Вивчення діагностичної інформативності конституційно- біологічних маркерів недиференційованої дисплазії сполучної тканини у хворих із спонділогенною вертебро-базилярною недостатністю

Abstract

На основі дослідження 272 пацієнти в умовах клініки (хворі на ВБН) та в умовах комплексних медичних оглядів (контрольна група) за методикою M. J. Glesby, було проаналізовано частоту та визначено прогностичну цінність фенотипових маркерів недиферинційованої дисплазії сполучної тканини у формуванні вертебро-базилярної недостатності. Обґрунтовано скринінговий алгоритм для впровадження на рівні сімейного лікаря; На основании исследования 272 пациентов в условиях клиники (больнье ВБН) и в условиях комплексньх медицинских осмотров (контрольная группа) по методике MJ Glesby, бьла проанализирована частота и определена прогностическая ценность фенотипических маркеров недифферинцированной дисплазии соединительной ткани в формировании вертебро-базилярной недостаточности в молодом возрасте. Обоснован скрининговьй метод для внедрения на уровне семейного врача; Spondylogenic mechanism of circulatory insufficiency in the vertebrobasilar system plays a significant role in the pathogenesis of vertebrobasilar insufficiency. It is known that the most common cause of pathological effects on vertebral arteries and its sympathetic autonomic plexus are degenerative-dysrtophic changes of cervical vertebtal column, instability and intervertebral disk hernia. The studying of degenerative-dysrtophic changes of cervical vertebtal column is based on the condition of the connective tissue. Among the pathological conditions of connective tissue, the leading role has undifferentiated dysplasia of connective tissue.Dysplasia of the connective tissue is an anomaly of tissue structure, which manifests in reducing the content of certain types of collagen or disturbing their ratio, which leads to a decreasing in the strength of the connective tissue of many organs and systems and, as a consequence, a disorders of their function. Dysplasia of the connective tissue can be diagnosed on the basis of physical examination in the complex evaluation of phenotypic (external and visceral) markers. The aim of the study was to determine the predictive value of constitutional-biological markers of undifferentiated connective tissue dysplasia in patients with spondylogenic vertebro-basilar insufficiency. Object and methods. The primary information base for the implementation of the research was the result of complex clinical-anamnestic examination of young patients with vertebro-basilar insufficiency. Main characteristics (frequency, diagnostic and prognostic values) of constitutional-biological markers were studied in comparative analysis two groups of patients: one group were the patients with vertebro-basilar insufficiency (n = 136 persons), the second -control (patients without vertebro-basilar insufficiency (n = 136 people). Analysis of the distribution of individual factors in two groups patients allowed from the standpoint of evidence-based medicine and the usage of modern methods of clinical-statistical analysis (variance, correlation analysis) and prognosis methods (serial analysis of Wald modifying E. V Hublera), determining the diagnostic value (I 2, bit), predictive value and impact factors performing the differences between two compared groups and prognostic factors (PF) was done. On the basis of the clinical and informational analysis of constitutional-biological markers of undifferentiated connective tissue dysplasia in patients with spondylogenic vertebro-basilar insufficiency, we received three rehabilitation groups of patients depending on the risk of vertebro-basilar insufficiency development. The study of diagnostic value and prognostic value of constitutional-biological markers of undifferentiated connective tissue dysplasia, which influence on the development of spondylogenic vertebro-basilar insufficiency, is necessary for substantiation of the system of diagnostic and prognostic algorithms for assessement the risk of formation of spondylogenic vertebro-basilar insufficiency. The most informative and prognostically significant constitutional-biological markers of undifferentiated connective tissue dysplasia in the group of patients with vertebro-basilar insufficiency is the presence of structural imbalance of cervical part of the vertebral column and the presence of (kyphosis / scoliosis). The indicated constitutional and biological indicators integratively reflect the effect of phenotypic peculiarities in the development of the risk of vascular disorders in young people. Perspectiveness for further research are related to the study of clinical and paraclinical features of young people with manifestations of spondylogenic vertebro-basilar insufficiency.