LICENTA Sindrom Metabolic

download LICENTA Sindrom Metabolic

of 107

Transcript of LICENTA Sindrom Metabolic

  • 8/13/2019 LICENTA Sindrom Metabolic

    1/107

    UNIVERSITATEA DUNREA DE JOSGALAI

    LUCRARE DE LICEN

    CORELAII NTRE SINDROMUL METABOLIC I SINDROMULDE APNEE OBSTRUCTIV N SOMN

    STUDENT CTLINA PETRACHE

    CONDUCTOR LICEN

    AS. UNIV. DR. SNZIANA LOVINFacultata ! "!#c#$a %# Fa&'ac# Gala(#

    )*+)

    1

  • 8/13/2019 LICENTA Sindrom Metabolic

    2/107

    CUPRINS

    +. INTRODUCERE

    ). PARTEA GENERAL

    I. S,'$ul $,&'al %# -at,l,#c

    II. Pat,l,#a /,'$ulu# ca 0act,& ! /c ca&!#,'ta1,l#c

    III. S#$!&,'ul ! a-$ ,1/t&uct#23 4$ /,'$5 !0#$#(##6 4$ca!&a&6 /2tat6c,$/c#$(

    IV. S#$!&,'ul 'ta1,l#c5 !0#$#(##6 -&2al$(36 #'-l#ca(## cl#$#c

    7. PARTEA PERSONAL

    8 ",t#2a(#a %# ,1#ct#2ul /tu!#ulu#8 "atal6 't,!8 R9ultat8 D#/cu(##

    :. CONCLUZII

    ;I;LIOGRAFIE

    2

  • 8/13/2019 LICENTA Sindrom Metabolic

    3/107

    INTRODUCERE

    Al&a t'# /t ',t#2at3 ! -&2al$(a !#catat#-,='# #$t&'#t$t36 !/t&uctu&a93 /,'$ul %#-&,2,ac3 >#-&/,'$,l$(3 !#u&$3 %# &a2 !9c>#l#1& $u&,u',&al %# 'ta1,l#c.P$t&u /#$!&,'ul ! a-$ 4$ /,'$ ! t#- ,1/t&uct#26 -au9a &/-#&at, /t &9ultatulc,la-/ulu# t,tal /au -a&(#al al c3#l,& a$ /u-,a& 4$ /,'$6 ca c c>#2ala93 cu'a$2&a 2aal3 "ull& ?#$/-#& cu l,ta 4$c>#/3@6 1&a!#ca&!# %# t,$u/ 2aal c&/cut.Rlua&a &/-#&a(## / 0ac -$t&8, /u-&0#c#al#9a& a /,'$ulu# ?'#c&,t&9#&@6 cu act#2a&/#'-at#c3 %# ta>#ca&!#.

    A-$a ,1/t&uct#2a 4$ /,'$ a& , -&2al$(!#cat?: 4$ -,-ula(#a $&al@64$//t , -&,1l'cl#$#c-u(#$ &cu$,/cut.

    S#$!&,'ul 'ta1,l#c =-', tul1u&a& c,'-l=a 'ta1,l#/'ulu# $&t#c al,&a$#/'ulu#6 #$clu! tul1u& al 'ta1,l#/'ulu# l#-#!#c ?,19#tat6 !#/l#-#!'#@6

    luc#!#c ?t,l&a$( alt&at la luc,9B !#a1t 9a>a&at t#- )@ %# -&,t#c ?>#-&uc'#@6-&cu' %# >#-&t$/#u$ a&tal ?tul1u&a& >',!#$a'#c cu -u$ct ! -lca&'ta1,l#c@. S#$!&,'ul 'ta1,l#c /t a/,c#at cu a-$a ,1/t&uct#2 4$ /,'$. S8a !,2!#tca-$a ,1/t&uct#2 4$ /,'$ /t u$ 0act,& ! /c #$!-$!$t -$t&u >#-&t$/#u$ %#&9#/t$(ala #$/ul#$.

    T&ata'$tul cu -&/#u$ -,9#t#2c,$t#$u?CPAP@ /t t&ata'$tul ! -'a l#$#-$t&u a-$a ,1/t&uct#2 $ /,'$ /#'-t,'at#c. T,tu%#6 0ctul CPAP a/u-&a/#$!&,'ulu# 'ta1,l#c $u /t cla&.

    Stu!#ul cl#$#c cu-$/ 4$ luc&a&a ! l#c$( 4%# -&,-u$ /3 a$al#99 c,&la(##l'ult#!#'$/#,$al 4$t& -&9$(a %# &a2#tata a-$# 4$ /,'$ %# c,'-,$$tl/#$!&,'ulu# 'ta1,l#c.

    3

  • 8/13/2019 LICENTA Sindrom Metabolic

    4/107

    La /0

  • 8/13/2019 LICENTA Sindrom Metabolic

    5/107

    PARTEA GENERAL

    I. Somnul normal i a!olo"i#

    S,'$ul &-&9#$t3 , /ta& $,&'al3 ca&actat3 -$ &!uc&a #'-,&ta$t3 a'#%c3l,& c,&-ulu#6 -,/tu&3 ca&act/t#c36 !#'#$ua&a /t3# ! c,$%t#$(3 %# a&3/-u$/ul,& la /t#'ul# !#$ '!#ul =t,&. S,'$ul $u /t , a1/$(3 -a/#23 ac,$%t#$(#6 c# u$ -&,c/ act#2 %# c,'-l=. R,lul /,'$ulu# #$clu!5 &0ac& $&t#c36&/ta& a t'ul,& 1#,l,#c6 'atua& c,$#t#23 %# a0ct#23 ?a!#c3 a cu$,a%t# %# a',(##l,&@6 &la&a 0u$c(##l,& #$/t#$ctual.

    C#clul ! 2> # /,'$ /t /t&

  • 8/13/2019 LICENTA Sindrom Metabolic

    6/107

    Somnul REM?$u'#t %# /,'$ -a&a!,=al6 !at,t3 act#2#t3(## #$t$/ a c&ulu#@ %#&omnul non'REM-&9#$t3 0u$c(## %# 'ca$#/' t,tal /-a&at. A/t0l6 cl 7 /t3u$!a'$tal al ,&a$#/'ulu# u'a$ /u$t &-&9$tat ! /ta&a ! 2>6 /,'$ul RE"%# /,'$ul $,$8RE".

    Sta!#ul + $,$8RE" /t u$ /ta!#u c&-u/cula& !#$ -u$ct ! 2!& '$tal5

    4$!#&a ,/c#la93 4$t& &al %# 0a$ta/t#c6 a-a& , /$9a(# ! -lut#& 6 /ta&a ! #$c,$%t#$(3/ a!#a& !ac3 ,c>## /u$t !/c>#%#6-,at 0# t&9#t ! 9,',t6 #a& 4$ ac/t /ta!#u 0u$c(##l /c&t,#6 t$/#u$a a&tal3 %#'ta1,l#/'ul 1a9al c,$t#$u3 /3 !#'#$u.

    S,'$ul -&,0u$! !1uta93 la 7*8 :* ! '#$ut !u-3 a!,&'#& cu /ta!#ul 7 $,$8

    RE". Ac/t /ta!#u /t ca&actat ! u$! c&1&al l$t ?0&c2$(3 '!# *. : -/cu$!3@ %# ! c#$c# , 'a# la !c#'#c al /,'$ulu# $u /t -

    !-l#$ !0#$#t. S c&! c3 a'#$l 1#,$ # 4$ /-c#al /&,t,$#$a #$!uc # c,$t&,la93 /,'$ul %# /ta&a ! 2>. O / ! c,$/tat3 au /u&at #'-l#ca&a /&,t,$#$# #$1#,c>#'#a /,'$ulu#. A/t0l6 L8t-t,0a$ul '3&%t 0a9a -a&a!,=al3 a /,'$ulu#6 #a&&9&-#$a6 ca& -&,!uc , !-l # a ',$,a'#$l,& !#$ c&6 !t&'#$3 u$ 0cta/'3$3t,&.

    S8a c,$/tatat ca $u&,$## $ucl#l,& &a0ulu# '!#a$ al t&u$c>#ulu# c&1&al c,$ #$ca$t#t3 # 'a ! /&,t,$#$36 #a& -,& #u$#l lat&al al -u$ ## 8 ca$t#t3 # 'a ! $,&a!&$al#$3 ?$,&-#$0$3@. D-l #a /&,t,$#$# !#$ c& /au 1l,ca&a 0a&'ac,l,#c3a /#$t9# -&,!uc , !&la& a tutu&,& /ta!##l,& /,'$ulu# ?#$clu/#2 /ta!#ul RE"@.A!'#$#/t&a&a ! 8>#!&,=#t-t,0a$ ?-&cu&/,& al /&,t,$#$#@ a'l#,&a93 /,'$ul 4$#$/,'$#.

    E=#/t3 !,29# =-'$tal ca& -l!a93 -$t&u -a&t#c#-a&a a!$,9#$# la-&,!uc&a /,'$ulu#. I$cta&a ! a!$,9#$3 4$ 2$tculul c&1&al la ,1,la$#6-&lu$ t !u&ata /,'$ulu# l$t6 - c

  • 8/13/2019 LICENTA Sindrom Metabolic

    7/107

    N,&-#$0$a a& u$ &,l #'-,&ta$t 4$ 'ca$#/'l 1#,c>#'#c al /,'$ulu#.A/t0l6 !&,ul -$ #$>#1# #a /#$t9# $,&-#$0$# /u-'3 /,'$ul &a-#!6 !#ta 1,at34$ 0$#lala$#$3(-&cu&/,& al $,&-#$0$#@ -&,2,ac3 , tul1u&a& at,',/ta9## ',$,a'#$c a c&ulu#. ;l,ca&a c3#l,& $,&a!&$c ! c3t& 8>#!&,=#8!,-a6ca& !#'#$ua93 c,$ #$utul ! $,&a!&$al#$3 ?NA@ 4$ '9$c0al6 &!uc /ta&a ! 2>

    # -,a!a /,'$ulu# -a&a!,=al.E/t c,$0#&'at3 &c#-&,c#tata # c,$=#u$a /#/t'l,& /&,t,$#$8 #

    $,&a!&$c 4$ 'ca$#/'l &l3# c#clul,& 2>8/,'$. A/t0l6 #$>#1# #a /#$t9#/&,t,$#$# # l9a&a $ucl#l,& t&u$c>#lu# c&1&al -&,2,ac3 #$/,'$#6 #a& l9a&a 0u/ulu#$,&a!&$c !,&/al -&,2,ac3 >#-&/,'$#6 4$/, #t3 cu '3&a 0a9# /,'$ulu# -a&a!,=al

    # a 'ta1,l#/'ulu# /&,t,$#$#.Ac/t !at -#$! >t&,$#tata /,'$ulu# ! $,a-t au -&'#/ , /#/t'at#9a&

    # , #$t&-&ta& 'a# 0u$!a'$tal3 cu -&,1l'l lat ! -at,l,#a /,'$ulu#.

    Sim!om(l( rin#ial(!/c/ ! -ac#$(## cu tul1u&3 ! /,'$ /u$t>#-&/,'$#a %# #$/,'$#a.)i(r&omnia/au /,'$,l$(a =c/#23 !#u&$3 /t !/c/3 ca t$!#$(a #&9#/t#1#l3

    ! a a!,&'# 4$ c#&cu'/ta$( $-,t#t6 0##$! , 'a$#0/ta& cu c,$/c#$(/,c#,c,$,'#c #'-,&ta$t5 4$ SUA a$ual +** *** ! acc#!$t &ut#& /u$t a/,c#at cu/,'$,l$(a la 2,la$6 #a& u$l !9a/t& ca %ua&a '#/#u$## C>all$& au 0,/t !a/'$a cau9at ! /c3&&a 2##l$(# la l,cul ! 'u$c3. C,$/c#$(l '!#cal cl'a# #'-,&ta$t /u$t tul1u&3l 'ta1,l#c6 /,'$,l$(a -&,!uc$#t3 ?#$/,'$# !'$(#$&@. ?)8:@

    7

  • 8/13/2019 LICENTA Sindrom Metabolic

    8/107

    Alt /#'-t,' $,ctu&$ !/c/ 'a# al/ ! -ac#$(## cu tul1u&3 ! 2$t#la(# 4$/,'$ /u$t5 /0,&3#tul $,ctu&$6 -au9l &/-#&at,# 4$ /,'$ ?at/tat ! a$tu&a@6>#-&/u!,&a(#a6 $#ctua6 /,'$ul a#tat6 -#&,9#/ul. "a# /u$t 4$t %# !cla$%at ! ',(## $at#2 /au-,9#t#2 ?)8@.

    S,c#t3(#l ! "!#c#$a S,'$ulu# !uc 4$ -&9$t , ca'-a$# ! /$/#1#l#9a& %# !!uca& a -u1l#culu# %# a -&act#c#$#l,& 4$ 2!&a &cu$,a%t# ac/t,& /#'-t,'6 -$t&uu$ !#a$,/t#c %# u$ t&ata'$t c,&ct al -at,l,## c,'-l= lat ! /,'$.

    8

  • 8/13/2019 LICENTA Sindrom Metabolic

    9/107

    II. Pa!olo"ia &omnului #a *a#!or +( ri #ar+iom(!a,oli#

    R#/cul ! a-a(# a /#$!&,'ulu# 'ta1,l#c 4$ c,$!#(##l -# ! /,'$ ! $,a-t/t !,2!#t ! 'ult#-l !at !#$ l#t&atu&3. Aca/t&la(# -,at 0# =-l#cat-$ 0a-tul

    cl#-/a /,'$ulu# 2a !t&'#$a l2 2/-&al al c,&t#9,lulu# /c %# a &9#/t$(# la#$/ul#$$0#9#,l,#c. Ac/t c&%t /u$t 4$/,(#t ! !#'#$ua&a $,ctu&$ a $#2lulu#-la/'at#c al l-t#$# %# ! c&%t&a a-t#tulu# cu a-a(#a ,19#t3(## %# !#$ $,u c&%t&a&9#/t$(# la #$/ul#$3 ?7@.

    $ u&'3 cu :* ! a$# /8a &a-,&tat , a/,c#& 4$t& c&%t&a ',&tal#t3(## %# =t&'l!u&at# ! /,'$ aut,8&a-,&tat?)@. Zc# ! alt /tu!## ult,a& au c,$0#&'at aca/t3a/,c#& /u1 0,&'a u$# cu&1 4$ U. A/,c# /#'#la& /8au &a-,&tat -$t&u 'ult#-l# al(#0act, -&,$,/t#c#6 cu' a& 0# >#-&t$/#u$a a&tal36 2$#'$tl c,&,$a$6,19#tata6 !#a1tul 9a>a&at %# c>#a& 1,l#l ,$c,l,#c ?a/#/t$tl '!#cal -at !/,'$ -$ tu& ! $,a-t au u$ /c c&/cut ! a !92,lta ca$c& ! /$/#2 'ult#$a(#,$al ca& /3 cu-$!3=-l,&a&a =t$/#23 a cal#t3(##6 /t&uctu# /,'$ulu#6 a !u&at# %# u$ /c&$#$ -$t&utul1u&3 /-c#0#c al /,'$ulu#6 4$ c,'1#$a(# cu 2alua&a ca&!#ac i'ta1,l#c3. ?7@

    III. Sin+romul +( an(( o,&!ru#!i- /n &omn0 +(*ini1ii2 /n#a+rar(2&(-(ri!a!(2 #on&(#in1(

  • 8/13/2019 LICENTA Sindrom Metabolic

    10/107

    II.a. D(*ini1i(

    342 52 678

    Sin+romul +( an(( o,&!ru#!i- /n &omn 3SA)OS8/t , c,$!#(# ca&actat3-$ -au9 &/-#&at,# &-t#t#2 ! -/t +* /cu$! 4$ cu&/ul /,'$ulu#6 !at,&at4$u/t3# !#$a'#c c3#l,& a$ /u-,a& -#-,='#&-t#t#23 ?+(&a!urri@ %# t&9# /cu&t &-tat ?mi#ro!r(9iri@ c !uc la !/t&uctu&a&a/,'$ulu#6 >#-&/,'$,l$(3 !#u&$3 %# &a2 c,'-l#ca(## ca&!#,2a/cula& %# 'ta1,l#c.Ct#l ! !#a$,/t#c %# &a2#tat -$t&u SAHOS /u$t -&9$tat 4$ ta1lul I.

    Ta,(l I. Ct#l ! !#a$,/t#c -$t&u SAHOS

    O,i(#!i- 0 OBLI:ATORIU

    3r(9ul!a!ul oli&omno"ra*i(i; oli"ra*i(i8

    < = (-(nim(n!( o,&!ru#!i-(;> +( &omn

    An((a o,&!ru#!i- ? orir(a *lu@ului orona9al(n!ru &2 #u (*or!ul r(&ira!or !ora#o'a,+ominal r(9(n!

    )ion((a o,&!ru#!i- ? r(+u#(r(a #u = a*lu@ului orona9al (n!ru &2 #u (*or!ulr(&ira!or !ora#o'a,+ominal r(9(n!

    Su,i(#!i- 3&im!om(8

    A )i(r&omnol(n1 +iurnSau

    B C(l u1in 4 +in urm!oar(l(0Q Cri9( +( &u*o#ar( no#!urn

    Q Tr(9iri mul!il(Q Somn non'r(ara!or

    Q O,o&(alQ Tul,urri +( #on#(n!rar(

    SAHOS /t ca&actat ! a-a(#a a -/t a-$# ?,- &/-#&at,#@ /au>#-,-$# ?&!uc ! -/t * al 0lu=ulu# &/-#&at,& ,&,$a9al@ - ,&a ! /,'$6 cu/#'-t,'at,' /u/t#2 ?/,'$,l$(3 !#u&$3@.

    1!

