ometendoОжирение и метаболизмObesity and metabolism2071-87132306-5524Endocrinology Research Centre10.14341/omet12354ometendo-12354Research ArticleОригинальные исследованияOriginal paperМаркеры эндотелиальной дисфункции у пациентов юношеского и молодого возраста с гипоталамическим синдромомMarkers of endothelial dysfunction in adolescent and young patients with hypothalamic syndromehttps://orcid.org/0000-0002-1304-0074ЦерцвадзеЛана КахаберовнаTsertsvadzeLana K.

Церцвадзе Лана Кахаберовна, аспирант, ORCID: https://orcid.org/0000-0002-1304-0074, eLibrary SPIN: 8302-1703, e-mail: doct.lana@mail.ru

Lana Kakhaberovna Tsertsvadze, MD, postgraduate student, ORCID: https://orcid.org/0000-0002-1304-0074, eLibrary SPIN: 8302-1703, e-mail: doct.lana@mail.ru

doct.lana@mail.ruhttps://orcid.org/0000-0002-4334-5434АвдееваМарина ВладимировнаAvdeevaMarina V.

Авдеева Марина Владимировна, д.м.н., профессор, ORCID: https://orcid.org/0000-0002-4334-5434, eLibrary SPIN: 6673-7195, e-mail: lensk69@mail.ru

194100, Санкт-Петербург, ул. Литовская, д. 2

Marina Vladimirovna Avdeeva, MD, PhD, professor, ORCID: https://orcid.org/0000-0002-4334-5434, eLibrary SPIN: 6673-7195, e-mail: lensk69@mail.ru

2 Litovskaya street, 194100 St. Petersburg

Lensk69@mail.ruhttps://orcid.org/0000-0002-1059-4610ЩегловаЛариса ВасильевнаScheglovaLarisa V.

Щеглова Лариса Васильевна, д.м.н., профессор, ORCID: https://orcid.org/0000-0002-1059-4610, eLibrary SPIN: 6983-3999, e-mail: shcheglovalar@mail.ru

Larisa Vasilievna  Scheglova, MD, PhD, professor, ORCID: https://orcid.org/0000-0002-1059-4610, eLibrary SPIN: 6983-3999, e-mail: shcheglovalar@mail.ru

shcheglovalar@mail.ruhttps://orcid.org/0000-0002-8833-304XВасиленкоВладимир СтаниславовичVasilenkoVladimir S.

Василенко Владимир Станиславович, д.м.н., профессор, ORCID: https://orcid.org/0000-0002-8833-304X, eLibrary SPIN: 1355-1790, e-mail: vasilenkovladi@yandex.ru

Vladimir Stanislavovich Vasilenko, MD, PhD, professor, ORCID: https://orcid.org/0000-0002-8833-304X, eLibrary SPIN: 1355-1790, e-mail: vasilenkovladi@yandex.ru

vasilenkovladi@yandex.ruСанкт-Петербургский государственный педиатрический медицинский университетРоссияSt. Petersburg State Pediatric Medical UniversityRussian FederationСанкт-Петербургский государственный педиатрический медицинский университет; Северо-Западный государственный медицинский университет им. И.И. МечниковаРоссияSt. Petersburg State Pediatric Medical University; North-Western State Medical University named after I.I. MechnikovRussian Federation202004122020173257268Copyright © Церцвадзе Л.К., Авдеева М.В., Щеглова Л.В., Василенко В.С., 20202020Церцвадзе Л.К., Авдеева М.В., Щеглова Л.В., Василенко В.С.Tsertsvadze L.K., Avdeeva M.V., Scheglova L.V., Vasilenko V.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.omet-endojournals.ru/jour/article/view/12354Обоснование

Обоснование. Эндотелиальная дисфункция является ранней, но обратимой стадией атеросклероза. Изменение функционального состояния сосудистого эндотелия растущего организма может являться основой развития многих заболеваний в зрелом возрасте. Изучение структурно-функционального состояния периферических артерий у юношей с гипоталамическим синдромом крайне важно для лучшего понимания механизмов формирования кардиомета-болических рисков в молодом возрасте.

