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2019, vol. 76, br. 2, str. 175-185
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Korelacija između koagulacionog i inflamatornog statusa kod bolesnika sa dijabetesom melitusom tip 2 u odnosu na polne razlike - da li postoji uticaj 8-nedeljnog vežbanja?
Correlation between coagulation and inflammation state in patients with diabetes mellitus type 2 in relation to gender differences: Is there any impact of eight-week exercise training?
aUniversity Hospital Ullevål, Physical Medicine and Rehabilitation Department, Oslo, Norway bUniverzitet u Beogradu, Medicinski fakultet, Univerzitetska dečija klinika + Univerzitet u Beogradu, Medicinski fakultet cUniverzitet u Beogradu, Medicinski fakultet + Klinički centar Srbije, Beograd
e-adresa: divnatrebinjac@gmail.com
Sažetak
Uvod/Cilj. Hiperkoagulacioni i inflamatorni status kod dijabetičara je opsežno proučavan u dosadašnjim istraživanjima, ali je mogući uticaj fizičkog treninga na međusobnu povezanost između koagulacionog i inflamatornog statusa nedovoljno istražen. Cilj našeg istraživanja bio je ispitivanje korelacija između inflamatornog i koagulacionog statusa kod bolesnika sa dijabetesom melitusom tip 2 u odnosu na pol, kao i uticaj fizičkog treninga na jačinu ovih korelacija i parametre koagulacionog i inflamatornog statusa. Metode. U istraživanje je bilo uključeno 60 bolesnika u stabilnom kliničkom stanju sa dobro regulisanim dijabetesom melitusom tip 2. Trening je primenjen u vidu intervalnog treninga sa maksimalnim intenzitetom od 75% maksimalne srčane frekvence, pet puta nedeljno u toku osam nedelja i treninga u vidu hoda brzinom od 5 km/h u trajanju od trideset minuta, pet puta nedeljno u toku osam nedelja. Sledeći fibinolitički, koagulacioni i inflamatorni parametri su analizirani pre i posle sprovedenog programa treninga: D-dimer, von Willebrand factor (vWF), fibrinogen, visokosenzitivni C-reaktivni protein (hs-CRP), leukociti, trombinsko vreme (TT), protrombinsko vreme (PT), aktivirano parcijalno tromboplastinsko vreme (APTT) i faktori koagulacije - FII, FV, FVII i FX. Rezultati. Naše istraživanje je pokazalo statistički značajno smanjenje nivoa vWF posle studije kod ispitanika muškog (p < 0,001) i ženskog pola (p < 0,001). Pozitivna korelacija između hs-CRP i fibrinogena, pokazana bazalno kod ispitanika muškog (p < 0,05, r = 0,492) i ženskog pola (p < 0,01, r = 0,516) koja bila je slabija kod ispitanika muškog pola (p < 0,01, r = 0,449), odnosno, gubila se kod ispitanica ženskog pola (p < 0,05, r = 0,059) nakon sprovedenog treninga. Pokazane su pozitivne bazalne korelacije kod ispitanika muškog pola između D-dimera sa jedne strane i hs-CRP (p < 0,01, r = 0,633) i fibrinogena (p < 0,01, r = 0,673) sa druge strane, kao i između hs-CRP i FII (p < 0,01, r = 0,728), FV (p < 0,05, r = 0,366), FVII (p < 0,05, r = 0,373, kao i između D-dimera i FII (p < 0,01, r = 0,851) i FVII (p < 0,05, r = 0,367), dok te korelacije nisu pokazane kod ispitanica ženskog pola. Naše istraživanje je kod ispitanika muškog pola pokazalo slabljenje jačine korelacija nakon sprovedenog treninga između D-dimera i hs- CRP (p < 0,05, r = 0,378), hs-CRP i FII (p < 0,01, r = 0,501), FV (p < 0,05, r = 0,298), FVII (p < 0,05, r = 0,351), kao i između D-dimera i FII (p < 0,01, r = 0,759), i FVII (p < 0,05, r = 0,296). Smanjenje nivoa FX kod ispitanica ženskog pola (p < 0,05) nakon sprovedenog treninga ukazuje na mogući antiinflamatorni efekat fizičkog treninga. Zaključak. Prema predhodnim istraživanjima, vWF može biti faktor rizika u populaciji dijabetičara i njegov povišeni nivo je povezan sa rizikom od nastanka kardiovaskularnog oboljenja. Mi smo pokazali da fizički trening u trajanju od osam nedelja može znacajno smanjiti nivo vWF kod oba pola, ukazujući na potencijalni povoljni efekat na parametre endotelne funkcije. Naše istraživanje je pokazalo veću jačinu korelacija između koagulacionih i inflamatornih parametara kod ispitanika muškog pola u odnosu na ispitanice ženskog pola. Prema našim rezultatima, osmonedeljni fizički trening dovodi do slabljenja jačine korelacija između koagulacionih i inflamatornih parametara kod ispitanika muškog pola i slabljenje ovih korelacija do potpunog gubitka kod ispitanica ženskog pola, ukazujući na jedinstveni efekat fizičkog treninga koji bi trebalo da bude ispitan u budućim istraživanjima.
