Медицина Медицина Мedicine Вступ Цукровий діабет (ЦД) вже давно віднесли до трійки захворювань, що найчастіше призводять до інвалідизації населення й смерті [3]. За даними Всесвітньої організації охорони здоров'я, ЦД збільшує смертність у 2-3 рази й суттєво скорочує тривалість життя. При цьому кількість хворих на ЦД щорічно збільшується в усіх країнах на 5-7 %, а кожні 12-15 років подвоюється [5]. Такі показники змушують лікарів говорити про неінфекційну епідемію щодо ЦД. За даними Міністерства охорони здоров'я, в Україні налічується близько 1,3 млн. хворих на ЦД, з них близько 200 тисяч хворих потребують щоденного прийому інсуліну. Результати дослідження Diabetes Controland Complications Trial (DCCT) свідчать, що на тлі жорсткого контролю глікемії у хворих ЦД 1-го типу значно знижується ризик виникнення хронічних ускладнень, зокрема діабетичної полінейропатії (ДП)-на 60 %. Дослідження United Kingdom Prospective Diabetes Study (UKPDS) показало, що зниження рівня глікозильованого гемоглобіну (HbA1c) у хворих на діабет 2-го типу лише на 1 % знижує ризик виникнення мікросудинних уражень на 37 %, уражень периферичних судин-на 43 %, а летальність, пов'язану з ЦД,-на 21 % [2]. Самоконтроль (вимірювання глюкози самим пацієнтом) є невід'ємним компонентом ефективної терапії ЦД [4].

Analytical view of the human organism, its physiology and pathology, treatment methods, formed under the influence of many centuries of observing the progress of the disease, when there was not this or that individual symptoms and groups related by birth, with common features and parallel flow of symptoms, under the influence of treatment and its effects have been studied as weight, texture, color, damaged organs, the link between a specific and complex pathology of affected organs and tissues. Thus was formed syndromal diagnosis of multiple sclerosis, where each syndrome reflects the general, substantiality and local disturbances, had characteristic diagnostic features. On the basis of this multi-faceted study of the patient was placed syndromic diagnosis and the appropriate treatment approach, aimed at restoring the overall balance of the body's defenses.

The objective of our research was to study the clinical ratios between the neurological, demographic and medical-psychological parameters in patients with multiple sclerosis. 89 patients with multiple sclerosis were questioned at time of routine clinic visits. Medical-psychological examination was carried out with the help of the Luscher Color Test. Neurological manifestations (severity of disease, type of the clinical course, duration, age at disease onset) and demographic manifestations (age and gender) of multiple sclerosis have been found to be connected with the dynamics of the level of emotional intensity, the type of vegetative balance and the level of working capacity of patients.

The paper shows the results of electrophysiological methods of investigation in patients with multiple sclerosis (MS) in the aspect of comorbidity. The studies of somatosensory evoked potentials (SSEP) in 216 patients with MS and electroneuromyography in 158 patients with MS, together with the assessment of neurological and psychological status. It is shown that according SSEP increase latency peripheral response in a progressive course of MS compared to remitting associated with older age of patients with progressive MS, and due to involvement in the pathological process of the peripheral nervous system (PNS) and the prevalence of pain syndrome (PS) in patients MS with comorbidity. It is demonstrated, on the basis of electroneuromyographic that MS patients with comorbidity tends to be deeper shock PNS. The data electroneuromyographic clinically appropriate initial stage of sensory or sensorimotor polyneuropathy, which proceeded in 84.8% of patients with MS subclinical and 15.2% had a clear clinical signs.

The research is dedicated to studying the clinical, neurophysiological, neuroimaging, neuropsychological, immunopathological manifestations of MS on the background of comorbid pathology, evaluation of complex treatment.The features of the manifestations of fatigue, depression, pain, cognitive impairment, sleep disorders in patients with MS based on comorbidity and impact of violations on the quality of life. On the basis of the study of risk factors, the analysis revealed the features of development of MS in conditions of comorbid pathology. Based on the factors studied, a pathogenetic model of the character of the effect of comorbidity on the course of MS with regard to prognostic signs for clinical, psychoemotional, neurophysiological and neuroimaging indicators has been created, and it is possible to individually assess the risk of development and progression of MS. Efficacy and comparative analysis of the use of complex (medicaments and non-medicaments) treatment was revealed, the frequency of exacerbations decreased and the effect on the course of the disease with MS taking into account the comorbid pathology and heterogeneity of clinical-neurological and psychoemotional disorders, clinical, neuropsychological, neuroimaging, neuroimaging signs of disease activity.