  • 8/13/2019 LICENTA Sindrom Metabolic

    11/107

    SAHOS /t cla/#0#cat 4$ u%,&6 '!#u %# /2& a/t0l5 uor!ac3 #$!#cl ! a-$8>#-,-$ - ,&a ! /,'$ ?IAH@ /t 4$t& %# +6 m(+iu-$t&u IAH 4$t& + %# 7* %#&(-(r-$t&u IAH -/t 7*.

    $ t#'-ul a-$# ,1/t&uct#2 '#%c3l t,&ac,8a1!,'#$al c,$t#$u36 4$c&c#ca&!# %# c&%t&

    t$/#,$al3 !u-3 -#/,!ul ,1/t&uct#2.E-#/,a!l ! a-$ /au ! >#-,-$ / 2al#!a93 cl#$#c !,a& !ac3 / 4$/,(/c !'#c&,t&9#& /au ! !/atu&a&.

    II,. $a#!orii +( ri mani*(&!ri0

    $a#!orii +( ri #la&i#i -$t&u SAHOS /u$t /=ul 'a/cul#$ %# ,19#tata6 #a&'a$#0/t3l cl 'a# /u/t#2 no#!urn( /u$t /0,&3#tul6 -au9l &/-#&at,# at/tat !a$tu&a6 $#ctua ?-$ l#1&a& ! --t#! $atu&t#c atal@6 /,'$ul a#tat %#>#-&/u!,&a(#a6 #a& +iurn(5 /,'$,l$(a6 tul1u&3l ! '', %# c,$c$t&a&6 c0ala'at#$al36 -#&,/#/ul 'at#$al6 >#-&t$/#u$a a&tal3 %# /c3!&a l#1#!,ulu# ?)6 :6 +6 7@

    Obezitatea /t cl 'a# #'-,&ta$t 0act,& ! /c -$t&u SAHOS6 -&9$(a /ac&/c#-&/,'$,l$(a !#u&$3 %# la/u1#c(## $,$8a-$#c# &3'

  • 8/13/2019 LICENTA Sindrom Metabolic

    12/107

    c,$t&,2&/at36 /8a c,$/tatat c3 -&/,a$l cu ,1/t&uc(# $a9al3 c&,$#c3 ?!',$/t&a1#l3$,'a$,'tc@ au u$ /c c&/cut -$t&u SAHOS. ?:@

    Perimetrul gtului6 '3/u&at la $#2lul ''1&a$# cc,t#&,#!#$6 /t u$#$!#cat,& &cu$,/cut al /culu# -$t&u SAHOS6 #$!-$!$t ! &a!ul ! ,19#tat5 /8a!',$/t&at c3 -&/,a$l ,19 cu SAHOS au -'t&ul ,&',$ 4$ -at,$9a SAHOS ?7@.

    Pac#$(## c -&9#$t3 >#-&/c&(# ! luc,c,&t#c,#9# 4$ ca!&ul 1,l## /au/#$!&,'ulu# Cu/>#$ -a& /3 0# a0cta(# 4$t&8, 'a& -&,-,&(# ! /#$!&,'ul a-$## ! /,'$?a-&,=#'at#2 7*@6 #a& u$! ct#l ! !#a$,/t#c $u /u$t /at#/03cut =#/t3 t,tu%#',!#0#c3 al a&>#tctu# $,&'al a /,'$ulu#. ?:@

    P3&l /u$t 4'-3&(#t 4$ ca c -%t -&2al$(a =act3 a tul1u&3l,& ! t#-ula-$# ! /,'$ la -ac#$(## cu >#-,t#&,#!#/'6 !a& /t 4$ $&al acc-tat c3 /c&$#$8ulac/t,& -ac#$(# $u /t -&,1a1#l c,/t80#c#$t. ?@

    II.#.Comor,i+i!1i0"a,tata /u1#c(#l,& cu a-$ ,1/t&uct#23 0##$! ,19#6 2,' &3/# 4$ -at,l,#a

    a/,c#at3 cu SAHOS %# c,'-l#ca(##l ,19#t3(##. D/atu&3l $,ctu&$ %# '#c&,t&9#l$&a93 la &

  • 8/13/2019 LICENTA Sindrom Metabolic

    13/107

    C&%t&a c&,$#c3 a t,$u/ulu# a!&$c6 !#/0u$c(#a $!,tl#al36 $u&,-at#a2tat#23 >#-,=#c36 $#2lul c&/cut al c#t,#$l,& -&,#$0la'at,#6 /tatu/ul -&,c,aula$t %#!9c>#l#1&l 'ta1,l#c at&,$ /u$t 'ca$#/'l 'a,& -$ ca& SAHOSac(#,$a93 ca u$ 0act,& ! /c ca&!#,2a/cula& #$!-$!$t. D#$t& -ac#$(## $,u!#a$,/t#ca(# cu SAHOS6 'a,tata -&9#$t3 >#-&t$/#u$ a&tal36 ca& -,at 0#

    $cu$,/cut3 -

  • 8/13/2019 LICENTA Sindrom Metabolic

    14/107

  • 8/13/2019 LICENTA Sindrom Metabolic

    15/107

    "ult#-l /tu!## -#!'#,l,#c au &a-,&tat c3 SAHOS / a/,c#a93 cu u$ /cca&!#,2a/cula& c&/cut6 cl 'a# 'ult !,29# =#/t#-&t$/#u$a a&tal36#$/u0#c#$(a ca&!#ac3 %# acc#!$tl 2a/cula& c&1&al. ?M*8M:@

    U$ /tu!#u a'-lu - :+ ! /u1#c(# ? Sl- Ha&t Halt> Stu!@ &a-,&ta93 c3tul1u&3l ! 2$t#la(# 4$ /,'$ / a/,c#a93 cu #$/u0#c#$(a ca&!#ac3 ?,!!/ &at#, 8 OR

    ).7@6 acc#!$t 2a/cula& c&1&al ?OR +.@ %# 1,al3 c,&,$aa$3 ?OR +.)@. ?M+@a. M(#ani&m(0Pac#$(## cu SAHOS -&9#$t3 >#-,='# #$t&'#t$t3 alt&$i(r!(n&i-i0A-&,=#'at#2 * !#$ -ac#$(## >#-&t$/#2#

    %# 7 !#$ c# cu >#-&t$/#u$ &9#/t$t3 la t&ata'$t au SAHOS. ?+*6 +*@$ /tu!#ul #/c,$/#$ ?#/c,$/#$ Sl- C,>,&t Stu!@6 , a/,c#& t#- !,938&3/-u$/

    a 0,/t 2#!$(#at3 4$t& tul1u&3l ! 2$t#la(# 4$ /,'$ %# >#-&t$/#u$6 #$!-$!$t !2

  • 8/13/2019 LICENTA Sindrom Metabolic

    16/107

  • 8/13/2019 LICENTA Sindrom Metabolic

    17/107

    D%# &l2a$(a cl#$#c3 $u /t cla& /ta1#l#t36 at'##l ca&!#ac /u$t c,'u$ la-ac#$(## cu SAHOS. $ Sl- Ha&t Halt> Stu!6 /u1#c(## cu SAHOS -&9#$t3 at'##! ) -#-,='#c3 0a2,a93 a-a(#a 1&a!#ca&!## /#$u/al6 a /t,-ulu# /#$u/al6 a1l,cul,& at,2$tcula&. ;&a!#ca&!#a $,ctu&$3 cu #'-act >',!#$a'#c $at#2 -,at0# t&atat3 -$ CPAP -

  • 8/13/2019 LICENTA Sindrom Metabolic

    18/107

    6 IL86 ICA"8+6 VCA"8+6 TNF86 E8/lct#$a %# ! a/'$a , a!9#2#tat -lac>ta&3c&/cut36 cu &3/-u$/ 0a2,&a1#l /u1 CPAP.

    CPAP i an"inaT&ata'$tul c,&ct al SAHOS cu CPAP la -ac#$(## cu a$#$3 $,ctu&$3 /

    a/,c#a93 cu /c3!&a -#/,a!l,& ! /u1!$#2la& ST %# a'l#,&a& /#'-t,'at#c36 #a&/cul 2$#'$tl,& c,&,$a$ 0atal %# $,$0atal /ca!. E=#/t3 , &la(# t#- !,938&3/-u$/ 4$t& /2tata SAHOS %# /cul c,&,$aa$6 ca& / &!uc /'$#0#cat#2 /u1CPAP. ?++6 +)@

    ,=. A##i+(n!(l( -aular( #(r(,ral( 3AVC80Pr(-al(n1a SA)OS la a#i(n1ii #u AVCDat -#!'#,l,#c /u&a93 , &la(# -ut&$#c3 4$t& TVS %# 2$#'$tl

    c&1&,2a/cula& acut6 'a# /t&

  • 8/13/2019 LICENTA Sindrom Metabolic

    19/107

    -ac#$(#l,& cu SAHOS. Aca/t3 c,'-l#ca(# 0##$! at.= D(r(&ia

    Pac#$(## cu SAHOS !92,lt3 , / ! -&,1l$' $u&,-/#>#c #$t&&la(#,$at5/,'$,l$(3 !#u&$36 !0#c#t c,$#t#26 !-&/# %# !0#c#t ! &la(#,$a&6 /c3!&a cal#t3(##2#(##. Pac#$(## c,'-l#a$(# la CPAP -&9#$t3 a'l#,&3 /'$#0#2cat#2 al ac/t,&a/-ct6 cua$t#0#ca1#l - /call -/#>,'tc 2al#!at actual'$t. ?+6 +@

    II.>.F Mor!ali!a!(aU$ /tu!#u -&,/-ct#2 - + a$# a a&3tat u$ /c ! 7 , 'a# 'a& ! ',&tal#tat !

    ,c cau93 la -ac#$(## cu tul1u&3 ! 2$t#la(# 4$ /,'$ 0a(3 ! c# 03&3 TVS. ?+M@U$ /tu!#u &c$t &a-,&taa93 u$ 2

  • 8/13/2019 LICENTA Sindrom Metabolic

    20/107

    IV. Sin+romul m(!a,oli# 3SM8 0 +(*ini1ii2 r(-al(n12 imli#a1ii#lini#(

    S" /t c,$!#(#a cl#$#c3 -&!#a1t#c3 c &u$%t , / ! alt&3 'ta1,l#c#$!-$!$t ca& c,'-,&t3 u$ /c ca&!#,2a/cula& c&/cut -$ #$#(#&a %# -&-tua&a-&,c/ulu# at&,/cl&,t#c #$0la'at,&8!$&at#2 2a/cula&6 4$ ca& #$/ul#$,&9#/t$(a %#>#-$/ul#$'#a c,'-$/at, &-&9#$t3 l'$tul -at,$#c c$t&al. Stu!##-#!'#,l,#c ! -&2al$(3 0ctuat - !#0t &u-u -,-ula(#,$al au !',$/t&at c3S" c,$/t#tu# u$ 0act,& 'a,& ! /c at

  • 8/13/2019 LICENTA Sindrom Metabolic

    21/107

    ",!ul ! 2#a(3 a& , #$0lu$(3 -ut&$#c3 a/u-&a tutu&,& c,'-,$$tl,&/#$!&,'ulu# 'ta1,l#c %#6 !#$ ac/t ',t#26 acc$tul -$c#-al 4$ 'a$a'$tul/#$!&,'ulu# 'ta1,l#c t&1u# -u/ - ',!#0#ca&a /t#lulu# ! 2#a(36 /u-&a2>at3 !/-c#al#/t6 4$ -a&t#cula&- 0,&tul ! a &!uc &utata c,&-,&al3 %# ! a c&%t $#2lul ! act#2#tat 0#9#c3.

    H#-&t$/#u$a a&tal36 !#/l#-#!'#a %# >#-&l#c'#a ?4$ l#'#tl ! !0#$#(# a!#a1tulu#@ -,t t,tu%# $c/#ta u$ t&ata'$t '!#ca'$t,/ /u-l#'$ta&.

    IV..In&ulinor(9i&!(n1a0

    "t,!l cla/#c ! !t&'#$a& a #$/ul#$,&9#/t$(# /u$t t/ta&a t,l&a$(# laa!'#$#/t&a&a ! luc,93 ?TTGO@6 t/tul &3/-u$/ulu# &a-#! la a!'#$#/t&a&a #$t&a2$,a/3! luc,936 't,!a cla'-ulu# ul#c'#c >#-$/ul#$'#c %# 't,!a cla'-ulu#>#-&l#c'#c. Ac/ta t/ta93 ca-ac#tata ! &3/-u$/ la-&,2,ca&a 'ta1,l#c3.

    M(!o+a )OMA?H,',/ta/#/ ",!l A////'$t@ /t#'a93 0u$c(#a clull,&

    1ta ?;@ %# a &c-t,l,& ! #$/ul#$3 ?/$/#1#l#tata 8 S@6 4$ c,$!#(## 1a9al6 ca-&,c$t &a-,&tat la 2al,l 4$ -,-ula(#a $&al3. "t,!a HO"A a -a&cu&/ 'a# 'ultta- ! 2,lu(# 4$c-#-&t$/#u$## a&tal a /u0t 'a# 'ult ',!#0#c3 lat ! !,29#lca& a/,c#a93 /cul ca&!#,2a/cula& cu !-3%#&a u$# a$u'#t 2al, 'a$,'tc. G>#!ulJNC !#$ )**7 cla/#0#c3 -&/,a$l 4$ $,&',t$/#26 -&8>#-&t$/#2 %# >#-&t$/#2?)+M@ ?Ta1l IV@.

    21

  • 8/13/2019 LICENTA Sindrom Metabolic

    22/107

    Ta,(lul IV. Cla&i*i#ar(a NC % a >i(r!(n&iunii ar!(rial(

    JNC 7 Classification of lood Pressure !P"

    Cla&i*i#ar( TA Si&!oli# 3mm )"8 TA Dia&!oli# 3mm )"8Normal +)* *

    Pr(>i(r!(n&iun( +)*8+7M *8M)TA &!a+iul I +:*8+M M*8MM)TA &!a+iul II +* +**.

    Actual'$t c,$!u#ta !#a$,/t#c3 %# t&a-ut#c3 u&'3&%t >#!ul S,c#t3(##Eu&,-$ ! H#-&t$/#u$ -$t&u 2alua&a %# t&ata'$tul >#-&t$/#u$## a&tal ?Ta1lV@.

    Ta,(lul V. Cla/#0#ca&a ESH a >#-&t$/#u$## a&tal

    Ca!("orii Si&!oli# 3mm)"8 Dia&!oli# 3mm)"8O!imNormalNormal /nal!)TA "ra+ I 3uoar8)TA "ra+ II 3mo+(ra!8)TA "ra+ III 3&(-(r8)TA &i&!oli# i9ola!

    X+)*+)*8+)M+7*8+7M+:*8+M+*8+MY+*Y+:*

    X**8:8MM*8MM+**8+*MY++*XM*

    Cn+ TAS i TAD &( /n#a+r(a9 /n #a!("orii +i*(ri!(2 &( ali# #(a mai /nal!.

    Ta,(lul VI. Val,l -&a al t$/#u$## a&tal la !#2&/ t#-u ! '3/u&a&Valoril( ra" al( TA 3mm)"8 (nn!ru +(*inir(a )TA /n *un#1i( +( +i*(ri!(l( !iuri+( m&urar(Con+i1ii TA& TA+Ca,in(! 5 GDomi#iliu 6'6= 7=Moni!ori9ar( 45> 4'6 7Moni!ori9ar(

    9iua noa!(a

    6'6=4

    7=%

    $ 2alua&a -ac#$tulu# >#-&t$/#26 u$ -a/ ,1l#at,u /t actual'$t/t&at#0#ca&a /culu#6 4$ 0u$c(# ! 2al,a&a 'a$,'tc3 %# ! 0act,# ! /c a/,c#a(#.

    $i"ura F. St&at#0#ca&a /culu# 4$ 0u$c(# ! 2al,l t$/#u$## a&tal %# 0act,# ! /ca/,c#a(#

    22

  • 8/13/2019 LICENTA Sindrom Metabolic

    23/107

    Ta,(l VII. Fact, -&,$,/t#c# 2alua(# -$t&u /t&at#0#ca&a /culu# la -ac#$(##>#-&t$/#2#$a#!ori +( ri#ar+io-aulari *olo&i1i(n!ru #la&i*i#ar(

    A*(#!ar( +( or"an1in!

    Dia,(!9a>ara!

    Con+i1ii #lini#(a&o#ia!(

    Ni-(lul TAS2 TADBr,a1i (&!( == ani$(m(i (&!( F= ani$uma!ulDi&lii+(mia 3#ol(&!(rol 4= m";+l2 )DL 5 B2 57$

    LDL ==m"8I&!ori# *amilial +( BCV3==B2 F=$8O,(9i!a!( a,+ominal34#m B2 77 #m $8

    HVSI"T -/t *.M"#c&,al1u'#$uaRa-,&t al1u'#$a8c&&at#$a ;Y))6 F7.@

    Gl#c'# Wu$ +)La )>-,/t-&a$!#al +M 'B!l

    AVC6 AITI"6 AP6R2a/culaa&6ICCN0&,-at#6 IRCA&t,-at#

    -c3Rt#$,-at#

    ;CV 1,al3 ca&!#,2a/cula&3 ; 13&1a(# F 0'# HVS >#-&t&,0# 2$tcula&3 /t#-&t$/#u$ a&tal3 /cu$!a&3 %# !>#-&t$/#u$ &9#/t$t3 la t&ata'$t. Pac#$(## cu SAHOS -,t -&9$ta -&,0#l $,$8!#--&/au #$2&/8!#--&6 #a& 2al,l t$/#,$al !#u&$ /u$t !#cat la 'a,tata -ac#$(#l,&."ca$#/'l /u$t lat ! >#-&/#'-at#c,t,$# %# ! act#2a&a /#/t'ulu# &$#$38a$#,t$/#$38al!,/t&,$6 a/,c#at t#,l,#c cu !/atu&3l $,ctu&$ %# cu 0&a'$ta&a/,'$ulu# ?M+6 M)6 +*6 +*@.

