Ministry of Education and Science, Goldberg Research Institute of Pharmacology and Regenerative Medicine, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russian Federation.
Ministry of Education and Science National Research Tomsk State University, Tomsk, Russian Federation.
Endocr Metab Immune Disord Drug Targets. 2020;20(4):564-569. doi: 10.2174/1871530319666191007115214.
The concept of metabolic syndrome (MetS) as a cluster of risk factors of type 2 diabetes and cardiovascular diseases has undergone some evolutionary transformations over the past years. Integrating the autonomic dysfunction into the pathogenesis of MetS creates the possibility of including a range of nosologies affecting treatment and clinical manifestations of pathologies belonging to MetS into the MetS cluster. The purpose of this work is to determine the involvement of autonomic dysfunction in the pathogenesis of associated pathological conditions in patients and MetS.
A cross-sectional study was conducted. The sample consisted of 158 patients with metabolic syndrome. The patients underwent a physical examination, including BMI; a blood chemistry test with the determination of the hormonal status (insulin, testosterone, dihydrotestosterone); a 24-hour monitoring of blood pressure (BP); an assessment of heart rate variability; studies showing the presence of gastric reflux (рН-measurement) or its damaging impact (endoscopy); men were tested with the IPSSQOL questionnaire and underwent transrectal ultrasound of the prostate and ultrasound of the bladder.
It is revealed that because of MetS, the occurrence of cardiac autonomic neuropathy reaches 37.5%. Some features of gastroesophageal reflux disease in patients with MetS are shown. Regurgitation prevails in the structure of complaints. In case of fibrogastroduodenoscopy, an endoscopynegative form of the disease occurs in 38%. According to the data of daily pH-measurement, when DeMeester score is high, in the supine position, 25% of the time accounts for alkaline reflux (рН > 7). It is found out that young men experience the enlargement of prostate volume and size; according to the IPSS questionnaire, the scores correspond to the initial manifestations of hyperplastic diseases of the prostate gland due to insulin resistance and normal level of androgens.
The paper demonstrates that the autonomic dysfunction of the nervous system (on a par with insulin resistance) is the main link in the development of MetS. This provides the basis for including the mentioned states - cardiac autonomic neuropathy, lower urinary tract symptoms, and gastroesophageal reflux disease - into the MetS cluster.
代谢综合征（MetS）作为 2 型糖尿病和心血管疾病风险因素的概念在过去几年中经历了一些演变。将自主神经功能障碍纳入 MetS 的发病机制中，为将影响治疗的一系列疾病和属于 MetS 的病理学临床表现纳入 MetS 集群创造了可能性。本工作的目的是确定自主神经功能障碍在代谢综合征患者和代谢综合征相关病理状况发病机制中的作用。
进行了一项横断面研究。样本包括 158 例代谢综合征患者。患者接受了体检，包括 BMI；血液化学测试，测定激素状态（胰岛素、睾酮、二氢睾酮）；24 小时血压监测；心率变异性评估；显示胃食管反流（рH 测量）存在或其破坏性影响（内窥镜检查）的研究；男性接受 IPSSQOL 问卷测试，并进行经直肠前列腺超声和膀胱超声检查。
结果显示，由于代谢综合征，心脏自主神经病变的发生率达到 37.5%。显示了代谢综合征患者胃食管反流病的一些特征。在患者的主诉中，反流占主导地位。在内窥镜检查中，疾病的内窥镜阴性形式占 38%。根据每日 рH 测量的数据，当 DeMeester 评分较高时，在仰卧位时，碱性反流（рH > 7）占 25%。发现年轻男性前列腺体积和大小增大；根据 IPSS 问卷，评分与由于胰岛素抵抗和正常水平的雄激素导致的前列腺增生性疾病的早期表现相对应。
本文表明，神经系统自主神经功能障碍（与胰岛素抵抗相当）是 MetS 发展的主要环节。这为将所述状态——心脏自主神经病变、下尿路症状和胃食管反流病——纳入 MetS 集群提供了依据。