Цель

Цель. Сравнить структурно-функциональное состояние сосудистой стенки у юношей с гипоталамическим синдромом и конституционально-экзогенным ожирением.

Методы

Методы. Обследовано 360 лиц мужского пола (средний возраст 21,27±2,44 года), которые разделены на 3 группы: 1 группа - с гипоталамическим синдромом (n=242); 2 группа - с конституционально-экзогенным ожирением (n=98); контроль - практически здоровые лица (n=20). Диагностическим критерием гипоталамического синдрома считалось ожирение с розовыми стриями. Проводился межгрупповой сравнительный анализ результатов клинического, лабораторного и инструментального обследования.

Результаты

Результаты. В группе пациентов с гипоталамическим синдромом эндотелийзависимая вазодилатация (9,44±1,26 против 10,37±1,21%; р=0,001) и эндотелийнезависимая вазодилатация (10,29±1,28 против 11,29±1,14%; р=0,001) хуже, чем при конституционально-экзогенном ожирении, а показатель эндотелийзависимой вазодилатации ниже общепринятой нормы. Помимо этого, у пациентов с гипоталамическим синдромом жесткость сосудистой стенки выше, чем у больных конституционально-экзогенным ожирением (15,47±2,58 против 13,24±3,84%; р=0,001). Выявлены статистически значимые корреляции между структурно-функциональным состоянием периферических артерий и гемодинамическими, гормональными, метаболическими изменениями, уровнем С-реактивного белка (р<0,05).

Заключение

Заключение. Полученные данные свидетельствуют об ухудшении функции эндотелия и повышении жесткости сосудистой стенки у больных, страдающих ожирением, независимо от его этиологии. У пациентов с гипоталамическим синдромом отмечаются более выраженные структурно-функциональные изменения сосудистой стенки, чем при конституционально-экзогенном ожирении.

Background

Background: Endothelial dysfunction is the first but reversible stage of atherosclerosis. A change in the functional state of the vascular endothelium, especially of a growing organism, can be the basis for the development of many diseases in adulthood. The study of the structural and functional state of peripheral vessels of adolescents with hypothalamic syndrome is extremely important for understanding of the mechanisms of formation of cardiometabolic risks.

Aims

Aims: to compare the structural and functional state of the vascular wall of young men with hypothalamic syndrome and constitutionally exogenous obesity.

Methods

Methods: During the study 360 males were examined (average age 21.27±2.44 years) and divided into 3 groups: group 1 -with hypothalamic syndrome (n=242); group 2 - with constitutionally exogenous obesity (n=98); control group - practically healthy individuals (n=20). Hypothalamic syndrome was verified in the presence of a symptom complex, including obesity and pink striae. Cross-group comparative analysis of results of clinical, laboratory and instrumental examination was carried out.

Results

Results: In the group of patients with hypothalamic syndrome, endothelium-dependent vasodilatation (9.44±1.26 versus 10.37±1.21%; p=0.001) and endothelium-independent vasodilatation (10.29±1.28 versus 11.29±1.14%; p=0.001) is worse than in the group of patients with constitutionally exogenous obesity, and the rate of endothelium-dependent vasodilatation is lower than the generally accepted norm. In addition, among patients with hypothalamic syndrome, the stiffness of the vascular wall is higher than among patients with constitutionally exogenous obesity (15.47±2.58 versus 13.24±3.84%; p=0.001). Statistically significant correlations were revealed between the structural and functional state of peripheral arteries and hemodynamic, hormonal, metabolic changes, and the level of C-reactive protein (p<0.05).

Conclusions

Conclusions: The obtained data indicate a deterioration of endothelial function and an increase in vascular wall stiffness in obese patients, regardless of its etiology. The patients with hypothalamic syndrome have more pronounced structural and functional changes in the vascular wall are observed than patients with constitutionally exogenous obesity.