    23

  • 8/13/2019 LICENTA Sindrom Metabolic

    24/107

    III.5. O,(9i!a!(a

    344F'4668

    In+i#(l( +( ma& #ororal 3IMC8 /au #$!#cl utlt /t cl 'a# /#'-lu#$/t&u'$t ! 2alua& $ut(#,$al36 0##$! !0#$#t ca &a-,&tul !#$t& 'a/a c,&-,&al3 %#

    -3t&atul tal## ?Bc')@. O 2al,a& /u1 +6 #$!#c3 /u1-,$!&al#tat6 4$t& +6 %# ) /tc,$/#!&at3 $,&'al36 ) %# 7* /u-&a-,$!&al#tat6 #a& -/t 7* ,19#tat. I"C /#$u& $u&0lct3 =act /tatu/ul $ut(#,$al al u$# -&/,a$.

    E&!imar(a #omo9i1i(i #ororal(ca-3t3 actual'$t $,# /'$#0#ca(## 4$ cl 'a#!#2&/ -at,l,##. "a/a a!#-,a/3 &-&9#$t3 ) !#$ 'a/a c,&-,&al3 t,tal3. "a/a /la13?@ c,$(#$ t /0&tu a-3 %# u$ /0&t -&,t#$l %# '#$&all !#$ c,&- ?'a/a u/cat3/la13 /au 'a/a clula&36 &-&9$t

  • 8/13/2019 LICENTA Sindrom Metabolic

    25/107

    c,$tu# la ',!#0#ca&a !#/tu(## 0lu#!l,& la -ac#$(## cu SAHOS6 ca& =-l#c3-,l#ua6 !'l -c %# >',c,$c$t&a(#a.

    III.=.S(+(n!ari&mulA#!i-i!a!(a *i9i#2 /t#'at3 4$ t&'$# ! #$t$/#tat6 0&c2$(3 %# !u&at36 &u$%t

    '#%c3l 2,lu$ta& ca& c&/c c>ltu#ala $&t#c3.E@(r#i1iul *i9i#/'$#0#c3 '#%c3lc,&-,&al -la$#0#cat %# &-t#t#2 &al#9at -$t&u a t/ta6 !92,lta /au '$(#$a-t#tu!#$#l 0#9#c. N,(#u$a ! &or! -&9#$t3 $ua$( cultu&al ! la !#'$/#u$ac,'-t#(#,$al3 la ca ! !#2&t#/'$t. C>ltu#ala $&t#c3 -$t&u a#!i-i!a!(aro*(&ional!-#$! ! cat,a -&,0/#,$al3. A#!i-i!1il( +om(&!i#(-,t c

  • 8/13/2019 LICENTA Sindrom Metabolic

    26/107

    P,!,'t&l /u$t #$/t&u'$t '#c#6 #0t#$ %# /#'-l6 -u&tat ! ,1#c# la cu&aua-a$tal,$#l,&6 ca& c,$(#$ u$ /#/t' 'ca$#c c ,/c#la93 cu '#%c3l %,l!ulu# 4$ '&/6act#2a93 u$ c,$tact lctc %# 4$/t&a93 u$ #'-ul/ la 0#ca& -a/. Su$t c,$c-uta%a!a& /3 4$/t&9 '#%c3l 2&t#cal6 !c# /u$t /u/c-t#1#l /3 4$/t&9 &, 4$-lu/ ?4$/t&a93 ca -a%# alt t#-u ! '#%c3 2&t#cal ca !#ca&a ! - /cau$@ /au 4$

    '#$u/ ?,'#t '#%c3 ! a'-l#tu!#$ '#c3@. Ut#l#9a&a -,!,'t&l,& a 0,/t -&,',2at3-$t&u a c,'1at /!$ta/'ul 4$ -,-ula(#a $&al36 +* *** ! -a%# - 9# 0#$! , 2al,a&&-&9$tat#23 -$t&u u$ /t#l ! 2#a(3 /3$3t,/. P,-ulatata ac/t,& #$/t&u'$t /!at,&a93 u%u$(# -u&t3# l,& %# a c#t## !atl,&6 4$/3 -ac#$(## t&1u# /38%# $,t9&9ultatl 9#l$#c 4$ ca9ul 4$/t&3# - 'a# 'ult 9#l. $ -lu/6 /u$t ,0t !,a& !at&0t,a& la $u'3&ul ! -a%# %# !#/ta$(a /t#'at36 $0##$! luat 4$ calcul t#'-ul al,cat!#2&/l,& act#2#t3(#6 #$t$/#tata 0,&tulu# %# ,1#c#ul 9#l$#c -&/,$al. C,'-a&a(#a4$t& -,!,'t&u %# u$ accl&,'t&u u$#a=#al &l23 !#0&$( /'$#0#cat#2 4$t& $u'3&ul! -a%# 4$/t&a(# cu cl !,u3 !#/-,9#t#26 -,!,'t&ul 0##$! 'a# -u(#$ /$/#1#l la

    '#%c3.Accl&,'t&l /u$t #$/t&u'$t 'a# a2a$/at ca& -&'#t cua$t#0#ca&a ca$t#t3(##%# a #$t$/#t3(## act#2#t3(## ',t,#. El -,t 4$/t&a c,$t#$uu !at - , -,a!3 lu$3 !t#'- 03&3 #$t&0&$(3 cu ,1#c#ul /u1#ctulu#. Accl&,'t&l -,t 0# u$#a=#al /au'ult#a=#al. Cl u$#a=#al !tcta93 accl&a(#a 4$t&8, /#$u&3 !#'$/#u$6 -ut#ulu# ?c#cl#/'@. I$0,&'a(#a /t c,'-a&a1#l3 cu ca,0t3 ! -,!,'t&6 !a& / !tcta93 '#%c3 'a# 0#$ %# / &!3 -att&$ul ',t,& 4$t#'-. I$/t&u'$tl 'ult#a=#al !tcta93 '#%c3 4$ 'a# 'ult -la$u u$l 0##$!ca-a1#l /3 &!a , 2atat ! -,9#(## c,&-,&al %# /t&,t#-u ',t,#6 0##$! !$u'#t %#',$#t,a& ! act#2#tat. D9a2a$tal c,$/tau 4$ -&(ul !#cat6 $c/a&ul =-&t#9#

    t>$#c %# al u$u# -&,&a' ! c#t#& a !atl,&6 4$/t&a&a ! a&t0act ! 2#1&a(#. T,at!tct,a&l ! '#%ca& ,'#t act#2#t3(#l t&$ulu# /u-,&B #$0,& $#'-l#cat 4$'3/u&3t,a&.

    IV.F. E-aluar(a riului

    D#a&a'a ! /t#'a& a /culu# SCORE /t c,$c-ut4$ /c,-ul 0ac#l#t3#2alu3# /culu# u$,& -&/,a$ a-a&$t /3$3t,a/. Pac#$(## ca& au a2ut u$ 2$#'$tcl#$#c6 ! t#-ul u$u# /#$!&,' c,&,$aa$ acut /au AVC6 ca& au !#a1t 9a>a&at t#- ) /au +cu '#c&,al1u'#$u /au $#2l 0,a&t c&/cut al u$u# /#$u& 0act,& ! /c6 au u$

    /c 0,a&t 4$alt %# / cal#0#c3 aut,'at -$t&u 2alua&a %# 'a$a'$tul #$t$/#2 al0act,l,& ! /c.?F#u&a @S#/t'ul SCORE /t#'a93 /cul la +* a$# ! a-a(# a u$u# -' 2$#'$t

    at&,/cl&,t#c 0atal6 #$!#0&$t !ac3 /t 2,&1a ! u$ #$0a&ct '#,ca&!#c6 acc#!$t 2a/cula&c&1&al6 a$2/' ! a,&t3 /au altl. Su$t #$clu/ t,at c,!ul !#$ Cla/#0#ca&aI$t&$a(#,$al3 a ;,l#l,& ?I$t&$at#,$al Cla//#0#cat#,$ ,0 D#/a//6 ICD@ ca& -,t 0# 4$ ',!&9,$a1#l -&/u-u/ a a2a , cau93 at&,/cl&,t#c3. "a,tata cl,&lalt /#/t'a-&c#a93 $u'a# /cul ! 1,alc,&,$aa$.

    26

  • 8/13/2019 LICENTA Sindrom Metabolic

    27/107

    $i"ura %. D#a&a'a SCORE5 /cul ! ;CV 0atal la +* a$#6 -$t&u -,-ula(##l cu/c 4$alt ! ;CV6 4$ 0u$c(# ! u&'3t,# 0act, ! /c5 2

  • 8/13/2019 LICENTA Sindrom Metabolic

    28/107

    A2a$tal ut#l#93# !#a&a'# ! /t#'a& a /culu# SCORE /u$t 'ult#-l. E/tu$ #$/t&u'$t #$tu#t#26 u%,& ! ut#l#9at. Ia 4$ c,$/#!&a& $atu&a 'ult#0act,al3 a 1,l#l,&ca&!#,82a/cula&. E/t#'a93 /cul -$t&u t,at 1,l#l ca&!#,82a/cula&at&,/cl&,t#c6 $u $u'a# -$t&u ;C. P&'#t u$ 'a$a'$t 0l=#1#l !ac3 $u -,at 0#

    at#$/ $#2lul #!al al u$u# 0act,& ! /c6 /cul t,tal -,at 0# t,tu%# &!u/ -$ &!uc&aalt,& 0act, ! /c. P&'#t , 2alua& 'a# ,1#ct#23 a /culu# 4$ t#'-. Sta1#l%t u$l#'1a c,'u$ !#$ -u$ct ! 2!& al /culu# -$t&u cl#$#c#$#. A&at3 ',!ul ! c&%t& a/culu# cu 2

  • 8/13/2019 LICENTA Sindrom Metabolic

    29/107

    -$ 0act, ! /c 'ult#-l# ca& au ca &9ultat c&%t&a /culu# t,tal ! 1,l# ca&!#,82a/cula& ?/c ! !c/ -$ 1,al3 ca&!#,82a/cula&3 Y la +* a$#@6 !#a1t 9a>a&at ! t#-) %# ! t#- + cu '#c&,al1u'#$u %# c&%t& 'a&cat3 a u$u# /#$u& 0act,& ! /c6 'a# al/!ac3 / a/,c#a93 cu a0cta&a ,&a$l,&8(#$t3 &u! ! &a!ul I al -ac#$(#l,& cu 1,l#ca&!#,82a/cula& at&,/cl&,t#c -&c,c /au cu /c !,/1#t ! 4$alt.

    O1#ct#2l -&2$(## 1,l#l,& ca&!#,82a/cula& /u$t ! a auta -&/,a$l cu /c/c39ut ! 1,al3 ca&!#,82a/cula&3 /3 4%# '$(#$3 ac/t /tatu/ - t,t -a&cu&/ul 2#(##6 %# ! al auta - cl cu /c t,tal c&/cut ! ;CV /3 4l &!uc3.Pac#$(## t&1u# /3 at#$3 ca&act/t#c#l -&/,a$l,& ca& t#$! /3 &3'#2al$t ! 1,l# ca&!#,82a/cula& t,tal ?0atal ] $,$80atal@ /t cu a-&,a- +* 'a# 'a& la -ac#$(## 'a# t#$

    ! /= 'a/cul#$6 %# 'a# &!u/ la 0'# %# la -&/,a$l 4$ 2

  • 8/13/2019 LICENTA Sindrom Metabolic

    30/107

    8 .Mo!i-a1ia i o,i(#!i-ul &!u+iului

    D#$t& tul1u&3l ! 2$t#la(# $,ctu&$36 /#$!&,'ul ! a-$8>#-,-$ ,1/t&uct#234$ /,'$ ?SAHOS@ / a/,c#a93 cl 'a# /ta& c&%t& -,$!&al3 /u1 CPAP. ?):78):@

    Sc,-ul /tu!#ulu# ! 0a(3 /u$t5 S3 calcul9 -&2al$(a /#$!&,'ulu# 'ta1,l#c %# a c,'-,$$tl,& /al la u$ &u-

    'a& -ac#$(# cu SAHOS a!&/a(# u$u# /#$u& la1,&at,& ! S,'$,l,#6c,'-a&at#2 cu -ac#$(## a!&/a(# La1,&at,a&l,& ! S,'$,l,# la ca& SAHOS/t a1/$t.

    S3 /tu!#9 c,&la(#a !#$t& c,'-,$$tl /#$!&,'ulu# 'ta1,l#c %# a$u'#tca&act/t#c# cl#$#c al -ac#$(#l,& cu SAHOS

    S3 a$al#99 0ctul t&ata'$tulu# SAHOS a/u-&a c,'-,$$tl,& /#$!&,'ulu#'ta1,l#c %# a/u-&a u$,& c,$!#(## a/,c#at ?/!$ta/'@

    8 4.Ma!(rial2 m(!o+(

    4.a. Tiul &!u+iului0-&,/-ct#26 - !u&ata a !,# a$# %# lu$#6 ,1/&2a(#,$al. E2alua&a

    -a&a'tl,& cl#$#c#6 'ta1,l#c# %# -,l#&a0#c#B-,l#/,'$,&a0#c# /8a 0ctuat la ','$tul!#a$,/t#culu#6 la 7 lu$#6 lu$# %# + a$.

    4.,.Pa#i(n1i0

    D#$ c# ! -ac#$(# a!&/a(# la1,&at,&ulu# ! S,'$,l,# al S-#talulu# CFRGala(# 4$ a$## )** )*+* ca& au 1$0#c#at ! -,l#&a0# ca&!#,8&/-#&at, 4$ /,'$6 a'#$clu/ 4$ /tu!#u u$ $u'3& ! 66= +( a#i(n1i6 la ca& /8au 4$!-l#$#t u&'3t,a&l c,$!#(##5

    3!

  • 8/13/2019 LICENTA Sindrom Metabolic

    31/107

  • 8/13/2019 LICENTA Sindrom Metabolic

    32/107

    8 7+ -ac#$(# au 0,/t =-l,&a(# -$ -,l#&a0# ca&!#,8&/-#&at, )* -$ -,l#/,'$,&a0# c,'-lt3 /u-&a2>at3.

    Poli"ra*ia #ar+io'r(&ira!orir( /8a 0ctuat cu aut,&ul u$u# a-a&at -,&ta1#l3SOMNO#>(#K E**or!2 4=2 (inmann2 :(rmania8 #u urm!oar(l( #anal( 3$i". 80

    8 &(n9or +( *lu@ r(&ira!or oro'na9al 3!(rmi&!or82 #u &(n9or +(

    -i,ra1ii in#lu&8 #(n!ur !ora#i# i a,+ominal #u #ri&!al i(9o(l(#!ri# (n!ru+(!(#!ar(a (*or!ului r(&ira!or !ora#o'a,+ominal

    8 &(n9or +( o9i1i( 3#a&ul #u m(r#ur88 ul&o@im(!ru

    $i". .P,9#(#a t&a$/!uct,l,& la -,l#&a0ul ca&!#,8&/-#&at,& SO"NOc>c E00,&t-ac#$t# # / =-l#c3 $c/#tata 4$!-3&t3# laculu# ! u$>## 4$a#$t ! 4$c-&a4$/t&3#6 -$t&u 1u$a 0u$c(#,$a& a -ul/,=#'t&ulu# ?0,t,&a0# cu ac,&!ul-ac#$t#@

    Pac#$(## au 0,/t =-l,&a(# -$ -,l#&a0# 4$ cu&/ul #$t&$3# ?+* ! -ac#$(#@ /au4$ /#/t' a'1ulat,u ?)7* -ac#$(#@. P$t&u -ac#$(## =-l,&a(# 4$ a'1ulat,u6 /8a/tat !ata -,&$## %# ,-# aut,'at a 4$/t&3#6 #a& -ac#$(## au 0,/t #$/t&u#(#a/u-&a ',$t3# /$9,l,& la culca&6 &9ultatl 0##$! #$t&-&tat a !,ua 9# ?F#.)5-ac#$ta a 0,/t #$/t&u#t3 /3 4$!-3&t9 lacul ! u$>##6 ca& #$t&0&3 cu ca-ta&a

    32

  • 8/13/2019 LICENTA Sindrom Metabolic

    33/107

    t&a$/cuta$3 c,&ct3 a SaO)@. U$ul !#$ -,l#&a0 a 0,/t #$/talat la S-#talul CFR Gala(#4$ !c'1 )**6 al !,#la 4$ #a$ua )*+*.

