Метаболічні складові поєднаного перебігу остеоартриту та ожиріння

Abstract

According to statistics provided by the World Health Organization, in 2020 there will be about 2 billion adults, 41 million children under the age of 5 and 340 million children and adolescents aged 5 to 19 who are obese. It is proved that quite often obesity is a predictor of the formation of diseases of the musculoskeletal system. The purpose of the study was to determine the state of lipid and carbohydrate metabolism in patients with different stages of obesity and to establish their influence on the course of osteoarthritis. Materials and methods. The study involved 75 patients with osteoarthritis, which proceed on the background of obesity (main group). 50 patients had manifestations of osteoarthritis without changes in body mass index and 37 almost healthy individuals were included in the control group. Anthropometric data and body mass index were calculated. The state of lipid metabolism was determined by indicators of total cholesterol, triglycerides, high, low and very low density lipoproteins, atherogenic factor. The rate of carbohydrate metabolism was assessed by the presence of insulin resistance by calculating the Homeostasis Model Assessment of Insulin Resistance index. Body mass index was calculated by the Kettle formula. Other anthropometric parameters were determined by measuring the volume of the thigh, waist volume and calculated the ratio of volume of the thigh to waist volume. As markers of lipid metabolism we studied the content of total cholesterol, triglycerides, high-density lipoproteins, low-density lipoproteins and very low-density lipoproteins in the blood system with peroxide. The atherogenicity index was determined by the formula of Klimov A. M. Statistical analysis was performed using the software package "Statistica 10.0" and Excel 2010. To quantify the results, the results were presented as the median with a quarterly interval [Q25%; Q75%] taking into account the lack of normal distribution. Quantitative and ordinal changes were compared using the Mann-Whitney test. The correlation was calculated using Spearman's rank correlations. In all procedures of statistical analysis, the significance level p was assumed to be equal to or less than 0.05 (p <0.05). Results and discussion. We divided the patients of the main group into subgroups depending on the body mass index: overweight patients with I and II obesity degree. The comparative analysis of indicators of lipid metabolism allowed to establish increase of indicators of all atherogenic classes in comparison with control. A statistically significant difference in the rate of total cholesterol was determined only in the case of its comparison between the group with elevated body weight and I degree of obesity. Conclusion. In patients with osteoarthritis, occurring on the background of overweight or obesity, there are shifts in lipid and carbohydrate metabolism, which contribute to metabolic disorders in the body and, in particular, cartilage as a type of connective tissue. Patients with isolated osteoarthritis also have hyperlipidemia and in some cases insulin resistance, which is a negative basis for the progression of the pathological process. One of the factors in the progression of osteoarthritis in obese patients can be considered the activation of free radical oxidation of lipids, which occurs both as a result of osteoarthritis and the presence of concomitant pathology