Niemirska Anna, Litwin Mieczysław, Antoniewicz Jolanta, Jurkiewicz Elzbieta, Kościesza Iwona, Sladowska Joanna, Janas Roman, Wawer Zbigniew T
Klinika Nefrologii, Transplantacji Nerek i Nadciśnienia Tetniczego, Instytut Pomnik-Centrum Zdrowia Dziecka, Warszawa.
Przegl Lek. 2006;63 Suppl 3:49-53.
Metabolic alterations related to obesity are regarded as significant risk factor for target organ damage in hypertensive patients. Fat tissue distribution seems to play significant role in metabolic alterations related to cardiovascular damage. The aim of the study was to test hypothesis that fat tissue distribution and excess of visceral fat is related to cardiovascular damage and metabolic cardiovascular risk factors in obese boys with yet untreated, primary hypertension.
40 boys (14.8 +/- 3.0 yrs) with untreated essential hypertensions.
amount of visceral (VAT), intraperitoneal visceral (ipVAT), extraperitoneal visceral (epVAT) and subcutaneous fat (SAT) was measured by nuclear magnetic imaging (NMR). Carotic intima media thickness (cIMT), fenoral intima media thickness (fIMT) and left ventricular mass index (LVMi) were evaluated by sonography. Oral glucose loading test was done, lipids, homocysteine, CRP, uric acid, microalbuminuria, adipocytokines, IGF-1 and IGF binding proteins (IGFBP) were determined.
The ratio of VAT to epVAT (V/Ve) correlated with carotid IMT (p=0.0001; r=0.561), standard deviation from median of the norm of cIMT (cIMT-SDS) (p=0.0001; r=0.681), femoral IMT (p=0.015; r=0.480) and fIMT-SDS (p=0.002; r=0.579). SAT correlated negatively with cIMT (p=0.0016; r=-0.355) and cIMT-SDS (p=0.01; r=-0.391). Waist to hip ratio (WHR) correlated with cIMT-SDS (p=0.03; r=0.401). VAT correlated positively and SAT negatively with HDL, apoA1, uric acid concentration and HOMA-IR value. VAT/epVAT correlated with HOMA-IR (p=0.02; r=0.402), free IGF-1 (p=0.001; r=0.478). epVAT also correlated with free IGF-1 (p=0.006; r=-0.494) and IGFBP3 (p=0.02; r=-0.471). Step-wise regression analysis revealed that relative excess of intraperitoneal visceral fat (VAT/epVAT) and WHR were independent predictors of cIMT-SDS(p=0.022, R2=0.755).
Fat tissue distribution correlates with early vascular injury and metabolic alterations in boys with primary hypertension. Relative excess of visceral fat assessed by NMR and truncal obesity expressed as WHR are independent risk factors for early vascular damage in overweight boys with primary hypertension.
与肥胖相关的代谢改变被视为高血压患者靶器官损害的重要危险因素。脂肪组织分布似乎在与心血管损害相关的代谢改变中起重要作用。本研究的目的是检验以下假设：在未经治疗的原发性高血压肥胖男孩中，脂肪组织分布和内脏脂肪过多与心血管损害及代谢性心血管危险因素有关。
40名患有未经治疗的原发性高血压的男孩（14.8±3.0岁）。
通过核磁共振成像（NMR）测量内脏脂肪（VAT）、腹膜内内脏脂肪（ipVAT）、腹膜外内脏脂肪（epVAT）和皮下脂肪（SAT）的量。通过超声评估颈动脉内膜中层厚度（cIMT）、股动脉内膜中层厚度（fIMT）和左心室质量指数（LVMi）。进行口服葡萄糖耐量试验，测定血脂、同型半胱氨酸、CRP、尿酸、微量白蛋白尿、脂肪细胞因子、IGF-1和IGF结合蛋白（IGFBP）。
VAT与epVAT的比值（V/Ve）与颈动脉IMT（p = 0.0001；r = 0.561）、cIMT中位数标准差（cIMT-SDS）（p = 0.0001；r = 0.681）、股动脉IMT（p = 0.015；r = 0.480）和fIMT-SDS（p = 0.002；r = 0.579）相关。SAT与cIMT（p = 0.0016；r = -0.355）和cIMT-SDS（p = 0.01；r = -0.391）呈负相关。腰臀比（WHR）与cIMT-SDS（p = 0.03；r = 0.401）相关。VAT与HDL、载脂蛋白A1、尿酸浓度和HOMA-IR值呈正相关，SAT与它们呈负相关。VAT/epVAT与HOMA-IR（p = 0.02；r = 0.402）、游离IGF-1（p = 0.001；r = 0.478）相关。epVAT也与游离IGF-1（p = 0.006；r = -0.494）和IGFBP3（p = 0.02；r = -0.471）相关。逐步回归分析显示，腹膜内内脏脂肪相对过多（VAT/epVAT）和WHR是cIMT-SDS的独立预测因子（p = 0.022，R2 = 0.755）。
脂肪组织分布与原发性高血压男孩的早期血管损伤和代谢改变相关。通过NMR评估的内脏脂肪相对过多和以WHR表示的躯干肥胖是原发性高血压超重男孩早期血管损伤的独立危险因素。
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