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2020, vol. 77, br. 8, str. 789-795
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Korelacija između kvantifikacionih skorova metaboličkog sindroma i brojnih laboratorijskih parametara udruženih sa njim
The correlation between metabolic syndrome quantification scores and numerous laboratory parameters related to this syndrome
Srećković Brankoa, Mrdović Igorb, Soldatović Ivanc  , Resan Mirkod, Janeski Nenade, Čolak Eminaf, Janeski Hristinag, Šumarac-Dumanović Mirjanah , Joković Miloši, Ivanović Nebojšaj, Gačić Jasnaj, Dimitrijević-Srećković Vesnah
aUniverzitet u Beogradu, Medicinski fakultet, KBC 'Bežanijska kosa' bClinical Centre of Serbia, Clinic for Emergency Internal Medicine, Belgrade + Univerzitet u Beogradu, Medicinski fakultet cUniverzitet u Beogradu, Medicinski fakultet, Institut za medicinsku statistiku i informatiku dVojnomedicinska akademija, Klinika za očne bolesti, Beograd + Univerzitet odbrane, Medicinski fakultet Vojnomedicinske akademije, Beograd eUniverzitet u Beogradu, Medicinski fakultet, KBC 'Zemun' fKlinički centar Srbije, Centar za medicinsku biohemiju, Beograd gUniverzitet u Beogradu, Medicinski fakultet, Univerzitetska dečija klinika hUniverzitet u Beogradu, Medicinski fakultet + Klinički centar Srbije, Klinika za endokrinologiju dijabetes i bolesti metabolizma, Beograd iUniverzitet u Beogradu, Medicinski fakultet + Vojnomedicinska akademija, Klinika za urgentnu internu medicinu, Beograd jUniverzitet u Beogradu, Medicinski fakultet, KBC 'Bežanijska kosa' + Univerzitet u Beogradu, Medicinski fakultet
e-adresa: vesnadsendo@gmail.com
Sažetak
Uvod/Cilj. Metabolički sindrom (MS) karakterišu osnovni faktori rizika [obim struka (OS), poremećaji glikoregulacije, hipertenzija, hipertrigliceridemija, nizak HDL-holesterol] kao i pridruženi faktori rizika - insulinska rezistencija (IR), C-reaktivni protein (CRP), mokraćna kiselina, inhibitor aktivacije plazminogena-1 (PAI-1), fibrinogen, hiperhomocisteinemija (HHci), nealkoholna masna bolest jetre (NAMBJ) i mikroalbuminurija. Cilj rada bio je da se analiziraju osnovni i pridruženi faktori rizika od MS kod bolesnika sa i bez MS i ustanovi korelacija siMS skora i siMS skora rizika sa osnovnim i pridruženim faktorima rizika od MS. Metode. Studijom su bila obuhvaćena 148 bolesnika sa prekomernom telesnom težinom [body mass index ((BMI) 25-30 kg/m2) i gojazni (BMI > 30 kg/m2), starosti 30-75 godina, podeljeni u dve grupe: I - sa MS (68 bolesnika) i II - bez MS (80 bolesnika). Korišćeni su siMS skor, kao metod za kvantifikaciju MS, i siMS skor rizika, kao indikator aterosklerotskih komplikacija. Rezultati. Bolesnici sa MS imali su statistički značajno više vrednosti OS, hipertenzije, triglicerida (p < 0,001), glikemije (p = 0,006), kao i pridruženih faktora rizika od MS [HOMA IR (p = 0,002) CRP (p = 0,01) mokraćne kiseline (p < 0,001), alanin aminotranferaze (ALT) (p = 0,007) i gama-glutamil transferaze (GGT) (p = 0,001)] i niže vrednosti HDL-holesterol, (p < 0,001) u odnosu na bolesnika bez MS. Skor siMS pokazao je korelaciju sa pridruženim faktorima MS [log HOMA IR, logCRP, mokraćnom kiselinom (p < 0,001) i fibrinogenom (p = 0,005), parametrima jetrene funkcije: logALT (p = 0,001), log GGT, (p < 0,001) i bubrežne funkcije: kreatininom (p = 0,013) i serumskim proteinima (p = 0,006)]. Skor siMS rizika je statistički značajno korelirao sa vrednostima homocisteina, trombocita, mokraćne kiseline, uree, albumina i proteina. Zaključak. Statistički značajno više vrednosti pridruženih faktora rizika od MS (HOMA-R, CRP, mokraćne kiseline, ALT, GGT) kod bolesnika sa MS potvrđene su i korelacijom sa siMS skorom. Skor siMS ukazuje na to da su insulinska rezisencija, CRP, fibrinogen, mokraćna kiselina, NAMBJ pridruženi faktori rizika od MS. Skor siMS rizika ukazuje na to da gojaznost i hiperproteinski unos povećavaju HHCi sa starenjem, te da povećavaju rizik od bubrežnih poremećaja i aterosklerotskih komplikacija.
Abstract
Background/Aim. Metabolic syndrome (MS) is characterized by basic cluster risk factors - waist circumference (WC), glucoregulation disorders, hypertension, hypertriglyceridemia, low HDL-cholesterol followed by associated factors such as insulin resistance (IR), C-reactive protein (CRP), uric acid, plasminogen activator inhibitor-1 (PAI-1), fibrinogen, hyperhomocysteinemia (HHcy), nonalcoholic fatty liver disease (NAFLD) and microalbuminuira. The aim of this study was to analyze basic and associated factors of MS in patients with and without MS as well as correlation of siMS score, siMS risk score with basic and confounding factors of MS. Methods. The study included 148 overweight [body mass index (BMI) 25-30 kg/m2 and obese patients (BMI > 30 kg/m2 )], age 30-75 years, classified into two groups: I - with MS (68 patients); II - without MS (80 patients). For quantification of MS, siMS score was used as a method, and siMS risk score was used as atherosclerotic complications risk indicator. Results. Patients with MS had statistically higher values of WC, hypertension, triglycerides (p < 0.001), glycemia (p = 0.006), as well as values of associated factors of MS [homeostatic model assessment (HOMA-IR)] (p = 0.002), CRP (p = 0.01), uric acid (p < 0.001), alanin transaminase (ALT) (p = 0.007) i gammaglutamyl transferase (GGT) (p = 0.001) and lower values of HDL-cholesterol (p < 0.001) compared to patients without MS. siMS score has shown correlation with associated factors of MS (log HOMA IR, logCRP, uric acid, (p < 0.001), fibrinogen (p = 0.005), liver enzymes logALT (p = 0.001) and log GGT (p < 0.001) and renal parametars (creatinine (p = 0.013) and serum protein (p = 0.006). siMS risk score correlated significantly with homocysteine, platelets, uric acid, blood urea nitrogen, albumins and proteins. Conclusion. In our study we found that patients with MS had higher values of associated factors of MS (HOMA-IR, CRP, uric acid, ALT, GGT), which was confirmed by correlation with siMS score. siMS score further indicated that IR, CRP, fibrinogen, uric acid and NAFLD are associated factors of MS. siMS risk score is another score that indicated that obesity and hyperprotein diet aggravates HHCy with age, increasing the risk for renal dysfunction and promoting atherosclerotic complications.
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