SOVREMENNAYA PEDIATRIYA.2016.5(77):16-24; doi10.15574/SP.2016.77.16 

Prophylaxis of disturbances of endothelial function within the children during transition from health to a syndrome of vegetative dysfunction 

Kvashnina L. V., Ignatova T. B.

SI «Institute of Pediatrics, Obstetrics and Gynecology, NAMS of Ukraine», Kiev 

The aim of the research — assessment of a condition of endothelial function and the lipid peroxidation/antioxidant defense system within the healthy children and children with a syndrome of vegetative dysfunction and carrying out correction of the revealed violations.

The materials and methods. 322 children of school age (12–17 years) who have been distributed on 2 groups were examined: 179 healthy children and 143 children with syndrome of vegetative dysfunction. The endothelial function assessment was carried out by means of test with «reactive hyperemia» with an assessment of an endothelium dependent vasodilation before and after carrying out occlusiontest and method of enzymatic analysis for determination the value of an endothelin — 1 and total of nitrogen oxide in a serum of blood. The assessment of a state oxidizing homeostasis on activity of non-enzymatic free radical oxidation by means of determination of concentration in a serum of blood of malondialdehyde was carried out within all children; concentration of antioxidant protection — on activity of a fermentable range superoxidedismutase, catalase and the general peroxidase activity; a cellular metabolism — on activity of a succinate dehydrogenase, lactate dehydrogenase, a glycerophosphate dehydrogenase.

The results of the research. During the carrying out the test with «reactive hyperemia» within the children were allocated 4 types of an endothelium dependent vasodilation. Most of healthy children had hyrerergic reaction of a humeral artery (35.6%), 29.90% of children had hyrerergic and 29.60% — normoergic, paradoxical — 11.74% of children. Within the children with syndrome of vegetative dysfunction the normoergic type of postocclusion reaction was not noted, within the majority the paradoxical endothelium dependent vasodilation (42.66% of children), hypoergic within the 25.18% of the children are revealed. In case of a function assessment of the endothelium is noted by an immunological method expressed imbalance between endothelia — 1 that NO in blood

with more adverse violations in case of hypoergic and paradoxical types. Within the children with syndrome of vegetative dysfunction the considerable imbalance of indicators of endothelial dysfunction with decrease in concentration of an endotelin-1 and increases of concentration of nitrogen oxide was noted that testifies to a expressed vascular spasm. In case of the lipid peroxidation / antioxidant defense system condition assessment concentration of malondialdehyde, one of end products the lipidperoxidation, gradually increases, and processes of antioxidant protection and energy mitochondrial processes of tissue respiration also itself are gradually oppressed about what witnesses decrease of the activity of pair mitochondrial enzymes — succinate — that glycerophosphate dehydrogenase, and also destabilization of level of a lactate dehydrogenase. Functional indicators of free radical oxidation have considerable informational content: functional index free radical oxidation and О₂ free radical oxidation which characterize influence of the basic fermentable antioxidant to a factor on pathogenic action of free radicals, including and not inactivated superoxidedismutase. The less value of functional index free radical oxidation observed in groups of children with paradoxical type of reactivity of an endothelium that syndrome of vegetative dysfunction. The opposite tendency is characteristic of an index of use of oxygen of free radical oxidation (O₂ of SRO) — within the children with syndrome of vegetative dysfunctionit has the most high value (133,13±4,95). For all children from risk group (hyrerergic, hypoergic and paradoxical types of an endothelium dependent vasodilation) and in complex treatment of children with syndrome of vegetative dysfunction, the preparations have been used: «Kratal for children» that «Kvertin» for 45 days.

