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Training and Resources for Clinical Excellence in Energetic Therapies [Laser correction of microcirculation disorders in patients having CHD
with hypercholesterinemia]
Vasil'ev AP, Sekisova MA, Strel'tsova NN, Senatorov IuN.
The study demonstrates that hypercholesterinemia in patients with coronary heart disease(CHD) is associated with functional depression of microcirculation, increase in totalperipheral vascular resistance, reduction in the functional efficiency of heart and decreasein activity tolerance. After receiving a course of low-intensity infrared laser radiationtreatment the patients displayed positive changes in blood lipid spectrum, which wasassociated with improvement in microcirculation, decrease in afterload, increase ineconomization of heart functioning and activity tolerance. The obtained resultsdemonstrate that the hypolipidemic effect of laser radiation is a substantial factor in theregression of CHD manifestations.
DYNAMICS OF HYPERLIPIDEMIA AND PERIPHERAL BLOOD
FLOW IN PATIENTS WITH DIABETES MELLITUS AFTER THE
COURSE OF COMBINED LASER THERAPY IN AMBULATORY-
POLYCLINIC CONDITIONS
T.V. Kovalyova, A.V. Farvayeva, L.T. Pimenov, S.M. Denisov Medical Academy, 2nd
Municipal Out-Patient Department, Izhevsk, RF Russian Medical University, 13th State
Clinic Hospital, Moscow, RF
The problem of metabolic-vascular disturbances in patients with diabetes mellitus still isone of the most important in clinic of inner diseases. In the course ofLT 218 patients,between 19-67 years of age, with diabetes mellitus (the period of observation is 7 years)have been investigated. Among them 93 had the 1st type of DM, 125 - the lind type. Theabsolute majority of the patients had a compensation or subcompensation of diabetes. Toestimate peripheral blood flow we used doppler-and/or rheovasography. 57 patientsunderwent a conjuctival biomicroscopy, In all patients we examined total bloodcholesterol (TC), in a part of the patients • triglycerides, LDL and HDL cholesterol level.
We also controlled glycemia and peripheral blood flow.
For the treatment we used intravenous laser blood irradiation (ILBI) by continuous He-Ne irradiation (wavelength - 0,63 mm, power at the light-guide end - 2 mW).
Simultaneously we performed percutaneous procedure by low-energy laser irradiation(apparatus 'MUSTANG') with the wavelength - 0,89 mm, power - from 5 to 20 mW onshin muscles (dose 4,5 J, frequency 80 Hz), liver, pancreas, spleen projections (frequency150 Hz), 4 min on each zone, 8-10 procedures, daily. Repeated courses were given in 3and 6 months. Sugarcorrecting medications were decreased 2 times in combination withantioxidant AEVIT. From the first days of treatment the patients' extremeties grewwarmer, decreased the pain syndrome, disappeared the symptoms of encephalopathy.
Together with the subjective rehabilitation of the patients, figures of TC, LDL cholesteroland triglycerides decreased to their norm or its upper limits with simultaneous increase ofalpha-LP. Sugar concentration in blood also decreased.
It is known that diabetic angiopathy is a result of generalised pathological metabolicdisorder, lipid metabolism disorder in particular, when the rates of LDL cholesterol andVLDL cholesterol in blood increase and damage the endothelium.
Thus, the application of combined laser therapy in complex treatment of patients withdiabetes mellitus we regard as an important and necessary component of angiopathiesprevention or their regress in cases of DM of any type and as a basis for prolongedcompensation of DM.
Used by permission of the Czech Society for the Use of Laser in Medicine,www.laserpartner.org Ambulatory Application of Combined Laser Therapy in Patients with
Diabetes Mellitus and Dyslipidemia
Laser Partner, 17.5.2002
T.V. Kovalyova, Out-Patient Department of the 2-nd Municipal Clinical Hospital,
Izhevsk, Russia
e-mail: laser@udm.ru
Abstract
This study sought to evaluate the dynamics of lipid metabolism in blood plasma andclinical efficiency of combined laser therapy (CLT) in patients with diabetes mellitus.
