patmedfarPatient-Oriented Medicine and PharmacyПациентоориентированная медицина и фармация2949-1924LLC Izdatelstvo OKI10.37489/2949-1924-0103XUHYXQpatmedfar-185Research ArticlePEDIATRICSПЕДИАТРИЯMicrocirculatory and tissue system as a marker of prenosological disorders of cardiovascular health in schoolchildrenМикроциркуляторно-тканевая система как маркер донозологических нарушений кардиоваскулярного здоровья у школьниковhttps://orcid.org/0000-0001-9141-5348БекезинВ. В.BekezinV. V.

Владимир Владимирович Бекезин, д. м. н., профессор, зав. кафедрой

кафедра детских болезней

Смоленск

Vladimir V. Bekezin, Dr. Sci. (Med.), Professor, Head of the Department

Department of Children's Diseases

Smolensk

smolenskbvv@yandex.ruhttps://orcid.org/0000-0001-6570-3848КозловаЕ. Ю.KozlovaE. Yu.

Елена Юрьевна Козлова, к. м. н., доцент

кафедра детских болезней

Смоленск

Elena Yu. Kozlova, Cand. Sci. (Med.), Associate Professor

Department of Children's Diseases

Smolensk

keu83smol@rambler.ruhttps://orcid.org/0000-0003-4820-9658ПересецкаяО. В.PeresetskayaO. V.

Ольга Владимировна Пересецкая, к. м. н., доцент, доцент кафедры

кафедра детских болезней

Смоленск

Olga V. Peresetskaya, Cand. Sci. (Med.), Associate Professor, Associate Professor of the Department

Department of Children's Diseases

Smolensk

olga_perec@inbox.ruФГБОУ ВО «Смоленский государственный медицинский университет»РоссияSmolensk State Medical UniversityRussian Federation202530082025335562Copyright © Bekezin V.V., Kozlova E.Y., Peresetskaya O.V., 20252025Бекезин В.В., Козлова Е.Ю., Пересецкая О.В.Bekezin V.V., Kozlova E.Y., Peresetskaya O.V.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.pomph.ru/jour/article/view/185Relevance

Relevance. The origins of cardiovascular pathology lie in childhood. The introduction of preventive medicine technologies in pediatrics should lead to significant results in the maintenance of adult health.

Objective

Objective. To study the state of the microcirculatory and tissue systems in schoolchildren to determine pre-nosological cardiovascular risk screening markers.

Materials and methods

Materials and methods. A comprehensive examination of 190 school-age children (14–17 years old) was conducted at the Children’s Health Center of Smolensk as part of preventive examinations of schoolchildren. Random sampling was used to enroll 82 schoolchildren. The examined schoolchildren were divided into 3 groups: Group 1–24 schoolchildren with a body mass index (BMI) within ±1 SDS BMI (kg/m2) and a normal outpatient blood pressure level; Group 2–36 schoolchildren with a BMI within ≥ +1 SDS BMI (kg/m2) and a normal outpatient blood pressure level; and Group 3 comprised 22 schoolchildren with a BMI in the range ≥ +1 SDS BMI (kg/m2) and elevated systolic blood pressure. Comprehensive examination of the schoolchildren included anthropometry [weight, height, BMI (kg/m2)], laser Doppler flowmetry, and fluorescence spectroscopy of the skin in the forearm area using a «Lasma PF» analyzer (Russia).

Results

Results. Analysis of the structure of the functional state of the microcirculatory and tissue system (FS MTS) in the examined schoolchildren revealed that in children of the 2nd Group, increased activity of FS MTS was recorded 1,8 times more often (p < 0,05) than in children of the 1st Group, and FS decompensation was already noted MTS in 11.1 % of children of the 2nd Group. In the 3rd Group, compared with the 2nd Group, active FS MTS was 7,8 times less likely to be registered, indicating the preservation of compensatory and adaptive mechanisms at the microcirculatory level. Simultaneously, 72.7 % of the children in Group 3 showed increased FS MTS activity, and FS MTS compensation was detected significantly more often than in Groups 1 and 2.

