Prediction of the duration of remission after combined therapy with oxygenhelium mixture inhalations in patients with diabetes mellitus and long-term trophic disorders in the lower extremities

Background. Trophic disorders of the lower extremities in diabetes mellitus and chronic obliterating diseases of the arteries of the lower extremities pose a complex therapeutic problem due to the high risk of amputations (5–24% within 6–18 months) and frequent relapses (40% within a year). The pathogenesis is caused by tissue ischemia due to macro- and microangiopathy, atherosclerotic arterial occlusion and microcirculation disorders. The low effectiveness of standard therapy and the lack of individual approaches to predicting the duration of remission determine the need to develop personalized treatment methods.

Objective. A method has been developed to determine the duration of the clinical effect after treatment with an oxygen-helium mixture in patients based on quantitative data characterizing the state of the pathological process before the start of therapy using multidimensional linear regression analysis.

Materials and methods. A multidimensional linear regression analysis of a number of parameters characterizing the clinical condition of the patient's body in the treatment of patients with diabetes mellitus, chronic obliterating diseases of the arteries of the lower extremities, and trophic ulcers was performed. The study was conducted using clinical data from 50 patients.

Results. A reliable range of indicators was obtained (diastolic blood pressure, LDL (mmol/L), duration of the disease (year), intermittent claudication (m), body temperature in degrees Celsius, UO (ml), height (cm), HDL (mmol/l), cholesterol (mmol/l), affecting the results ongoing therapy. A method for calculating the duration of remission in a particular patient has been developed. The results obtained will improve the quality of care and the correctness of prescribing combination therapy, which in turn will reduce the frequency of surgical procedures.

Conclusion. A methodology has been developed for determining the timing of repeated oxygen-helium therapy courses.

1. 1 Petlenko V.P., Baranovsky A.Yu. Methodological foundations of forecasting in medicine. Clinical medicine. 1992;1:3–8. (In Russ.).

2. 2 Shevtsov V.I., Shchurova E.N. Forecasting the duration of a positive result of treatment using the Ilizarov method in a patient with obliterating thromboangiitis of the vessels of the extremities. Geniuses of Orthopedics. 1997;2:69–72. (In Russ.).

3. 3 Demyanova V.V. Forecasting the effectiveness of various treatment methods. Bulletin of saint petersburg university. Applied mathematics. Informatics. Control processes. 2007;10(4):3–16. (In Russ.).

4. 4 National useful guidelines “Chronic wounds. Trophic ulcers of the lungs of the extremities”. Edited by Academician of the Russian Academy of Sciences V.S. Savelyev, Prof. I.A. Suchkov, Prof. A.V. Pokrovsky, Prof. R.Sh. Akchurin [et al.]; Russian Society of Surgeons, Association of Phlebologists of Russia, Russian Society of Angiologists and Vascular Surgeons. M.: Media Sfera, 2020. Vol. 2. 88 p. (In Russ.).

5. 5 Ayushinova N.I., Menshikova L.V. Trophic ulcers of the lower extremities in general medical practice. Study guide. Irkutsk. 2021. 36 p. (In Russ.).

6. 6 Grigorieva A.I. Chronic obliterating diseases of the arteries of the extremities. Modern outpatient treatment. Moscow surgical journal. 2022;Special issue:43–51. (In Russ.). https://doi.org/10.17238/2072-3180-2022-43-51

7. 7 Panasyuk O.V., Mogilevets E.V., Naumov A.V. Hyperhomocysteinemia on the development of obliterating atherosclerosis of arterial complications. Healthcare (Minsk). 2020;2(875):30–35. (In Russ.).

8. 8 Karpov Yu.A. Atherosclerosis of the arteries of the affected extremities: issues of therapeutic behavior. Atmosphere. Cardiology news. 2021;1:45–53. (In Russ.) https://doi.org/10.24412/2076-4189-2021-12346

9. 9 Galstyan G. R., Vikulova O. K., Dedov I. I. Epidemiology of diabetic foot syndrome and limb amputations in the Russian Federation according to the Federal Register of Patients with Diabetes Mellitus (2013-2016). Diabetes mellitus. 2018;21(3):170–177. (In Russ.) https://doi.org/10.14341/DM9688

10. 10 Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE, et al. AHA/ACC guidelines for the care of patients with lower extremity peripheral arterial disease: a report of the American College of Cardiology/American Heart Association Clinical Practice Guidelines Task Force. Circulation. 2017 Mar 21;135(12):e726-e779. https://doi.org/10.1161/CIR.00000000000000471. Epub 2016 Nov 13. Erratum in: Circulation. 2017 Mar 21;135(12):e791–e792. https://doi.org/10.1161/CIR.000000000000000502. PMID: 27840333; PMCID: PMC5477786.