Introduction
Atherosclerosis in patients with diabetes mellitus (DM) is characterized by earlydevelopment and spreading, that enables to speak about DM as a natural model ofatherosclerosis [5]. DM and atherosclerosis are diseases with similar lipid disordersaccompanied by hypercholesterolemia, hypertriglyceridemia and hypo-alpha-cholesterolemia [5]. It is established that under insulin-dependent DM (IDDM)hyperlipoproteinemia is secondary. It results from absolute insulin insufficiency andreduction of lipoprotein lipase activity. Hyperlipoproteinemia may be reversible providedthat it is effectively treated. Besides, any dyslipoproteinemia under DM is not only astrong risk factor for the development of atherosclerosis, but also is one of the leadingfactors in a specific microangiopathy pathogenesis [1,2]. “Usual” for DM patientshypoxia is considerably intensified under dys- and hyperlipoproteinemia, simultaneouslyincreasing insulin defficiency and decreasing receptor sensitivity of cells. It hampers thetreatment of patients and promotes the progression of diabetic microangiopathies.
Patients with NIDDM are not protected from CHD caused by qualitative and quantitativechanges of blood lipoproteins (LP) [3]. Out of quantitative LP changes characteristic ofNIDDM are hypertriglyceridemia and high-density lipoprotein cholesterol reduction[6,15,16,20,25,27] on early stages of the disease [9], which are registered in 20% patients[17,22,26]. According to some investigations [4,7,14] the most common lipid disorderunder NIDDM is combined hyperlipidemia, revealed in the high levels of triglycerides(TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c) and the reducedlevel of high-density lipoprotein cholesterol (HDL-c). The most usual lipid disorderunder NIDDM is hypertriglyceridemia, in most cases type IV, generally stipulated by theintensified very low-density lipoproteins cholesterol (VLDL-c) synthesis [5]. The HDL-creduction is revealed both under newly established NIDDM and in patients with aprolonged diabetic record corrected by hypoglycemic preparations and insulin. Someinvestigations established a connection between insulin resistance and the low level ofHDL-c [18]. The HDL-c concentration increases under insulin therapy [21] and weightreduction [3,13]. According to M. Laakso et al. (1988), the HDL-c reduction is of greatimportance for CHD morbidity and mortality prognosis in patients with NIDDM. TheHDL-c reduction down to 0,9 mmol/l and less was accompanied by the fourfold risk ofCHD death.
A number of investigations [10,17,22] showed that hypercholesterolemia, stipulated bythe increased level of LDL-c, is revealed in 54-77% of patients. Correction of glycemia isaccompanied by the reduction of TC and LDL-c level [27]. Multiple Risk FactorIntervention Trial (MRFIT) [24] established the interconnection between TC and heartmortality of patients with DM. The obtained results showed that the higher cholesterollevel in diabetic patients caused the higher risk of heart death. However, the samecholesterol level caused the higher (3-4 times) CHD mortality in patients with DM ascompared to patients without it.
The analysis of not numerous literature showed that there are still no any optimumapproaches to lipid disorders treatment under DM. Moreover, dyslipidemia in diabeticpatients are not practically corrected at present, that is mainly stipulated by high pricesfor known drugs.
Objective: This study sought to evaluate the dynamics of lipid metabolism in bloodplasma and clinical efficiency of combined laser therapy (CLT) in patients with IDDMand NIDDM.
Materials and Methods
Within the last 2 years in conditions of out-patient department we observed 205 patientswith NIDDM and 54 – with IDDM.
The lipidnormalizing effect of CLT in combination with antioxidant therapy (aevit 600mg a day) we have studied in 60 individuals with NIDDM (8 men and 52 women), meanage - 57,3± 3,2 years, with the level of fasting glycemia no more than 9,0 mmol/l, HbA1c– 7,3± 0,19 and 7,27± 0,23%. The other 29 patients (with NIDDM) constituted thecontrol group and have been treated only by sugar-reducing medications.
In all patients we conducted lipid profile investigation. We also controlled glycemia,enzymatic blood activity (ALT, AST), clinical manifestations of angiopathy andperformed the conjunctival biomicroscopy. All examinations have been done prior totreatment, in 2 weeks (i.e. immediately after the treatment), in 8 days, 1, 4 and 9 monthsafter the treatment.