Conclusions

Conclusions. Screening prenosological markers of cardiovascular risk in overweight/obese schoolchildren according to the results of laser Doppler flowmetry and laser fluorescence spectroscopy (Lasma PF) are the "increased activity" of FS MTS against the background of high values of the flaxmotion index (increased sympathetic effects on microcirculatory blood flow).

Актуальность

Актуальность. Истоки кардиоваскулярной патологии лежат в детском возрасте. Внедрение технологий превентивной (профилактической) медицины в педиатрии должно привести к значимым результатам по сохранению здоровья у взрослых.

Цель исследования

Цель исследования: изучить состояние микроциркуляторно-тканевой системы у школьников с целью определения донозологических скрининговых маркеров кардиоваскулярного риска.

Материалы и методы

Материалы и методы. Проведено комплексное обследование 190 детей школьного возраста (14–17 лет) в Центре здоровья детей ОГБУЗ ДКБ г. Смоленска в рамках профилактических осмотров школьников. Методом случайной выборки в исследование были включены 82 школьника. Обследованные школьники были разделены на 3 группы: 1-я группа — 24 школьника с индексом массы тела (ИМТ) в пределах ±1 SDS ИМТ (кг/м2) и нормальным уровнем амбулаторного АД; 2-я группа — 36 школьников с ИМТ в пределах ≥ +1 SDS ИМТ (кг/м2) и нормальным уровнем амбулаторного АД; 3-я группа — 22 школьника с ИМТ в пределах ≥ +1 SDS ИМТ (кг/м2) и повышенным систолическим артериальным давлением. Комплексное обследование школьников включало антропометрию (вес, рост, ИМТ (кг/м2)); лазерную допплеровскую флоуметрию и флуоресцентную спектроскопию кожи в области предплечья на анализаторе «Лазма ПФ» (Россия).

Результаты

Результаты. Анализ структуры функционального состояния микроциркуляторно-тканевой системы (ФС МТС) у обследованных детей выявил, что у детей 2-й группы повышенная активность ФС МТС регистрировалась в 1,8 раза чаще (p < 0,05), чем у детей 1-й группы; а у 11,1 % детей 2-й группы отмечалась уже декомпенсация ФС МТС. У школьников 3-й группы по сравнению с детьми 2-й группы в 7,8 раза реже регистрировалась активное ФС МТС, свидетельствующее о сохранности компенсаторно-адаптационных механизмов на микроциркуляторном уровне. При этом у 72,7 % детей 3-й группы отмечалась повышенная активность ФС МТС и достоверно чаще, чем у детей 1-й и 2-й групп выявлялась компенсация ФС МТС.

Выводы

Выводы. Скрининговыми донозологическими маркерами кардиоваскулярного риска у школьников с избыточной массой тела / ожирением по результатам лазерной допплеровской флоуметрии и лазерной флуоресцентной спектроскопии («Лазма ПФ») являются «повышенная активность» ФС МТС на фоне высоких значений индекса флаксмоций (усиление симпатических влияний на микроциркуляторный кровоток).

дети с избыточной массой и ожирениеммикроциркуляторно-тканевая системакардиоваскулярный рискoverweight and obese childrenmicrocirculatory and tissue systemcardiovascular riskДанное исследование выполнено при грантовой поддержке ФГБОУ ВО «Смоленский государственный медицинский университет»This study was carried out with the grant support of the Smolensk State Medical UniversityIntroduction

To date, research on the functioning of the blood microcirculation system remains a focus of scientific attention due to its involvement in many vital processes in the human body [1, 3, 5, 8]. Optical non-invasive diagnostic methods have already proven themselves effective in identifying disorders of peripheral blood flow associated with the development of cardiovascular diseases (arterial hypertension, coronary artery disease, stroke), type 2 diabetes mellitus, and other markers of metabolic syndrome [2, 4, 6, 9].