11. 11 Brownlee M. Pathobiology of diabetic complications: a unifying mechanism. Diabetes. 2005 Jun;54(6):1615-25. (In Russ.). https://doi.org/10.2337/diabetes.54.6.1615. PMID: 15919781.

12. 12 Lee R., Margaritis M., Channon M., et al. Assessment of oxidative stress in human cardiovascular diseases: methodological aspects and issues. Current Medicinal Chemistry. 2012;19(16):2504–2520. https://doi.org/10.2174/092986712800493057

13. 13 Ilkun O., Budina S. Cardiac dysfunction and oxidative stress in metabolic syndrome: an update on antioxidant therapy. Current Pharmaceutical Design. 2013;19(27): 4806–4817. (In Russ.). https://doi.org/10.2174/1381612811319270003

14. 14 Fadini GP et al. Disease mechanisms: endothelial dysfunction in diabetes. Nat. Rev. Endocrinol. 2007;3(1):42–51. (In Russ.). https://doi.org/10.1038/ncpendmet0366

15. 15 Hinchliffe RJ, Brownrigg JR, Apelquist J, Boyko EJ, Fitridge R, Mills JL, Rickers J, Shearman KP, Zierler RE, Schaper NK; International Diabetic Foot Working Group. IWGDF guidelines for the diagnosis, prognosis, and treatment of peripheral arterial disease in patients with diabetic foot ulcers. Diabetes Metab Res Rev. 2016 Jan;32 Suppl 1:37–44. https://doi.org/10.1002/dmrr.2698. PMID: 26332424.

16. 16 Brem H., Tomic-Canic M. Cellular and molecular basis of wound healing in diabetes. J Clin Invest. 2007;117(5):1219–1222. https://doi.org/10.1172/JCI32169

17. 17 Tseilikman V.E., Lukin A.A. On the influence of oxidative stress on the human body. International Research Journal2022;3(117). (In Russ.). https://doi.org/10.23670/IRJ.2022.117.3.037

18. 18 Ilyukhin EA, Bulatov VL, Galchenko MI. Accuracy and reproducibility of measuring the areas of phantom skin lesions of irregular shape using the local LesionMeter application. Phlebology. 2020;14(4):266– 274. (In Russ.). https://doi.org/10.17116/flebo202014041266

19. 19 Sharashova EE, Kholmatova KK, Gorbatova MA, Grzhibovsky AM. Application of multiple linear regression analysis in healthcare using the SPSS statistical software package. Science and Healthcare. 2017;3:5-31. (In Russ.).

20. 20 Gorkavenko F.V., Shchurov D.G., Omelyanovsky V.V. Analysis of factors determining the effectiveness of oncological care at the level of a constituent entity of the Russian Federation using multiple linear regression. Medical Technologies. Assessment and Choice. 2023;1(45):9–26. (In Russ.). https://doi.org/10.17116/medtech2023450119

21. 21 Electronic Textbook on Statistics. StatSoft Inc.; 2012. (In Russ.);

22. 22 Harris CR, Millman KJ, van der Walt SJ, Gommers R, Virtanen P, Cournapeau D, et al. Array programming with NumPy. Nature. 2020;585(7825):357–362; (In Russ.).

23. 23 Shestakova M.V., Sklyanik I.A., Dedov I.I. Is long-term remission or cure of type 2 diabetes possible in the 21st century? Editorial article. Therapeutic archives. 2017;10:4–11. (In Russ.).

24. 24 Fletcher GF, Ades PA, Kligfield P, Arena R, Balady GJ, Bittner VA, Coke LA, Fleg JL, Forman DE, Gerber TC, Gulati M, Madan K, Rhodes J, Thompson PD, Williams MA; American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee of the Council on Clinical Cardiology, Council on Nutrition, Physical Activity and Metabolism, Council on Cardiovascular and Stroke Nursing, and Council on Epidemiology and Prevention. Exercise standards for testing and training: a scientific statement from the American Heart Association. Circulation. 2013 Aug 20;128(8):873–934. https://doi.org/10.1161/CIR.0b013e31829b5b44