Clinical and functional characteristics of neurocirculatory dystonia in draft-age young men in the Republic of Bashkortostan

The dissertation is devoted to the study of the clinical and functional characteristics of neurocirculatory dystonia (NCD) in draft-age young men residing in the Republic of Bashkortostan. The work was carried out within specialty 14.00.05 and is aimed at clarifying the prevalence of NCD among cardiovascular pathology in conscripts and at assessing the role of risk factors for chronic non-communicable diseases in the formation of autonomic imbalance. The study covers the clinical examination of the cohort, the analysis of the bioelectric activity of the heart (standard electrocardiography, Holter monitoring), the investigation of autonomic tone and autonomic support of the cardiovascular system (cardiointervalography, heart rate variability, clinostatic–orthostatic test), the assessment of intracardiac hemodynamics, exercise tolerance, and psychoemotional status. The data obtained were compared with the clinical variants of NCD and used to substantiate the early diagnosis and prevention of disturbances of adaptive mechanisms in young persons.

In the Constitution of the Russian Federation, the human being and his or her rights are declared the highest values; accordingly, the protection of the health of the rising generation is one of the state's priority tasks.

The indicator of fitness of citizens for military service has remained extremely low over recent decades and has steadily declined from 80.2% in 1994 to 48.6% in 2006. The state of prolonged psychoemotional stress, in which more than 70% of the population of Russia lives, reduces the adaptive and compensatory mechanisms that maintain health and substantially affects the number of persons fit for service in the Armed Forces (Kulikov V.V., 2001). At present, the health of draft-age young men in the Russian Federation is characterized by high morbidity and unsatisfactory indicators of physical development and mental health (Ketova G.G., 2001). Among conscripts, the proportion of chronic non-communicable diseases has increased; within this group, neurocirculatory dystonia (NCD) occupies a special place, as it restricts the choice of profession and service in the Armed Forces.

Neurocirculatory dystonia is of concern not only to therapists but also to cardiologists, neurologists, and psychiatrists, and throughout the last century it has appeared under numerous names. At the same time, despite the prevalence of the disease, constructive clinical recommendations for the prevention of NCD are extremely few, which attests to the complexity of the problem. This may explain why no purposeful strategy for the treatment process has yet been developed (Kushnir S.M., 2001; Vein A.M., 2003; Ushakov I.B., 2003). One important question in the study of neurocirculatory dystonia concerns the analysis of the causes, factors, and mechanisms that underlie its clinical manifestations and outcomes, especially since, in the opinion of a number of authors, NCD is a predictor of such diseases as essential hypertension, ischemic heart disease, peptic ulcer, and others (Makolkin V.I., Abakumov S.A., 2005).

The works of Russian authors present the results of studies on the health status of pre-conscripts and conscripts, recommendations on early detection, and the development of preventive measures for conscripts (Krasilnikov V.I., 2002; Ziangirov R.A., 2004). The contradictory information on the frequency and severity of clinical manifestations of neurocirculatory dystonia, as well as the limited number of regional medico-social studies on the role of risk factors in the formation of chronic non-communicable diseases, determined the aims and objectives of the present research.

Aim of the study: to investigate the clinical and functional characteristics of neurocirculatory dystonia and to assess the role of risk factors for chronic non-communicable diseases in the formation of autonomic imbalance in persons of draft age.

Objectives of the study:

1. To identify the principal risk factors for the development of neurocirculatory dystonia in draft-age young men under present-day conditions.

2. To study the clinical features of neurocirculatory dystonia in draft-age young men.

3. To determine the functional state of the cardiovascular system in draft-age persons with different clinical variants of NCD.

4. To study psychovegetative relationships and adaptive capacities in draft-age persons with neurocirculatory dystonia.

Scientific novelty. In the Republic of Bashkortostan it has been established that, among cardiovascular pathology in draft-age persons, neurocirculatory dystonia occupies first place.