гипоталамический синдроможирение с розовыми стриямиэндотелиальная дисфункцияhypothalamic syndromeobesity with pink striaeendothelial dysfunctionИсследование выполнено при лабораторном и инструментальном обеспечении плановой НИР с использованием ресурсов базового медицинского учрежденияReferencesGBD 2015 Obesity Collaborators. Health Effects of Overweight and Obesity in 195 Countries over 25 Years. N Engl J Med. 2017;377(1):13-27. doi: https://doi.org/10.1056/NEJMoa1614362GBD 2015 Obesity Collaborators. Health Effects of Overweight and Obesity in 195 Countries over 25 Years. N Engl J Med. 2017;377(1):13-27. doi: https://doi.org/10.1056/NEJMoa1614362Mattsson M, Maher GM, Boland F, et al. Group-based trajectory modelling for BMI trajectories in childhood: A systematic review. Bierhaus A, ed. Obes Rev. 2019;20(7):998-1015. doi: https://doi.org/10.1111/obr.12842Mattsson M, Maher GM, Boland F, et al. Group-based trajectory modelling for BMI trajectories in childhood: A systematic review. Bierhaus A, ed. Obes Rev. 2019;20(7):998-1015. doi: https://doi.org/10.1111/obr.12842Крук Л.П., Строев Ю.И., Чурилов Л.П. Функциональное состояние щитовидной железы при гипоталамическом синдроме пубертатного периода // Сб. «Здоровье - основа человеческого потенциала: проблемы и пути их решения». - 2018. - Т. 13. - №1. - С. 297-304.Kruk LP Stroev YuI, Churilov LP Funkcional’noe sostoyanie shchitovidnoj zhelezy pri gipotalamicheskom sindrome pubertatnogo perioda [abstract]. St. Petersburg. 2018; 13 Suppl 1: 297-304. (In Russ.)Габбасова Н.В., Дзень Н.В., Хаперскова М.А. Анализ заболеваемости ожирением в Воронежской области за период 2011-2016 годы // Научно-медицинский вестник Центрального Черноземья. - 2017. - No70. - С. 11-15. doi: https://doi.org/10.1038/ajh.2010.50Gabbasova NV, Dzen NV, Khaperskova MA. Analysis of the incidence of obesity in the Voronezh region for the period 2011-2016. Scientific and Medical Bulletin of the Central Chernozem Region. 2017; (70): 11-15. (In Russ.)Friedemann C, Heneghan C, Mahtani K, et al. Cardiovascular disease risk in healthy children and its association with body mass index: systematic review and meta-analysis. BMJ. 2012;345(sep25 2):e4759-e4759. doi: https://doi.org/10.1136/bmj.e4759Genovesi S, Antolini L, Giussani M, et al. Hypertension, Prehypertension, and Transient Elevated Blood Pressure in Children: Association With Weight Excess and Waist Circumference. Am JHypertens. 2010;23(7):756-761. doi: https://doi.org/10.1038/ajh.2010.50Valerio G, Maffeis C, Saggese G, et al. Diagnosis, treatment and prevention of pediatric obesity: consensus position statement of the Italian Society for Pediatric Endocrinology and Diabetology and the Italian Society of Pediatrics. Ital J Pediatr. 2018;44(1):88. doi: https://doi.org/10.1186/s13052-018-0525-6Friedemann C, Heneghan C, Mahtani K, et al. Cardiovascular disease risk in healthy children and its association with body mass index: systematic review and meta-analysis. BMJ. 2012;345(sep25 2):e4759-e4759. doi: https://doi.org/10.1136/bmj.e4759Лавренкова Е.А., Драпкина О.М. Инсулинорезистентность при ожирении: причины и последствия // Ожирение и метаболизм. -2020. - Т. 17. - No1. - С. 48-55 doi: https://doi.org/10.14341/omet9759Valerio G, Maffeis C, Saggese G, et al. Diagnosis, treatment and prevention of pediatric obesity: consensus position statement of the Italian Society for Pediatric Endocrinology and Diabetology and the Italian Society of Pediatrics. Ital J Pediatr. 2018;44(1):88. doi: https://doi.org/10.1186/s13052-018-0525-6Смирнова Н.Н., Куприенко Н.Б., Жестянникова Е.