In the Russian Federation, within the framework of the national project "New Health Preservation Technologies" (2025-2030), the emphasis is on the development of preventive medicine technologies to ensure active and healthy longevity of citizens. Currently, in the RF, cardiovascular diseases (ranking 1st in the structure of overall morbidity in adults) continue to contribute significantly to mortality rates. Furthermore, the origins of cardiovascular pathology undoubtedly lie in childhood. The introduction of preventive medicine technologies in pediatrics should lead to significant results in preserving adult health in subsequent years [3, 5].

Objective

To study the state of the microcirculatory-tissue system in schoolchildren in order to determine prenosological screening markers of cardiovascular risk.

Materials and Methods

A comprehensive examination of 190 school-age children (14-17 years) was conducted at the Children's Health Center of the Smolensk Regional Children's Clinical Hospital as part of preventive check-ups for students from secondary educational institutions in Smolensk. Using random sampling, 82 schoolchildren were included in the study.

Depending on body mass index (BMI, kg/m²) and the level of ambulatory blood pressure (mean value of three BP measurements by the auscultatory method [1]), all examined schoolchildren were divided into 3 groups: Group 1 – 24 schoolchildren with BMI within ±1 SDS BMI (kg/m²) and normal ambulatory BP levels (systolic and diastolic BP did not exceed the 90th percentile for age, height, and sex); Group 2 – 36 schoolchildren with BMI within ≥ +1 SDS BMI (kg/m²) and normal ambulatory BP levels; Group 3 – 22 schoolchildren with BMI within ≥ +1 SDS BMI (kg/m²) and elevated systolic blood pressure (ambulatory BP exceeded the 90th percentile for age, height, and sex (14-15 years) or was equal to or greater than 135 mm Hg (16-17 years)).

The characteristics of the examined groups are presented in Table 1. There were no age or gender differences between the groups (Table 1).

Table 1. Characteristics of the Examined Groups

CriteriaGroup 1 (n=24)Group 2 (n=36)Group 3 (n=22)Age (years)15.3 ± 1.0514.9 ± 1.0215.1 ± 1.06Sex:   Boys (abs., %)13 (54.2%)19 (52.8%)11 (50.0%)Girls (abs., %)11 (45.8%)17 (47.2%)11 (50.0%)BMI (kg/m²) (M±SD)19.4 ± 1.9926.3 ± 2.34 “26.1 ± 2.47 *BMI Conclusion (abs., %):   - Normal24 (100%)0 (0%) “0 (0%) *- Overweight0 (0%)27 (75%) “16 (72.7%) *- Obesity grade 10 (0%)7 (19.4%) “4 (18.2%) *- Obesity grade 20 (0%)2 (5.6%) “2 (9.1%) *SBP (mm Hg) (M±SD)119.6 ± 4.63123.9 ± 5.77 “134.8 ± 5.92 * #DBP (mm Hg) (M±SD)72.8 ± 3.7673.6 ± 3.1275.8 ± 3.54BP Conclusion (abs., %):   Normal BP24 (100%)36 (100%)0 (0%) * #High Normal BP0 (0%)0 (0%)9 (40.9%) * #Isolated Systolic Hypertension Grade 10 (0%)0 (0%)13 (59.1%) * #Notes:* – significance of differences (p < 0.05) between children in Groups 1 and 3;“ – significance of differences (p < 0.05) between children in Groups 1 and 2;# – significance of differences (p < 0.05) between children in Groups 2 and 3.   