Hypolipidemic action of CLT has been evaluated by the dynamics of TC, TG, LDL-C,HDL-C and atherogenity rate (AR). Lipid profile has been investigated in venous bloodserum taken in the morning hours after 12-14 hours fasting. For trials we usedbiochemical analyser. TC - by Enzyme methods (CHOD-PAP), TG - UV enzymemethod, HDL-c – after VLDL-c and LDL-c sedimentation by heparin in magnesium ionspresence. VLDL-c and LDL-c we determined by W. Friedwald: VLDL-c = TG/5, LDL-c= TC - (HDL-c – VLDL-c). AR has been calculated by A.N. Klimov: AR = TC – HDL-c/HDL-c.
The conjunctival biomicroscopy has been conducted with the help of photoobservationslot lamp. Different parameters of microcirculation (vascular convolution, blood flowspeed, arteriovenular interrelations, red blood cell aggregation, etc.) have been assessed.
We performed a staged course treatment within 9 months. Repeated courses were givenin 3 and 6 months. Each course consisted of 8-10 sessions of intravenous laser bloodirradiation (ILBI) by red spectrum laser, l =0,63 mm, capacity at the light-guide end - 2mW, exposure - 15-30 min. Simultaneously we conducted a percutaneous procedure bylow intensive laser irradiation (LILI) in the near infrared spectrum, l =0,89 mm, capacityat the light-guide end - 5 - 20 mW in combination with magnetic nozzles ongastrocnemius muscle, liver, pancreas, spleen projections - frequency 150 Hz, exposure 4min. on each zone.
29 patients of the control group showed no obvious deviations of blood plasma lipidsafter 10-days intake of aevit (table 1). This conformity has been also registered under thesubsequent courses of antioxidant therapy by aevit in 3 and 6 months.
In the main group of patients (table 2) TC level prior to treatment averaged to 8,2± 0,31mmol/l, TG - 2,14± 0,08 mmol/l, LDL-c - 7,87± 0,30 mmol/l, HDL-c - 0,99± 0,04mmol/l. AR made up 7,28± 0,28, LDL/HDL-c ratio - 7,94± 0,30 (with current standardbeing < 5,0).
Immediately after the conducted therapy no significant deviations of lipid profile havebeen seen. The level of TC slightly decreased to 7,98± 0,31 (p<0,01). The level of TGeven slightly increased until 2,51± 0,09 (p<0,01). In a part of patients the normalizationof the examined parameters was accompanied by a temporary elevation of LDL-c from7,87± 0,30 tî 7,9± 0,30 (p<0,05), that was probably connected with the intensifiedbiosynthesis of lipids, resulting from the improved metabolism in liver. At the same timeHDL-c concentration increased from 0,99± 0,04 tî 1,14± 0,04 (p<0,05). AR decreased from 7,28± 0,28 tî 6,00± 0,23 (p<0,05), respectively. LDL/HDL-c ratio made up 6,92±0,27 (p<0,05).
Hypolipidemic action of CLT has been distinctively revealed in 1 month after theperformed treatment with the efficient reduction of TC level from 7,98± 0,31 tî 5,31±0,20 (_< 0,01). The tendency to the reduction of TG from 2,51± 0,09 tî 1,69± 0,06(p<0,01) and elevation of HDL-c from 1,14± 0,04 tî 1,42± 0,05 (p<0,01) has beenregistered. The level of LDL-c decreased from 7,90± 0,30 tî 6,63± 0,25 (_<0,05). ARlowered from 6,00± 0,23 tî 2,73± 0,10 (_<0,01). The LDL/HDL-c ratio decreased from6,92± 0,27 tî 4,66± 0,18 (p<0,01).
In 9 months the level of TC made up 6,01± 0,23 (p<0,01), TG – 1,62± 0,06 (p<0,01),LDL-c – 5,82± 0,22 (p<0,01), HDL-c – 1,39± 0,05 (p<0,01), AR – 3,30± 0,13 (p<0,001),LDL/HDL-c – 4,18± 0,16 (p<0,01).
Within the whole staged treatment blood plasma lipids in patients of the control groupremained practically unchanged.
