Clinical and laboratory algorithm for diagnosis of metabolic syndrome with use of new medical technologies in liquidators of Chernobyl accident
Authors: Drygina L. B. , Pyatibrat A. O. , Astafiev O. M. , Shantyr I. I. , Rodionov G. G. 
Published: December 2021

Based on a long-term dynamic study of the state of health of liquidators of the consequences of the Chernobyl accident, it was found that 75 % of patients have a metabolic syndrome, burdened with concomitant somatic pathology. The article presents literature data on the key role of adipokine levels in the development of the metabolic syndrome of adipose tissue, hormonal indicators, vitamins and other nutrients, which require modern methods of laboratory diagnostics to determine.

The aim. To develop a clinical and laboratory algorithm for diagnosing metabolic syndrome in liquidators of the consequences of the Chernobyl accident using new medical technologies.

Methods. 122 liquidators of the consequences of the Chernobyl accident with cerebrovascular diseases, diseases of the digestive system and endocrine system pathology were examined. Based on the International recommendations of 2009, two groups were formed: those with the absence (n = 32) and the presence (n = 90) of metabolic syndrome (MS). The control group consisted of 30 people with MS who were examined and treated at the clinic, but did not have contact with radiation. All patients were male, with an average age of 64–66 years. The main biochemical parameters in blood serum were determined. Immunochemiluminescent method was used to determine hormonal parameters. Mass spectrometry was used to determine the indicators of oxidative stress (MDA, fat-soluble vitamins A, E, D, polyunsaturated fatty acids), and trace elements.

Results and analysis. A characteristic feature of MS in LPA is a signifcantly (p < 0.05) low level of total testosterone in the blood serum and the calculated ratio of testosterone/estradiol. With increasing number of MS components signifcantly (p < 0.05) increases in serum level of basal insulin and HOMA IR, leptin levels, decreases the concentration of adiponectin. The analysis of the obtained results did not reveal signifcant differences in the content of the main markers of MS in LP and patients of the control group with MS. In 25% of LPA with MS, adiponectin values are determined below the lower limit of the reference range (less than 5.6 μg/ml), and the leptin content is higher than 21.0 ng/ml at the upper limit of the reference range of 5.6 ng/ml. there Is a stable tendency to reduce HDL cholesterol. When comparing the studied indicators for MS in patients with MS at the Chernobyl NPP and the control group, a statistically signifcant increase in the concentration of vitamin E (9.7 [6.8–12.7] and 6.3 [5.3–7.7]; p = 0.001) was found by 54 % and a decrease in the level of linoleic acid (230.9 [184.6–293.0] and 262.3 [214.1–426.3]; p = 0.014) by 12 %. A decrease in selenium, zinc, copper and iodine was detected.

Conclusion. The results of the study demonstrated that liquidators of the consequences of the Chernobyl accident with metabolic syndrome may develop various pathogenetic variants of MS, which can be clarifed by the proposed additional criteria of the diagnostic algorithm. Identifying the pathogenetic variant of MS opens up the possibility of a personalized approach to MS therapy and prevention of the development of circulatory diseases and diabetes.