The comprehensive examination of schoolchildren included anthropometry (weight, height, BMI (kg/m²)); laser Doppler flowmetry and fluorescence spectroscopy of the skin in the forearm area using the "Lazma PF" analyzer (Russia) [7]. The following microcirculation parameters were assessed: M – arithmetic mean value of the microcirculation index (conventional units); M nutr. – mean value of nutritive blood flow (conv. units); σ – standard deviation of blood flow fluctuations from the mean value M (conv. units); Kv – coefficient of variation of blood flow fluctuations (%); An and Am – amplitudes of blood flow fluctuations (conv. units) due to neurogenic and myogenic mechanisms of vascular tone regulation, respectively; Ad and Ac – amplitudes of respiratory and cardiac blood flow fluctuations (conv. units); Fluxmotion Index (FMI = (Am + An) / (Ad + Ac), conv. units), characterizing the balance ratio between active and passive mechanisms of microcirculation regulation. Using laser fluorescence spectroscopy ("Lazma PF", Russia), the relative fluorescence amplitude of nicotinamide adenine dinucleotide (ANADN (A460/A365), conv. units) was assessed; as well as the Oxidative Metabolism Index (OMI, conv. units), linking the nutritive component of blood perfusion (microcirculation) (Mnutr.) and the fluorescence amplitude of the NADH coenzyme (ANADN). The microcirculation and oxidative metabolism studies were conducted under identical conditions for 4 minutes in the area of the right forearm.

Statistical processing of the research results was performed using the data analysis package of Microsoft Excel 2003, applying parametric (M, SD) and non-parametric (Me, 25th-75th perc.) statistics methods. Differences were considered statistically significant at p < 0.05.

Results and Discussion

Parameters characterizing the state of microcirculation (perfusion) and its variability in the examined children (Groups 1, 2, and 3) are presented in Table 2. It was revealed that schoolchildren with overweight/obesity and normal BP (Group 2) showed a trend towards an increase in the median perfusion (M, conv. units) compared to children in Group 1 (the increase in microcirculation occurred mainly due to an increase in M nutr. (an increase of 9.1%; p > 0.05). Against the background of increased perfusion, a significant decrease of 51.9% in the coefficient of variation of blood flow fluctuations (Kv (%)) was noted in children of Group 2 compared to children of Group 1 (decrease from 40.41% to 26.6%; p < 0.05). In schoolchildren of Group 3 with elevated systolic BP, a more significant increase in median perfusion (M, conv. units) was recorded compared to children in Groups 1 and 2 – by 29.6% and 23.0%, respectively (p < 0.05). The increase in microcirculation was also largely due to an increase in M nutr. (an increase of 53.3% compared to children in Group 1). A similar (as in children of Group 2) decrease in the coefficient of variation of blood flow fluctuations (Kv (%)) and blood flow variability (σ, conv. units) was observed in schoolchildren of Group 3 compared to children of Group 1 (p < 0.05).

Table 2. Comparative Characteristics of the State of Microcirculation (Perfusion) and Its Variability in the Examined Children (1st, 2nd, and 3rd Groups)

Groups (Me, 25th–75th perc.)M (conv. units)M nutr. (conv. units)σ (conv. units)Kv (%)Group 1 (n=24)4.99 [4.03; 5.58]2.76 [1.96; 3.53]2.23 [1.54; 3.03]40.41 [28.13; 61.78]Group 2 (n=36)5.26 [4.34; 5.96]3.01 [2.75; 3.12]1.29 [0.74; 1.68] “26.6 [20.73; 37.63] “Group 3 (n=22)6.47 [5.62; 7.11] * #4.23 [3.51; 5.03] * #1.27 [0.78; 1.49] *23.9 [19.65; 27.94] *Notes:* – significance (p < 0.05) between children of Groups 1 and 3;“ – significance (p < 0.05) between children of Groups 1 and 2;# – significance (p < 0.05) between children of Groups 2 and 3.    