Abstract
Background/Aim. The hypercoagulable state and inflammation state in diabetics has been widely studied by previous researchers, but there is a lack of research about a possible impact of exercise training on this relationship. The aim of this study was to assess and compare correlation between the coagulation and inflammation status in patients with type 2 diabetes mellitus taking into account the gender differences as well as an impact of the 8-week exercise training on the correlation coefficient and parameters of the inflammation and coagulation state. Methods. A total of 60 patients in stable clinical condition and well-regulated diabetic status passed through all phases of the study. The exercise training included the exercise program as interval training with estimated intensity uphill to 75% of a maximal heart rate in particular individual, 5 times a week for 8 weeks, and walking for 30 minutes with a speed of 5 km/h, 5 times a week for 8 weeks. Further fibrinolytic, coagulation and inflammatory parameters were analyzed before and after the study: D-dimer, von Willebrand factor (vWF), fibrinogen, high sensitivity CRP (hs-CRP), leukocytes, thrombin time (TT), prothrombin time (PT), activated partial thromboplastin time (APTT) and coagulation factors: FII, FV, FVII and FX. Results. Our research showed a statistically significant reduction in the mean vWF levels after intervention both at the males (p < 0.001) and females (p < 0.001). According to a correlation analysis between hs-CRP and fibrinogen, there was a positive correlation as baseline both at the males (p < 0.05, r = 0.492) and females (p < 0.01, r = 0.516) which became weaker in the males (p < 0.01, r = 0.449) and disappeared in the females (p < 0.05, r = 0.059) after intervention. The correlation which existed as baseline in the males between D-dimer and either hs-CRP (p < 0.01, r = 0.633) or fibrinogen (p < 0.01, r = 0.673) as well as the correlation between hs-CRP and FII (p < 0.01, r = 0.728), FV (p < 0.05, r = 0.366), FVII (p < 0.05, r = 0.373) coagulation as well as between D-dimer and FII (p < 0.01, r = 0.851), FVII (p < 0.05, r = 0.367)was absent in the females. Our research demonstrated a weakening correlations in the males after intervention between D-dimer and hs-CRP (p < 0.05, r = 0.378), between hs-CRP and FII (p < 0.01, r = 0.501), FV (p < 0.05, r = 0.298), FVII (p < 0.05, r = 0.351) as well as between D-dimer and FII (p < 0.01, r = 0.759), and FVII (p < 0.05, r = 0.296). The increase of the FX values (p < 0.05) in the females after intervention suggested the possible antiinflammatory effect of exercise training. Conclusion. According to previous research, the higher levels of vWF was associated with a risk of cardiovascular disease in people with type 2 diabetes mellitus and vWF may be a risk factor unique to these populations. We demonstrated that the 8-week exercise training can significantly reduce the value of vWF in the males and females, suggesting a potential beneficial effect on the endothelial function parameters. Our research demonstrated a stronger correlation between the coagulation and inflammation parameters as baseline in the males than in the females with type 2 diabetes mellitus. According to our results, the 8-week exercise training lead to a weakening of the strength of correlation between the coagulation and inflammation parameters in the males and complete disappearance of this correlation in the females, suggesting a unique effect of exercise training that should be explored in future research.
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