We also established positive deviations in clinical picture. It manifested in dynamics ofgeneral clinical diabetic symptoms, diabetic macropathy of lower limbs under thefollowing scale: pain - sensitiveness to cold - walking, conjunctival biomicroscopychanges. The state of patients, suffering from IDDM and NIDDM complicated bydiabetic angiopathy of pelvic limbs, improved in the main group after 2-3 sessions ofCLT. Patients showed decrease or disappearance of pain, cramps and paresthesia,“getting warmer” of limbs. No dynamics of clinical picture in the control group havebeen revealed. By the end of treatment, symptoms of diabetic encephalopathy andasthenia disappeared in all patients. Mood and sleep also improved.
By the end of treatment fasting glycemia in NIDDM patients decreased from 14,21± 0,85to 11,27± 0,67. In 3 weeks the level of glycemia in this group of patients decreased atmost until 6,01± 0,35. Fasting glycemia in IDDM patients even increased from 10,46±1,46 to 11,82± 1,65. And only after the third week it reduced to 7,45± 1,04. Thus, thedistinctive positive effect in respect of carbohydrate metabolism has been reached.
Consequently, dosages of insulin and sugarcorrecting medications have beenconsiderably lowered.
The results of ophthalmologic investigation demonstrated the improved retinal bloodcirculation in the greater part of patients of the main group with diabetic retinopathy. Ithas been expressed in the normalization of arteriola/venule ratio, reduction ofplasmarrhage, resorption of micromacular hemorrhages and retinal edema, improvementof retinal trophism. Under the influence of CLT the blood flow speed in retinal vesselsincreased by 35-38%, red blood cell aggregation lowered 1,3-1,4 times. Patients of thecontrol group did not show any improvement of retinal blood circulation.
Thus, our experience of the ambulatory application of laser therapy demonstrated thedistinct effect in respect of lipid profile normalization. No side effects and complicationshave been registered.
Conclusions
1. Combined laser therapy enables to avoid the intake of hypolipidemic and lipotropic agents, as in the result of treatment we observed the prolonged effect inrespect of the most important, pathogenetically significant deviations of lipidmetabolism: a true increase of HDL-c in the nearest catamnesis (which preservesup to 6-10 months) and decrease of LDL-c. Simultaneously we registered a truelowering of TC, TG to the norm or its upper limits. AR reduced more than 3 timesand the LDL/HDL-c ratio - twice.
2. The application of a staged CLT in treatment of patients with IDDM and NIDDM enables to obtain a distinct, long-term, positive effect in respect of carbohydratemetabolism, simultaneously reducing insulin and sugarcorrecting medicationsdosage. It also results in microcirculation improvement.
Table 1: Dynamics of lipid profile (mmol/l) in patients with diabetes mellitus (M ± m) 2,14 ± 8,20 ± 7,87 ± 0,99 ± 7,28 ± 7,94 ± 0,300,10 2,51 ± 7,98 ± 7,90 ± 1,14 ± 6,00 ±0,11 1,69 ± 5,31 ± 6,63 ± 1,42 ± 2,73 ± 4,66 ± 0,180,07 2,10 ± 7,91 ± 7,79 ± 0,92 ± 7,59 ±0,12 1,72 ± 5,42 ± 6,21 ± 1,61 ± 2,37 ± 3,85 ± 0,18 1,51 ± 5,27 ± 5,42 ± 1,67 ± 2,15 ± 8,71 ± 0,49 2,12 ± 7,94 ± 7,84 ± 0,90 ± 7,82 ±0,12 1,62 ± 6,01 ± 5,82 ± 1,39 ± 3,30 ± 4,18 ± 0,19 1,54 ± 5,28 ± 5,70 ± 1,42 ± 2,70 ± 8,57 ± 0,48 2,12 ± 7, 89 ± 7,80 ± 0,91 ± 7,67 ±0,12 I – Control group (n=22) – patients with DM without application of LLLT II – Main group (n=37) – patients with DM with application of LLLTTable 2: Rates of glycemia (M ± m) I - Control group (n=22) – patients with DM without application of LLLT - (IDDM – 10patients, NIDDM – 20 patients); II – Main group (n=37) – patients with DM with application of LLLT - (IDDM – 10patients, NIDDM – 27 patients).
