doktorska disertacija
Andreja Štelcar (Avtor), Nataša Marčun-Varda (Mentor), Ivan Krajnc (Član komisije za zagovor)

Povzetek

Izhodišča: Arterijska hipertenzija (AH) je ob aterosklerozi najpogostejša bolezen obtočil pri odraslih in predstavlja enega glavnih dejavnikov tveganja za nastanek in razvoj srčno-žilnih bolezni. Z vse večjo pojavnostjo debelosti v populaciji otrok in mladostnikov je postala esencialna arterijska hipertenzija (EH) ena najpogostejših kroničnih bolezni tudi v otroški dobi. AH je povezana z nastankom poškodb hipertenzivnih tarčnih organov in s tem z nastankom srčno-žilnih bolezni. Čeprav se pri otrocih srčno-žilne bolezni v manifestni obliki redko pojavljajo, rezultati številnih raziskav kažejo, da se proces ateroskleroze začne že v otroštvu. To velja tudi za pojavljanje srčno-žilnih dejavnikov tveganja, med katerimi je tudi AH, ki proces ateroskleroze pospešujejo. Da bi preprečili ali vsaj omilili nastanek srčno-žilnih bolezni, je pomembno pravočasno odkritje in zdravljenje bolezni oziroma zgodnjih sprememb. To še prav posebej velja za otroško populacijo, pri kateri so zato raziskave usmerjene v iskanje čim zgodnejših pokazateljev hipertenzivne poškodbe in prisotnosti drugih domnevnih srčno-žilnih dejavnikov tveganja. Metode: V raziskavo smo vključili 100 otrok obeh spolov, ki so se zdravili na Kliniki za pediatrijo UKC Maribor, in smo jim trikrat zapored v različnih razmerah izmerili povišan krvni tlak (KT) ter ga nato potrdili s 24-urnim merjenjem KT ter postavili diagnozo EH. Kontrolno skupino otrok je sestavljalo 50 po spolu in starosti primerljivih zdravih otrok z normalnim KT. Opravili smo natančno anamnezo in klinični pregled, pri preiskovani skupini pa še pregled očesnega ozadja. Pri vsakem posamezniku smo izmerili telesno težo, telesno višino ter obseg pasu in bokov. Iz omenjenih meritev smo izračunali indeks telesne mase (BMI). Po standardnem postopku smo v krvi določili hemogram, reaktivni protein C (CRP), sečnino, kreatinin, sečno kislino, elektrolite, koncentracijo celokupnega holesterola, holesterola HDL, holesterola LDL, trigliceridov, krvnega sladkorja, homocisteina, apolipoproteina A1(apoA1) in B (apo B), lipoproteina (a), insulina in mikroalbumina v urinu. Adiponektin in leptin smo določali s kvantitativno sendvič imunoencimsko metodo, grelin pa po postopku kvantitativne sendvič ELISE. Za določitev fibrinogena smo uporabili modificirano metodo po Claussu. Inhibitor aktivatorja plazminogena (PAI-1) smo določili kromatografsko. Vsem otrokom smo opravili ultrazvočno meritev debline intime-medije (IMT) vratnih žil, ultrazvočno meritev mase levega prekata (LVM) in z aplanacijsko tonometrijo opravili meritev žilne kompliance (PWV). Rezultati: Med otroci z EH in kontrolno skupino smo ugotovili statistično značilne razlike v telesni teži (p < 0,001), obsegu pasu (p < 0,001), razmerju pas/boki (p < 0,001) in BMI (p < 0,001). Otroci z EH so imeli izrazito višje vrednosti holesterola LDL (p = 0,032), trigliceridov (p = 0,011), insulina (p < 0,001), sečne kisline (p = 0,002), krvnega sladkorja (p = 0,003) in nižje vrednosti holesterola HDL (p = 0,017) in apolipoproteina A1 (p = 0,008). Statistično pomembno razliko v adipokinih smo uspeli dokazati le za adiponektin (p < 0,010). Otroci z EH so imeli tudi višje vrednosti vseh morfoloških preiskav, a statistično pomembne razlike smo potrdili le za LVM (p < 0,001), debelino zadnje stene levega prekata (p < 0,001), debelino medprekatnega pretina (p < 0,003), IMT desno (p < 0,001), IMT levo (p < 0,001), medtem ko se skupini v vrednostih PWV nista statistično razlikovali. Kljub vsemu je imela skupina z EH statistično višje vrednosti nekaterih drugih posrednih znakov zmanjšane žilne kompliance, kot sta pulzni tlak v aorti (AoPP) (p < 0,001) in augmentacijski indeks korigiran za srčno frekvenco 75/min (Alx@HR 75) (p = 0,044).

