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Women with obesity and problems of reproductive health had 3.5 fold increase of prolactin amount (P<0.01), which depended on the stage of obesity, and in the cases with excessive body weight in the main group its amount was increased 2.2 fold, while at the III stage 4.8 fold.
By means of correlation analysis between the values of BWI and prolactin level we determined strong positive link (r=+0.856).
Thus, we determined dependence of prolactin values and obesity stage in women with problems of reproductive health, proving its participation in the development of obesity and problems of reproductive health. That hypothesis can be explained with the physiological effects of prolactin, possessing direct stimulating impact on b-cells of pancreas and participation in the development of tissue insulin resistance. Besides that, prolactin can directly affect cells of fatty tissue, stimulating proliferative and metabolic processes in adipocytes, lead-
ing to the increase of fat tissue amount and development of leptin resistance.
In relation to the above mentioned, we can say that, in women of reproductive age with increased level of prolactin, it is rational to monitor the values of BWI, to maintain ideal weight and to decrease the number of concomitant diseases.
Conclusions:
1. In 74.3% of the women with problems of reproductive health have abdominal type of obesity, and in 25.7% gluteo-femoral type.
2. Among the women with symptoms of polycystic ovaries syndrome obesity was registered in 88.4% cases.
3. We determined increase of prolactin level in blood dependently on the stage of obesity.
4. We revealed correlation interrelation of BWI value with the level of prolactin.
References:
1. Dedov I. I., Melnichenko G. A., Romantsova T. I. Hyper prolactinemia syndrome. Tver. Triad, 2004.
2. Karpova Y. A. Obesity and reproductive function in women. Reproduction problems. M., 2006 № 4. P. 57-62.
3. Neuroendocrinology. ("Williams Endocrinology" series G. M. Kronenberg, S. Melmed, K. S. Polonski, P, R. Larsen. M.: «Rid Elsiver», 2010.
4. Prilepskaya V. N., Tsallagova Y. V.//Regulation of hunger and saturation//Doctors' country: resource for health care specialists, 2014. http/medstrana.com/articles/4675/
5. Manual on gynecologic endocrinology. Manusharovs R. A., Cherkezova E. I. Moscow 2011. P. 166.
6. Tatarchuk T. F., Kosey N. V., Gandji I. U. Fat tissue and reproductive system in women. Health of Ukraine. 2008, № 24/1, P. 14-16.
7. Haslam D.W. Obesity. Lancet 2005; 366: 1197-209.
8. Julia Fernanda et al. Hyperprolactinemia and body weight: prevalence of obesity and overweight in patients with hyperp-rolactinemia//Research Journal of Endocrinology and Metabolism. - 2013. - 1 (2). - P. 2053-2064.
9. Phan-Hug F., Beckmann J. S., Jacquemont S. Genetic testing in patients with obesity. Best Pract Res Clin Endocrinol Metab. 2012 Apr,-26 (2): 133-143.
Rakhimgaziyev Umid Gazivayevich, Assistant, Ambulatory Medicine Departmen, Tashkent pediatric medical institute E-mail: mbshakur@mail.ru
Peculiarities of mineral density of bone tissue in children with juvenile rheumatoid arthritis
Abstract: The change of structural functional status of bone tissue parameters in children suffering JRA with joint-visceral and joint forms of the disease, differed in its character, while the expression of these changes depended on the form of the disease.
Keywords: juvenile rheumatoid arthritis, bone mineral density, children.
Topicality. Juvenile rheumatoid arthritis (JRA) is inflammatory disease with chronic character, which damages joints
usually in children under 16 years old. Nowadays among children diseases with rheumatoid character juvenile arthritis takes the first place. This disease is spread around the whole world and the percentage of morbidity among children varies from 0.05 to 0.6 [2]. Associate and inalienable clinical mani-
festation ofJRA is development of skeletal-muscle pathology, the intensity of which testifies about severity of the disease and adequacy of the performed therapy [2], progressing of erosive-destructive alterations in joints, and formation of osteoporosis (OP) [3; 4].
According to the data of statistical studies, JRA affects from 2 to 16 individuals per 100 000 of children population,
Section 7. Medical science
in the age under 16 years old [1]. The spread ofJRA in various countries takes from 0,05% to 0,6% [5]. Approximately in 50% of the children the disease starts before 5 years old. Girls suffer JRA 1.5-2 times more often than boys. The disease has a great social importance due to often loss of workability in early age. The percentage of invalid children with set diagnosis of juvenile rheumatoid arthritis is high about 70%. About 50% of the patients lose workability after 3 years history of the disease [4; 6].
There is decrease of social functioning level in a society, deterioration of life quality occurring as a result of pathologic alterations of structural-functional status of skeletal system in the patients with JRA and it levels the resource of their "social return" [8]. In compliance with the data taken from our and foreign references [7; 9], patience with JRA have notable decrease of osteodensitometering parameters, change of mineral exchange values, and osteogenesis markers.