Parameters characterizing the regulation of microcirculation (perfusion) in children of Groups 1, 2, and 3 are presented in Table 3. In schoolchildren with overweight/obesity and normal BP (Group 2), a feature of microcirculation regulation compared to children in Group 1 is a decrease in the amplitude of respiratory and cardiac blood flow fluctuations (Ad – by a factor of 2.31 (p < 0.05); Ac – by a factor of 1.95 (p < 0.05)). A similar trend in microcirculation regulation (decrease in the amplitude of respiratory and cardiac blood flow fluctuations) was also recorded in children of Group 3 compared to children of Group 1 (Table 3). Furthermore, in schoolchildren of Group 3 with elevated systolic BP, a significant increase in the median amplitude of neurogenic (An by a factor of 1.86) and myogenic (Am by a factor of 1.63) mechanisms of blood flow regulation was recorded (p < 0.05) compared to children in Group 1; similar features of microcirculatory blood flow regulation were noted in schoolchildren of Group 3 compared to children of Group 2 (Table 3). It should be separately noted that in schoolchildren of Group 3, a more pronounced dependence of vascular tone regulation on the nervous and muscular components was recorded compared to children in Groups 1 and 2; this is evidenced by an increase in the median FMI in schoolchildren of Group 3 by a factor of 1.83 compared to the FMI of children in Group 1 (p < 0.05) and by a factor of 1.47 (p < 0.05) compared to the FMI of children in Group 2.

Table 3. Indicators of Microcirculation Regulation in the Examined Children (1st, 2nd, and 3rd Groups)

Groups (Me, 25th–75th perc.)An (conv. units)Am (conv. units)Ad (conv. units)Ac (conv. units)FMIGroup 1 (n=24)0.71 [0.48; 1.16]0.79 [0.46; 1.12]0.97 [0.69; 1.19]0.82 [0.58; 1.07]1.058 [0.828; 1.324]Group 2 (n=36)0.84 [0.25; 1.08]0.68 [0.33; 1.04]0.42 [0.27; 0.71] “0.41 [0.21; 0.62] “1.314 [1.137; 1.607] “Group 3 (n=22)1.32 [1.11; 1.64] * #1.29 [1.07; 1.59] * #0.59 [0.36; 0.98]0.61 [0.39; 0.94]1.936 [1.589; 2.423] * #Notes:* – significance (p < 0.05) between children of Groups 1 and 3;“ – significance (p < 0.05) between children of Groups 1 and 2;# – significance (p < 0.05) between children of Groups 2 and 3.     

Table 4. Oxidative Metabolism Indicators in the Examined Children (1st, 2nd, and 3rd Groups)

Groups (Me, 25th–75th perc.)A365 (conv. units)A460 (conv. units)ANADN (conv. units)OMI (conv. units)Group 1 (n=24)45 [34; 62]64 [52; 73]1.51 [1.27; 1.72]0.79 [0.68; 1.12]Group 2 (n=36)52 [43; 77]68 [62; 70]1.30 [1.12; 1.64]1.16 [0.89; 1.83]Group 3 (n=22)42 [31; 64]75 [70; 89] * #1.79 [1.68; 1.99] * #1.64 [1.42; 2.11] *Notes:* – significance (p < 0.05) between children of Groups 1 and 3;# – significance (p < 0.05) between children of Groups 2 and 3.    

Analysis of oxidative metabolism indicators showed that children in Group 2 exhibited a trend (p > 0.05) towards an increase in OMI compared to children in Group 1. Meanwhile, schoolchildren in Group 3 showed a significant increase in OMI by a factor of 2.1 (p < 0.05) compared to children in Group 1, against the background of an increase in the fluorescence amplitude of nicotinamide adenine dinucleotide (ANADN) and M nutr. (Tables 2, 4). The integral complex indicator OMI reflects the state of metabolic processes in the skin, including consideration of microcirculatory blood flow. In this regard, in the second stage, based on the analysis of oxidative metabolism data (OMI, conv. units) from schoolchildren in Group 1, normative parameters characterizing the functional state of the microcirculatory-tissue system (FS MTS) were proposed for further assessment of its structure in children of Groups 2 and 3.