    $i". 4A/-ctul &a0#c al 4$/t&3# cu -,l#&a0ul SO"NOc>c E00,&tPa#$a &-&9#$t3 , -,c3 ! '#$ut 4$ ca& /u$t &!at ! /u/ 4$ ,/5 cu&1a

    0lu=ulu# &/-#&at,&6 '#%c3l t,&ac#c6 a1!,'#$al6 /0,&3#tul6 ,=#'ta6 0&c2$(aca&!#ac3 -c36 -,9#(#a 4$ /,'$

    ^/ &'a&c3 !,u3 &, a1/$(a /'$alulu# la t&a$/!uct,&ul a1!,'#$al ?c$tu&3!-la/at3@ %# l#-/a 2al#!3# aut,'at a a-$#l,& ,1/t&uct#2 ! c3t& /,0tul a-a&atulu#?&,a& t'-,&a&3 a -&,&a'ulu#@

    Poli&omno"ra*ia #oml(! -i+(o'&ura-(">(a! a 0,/t #$!#cat3 4$ u&'3t,a&l&ca9u

    8 la -ac#$(## cu /#'-t,' /u/t#2 ?/,'$,l$(36 tul1u&3 &/-#&at,#4$ /,'$ @ la ca& -,l#&a0#a ca&!#,8&/-#&at, a 4$/t&at /u1 2$#'$t - ,&3

    8 la -ac#$(## cu tul1u&3 $u&,l,#c ?'#%c3 #$2,lu$ta&6 /$9a(##-at,l,#c a/,c#at /,'$ulu#@

    8 la -ac#$(## cu tul1u&3 2$t#lat,# &a2 ?SaO) /u1 M* !#u&$6 SaO)'#$#'3 $,ctu&$3 /u1 *6 t#'-ul cu SaO) /u1 -/t u'3tat!#$ $,a-t@ ca& $c/#tau /u-&a2>& $,ctu&$3 4$ t#'- &al -$t&ut#t&a&a t&ata'$tulu#

    Poli&omno"ra*ia #oml(! -i+(o'&ura-(">(a! /8a 0ctuat cu aut,&ul

    /#/t'ului SomnoLa, (nmann -(r&ion 4.2 4=2 :(rmania2 #ar( #urin+(08 /$9,& ! 0lu= &/-#&at,& ,&,8$a9al ?t&'#/t,&@6 cu /$9,& ! 2#1&a(##

    #$clu/8 c$tu&3 t,&ac#c3 %# a1!,'#$al3 cu c/tal -#9,lctc -$t&u

    !tcta&a 0,&tulu# &/-#&at,& t,&ac,8a1!,'#$al8 /$9,& ! -,9#(# ?ca-/ul3 cu '&cu&@8 -ul/,=#'t&u8 ) ca$al -$t&u lct&,$c0al,&a'3 ?EEG@

    33

  • 8/13/2019 LICENTA Sindrom Metabolic

    34/107

    8 + ca$al lct&,ca&!#,&a'3?ECG@8 + ca$al lct&,,cul,&a'3 ?EOG@8 + ca$al lct&,'#,&a'3 ?E"G@ '$t,$#&36 + ca$al E"G t#1#al38 + ca$al ! c,'u$#ca& cu /#/t'ul ! 2$t#la(# $,$#$2a9#238 "#c&,0,$

    8 S$9,& ! #$0&a&,%##8 Ca'&3 2#!,

    P,l#/,'$,&a0#a /8a 0ctuat cu #$t&$a&6 -ac#$tul 0##$! /u-&a2>at !#$ ca'&a !c,'a$!3 ! a/#/t$t. P,l#/,'$,&a0ul a 0,/t #/talat 4$ ca'&3 #9,lat3 la /-#talul CFR 4$#a$ua )**M. T&a/ul a 0,/t 2al#!at 'a$ual %# #$t&-&tat ult,& c,$0,&' /ta$!a&!l,$t&$a(#,$al 4$ 2#,a& ?F#. 7@.

    $i". 6. A/-ct &a0#c al 4$/t&3# -,l#/,'$,&a0#cO -,c3 $u&,l,#c3 ?7* /c@ c,$(#$ cl !,u3 ca$al EEG6 ca$alul EOG6ca$all E"G6 ca$alul ECG %# ,-(#,$al -lt#/',&a'a

    O -,c3 &/-#&at, ?) '#$ut@ c,$(#$5 0lu=ul &/-#&at,&6 0,&tul t,&ac#c %#a1!,'#$al6 /atu&a(#a ,=#$ulu#6 /0,&3#tul6 0&c2$(a ca&!#ac36 -,9#(#a c,&-ulu#

    4.(.E@lorar(a m(!a,oli#0

    8 M(!a,oli&mul "lu#i+i#0 Pac#$(## au 1$0#c#at ! 2alua&a l#c'## W u$6

    #a& c# cu 2al, -/t +** 'B!l au 1$0#c#at %# ! t/ta&a t,l&a$(# la luc,93 ,&al3 ?4$ a0a&3 ! -&/,a$l -/t * a$# %# %# !#a1t#c## cu$,/cu(#6 laca& /8a &c,ltat l#c'#a la )> -,/t-&a$!#al@. Ct#l ! !#a$,/t#c -$t&utul1u&3l ! l#c,&la& /u$t cu-$/ 4$ ta1lul II.

    8 La -ac#$(## cu tul1u&3 ! l#c,&la&6 /8a #$!#cat '3/u&a&a >',l,1#$#l#c,9#lat H1A+C

    8 La -ac#$(## cu$,/cu(# cu !#a1t 9a>a&at6 la ca& H1A+C a a2ut 2al,-at,l,#c ?-/t . 6 /8a 0ctuat u&'3&a -&,0#lulu# l#c'#c - ): >6

    34

    A-$,1/t&uct#23

    D/atu&a&

    "#c&,t&9#&

  • 8/13/2019 LICENTA Sindrom Metabolic

    35/107

    a-&,=#'at#2 2al, W u$ %# 7 -,/t-&a$!#al6 la ,&l5 6 6 +)6 +:6 +6 )*6 ):67@.

    8 La u$ $u'3& '#c ! -ac#$(# /8a ',$#t,at t#'- ! ) > l#c'#a cu aut,&ul/#/t'ulu# Gluc,Da8S ?A. "$a$# D#a$,/t#c/6 Fl,&$c6 Ital)cu /c,-ul! a u&'3 2,lu(#a cu&1# l#c'#c /u1 t&ata'$tul -$t&u SAHOS. Datl

    $u /u$t #$clu/ 4$ -&luc&a&a /tat#/t#c3 0#$al36 &u-ul ! -ac#$(# 0#$! &/t&Sau ori#( -aloar(-/t )**'B!l

    8 M(!a,oli&mul lii+i#0 -ac#$(## au 1$0#c#at ! '3/u&a&a c,l/t&,lulu#t,tal6 a tl#c!l,& /c %# a 0&ac(#u$## HDL. F&ac(#u$a LDL /8a calculat-$ 0,&'ula F!al! ?c,l/t&,l t,tal HDL TGB@ la -ac#$(## cutl#c! /u1 :** 'B!l /au a 0,/t '3/u&at3 !#&ct 4$ ca9 c,$t&a&.

    Ta,(l III. Val,l $,&'al al 0&ac(#u$#l,& l#-#!#c /c ?NCEP ATP III@ ?)+7@

    35

  • 8/13/2019 LICENTA Sindrom Metabolic

    36/107

    $ra#1iun( lii+i# S(mni*i#a1i(Col(&!(rol !o!al = ' 4 N,&'al446G G&a$#(3

    45 C&/cutLDL'#ol(&!(rolJ O-t#'al4G N,&'al84$alt6=G G&a$#(3F7G C&/cut G F,a&t c&/cut

    )DL'#ol(&!(rolJ 5 Sc39ut

    J 6 F,a&t /c39utTri"li#(ri+(J = O-t#'al=GG N,&'al84$alt45GG C&/cut = F,a&t c&/cut

    E2alua&a 'ta1,l#c3 ?l#c'# %# -&,0#l l#-#!#c@ /8a 0ctuat la 2#9#ta #$#(#al36 la 7lu$#6 la lu$# %# la + a$.

    E2alua&a c,'-lt3 a 0,/t -,/#1#l3 la 7 lu$# la 7)+ -ac#$(#6 la lu$# la )M-ac#$(# %# la + a$ la ): -ac#$(#.

    4.*. M&ur!ori an!room(!ri#(0

    Pac#$(## au 1$0#c#at ! '3/u&a&a -'t&ulu#

  • 8/13/2019 LICENTA Sindrom Metabolic

    37/107

    In+i#( ValoriP(rim(!rul "!ului 3#m8 F'#5 -at,l,#c -/t :+ c'

    ;3&1a(# 5 -at,l,#c -/t :7 c'P(rim(!rul a,+ominal 3#m8 F'#5 -at,l,#c -/t M: c'

    ;3&1a(# 5 -at,l,#c -/t c'

    In+i#(l( +( ma& #ororal 3K";m4

    8. N,&'al5 +. ):.M B')

    Su-&a-,$!&al5 ): 8)M.M B')

    O19#tat &. I5 7* 7:.M B')

    O19#tat &. II5 7 8 :* B')

    O19#tat &. III5 -/t :* B')

    O19#tat ',&1#!35 -/t : B')

    4.". M&urar(a !(n&iunii ar!(rial(

    "3/u&a&a t$/#u$## a&tal /8a &al#9at 4$ ','$tul -'# c,$/ulta(##6 4$','$tul ',$t3# a-a&atulu# ! /tu!#u al /,'$ulu# %# la 2#9#ta -$t&u #$t&-&ta&a

    !atl,& ! -,l#&a0#B-,l#/,'$,&a0# ?4$ !cu1#t %# %9#-&t$/#u$ !>alat al16 c,$t&,lul t$/#u$## a&tal /u1 '!#ca(#. D#$ c# 77 ! -ac#$(#6',$#t,a&a A;P" /8a 0ctuat la :.

    4.>. E-aluar(a &omnol(n1(i /8a &al#9at cu aut,&ul /cal# ! ): ! -u$ct E-,&t>6 u$-u$cta -$t&u /,'$,l$(3 'a# 'a& ! 0##$! c,$/#!&at la l#'#ta cu $,&'alul6 #a& +*-at,l,#c ?a$=a +@.

    4.i In+i#a1ia +( CPAP i urmrir(a a#i(n1ilor &u, CPAP0

    Pa#i(n1ii &im!oma!i#i ?/,'$,l$(36 /0,&3#t6 -au9 &/-#&at,# acu9at/au at/tat8 #u un in+i#( +( an(('>ion(( 3IA)8 (&!( = ( ora +( &omn au,(n(*i#ia! +( in+i#a1i( +( CPAP. I$!#ca(#a ! CPAP /8a 1a9at - IAH6 -&9$(a

    /#'-t,'at,l,## %# a1/$(a c,$t&a#$!#ca(##l,& l,cal /au $&al.P&/c&a -&/#u$## 0#cac /8a 0ctuat -$58 t#t&a& aut,'at35 ) $,-(# ! t#t&a& cu u$ a-a&at ! -&/#u$ -,9#t#23

    aut,&lat3 ?S,'$,S'a&t) #$'a$$ G&'a$#a -&/#u$ : +) ';a&@ /u1c,$t&,l -,l#&a0#c./au

    8 t#t&a& 'a$ual3 /u-&a2>at3 -,l#/,'$,&a0#c ?+ $,a-t@.

    37

  • 8/13/2019 LICENTA Sindrom Metabolic

    38/107

    P&/#u$a 0#c#$t3 a 0,/t c,$/#!&at3 ca 'a# '#c3 -&/#u$ ca& &!uc %#'$(#$ 2$#'$tl ,1/t&uct#2 /u1 +* - ,&3.

    T,(# -ac#$(## au -'#t #$!#ca(## /#'#la& cu -#& la 0,l,/#&a %# 4$t&(#$&aa-a&atulu# %# '3%t## ! CPAP.

    C,/tul 2$t#la(## $,$#$2a9#2 la !,'#c#l#u a 0,/t #$t&al /u-,&tat ! -ac#$t6 cuct :+6 Puta$8;$$tt

    C,'-l#a$(a la CPAP a 0,/t !0#$#t3 ca 0,l,/#&a t&a-## -$t&u 'a# 'ult ! : ,&- $,a-t6 -/t * !#$ $,-(#@. Datl ! c,'-l#a$(3 au 0,/t =t&a/ !#$ /,0tul a-a&atl,&! CPAP.

    U&'3&a -ac#$(#l,& /8a 0ctuat -$ c,$t&,l '!#cal la 6 luni2 la F luni i la unan%# -$ /u-,&t t>$#c la !,'#c#l#u !#$ -a&ta 0#&'# -&/tat,a&.

    C,$t&,lul '!#cal -,!#c a u&'3t /tatu/ul -,$!&al6 /#-'-t,'at,l,#a ?4$/-c#al /,'$,l$(a@6 0ctl a!2&/ la CPAP6 c,$t&,lul -,l#&a0#c al 0#c#$(# CPAP6#a& !ac3 au =#/tat 2aa(## -,$!&al #'-,&ta$t ?-/t +* @6 /8a 0ctuat !#$ $,u4$/t&a&a ! !#a$,/t#c. $ -lu/6 la c,$t&,lul '!#cal -,!#c /8au 0ctuat =-l,&3l'ta1,l#c %# /8a '3/u&at t$/#u$a a&tal3.

    4.. Tra!am(n!ul #on+i1iilor a&o#ia!(0 Pac#$(## c,'-l#a$(# %# c# $,$c,'-l#a$(# laCPAP au -'#t t&ata'$t 0a&'ac,l,#c %# #$t&2$(## !uca(#,$al /#'#la& -$t&u

    c,$!#(##l a/,c#at ?>#-&t$/#u$6 !#a1t6 !#/l#-#!'# [email protected]. A#!i-i!a!(a *i9i# 9ilni# a 0,/t 2aluat3 cu aut,&ul u$u# -!,'t&u ! c$tu&3?Ka/-&8 R#c>t&6 G&'a$#a@ ca& a 0,/t -u&tat t#'- ! , /3-t3'

  • 8/13/2019 LICENTA Sindrom Metabolic

    39/107

    8 rin#iiul r(&(#!rii (r&oan(i0S8a 0ctuat , #$0,&'a& /-c#0#c3 a-ac#$(#l,& cu -#& la a0c(#u$#l ! ca& /u0&3 %# la 1$0#c##l =-l,&3l,&%# t&ata'$tl,& -&,-u/. Au 0,/t ut#l#9at !,a& !,cu'$tl '!#cal c-&9$tau , 0#%3 ! c,$/#'(3'#t3(##.

    Pa#i(n1ii in#lui /n &!u+iu au a##(!a! rin &(mnar(a#on&im1mn!ului in*orma! ar!i#iar(a la &!u+iu2 iar #omi&ia +( (!i# aSi!alului C$R :ala1i a aro,a! /n +(#(m,ri( 4% /n#((r(a &!u+iului.

    4.m. Pr(lu#rar(a &!a!i&!i# a +a!(lor

    Datl -&,2$#t !#$ a$a'$936 =a'$ul 0#9#c %# !,cu'$tl '!#cal al-ac#$(#l,& au /tat la 1a9a c,$/t#tu## u$# 1a9 ! !at a c3 /t&uctu&3 a 0,/t -&9$tat34$ ca!&ul /c(#u$## "atal %# 't,!3.

    A$al#9a /tat#/t#c3 a 0,/t 0ctuat3 ut#l#9# -3t&at ?_ )@.

    C,&la(##l 4$t& /tu ! !at /8a 0ctuat cu aut,&ul c,0#c#$tulu# ! c,&la(#Pa&/,$ &.

    $ ca9ul 4$ ca& /8a -u/ -&,1l'a &a-,&t3# u$# !#0&$( 4$t& &u-u /8a&a-,&tat 2al,a&a ac/t# !#0&$( ?-$t&u 2aa1#l ! t#- c,$t#$uu@ cu #$t&2alul !4$c&!& M %# -&aul ! /'$#0#ca(# at#$/6 -&cu' %# t/tul /tat#/t#c ut#l#9at ?NS -&/cu&ta& -$t&u $/'$#0#cat#2@.

    8 6.R(9ul!a!(0

    3

  • 8/13/2019 LICENTA Sindrom Metabolic

    40/107

    A' #$clu/ 4$ /tu!#u u$ $u'3& ! 66= +( a#i(n1i a!&/a(# La1,&at,&ulu# !S,'$,l,# al S-#talulu# CFR Gala(#6 la ca& a' u&'3t 4$ -,a!a !c'1 )** 'a# )*+* -a&a't# !/c%# la "atal %# 't,!.

    6.a.Poula1ia &!u+ia!

    V

  • 8/13/2019 LICENTA Sindrom Metabolic

    41/107

    30,00 40,00 50,00 60,00 70,00

    VARSTA

    0

    5

    10

    15

    IAH

    D#$ c# )7 ! -ac#$(# cu SAHOS 5 :* 0,/t !#a$,/t#ca(# cu SAHOS u/,& ?IAH M.+ Q 6.F;>8 5 *(m(i 2 6F ,r,a1i

    : cu SAHOS '!#u6 ?IAH )+. Q 5.=;>,8 7 *(m(i2 5 ,r,a1i

    +: cu SAHOS /2&6 IAH ?.: Q %.;>82 *(m(i2 2 6% ,r,a1i

    S ,1/&23roor1ia r(mar#a,il a a#i(n1ilor #u SA)OS &(-(r 3F682 ca cc,&/-u$! cu !atl c,''u$#cat 4$ l#t&atu&3 ?M@. F#u&a &!3 &-a&t#(#a - cat,#! &a2#tat a -ac#$(#,& cu SAHOS.

    T/tul _ )5 _ ) ?:*8@B ] ?:8@B ] ?+:8@B *66 2al,a& 'a# '#c3 !c& -$t&u ) &a! ! l#1&tat6 !c# $u -ut' &/-#$#-,t9a $ul36 a%a!a& !#/tu(#a ca9ul,& cu a-$ u%,a&36 '!# %# /2&3 $u /t/'$#0#cat#23.

    41

  • 8/13/2019 LICENTA Sindrom Metabolic

    42/107

    $i". F.R-a&t#(#a - cat,# ! &a2#tat a -ac#$(#,& cu SAHOS

    SAHOS USOR

    17%

    SAHOS MEDIU

    20%SAHOS SEVER

    63%

    PACIENTI CU SAHOS

    I$!#cl ! a-$8 >#-,-$ a a2ut , !#/tu(# u%,& a/#'tc36 a%a cu' /!#$ 0#u&a 6 #$!#cl ! a/#'t ?/$//@ 0##$! ! *67*. A%a!a&64'-3&(#&a cla/#c3 4$SAHOS u%,&6 '!#u %# /2& 4$ 0u$c(# ! IAH ?2al,l ! &0$(3 0##$! 6 + %#&/-ct#2 7*B>@ $u /t -,t#t3 -$t&u a /-a&a -ac#$(## !#$ ac/t &u- - /u1&u- !&a2#tat a SAHOS6 4$ 2!&a c,'-a&3# ult,a& -a&a'tl,& cl#$#c# %# 'ta1,l#c#.'-3&(#&a / 2a 0ac !c# - cua&t#l ?2al, al u$u# -a&a't&u ca& 4'-a&t &u-ul 4$ :/u1&u- ! 0&c2$( al@.

