Diabetológiai kérdőjelek = Questions in diabetology to be elucidated

A cardiovascularis kórképek gyógyításában elért eredmények ellenére a szív-ér rendszeri megbetegedések gyakorisága a fejlett és fejlődő világban növekszik. Ez a tény összefügg a világméretű elhízás-, illetve diabetespandémiával, valamint az úgynevezett urbanizált életforma térhódításával. A szerzők ismertetik a civilizációs életforma és a krónikus stressz összefüggését, valamint a következményes életforma-változások, szív-ér rendszeri kockázatnövekedés érveit. Továbbá megfogalmazzák a cardiovascularis kockázatcsökkentés mai gyakorlatának (polipill-alkalmazás, úgynevezett célértékek elérése) kritikáját. Hangsúlyozzák a cardiovascularis kockázati tényezők következményes természetét, ebből adódóan a kockázati faktor csökkentésére irányuló kezelés mérsékelt hatásfokát. Kiemelik az oki kezelés (életmód-intervenciók, krónikus stresszkezelés) elvi elsőbbrendűségét a gyógyszeres intervenciókkal szemben. Tárgyalják a macroangiopathia és a microangiopathia patogenezisének azonos és eltérő jegyeit. Ismertetik a krónikus stressz szerepét a diabetes kialakulásában, valamint a krónikus stressz létrejöttének kiváltó okait. Tárgyalják a metabolikus szindróma, a 2-es típusú diabetes hátterében levő anyagcserezavar (diszmetabolizmus) létét támogató experimentális és klinikai adatokat, hangsúlyozzák a nem ischaemiás diabeteses cardiomyopathia önálló cardiovascularis kockázati faktorának szerepét. Részletezik a diabeteses cardiovascularis kockázatcsökkentés lehetőségeit: hangsúlyozzák a magas vérnyomás, a hyperlipidaemia csökkentésének hatékonyságát szemben a vércukorcsökkentés mérsékeltebb hatásosságával. Hangsúlyozzák, hogy a fokozott diabeteses cardiovascularis kockázat megszüntetése csak az alapokot képező anyagcserezavar (diszmetabolizmus) ismerete és kezelése által lehetséges. Ismertetik az úgynevezett metabólikus promóterekkel elért eredményeket. Orv. Hetil., 2011, 152, 1353–1361. | Despite advances in the management of cardiovascular diseases, the incidence of cardiovascular diseases is increasing both in developed and developing world. This phenomenon is associated with the worldwide pandemic of obesity and type 2 diabetes; both are related to the life style of urbanization. The association between life conduct of civilization and chronic stress resulting in augmentation of cardiovascular risk is detailed. Therapeutic policy practiced nowadays (polypill administration, achieving target values) in order to reduce cardiovascular risk is criticized. Primary causal role of chronic stress and life style, and secondary resultant nature of cardiovascular risk factors are stressed out in the pathogenesis of increased cardiovascular risk; therefore, limited value of an approach focusing on the management of cardiovascular risk factors, instead of targeting the primary cause, i.e. chronic stress and life conduct is emphasized. A short account is given about the similarities and dissimilarities in the pathogenesis of macro- and microangiopathy. The primary causal role of chronic stress in fetal and adult diabetes, furthermore possible triggers evoking chronic stress is discussed. Supportive experimental and clinical data are reported about the nature of basic metabolic dysregulation (dysmetabolism) in the pathogenesis of metabolic syndrome and type 2 diabetes. Besides the well documented significance of ischemic clinical manifestations of diabetes, the role of non-ischemic diabetic cardiomyopathy as an independent risk factor in evoking the total burden of cardiovascular risk in diabetes is emphasized. In reducing the cardiovascular risk in diabetics the management of high blood pressure and dyslipidemia is more effective compared to that of hyperglycemia. Besides managing cardiovascular risk factors, the successful treatment of dysmetabolism is importantly needed to eliminate the total excessive cardiovascular risk in diabetes. In order to achieve this goal the potential role of metabolic promoters is stressed out. Orv. Hetil., 2011, 152, 1353–1361

APOE epsilon status in Hungarian patients with primary progressive multiple sclerosis

PRINCIPLES: Apolipoprotein E (ApoE), an important glycoprotein in the transport, uptake and redistribution of cholesterol, is necessary in nerve tissue repair. The APOE gene (APOE) is involved in neurodegenerative diseases, the best-known association being that between the APOE epsilon4 allele and Alzheimer's disease. Multiple sclerosis (MS) is a chronic inflammatory neurological disease. The aim of this study was to assess (multicentre assessment) the possible influence of the APOE gene on the susceptibility of primary progressive MS (PPMS) in Hungary. METHODS: Polymerase chain reaction and restriction fragment length polymorphism were carried out on DNA isolated from 135 volunteers. RESULTS: The number of PPMS patients without the epsilon2 allele was found to be remarkably high, whilst the epsilon2 allele was overrepresented in the RRMS group. A markedly high frequency of the epsilon4 allele was found in the PPMS group and a very low frequency in the HC group. With regards to the clinical parameters, significant differences were observed between the RRMS and PPMS groups. Differences were also detected regarding the EDSS and MSSS scores when the patients were grouped by the presence or absence of the epsilon2 allele. All of the observed differences in the clinical parameters disappeared when the patients were further stratified by the type of MS. CONCLUSIONS: Our findings suggest that the presence of the epsilon2 and epsilon4 alleles may play a role in the development of the disease. However, if any type of the disease has already developed the alleles show no association with the clinical parameters

Tumour necrosis factor alpha gene (TNF-alpha)-376 polymorphism in Hungarian patients with primary progressive multiple sclerosis

Tumour necrosis factor alpha (TNF-alpha) is associated with clinical activity in relapsing-remitting multiple sclerosis (RRMS) and the development of progressive disease. Our aim was to investigate the TNF-alpha -376 polymorphism in primary progressive MS (PPMS) patients. Polymerase chain reaction and restriction fragment length polymorphism were carried out on 45 PPMS patients, 45 age and sex-matched RRMS patients and 45 healthy controls (HC). The GG genotype and the guanine allele (G) were detected significantly more often in the PPMS group as compared with the HC group (p=0.027; p=0.032). The G allele may be one of the factors responsible for progression in PPMS