ABSTRACT
FUNDAMENTO: Hiperglicemia na fase aguda do infarto do miocárdio é importante fator prognóstico. Entretanto, sua fisiopatologia não está completamente elucidada. OBJETIVO: Analisar simultaneamente correlação entre hiperglicemia e marcadores bioquímicos relacionados ao estresse,metabolismo glicídico e lipídico, coagulação, inflamação e necrose miocárdica. MÉTODOS: Oitenta pacientes com infarto agudo do miocárdio foram incluídos prospectivamente. Os parâmetros analisados foram: glicose, hormônios do estresse (cortisol e norepinefrina), fatores do metabolismo glicídico [hemoglobina glicada (HbA1c), insulina], lipoproteínas (colesterol total, LDL, HDL, LDL eletronegativa minimamente modificada e adiponectina), glicerídeos (triglicérides, VLDL e ácido graxo), fatores da coagulação (fator VII, fibrinogênio,inibidor do ativador do plasminogênio-1), inflamação (proteína C reativa ultrassensível) e necrose miocárdica (CK-MB e troponina). Variáveis contínuas foram convertidas em graus de pertinência por intermédio de lógica fuzzy. RESULTADOS: Houve correlação significativa entre hiperglicemia e metabolismo glicídico (p < 0,001), lipoproteínas (p = 0,03) e fatores de necrose (p = 0,03). Na análise multivariada, somente metabolismo glicídico (OR = 4,3; IC = 2,1-68,9 e p < 0,001) e necrose miocárdica (OR = 22,5; IC = 2-253 e p = 0,012) mantiveram correlação independente e significativa.Para análise da influência da história de diabetes mellitus , modelo de regressão, incluindo somente pacientes sem diabetes mellitus foi desenvolvido, e os resultados não alteraram. Finalmente, no modelo ajustado para idade, sexo e variáveis clínicas(história de diabetes mellitus, hipertensão arterial e dislipidemia), três variáveis mantiveram associação significativa e independente com hiperglicemia: metabolismo glicídico (OR = 24,1; IC = 4,8-122,1 e p < 0,001) necrose miocárdica (OR = 21,9; IC = 1,3-360,9 e p = 0,03) e história de DM (OR = 27, IC = 3,7-195,7 e p = 0,001). CONCLUSÃO: Marcadores do metabolismo glicídico e necrose miocárdica foram os melhores preditores de hiperglicemia em pacientes com infarto agudo do miocárdio.
BACKGROUND: Hyperglycemia in the acute phase of myocardial infarction is an important prognostic factor. However, its pathophysiology is not fully understood. OBJECTIVE: To analyze simultaneously the correlation between hyperglycemia and biochemical markers related to stress, glucose and lipid metabolism, coagulation, inflammation, and myocardial necrosis. METHODS Eighty patients with acute myocardial infarction were prospectively included. The following parameters were analyzed: blood glucose; stress hormones (cortisol and norepinephrine); glucose metabolism factors [glycated hemoglobin (HbA1c); insulin]; lipoproteins (total cholesterol, LDL, HDL, minimally modified electronegative LDL, and adiponectin); glycerides (triglycerides, VLDL and fatty acids); coagulation factors (factor VII, fibrinogen, plasminogen activator inhibitor-1); inflammation (high-sensitivity C reactive protein); and myocardial necrosis (CK-MB and troponin). Continuous variables were converted into degrees of relevance using fuzzy logic. RESULTS: Significant correlation was observed between hyperglycemia and glucose metabolism (p < 0.001), lipoproteins (p = 0.03), and necrosis factors (p = 0.03). In the multivariate analysis, only glucose metabolism (OR = 4.3; CI = 2.1-68.9; and p < 0.001) and myocardial necrosis (OR = 22.5; CI = 2-253; and p = 0.012) showed independent and significant correlation. For the analysis of the influence of history of diabetes mellitus, a regression model including only patients without diabetes mellitus was developed, and the results did not change. Finally, in the model adjusted for age, gender, and clinical variables (history of diabetes mellitus, hypertension and dyslipidemia), three variables maintained a significant and independent association with hyperglycemia: glucose metabolism (OR = 24.1; CI = 4.8-122.1; and p < 0.001), myocardial necrosis (OR = 21.9; CI = 1.3-360.9; and p = 0.03), and history of DM (OR = 27; CI = 3.7-195.7; and p = 0.001). CONCLUSION: Glucose metabolism and myocardial necrosis markers were the best predictors of hyperglycemia in patients with acute myocardial infarction.