    $i". %.H#/t,&a'a c &-&9#$t3 !#/tu(#a 0&c2$(l,& -a&a't&ulu# IAH 4$ &u-ul cu

    SAHOS

    IAH

    95,0

    90,0

    85,0

    80,0

    75,0

    70,0

    65,0

    60,0

    55,0

    50,0

    45,0

    40,0

    35,0

    30,0

    25,0

    20,0

    15,0

    10,0

    5,0

    20

    10

    0

    Std. Dev = 23,86

    Mean = 40,6

    N = 235,00

    42

  • 8/13/2019 LICENTA Sindrom Metabolic

    43/107

  • 8/13/2019 LICENTA Sindrom Metabolic

    44/107

    +)M au #$#(#at t&a-#a

    o 7 a1a$!,$ 4$t& ) lu$# %# + a$

    o : ut#l#9at, #$a!c2a(#

    o G #omlian1i

    $i".G. R-a&t#(#a - cat,# ! c,'-l#a$(3 a -ac#$(#l,& cu SAHOS

    FARA TITRARE

    19%

    TITRATI

    FARA

    CMPLIANTA

    ABANDON

    15%

    UTILIZATORI

    INADECVATI

    2%

    COMPLIANTI

    38%

    UTILIZATORI

    40%

    PACIENTI CU SAHOS

    R-a&t#(#a /8a 03cut - ) 'a cat,#6 -$t&u u%u$(a a$al#93# !atl,&5+: -ac#$(# c,'-l#a$(# %# M* -ac#$(# $c,'-l#a$(# la CPAP. Ca&act/t#c#lac/t,& !,u3 &u- ! -ac#$(# / &3//c 4$ ta1lul V.

    T/tul _ )5 _ ) ?+:8++@B++ ] ?M*8++@B++ *6*6 2al,a& 'a# '#c3 !c& -$t&u + &a! ! l#1&tat6 !c# $u -ut' &/-#$ #-,t9a $ul36a%a!a& !#/tu(#a ca9ul,& cu %# 03&3 c,'-l#a$(3 $u /t /'$#0#cat#23.

    Ta,(l V.Ca&act/t#c#l cl#$#c al -ac#$(#l,& c,'-l#a$(# %# $c,'-l#a$(# laCPAP

    Comlian1i N(#omlian1i

    Nr. M* +:IA) 3;>8 :M. ):.) 7:.M )+.$(m(i + ?+@ ?:.@Br,a1i ?:@ +7 ?M.)@Vr&! 3ani8 :.M . ).+ .+IMC 3K";m48 7:.7 :.M 7).7 ).+Somnol(n1 3;458 +M.+ 7. +:.7 .+A#!i-i!a!( *i9i# ):6 `+:.: 7) `+7+.

    44

  • 8/13/2019 LICENTA Sindrom Metabolic

    45/107

  • 8/13/2019 LICENTA Sindrom Metabolic

    46/107

    $i". . IAH 4$ &u-ul -ac#$(#l,& c,'-l#a$(# %# cl al -ac#$(#l,& $c,'-l#a$(#

    14590N =

    iah ne!"#$iantiiah !"#$ianti

    100

    80

    60

    40

    20

    0

    -20

    $i". . S,'$,l$(a 4$ &u-ul ! -ac#$(# c,'-l#a$(# %# 4$ cl ! -ac#$(# $c,'-l#a$(#

    90145N =

    %!"n!$enta !"#$iant%!"n!$enta ne!"#$ia

    30

    20

    10

    0

    24

    P$t&u c,'-a&a(#a 4$t& c#lal(# -a&a't /8a &cu&/ 4$ c,$t#$ua& la t/tul t Stu!$t.Pac#$(## c,'-l#a$(# la CPAP au 0,/t 5

    'a# #$act#2# 0#9#c ?- *.***7@

    46

  • 8/13/2019 LICENTA Sindrom Metabolic

    47/107

    'a# 2 .) ` :.+ P't&ul '!#u al

  • 8/13/2019 LICENTA Sindrom Metabolic

    48/107

    D%# $u 4$t&u$/c ct#l ! SAHOS6 ac%t# -ac#$(# $u -,t 0#c,$/#!&a(# /3$3t,%#6 !,a&c # au 0,/t a!&/a(# la1,&at,&ulu# ! /,'$,l,# -$t&uacu9 /-c#0#c ?/0,&3#t6 !#/-$ $,ctu&$36 /,'$,l$(36 '#%c3 a$,&'al 4$ /,'$ tc@.

    6.,.Comara1ia /n!r( aram(!rii #lini#i i ara#lini#i ai a#i(n1ilor #u i *r

    SA)OSPac#$(## cu SAHOS au 0,/t 'a# 2

  • 8/13/2019 LICENTA Sindrom Metabolic

    49/107

    TG SAHOS +7 M*6** **6** +M)6* +677TG &u- 03&3 SAHOS +** ++*6** ::*6** +)6M *67Gl. SAHOS )+7 6** :**6** ++6) ::6MGl. &u- 03&3 SAHOS +** M6** 7**6** ++*6M 7)6MIAH )7 6** M76** :*6M )76

    P. a1!. -'t&ul a1!,'#$al ?c'@6 TAS t$/#u$a a&tal3 /#/t,l#c36 TAD t$/#u$a a&tal3 !#a/t,l#c36 TG tlc!6 Gl l#c'#6 IAH #$!= a-$ >#-,-$

    $i". 6. V

  • 8/13/2019 LICENTA Sindrom Metabolic

    50/107

    R(9ul!a! &(mni*i#a!i- la ANOVA.T(&!ul ! S!u+(n! 0 ? .6 3&(mni*i#a!i-8.

    Pac#$(## cu SAHOS au a2ut 2 la -ac#$(## cu %# 03&3 SAHOS

    Ta,(l . T/tul ANOVA -$t&u c,'-a&a(#a /,'$,l$(# la -ac#$(## cu %# 03&3 SAHOS

    Su'a-at&atl,& !0 Pat&at'!#u F S'$#0.

    INTERGRUP :67M + )M6) 76*M7 *6*+INTRAGRUP ++M6+)+ 7 +:6)*TOTAL +:6* MM

    T(&!ul ANOVA0 &(mni*i#a!i-T(&!ul ! S!u+(n! 0 ? 2 3&(mni*i#a!i-8.

    5!

  • 8/13/2019 LICENTA Sindrom Metabolic

    51/107

    Pac#$(## cu SAHOS au 0,/t /'$#0#cat#2 'a# /,'$,l$(# !c

  • 8/13/2019 LICENTA Sindrom Metabolic

    52/107

    Su'a-at&atl,&

    !0 Pat&at '!#u F S'$#0.

    INTERGRUP )M6M:* )+ +)76M +67M* *6+*INTRAGRUP M::6** M6*)

    TOTAL M:)6MM* MMT(&!ul ! S!u+(n! 0 ? 2GG 3n(&(mni*i#a!i- ' NS82 il#o@on 0 ? 7%F.=2 ? 4.=673n(&(mni*i#a!i- ' NS8D%# -'t&ul a1!,'#$al a 0,/t 'a# 'a& la -ac#$(## cu SAHOS6 !#0&$(a $u a 0,/t/'$#0#cat#23 la $#c# u$ul !#$ t/tl 0,l,/#t.

    $i". %.P't&ul

  • 8/13/2019 LICENTA Sindrom Metabolic

    53/107

    TOTAL )+67M* MM

    T(&!ul ! S!u+(n!0 ? =27 3NS8il#o@on0 ? 77FG.=2 ? .% 3NS8

    D%# -'t&ul

  • 8/13/2019 LICENTA Sindrom Metabolic

    54/107

    I$!#cl ! 'a/3 c,&-,&al3 a 0,/t !#0t la -ac#$(## cu SAHOS 0a(3 ! c# 03&3SAHOS ?77 B') 0a(3 ! ) B')@6 !a& t/tl 0,l,/#t $u au 2#!$(#at /'$#0#ca(#/tat#/t#c3.

    $i". G.Act#2#tata 0#9#c3 ?-a%# - 9#@ la -ac#$(## cu %# 03&3 SAHOS

    10098N =

    &ASI (A)A SAH*S&ASI SAH*S

    12000

    10000

    8000

    6000

    4000

    2000

    0

    -2000

    20752

    61

    Ta,(lul IV. T/tul ANOVA -$t&uc,'-a&a(#a #$!#clu# ! 'a/3 c,&-,&al3 la -ac#$(##cu %# 03&3 SAHOS

    I"C SAHOS 0a&a SAHOS Su'a-at&atl,

    &

    !0 Pat&at'!#u

    F S'$#0.

    INTERGRUP +M6+* +7 +76) +67* *6))

    INTRAGRUP M*6* +*6:TOTAL +*6*: MM

    54

  • 8/13/2019 LICENTA Sindrom Metabolic

    55/107

  • 8/13/2019 LICENTA Sindrom Metabolic

    56/107

    C,l/t&,lul t,tal a 0,/t 'a# /c39ut la -ac#$(## cu SAHOS 0a(3 ! c# 03&3 SAHOS?)) 0a(3 ! ):+@. C>#a& %# 03&3 &l2a$(3 /tat#/t#c36 &-&9#$t3 , -a&t#culatat c 2a 0#/tu!#at3 4$ c,$t#$ua& 4$ c,&la(# cu IAH.

    $i". 4.C,l/t&,lul HDL la -ac#$(## cu %# 03&3 SAHOS

    100213N =

    HD/ (A)A SAH*SHD/ SAH*S

    70

    60

    50

    40

    30

    20

    10

    0

    8319728448

    936

    215226

    9

    17

    Ta,(lul VI. T/tul ANOVA -$t&uc,'-a&a(#a c,l/t&,lulu# HDL la -ac#$(## cu %#03&3 SAHOSHDL SAHOS 03&3 SAHOS Su'a

    -at&atl,&!0 Pat&at '!#u F S'$#0.

    INTERGRUP +*6+7 )) 6:+ +6)7* *6)*INTRAGRUP :+)6) 67*TOTAL 67 M

    T(&!ul ! S!u+(n! 0 ? 24 3NS8il#o@on 0 (roar(

    56

  • 8/13/2019 LICENTA Sindrom Metabolic

    57/107

    HDL a 0,/t 'a# /c39ut 4$ 0&u-ul cu SAHOS 0a(3 ! cl 03&3 SAHOS?77 'B!l0a(3 ! :) 'B!l@6 !a& /u-&a-u$&a -a&(#al3 a =t&'l,& !#/tu(## 0ac ca !#0&$(a /3$u 0# /'$#0#cat#23 ?0#. )+5 'u/t3(#l &a0#cl,& / /u-&a-u$@.

    $i". 44.C,l/t&,lul LDL la -ac#$(## cu %# 03&3 SAHOS

    9595N =

    /D/ SAH*S/D/ (A)A SAH*S

    200

    180

    160

    140

    120

    100

    80

    8166628263

    98845010

    97

    1

    Ta,(lul VII. T/tul ANOVA -$t&uc,'-a&a(#a c,l/t&,lulu# LDL la -ac#$(## cu %#03&3 SAHOSLDL SAHOS 03&3 SAHOS

    Su'a-at&atl,& !0 Pat&at '!#u F S'$#0.

    INTERGRUP +7776 ) 7)6** +6)+ *6)+:INTRAGRUP ):76 :+6TOTAL :))M6 M:

    T(&!ul ! S!u+(n! 0 ? G2% 3NS8il#o@on 0 ? 4F42 J? 6.76F('G 3NS8

    57

  • 8/13/2019 LICENTA Sindrom Metabolic

    58/107

    Nu /8a -utut 2#!$(#a /'$#0#ca(# /tat#/t#c3 4$ -#$(a !#0&$(# LDL 4$t&&u-ul cu SAHOS ?+) 'B!l@ %# 03&3 SAHOS ?+) 'B!l@.

    $i". 46.Tl#c!l /c la -ac#$(## cu %# 03&3 SAHOS

    100163N =

    (A)A SAH*S SAH*S

    700

    600

    500

    400

    300

    200

    100

    0

    4450

    4334633777

    72

    74

    57

    31190

    219

    1141117

    17

    1889

    Ta,(lul VIII. T/tul ANOVA -$t&uc,'-a&a(#a tl#c!l,& /c la -ac#$(## cu %#03&3 SAHOSTG SAHOS 03&3 SAHOS Su'a

    -at&atl,&!0 Pat&at '!#u F S'$#0.

    INTERGRUP +)76 77 *MM6* *6:+ *6MINTRAGRUP )776 )M M:)6:TOTAL ::+*6 )

    T(&!ul ! S!u+(n!0 ? 2Tl#c!l /c au 0,/t /'$#0#cat#2 'a# c&/cut la SAHOS 0a(3 ! &u-ul

    03&3 SAHOS ?+M) 0a(3 ! +) 'B!l@.

    58

  • 8/13/2019 LICENTA Sindrom Metabolic

    59/107

    $i". 45.Gl#c'#a W u$ la -ac#$(## cu %# 03&3 SAHOS

    100213N =

    / (A)A SAH*S/ SAH*S

    500

    400

    300

    200

    100

    0

    3219

    35374424

    76

    48

    2211981111901105111922020719315513711581140114

    235

    217

    188

    9

    234

    Ta,(lul I. T/tul ANOVA -$t&uc,'-a&a(#a l#c'## W u$ la -ac#$(## cu %# 03&3SAHOS

    GL SAHOS 03&3 SAHOSSu'a-at&atl,&

    !0 Pat&at '!#u F S'$#0.

    INTERGRUP :767 : +*+76+M *6M* *6M+INTRAGRUP +M*6 : +)76+7TOTAL ++*)76M M

    T(&!ul ! S!u+(n!0 ? 2F 3NS8

    5

  • 8/13/2019 LICENTA Sindrom Metabolic

    60/107

    il#o@on0 ? 5%%4.=2 J? .456 3NS8D%# t/ta&a l#c'## W u$ %# a t,l&a$(# la luc,93 a &l2at u$ -&,c$t 'a#

    'a& ! -ac#$(# cu tul1u&3 ! l#c,&la& 4$ &u-ul cu SAHOS 0a(3 ! cl 03&3SAHOS ?!u-3 cu' 2,# a&3ta 4$ c,$t#$ua&@6 2al,a&a l#c'## W u$ $u a 0,/t/'$#0#cat#2 !#0t3 4$ cl !,u3 &u-u.

    $i". 4=.T$/#u$a a&tal3 /#/t,l#c3 la -ac#$(## cu %# 03&3 SAHOS

    100235N =

    AS (A)A SAH*SAS SAH*S

    240

    220

    200

    180

    160

    140

    120

    100

    80

    Ta,(lul . T/tul ANOVA -$t&uc,'-a&a(#a t$/#u$## a&tal /#/t,l#c la -ac#$(## cu%# 03&3 SAHOSTAS SAHOS 03&3 SAHOS Su'a

    -at&atl,&!0 Pat&at '!#u F S'$#0.

    INTERGRUP :6*+ + :6M7 +6+77 *67:*INTRAGRUP 7:)+6M 7 :+76*7TOTAL :+M MM

    T(&!ul ! S!u+(n!0 ? 2% 3NS8il#o@on0 ? %5572 ? 24 3NS8

    6!

  • 8/13/2019 LICENTA Sindrom Metabolic

    61/107

  • 8/13/2019 LICENTA Sindrom Metabolic

    62/107

  • 8/13/2019 LICENTA Sindrom Metabolic

    63/107

  • 8/13/2019 LICENTA Sindrom Metabolic

    64/107

    E@#(& on+(ral0 464?MM@Su-&a-,$!&al#5 +O,(9i0 7?@

    O19#tat & +5 +++O19#tat & )5:O19#tat & 75O19#tat ',&1#!35M

    E@#(& on+(ral0 %7?@Su-&a-,$!&al#5 :O,(9i0 64?7)@

    G&a!ul +5 7)

    )+.+)CI .7 8 :.

    S,'$,l$(3 5 )+S,'$,l$(3 +*57G

    S,'$,l$(3 5 :MS,'$,l$(3 +*5 47

    ^0 0'#6 1 13&1a(#

    6.+.Cor(la1iil( +in!r( -aloril( aram(!rilor #lini#i i m(!a,oli#i i "ra-i!a!(a

    "ra-i!a!(a SA)OS 3(@rima! rin IA)80C,&la(#a 2

  • 8/13/2019 LICENTA Sindrom Metabolic

    65/107

  • 8/13/2019 LICENTA Sindrom Metabolic

    66/107

    Ta,(l III. C,&la(#a !#$t& -'t&ul

  • 8/13/2019 LICENTA Sindrom Metabolic

    67/107

    $i". 4G.G&a0#c t#- /catt& -l,t #lu/t&

  • 8/13/2019 LICENTA Sindrom Metabolic

    68/107

    $i". 6.G&a0#c t#- /catt& -l,t #lu/t-,='#@. A$al#9

  • 8/13/2019 LICENTA Sindrom Metabolic

    69/107

    $i". 6.G&a0#c t#- /catt& -l,t #lu/t&

  • 8/13/2019 LICENTA Sindrom Metabolic

    70/107

    Ta,(l VI. C,&la(#a !#$t& 2al,a&a c,l/t&,lulu# LDL %# IAH IAH LDL SAHOSIAH Pa&/,$ + 8*6)+?^^@ S'$#0.?)8

    ta#l!@. *6***

    N )7 ))MLDL SAHOS Pa&/,$ 8

    *6)+?^^@

    +

    S'$#0. ?)8ta#l!@ *6*** .

