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Methods of an estimation of gravity of a current menopauzalnogo a metabolic syndrome

MMS, being an interdisciplinary problem, arrests to itself in on - slednee time more and more steadfast attention. Diagnostics, pas - inspection tsienta about detection MMS is an actual problem. The inspection program is extensive, includes as traditional methods (interrogation, wasps - motr), and laboratory, tool diagnostics.

In our opinion, op - timalnoj the program developed by collective of authors under ruko - vodstvom N.A.Beljakova, G.B.Seidova [3 is, with. 70—71]:

1. The family anamnesis (revealing of a genetic predisposition to adiposity, a diabetes, an arterial hypertensia, ischemic bo - lezni hearts, a gout).

2. The social anamnesis (features of a way of life, alimentary habits, a food intake regimen, a trade and a post, stressful situations).

3. The obstetric and gynecologic anamnesis (body mass at a birth, disturbances of a menstrual cycle, age menarhe, premature adrenar - he, nevynashivanie pregnancy, gestatsionnyj a diabetes, gestatsion - naja an arterial hypertensia).

4. Revealing of excesses of androgens at women (a hirsutism, vulgar ug - ri, an androgenic baldness, a seborrhea).

5. Revealing of gravity of climacteric disorders on a calculation method menopauzalnogo index Kupperman H. And co-workers. [119; 126] in E.V.Uvarovoj's updating modified menopauzalnyj an index (MMI).

6. Revealing of clinical signs insulinorezistentnosti (narushe - nie respirations during a dream, nigroidnyj an acanthosis, bulimic implications, tromboticheskie complications).

7. Anthopometrical data (growth, body mass, an index of mass of a body, from - wearing a waist-hip).

8. Measurement of level of arterial pressure.

9. Definition of a lipide spectrum of blood serum (the general holesteri - on, triglycerides, cholesterol of lipoproteins of high density).

10. Definition of an alkaline phosphatase, bilirubin of the general, direct and indirect.

11. Definition of the maintenance of a glucose in blood on an empty stomach.

12. Definition of the maintenance of insulin in blood on an empty stomach, definition of level of antibodies to insulin and insulinic receptors.

13. Carrying out of the test for tolerance to a glucose with simultaneous opre - division of level of insulin.

14. Definition of level of an alaninaminotranspherase (ALT), aspartatami - notransferazy (nuclear heating plant), kreatinfosofokinazy (KFK).

15. Definition of level of alimentary enzymes: lipases and amylases.

16. Definition of components of coagulating system of blood (including. Fib - rinogena).

17. Definition of level of the general calcium

18. Definition of level of urinary acid.

19. Level definition leptina.

20. Definition of level of the globulin binding sexual hormones.

21. Definition of level of hormones of genesial system at women (general Testosteron-Depotum about calculation of an index of free androgens, LG, FSG, parity LG/FSG).

22. Ultrasonic research of organs of a small basin and mammary glands at women.

Prominent features menopauzalnogo a metabolic syndrome. Changes affect as the general status of the patient, and change it is nye biochemical indicators, basically in three systems: adverse changes in a lipide spectrum of the blood, the raised thrombogenesis, insu - linorezistentnost/giperinsulinemija and (or) giperinsulinemija. In most the general approach the clinical picture looks as follows [62]:

ѕ rising of level of the general cholesterol;

ѕ cholesterol rising lipoproteinov low density (LPNP);

ѕ cholesterol depression lipoproteinov high density (LPVP);

ѕ rising of level of triglycerides;

ѕ rising of level of a fibrinogen;

ѕ level rising gomotsisteina;

ѕ hyperaggregation of thrombocytes;

ѕ rising of a level of a factor VII;

ѕ depression of level of an inhibitor of the plasma activator-1 (ПАИ-1);

ѕ intensifying of processes of oxidation;

ѕ deterioration of function of an endothelium;

ѕ rising insulinorezistentnosti;

ѕ depression of biosynthesis of insulin;

ѕ depression of a clearance of insulin;

ѕ rising of level of a glucose;

ѕ depression of level of the globulins binding sexual hormones;

ѕ level rising leptina;

ѕ superfluous mass of a body;

ѕ an abdominal variant of adiposity.

The increase of mass of a body becomes perceptible at 75—80 % of women with the beginning perime - nopauzy, becomes especially expressed in a postmenopause. According to I.G.Shestakovoj (2001 [91], at women the augmentation of mass of a body is elderly 52,6±5,3 year makes 5—24 kg (9,7±4,2 kg) in comparison with genesial age; at 50,9 % from them an index of mass of a body more than 30 kg/m? [91]. The tendency to augmentation of mass of a body is accompanied by constitution change: instead of gi - nekoidnogo it is formed central or abdominal (androidnyj) cook - ant obesities, that, undoubtedly, it is bound to weakening estrogennogo influences on tissues, change of balance of sexual steroid hormones aside andro - genes at the expense of remaining biosynthesis of Testosteron-Depotum in ovaries and androge - it is new in adrenals [111].