The preserved tendency of osteoporosis morbidity growth among children population with rheumatoid diseases proves insufficiency of existing prophylactic methods efficacy.
The aim of the research: The aim of the research was to study structural-functional status of bone tissue, taking into account expression of mineral density values' shifts in the patients with JRA.
Materials and methods: In TashPMI clinics we studied 36 children (6-16 years old) with JRA. The average age of the examined children was 11.3 ± 0.8 years old. Before the checking of the children of control group (20) we performed detailed study of their anamnesis for detection of chronic diseases, long term administration of any agents affecting bone tissue, orthopedic tests and anthropometric tests.
Anthropometric tests were performed in compliance with unified strategy using standard equipment. Height-weight values were measured for the calculation of body weight index (BWI) according to the following formula: BWI = body weight/heigh [2].
In the study of structural functional features of bone and muscle tissue we applied osteodensitometering method and biochemical analysis. Osteodensotometering was performed with the help of ultrasound osteodensitometer General Electric Medical Systems (USA). We determined qualitative and quantitative parameters of trabecular BT architectonics: 1) speed of ultra sound transmission (SUT, m/s) — dependent on elasticity and density of bone; 2) broadband ultrasound weakening (BUW, dB/mHz) — reflecting BT density, quantity, size and space orientation of trabecular bone; 3) rigidity or density index of BT (BTDI,%) — characterizing status of spongy BT.
Values of osteocalcin (OC) were studied as a marker of osteogenesis. The level of OC in blood serum was determined with the help of solid-phase immune enzyme analysis. NMID Osteocalcin (Nordic Bioscience Diagnostics A/S, Canada) test system was used.
Biochemical tests of calcium and phosphorus exchange values and markers of bone resorption and osteogen-
esis in blood serum and urine were performed for all patients.
Statistic processing of the obtained data was performed with the help of computer variation, correlation, regression, mono and multifactor dispersion analysis (license programs Microsoft Excel and Statistica, StatSoft, USA). We determined the average means (M), its mistakes (m), mean quadrate deviations, correlation coefficients, regression criteria, dispersion criteria, Student criterion (t), and reliability of the statistical values (p).
Results and discussion. The severity of the disease and activity of rheumatoid process were determined on the basis of clinical checking in compliance with the common diagnostic criteria.
According to sex the patients with JRA were divided as follows: boys — 16 (44.4%), girls — 20 (55.6%) . At the moment of visual examination in compliance with JRA. classification joint form (JF) of the disease was revealed in 28 (77.8%), joint-visceral form (JVF) — in 8 (22.2%) children. Various degrees of functional insufficiency were noted in 68.2% children. Polyarthritis was registered in 61.3% of the examined children, oligoarthritis — in 32.3%, monoarthritis — in 5.4% of the patients. Duration of the disease among the checked children was in the terms from 6 months to 14 years. Average age of the disease debut was 6.5 years old. Factors, which served to be trigger mechanism of JRA, were such as acute respiratory viral diseases (42.9%), tonsilitis (21.4%), trauma (11.1%) and others. (24.6%).
To evaluate the values of structural functional status of bone tissue in the patients with JRA dependently on the form of the disease, we studied the values of bone density, permeability for ultrasound, and intensity of ultrasound transmission.
Comparative analysis of the obtained data of the patients with JRA and the children of the control group showed a reliable (p< 0.001) decrease of all values of US densitometer-ing in all checked children. That indicates disorganization of bone structures under the influence of systematization of connective tissue inflammation process.
In the analysis of the obtained data we paid special attention to decrease of bone tissue rigidity, as that value was the sign of osteoporosis development. In our study decreased values of bone structure density index were detected in 21 (75.0%) patients with joint form and in 8 (100%) patients with joint-visceral form of JRA.. Consequently, we can consider that sex, age, hypo kinesis, medical therapy, unfavorable factors of environment, genetic predisposition to rheumatic diseases, hormonal misbalance, and low peak bone mass have a significant contribution in the development and progressing of bone pathology.
Besides that, we revealed reliable (p<0.01) decrease of bone tissue density in case of joint form of JRA in relation to joint-visceral one. The value of ultrasound transmission speed in case of joint form was 1522.12±1.85 m/s, and for joint-visceral form — 1501.02±3.98 m/s.
Detection of changes of ultrasound transmission speed (UTS) value to the side of diminishing in cases of joint-vis-
ceral form of the essential disease in comparison with the j oint form was statistically reliable (p<0.001). Reliable differences between mean values of broadband ultrasound weakening parameters in children with joint-visceral form and j oint form of the disease were not detected.
Changes of structural functional status of bone tissue in the patients with J^A in the form of osteoporosis were revealed 2 times more often among the patients with joint-visceral form of the disease: 91.2% of the patients with joint-visceral form of J^ had changes of structural functional stats of bone tissue in the form of osteoporosis or osteopenia with various degrees of manifestation.
