Obez çocuk ve adölesanlarda insülin rezistansının ventriküler repolarizasyon değerlerine olan etkisi
Küçük Resim Yok
Tarih
2020
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Bolu Abant İzzet Baysal Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Sıklığı gün geçtikçe artan obezite morbidite ve mortaliteyi arttırması nedeniyle önemli bir sağlık sorunudur. Bir sebebinin de obezite olduğu koroner kalp hastalığı dünyada en sık ölüm nedenidir. Obezite; kardiyovasküler hastalıklara yatkınlık oluşturarak aritmi riskini de arttırabilmektedir, ventriküler repolarizasyon anormallikleri, kalbin ventriküler aritmilere duyarlılığını arttırarak ani kardiyak ölüme yol açabilmektedir. İnsülin direncinin bu anormalliklere katkısının olup olmadığı bilinmemektedir. Çalışmamız obezlerde insülin direncinin kardiyak ileti sisteminde bir etkisinin olup olmadığını incelemeyi amaçlamaktadır. Gereç ve Yöntemler: Çalışmaya 6-18 yaş arası VKİ 95. persentilin üzerinde olan 50 obez ile 47 sağlıklı çocuk ve adölesan dâhil edildi. Tüm olguların fizik muayeneleri ve antropometrik ölçümleri yapıldıktan sonra biyokimyasal tetkikleri yapıldı, EKG'leri çekildi, EKG dalgaları ve intervallerTorQ 150 mm Digital Caliper LCD cihazı ile büyütülerek elle ölçüldü. Bulgular: Obez grubun 19'u erkek (%38), 31'i kız (%62) ve 27'si çocuk (%54), 23'ü adelösan (%46) olup, yaşları 11.3±3.5 yıl idi, kontrol grubuyla karşılaştırıldığında bu özellikler benzerdi, ancak AKŞ (p=0.05), insülin (p=0.001), HOMA-IR (p=0.005), HbA1c (p<0.001), trigliserid (p<0.001) ve EKG parameterelerinden QTc (p=0.001), QTd (p<0.001), QTdc (p<0.001), JTc (p<0.001), Tpe (p<0.001), Tpe/QTort (p<0.001), Tpe/QTc (p<0.001), Tpe/JT (p<0.001) ve Tpe/JTc (p<0.001) anlamlı oranda farklıydı. Obezlerin 25 tanesinde (%50) insülin direnci vardı, insülin direnci olmayanlarla karşılaştırıldığında insülin direnci olanların AKŞ (p=0.016), insülin (p=0.005), HOMA-IR (p=0.013) ve trigliserid (p<0.001) istatistiksel açıdan farklı idi, hastaların EKG'lerinde sadece JTc istatiksel açıdan farklı idi (321.7±17.7'ye karşılık 332.3±16.5 ms, p=0.033). İnsülin direnci olanlarda JTc; kolesterol (p=0.008), QTc (p<0.001), JT (p=0.015), kolesterol/HDL (p=0.048), QRS süresi (p=0.016), Tpe (p=0.006), Tpe/QT ortalama (p=0.003), Tpe/QTc (p<0.001), Tpe/JT (p<0.001) ve Tpe/JTc (p<0.001) ile korelasyon göstermektedir. JTc süresini en fazla JT (p<0.001) ve QTc (p<0.001) etkilemektedir. JTc'nin 327 ms cut-off değeri obezlerde insülin direncine işaret etmetedir (AUC:0.66, 95%CI (0.51-0.81), p=0.044) (sensitivite %60, spesifite %60). Sonuç: Obezite ventriküler repolarizasyon anormaliliklerine sebep olmaktadır. Obezite ile beraber olan insülin direnci bu riski daha da arttırmaktadır. Bir EKG parametresi olan JTc bu tip hastalarda ventriküler repolarizasyon anormaliliğini ve aritmi riskini değerlendirmede yol gösterici olabilir.