    N ))M ))M^^ c,&la(# /'$#0#cat#23

    C,&la(#a -a&a!,=al $at#23 4$t& LDL %# IAH / -,at =-l#ca -$ aca%# 2-at,$#c3 >-at#c3 ?ca 4$ ca9ul c,l/t&,lulu# t,tal@.

    $i". 66.G&a0#c t#- /catt& -l,t #lu/t&

  • 8/13/2019 LICENTA Sindrom Metabolic

    71/107

    Tl#c!l /c $u /8au c,&lat /'$#0#cat#2 cu IAH ?& *6*)@6 #a& 2al,lt$/#,$al /8au c,&lat /la1 cu &a2#tata SAHOS ?& *6) -$t&u TAS %# *6+ -$t&u TAD@.

    Ta,(l VII. C,&la(#a !#$t& 2al,a&a tl#c!l,& %# IAH IAH TG

    SAHOSIAH Pa&/,$ + *6*)S'$#0.?)8ta#l!@

    . *6

    N )7 +7TG SAHOS Pa&/,$ *6*) +

    S'$#0. ?)8ta#l!@

    *6 .

    N +7 +7

    Ta,(l VIII. C,&la(#a !#$t& 2al,a&a t$/#u$## a&tal /#/t,l#c %# IAH IAH TAS

    SAHOSIAH Pa&/,$ + *6)**?^^@ S'$#0.?)8

    ta#l!@. 6**)

    N )7 )7

    71

  • 8/13/2019 LICENTA Sindrom Metabolic

    72/107

    TAS SAHOS Pa&/,$ *6)**?^^@ + S'$#0. ?)8

    ta#l!@*6**) .

    N )7 )7^^ C,&&lat#,$ #/ /#$#0#ca$t at t> *.*+ l2l ?)8ta#l!@.

    Ta,(l I. C,&la(#a !#$t& 2al,a&a t$/#u$## a&tal !#a/t,l#c %# IAH IAH TAD

    SAHOSIAH Pa&/,$ + *6+))

    S'$#0.?)8ta#l!@

    . *6*7

    N )7 )7:TAD SAHOS Pa&/,$ *6+)) +

    S'$#0. ?)8ta#l!@

    *6*7 .

    N )7: )7:

    Ta,(l . C,&la(#a !#$t& 2al,a&a l#c'## a u$ %# IAH IAH GL SAHOS

    IAH Pa&/,$ + *6)7:?^^@ S'$#0.?)8

    ta#l!@. *6**+

    N )7 )+7GL SAHOS Pa&/,$ *6)7:?^^@ + S'$#0. ?)8

    ta#l!@*6**+ .

    N )+7 )+7^^ C,&&lat#,$ #/ /#$#0#ca$t at t> *.*+ l2l ?)8ta#l!@.

    $i". 65.G&a0#c t#- /catt& -l,t #lu/t&

  • 8/13/2019 LICENTA Sindrom Metabolic

    73/107

    Ca 'a# -ut&$#c3 !#$t& c,&la(## a 0,/t ca $at#23 4$t& act#2#tata 0#9#c3?$u'3& ! -a%# - 9#@ %# IAH ?& 8*6@.

    Ta,(l . C,&la(#a !#$t& $u'3&ul ! -a%# - 9# %# IAH IAH PASI SAHOSIAH Pa&/,$ + 8*6?^^@ S'$#0.?)8

    ta#l!@. *6***

    N )7 MPASI SAHOS Pa&/,$ 8

    *6?^^@+

    S'$#0. ?)8ta#l!@

    *6*** .

    N M M

    ^^ C,&&lat#,$ #/ /#$#0#ca$t at t> *.*+ l2l ?)8ta#l!@.

    $i". 6=.G&a0#c t#- /catt& -l,t #lu/t&

  • 8/13/2019 LICENTA Sindrom Metabolic

    74/107

    6.(.Comara!ia in!r( aram(!ri ( #uar!il( +( "ra-i!a!( a an((iDu-3 cu' /8a &'a&cat a$t,&6 4'-3&(#&a -ac#$(#l,& - 7 &u- ! &a2#tat 4$

    0u$c(# ! IAH c,$/#!&

  • 8/13/2019 LICENTA Sindrom Metabolic

    75/107

    PA C: M +*6** +:6** +)76)77 M6+::PA ? (rim(!rul a,+ominal2 P: ? (rim(!rul "!ului

    Pac#$(## !#$ cua&t#la : ?cu SAHOS cl 'a# /2&@ au ,/t 'a# ,19# !cB):@

    Pac#$(## !#$ cua&t#la : au 0,/t 'a# /,'$,l$(# ?/c,& ESS )*6M 0a(3 ! M6@ %# 'a#/!$ta ?M: -a%# - 9# 0a(3 ! +++7@ !c

  • 8/13/2019 LICENTA Sindrom Metabolic

    76/107

    HDL C7 +6** *6** 7*6+) 6MM7HDL C: ++6** :)6** )6:+: 6:*TG C+ +)6** **6** )*+67+ +**6*M7TG C) +*M6** :**6** +M+6** 6:):7TG C7 M*6** 7**6** ++6 6+)M

    TG C: ++*6** **6** )*:6M7+ *6*)*GL C+ 6** 7*6** +*67: 7M6M7:MGL C) M*6** )+*6** ++6): 7*67:*MGL C7 M6** )+*6** ++76)M7 776+)M))GL C: M *6** :**6** +7)6* +6*MTG tlc!6 GL l#c'#

    Pac#$(## !#$ cua&t#la : 0a(3 ! cua&t#la + au -&9$tat 2al, 'a# 'a al l#c'##1a9al ?+7) ' B!l 0a(3 !+*@ %# 'a# '#c# al HDL ?) 'B!l 0a(3 ! 76@ %# 2al,-a&a!,=al 'a# '#c# al c,l/t&,lulu# t,tal ?+ 0a(3 ! ):) 'B!l@.

    Ta,(lul IV. T$/#u$a a&tal3 4$ cl : cua&t#l ?C+8C:@N "#$ "a= "!# DS

    TAS C+ +)*6** +M*6** +)67) +6))::+TAS C) M +)*6** ))*6** +6) ):6)+M)TAS C7 M +)*6** ))*6** +6M )76+M*TAS C: +)*6** ))*6** +6 ):67**TAD C+ *6** ++*6** M*6* 6M+M*TAD C) M *6** +7*6** M+6: M67TAD C7 +*6** +7*6** M767) +6M7*

    TAD C: M *6** +M*6** M:6:: ):+6:7)TAS t$/#u$a a&tal /#/t,l#c36 TAD t$/#u$a a&tal3 !#a/,l#c3

    Pac#$(## !#$ cua&t#la : au -&9$tat 2al, t$/#,$al 'a# 'a 0a(3 ! cua&t#la +.$ c,$t#$ua& /8a =a'#$at /'$#0#ca(#a /tat#/t#c3 a !#0&$(l,& ! -a&a't 4$t&cua&t#ll =t&' cu aut,&ul t/tl,& ! /'$#0#ca(# ANOVA %# t Stu!$t.

    $i". 6F.V

  • 8/13/2019 LICENTA Sindrom Metabolic

    77/107

  • 8/13/2019 LICENTA Sindrom Metabolic

    78/107

    59595958N =

    S*M .A) 4

    S*M .A) 3

    S*M .A) 2

    S*M .A) 1

    30

    20

    10

    0

    Ta,(l VI. T/tul ANOVA -$t&u c,'-a&a(#a /,'$,l$(# 4$t& cua&t#la + %# :Su'a

    -at&atl,&!0 Pat&at

    '!#uF S'$#0.

    INTERGRUP +*6 +767:: +67 *6))M

    INTRAGRUP ::67 :M M6+TOTAL +6+)+

    T(&!ul ANOVA0 N(&(mni*i#a!i-

    T(&!ul ! S!u+(n!0 &u, 2 3&(mni*i#a!i- (n!ru CI GG8

    $i". 6%.Act#2#tata 0#9#c3 ?-a%#B9#@ 4$ cl : cua&t#l al &u-ulu# cu SAHOS

    78

  • 8/13/2019 LICENTA Sindrom Metabolic

    79/107

    25262522N =

    &ASI .4&ASI .3&ASI .2&ASI .1

    8000

    6000

    4000

    2000

    0

    -2000

    84

    2234

    Ta,(l VII. T/tul ANOVA -$t&u c,'-a&a(#a act#2#t3(## 0#9#c 4$t& cua&t#la + %# :Su'a

    -at&atl,&!0 Pat&at

    '!#uF S'$#0.

    INTERGRUP ):**** 7)6+:7 6 *6**+.INTRAGRUP *6***

    * 7)6+:7

    TOTAL ):****

    ANOVA0 S(mni*i#a!i-

    7

  • 8/13/2019 LICENTA Sindrom Metabolic

    80/107

    $i". 67.I$!#cl ! 'a/3 c,&-,&al3 4$ cl : cua&t#l al &u-ulu# cu SAHOS

    59595958N =

    IM. .4IM. .3IM. .2IM. .1

    60

    50

    40

    30

    20

    36

    35

    58

    57

    Ta,(l VIII. T/tul ANOVA -$t&u c,'-a&a(#a I"C 4$t& cua&t#la + %# :Su'a

    -at&atl,&!0 Pat&at

    '!#uF S'$#0.

    INTERGRUP +M6) +M 67M *6 *6M+:INTRAGRUP :6+M 7 +6++*

    TOTAL 776):

    ANOVA 0 N(&(mni*i#a!i-

    T(&!ul ! S!u+(n!0 &u, 2 3&(mni*i#a!i- (n!ru GG CI8

    8!

  • 8/13/2019 LICENTA Sindrom Metabolic

    81/107

  • 8/13/2019 LICENTA Sindrom Metabolic

    82/107

    $i". 5.P't&ul

  • 8/13/2019 LICENTA Sindrom Metabolic

    83/107

    $i". 5.C,l/t&,lul t,tal 4$ cl : cua&t#l al &u-ulu# cu SAHOS

    59595958N =

    .*/S .4.*/S .3.*/S .2.*/S .1

    400

    300

    200

    100

    Ta,(l LI. T/tul ANOVA -$t&u c,'-a&a(#a c,l/t&,lulu# 4$t& cua&t#la + %# :Su'a -at&atl,& !0 Pat&at '!#u F S'$#0.

    INTERGRUPINTRAGRUPTOTAL

    )*+6M: )7

    M*76+)M +6++M

    *67

    ))*6* + ))*6* *6)

    7

    *6*

    )*+67*: ))

    M7:6+* +6+

    *67:7

    ):+6* 7:

    *6:*:

    :))76):

    83

  • 8/13/2019 LICENTA Sindrom Metabolic

    84/107

    ANOVA0 N(&(mni*i#a!i-T(&!ul ! S!u+(n!0 &u, 2 3&(mni*i#a!i- (n!ru GG CI8

    $i". 54.C,l/t&,lul LDL 4$ cl : cua&t#l al &u-ulu# cu SAHOS

    57555958N =

    /D/ .4/D/ .3/D/ .2/D/ .1

    200

    180

    160

    140

    120

    100

    80

    60

    13

    53

    Ta,(l LII. T/tul ANOVA -$t&u c,'-a&a(#a c,l/t&ululu# LDL 4$t& cua&t#la + %# :Su'a -at&atl,& !0 Pat&at '!#u F S'$#0.

    INTERGRUPINTRAGRUPTOTAL

    ++*6))* 7)

    7)6) *6M*:

    *6+*

    )6)+ + )6)+ +6M*

    *6+

    84

  • 8/13/2019 LICENTA Sindrom Metabolic

    85/107

    +*):6M:* 7+

    7:M6+M) *6*

    *6:

    M))6777 )7

    :*+6+

    )*7:6:

    ANOVA0 N(&(mni*i#a!i-T(&!ul ! S!u+(n!0 &u, 2== 3n(&(mni*i#a!i-8

    $i". 56.C,l/t&,lul HDL 4$ cl : cua&t#l al &u-ulu# cu SAHOS

    58435557N =

    HD/ .4HD/ .3HD/ .2HD/ .1

    70

    60

    50

    40

    30

    20

    10

    0

    4129

    2

    9

    17

    Ta,(l LIII. T/tul ANOVA -$t&u c,'-a&a(#a c,l/t&ululu# HDL 4$t& cua&t#la + %# :Su'a -at&atl,& !0 Pat&at '!#u F S'$#0.

    INTERGRUPINTRAGRUP

    +*6*+ )+

    M6) +6):

    *6))

    85

  • 8/13/2019 LICENTA Sindrom Metabolic

    86/107

    TOTAL +67+ + +67+ 6)+ *6**+)67 )

    *)67) +677

    *6)):

    )+*6+* 7:

    +6M+

    76+)

    ANOVA0 N(&(mni*i#a!i-T(&!ul ! S!u+(n!0 n(&(mni*i#a!i- 3 ? 248

    $i". 55.Tl#c!l /c 4$ cl : cua&t#l al &u-ulu# cu SAHOS

    58343338N =

    .4 .3 .2 .1

    700

    600

    500

    400

    300

    200

    100

    0

    12

    414312574984

    5653

    31

    7

    17

    9

    86

  • 8/13/2019 LICENTA Sindrom Metabolic

    87/107

    Ta,(l LIV. T/tul ANOVA -$t&u c,'-a&a(#a tl#c!l,& 4$t& cua&t#la + %# :Su'a -at&atl,& !0 Pat&at '!#u F S'$#0.

    INTERGRUPINTRAGRUP

    TOTAL

    7+7:6M ):

    +7)*+6:: 76+*

    244

    7))6M + 7))6M 6)M *67*7+77+)6)MM )7

    +7))6): 76)*

    *6*)*

    *M677 +)

    :):6*M

    7++67* 7

    S(mni*i#a!i- (n!ru G= CI 3 &u, 2=8.

    $i". 5=.Gl#c'#a W u$ 4$ cl : cua&t#l al &u-ulu# cu SAHOS

    87

  • 8/13/2019 LICENTA Sindrom Metabolic

    88/107

    59415558N =

    / .4/ .3/ .2/ .1

    500

    400

    300

    200

    100

    0

    14443117

    59

    41

    12

    58

    2382023

    5352572356

    47

    51

    9

    Ta,(l LV. T/tul ANOVA -$t&u c,'-a&a(#a l#c'## W u$ 4$t& cua&t#la + %# :

    Su'a -at&atl,& !0 Pat&at '!#u F S'$#0.

    INTERGRUP

    INTRAGRUPTOTAL

    )M7M6M7+ 7

    +

    +*6:* +6+

    *

    *67::

    )6M) + )6M) *6**

    *6)

    )6MM 7*

    +)6)7) +6)*

    *67+

    7M)6** )

    +:*6*M

    M*M*)6:7+

    ANOVA0 N(&(mni*i#a!i-

    T(&!ul ! S!u+(n!0 ? 2= 3&(mni*i#a!i- (n!ru G= CI8

    88

  • 8/13/2019 LICENTA Sindrom Metabolic

    89/107

  • 8/13/2019 LICENTA Sindrom Metabolic

    90/107

  • 8/13/2019 LICENTA Sindrom Metabolic

    91/107

  • 8/13/2019 LICENTA Sindrom Metabolic

    92/107

    3NS8GL C+ 8 : 8)767) )6 M6 8:)6: 8:6+ 8)6:

    *6*+

    TAS C+ 8 : 8+6) )6+M 76* 8))6 86: 8:6+

    *6***

    TAD C+ 8 : 8)6M7 +)67 +6) 86+ 67+ 8+6

    2%F

    3NS8

    6.*.E-olu1ia aram(!rilor #lini#i i m(!a,oli#i la a#i(n1ii #u SA)OSLa 7 lu$#6 act#2#tata 0#9#c3 4$ &u-ul ! )7 ! -ac#$(# cu SAHOS a c&/cut cu

    6 /,'$,l$(a a/c39ut cu )M6 -'t&ul a1!,'#$al a /c39ut cu )66 I"C cu )6M6c,l/t&,lul a /c39ut cu M6 HDL a c&/cut cu )+6 LDL a /c39ut cu 66 l#c'#a a/c39ut cu 6 t$/#u$a a&tal3 /#/t,l#c3 a /c39ut cu 6 #a& ca !#a/t,l#c3 a /c39ut cu)67 ?0#. :@. T,at !#0&$(l !#$t& 2alua&a la 7 lu$# %# ','$tul #$#(#al au 0,/t/'$#0#cat#2 /tat#/t#c ?- /u1 *6*@. D#0&$(l au 0,/t 'ult 'a# &!u/ la lu$# %# la + a$.

    $i". 57. R-&9$ta&a &a0#c3 a 2,lu(## -a&a'tl,& cl#$#c# %# 'ta1,l#c# - l,tul4$t&. ;a&l &-&9#$t3 !#0&$(l !#$t& -a&a't la 7 lu$# 0a(3 ! ','$tul #$#(#al6 la lu$# 0a(3 ! 7 lu$# %# la + a$ 0a(3 ! lu$#

    2

  • 8/13/2019 LICENTA Sindrom Metabolic

    93/107

    $ &u-ul cl,& M* ! -ac#$(# c,'-l#a$(# la CPAP6 act#2#tata 0#9#c3 a c&/cut cu)6 /,'$,l$(a a /c39ut cu :6 I"C a /c39ut cu 6 -'t&ul a1!,'#$al cu 66c,l/t&,lul t,tal a /c39ut cu +*6 HDL a c&/cut cu :*6 LDL a /c39ut cu ++66l#c'#a cu +6 t$/#u$a a&tal3 /#/t,l#c3 a /c39ut cu %# ca !#a/t,l#c3 a /c39ut cu7 ?!#0&$( /'$#0#cat#2 la t/tul t Stu!$t - -&c>#5 - /u1 *6*@. La 7 lu$# %# la

    lu$#6 ac/t 1$0#c## /8au -3/t&at6 03&3 ',!#0#c3 /'$#0#cat#2 ult,a&$ &u-ul cl,& +: ! -ac#$(# $c,'-l#a$(#6 act#2#tata 0#9#c3 a c&/cut !,a& cu 6/,'$,l$(a a !#'#$uat cu +76 -'t&ul a1!,'#$al a a/c39ut cu *66 I"C a /c39ut cu+6:6 c,l/t&,lul cu 6 HDL a c&/cut cu M6 LDL a !#'#$uat cu :6 tl#c!l au/c39ut cu M6 l#c'#a cu 766 t$/#u$a a&tal3 /#/t,l#c3 a /c39ut cu 66 #a& ca!#a/t,l#c3 cu )6: .