И. Эндотелиальная дисфункция при ожирении у детей. - 2019. - Т. 4. - №2. - С. 35-41 // Медицина: теория и практикаLavrenova EA, Drapkina OM. Insulin resistance in obesity: pathogenesis and effects. Obesity and metabolism. 2020;17(1):48-55. (In Russ.) doi: https://doi.org/10.14341/omet9759Чусова Н.А. Роль эндотелиальной дисфункции при ожирении // Международный студенческий научный вестник. - 2019. - №5-2. -С. 67Smirnova NN, Kuprienko NB, Gestjannikova EI. Endothelial dysfunction in obese children. Medicine: theory and practice. 2019;4(2):35-41. (In Russ.)Nikonova L V., Tishkovskiy S V., Butrim OS, Davydchyk E V. Hypothalamic syndrome. The role of the hypothalamus in the formation of eating behavior and obesity. J Grodno State Med Univ. 2019;17(4):355-360. doi: https://doi.org/10.25298/2221-8785-2019-17-4-355-360Chusova NA. Role of endothelial dysfunction in obesity. International student scientific bulletin. 2019;(5-2):67. (In Russ.)Строев Ю.И., Чурилов Л.П., Али Н., и др. Ожирение с розовыми стриями - проблемная патология детей и подростков // Сб. материалов IX российского форума «Педиатрия Санкт-Петербурга: опыт, инновации, достижения». - 2019. - С. 166-173Nikonova L V., Tishkovskiy S V., Butrim OS, Davydchyk E V. Hypothalamic syndrome. The role of the hypothalamus in the formation of eating behavior and obesity. J Grodno State Med Univ. 2019;17(4):355-360. doi: https://doi.org/10.25298/2221-8785-2019-17-4-355-360Borowska-Striuk T. Therapeutic tactics in the hypothalamic syndrome of puberty in girls. Medicni perspektivi (Medical perspectives). 2018;23(3):92-97. doi: https://doi.org/10.26641/2307-0404.20183.147963Stroev YuI, Churilov LP Ali N, et al. Ozhirenie s rozovymi striyami -problemnaya patologiya detej i podrostkov [abstract]. St. Petersburg. 2019; S.166-173. (In Russ.)Bereket A, Kiess W, Lustig RH, et al. Hypothalamic Obesity in Children. In: Kiess W, Wabitsch M, Maffeis C, Sharma AM (eds): Metabolic Syndrome and Obesity in Childhood and Adolescence. Pediatr Adolesc Med. Basel, Karger, 2015;19:13-30. doi: https://doi.org/10.1159/000368102Borowska-Striuk T. Therapeutic tactics in the hypothalamic syndrome of puberty in girls. Medicni perspektivi (Medical perspectives). 2018;23(3):92-97. doi: https://doi.org/10.26641/2307-0404.20183.147963Bereket A, Kiess W, Lustig RH, et al. Hypothalamic obesity in children. Obes Rev. 2012;13(9):780-798. doi: https://doi.org/10.1111/j.1467-789X.2012.01004.xBereket A, Kiess W, Lustig RH, et al. Hypothalamic Obesity in Children. In: Kiess W, Wabitsch M, Maffeis C, Sharma AM (eds): Metabolic Syndrome and Obesity in Childhood and Adolescence. Pediatr Adolesc Med. Basel, Karger, 2015;19:13-30. doi: https://doi.org/10.1159/000368102Ershevskaya AB, Novikova AP Lesik IP. Pathogenetic mechanisms of obesity in children // Bulletin of Novgorod State University. 2018;(5):35-37. (In Russ.)Bereket A, Kiess W, Lustig RH, et al. Hypothalamic obesity in children. Obes Rev. 2012;13(9):780-798. doi: https://doi.org/10.1111/j.1467-789X.2012.01004.xOtto NYu, Sagitova GR, Nikulina NYu, Ledyaev MYa. The frequency of the metabolic syndrome and other complications of obesity in the practice of a pediatric endocrinologist. Bulletin of Novgorod State University. 2018;67(3):93-98. (In Russ.)Ershevskaya AB, Novikova AP Lesik IP. Pathogenetic mechanisms of obesity in children // Bulletin of Novgorod State University. 2018;(5):35-37. (In Russ.)Tochilina OV, Andreeva IN. Physical factors in the complex treatment of hypothalamic dysfunction in adolescence. Bulletin of physiotherapy and balneology. 