Взаимосвязь функционального состояния поджелудочной железы и метаболического синдрома у детей

Abstract

Relevance. Pancreas refers to the organs, the functional state of which is the most significant factor in the development of hormonal and metabolic disorders. Objective: to study the morphofunctional state of the pancreas in children with obesity and to evaluate its relationship with the main components of the metabolic syndrome (MS). Materials and methods. Surveyed 483 children with obesity from 6 to 16 years. Group I - 237 children with obesity complicated by MS, Group II - 246 children with obesity without signs of MS. A complex of clinical, laboratory and instrumental methods of examination was carried out using standard methods; 90 children (60 children from group I and 30 children from group II) underwent an ultrasound examination of the pancreas (RV) with the determination of the postprandial reaction. The results of the study. In 94.9% of children I gr. and 89.8% of children II g. various changes in the structure of the pancreas were revealed: an increase in acoustic density (77.6% and 63.8%, respectively), the presence of hyperechoic inclusions in the parenchyma (86.1% and 82.1%, respectively). The total size of the pancreas on an empty stomach in children in I group exceeded the normative figures and was more than that of II gr. (59.85 ± 6.27 mm and 53.11 ± 7.62 mm, respectively, p <0.05). After food stimulation, this indicator amounted to 65.75 ± 7.41 mm in I gr., and about 59.64 ± 5.40mm (p <0.05) in II gr. Exclusively in I gr. (16.7%) postprandial reaction was absent or was sharply reduced (less than 5%). The level of glucose, insulin, C-peptide and HOMA-IR index was higher than in the compared subgroups, and significantly exceeded the standard indicators in children with a reduced postprandial reaction. Triglyceride levels were also significantly higher, and high-density lipoproteins were lower than in other subgroups. In children with non-alcoholic fatty liver disease, the total size of the pancreas on an empty stomach was larger than in children with a normal organ structure (p <0.001), and the postprandial reaction of the pancreas was significantly lower: 7.5% (6.8-8.5%), respectively and 10.4% (11.8-17.9%) (p <0.01). With an increase in the thyroid gland, the size of the pancreas head on an empty stomach was significantly larger than in children with a normal thyroid volume. A decrease in the postprandial response of less than 5% was observed in 33.3% of children with an enlarged thyroid, and in 16.7% of children with normal thyroid size (p <0.05), the normal response of the pancreas (more than 15%) was determined solely in children with not Thyroid gland (11.9%). Findings. Most obese children (up to 95%), regardless of the presence of MS, revealed structural and functional changes in the pancreas. A significant decrease in the postprandial pancreatic response was recorded in children with MS. Only in children with MS (16.7%), the postprandial pancreatic reaction was absent or was sharply reduced (less than 5%), which should be considered as a clinical sign of impaired adaptive capacity of the pancreas against the background of a latent chronic inflammatory process. The relationship between carbohydrate metabolism and lipid metabolism with the total size and size of the pancreatic head on an empty stomach and after food load has been established. Children with NAFLD have a higher risk of developing CP. A close relationship between the morphofunctional state of the pancreas and thyroids has been established.