Considering the recommendations of the "Lazma PF" analyzer manual [7] and the OMI values obtained in the study for children in Group 1 (25th–75th perc., conv. units), it is proposed to distinguish 4 types of FS MTS in schoolchildren aged 14-17 years:

Table 5. Structure of the Functional State of the Microcirculatory-Tissue System (FS MTS) in the Examined Children (1st, 2nd, and 3rd Groups)

GroupsFS MTS based on OMI Data    ActiveIncreased ActivityCompensationDecompensationGroup 1 (n=24)16 (66.6%)7 (29.2%)1 (4.2%)0 (0%)Group 2 (n=36)13 (36.1%) “19 (52.8%) “0 (0%)4 (11.1%) “Group 3 (n=22)1 (4.6%) * #16 (72.7%) *5 (22.7%) * #0 (0%)Notes:* – significance (p < 0.05) between children of Groups 1 and 3;“ – significance (p < 0.05) between children of Groups 1 and 2;# – significance (p < 0.05) between children of Groups 2 and 3.    

Analysis of the structure of the functional state of the microcirculatory-tissue system (FS MTS) in the examined children revealed that in children of Group 2, "Increased Activity" FS MTS was recorded 1.8 times more often (p < 0.05) than in children of Group 1; and 11.1% of children in Group 2 already had "Decompensation" FS MTS (Table 5). In schoolchildren of Group 3 compared to children of Group 2, "Active" FS MTS, indicating the preservation of compensatory-adaptive mechanisms at the microcirculatory level, was recorded 7.8 times less frequently. At the same time, 72.7% of children in Group 3 had "Increased Activity" FS MTS, and "Compensation" FS MTS was detected significantly more often than in children of Groups 1 and 2 (Table 5).

A comprehensive summary analysis of the features of the functional state of the microcirculatory-tissue system in schoolchildren of Groups 2 and 3 compared to children of Group 1 is presented in Table 6.

Table 6. Stage-by-Stage Summary Analysis of the Features of the Functional State of the Microcirculatory-Tissue System in Schoolchildren of the 2nd and 3rd Groups Compared with Children of the 1st Group

STAGESMicrocirculation ParametersNature of FS MTS Changes in Group 2 SchoolchildrenNature of FS MTS Changes in Group 3 SchoolchildrenSTAGE IBasic Microcirculation Parameters   Perfusion (M, M nutr.)(→/) * Variability (σ, Kv) * * Regulation (An, Am, Ad, Ac) (Ad) *;  (Ac) * (Am) *;  (An) * (Ad);  (Ac) Regulation (FMI) * *STAGE IIBasic Oxidative Metabolism Parameters   A460; ANADN- * OMI (conv. units)() *STAGE IIIFunctional State of the Microcirculatory-Tissue System (FS MTS)   Active FS MTS * * Increased Activity FS MTS * * Compensation FS MTS- * Decompensation FS MTS *-Notes: * – significance of differences (p < 0.05) for parameters in schoolchildren of Groups 2 and 3 compared to children of Group 1.Legend:  Increase /  Decrease (single arrow: trend/change, double arrow: pronounced/significant change)   

The research results showed that the functional state of the microcirculatory-tissue system closely correlates with the state of the cardiovascular system and, accordingly, can be used as one of the diagnostic markers of preclinical impairments of cardiovascular health in schoolchildren.

Conclusion

Thus, the results of the study on the state of microcirculation, its variability, and regulation in schoolchildren indicate the dependence of these parameters on both body mass index and the level of ambulatory (systolic) blood pressure. In schoolchildren with elevated ambulatory BP against the background of excess body fat, the features of FS MTS were: a significant increase in perfusion (microcirculation) against the background of reduced variability and enhanced active mechanisms of blood flow regulation, characterized by the predominance of sympathetic influences; as well as an increase in the intensity of oxidative metabolism at the microcirculatory level.

Based on the results of laser Doppler flowmetry and laser fluorescence spectroscopy ("Lazma PF"), the prenosological screening diagnostic markers of cardiovascular risk in schoolchildren with overweight/obesity should be considered "increased activity" of FS MTS against the background of high values of the Fluxmotion Index (indicating increased sympathetic influences on microcirculatory blood flow).

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The authors declare that there are no conflicts of interest present.