The Aim: Obesity with increasing frequency is an important health problem, because of its increasing effect on the morbidity and mortality. Coronary hearth disease is World's leading cause of death and obesity is one of tehe causes of coranary heart diseases. Obesity can increase the risk of arrhythmia by predisposing to cardiovascular diseases, abnormalities of ventricular repolarization may increase the sensitivity of the heart to ventricular arrhythmias, leading to sudden cardiac death. It is not known whether insulin resistance contributes to these abnormalities. Our study aims to investigate whether insulin resistance has an effect on cardiac conduction system in obese patients. Materials and Methods: 50 obese and 47 healthy children and adolescents between the ages of 6 and 18 and whose BMI was above the 95th percentile were included in the study. After physical examination and anthropometric measurements of all cases, biochemical tests were performed, ECG was performed, ECG waves and intervals were measured manually by magnifying with TorQ 150 mm Digital Caliper LCD device. Results: Of the obese group, 19 were male (38%), 31 were female (62%) and 27 were child (54%), 23 were adolescent (46%) and their ages were 11.3 ± 3.5 years. these characteristics were similar when compared, but the FBS (p = 0.05), insulin (p = 0.001), HOMA-IR (p = 0.005), HbA1c (p <0.001), triglyceride (p <0.001) and ECG parameters; QTc (p = 0.001) ), QTd (p <0.001), QTdc (p <0.001), JTc (p <0.001), Tpe (p <0.001), Tpe / QTort (p <0.001), Tpe / QTc (p <0.001), Tpe / JT (p <0.001) and Tpe / JTc (p <0.001) were significantly different. Twenty-five (50%) of the obese patients had insulin resistance, compared to those without insulin resistance FBG (p = 0.016), insulin (p = 0.005), HOMA-IR (p = 0.013), triglyceride (p <0.001) and only JTc was statistically different in the ECG (321.7 ± 17.7 vs. 332.3 ± 16.5 ms, p = 0.033). In patients with Insulin resistance, JTc correlated with cholesterol (p = 0.008), QTc (p <0.001), JT (p = 0.015), cholesterol / HDL (p = 0.048), QRS duration (p = 0.016), Tpe (p = 0.006), Tpe / QT average ( p = 0.003), Tpe / QTc (p <0.001), Tpe / JT (p <0.001) and Tpe / JTc (p <0.001). JT (p <0.001) and QTc (p <0.001) had the greatest effect on JTc duration. The 327 ms cut-off value of JTc indicates insulin resistance in obese subjects (AUC: 0.66, 95% CI (0.51-0.81), p = 0.044) (sensitivity 60%, specificity 60%) Conclusion: Obesity causes ventricular repolarization abnormalities. Insulin resistance associated with obesity increases this risk even further. JTc, an ECG parameter, may be helpful in assessing ventricular repolarization abnormalities and arrhythmia risk in such patients.
The Aim: Obesity with increasing frequency is an important health problem, because of its increasing effect on the morbidity and mortality. Coronary hearth disease is World's leading cause of death and obesity is one of tehe causes of coranary heart diseases. Obesity can increase the risk of arrhythmia by predisposing to cardiovascular diseases, abnormalities of ventricular repolarization may increase the sensitivity of the heart to ventricular arrhythmias, leading to sudden cardiac death. It is not known whether insulin resistance contributes to these abnormalities. Our study aims to investigate whether insulin resistance has an effect on cardiac conduction system in obese patients. Materials and Methods: 50 obese and 47 healthy children and adolescents between the ages of 6 and 18 and whose BMI was above the 95th percentile were included in the study. After physical examination and anthropometric measurements of all cases, biochemical tests were performed, ECG was performed, ECG waves and intervals were measured manually by magnifying with TorQ 150 mm Digital Caliper LCD device. Results: Of the obese group, 19 were male (38%), 31 were female (62%) and 27 were child (54%), 23 were adolescent (46%) and their ages were 11.3 ± 3.5 years. these characteristics were similar when compared, but the FBS (p = 0.05), insulin (p = 0.001), HOMA-IR (p = 0.005), HbA1c (p <0.001), triglyceride (p <0.001) and ECG parameters; QTc (p = 0.001) ), QTd (p <0.001), QTdc (p <0.001), JTc (p <0.001), Tpe (p <0.001), Tpe / QTort (p <0.001), Tpe / QTc (p <0.001), Tpe / JT (p <0.001) and Tpe / JTc (p <0.001) were significantly different. Twenty-five (50%) of the obese patients had insulin resistance, compared to those without insulin resistance FBG (p = 0.016), insulin (p = 0.005), HOMA-IR (p = 0.013), triglyceride (p <0.001) and only JTc was statistically different in the ECG (321.7 ± 17.7 vs. 332.3 ± 16.5 ms, p = 0.033). In patients with Insulin resistance, JTc correlated with cholesterol (p = 0.008), QTc (p <0.001), JT (p = 0.015), cholesterol / HDL (p = 0.048), QRS duration (p = 0.016), Tpe (p = 0.006), Tpe / QT average ( p = 0.003), Tpe / QTc (p <0.001), Tpe / JT (p <0.001) and Tpe / JTc (p <0.001). JT (p <0.001) and QTc (p <0.001) had the greatest effect on JTc duration. The 327 ms cut-off value of JTc indicates insulin resistance in obese subjects (AUC: 0.66, 95% CI (0.51-0.81), p = 0.044) (sensitivity 60%, specificity 60%) Conclusion: Obesity causes ventricular repolarization abnormalities. Insulin resistance associated with obesity increases this risk even further. JTc, an ECG parameter, may be helpful in assessing ventricular repolarization abnormalities and arrhythmia risk in such patients.
Açıklama
Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları Ana Bilim Dalı
Anahtar Kelimeler
Çocuk Sağlığı ve Hastalıkları, Child Health and Diseases