2017;23(4):181. (In Russ.)Otto NYu, Sagitova GR, Nikulina NYu, Ledyaev MYa. The frequency of the metabolic syndrome and other complications of obesity in the practice of a pediatric endocrinologist. Bulletin of Novgorod State University. 2018;67(3):93-98. (In Russ.)Oluwagbemigun K, Buyken AE, Alexy U, Schmid M, Herder C, Nothlings U. Developmental trajectories of body mass index from childhood into late adolescence and subsequent late adolescence-young adulthood cardiometabolic risk markers. Cardiovasc Diabetol. 2019;18(1):9. doi: https://doi.org/10.1186/s12933-019-0813-5Tochilina OV, Andreeva IN. Physical factors in the complex treatment of hypothalamic dysfunction in adolescence. Bulletin of physiotherapy and balneology. 2017;23(4):181. (In Russ.)Rogoza A.N., Nikol’skij V.P, Oshchepkova EV Sutochnoe monitorirovanie arterial’nogo davleniya pri gipertonii. Metodicheskie voprosy. - M., 2005. - 36 s. (In Russ.)Oluwagbemigun K, Buyken AE, Alexy U, Schmid M, Herder C, Nothlings U. Developmental trajectories of body mass index from childhood into late adolescence and subsequent late adolescence-young adulthood cardiometabolic risk markers. Cardiovasc Diabetol. 2019;18(1):9. doi: https://doi.org/10.1186/s12933-019-0813-5Recommendations for the quantitative assessment of the structure and function of the heart chambers. Russian Journal of Cardiology. 2012; 95(3): 1-28. (In Russ).Rogoza A.N., Nikol’skij V.P, Oshchepkova EV Sutochnoe monitorirovanie arterial’nogo davleniya pri gipertonii. Metodicheskie voprosy. - M., 2005. - 36 s. (In Russ.)Celermajer DS, Sorensen KE, Spiegelhalter DJ, et al. Aging is associated with endothelial dysfunction in healthy men years before the age-related decline in women. J Am Coll Cardiol. 1994;24(2):471-476. doi: https://doi.org/10.1016/0735-1097(94)90305-0Recommendations for the quantitative assessment of the structure and function of the heart chambers. Russian Journal of Cardiology. 2012; 95(3): 1-28. (In Russ).Early diagnosis of cardiovascular disease (CVD) is the main area of our research and development In Russ.) Доступно по: https://angioscan.ru/ru/parfenov-method/af-assessment. Ссылка активна на 17.02.2020Celermajer DS, Sorensen KE, Spiegelhalter DJ, et al. Aging is associated with endothelial dysfunction in healthy men years before the age-related decline in women. J Am Coll Cardiol. 1994;24(2):471-476. doi: https://doi.org/10.1016/0735-1097(94)90305-0Zhukovets IV, Bystritskaya TS, Koneeva EYa, Putintseva OG. Etiology and pathogenesis of hypothalamic dysfunction: a modern view of the problem (Literature review). Bulletin of physiology and respiratory pathology. 2011; (42): 96-99. (In Russ.)Early diagnosis of cardiovascular disease (CVD) is the main area of our research and development In Russ.) Доступно по: https://angioscan.ru/ru/parfenov-method/af-assessment. Ссылка активна на 17.02.2020Zhukovets IV. Controversial issues of nosoology: metabolic syndrome or dysfunction of the hypothalamus? Amur Medical Journal. 2014;5(1):105-108. (In Russ.)Zhukovets IV, Bystritskaya TS, Koneeva EYa, Putintseva OG. Etiology and pathogenesis of hypothalamic dysfunction: a modern view of the problem (Literature review). Bulletin of physiology and respiratory pathology. 2011; (42): 96-99. (In Russ.)Stroyev YuI, Churilov LP Skin striae: new ideas about the pathogenesis and diagnostic significance of the old symptom. Medicine. XXI Century. 2008;(11):50-55. (In Russ.)Zhukovets IV. Controversial issues of nosoology: metabolic syndrome or dysfunction of the hypothalamus? Amur Medical Journal. 