Medycyna Metaboliczna, 2014, tom XVIII, nr 2

www.medycyna-metaboliczna.pl
31
ZOFIA SZCZEKLIK-KUMALA
OtyO JAKO stAN PROzAKRzEPOWy
ObEsIty As thE PROthROMbOtIC stAtE
Towarzystwo Edukacji Terapeutycznej, Warszawa
Warszawski Uniwersytet Medyczny.
bACKGROUND AND AIMs
Disturbances in thrombosis and fbrinonolysis con-
stitute one of the independent risk factors of atheroscle-
rosis and embolism. They create a specifc challenge in
the management of obesity. The clinical signifcance of
the thrombosis and fbrinolysis markers in obesity is, ho-
wever, not suffciently established. Therefore a study was
undertaken. As the direct aim of research, the comparative
determination and analysis of correlations in a general po-
pulation group divided into 2 arms: a) with BMI < 29 kg/
m2, and b) BMI 30 kg/m2 of: 1) phenotypic values; 2)
pathophysiological parameters; 3) values and distribution
of thrombosis and fbrinolysis markers; and 4) endothelial
function indicator - von Willebrand factor in venous plas-
ma were studied.
MAtERIAl AND MEthODs
The whole group under study was composed of 269
persons above 19 years of age. They were selected by
the proportional stratifcation method and represented
the demographic profle of the general population of the
city of Warsaw. This population was divided into 2 sub-
groups: 1) control - with BMI between 19 and 29 kg/
m2, fat body mass < 20% and, 2) the group with obe-
sity - BMI 30 kg/m2 and fat body mass > 20%. By
allocating and comparing in these subgroups the results
of the studies of thrombosis and fbrinolysis markers, the
possibility of the prothrombotic risk of obesity could be
assessed. In these 2 populations, the thrombosis, fbri-
nolysis and endothelial status markers were determined
with methods as follows: 1) clinical phenotypic diag-
nostics: BMI, fat body mass - bioimpedance, Bodystat
1500, W, WRR - (WHO) accordingly to the WHO; 2)
biochemical studies: plasma glucose - glucose oxida-
se method, oral glucose tolerance test (WHO), serum
insulin - IRMA, Polatom RIA, C-peptide - X Biodata
set, insulin resistance, HOMA - Mathew procedure; 3)
thrombosis and fbrinolysis markers - fbrinogen - von
Claus method, tissue plasminogen activator (t-PA) - Bio-
pol, reagents Immulyse, plasminogen activator inhibitor
(PAI-l) - Biopol set, von Willebrand factor - Biopol set.
Statistical analysis: ANOVA, SAS.
REsUlts
The study is of comparative character. All results were
divided into 2 subgroups: frst - characterizing the control
group with BMI 19-29 kg/m2 and fat body mass < 20%,
and the second - the group with obesity. Persons with BMI
19-29 kg/m2 and fat body mass < 20% signifcantly diffe-
red from the subjects with obesity BMI 30 kg/m2 and
fat body mass > 20% as follows: l) W (p < 0,01), WHR
(p < 0,05); 2) fasting glycemia (p < 0,001), OGTT (p <
0,05), triglycerides (p < 0,02), plasma insulin (p < 0,006),
C-peptide (p < 0,01), HOMA (p < 0,05); 3) coagulation
markers: fbrinogen (p < 0,01), t-PA, PAI-I (p < 0,05); 4)
von Willebrand factor (p < 0,05). Statistically valid diffe-
rences were also found in the assessment of correlation
between phenotypic and thrombosis markers.
CONClUsIONs
Obesity (BMI, fat body mass) associated with insu-
lin resistance (W, WHR, fasting insulin, C-peptide, fas-
ting glycemia, HOMA, triglycerides) is in a statistically
signifcant manner, correlated to the increased levels of
fbrinogen, t-PA and PAI-l. It points to a tendency toward
increased thrombosis and fbrinolytic defciency. These
fndings were signifcantly correlated with the augmenta-
tion of the von Willebrand factor. The results suggest the
need for regular testing the individual prothrombotic risk
in obesity for preventive purposes.
Medycyna Metaboliczna, 2014, tom XVIII, nr 2
www.medycyna-metaboliczna.pl
32
bIblIOGRAPhy
1. Tato J, Czech A, Bernas M: Otyo, zesp metaboliczny,
Wyd. Lek. PZWL, Warszawa, 2007.
2. Tato J, Czech A, Opolski G, Zembala M (red.): Cukrzyco-
we choroby serca, Wyd. Via Medica, Gdask, 2005.
3. Dunn J., Grant P.: Atherothrombosis and the metabolic syn-
drome, rozdz. w The Metabolic Syndrome, Byrne Ch.D.,
Wild S.H. (red.), Wiley and Sons, Chichester, 2005.
4. Jarzbska M.: Zaburzenia krzepnicia krwi i fbrynolizy w
otyoci, zespole metabolicznym i cukrzycy, rozdz. w Od
otyoci do ostrego zespou wiecowego, Cybulska B,
Duniewski M. (red.), Wyd. Medical Education, 2008.
Adres do korespondencji:
Z. Szczeklik-Kumala
Tow. Edukacji Terapeutycznej
ul. Pocka 15C/73
01-231 Warszawa
e-mail: j.taton@interia.pl
Nadesano: 10.07.2013
Zakwalifkowano do druku: 15.12.2014
c.d. Standardy edukacji terapeutycznej
EDUKACJA tERAPEUtyCzNA sElEKtyWNA,
INDyWIDUAlIzOWANA
stANDARD 9
indywidualne wymogi medyczne
Stosuje si zasady edukacji wymienione w dziale edukacji powszechnej, ale edukacja
- jest prowadzona przez mniejszy wyspecjalizowany zesp (np. lekarz i edukator)
- moe odnosi si tylko do indywidualnie wybranych tematw lub sytuacji pacjenta
Do edukacji wykorzystuje si dostpne, nowe technologie w sposb maksymalnie moliwy komputer, zapisy
grafczne, wyliczenia rednich itp.
Dokonuje si okresowych ocen metodologicznych