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DYNAMICS OF LIPID METABOLISM AND PERIPHERAL BLOOD FLOW
RATES IN PATIENTS WITH ATHEROSCLEROSIS IN CONJUNCTION WITH
RENAL DYSFUNCTION AFTER THE COURSE OF COMBINED LASER
THERAPY
T.V. Kovalyova, L.T. Pimenov, SMDenisov Izhevsk, Moscow, Russia
Correction of hyperlipidemia is an important step in prevention of atherosclerosis. Withinthe last years Low-Level Laser Irradiation (LLLI) has been widely used in the treatmentof patients with atherosclerosis. It is an effective medical remedy which has a distincttherapeutic influence on a wide range ofdegenerate-dystrophic and inflammatorydiseases.
Within the 8 years a number of patients with atherosclerosis appealed to our Center fortreatment. In all of them we observed an expressed hyperlipidemia, rheologic bloodproperties disorder, hypercoagulative deviation in coagulative system ofhomeostasis(changes ofthrombocytic-vascular hemostasis). After the course of combined lasertherapy (CLT), practically in all patients we observed a distinct antiatherogenic effect.
Taking into account that hypolipidemic effect of intravenous laser blood irradiation(ILBI) is insufficiently studied, the necessity in more detailed researches is ripe.
This study sought to evaluate the dynamics of blood plasma lipid spectrum rates andclinic effect in patients with atherosclerosis combined with various renal pathology afterthe course of CLT - low-level laser irradiation in the red and near infrared spectrum.
Besides, in this investigation we aim to prove the advantages of CLT application inpatients of this group as a highly efficient, ecologically clear and perfect medical remedywith a distinct hypolipidemic, lipotroimages action as compared with the knownexpensive phannacologic agents with a lot of side-effects.
Analysis of the examinations has showed the true increase of HDL level in the nearestcatamnesis (which preserves up to 6 months) after the conducted CLT. The less activedynamics was registered for the phenomenon ofLDL level decrease, hi average, there hasbeen a more "postponed" reaction - 2-3 months.
Our study has demonstrated the decreased level of total cholesterol, LDL cholesterol andtriglyeerides to the norm or its upper limits with simultaneous increase of HDLcholesterol level in patients with atherosclerosis.
Taking into consideration that CLT has a multifactorial adaptive influence on anorganism, the applied method gives the unique possibility (for the patients with combinedatherosclerosis and renal pathology, in particular) to extend the remission period of thebasic disease 2,5 times, in average, without the application of phannacologic agents, or toconsiderably dicrease it avoiding polypragmasy. The obtained results of the stablehypolipidemic action of CLT allow to prevent the atherogenesis in patients withmetabolic disorders (particularly renal pathology) or to achieve the atherosclerosisregression, LASER TREATMENT FOR HYPERLIPIDEMIA
Suboverova N.O, Vereschaka N.N., Herasimova O.N., Beliacova T.N. Soloviova L.A.
Clinic hospi tal N 1 of the President of Medical Center, Russia
Not a sing method of hyperlipidemia treatment among the generally accepted ones (suchas diet, regular moderate physical exercies in open air, radical therapy) can be cousideredeffectiv enough. Consequently, the problem of looking for new effective methods oftreatment remains urgent.
The approach to treatment depends on the type of hyperlipidemia and its seriousness.
There is a cause and effect connection between lipid metabolism disorders and suchwidely spread diseases as ischemic heart disease, arteriosclerosis, diabetes, hypertoniaand others. Most authors point out a correlation between the level of triglycerids andtrombogenesis, hemodinamic disorders and a lipiid level rise in plasma.
Taking into account the vascular dilating, antiagregating, analgetic effects of lowintensive helium-neon laser radiation (LLR) and also its property to improve metabolismand microcffculation, we applied tht in-vein laser blocd uradiation method (ILBI)together with traditional therapy methods to patients, who suffer from ishemic heartdisease (IHD), hypertonia and diabetes.
We could observe 36 patients, suffering from fflD, stable stenocardia (11-111 functionalclass), unstabi stenocardia, arteriosclerotical and postmiocardial infarctioncardiosclerosis; 40 patients suffering from hypertonia; 95 patients suffering from diabetes(1 and 11 types). The age of patients with initial hyperlipidemia was 38-45; WI Th secondary hyperlipidemia was 57-67. The ILBI was carried out with the light-quide outpu t power 1,5-3 mW during 20-30 minutes through a perypherical vein withHe-NE laser <ALOC 1, ALOU - 2> (wavelength 630 nm). The cours consisted of 8-10sessions which were held daily or every other day. The basic therapy of the magorpathology included according to the situation traditional therapy.