In the studies ofbiochemical values of mineral exchange in the patients with J^., dependently on the form of the disease, we detected a reliable decrease (p<0.01) of Mg in blood serum in cases of joint and joint-visceral forms of the disease, where that value was 0.81±0.06 and 0.76±0.05 mmol/l correspondingly.
In case of joint-visceral form of J^A there was notable average value of blood serum P and rise of Ca day secretion (p<0.05) and P with urine (p<0.05), testifying acceleration of bone exchange, particularly bone resorption processes.
It was noted, that patients with J^. had decrease of Ca, P and Mg amount in blood serum and excretion of P with urine in comparison with the group of healthy children. The most expressed alterations were registered in patients with joint-visceral form of the disease.
Besides that we performed estimation of osteocalcin amount, and revealed that children with J^. had osteocalcin amount in serum reliably (p < 0.001) below the values of healthy children (71.22±1.21 and 92.46±1.67 ng/ml correspondingly), proving low osteosynthesis and diminished activity of osteoblasts in the patients with J^..
In children with joint-visceral form of the disease the amount of osteocalcin was reliably lower than in the patients with joint form (58.88±3.76 and 74.34±1.24 ng/ml correspondingly, p < 0.05), indicating decrease of osteosynthesis in the children with joint-visceral form ofJ^A.
Thus, even with small clinical material, the obtained results of the research prove that the processes of bone metabo-
lism in children with juvenile arthritis have various orientations: from activation of bone exchange to its suppression. The most expressed disorders of bone metabolism such as hypocalciumemia, hyper calciumuria, hyper phosphatemia, hypomagnesiumemia, decrease of osteocalcin amount, physical development retardation are revealed in children with polyarticular variant ofjuvenile chronic arthritis with systemic forms of juvenile rheumatoid arthritis.
Conclusion. It was determined that decrease of bone structures density index was detected in 21 (75.0%) patients with joint form and 8 (100%) patients with joint-visceral form of J^. The value of ultrasound transmission speed in cases of joint form was 1522.12±1.85 m/s, and in cases of joint-visceral form — 1501.02±3.98 m/s. (p<0.001). Alterations of BTDI in patients with J^. such as osteoporosis were revealed 2 times more often than among the patients with j oint-visceral form.
It was revealed, that in cases of joint-visceral form there was notable decrease of average level of phosphorus in blood serum and increase of day excretion of Ca with urine (p < 0.05). Thus, in cases of joint form the total amount of Ca was 2.34±0.06 mmol/l, inorganic phosphorus — 1.21 ± 0.07 mmol/l; in cases of joint-visceral form — 2.30±0.02 mmol/l, 1.17 ± 0.09 mmol/l correspondingly, proving acceleration of bone resorption processes.
It was detected that patients with j oint-visceral form of the disease the level of osteocalcin was 58.88 ± 3.76 ng/ml, with joint form — 74.34 ± 1.24 ng/ml (p < 0.05), indicating diminished osteosynthesis and decreased activity of osteoblasts. We revealed direct correlation links with SUT, BUW and BTDI (r = -0.71; r = -0.64; r = -0.68 correspondingly), and the level of osteocalcin and Mg (r = -0.42; r = -0.25 correspondingly).
Thus, the change of structural functional status of bone tissue parameters in children suffering J^A with joint-visceral and joint forms of the disease, differed in its character, while the expression of these changes depended on the form of the disease. The obtained data testify the necessity to study values of structural functional status of bone tissue in children with various forms ofJ^A, and that will provide effective performance of rehabilitation measures.
References:
1. Marushko T. B. Therapy of osteopenic syndrome with rheumatoid arthritis//Modern pediatrics. - 2004. - № 4 (5). -P. 101103.
2. Savelko N. V. Influence ofmud cure and sinusoidal modulating currents on the structural functional status ofbone tissue in patients with juvenile rheumatoid arthritis in the process of sanatorium resort therapy: doctoral dissert. 14.01.33. - Yalta, 2009. - 215 p.
3. Semenova O. V. Evolution, outcome and quality of life of patients with various forms of juvenile idiopathic arthritis with long progress: Abstract of doctoral diss.. - M., 2006. - 21 p.
4. Tekuchenko Y. V. Characteristics ofstructural functional status ofbone tissue in children suffering rheumatoid arthritis and correction ofthe revealed disorders at the stage ofsanatorium resort rehabilitation: Doctoral diss.: 14.01.10. - Simferopol, 2007. - 184 p.
5. Falameyeva O. V., Khrapova J. V., Sadovskaya T. N., Verkhoturova V. T. Mineral density ofbone tissue of vertebral column in healthy population of children, adolescent and youth age//Vertebral surgery. 2008. № 1. P. 58-65.
6. Falameyeva O. V., Sadovoi M. A., Khrapova J. V., Venediktova A. A., Rusova T. V. Method of risk groups formation with the development of osteoporosis in children and teenagers.//Salvation of license issue 01.02.2008 № 2007111227. Priority 22.03.2007.