    3

  • 8/13/2019 LICENTA Sindrom Metabolic

    94/107

    8 5.Diu1ii

    S ,1/&23roor1ia r(mar#a,il a a#i(n1ilor #u SA)OS &(-(r 3F682 ca

    c c,&/-u$! cu !atl c,''u$#cat 4$ l#t&atu&3 ?M@. $ -,-ula(#a $&al36 HTA a& ,-&2al$(3 ! )M 7+ ?):@6 -&2al$(a tul1u&3l,& ! l#c,&la& +: )*6 a,19#t3(## ! 8) 4$ Eu&,-a6 #a& a !#/l#-#!'## at&,$ ! -

  • 8/13/2019 LICENTA Sindrom Metabolic

    95/107

  • 8/13/2019 LICENTA Sindrom Metabolic

    96/107

    'a$a'$t 4$ a$/a'1lu a 0act,l,& ! /c a/,c#a(# ,19#t3(##6 a/t0l ca -$t&u cl#$#c#a$/3 !2#$3 0#&a/c3 a1,&!a&a l,1al3 a ac/t# c,$/tla(## cl#$#c6 #$!#0&$t /u1 c %a1l,$/t a !0#$#t3.

    E=-&(## &c,'a$!3 ca l'$t ! 'a$a'$t /c>#'1a&a /t#lulu# ! 2#a(36',lcul a$t#>#-&t$/#2 cu 0ct -l#,t&,- cu' a& 0# /a&ta$##6 '!#ca(# act#23 'ta1,l#c

    ca $,&',l#-'#a$t %# 't0,&'#$. Acc$tul / -u$ - !#t3 %# 'a# al/ =&c#(#u 0#9#c.La -ac#$(## cu SAHOS6 S" -,at 0# -&9$t ! M , 'a# 0&c2$t !c#a& c&%t& -,$!&al3 /u1 CPAP. ?):78):@

    N,utata ac/tu# /tu!#u c,$/t3 4$ -&,c$tul 'a& -,$!&al - ca& l8au -#&!ut-ac#$(## c,'-l#a(# la CPAP ?6@6 'ult 'a# 'a& !c'a(# -,!#c lac,$/ulta(# #$!#0&$t ! c,'-l#a$(a l,& la CPAP. F##$! '!#c #$t&$#/t6 a' t&atat at

  • 8/13/2019 LICENTA Sindrom Metabolic

    97/107

    4$c&cat /3 /lct9 !#$ $u'3&ul 'a& ! -ac#$(# a!&/a(# la1,&at,&ulu# !#$ Gala(#-ac#$(## cu a/-ct t#-#c ! SAHOS -u&6 SAHOS 0##$! 4$ ',! !0#$#t,u lat ! S".

    5. Con#lu9ii

    .Pr(-al(n1a &in+romului m(!a,oli# la a#i(n1ii &!u+ia1i #u +ia"no&!i# +( SA)OS(&!( +( F2 aroia! +( #(a raor!a! /n li!(ra!ur i mai mar( #u 6 +(#! #(a/n lo!ul +( a#i(n1i *r SA)OS

    7

  • 8/13/2019 LICENTA Sindrom Metabolic

    98/107

    4.Anumi!( #omon(n!( al( SM i #on+i1ii #lini#( a&o#ia!( &( #or(l(a9 #u &(-(ri!a!(aSA)OS (@rima! rin IA) 0 o,(9i!a!(a a,+ominal2 &(+(n!ari&mul2 >io'D)L'(mia.

    6.Toa!( #omon(n!(l( &in+romului m(!a,oli#2 #a i anumi!( #on+i1ii a&o#ia!(

    3&(+(n!ari&m8 &( am(lior(a9 &u, !ra!am(n! &(#i*i# #u CPAP mai (-i+(n! +(#! laa#i(n1ii #u SA)OS &u, a#((ai in!(r-(n1i( *arma#olo"i# i (+u#a1ional.

    BIBLIO:RA$IE

    8

  • 8/13/2019 LICENTA Sindrom Metabolic

    99/107

    +. )Gu#ll'#ault C6 F&a'>&9 S. #$ P$c#-l/ a$! P&act#c ,0 Sl- "!#c#$. E!/K&& "H6 R,t> T. b D'$t C. El/2#& Sau$!&/6 P>#la!l->#a6 )**5 *M*

    ). 7."a>,al! "6 Sc>$c CH. I$/#>t/ 0&,' /tu!#$ >u'a$ /l- !#/,&!&/.Natu& )** :75 +)M8+).

    7. :A'ca$ Aca!' ,0 Sl- "!#c#$. I$t&$at#,$al cla//#0#cat#,$ ,0 /l-!#/,&!&/6 )$! E!#t#,$5 D#a$,/t#c a$! c,!#$ 'a$ual. /tc>/t&6 IL5 A'ca$Aca!' ,0 Sl- "!#c#$ )**.

    :. +Ku/>#!a CA6 E0&,$ ;6 Gu#ll'#$ault C. A -&!#ct#2 ',&->,'tc ',!l 0,&t> ,1/t&uct#2 /l- a-$a /$!&,'. A$$ I$t&$ "! +MM +)? Pt +@5 +8.

    . +L,2#$ S6 Val D6 C&$,'a9 A6 "#>3/cu T. P&8t/t -&,1a1#l#t ,0 ,1/t&uct#2/l- a-$a. P$u',l,#a. )** ?:@5+M:8)*+.

    60 ). Ha'',$! EC. S,' -&l#'#$a& 0#$!#$/ ,$ ->/#cal c,'-la#$t/ 0&,' a-&,/-ct#2 /tu! ,0 +6*:6**: '$ a$! ,'$. A' J Pu1l#c Halt> Nat#,$/Halt>. +M::5++)7.

    70 )M. Al Laat# N"6 Patl SR6 Aa/ NT. E-#!'#,l,6 / 0act,&/6 a$!c,$/u$c/ ,0 ,1/t&uct#2 /l- a-$a a$! />,&t /l- !u&at#,$. P&,Ca&!#,2a/c D#/. )**M+5)M7.

    80 7*. Aa/ NT6 >#t DP6 "a$/,$ JE6 t al. A -&,/-ct#2 /tu! ,0 /l- !u&at#,$a$! c,&,$a& >a&t !#/a/ #$ ,'$. A&c> I$t&$ "!. )**7+75)*M.

    M. 7+. P#$>#&, SP6 Sc>&$>a''& ES6 T,&,& SS6 "#c>l/ K;. A -&,/-ct#2/tu! ,$ >a1#tual !u&at#,$ ,0 /l- a$! #$c#!$c ,0 1&a/t ca$c& #$ a la& c,>,&t,0 ,'$. Ca$c& R/. )**5)+.

    1!0 7). ;l##/ DL6 ,u$ T;. T> -a&a1l ,0 -a&a1,la5 >at t> U8/>a-! cu&2ca$ a$! ca$$,t tll u/ a1,ut /l-. Sl-. )**7*5++:

    110 77. Ta> S6 L#$ L6 Au/t#$ D6 ,u$ T6 "#$,t E. S>,&t /l- !u&at#,$ #/

    a//,c#at! #t> &!uc! l-t#$6 l2at! >&l#$6 a$! #$c&a/! 1,! 'a// #$!=.PL,S "!. )**:+5)120 7:. S-#l K6 L-&,ult R6 Va$ Caut& E. I'-act ,0 /l- !1t ,$ 'ta1,l#c a$!

    $!,c$ 0u$ct#,$. La$ct. +MMM7:5+:7M.130 7. Patl SR6 Z>u [6 St,&0&8I//& A6 t al. Sl- !u&at#,$ a$! 1#,'a&&/ ,0

    #$0la''at#,$. Sl-. )**M7)5)**:.140 7. Ca--ucc#, FP6 St&a$/ S6 Ka$!ala N;6 t al. G$!&8/-c#0#c a//,c#at#,$/ ,0

    />,&t /l- !u&at#,$ #t> -&2al$t a$! #$c#!$t >-&t$/#,$5 t> >#t>all IIStu!. H-&t$/#,$. )***5M7**.

    150 7. K#$ CR6 K$ut/,$ KL6 Rat>,u9 PJ6 S#!$ S6 L#u K6 Lau!&!al DS. S>,&t/l- !u&at#,$ a$! #$c#!$t c,&,$a& a&t& calc#0#cat#,$. JA"A. )**7**5)M

    +. 7.P>#ll#-/,$ EA. Sl- !#/,&!&/. I$5 "u&&a JF6 Na!l JA6 !/. T=t1,, ,0&/-#&at,& '!#c#$. V,l. ). P>#la!l->#a5 .;. Sau$!&/6 +M5+:+8*.

    +. 7M. O&t'$,lu O6 Su/lu AE6 ucl OT6 O$&c# T"6 Sa>#$ A. ;,! 0atc,'-,/#t#,$5 a -&!#ct#2 0act,& 0,& ,1/t&uct#2 /l- a-$a. La&$,/c,- )**++?@5 +:M78+:M.

    http://www.ncbi.nlm.nih.gov/pubmed/18320795?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=1http://www.ncbi.nlm.nih.gov/pubmed/18320795?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=1http://www.ncbi.nlm.nih.gov/pubmed/18320795?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=1http://www.ncbi.nlm.nih.gov/pubmed/18320795?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=1
  • 8/13/2019 LICENTA Sindrom Metabolic

    100/107

    +. :*. >#ttl AT6 "a&/>all I6 ",&t#',& IL6 &a#t> PK6 Slla& RJ6 D,ula/ NJ.Nc /,0t t#//u a$! 0at !#/tut#,$5 c,'-a/,$ 1t$ $,&'al '$ a$! ,'$1 'a$t#c &/,$a$c #'a#$. T>,&a= +MMM :?:@5 7)787).

    +M. :+. H,00/t#$ V6 "at#a S. D#00&$c/ #$ a1!,'#$al a$! $c c#&cu'0&$c/ #$

    -at#$t/ #t> a$! #t>,ut ,1/t&uct#2 /l- a-$,a. Eu& R/-#& J +MM) 5 787+.

    )*. :). Da2#/ RJ6 Al# NJ6 St&a!l#$ JR. Nc c#&cu'0&$c a$! ,t>& cl#$#cal0atu&/ #$ t> !#a$,/#/ ,0 t> ,1/t&uct#2 /l- a-$,a /$!&,'. T>,&a= +MM):?)@5 +*+8+*.

    )+. :7. Kat9 I6 St&a!l#$ J6 Slut/ AS6 Za'l N6 H,00/t#$ V. D, -at#$t/ #t>,1/t&uct#2 /l- a-$a >a2 t>#c $c/d A' R2 R/-#& D#/ +MM* +:+? Pt +@5+))8+)7+.

    )). ::.L##/t&, G6 R,'1au= P>.6 ;l C6 Du& "6 Au1&t G6 R,!$/t#$ DO. H#>"alla'-at# /c,& a$! $a/al ,1/t&uct#,$ a& a//,c#at! / 0act,&/ 0,& ,1/t&uct#2/l- a-$,a. Eu& R/-#& J )**7 )+5 ):)).

    )7. :.R,'1au= P6 L##/t&, G6 Ha',#& "6 t al. Na/al ,1/t&uct#,$ a$! #t/ #'-act ,$/l-8&lat! 1&at>#$ !#/,&!&/. R>#$,l, )** :7?:@5 ):)8)*.

    ):. :. Jul#a8S&!a G6 P&98P$at G6 Saa2!&a8Sa$ta$a P t al. U/0ul$// ,0c->al,'t& #$ /-a$ -,l/,'$,&a-> ,0 -at#$t/ #t> /u/-ct! ,1/t&uct#2/l- a-$a. Sl- ;&at> )**+*?:@5 ++8+.

    ). :. S,a&/ "C6 ! A9&!, ;#tt$c,u&t LR6 Z,$at, AI6 G&,, LC. A--l#cat#,$

    ,0 t> Ku/>#!a ',&->,'tc ',!l #$ -at#$t/ #t> /l-8!#/,&!&! 1&at>#$.R2 ;&a/ Ot,&$,la$,l )** )?:@5 :+8:.

    ). :. Ju$ DG6 C>, H6 G&u$/t#$ RR6 ;. P&!#ct#2 2alu ,0 Ku/>#!a #$!=a$! ac,u/t#c ->a&$,'t& 0,& t> 2aluat#,$ ,0 u--& a#&a #$ /u1ct/ #t> ,t>,ut ,1/t&uct#2 /l- a-$a. J K,&a$ "! Sc# )**: Oct+M?@5)8

    ). :M.;ucca C6 C#c,l#$ A 6 ;&u//#$, L t al. T,,t> l,// a$! ,1/t&uct#2 /l- a-$,a.R/-#& R/ )** ?+@5 .

    ). *.G&u$/t#$ RR6 H, K6 Sull#2a$ CE. Ac&,'al a$! /l- a-$a. A$$ I$t&$

    "! +MM+ ++5 )87).)M. +.Attal P6 C>a$/,$ P. E$!,c$ a/-ct/ ,0 ,1/t&uct#2 /l- a-$a. J Cl#$

    E$!,c$,l "ta1. )*+* F1M?)@5:78M.7*. ).G&u$/t#$ RR6 H, K6 ;&t>,$8J,$/ " t al. C$t&al /l- a-$a #/

    a//,c#at! #t> #$c&a/! 2$t#lat,& &/-,$/ t, ca&1,$ !#,=#! a$!>-&/c&t#,$ ,0 &,t> >,&',$ #$ -at#$t/ #t> ac&,'al. A' J R/-#& CtCa& "! +MM: +*5 :M8*).

    1!!

  • 8/13/2019 LICENTA Sindrom Metabolic

    101/107

    7+. 7Sa$!1l,' RE6 "at/u',t, A"6 Sc>,$ R; t al. O1/t&uct#2 /l- a-$a#$!uc! 1 t/t,/t&,$ a!'#$#/t&at#,$. N E$l J "! +M7 7*5 *8+*.

    7). :S>#-l JE6 Sc>t#$a&t DE6 Ta$!,$ R t al. Sl- a&c>#tctu& a$! /l- a-$a#$ -at#$t/ #t> Cu/>#$e/ !#/a/. Sl- +MM) +5 +:8+.

    77. Ka-u& VK6 K,-/ll TD6 !"au1 J t al. A//,c#at#,$ ,0 >-,t>&,#!#/' a$!,1/t&uct#2 /l- a-$a. A' J R/-#& Ct Ca& "! +MM+5+7M8+77

    7:. Attaa$ HP6 Sa1 AN. >$ t, /u/-ct ,1/t&uct#2 /l- a-$a /$!&,'5/'-t,'/ 'a 1 /u1tl6 1ut t&at'$t #/ /t&a#>t0,&a&!. P,/t&a! "! )**)+++?7@5 *8

    7. Ku/>#!a CA6 L#tt$& "R6 ",&$t>al& T6 Al//# CA6 ;a#l D6 C,l'a$ J J&.P&act#c -a&a't&/ 0,& t> #$!#cat#,$/ 0,& -,l/,'$,&a-> a$! &lat!-&,c!u&/5 a$ u-!at 0,& )**. Sl- )** )?:@5 :MM8)+.

    7. Alt'a$ D. P&act#cal /tat#/t#c/ 0,& '!#cal &/a&c>. L,$!,$5 C>a-'a$ a$! Hall+MM+. ))M.

    7. M,u$ T6 Palta "6 D'-/ J6 t al. T> ,ccu&&$c ,0 /l-8!#/,&!&!1&at>#$ a',$ '#!!l8a! a!ult/. N E$l J "! +MM7 7)?+@5 +)7*8+)7.

    7. *Du&f$ J6 E/$a,la S6 Ru1#, R6 I9tuta A. O1/t&uct#2 /l- a-$a8>-,-$a a$!&lat! cl#$#cal 0atu&/ #$ a -,-ulat#,$81a/! /a'-l ,0 /u1ct/ a! 7* t, * &.A' J R/-#& Ct Ca& "! )**+ +75 M.

    7M. +Sal2a!,& J6 Ia&t J6 S#l2a C6 G,'9 A'1&,/# J6 D#9 Ca1all&, A6 F&u>1c

    G. T> ,1/t&uct#2 /l- a-$,a /$!&,' #$ ,1/#t5 a c,$/-#&at,& #$ t> />a!,.R2 "! U$#2 Na2a&&a )**: :?)@5 8).

    :*. )R,c> F6 P#c>,t V6 S0,&9a E t al. P&!#ct#$ /l- a-$,a /$!&,' 0&,' >a&t-,!5 a t#'80&u$c a2lt a$al/#/. Eu& R/-#& J )**7 ))5 M7M:).

    :+. 7T#/>l& PV6 La$ EK6 Sc>luc>t& "D6 R!l#$ S. I$c#!$c ,0 /l-8!#/,&!&! 1&at>#$ #$ a$ u&1a$ a!ult -,-ulat#,$5 t> &lat#2 #'-,&ta$c ,0 /0act,&/ #$ t> !2l,-'$t ,0 /l-8!#/,&!&! 1&at>#$. JA"A )** )M?+@5))7*8))7.

