Бокова Татьяна Алексеевна, доктор медицинских наук, доцент, руководитель педиатрического отделения, профессор кафедры педиатрии факультета усовершенствования врачей; профессор кафедры педиатрии с инфекционными болезнями у детей
129110, г. Москва, ул. Щепкина, д 61/2, Россия,
117997, г. Москва, ул. Островитянова, 1, Россия
Tatiana A. Bokova, PhD, MD, Нead of the pediatric Department; Professor of Pediatrics Department Moscow regional research; Professor of Department of Pediatrics with infectious diseases in children
61/2 Shchepkina ul., Moscow, 129110, Russia,
1, ul. Ostrovityanova, Moscow, 117997, Russia
Актуальность. Нарушения липидного обмена тесно взаимосвязаны с абдоминальным (висцеральным) ожирением и формированием метаболического синдрома (МС).
Цель исследования: изучить особенности липидного спектра крови у детей с ожирением в зависимости от наличия признаков МС.
Материалы и методы исследования: обследовано 483 ребёнка с ожирением: I группа — 237 детей с МС, II группа — 246 детей без МС. Обследование включало сбор анамнеза, антропометрию, измерение АД, ультразвуковое исследование органов брюшной полости, биохимическое исследование сыворотки крови и липидного профиля.
Результаты. Изменение липидного профиля выявлено у 76,8% детей I группы и 43,9% детей II группы; у 38,0% детей I группы изменения касались одного показателя, у 35,8% детей — двух, а у 3,0% — трех и более показателей, во II группе изменения одного показателя — 36,2%, двух — 7,7%. Повышение ТГ имели 53,6% детей I группы и 8,5% детей II группы, снижение уровня ХС ЛПВП — 52,8% и 24,0%. Исключительно в I группе диагностировалось их сочетание: мальчиков –62,5%, девочек –31,5%. Во II группе у детей младше 10 лет гипо-α-липопротеидемия выявлена у 27,8%, гипертриглицеридемия — у 11,1%. Снижение ХС ЛПВП имели 46,5% детей I группы с НАЖБП и 58,4% без неё, во II группе — 15,7% и 17,6% соответственно. В I группе сочетание гипертриглицеридемии и гипо-α-липопротеидемии отмечалось у 28,9% детей с НАЖБП и 22,5% детей без неё. Частота нарушений липидного профиля по мере длительности заболевания достоверно увеличивалась.
Выводы. У половины детей с МС выявляются повышение е ТГ и снижение ХС ЛПВП, что достоверно превышает аналогичные показатели детей с неосложнённым ожирением. Исключительно у детей с МС отмечается сочетание гипертриглицеридемии и гипо-α-липопротеидемии. У 28% детей с ожирением в возрасте до 10 лет выявлена гипо-α-липопротеидемия, у 11% — гипертриглицеридемия. Наличие у детей с ожирением сочетания МС и НАЖБП является прогностически неблагоприятным фактором риска формирования и прогрессирования нарушений липидного обмена. Установлено прогрессирующее нарушение липидного профиля по мере длительности ожирения.
Relevance. Disorders of lipid metabolism are closely related to abdominal (visceral) obesity and MS in adolescence, as well as the development of early cardiovascular complications in adulthood.
The purpose of the study: to Study the features of the blood lipid spectrum in obese children, depending on the presence of signs of MS.
Materials and methods: 483 obese children (SDS BMI ≥ 2.0) (349 boys and 234 girls) aged from 5 to 16 years were. I group — 237 children (145 boys and 92 girls) with MS (IDF, 2007), II group — 246 children (140 boys and 106 girls) with obesity without signs of MS. The examination included anamnesis collection, anthropometry, blood PRESSURE measurement, ultrasound examination of the abdominal organs, biochemical examination of blood serum and lipid profile.
Results. Change in lipid profile were detected in 76.8% of children in I group and 43.9% of children in II group have 38,0% of children in I group the changes on a single metric, the 35.6% of children two, and 3.0% — three and more indicators, whereas in II group the most frequently recorded changes of only one (36,2%), at least two indicators (7,7%). In I group children, there was a significant increase in TG, the atherogenicity coefficient, and a decrease in HDL cholesterol. 53.6% of children of I group and only 8.5% of children of II group had an increase in the level of TG, and 52.8% and 24.0% of children had a decrease in HDL levels, respectively. The combination of hypertriglyceridemia and hypo-α-lipoproteidemia was diagnosed exclusively in I group (27.0%), of which boys –62.5%, girls –31.5%. In I group the frequency of hyperglyceridemia and hypo-α-lipoproteinemia regardless of age was significantly higher than II group, while in both groups a higher frequency compared to hyperglyceridemia had Hypo-α-lipoproteinemia. In II group, children under 10 years of age also had lipid profile disorders-hypo-α-lipoproteidemia in 27.8%, hypertriglyceridemia‑11,1%. An increase in the level of TG in children with signs of NAFLD in I group was diagnosed not only more often than in children without it, but also in comparison with children of II group. 46,5% of children in I group with NAFLD and 58.4% without it had a decrease in HDL cholesterol; in II group, these values were 15.7% and 17.6%, respectively. In I group, the combination of hypertriglyceridemia and Hypo-α-lipoproteidemia was observed in 28.9% of children with NAFLD and 22,5% of children without it; in II group, they were registered separately. Regardless of the group, 48,7% of children who were obese for 1–2 years and 60,1% of children with a disease duration of 5 years or more had lipid profile disorders. Violations of one component had 31,6% and 31.1% of children, respectively, the frequency of violations of two or more components as the duration of the disease significantly increased — from 17.1% to 29.0%.
Conclusions. In half of children with MS, lipid metabolism disorders are detected in the form of an increase in the level of TG (53.6%) and a decrease in HDL (52.8%), which is significantly higher than in children with uncomplicated obesity (8.5% and 24.0%). Exclusively in children with MS, there is a combination of hypertriglyceridemia and hypo-α-lipoproteinemia (27%). In 28% of obese children under 10 years of age, hypo-α-lipoproteidemia was detected, in 11% — hypertriglyceridemia, which indicates that dyslipidemia is formed in them at a young age and progresses with the duration of the disease, and its early manifestation is a violation of the excretion of tissue cholesterol due to a decrease in HDL levels. The presence of a combination of MS and NAFLD in obese children is a prognostically unfavorable risk factor for the formation and progression of more pronounced disorders of lipid metabolism. Installed deterioration of the lipid spectrum of blood serum as the duration of obesity, manifested by a reliable increase in the frequency of combined violations of two or more indicators that indicates a need for complex treatment and preventive measures at earlier stages of the disease (first 1–2 years) to reduce the risk of formation of MS and atherogenic complications in the future.
The authors declare that there are no conflicts of interest present.