The abdominal variant of adiposity can be diagnosed on otnoshe - niju: volume of a waist/volume of hips which is enlarged at the majority of women of the senior age groups to 0,85-0,90 and more. The number of such women in on - stmenopauze reaches 81,8 %. At mass of a body of 90 kg and it is more appreciable vozras - the risk of a hyperplasia and a cancer endometrija [121], risk cardiovascular zabo - levany thaws.

MMS is the symptom-complex generated in menopauzalnyj the period, i.e. During this period lives of the woman which is characterised by sharp depression of genesial function, including its main component, — a hormonal component. Hormonal changes in perimenopauze and in a postmenopause lead to formation climacteric (menopauzalno - go) a syndrome, — a pathological symptom-complex which includes neurovegetative, obmenno-endokrinnye, the psychoemotional disturbances arising against age changes in an organism of the woman. On harak - teru implications and occurrence time these changes are parted on three groups [6]:

ѕ early symptoms (vasculomotor) — the fever inflow, the raised sweating, a fever, a tachycardia, a headache, a cardialgia, razdra - zhitelnost, anxiety, depression;

ѕ "srednevremennye" — urogenital disturbances, changes from a skin;

ѕ "late" — an osteoporosis and diseases cardiovascular sis - themes.

Thus, to diagnose the termination of the genesial period it is possible by means of the anamnesis collecting (an irregular menstrual cycle, otsut - stvie menses), and also by means of laboratory methods of diagnostics. In peri - a menopause at the woman the number of follicles in ovaries decreases, odnovre - menno level of Gonadotropinums in a blood plasma (especially FSG) is enlarged. The simultaneous augmentation of level FSG in plasma and sharp reduction estro - genes is a universal sign meopauzy. High level FSG jav -

ljaetsja compensatory reaction of a pituitary body in reply to level depression estro - genes [3].

Climacteric disorders also require an objective estimation, especially gravity of their current, since. In most cases shipping their patient is a subjective indicator. For an estimation of severity level of a climacteric syndrome there are some classifications (tab. 2 see): a gravity estimation by quantity of inflow, calculation menopauzalnogo index Kupperman H. (1959) and co-workers. [126] in updating E. V.Uvarovoj (1983), it modified menopauzalnyj an index (MMI). By means of this questionnaire degree of expression of this or that symptom is defined on 4 ball scale: 0 points — norm; 1 point — softly expressed easy degree; 2 points — symptoms of average degree of expression; 3 points — you - razhennaja degree of implication of a climacterium [31]. All symptoms of a climacterium were time - deleny and are structured in MMI on 3 groups which are characteristic for spe - tsifiki climacterium implications: neurovegetative, obmenno-endokrinnye and psychoemotional disturbances. To easy degree carry to 10 inflow a day, to average — from 10 to 20. The serious form is characterised frequent at - livami (more than 20 a day) and other symptoms leading znachitel - ache to disability. MMI it is estimated in points by addition on - kazatelej the basic three groups of symptoms: neurovegetative, endokrinno - metabolic and psychoemotional. Weak degree is characterised by 12 34 points, moderated — 35—58, serious more than 58 points.

Table 2 — Menopauzalnyj an index

Symptom

Points
1 2 3
Neurovegetative disturbances:
BP, mm hg The raised 150/90 160/100 > 160/100
The lowered 100/70 90/60
Headaches Seldom Often Constantly
Vestibulopathies + + + + + +
Palpitation in rest 1—2
Intolerance of a heat + + + + + +
Cramp/NUMBNESS + + + + + +
Goose skin Occasionally At night Always
Dermographism The white The red
Xeroderma The moderated Keratosis Scab
Sweating + + + + + +
Puffiness Persons, weak Century Constantly
Allergic reactions Rhinitis Urticaria Quincke's edema
Exophthalmos, shine of eyes + + + + + +
Hypererethism + + + + + +
Drowsiness In the morning In the evening Constantly
Dream disturbances At a backfilling Intermittence Sleeplessness
Fever inflow (a day) 20
Dyspnea attacks (in a week) 1—2
Simpato-adrenalovye crises (a day) 1—2
Endokrinno-metabolic

Disturbances:

Adiposity, IMT 27—30 31—40 > 40
Thyroid dysfunction + + + + + +
Diabetes + + + + + +
Hyperplasia of mammary glands The diffusive The nodulose Fibroadenoma
Is muscular-articulate pains Seldom Periodically Constantly
Thirst + + + + + +
Atrophy of genitals + + + + + +
Psychoemotional disturbances:
Fatigability + + + + + +
Memory depression + + + + + +
Tearfulness, excitability + + + + + +
Appetite change Rising Depression Loss
Obsessions The suspicious Pavors Suicide
Mood The labile Depressions Melancholia
Libido Oppression Absence Rising

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A source: GAVRILOVA Nadezhda Petrovna. PERSONIFICATION of HORMONAL THERAPY of CLIMACTERIC DISORDERS At WOMEN With the METABOLIC SYNDROME And the CHOLESTASIA. The dissertation on competition of a scientific degree of the candidate of medical sciences St.-Petersburg - 2014. 2014

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