Lembryk I. S., Tymoshchuk O. V., Kocherga Z. R.

CONDITION OF THE MICROCIRCULATION IN ADOLESCENTS WITH OBESITY AND CONCOMITANT INVOLVEMENT OF THE PANCREAS: MODERN LOOK AT THE PROBLEM AND OUR OWN CLINICAL SUPERVISION

---

About the author:	Lembryk I. S., Tymoshchuk O. V., Kocherga Z. R.
Heading	CLINICAL MEDICINE
Type of article	Scentific article
Annotation	In view of worldwide burden of obesity, triggers leading to it in children and adolescents have to be urgently identified. Publications of recent years reveal the important pathogenetic role of the pancreas in regulation and activity of the microcirculation, at the level of target organs due to future appearance of abdominal ischemic syndrome, and in general, systemic atherosclerosis. Microcirculation (in particular, arterioles, capillaries and venules) is conceivably a key compartment or “special mirror” determining the situation in a whole organism. It is confirmed, that indirect methods of investigation of microcirculation are not known since nowadays. Objectives of the study: to improve condition of the microcirculation in adolescents with alimentary-constitutional obesity with involvement of the pancreas. Materials and methods of investigation. The article presents data on the state of microcirculation in 120 adolescents with primary obesity combined with functional pancreatic disorder and without it, as well as in 30 adolescent control groups. All children were examined in accordance with modern diagnostic and treatment protocols. During the work, the basic principles of bioethics were adhered to: informed consent was received from one parent (mother) for the participation of the child in the study, adhered to the basic principles of the Helsinki Declaration (1975 with its subsequent revision in 2000). During the conduction of scientific research, no biological experiment was conducted involving vertebrate animals. The min principles of bioethics were followed. Results of the investigation. According to our data, alimentary-constitutional obesity in adolescence is accompanied by pancreatic lesion more frequently (54.2% and 45.8%, p> 0.05). The combined pathology of the digestive system predominantly affects boys (61.5% and 38.5%, p <0.05). The prevalence of ailment before the time of hospitalization in most of the examined children with combined pathology is 6.0 ± 2.1% years, and in the case of an isolated course of the disease - 4.5 ± 3.1% years. Among the symptoms of pancreatic damage in obese children, pain in the left hypochondrium lasting several hours and poorly removed by spasmolytics (76.9% and 21.8%, χ2 = 17.69, p <0.05) was the most common. The duration of the disease in patients with this co-morbidity was 6.0 ± 2.1% years. These children also represent signs of insulin resistance (HOMA index was more than 3.5 U.S.), an increase in Hipstick / Waistline of more than 0.7, and an increased BMI of 26.0 ± 0.1.Violation of the exo-and endocrine functions of the pancreas is also noted in adolescents with a combined course of obesity. Among violations of microcirculation, according to biomicroscopy data of bulbar conjunctiva, extravascular disorders of microcirculation (the appearance of hemorrhages and perivascular edema) are more frequent than in the case of isolated pathology (64.6 ± 1.2% and 41.8 ± 2.3%, p < 0.05). Among the vascular disorders, the tortuosity of venules and capillaries (in 70.2 ± 5.2% of cases), the unevenness of the caliber of vessels (52.0 ± 8.2% of cases), the reduction of the arteriolo-venular coefficient to 1: 4 were more often considered. Alimentary-constitutional obesity is often accompanied by lesions of the pancreas with a pronounced clinic, a violation of the exo- and endocrine functions of the pancreas. In combined pathology, extra-vascular microcirculatory disorders, such as hemorrhages and edema, are more often noted.
Tags	adolescents, obesity, pancreas, microcirculation, diagnostics
Bibliography	Babinets L.S. Kytsai K.Iu. Kliniko-patohenetychni aspekty khronichnoho pankreatytu biliarnoho genezu ta ozhyrinnia. Hastroenterolohiia. 2016;1(59):86-92. Gubergrits N.B., Hristich T.M., Bondarenko O.A. Nealkogolnaya zhirovaya bolezn podzheludochnoy zhelezyi. Donetsk: Lebed; 2013. 234s. Malaya L.T., Miklyaev I.Yu., Kravchun P.G. Mikrotsirkulyatsiya v kardiologii. H.: Vischa shkola; 1977. 232s. Miheeva I.G., Efimtseva E.A., Miheev O.V., Kruglyakov A.Yu. Klinicheskoe znachenie biomikroskopii bulbarnoy konyunktivyi v pediatricheskoy praktike. Pediatriya. 2007; 86 (2): 99-102. Boillot A,  Zoungas S, Mitchell P, Klein R et al. Obesity and the Microvasculature: A Systematic Review and Meta-Analysis [Internet]. PLoS One. 2013; 8(2): e52708. Published online 2013 Feb. doi: 10.1371/journal.pone.0052708 Czernichow S, Kengne AP, Stamatakis E, Hamer M, Batty GD. Body mass index, waist circumference and waist-hip ratio: which is the better discriminator of cardiovascular disease mortality risk?: evidence from an individual-participant meta-analysis of 82 864 participants from nine cohort studies. Obesity Review. 2011; 12(9): 680–7.  Rosario Scalia. Microcirculation  in  adipose  tissue  inflammation.  Review Endocrine Metabolic Disorders.- 2013.- 14.-C. 69-76. Schlager O, Willfort-Ehringer A, Hammer A et al. Microvascular function is impaired in children with morbid obesity. Vascular Medicine. 2011; 16(2): 97–102.
Publication of the article	«World of Medicine and Biology» №1(63), 2018 year, 042-046 pages, index UDK 616-056.52+616.37+613.96
DOI	10.26724/2079-8334-2018-1-63-42-46