Çocuklarda trombosit indeksleri ve obesite arasındaki ilişki

Amaç: Bu çalışmada insulin direnci olan ve olmayan obez çocuklarda trombosit sayısı, ortalama trombosit volümü (MPV) ve trombosit dağılım genişliği (PDW) parametrelerinin metabolik bir belirleyici olarak kullanılıp kullanılamayacağını göstermeyi amaçladık. Gereç ve Yöntem: Çalışmaya 267 obez çocuk ( kız 160) ve 50 ( 25 kız) kontrol alındı. Antropometrik ölçümler, serum trigliserid,total kollesterol, yüksek dansiteli lipoprotein kollesterol (HDL), düşük dansiteli lipoprotein kolesterol (LDL), Alanin aminotransferaz( ALT) Asparta aminotransferaz (AST), ürik asit, hemogloulin, , trombosit sayısı, MPV, PDW tüm hastalarda bakıldı. İnsulin direnci homostatik model assesmant (HOMA-IR) kullanarak ve oral glikoz yükleme testi (OGTT) yapılarak belirlendi. Bulgular: Ürik asit değerleri obez grupta anlamlı yüksek saptandı. Ancak trombosit indeksleri arasında istatistiksel anlamlı fark bulunamadı. Trombosit sayısı, MPV,PDW değerleri insulin direnci olan, olmayan ve control grubunda istatistiksel olarak anlamlı farklı saptanmadı. Buna ragmen MPV HOMA-IR değeri, trombosit sayısı ,ALT ve LDL arasında arasında negatif yönde korelasyon varken MPV ile PDW arasında pozitif korelasyon saptandı.Sonuç: Obezite ile trombosit sayısı, PDW ve MPV arasındaki ilişki daha önce gösterilmiştir. Biz düşündüğümüz gibi trombosit indeksleri ile obezite derecesi arasında bir ilişki saptayamadık. Ancak insulin direncini belirlemede seçilmiş hastalarda ürik asit düzey ölçümü daha yararlı olabilir.

Anahtar Kelimeler:

Çocukluk, obezite, trombosit, ortalama platalet birim

Relationship between obesity and platelet indices in children

Purpose: The aim of this study was to assess platelet count, MPV and PDW as metabolic indicator in obese children with or without insuline resistances.Materials and Methods: Two hundered sixtyseven obese patients (160 female) and 50 (25 female) controls were enrolled. Anthropometric measurements, triglyceride, total cholesterol, high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), alanine aminotransferase (ALT), aspartate aminotransferase (AST), uric acid, hemoglobin, platelet count, MPV, PDW and insulin resistance by using homeostasis model of assessment of insulin resistance (HOMA-IR) and oral glucose tolerance test were investigated. Results: Uric acid level were significantly higher in the obese group while there was no statistically significantly differences in platelet indices between in the two groups. Platelet counts, MPV and PDW levels were not significantly different between in three groups. However MPV inversely correlated with HOMA-IR, platelet counts, ALT and LDL levels and positively correlated with PDW. Conclusion: The relationship between platelets, MPV, PDW has previously been demonstrated. However platelet indices may not to be related to degree of obesity as currently thought. Uric acid may be a more useful marker for selected patients with insulin resistance.

Keywords:

Childhood, Obesity, Platelet, Mean platalet volume,

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1. Han JC, Kimm SYS. Childhood obesity-2010: progress and challenges. Lancet. 2010;375:1737-48.
2. Gómez García A, Núñez GG, Sandoval ME, Castellanos SG, Alvarez Aguilar C. Factors associated with early platelet activation in obese children. Clin Med Res. 2014;12:21-6.
3. Ly HQ, Kirtane AJ, Murphy SA, Buros J, Cannon CP, Braunwald E et al. Association of platelet counts on presentation and clinical outcomes in ST- elevation myocardial infarction (from the TIMI Trials). Am J Cardiol. 2006;98:1-5.
4. Samocha-Bonet D, Justo D, Rogowski O, Saar N, Abu-Abeid S, Shenkerman G et al. Platelet counts and platelet activation markers in obese subjects. Mediators Inflamm. 2008;2008:1-6.
5. Shin WY, Jung DH, Shim JY, Lee HR. The association between non-alcoholic hepatic steatosis and mean platelet volume in an obese Korean population. Platelets. 2011;22:442-6.
6. Turk U, Tengiz I, Ozpelit E, Celebiler A, Pekel N, Ozyurtlu F et al. The relationship between platelet indices and clinical features of coronary artery disease. Kardiol Pol. 2013;71:1129-34.
7. Coban E, Adanir H, Bilgin D. The association of mean platelet volume levels with hypertensive retinopathy. Platelets. 2008;19:115-8.
8. Arslan N, Makay B. Mean platelet volume in obese adolescents with nonalcoholic fatty liver disease.J Pediatr Endocrinol Metab. 2010;23:807-13.
9. Aypak C, Türedi O, Bircan MA, Yüce A. Could mean platelet volume among complete blood count parameters be a surrogate marker of metabolic syndrome in pre-pubertal children? Platelets. 2014;25:393-8.
10. Chu SG , Becker RC, Berger PB, Bhatt DL, Eikelboom JW, Konkle B et al. Mean platelet volume as a predictor of cardiovascular risk: a systematic review and meta-analysis. J Thromb Haemost. 2010;8:148-56.
11. Arslan N, Makay B, Hızlı S, Koçyiğit A, Demircioğlu F, Tuncel AS et al. Assessment of atherosclerosis in obese adolescents: positive correlation of mean platelet volume and carotidintima media thickness. J Paediatr Child Health. 2013;49:963-8.
12. Arslan N, Makay B. Mean platelet volume in obese adolescents with nonalcoholic fatty liver disease.J Pediatr Endocrinol Metab. 2010;23:807-13
13. Kim SH, Lee JW, Hwang HJ. Associations between combinations of body mass index plus non-alcoholic fatty liver disease and diabetes mellitus among Korean adults. Asia Pac J Clin Nutr. 2011;20:14-20.
14. Shah B, Sha D, Xie D, Mohler ER 3rd, Berger JS. The relationship between diabetes, metabolic syndromeand platelet activity as measured by mean plateletvolume: the National Health and Nutrition Examination Survey, 1999-2004. Diabetes Care. 2012;35:1074-8.
15. Coban E, Yilmaz A, Sari R. The effect of weight loss on the mean platelet volume in obese patients Platelets. 2007;18:212-6.
16. Cardoso AS, Gonzaga NC, Medeiros CC, Carvalho DF Association of uric acid levels with components of metabolic syndrome and non-alcoholic fatty liver disease in overweight or obese children and adolescents. J Pediatr. 2013;89:412-8.
17. De Luca G, Verdoia M, Cassetti E, Schaffer A, Di Giovine G, Bertoni A et all. Novara Atherosclerosis Study (NAS) group. Mean platelet volume is not associated with platelet reactivity and the extent of coronary artery disease in diabetic patients. Blood Coagul Fibrinolysis. 2013;24:619-24.