Subject(s)
Female , Humans , Male , Middle Aged , Diabetes Mellitus/diagnosis , Hyperglycemia/diagnosis , Myocardial Infarction/blood , Troponin/blood , Biomarkers/blood , Blood Coagulation/physiology , Creatine Kinase, MB Form/blood , Diabetes Mellitus/blood , Epidemiologic Methods , Glycated Hemoglobin/analysis , Hyperglycemia/blood , Inflammation/blood , Insulin/blood , Lipoproteins/blood , Myocardial Infarction/pathology , Necrosis , Stress, Physiological/physiologyABSTRACT
La obesidad infantil es reconocida por la Organización Mundial de la Salud como un problema de Salud Pública, pudiendo perpetuarse y asociarse a diabetes mellitus tipo 2, hipertensión arterial y enfermedades cardiovasculares. El objetivo fue conocer la relación entre el índice de masa corporal con la glicemia y dislipidemia en el niño obeso. Método: Estudio descriptivo en 64 pacientes obesos de la consulta de Nutrición del Hospital "Jorge Lizarraga". 2006. Criterios de inclusión: Edad: 6 meses a 15 años, de ambos géneros, Índice de Masa Corporal (IMC) superior percentil 95, obesidad exógena, y reporte en la historia: glicemia en ayuna, colesterol sérico total y triglicéridos. Evaluación socioeconómica (Graffar). Análisis estadístico: frecuencias absolutas, porcentajes, prueba Z, Chi cuadrado, test exacto de Fisher y coeficiente de correlación de Pearson. Significación estadística fue p<0,05. Resultados: 81,2% (p<0,001), fueron escolares y adolescentes. Predominó el género masculino 57,8%. 75% correspondió al Graffar III, IV y V. 35,9% (p< 0,001) presentó hipercolesterolemia y 62,5% (p<0,001) hipertrigliceridemia, con predominio en el género masculino, y 6,2% hiperglicemia. No hubo correlación entre el IMC y los valores bioquímicos. Discusión y Conclusión: La edad frecuentemente observada en los pacientes refleja la percepción tardía de los padres y médico tratante acerca de la malnutrición. Se evidenció un alto porcentaje de niños obesos pertenecientes a los estratos III, IV y V del Graffar. A pesar de no establecerse una asociación estadísticamente significativa, entre el IMC y los valores bioquímicos evaluados, se encontró un alto porcentaje de niños obesos con hiperlipidemia, particularmente hipertrigliceridemia.
Corporal mass index. Dislipidemics and hyperglicemia as cardiovascular risk factors in obese children. Children obesity is accepted as a Public Health problem, it can remain and be associated with Diabetes Mellitus type 2, arterial hypertension and heart diseases. Our purpose was to assess the relation between Corporal Mass Index, hyperglicemia and dislipidemia as cardiovascular risks. A retrospective, cross sectional and descriptive survey was performed, among 64 obese patients attending the nutritioinal consultancy in " Jorge Lizarraga Hospital" Valencia, Carabobo State, during 2006. Inclusion criteria were: age between 6 months and 15 years, both sexes, Corporal Mass Index(CMI), above 95 percentile, exogen obesity reported in Medical Histoty. Laboratory tests:fast glicemia, total serum cholesterol and tryglicerids. Socio economic evaluation(through Graffar standards) . Statistical analysis included.absolute frequency percentages, Z tests, Chisquare, Fisher X2 test and Pearson's correlation coefficient. Statistical significance was p<0.05. Results: 81.2 % (p<0.001) were elementary school children or teenagers. 57.8% were male children. 75% were considered in Graffar III, IV and V standards. 35.9% (p<0.001) had hypercholesteroemia and 62.5 (p<0.001) , hypertrigliceridemia, affecting mainly male children. 6.2% reported hyperglicemia. No correlation between IMC and biochemical values was observed. Concluding. The age of patients most commonly observed, indicates that parents and physicians acquire a late view of the problem. Dislipidemia's frequency increases with age. A coexistence of the so-called "poverty obesity" was also assessed. IMC and dislipidemics specially hypertrigliceridemia might be proper indicators of cardiovascular risk.
ABSTRACT
Se realizó un estudio longitudinal con el objetivo de conocer la relación de la hipertensión arterial con la obesidad, las hiperlipoproteinemias y la hiperglucemia. La muestra estuvo constituida por 218 pacientes. Se correlacionaron los niveles de glucemia y de lípidos en los hipertensos y normotensos. El método estadístico utilizado fue el de la prueba t de Student (p £ 0,005 con significación estadística). Los hipertensos obesos y los no obesos tuvieron mayores niveles de glucemia y de lípidos que los normotensos obesos y no obesos (p < 0,005). El 77,2 % de los hipertensos presentó al menos un factor de riesgo cardiovascular asociado. Se concluyó que los niveles de glucemia y de lípidos son mayores en los hipertensos que en los normotensos, independientemente de la presencia de obesidad o no, y que la hipertensión arterial se asocia frecuentemente con otros factores de riesgo cardiovascular.
A longitudinal study was conducted aimed at knowing the relation of arterial hypertension with obesity, the hyperlipoproteinemias and hyperglycemia.The sample was composed of 218 patients. The levels of glycemia and lipids in the hypertensive and normotensive were correlated. The statistical method used was the t of Student test (p £ 0.005 with statistical significance). The obese and non-obese hypertensive had higher levels of glycemia and lipids than the obese and non-obese normotensive (p<0.005). 77.2 % of the hypertensive had at least an associated cardiovascular risk factor. It was concluded that the levels of glycemia and lipids are higher in the hypertensive than in the normotensive independently of the presence or not of obesity, and that arterial hypertension is frequently associated with with other cardiovascular risk factors.