It has been shown that the most significant risk factors for chronic non-communicable diseases in the population of draft-age young men are smoking, alcohol consumption, low physical activity, insufficient body weight, and psychoemotional tension. The state of autonomic regulation in conscripts is characterized by tension of the adaptive-compensatory mechanisms, which is more pronounced in the hypertensive variant of neurocirculatory dystonia.

The autonomic support of cardiac activity, according to the clinostatic–orthostatic test in persons with hypertensive-type neurocirculatory dystonia, is characterized by excessive activation of the sympathetic division of the autonomic nervous system, whereas in the cardiac type it is characterized by tension of autonomic balance as a result of excessive activation of cerebral ergotropic and humoral-metabolic influences.

It has been shown that the combination of clinical manifestations of autonomic imbalance of the cardiovascular system with psychoemotional disorders in young men with neurocirculatory dystonia indicates the formation of a psychovegetative syndrome, which explains the need for further study of the psychosomatic health of draft-age young men.

Practical significance of the work. The revealed high frequency of risk factors for chronic non-communicable diseases provides a scientific basis for the development of methods for the correction of clinical manifestations of NCD in draft-age persons. The study substantiates the possibility of early dispensary registration of adolescents with NCD. Changes in heart rate variability indices during the clinostatic–orthostatic test may be used as diagnostic criteria for the severity of autonomic dysfunction.

The results of the study make it possible to identify among young persons the contingent most at risk of developing NCD and to follow the dynamics of the pathological process. A list of examinations and functional tests for the early diagnosis of the adaptive capacities of the organism has been proposed, which will permit effective primary prevention of the development of cardiovascular diseases.

Statements submitted for defense:

1. In draft-age young men, a high frequency of risk factors for chronic non-communicable diseases that are significant for the formation of neurocirculatory dystonia is revealed.

2. In conscripts with the hypertensive variant of neurocirculatory dystonia, signs of impaired autonomic regulation of cardiac rhythm are present.

3. Autonomic support during the clinostatic–orthostatic test in young men with the hypertensive variant of neurocirculatory dystonia is characterized by a predominance of the hypersympathicotonic variant, whereas in the cardiac variant the asympathicotonic variant and the variant with excessive involvement of the sympathoadrenal system occur with equal frequency.

4. In young men with neurocirculatory dystonia, autonomic imbalance is combined with changes in the psychoemotional sphere and with disturbances of adaptive capacities.

Implementation of the results of the study in practice. The results of the study are used in the Ufa Garrison Military Hospital of the Ministry of Defense of the Russian Federation, in the Kuvatov Republican Clinical Hospital, and in the educational process of the Department of Polyclinic Therapy of the Bashkir State Medical University.

Approval of the work. The main results of the study were presented at the All-Russian Scientific and Practical Conference with international participation "Contemporary Problems of Occupational Medicine," dedicated to the 50th anniversary of the Ufa Research Institute of Occupational Medicine and Human Ecology (Ufa, 2005); the 71st Final Republican Scientific Conference of Students and Young Scientists with international participation "Issues of Theoretical and Practical Medicine" (Ufa, 2006); the I National Congress of Therapists (Moscow, 2006); the scientific conference "Scientific Research of Higher Education" (Spain, 2006); and the IV Scientific Conference "Contemporary Problems of Experimental and Clinical Medicine" (Thailand-Pattaya, 2007).

The dissertation was approved at a meeting of the Problem Commission on Internal Diseases of the Bashkir State Medical University (Ufa, March 2007).

Publications. Nine printed works have been published on the materials of the dissertation.

Scope and structure of the dissertation. The dissertation is presented on 135 pages of printed text and consists of an introduction, a literature review, material and methods of the study, results of the author's own research and discussion of the obtained data, a conclusion, conclusions, practical recommendations, and a bibliography. The bibliographic list contains 240 sources, including 194 Russian and 46 foreign authors. The work is illustrated with 25 tables and 15 figures.