2014;5(1):105-108. (In Russ.)Tsertsvadze LK, Avdeeva MV, Scheglova LV, Vasilenko VS. Features of the hormonal and cardiometabolic profile in young men with the hypotalamic syndrome of the late pubertary period. Modern problems of science and education. 2019;(4):36. (In Russ.) doi: https://doi.org/10.17513/spno.29064Stroyev YuI, Churilov LP Skin striae: new ideas about the pathogenesis and diagnostic significance of the old symptom. Medicine. XXI Century. 2008;(11):50-55. (In Russ.)Tsertsvadze LK, Avdeeva MV, Scheglova LV, Erina MYu. Predictors of metabolic syndrome in youths and young men depending on the degree of purification and reason of obesity. Modern problems of science and education. 2019;(5). (In Russ.) doi: https://doi.org/10.17513/spno.29094Tsertsvadze LK, Avdeeva MV, Scheglova LV, Vasilenko VS. Features of the hormonal and cardiometabolic profile in young men with the hypotalamic syndrome of the late pubertary period. Modern problems of science and education. 2019;(4):36. (In Russ.) doi: https://doi.org/10.17513/spno.29064Ribeiro ACR, Lyra A, Bonfitto AJ, et al. Assessment of intimamedia thickness of the carotid artery and intraluminal diameter of the brachial artery as cardiovascular risk markers in Brazilian adolescents with overweight or obesity. J Pediatr Endocrinol Metab. 2020;33(3):339-345. doi: https://doi.org/10.1515/jpem-2019-0254Tsertsvadze LK, Avdeeva MV, Scheglova LV, Erina MYu. Predictors of metabolic syndrome in youths and young men depending on the degree of purification and reason of obesity. Modern problems of science and education. 2019;(5). (In Russ.) doi: https://doi.org/10.17513/spno.29094Murni IK, Sulistyoningrum DC, Susilowati R, Julia M. Risk of metabolic syndrome and early vascular markers for atherosclerosis in obese Indonesian adolescents. Paediatr Int Child Health. 2020;40(2):117-123. doi: https://doi.org/10.1080/20469047.2019.1697568Ribeiro ACR, Lyra A, Bonfitto AJ, et al. Assessment of intimamedia thickness of the carotid artery and intraluminal diameter of the brachial artery as cardiovascular risk markers in Brazilian adolescents with overweight or obesity. J Pediatr Endocrinol Metab. 2020;33(3):339-345. doi: https://doi.org/10.1515/jpem-2019-0254Bruyndonckx L, Hoymans VY, Van Craenenbroeck AH, et al. Assessment of Endothelial Dysfunction in Childhood Obesity and Clinical Use. Oxid Med Cell Longev. 2013;2013(2):1-19. doi: https://doi.org/10.1155/2013/174782Murni IK, Sulistyoningrum DC, Susilowati R, Julia M. Risk of metabolic syndrome and early vascular markers for atherosclerosis in obese Indonesian adolescents. Paediatr Int Child Health. 2020;40(2):117-123. doi: https://doi.org/10.1080/20469047.2019.1697568Лындина М.Л., Шишкин А.Н. Клинические особенности эндотелиальной дисфункции при ожирении и роль фактора курения // Регионарное кровообращение и микроциркуляция. -2018. - Т. 17. - №2 - С. 18-25 doi: https://doi.org/10.24884/1682-6655-2018-17-2-18-25Bruyndonckx L, Hoymans VY, Van Craenenbroeck AH, et al. Assessment of Endothelial Dysfunction in Childhood Obesity and Clinical Use. Oxid Med Cell Longev. 2013;2013(2):1-19. doi: https://doi.org/10.1155/2013/174782Lyndina ML, Shishkin AN. Clinical features of endothelial dysfunctions in patients with obesity and role of smoking. Regional blood circulation and microcirculation. 2018;17(2):18-25. doi: https://doi.org/10.24884/1682-6655-2018-17-2-18-25Lyndina ML, Shishkin AN. Clinical features of endothelial dysfunctions in patients with obesity and role of smoking. Regional blood circulation and microcirculation. 2018;17(2):18-25. doi: https://doi.org/10.24884/1682-6655-2018-17-2-18-25

The authors declare that there are no conflicts of interest present.