 (n= 29) and subgroup 2.1 (n= 23) included patients with pronator teres syndrome (PTS); subgroup 1.2 (n= 29) and subgroup 2.2 (n= 23) included patients with carpal tunnel syndrome (CTS). The control group included 20 practically healthy individuals: 7 males (70.0%) and 3 females (30.0%). The average age of the examined control group was 40.1±5.6 years.
Analysis of laboratory and instrumental methods of examination confirmed CP, and also allowed to establish the severity of exocrine pancreatic insufficiency (EPI). A decrease in the level of pancreatic elastase-1 (PE-1) to 70.05±3.09 mcg/g in patients of group I and to 92.56±2.11 mcg/g in patients of group II was diagnosed, which confirms severe exocrine pancreatic insufficiency. Analysis of bioimpedancemetry data indicates a pronounced accumulation of body adipose tissue in patients with insulinresistance (IR) of group II, especially in females, namely an increase in fat content to 44.71±0.61% with a norm of 30.75±0.29% in females of the control group (p<0.01). Analysis of the statistical study indicates a relationship between the severity of EPI according to breath tests and the PE-1 index and the degree of obesity in these patients.
Analysis of the results of microbiological examination of fecal bacterial composition indicates a decrease in the amount of both anaerobic and aerobic normoflora. At the same time, among patients of group I, dysbiosis of the colon was more often detected – in 27.6%, while in patients of group II, dysbiosis of the colon of the II-III degree was more often detected – in 34.8-27.6% of those examined, respectively (p<0.05). At the same time, the decrease in the number of Bifidobacterium and Lactobacillus depends on the severity of obesity and the body composition in these patients.
A significant decrease in the level of vitamin B1 (thiamine) in the blood serum was detected, with the most pronounced changes in patients of group I (decrease to 32.38±0.31 μg/l – p<0.01). The level of pyridoxine hydrochloride (vitamin B6) in the blood serum of the examined patients also differed maximally from this indicator in the control group in patients of group I, namely decrease to 5.76±0.28 mcg/l – p<0.001. The folic acid (vitamin B9) index in patients of group I was 2.98±0.27 ng/ml, which is 6.14±0.02 ng/ml less than the control group index (p<0.001), and the level of cyanocobalamin (vitamin B12) in patients of group I decreased to 123.67±2.08 pg/ml, with a norm of 425.77±3.21 pg/ml in the control group (p<0.001).
Ultrasound examination of peripheral nerves indicates a significant difference in the obtained indicators in patients with PTS with CP and obesity compared with the data of the control group. A significant increase in the cross-sectional area of the wrist was established with maximum values in patients of subgroup 2.1 – up to 14.22±0.31 mm2 (p<0.01). In patients with CP and obesity, conduction disorders along the peripheral nerves of the UL were determined according to electroneuromyography data. Minor differences were found between individuals from subgroups 1.1 and 2.1.
Patients with PNCN were prescribed a drug containing uridine-5-disodium monophosphate, vitamins B9 and B12. Analysis of the results obtained after complex treatment in patients with both PTS and CTS indicates positive dynamics of clinical symptoms.
Key words: compressive neuropathy of the peripheral nerves of the upper limbs (tunnel syndrome); exocrine pancreatic insufficiency; chronic pancreatitis; anthropometric indicators (body mass index; obesity; sarcopenia); metabolic disorders (lipid metabolism indicators, carbohydrate metabolism, insulin resistance, type 2 diabetes mellitus); microbiome (colon dysbiosis, intestinal permeability disorders); diagnostics (ultrasound diagnostics, electroneuromyography, B vitamins); treatment.
