Клинические фенотипы осложнений ожирения у мальчиков-подростков

Введение. Ожирение у подростков является широко распространенным и клинически гетерогенным заболеванием. Цель исследования. Изучение клинического разнообразия проявлений наиболее значимых осложнений ожирения у мальчиков-подростков. Материалы и методы. В исследовании участвовали 104 подростка 14–17 лет с ожирением (код МКБ-10 E66.0). Проводилось комплексное обследование, включавшее оценку анамнеза, антропометрию, гормональный профиль (ЛГ, ФСГ, тестостерон, кисспептин и др.), биохимические показатели крови (липиды, глюкоза), УЗИ сердца и брюшной полости, измерение артериального давления. Для анализа данных использовались методы описательной статистики и модель Раша. Результаты. Определены 3 клинических фенотипа лиц с гетерогенными склонностями к развитию осложнений. Пациенты первого фенотипа имели максимальную вероятность формирования нарушений метаболизма глюкозы и кардиоваскулярных осложнений. Для представителей второго была характерна в субмаксимальной степени инсулинорезистентность и в меньшей — дислипидемия, вероятность артериальной гипертензии была минимальной. Для третьего был характерен максимальный риск развития дислипидемии и неалкогольной жировой болезни печени, а риск нарушений метаболизма глюкозы был минимальным. Самый высокий потенциал формирования всех осложнений отмечался у представителей первого клинического фенотипа, заметно превышая показатели второго и третьего. Выявлена ассоциация высокой склонности к артериальной гипертензии с более высокими оценками полового развития по шкале Таннера. Выводы. Мальчики-подростки с ожирением имеют различную склонность к формированию отдельных вариантов осложнений. Артериальная гипертензия имеет тенденции к ассоциации с инсулинорезистентностью, дислипидемия — с неалкогольной жировой болезнью печени. Уровень тестостерона и стадия полового развития имеют прогностическое значение в отношении развития клинического фенотипа, характеризующегося повышенной склонностью к формированию артериальной гипертензии.

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