Estellés A, Dalmau J, Falcó C, Berbel O, Castelló R, España F, Aznar J
Research Center, La Fe University Hospital, Valencia, Spain.
Thromb Haemost. 2001 Aug;86(2):647-52.
An association between an increase in plasminogen activator inhibitor type 1 (PAI-1) and obesity, and also between elevated levels of PAI-1 and the presence of PAI-1 promoter 4G allele has been described in adults and can contribute to increased risk of cardiovascular disease. It has also been suggested that in adults a decrease in adiposity has beneficial effects on the haemostatic system. However, less information is available regarding adiposity and fibrinolysis in children. The aim of the present study is to evaluate the effect of weight loss and the influence of the PAI-1 promoter 4G/5G genotype on the fibrinolytic system and lipid parameters in obese children. The clinical groups included 102 obese children and 105 controls of similar age and sex distribution. A significant decrease in fibrinolytic activity due to a significant increase in PAI-1 antigen and activity levels was observed in the obese children in comparison with the control group. In obese children, no significant differences in PAI-1 levels between the PAI-1 4G/5G genotypes were obtained. A significant correlation was observed between PAI-1 antigenic and functional levels and body mass index (BMI), as well as between PAI-1 levels and both triglyceride and insulin levels. No correlation between PAI-1 levels and either cholesterol or glucose levels was observed. After a three-month period of treatment to reduce weight, an increase in fibrinolytic activity due to a decrease in PAI- levels was observed in the obese children who had reduced their BMI in comparison with the group of obese children who did not show a decrease in their BMI. No significant differences between the two groups with respect to the variations in tissue type plasminogen activator and fibrinogen levels were obtained after three months of intervention to reduce weight. A significant correlation was observed between variations in BMI and variations in PAI-1 levels, and a significant inverse correlation was also observed between previous PAI-1 levels and variation in PAI-1 levels. Therefore, the largest decrease in PAI-1 levels was observed in the obese children with the highest previous PAI-1 levels. In conclusion, a decrease in BMI in obese children shows a favourable effect on the fibrinolytic system due to a decrease in PAI-1 levels. However, no influence of 4G/5G genotype on PAI-1 levels was observed.
纤溶酶原激活物抑制剂1（PAI-1）增加与肥胖之间的关联，以及PAI-1水平升高与PAI-1启动子4G等位基因的存在之间的关联，在成年人中已有描述，且可能导致心血管疾病风险增加。也有人提出，在成年人中，肥胖程度降低对止血系统有有益影响。然而，关于儿童肥胖与纤维蛋白溶解的信息较少。本研究的目的是评估体重减轻的影响以及PAI-1启动子4G/5G基因型对肥胖儿童纤维蛋白溶解系统和脂质参数的影响。临床组包括102名肥胖儿童和105名年龄和性别分布相似的对照组。与对照组相比，肥胖儿童中由于PAI-1抗原和活性水平显著增加，纤维蛋白溶解活性显著降低。在肥胖儿童中，PAI-1 4G/5G基因型之间的PAI-1水平无显著差异。观察到PAI-1抗原和功能水平与体重指数（BMI）之间存在显著相关性，以及PAI-1水平与甘油三酯和胰岛素水平之间也存在显著相关性。未观察到PAI-1水平与胆固醇或血糖水平之间存在相关性。在为期三个月的减肥治疗期后，与BMI未降低的肥胖儿童组相比，BMI降低的肥胖儿童中由于PAI-水平降低，纤维蛋白溶解活性增加。在为期三个月的减肥干预后，两组在组织型纤溶酶原激活物和纤维蛋白原水平变化方面未获得显著差异。观察到BMI变化与PAI-1水平变化之间存在显著相关性，并且还观察到先前的PAI-1水平与PAI-1水平变化之间存在显著负相关性。因此，先前PAI-1水平最高的肥胖儿童中PAI-1水平下降最大。总之，肥胖儿童BMI降低由于PAI-1水平降低，对纤维蛋白溶解系统显示出有利影响。然而，未观察到4G/5G基因型对PAI-1水平有影响。