    :). :"cN#c>,la/ T6 ;,$/#$,& "R t> "a$a'$t C,''#tt ,0 EU COSTACTION ;). Sl- a-$,a a/ a$ #$!-$!$t / 0act,& 0,& ca&!#,2a/cula&!#/a/5 cu&&$t 2#!$c6 1a/#c 'c>a$#/'/ a$! &/a&c> -,t#/. Eu& R/-#& J)** )M?+@5 +8+.

    :7. ;aut JP6 Ha''& L6 L2 P t al. N#>t8t#' a$! !#a/t,l#c >-&t$/#,$ a&c,'',$ a$! u$!&/t#'at! c,$!#t#,$/ #$ $l !#a$,/! a-$,#c -at#$t/. JH-&t$/ )** )7?7@5 )+8).

    1!1

  • 8/13/2019 LICENTA Sindrom Metabolic

    102/107

    ::. A&9t "6 ,u$ T6 F#$$ L6 Sat&u! J;6 ;&a!l TD. A//,c#at#,$ ,0 /l-!#/,&!&! 1&at>#$ a$! t> ,ccu&&$c ,0 /t&,. A' J R/-#& Ct Ca& "!)** +)5 +::+:+

    :. P,&t>a$ K"6 "l#$ JH6 Ku-#la JT6 V$>, KK6 Pa&t#$$ "". P&2al$c ,0

    /l- a-$a /$!&,' #$ l,$ atal 0#1llat#,$5 a ca/8c,$t&,l /tu!. C>/t )**:+)?7@5 M8.

    :. "a$#/t CH6 #ll/,$ K6 $/l R6 t al. D2l,-'$t ,0 &/-#&at,& c,$t&,l#$/ta1#l#t #$ >a&t 0a#lu&5 a $,2l a--&,ac> t, !#//ct t> -at>,->/#,l,#cal'c>a$#/'/. J P>/#,l )** 5 78:*+.

    470 Kaa& RK6 ;&& R;. P,/#t#2 a#&a -&//u& t&at'$t 0,& ,1/t&uct#2 /l-a-$a. C>/t. )**+7)5+*8+*)

    :. MG#l/ TL6 La//&/,$ TJ6 S'#t> ;H6 >#t J6 >t J6 Cat/ CJ. C,$t#$u,u/-,/#t#2 a#&a/ -&//u& 0,& ,1/t&uct#2 /l- a-$,a #$ a!ult/. C,c>&a$

    Data1a/ S/t R2. )** Jul +M75CD**++*.40 *S>#2ala& ;6 Va$ ! H$#$ C6 K&&'a$/ "6 t al. O1/t&uct#2 /l- a-$a/$!&,'5 ',& #$/#>t/ ,$ /t&uctu&al a$! 0u$ct#,$al ca&!#ac alt&at#,$/6 a$! t> 00ct/ ,0 t&at'$t #t> c,$t#$u,u/ -,/#t#2 a#&a -&//u&.J A' C,ll Ca&!#,l.)** A-& ::?@5+:778M.

    5!0 +;a99a$, LA6 K>a$ Z6 R$,l!/ K6 H J. E00ct ,0 $,ctu&$al $a/al c,$t#$u,u/-,/#t#2 a#&a -&//u& ,$ 1l,,! -&//u& #$ ,1/t&uct#2 /l- a-$a.H-&t$/#,$. )** Au*?)@5:+8)7.

    510 )K/ N;6 Pac AI6 Kl#$ LR6 t al. O1ct#2 'a/u&'$t ,0 -att&$/ ,0$a/al CPAP u/ 1 -at#$t/ #t> ,1/t&uct#2 /l- a-$a. A' J R/-#& Ct Ca&"!. +MM7+:58M.

    ). 7a2& TE6 G&u$/t#$ RR. A!>&$c t, c,$t#$u,u/ -,/#t#2 a#&a -&//u&t>&a-5 t> c>all$ t, 00ct#2 t&at'$t. P&,c A' T>,&ac S,c.)**?)@5+78+

    7. :R#ll T6 At#$/,$ G.6 G&/,$ .6 D&u/t ;.6 F,&/t> J.6 E!a&!/ ;.6 t al6S,' c>&,$,1#,l,#cal c,$/#!&at#,$/ &lat! t, ->/#cal =&c#/6 Cl#$ T&6)**6 +?7@6 ):M8:

    :. S#0! 6 S#0! .6 Ra1$1au& "6 H11&a$! J. S$,$ a$! Sl-A-$a #$ O1/ A!,l/c$t/5 E00ct ,0 L,$8t&' #>t L,//8R>a1#l#tat#,$6Sl- ;&at>6 +MMM6 7?7@6 78.

    . L#' J6 La//&/,$ TJ6 Flt>a' J6 >t J. O&al a--l#a$c/ 0,& ,1/t&uct#2/l- a-$,a.C,c>&a$ Data1a/ S/t R2. )** Ja$ )?+@5CD**::7.

    . K#&$// J6 K/>$a$6 Pat#l S6 Sc>$#!& H. U--& A#&a O1/t&uct#,$ #$S$,$ a$! U--& A#&a R/#/ta$c S$!&,'6 4$5 Ra$!&at> .J.6 Sa$$&;.".6 S,'&/ V.K. ?!/@5 Sl- A-$a. P&, R/-#& R/. ;a/l6 Ka&&6 )**6 76M8M

    . ;tta G6 P-#$ JL6 Val D6 D/c>au= C6 Ra->al ;6 L2 P. O1/t&uct#2/l- a-$a /$!&,'5 0#0t8,$ c,$/cut#2 -at#$t/ t&at! 1 'a=#ll,0ac#al/u&&6 A' J R/-#& Ct Ca& "!6 )***6 +)6 :+8M.

    1!2

    http://www.ncbi.nlm.nih.gov/pubmed/16855960http://www.ncbi.nlm.nih.gov/pubmed/16855960http://www.ncbi.nlm.nih.gov/pubmed/16580533http://www.ncbi.nlm.nih.gov/pubmed/16580533http://www.ncbi.nlm.nih.gov/pubmed/16580533http://www.ncbi.nlm.nih.gov/pubmed/17548722http://www.ncbi.nlm.nih.gov/pubmed/17548722http://www.ncbi.nlm.nih.gov/pubmed/16855960http://www.ncbi.nlm.nih.gov/pubmed/16855960http://www.ncbi.nlm.nih.gov/pubmed/16580533http://www.ncbi.nlm.nih.gov/pubmed/16580533http://www.ncbi.nlm.nih.gov/pubmed/16580533http://www.ncbi.nlm.nih.gov/pubmed/17548722http://www.ncbi.nlm.nih.gov/pubmed/17548722
  • 8/13/2019 LICENTA Sindrom Metabolic

    103/107

    . MF&a$l#$ KA6 A$tt#la H6 A=l//,$ S6 t al. E00ct/ a$! /#!800ct/ ,0 /u&&0,& /$,$ a$! ,1/t&uct#2 /l- a-$a88a //t'at#c &2#. Sl-. )**M Ja$ +7)?+@5 )87.

    M. M*A$c,l#8I/&al S6 DuHa'l ER6 St-$,/ C6 E$l& R6 C,>$8Z#,$ "6

    "a&l& ". T> &lat#,$/>#- 1t$ c,$/t#2 >a&t 0a#lu&6 /l- a-$a6 a$!',&tal#t #$ ,l!& '$. C>/t )**7 +):5 +:** +:*.

    *. M+N#t, FJ6 ,u$ T;6 L#$! ;K6 t al. A//,c#at#,$ ,0 /l-8!#/,&!&! 1&at>#$6/l- a-$a6 a$! >-&t$/#,$ #$ a la& c,''u$#t81a/! /tu!5 Sl- Ha&tHalt> Stu!. JA"A )*** )75 +)M +7.

    +. M)P--a&! PE6 ,u$ T6 Palta "6 Sat&u! J. P&,/-ct#2 /tu! ,0 t> a//,c#at#,$1t$ /l-8!#/,&!&! 1&at>#$ a$! >-&t$/#,$. #/c,$/#$ Sl- C,>,&tStu!. N E$l J "! )*** 7:)5 +7 +7:.

    ). M7;a//tt# C6 Al!c> "S6 C>&2#$ RD6 u#$t D. Sl- a-$a #$ -at#$t/ #t>t&a$/#$t #/c>'#c attac a$! /t&,5 A -&,/-ct#2 /tu! ,0 M -at#$t/.

    Nu&,l, +MM :5 ++ ++7.7. M:;a//tt# C6 "#la$,2a "6 Gu& ". Sl-8!#/,&!&! 1&at>#$ a$! acut#/c>'#c /t&,5 D#a$,/#/6 / 0act,&/6 t&at'$t6 2,lut#,$6 a$! l,$8t&'cl#$#cal ,utc,'. St&, )** 75 M M).

    :. MS,'&/ VK6 D$ "E6 "a& AL6 A11,u! F". S'-at>t#c8$&2 act#2#t!u$ /l- #$ $,&'al /u1ct/. N E$l J "! +MM7 7)5 7*7 7*.

    . MS,'&/ VK6 "a& AL6 Za2ala DC6 A11,u! F". C,$t&a/t#$ 00ct/ ,0 >-,=#aa$! >-&ca-$#a ,$ 2$t#lat#,$ a$! /'-at>t#c act#2#t #$ >u'a$/. J A--lP>/#,l +MM 5 )+*+ )+*.

    . MS,'&/ VK6 "a& AL6 Za2ala DC6 A11,u! F". I$0lu$c ,0 2$t#lat#,$ a$!>-,ca-$#a ,$ /'-at>t#c $&2 &/-,$// t, >-,=#a #$ $,&'al >u'a$/. J A--l

    P>/#,l +MM 5 )*M )+**.. MNa#c9 K6 2a$ ! ;,&$ PJ6 ",$ta$, N6 D$ "E6 P>#ll#-/ ;G6 S,'&/VK. C,$tut#,$ ,0 t,$#c c>',&0l= act#2at#,$ t, /'-at>t#c act#2#t a$!1l,,! -&//u& #$ -at#$t/ #t> ,1/t&uct#2 /l- a-$a. C#&culat#,$ +MM M5 M:7 M:.

    . MMS,'&/ VK6 >#t DP6 A'#$ R6 t al A'ca$ Ha&t A//,c#at#,$ C,u$c#l 0,&H#> ;l,,! P&//u& R/a&c> P&,0//#,$al E!ucat#,$ C,''#tt6 C,u$c#l ,$Cl#$#cal Ca&!#,l, A'ca$ Ha&t A//,c#at#,$ St&, C,u$c#l A'ca$Ha&t A//,c#at#,$ C,u$c#l ,$ Ca&!#,2a/cula& Nu&/#$ A'ca$ C,ll ,0Ca&!#,l, F,u$!at#,$. Sl- a-$a a$! ca&!#,2a/cula& !#/a/5 A$ A'ca$Ha&t A//,c#at#,$BA'ca$ C,ll ,0 Ca&!#,l, F,u$!at#,$ Sc#$t#0#cStat'$t. C#&culat#,$ )** ++5 +** ++++

    M. +**G&u$/t#$ RR. "ta1,l#c a/-ct/ ,0 /l- a-$a. Sl- +MM+M5S)+S))**. +*+Na#c9 K6 2a$ ! ;,&$ PJ6 ",$ta$, N6 D$ "E6 P>#ll#-/ ;G6 S,'&/

    VK. C,$tut#,$ ,0 t,$#c c>',&0l= act#2at#,$ t, /'-at>t#c act#2#t a$!1l,,! -&//u& #$ -at#$t/ #t> ,1/t&uct#2 /l- a-$a. C#&culat#,$ +MM M5 M:7 M:.

    1!3

  • 8/13/2019 LICENTA Sindrom Metabolic

    104/107

    +. +*)"a& AL6 V#ct,& RG6 N&>! C6 all#$ ;G. "#c&,$u&,&a->#c /tu!#/ ,0 t>'c>a$#/'/ ,0 /'-at>t#c $&2 &/-,$// t, /tat#c =&c#/ #$ >u'a$/. C#&c R/+M 5 :+ :M

    ). +*Jl#c S6 Pa!ltt# "6 Kaut S"6 t al. I$0la''at#,$6 ,=#!at#2 /t&//6 a$!&-a#& ca-ac#t ,0 t> 2a/cula& $!,t>l#u' #$ ,1/t&uct#2 /l- a-$a. C#&culat#,$

    )** ++5 ))* )).7. +*S#l2&1& DS6 O/$1& A6 Ia#$a A. Sl-8&lat! 1&at>#$ !#/,&!&/ a/ a'a,& cau/ ,0 //$t#al >-&t$/#,$5 Fact ,& 0#ct#,$d Cu&& O-#$ N->&,lH-&t$/ +MM 5 77 7.

    :. +*L,a$ AG6 P&l#,/# S"6 "$t A6 t al. H#> -&2al$c ,0 u$&c,$#9!/l- a-$,a #$ !&u8&/#/ta$t >-&t$/#,$. J H-&t$/ )**+ +M5 ))+ )).

    . +*M;a99a$, LA6 K>a$ Z6 R$,l!/ K6 H J. E00ct ,0 $,ctu&$al $a/al CPAP ,$1l,,! -&//u& #$ ,1/t&uct#2 /l- a-$a. H-&t$/#,$ )***5:+ )7.

    . ++*Ha$t$/ P6 Va$ "&>a> A6 ",/call, A6 t al. T> #'-act ,0c,$t#$u,u/ -,/#t#2 a#&a -&//u& ,$ 1l,,! -&//u& #$ -at#$t/ #t> ,1/t&uct#2/l- a-$a /$!&,'5 E2#!$c 0&,' a 'ta8a$al/#/ ,0 -lac1,8c,$t&,ll!

    &a$!,'#9! tal/. A&c> I$t&$ "! )** +5 :. +++S#$ DD6 F#t9&al! F6 Pa&& JD6 Nt,$ G6 Fl,&a/ JS6 ;&a!l TD. R#/0act,&/ 0,& c$t&al a$! ,1/t&uct#2 /l- a-$a #$ :* '$ a$! ,'$ #t>c,$/t#2 >a&t 0a#lu&. A' J R/-#& Ct Ca& "! +MMM +*5 ++*+ ++*.

    . ++)Ja2a> S6 Pa&& TJ6 L#'#$ JD6 t al. Sl- a-$a #$ + a'1ulat,& 'al-at#$t/ #t> /ta1l >a&t 0a#lu&5 T-/ a$! t>#& -&2al$c/6 c,$/u$c/6 a$!-&/$tat#,$/. C#&culat#,$ +MM M5 )+: )+M.

    M. ++7 a$ H6 Pa&& JD6 Nt,$ GE6 t al. I$0lu$c ,0 ,1/t&uct#2 /l- a-$a,$ ',&tal#t #$ -at#$t/ #t> >a&t 0a#lu&. J A' C,ll Ca&!#,l )** :M5 +) +7+.

    *. ++:R,1,t>a' JL6 Ra1/,$ J6 P&'utt S6 ;&,'1&&8;a&$a ;. L0t 2$tcula&

    >',!$a'#c/ !u$ &/-#&at#,$. J A--l P>/#,l +MM :5 +)M +7*7.+. ++Pt&/ J6 F&a/& C6 Stua&t RS6 ;au'a&t$& 6 R,1,t>a' JL. Nat#2#$t&at>,&ac#c -&//u& !c&a// #$!-$!$tl l0t 2$tcula& 0#ll#$ a$!'-t#$. A' J P>/#,l +MM )5 H+)* H+7+.

    ). ++S>#,'# T6 Gu#ll'#$ault C6 St,,>/ R6 Sc>$#tt& I. L0ta&! />#0t ,0 t>#$t&2$tcula& /-tu' a$! -ul/u/ -a&a!,=u/ #$ ,1/t&uct#2 /l- a-$a/$!&,'. C>/t +MM+ +**5 M: M*).

    7. ++T,ll FA6 Ju! V6 u PL6 "a&a$! ON. R!uc! /t&, 2,lu' &lat! t,-lu&al -&//u& #$ ,1/t&uct#2 /l- a-$a. J A--l P>/#,l +M7 5 ++ +):.

    :. ++Ka$, 6 Fl,&a/ JS6 U/u# K6 t al. Ca&!#,2a/cula& 00ct/ ,0 c,$t#$u,u/-,/#t#2 a#&a -&//u& #$ -at#$t/ #t> >a&t 0a#lu& a$! ,1/t&uct#2 /l- a-$a.N E$l J "! )**7 7:5 +)77 +):+.

    . ++MKa/a# T6 Na&u# K6 D,># T6 t al. P&,$,/#/ ,0 -at#$t/ #t> >a&t 0a#lu& a$!,1/t&uct#2 /l- a-$a t&at! #t> c,$t#$u,u/ -,/#t#2 a#&a -&//u&. C>/t)** +775 M* M.

    . +)*U/u# K6 ;&a!l TD6 S-aa J6 t al. I$>#1#t#,$ ,0 aa /'-at>t#c $&2act#2#t ,0 >a&t 0a#lu& -at#$t/ #t> ,1/t&uct#2 /l- a-$a 1 $,ctu&$alc,$t#$u,u/ -,/#t#2 a#&a -&//u&. J A' C,ll Ca&!#,l )** :5 )** )*++.

    1!4

  • 8/13/2019 LICENTA Sindrom Metabolic

    105/107

    . +)+"a$/0#l! DR6 G,ll,l NC6 Ka D"6 R#c>a&!/,$ "6 ;$ P6 Nau>t,$"T. C,$t&,ll! tal ,0 c,$t#$u,u/ -,/#t#2 a#&a -&//u& #$ ,1/t&uct#2 /l-a-$a a$! >a&t 0a#lu&. A' J R/-#& Ct Ca& "! )**: +M5 7+ 7.

    . +))Da2#/ RJ6 Ha&$t,$ KJ6 O&'&,! OJ6 St&a!l#$ JR. Na/al c,$t#$u,u/-,/#t#2 a#&a -&//u& #$ c>&,$#c >a&t 0a#