Ključne besede

kardiovaskularne bolezni;tunika intima;tunika medija;debelina;krvne žile;komplianca;mikroalbuminurija;

Podatki

Jezik: Slovenski jezik
Leto izida:
Tipologija: 2.08 - Doktorska disertacija
Organizacija: UM MF - Medicinska fakulteta
Založnik: A. Štelcar]
UDK: 616.12-008.331.1-053.2(043.3)
COBISS: 290673408 Povezava se bo odprla v novem oknu
Št. ogledov: 1279
Št. prenosov: 135
Ocena: 0 (0 glasov)
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Sekundarni jezik: Angleški jezik
Sekundarni naslov: Assessment of early cardiovascular risk factors in children with essential hypertension
Sekundarni povzetek: Background: Arterial hypertension (AH) and atherosclerosis are the most common diseases of the cardiovascular system in adults, AH being one of the main risk factors for the development of cardiovascular diseases. Following an increase in obesity among children and adolescents, essential hypertension (EH) has become of the most frequent chronic diseases in youth. AH is linked with initial damage to the hypertensive target organs and the development of cardiovascular diseases. Although manifestations of cardiovascular diseases are rare in children, numerous studies show that the process of atherosclerosis begins in childhood. AH is among the cardiovascular disease risk factors that accelerate the process of atherosclerosis. In order to prevent or at least mitigate the development of cardiovascular diseases, it is important to diagnose and treat the diseases and early changes. This applies in particular to the child population, where studies aim to investigate the earliest possible indicators of hypertensive damage and the presence of other apparent cardiovascular risk factors. Methods: The study comprised 100 children of both genders who were treated at the Department of Pediatrics, University Medical Centre Maribor. They all had three consecutive high blood pressure (BP) readings in different situations, readings that were confirmed by 24-hour monitoring of BP; all were diagnosed with EH. The control group consisted of 50 healthy children of comparable gender and age with normal BP. A detailed clinical examination was carried out, and the patients’ medical history was evaluated; in addition, the eye fundus was examined in the test group. Body weight, height as well as waist and hip circumference were determined for each individual. The results were used to calculate the body mass index (BMI). A standard blood test procedure was used to determine the, totally blood count, C- ractive protein (CRP), urea, creatinine, uric acid, electrolytes, total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, glucose, homocysteine, apolipoproteins A1 (apo A1) and B (apo B), lipoprotein (a), insulin and microalbumin in the urine. Adiponectin and leptin levels were determined with a quantitative sandwich enzyme immunoassay technique and ghrelin with the sandwich ELISA method. The fibrinogen level was determined with a modified Clauss method. PAI-1 was determined by chromatography. The intima-media thickness (IMT) of the carotid arteries and the left ventricular mass (LVM) were measured by ultrasound in all children, and arterial compliance (PWV) was determined with applanation tonometry. Results: Statistically significant differences in body weight (p<0.001), waist circumference (p<0.001), the waist-hip ratio (p<0.001) and the BMI (p<0.001) were established between children with EH and the control group. Children with EH had significantly higher LDL cholesterol (p=0.032), triglycerides (p=0.011), insulin (p<0.001), uric acid (p= 0.002) and glucose (p=0.003) levels, while HDL cholesterol (p= 0.017) and apo A1 (p= 0.008) levels were lower. With respect to adipokines, statistically significant difference could only be proven in the case of adiponectin (p< 0.010). All morphological examination values were also higher in children with EH; however, statistically significant differences were confirmed only in the case of LVM (p<0.001), the left ventricular posterior wall thickness (<0.001), the interventricular septum thickness (p<0.003), IMT right (p<0.001) and IMT left (p<0.001), while the groups did not differ statistically with respect to the PWV values. Nevertheless, the group with EH had statistically higher values of some other indirect signs of reduced arterial compliance, such as the aortic pulse pressure (AoPP) (p<0.001) and the augmentation index corrected for heart rate 75 b. p. m. (Alx@HR 75) (p=0.044).
Sekundarne ključne besede: Esencialna arterijska hipertenzija;Disertacije;Otroci;Kardiovaskularni sistem;Bolezni;Dejavniki tveganja;
URN: URN:SI:UM:
Vrsta dela (COBISS): Doktorska disertacija
Komentar na gradivo: Univ. v Mariboru, Medicinska fak.
Strani: 101 str.
ID: 8752526