4th Department of Pediatrics, Medical School, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece.
Eur J Pediatr. 2011 Jul;170(7):879-86. doi: 10.1007/s00431-010-1370-9. Epub 2010 Dec 8.
Obesity in childhood increases the risk for early adult cardiovascular disease. However, the underlying mechanism is not fully known. The aims of this study were to measure levels of prothrombotic factors and examine their possible association with obesity and insulin resistance in obese children and adolescents. A total of 313 obese children and adolescents were recruited. In a cross-sectional design, we measured anthropometric parameters, plasminogen activator inhibitor-1-antigen (PAI-1-Ag), von Willebrand factor-antigen (vWF-Ag), fibrinogen (FB), lipids, fasting glucose, and insulin (FI) levels. Insulin resistance was estimated using the homeostasis model assessment for insulin resistance (HOMA-IR) index. Boys presented significantly higher PAI-1-Ag levels than girls (82.6 vs. 71.3 ng/ml, p = 0.01). Higher levels of PAI-1-Ag (96.8 vs. 69 ng/ml, p < 0.001), vWF-Ag (123.5 vs. 107.6%, p = 0.004) but not FB (353.1 vs. 337.6 mg/dl, p = 0.137) were found in insulin-resistant (IR) participants after adjusted for age, gender, and pubertal stage. IR patients were at 2.98 (CI: 1.084-8.193) and 4.86 (CI: 1.119-15.606) times greater risk for high PAI-1-Ag and vWF-Ag levels, respectively. All three prothrombotic factors were positively correlated with body mass index (BMI) and FI levels (p < 0.05), but only PAI-1-Ag and vWF-Ag were significantly correlated with HOMA-IR index (p ≤ 0.001). After adjustment for confounding factors, both BMI and HOMA-IR indices remained significantly associated with PAI-1-Ag (r₂ = 0.225, p < 0.001) and vWF-Ag levels (r₂ =0.077, p = 0.003).
This study shows that obesity in youngsters, when accompanied with insulin resistance, is associated with at least threefold increased risk for elevated levels of prothrombotic factors, contributing to the early development of atherothrombosis. This impaired prothrombotic state may partially explain the increased risk for developing cardiovascular disease later in adulthood.
测量促血栓形成因子的水平，并研究其与肥胖和肥胖青少年胰岛素抵抗的可能相关性。
本横断面研究共纳入 313 名肥胖青少年，测量了人体测量参数、纤溶酶原激活物抑制剂 1 抗原（PAI-1-Ag）、血管性血友病因子抗原（vWF-Ag）、纤维蛋白原（FB）、血脂、空腹血糖和胰岛素（FI）水平。采用稳态模型评估胰岛素抵抗（HOMA-IR）指数估计胰岛素抵抗。
男孩的 PAI-1-Ag 水平显著高于女孩（82.6 与 71.3 ng/ml，p=0.01）。调整年龄、性别和青春期阶段后，IR 参与者的 PAI-1-Ag（96.8 与 69 ng/ml，p＜0.001）和 vWF-Ag（123.5 与 107.6%，p=0.004）水平更高，但 FB（353.1 与 337.6 mg/dl，p=0.137）水平无差异。IR 患者的 PAI-1-Ag 和 vWF-Ag 水平分别高出 2.98（95%CI：1.084-8.193）和 4.86（95%CI：1.119-15.606）倍。所有三种促血栓形成因子均与 BMI 和 FI 水平呈正相关（p＜0.05），但仅 PAI-1-Ag 和 vWF-Ag 与 HOMA-IR 指数显著相关（p≤0.001）。调整混杂因素后，BMI 和 HOMA-IR 指数仍与 PAI-1-Ag（r²=0.225，p＜0.001）和 vWF-Ag 水平（r²=0.077，p=0.003）显著相关。
本研究表明，青少年肥胖合并胰岛素抵抗与升高的促血栓形成因子水平相关，发生动脉血栓形成的风险增加至少三倍，这可能部分解释了成年后发生心血管疾病风险增加的原因。
