Parikh A, Sochett E B, McCrindle B W, Dipchand A, Daneman A, Daneman D
Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.
J Pediatr. 2000 Oct;137(4):465-9. doi: 10.1067/mpd.2000.109002.
To determine the presence and correlates of early heart and blood vessel dysfunction in adolescents with type 1 diabetes mellitus (DM) of relatively short duration.
A total of 33 patients with DM (20 male, mean age 15.8 +/- 1.3 years, mean DM duration 9.3 +/- 3.9 years) and 16 healthy subjects in a nondiabetic control group (7 male, mean age 17.4 +/- 1.7 years) underwent (1) ultrasonography of the right carotid artery to assess distensibility, compliance, and intimal-medial thickness (IMT), (2) echocardiographic assessment of systolic and diastolic ventricular function, (3) lipid profile and hemoglobin A(1c), and (4) overnight timed urine collections for albumin excretion rate.
Ultrasonography showed significantly lower carotid artery distensibility in the DM group (38.5 +/- 8.2 x 10(-3) vs 46.5 +/- 11.7 x 10(-3)/kPa, P =.01) but no difference in compliance (14.0 +/- 3.4 x 10(-7) vs 15.8 +/- 2.9 x 10(-7)m(2)/kPa, P =.08) or IMT (0.061 +/- 0.013 vs 0.060 +/- 0.014 cm, P =.77). Left ventricular (LV) end-diastolic diameter, LV posterior wall thickness, end-systolic wall stress, shortening fraction, ejection fraction, LV mass, and diastolic function were similar in both groups. Total cholesterol, low density lipoprotein, high density lipoprotein, triglycerides, and blood pressure were also similar. The median albumin excretion rate was 4.8 microg/min in the DM group (range 1.1 to 19.2) and 3.0 microg/min in the control group (range 1.4 to 5.8) (P =.03). Hemoglobin A(1c) correlated inversely with both distensibility (r = -.43, P =.02) and compliance (r = -.39, P =.032).
This study indicates that early changes in macrovascular function, namely lower carotid artery distensibility, may precede abnormalities in cardiac function or in arterial IMT in adolescents with short duration type 1 DM. It also supports a relationship between hyperglycemia and carotid artery dysfunction.
确定病程相对较短的1型糖尿病（DM）青少年早期心脏和血管功能障碍的存在情况及其相关因素。
共有33例DM患者（20例男性，平均年龄15.8±1.3岁，平均DM病程9.3±3.9年）和16例健康非糖尿病对照组受试者（7例男性，平均年龄17.4±1.7岁）接受了以下检查：（1）右侧颈动脉超声检查以评估扩张性、顺应性和内膜中层厚度（IMT）；（2）超声心动图评估心室收缩和舒张功能；（3）血脂谱和糖化血红蛋白A1c；（4）过夜定时尿液收集以测定白蛋白排泄率。
超声检查显示DM组颈动脉扩张性显著降低（38.5±8.2×10⁻³ 对比46.5±11.7×10⁻³/kPa，P = 0.01），但顺应性（14.0±3.4×10⁻⁷对比15.8±2.9×10⁻⁷m²/kPa，P = 0.08）或IMT（0.061±0.013对比0.060±0.014 cm，P = 0.77）无差异。两组的左心室（LV）舒张末期直径、LV后壁厚度、收缩末期壁应力、缩短分数、射血分数、LV质量和舒张功能相似。总胆固醇、低密度脂蛋白、高密度脂蛋白、甘油三酯和血压也相似。DM组白蛋白排泄率中位数为4.8μg/min（范围1.1至19.2），对照组为3.0μg/min（范围1.4至5.8）（P = 0.03）。糖化血红蛋白A1c与扩张性（r = -0.43，P = 0.02）和顺应性（r = -0.39，P = 0.032）均呈负相关。
本研究表明，在病程较短的1型DM青少年中，大血管功能的早期变化，即颈动脉扩张性降低，可能先于心脏功能或动脉IMT异常出现。研究还支持高血糖与颈动脉功能障碍之间的关系。
