ЕФЕКТИВНІСТЬ ЗАСТОСУВАННЯ ТІВОРЕЛЮ ТА КВЕРЦЕТИНУ ПРИ ПОСТКОВІДНОМУ СИНДРОМІ У ХВОРИХ НА ЦУКРОВИЙ ДІАБЕТ 2-ГО ТИПУ

The aim of the study was to investigate the effectiveness of tivorel and quercetin in patients with type 2 diabetes ( T2D ) and post-COVID syndrome by evaluating glucose metabolism, lipid metabolism, systemic inflammation, endothelial function, and hemostasis indicators during treatment. The study involved 40 patients with type 2 diabetes and post-COVID syndrome who were hospitalized. Patients were divided into two groups: the main group of 20 patients received tivorel (20 mg levocarnitine + 42 mg arginine hydrochloride, manufactured by LLC "Yuria-Pharm") intravenously on a daily basis for 10 days, followed by oral administration of tivorel aspartate (20 ml twice a day) for 21 days. In addition, they were treated with quercetin ("Quertin," manufactured by PJSC "Borshchagivskiy HFZ") at a dosage of 2 tablets, three times a day (a daily dose of 240 mg quercetin) for one month. The control group included 20 patients who did not receive the aforementioned therapy. The study of the lipid spectrum of blood plasma (total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C, LDL-C, VLDL-C) was performed using diagnostic reagent kits. To assess the state of carbohydrate metabolism, glucose levels were determined during a standard oral glucose tolerance test (OGTT), as well as glycosylated hemoglobin (HbA1c). Plasma fibrinolytic activity (total fibrinolytic activity (TFA), enzymatic fibrinolytic activity (EFA) and non-enzymatic fibrinolytic activity (NFA)), prothrombin time (PT), PI, APTT, factor XIII activity (FXIII), plasma fibrinogen level, and AT III activity were determined using standard methods. Serum levels of C-reactive protein (CRP), interleukin-10 (IL-10), 8-isoprostane, and D-dimer were also measured using ELISA. Endothelial function was assessed by blood levels of stable metabolites of nitric oxide (nitrites/nitrates), endothelin-1 (ET-1). The use of tivorel and quercetin in the comprehensive therapy of patients with type 2 diabetes and post-COVID syndrome led to a reduction in total cholesterol (TC) and triglycerides (TG) in serum at 18.2% and 22.4%, respectively, and an increase in high-density lipoprotein cholesterol (HDL-C) at 38.6%. Significant reductions in low-density lipoprotein cholesterol (LDL-C), very low-density lipoprotein (VLDL-C) and atherogenic coefficient (AC) were also noted. Fasting glucose levels decreased 1.8-fold, 2-hour glucose levels dropped at 44.3%, and glycated hemoglobin decreased at 28.2% fasting and with a standard glucose tolerance test. This treatment also had a positive impact on systemic inflammation and oxidative stress, as indicated by reductions in 8-isoprostane (at 30.6%), C-reactive protein (CRP) (at 50.5%), and Interleukin-1 (IL-1) (at 20.6%). The levels of nitric oxide metabolites decreased at 32.2%, and endothelin-1 (ET-1) decreased at 18.4%. Tivorel and quercetin improved hemostasis markers, including reduction in prothrombin index (PTI), fibrinogen, and D-dimer, as well as the increase in activated partial thromboplastin time (APTT), antithrombin III (ATIII), total and enzymatic fibrinolytic activity. The use of tivorel and quercetin in the complex treatment of patients with type 2 diabetes with post-Covid syndrome is an effective combination for improving the functional state of the endothelium and indicators of the hemostasis system.