Malishevskaya T N, Filippova Yu E
Helmholtz National Medical Research Center of Eye Diseases, Moscow, Russia.
Regional Ophthalmological Dispensary, Tyumen, Russia.
Vestn Oftalmol. 2023;139(4):35-43. doi: 10.17116/oftalma202313904135.
In patients with glaucoma, one of the main initiating mechanisms that triggers the chain of events is disruption of the universal mechanism for regulating vascular tone due to endothelial dysfunction (ED). The main manifestation of ED is an imbalance of vasoconstrictor and vasodilator endothelial mediators, which inconsistency triggers the mechanisms of adaptive distress leading to the progression of morphological destruction, dyslipidemia, acceleration of atherogenesis, development of hemodynamic and hydrodynamic disorders. The drug Mexidol has a wide range of pharmacological activity and affects the main pathogenetic links of primary open-angle glaucoma (POAG).
The study analyzes the vascular remodulation, antioxidant and antihypoxic effects of the drug Mexidol in patients with PAOG.
The study included 78 patients with POAG of the early (=43) and advanced stage (=35) with average age of 67.8±1.5 years. The main study group consisted of 47 patients who received Mexidol in addition to local hypotensive treatment; 31 patients comprised the control group. In the comparison groups, the degree of ED was determined by the results of reactive hyperemia test, patients' blood plasma was analyzed for levels of stable nitric oxide metabolite (nitrite NO) and endothelin-1 (ET-1). General assessment of oxidative stress was carried out by high-performance liquid chromatography. Functional activity of the retina was studied using an electroretinograph and static computer perimetry performed according to the standard technique.
The following changes are observed in patients of the main group using Mexidol: the index of oscillatory potentials significantly increases, peak latency decreases, perimeter indices show positive trends, vascular endothelial function improves according to reactive hyperemia test, concentration of vasoconstrictor mediator ET-1 in blood plasma decreases and of nitrite (NO) increases moderately, the coefficient of bioeffective vasotonic activity decreases, the level of glutathione peroxidase increases (<0.05 compared to the baseline value), the level of malonyldialdehyde decreases, lipid metabolism improves (reduction in total cholesterol, low-density lipoprotein-cholesterol, triglycerides, decrease in the Atherogenic Index compared to the initial level).
The drug Mexidol proved to be an effective endothelial protector, a powerful antioxidant and antihypoxant, contributed to deceleration of atherogenesis in patients with POAG.
在青光眼患者中，引发一系列事件的主要起始机制之一是由于内皮功能障碍（ED）导致调节血管张力的普遍机制被破坏。ED的主要表现是血管收缩和血管舒张内皮介质失衡，这种不一致引发适应性应激机制，导致形态破坏进展、血脂异常、动脉粥样硬化加速、血流动力学和流体动力学紊乱。药物美西多具有广泛的药理活性，并影响原发性开角型青光眼（POAG）的主要发病环节。
本研究分析药物美西多对POAG患者的血管重塑、抗氧化和抗缺氧作用。
该研究纳入78例POAG患者，其中早期（=43例）和晚期（=35例）患者，平均年龄67.8±1.5岁。主要研究组由47例除局部降压治疗外还接受美西多治疗的患者组成；31例患者为对照组。在比较组中，通过反应性充血试验结果确定ED程度，分析患者血浆中稳定一氧化氮代谢物（亚硝酸盐NO）和内皮素-1（ET-1）水平。通过高效液相色谱法对氧化应激进行总体评估。使用视网膜电图和按照标准技术进行的静态电脑视野检查研究视网膜的功能活性。
在使用美西多的主要研究组患者中观察到以下变化：振荡电位指数显著增加，峰值潜伏期缩短，视野指数呈阳性趋势，根据反应性充血试验血管内皮功能改善，血浆中血管收缩介质ET-1浓度降低，亚硝酸盐（NO）适度增加，生物有效血管张力活性系数降低，谷胱甘肽过氧化物酶水平升高（与基线值相比<0.05），丙二醛水平降低，脂质代谢改善（总胆固醇、低密度脂蛋白胆固醇、甘油三酯降低，动脉粥样硬化指数与初始水平相比降低）。
药物美西多被证明是一种有效的内皮保护剂、强大的抗氧化剂和抗缺氧剂，有助于减缓POAG患者的动脉粥样硬化进程。
