ASPECTE EVOLUTIVE ALE SINDROMULUI METABOLIC LA COPII SUB TRATAMENT CU INHIBITORII LIPAZEI GASTROINTESTINALE
DOI:
https://doi.org/10.52692/1857-0011.2024.1-78.11Cuvinte cheie:
sindrom metabolic, copii, obezitate, hipertensiune arterialăRezumat
Introducere. În paralel cu tendințele crescânde ale ratelor de obezitate se atestă creșterea prevalenței sindromului metabolic (SM) la copii, acest fapt dictează ca fiecare componentă a SM să fie identificată cât mai precoce, iar scopul tratamentului constă în reducerea obezității, gestionarea complicațiilor metabolice, a rezistenței la insulină și, de asemenea, managementul hipertensiunii arteriale (HTA).Scopul studiului: Determinarea factoriilor de risc, a rolului unor markeri proinflamatori (TNF α, PCR-hs) și adipokine (leptina, adiponectina) în instalarea SM la copii și a evoluției acestora sub tratamentul cu inhibitorii lipazei gastrointestinale (ILG)Material și metode. Rezultatele prezentate sunt obținute ca urmare a realizării unui proiect din cadrul Programului de Stat 2020-2023 cu titlul ,,Aspecte evolutive ale sindromului metabolic la copii sub tratament cu inhibitorii lipazei gastrointestinale”, cifrul proiectului 20.80009.8007.33. Studiul a inclus 57 de copii cu SM (IDF, 2007). În funcție de terapia medicamentoasă aferentă tratamentului non-farmacologic, copiii din cercetare s-au divizat în 3 loturi: lotul I - 23 copii, care au primit orlip (orlistat) - ILG, lotul II - 15 copii, care au urmat Inhibitorii Enzimei de Conversie a Angiotensinei (IECA) și lotul III - 19 copii, care au administrat atât ILG, cât și IECA. Lotul martor la constituit 50 de copii normotensivi și normoponderali de vârstă similară (raportul de gen: 1:1). S-au analizat factorii de risc, indicele masei corporale (IMC), circumferința abdomenului (CA), valorile tensionale, colesterolul total (CT), LDL - C, HDL - C, trigliceride (TG), glicemia bazală (GB), insulina serică, TNFα, PCR-hs, leptina, adiponectina inițial și la intervalul de 3 luni.Protocolul studiului a fost aprobat de către Comisia de Etică Medicală din cadrul IMSP Institutul de Cardiologie, Republica Moldova (proces verbal nr.2 din 20 februarie 2020).Rezultate: Majoritatea copiilor din cercetare au avut o anamneză heredo-colaterară agravată prin HTA și obezitate, au fost sedentari sau moderat sedentari și au avut o cultură alimentară precară. Dintre componentele SM (IDF, 2007), asociate obezității abdominale, a predominat: HTA la 38 (66,7%) copii, hipertrigliceridemie - 32 (56,1%%) copii, majorarea GB - 17(29,8%) copii și hipo-HDL-C - 11 (19,3%) copii. IMC la intervalul de 3 luni de la inițierea medicației cel mai important a scăzut în lotul I (-4,025±1,267 kg/m2), urmat de lotul II (-3,33±0,972 kg/m2) și III (-3,046±0,840 kg/ m2). CA cel mai important a scăzut în lotul III (-10,63±3,732 cm) vs lotul II (-9,167±1,783 cm) vs lotul I (- 4,700±2,352 cm). Tendințe similare s-au obținut și pentru valorile tensionale: lotul III (-18.75±1,897 mm Hg) vs lotul II (-12,167±1,359 mm Hg) vs lotul I (-3,900±4,613 mm Hg). LDL-C a scăzut mai important în lotul II al cercetării (-0,46±0,211 mmol/l), iar TG - în lotul III (-0,77±0,325 mmol/l) și II (-0,53±0,112 mmol/l). HDL-C a crescut cu +0,60±0,274 mmol/l în lotul I, cu+0,15±0,066 mmol/l în lotul II și cu +0,12±0,031mmol/l în lotul III. Insulina serică s-a micșorat mai important în lotul III al cercetării (-9,36±4,53 µU/mL). Tendințe similare s-au constatat și pentru GB (lotul III -1,24±0,322 mmol/l). TNF α s-a micșorat mai important în lotul III (-2,65±0,911 pg/ml) vs lotul I (-1,24±0,508 pg/ml) și lotul II (-1,61±1,018 pg/ml). PCR hs a diminuat mai important în lotul I (-0,69±0,785 mg/l) și lotul II (-0,74±0,593 mg/l) vs lotul III (-0,42±0,617 mg/l). Valorile leptinei s-au micșorat important în toate loturile de cercetare la intervalul de 3 luni de la inițierea medicației (lotul I cu - 8,80±3,64 ng/ml, lotul II cu -10,92±4,084 ng/ml, lotul III cu -9,75±6,172 ng/ml). Valorile adiponectinei au crescut cu +1,83±1,087 µg/L în lotul III al cercetării.Concluzie: În combinație cu o dietă redusă în calorii, exerciții fizice regulate și modificări comportamentale, tratamentul cu ILG și IECA la copiii cu SM din cercetare a contribuit la scăderea gradului de obezitate, valorilor tensionale, și respectiv, normalizarea profilului lipidic și glucidic și, totodată, a scos în evidență atât importanța prevenirii, depistării și gestionării precoce a obezității, precum și legătura de cauzalitate dintre obezitate, HTA și inflamația cronică.
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