DYNAMICS OF HYPERLIPIDEMIA AND PERIPHERAL BLOOD FLOW IN
PATIENTS WITH DIABETES MELLITUS AFTER THE COURSE OF
COMBINED LASER THERAPY IN CONDITIONS OF OUT-PATIENT
DEPARTMENT
It is known that diabetic angiopathy is a result of a generalized pathological metabolicdisorder, lipid and carbohydrate metabolism in particular, when the increased rates oflow-density lipoprotein cholesterol (LDL-C) and very low-density lipoprotein cholesterol(VLDL-C) in blood damage the endothelium.
Within the last 3 years in conditions of out-patient department we observed 218 patientswith diabetes mellitus (DM), between 17-69 years of age. The lipidnormalizing effect wehave studied in 27 individuals (8 men and 19 women). 7 patients suffered from insulin-dependent diabetes mellitus, 20 patients - from non-insulin-dependent diabetes mellitus.
Mild form was registered in 6 patients, moderate - in 14, severe - in 7 patients. In patientsstudied the diabetic record averaged over 10 years.
We performed a staged course treatment by method of combined laser therapy (CLT)within the year. A course of therapy consisted of 8-10 procedures carried out daily(except Sundays). Repeated courses were given in 3 and 6 months.
To protect from the phenomenon of the . secondary exacerbation. we combined our therapy with acompulsory intake of a natural antioxidant AEVIT (vitamins A,E) in the dose of 600 mgs a day.
For the treatment we used intravenous laser blood irradiation (ILBI) by continuoushelium-neon irradiation with the wavelength - 0,63 mm, capacity - 2 mW, exposure - 15-30 min (apparatus . ALOK-1. , . ALTO. ). Simultaneously, we performed a percutaneousprocedure by low-intensive laser irradiation (LILI) in the near infrared spectrum with thewavelength - 0,89 mm, capacity - 5-20 mW, in combination with magnetic nozzles(apparatus . Mustang. ) on the following zones: calf muscles - dose 4,5 J, frequency 80 Hz; exposure 4 min; liver, pancreas, spleen projections - frequency 150 Hz, exposure 4 min on each zone.
To asssess the hypolipidemic action of CLT we investigated dynamics of total cholesterol(TC), triglycerides (TG), LDL-C, high-density lipoprotein cholesterol (HDL-C) andatherogenity rate (AR). We also controlled glycemia and peripheral blood flow.
Clinical improvements (decrease or disappearance of pain, cramps and paresthesia; .
getting warmer. of limbs) have been registered from the first days of treatment. Insulinand sugarcorrecting medications dosages have been decreased 1,5-2 times. Together withsubjective rehabilitation of patients, we registered a true increase of HDL-C rate (by43,4%) with a simultaneous decrease of TC (35,6%), TG (28%) and LDL-C (27,6%). TheAR reduced by 69,1%. The LDL-to-HDL cholesterol ratio decreased by 57,6%.
Thus, the positive dynamics of the examined parameters and the revealed hypolipidemiceffect of CLT are the basis for its immediate inclusion in the treatment of patients withDM, associated with dislipoproteinemia and specific angiopathy. CLT may be also usedas a preventive method in the treatment of patients without diabetic complications Dynamics of lipid metabolism and peripheral blood flow rates in patients
with atherosclerosis in conjunction with renal dysfunction after the course
of combined laser therapy.
Kovalyova T V et al.
During an 8 year period patients with atherosclerosis and renal dysfunction have beentreated with intravenous laser blood irradiation (ILBI). The study has demonstrated adecreased level of total cholesterol, LDL cholesterol and triglycerides with ansimultaneous increase of HDL cholesterol levels. No pharmaceuticals were given duringthe treatment period. The authors state that ILBI results in a stable hypolipidemicsituation which prevents atherogenesis in patients with metabolic disorders, particularlyin patients with renal pathologies.

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