Sciences of Europe # 76, (2021)
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MEDICAL SCIENCES THE EFFICACY OF TRIMETAZIDINE ADMINISTRATION IN A COMPREHENSIVE TREATMENT OF BRAIN CONCUSSION Zhukovskyi О. Bukovinian State Medical University, Chernivtsi DOI: 10.24412/3162-2364-2021-76-1-19-21 ABSTRACT The efficacy of Trimetazidine administration in a comprehensive treatment of brain concussion has been studied. A normalization effect of the drug on hypoxia processes, condition of the pro- and antioxidant systems, neuron-specific enolase level has been determined. Keywords: brain concussion, Trimetazidine. Introduction. Considering an important role of hypoxia, disorders of pro- and antioxidant balance, development of autoimmune reactions in pathogenesis of mild neurotrauma and brain concussion (BC) in particular, the necessity to control all these parameters is of no doubt, as well as administration of drugs possessing neuroprotective properties in a comprehensive treatment [1,7]. From this point of view the study of Trimetazidine (“Preductal”) efficacy, a drug possessing pronounced anti-hypoxic and antioxidant properties, is rather topical and perspective [4]. Materials and methods. To solve the tasks 60 individuals were examined comprehensively. They were distributed into three groups: 1 group – practically healthy individuals (20 people); 2 group – BC patients receiving basic therapy (20 people); 3 group – BC patients receiving Trimetazidine in addition to the basic therapy (20 people). The basic therapy included analgesics, diuretics, sedatives, vasoactive and nootropic agents. Trimetazidine was administered in a daily dose of 60 mg 3 times a day for the whole course of treatment (7-10 days). Biochemical examinations of plasma and erythrocytes of the patients and donors were made on the
first, fifth day after injury, and after completion of treatment. The levels of lactate, protein oxidative modification (POM), Malone aldehyde (MA), reduced glutathione [8], HS-groups [5], activity of ceruloplasmin [2] and catalase [3] were examined. The content of neuronspecific enolase (NSE) in the blood serum was determined by means of indirect immune-enzyme analysis. The data were processed statistically using Student criterion. Results and discussion. On the first day after trauma all the patients with BC developed statistically reliable increase of lactate in the blood plasma which was indicative of activation of hypoxic processes in the nervous tissue. A gradual dynamic increase of lactate content was observed in patients with BC who received a comprehensive treatment. The situation was a little different in the third group of patients, who received Trimetazidine in addition to basic therapy. Lactic acid level in those patients did not increase, but it statistically reliably decreased. After initiated treatment in the patients from the third group the indices of lactate content were close to that of normal. On the basis of the data obtained a conclusion can be drawn that Trimetazidine inhibits accumulation of lactate and prevents the development of hypoxia in the cerebral tissue.
Table 1 Lactate content in the blood of patients with brain concussion On admission 5 day After treatment 1 control group Index 2 group 3 group 2 group 3 group 2 group 3 group (n=20) (n=20) (n=20) (n=20) (n=20) (n=20) (n=20) 2,480,02 2,180,01 2,470,02 2,720,03 2,360,02 р10,01 2,780,02 Lactate content, mmol/L 2,100,02 р10,01 р10,05 р10,01 р10,01 р20,01 р10,01 р20,05 р20,01 Notes: р1 – difference between patients with BC and control group; р2 – difference between both groups of patients Hypoxia development results in different metabolic disorders including changes of pro- and antioxidant balance. Considering an important role of the processes of lipid and protein peroxide oxidation in the development of irreversible changes in case of neurological injuries, we have examined these indices, and the condition of the blood antioxidant system in patients with BC. Having analyzed the indices of lipid and protein peroxide oxidation at the first day after injury
statistically reliable increase of MA level, one of the final products of lipid peroxidation was found, as well as the degree of protein oxidative modification (POM) in comparison with the control indices (Table 2). Violent reaction of these processes after injury as naturally associated with the body protective reaction – increased activity of the antioxidant system. Thus, increased activity of catalase and ceruloplasmin, increased level of