The conclusion. The conducted researches have allowed to consider concentration of endothelin in blood — 1 (1,54±0,08) fmol/mkl and the nitrogen oxide (16,27Ѓ}1,72) μmol/l in case of normoergic type of endothelial dependence vasodilation by the standard indicators of endothelial function this ultrasonic triplex research within the children of the school age. The most adverse -hypoergic and paradoxical forms of postocclusion reaction. The children with these forms of endothelial dysfunction are possible to carry to the preclinicalof states of health and consider them as risk group on progress of cardiovascular diseases and recommend to carry out preventive actions. Carrying out the correction of the found malfunction of endothelium and the lipid peroxidation / antioxidant defense systems allowed to lower risk of development of cardiovascular diseases in 79.9% of healthy children and to prevent the deterioration in a condition and transformation within the 74.13% of children with syndrome of vegetative dysfunction in more difficult cardiovascular diseases.

Key words. Children, endothelial function, lipid peroxidation / antioxidant defense system, Kratal for children, Kvertin.

REFERENCES

1. Korenev NM, Bogmat LF., Nosova EM. et al. 2013. Arterial hypertension within the teenagers: factors of stabilization and progress. The health of the child. 3: 6-11.

2. Burlaj VG, Kuhta NM.,Misura LI. et al. 2006. Vegetative dysfunction within children: the results of the research . Pediatrics, obstetrics and gynecology. 2: 24-28.

3. Gorbas IM. 2010. The epidemiological situation regarding cardiovascular diseases in Ukraine 30 -year monitoring. Practical angelology. 9-10:6-9.

4. Gorlenko OM,.Kishko NJ. 2008. Primary prevention of cardiovascular disease in childhood. Theses of they reports of the XII Congress of the World Federation of Medical Associations 25-28 September. Ivano- Frankivsk. 107.

5. Vorobjova EN., Shumaher GI., Khoreva MA., Osypova IV. 2010. Endothelium dysfunction — a key link in an atherosclerosis pathogenesis. Rus. cardiol. mag. 2: 84–91.

6. Zvezdina IV, Zhygareva NS., Agapova LA. 2009. Functional condition of cardiovascular system within the children in dynamics of training at primary school. Russian pediatric magazine. 2: 19-23.

7. Chekman IS., Gorchakova NA., Frantsuzova SB. et al. 2005. Cardioprotectors. К.164-168.

8. Komarov FI., Korovkin VV., Menshov BF.1981. Biochemical researches in the clinic. М.: Medicine. 133-143.

9. Kupko N. 2011. Quercetin: properties and application (abstract review). Rational pharmacotherapy. 4 (21): 57-60.

10. Lebedynez NV. 2007. State of the cardiovascular system of pupils of innovative schools. Environment and health. 1: 20-23.

11. Lishnevskaja VJ. 2014. Endotelialny dysfunction: what the practical doctor needs to know. Medicine. 10: 27-30

12. Nebijeridze DV. 2005. Clinical value of dysfunction of an endothelium at arterial – hypertension. System hypertension. Annex to ConsiliumMedicum. 1 (7): 21-23.

13. Galenko – Jaroshevskij PA., Chekman IS., Gorchakova NA. 2002. Pharmacology sketches of metabolitetools. М.:Medicine. 280.

14. Kvashnina LV., Ignatova TB., Rodionov VP., Makovkina JA. 2013. Approaches to treatment of vegetative dysfunctions within the children proceeding with violation of a lipidic exchange and endothelial dysfunction. Sovremennaya pediatriya. 8 (56): 102-108

15. Kovalenko VM., Kornadski VM. 2011. Regional features of health of the people in Ukraine (analytical and statistical manual). MBC “Medinform”. 166

16. Niankovskij SL, Yatsula MS., Chikajlo MI., Pasechnuk IV. 2012. The state of health of schoolchildren in Ukraine. The health of a child. 5: 109-114.

17. Tarkunov PA., Sapronov NS. 1997. The cardioprotective effect of taurine. Ex-remental and clinical pharmacology.5 (60): 70–77.

18. Brocq ML., Leslie SJ., Milliken P. et al. 2008. Endothelial Dysfunction: From Molecular Mechanisms to Measurement, Clinical Implications and Therapeutic Opportunities. Antioxidants & Redox Signaling. 10 (9): 1631-1674. http://dx.doi.org/10.1089/ars.2007.2013; PMid:18598143