Wiegman Albert, de Groot Eric, Hutten Barbara A, Rodenburg Jessica, Gort Johan, Bakker Henk D, Sijbrands Eric J G, Kastelein John J P
Department of Paediatrics, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands.
Lancet. 2004 Jan 31;363(9406):369-70. doi: 10.1016/S0140-6736(04)15467-6.
Patients with familial hypercholesterolaemia have severe coronary-artery disease early in adult life. Whether lipid-lowering treatment should be started in childhood remains to be established. We therefore assessed 201 children heterozygous for familial hypercholesterolaemia and 80 unaffected siblings (both age ranges 8-18 years) with B-mode ultrasound to measure carotid wall intima-media thickness. Mean combined carotid intima-media thickness of heterozygotes was significantly greater than that of unaffected siblings (0.494 mm [SD 0.051] vs 0.472 [SD 0.049], p=0.002). A significant deviation in intima-media thickness was noted from age 12 years in children with familial hypercholesterolaemia. Findings on multivariate analysis showed LDL cholesterol, age, and sex to be strong and independent predictors of intima-media thickness. Since raised LDL cholesterol concentrations can be lowered efficiently, clinical studies are needed to investigate long-term safety and effectiveness of statin treatment in children with familial hypercholesterolaemia.
家族性高胆固醇血症患者在成年早期就患有严重的冠状动脉疾病。是否应在儿童期开始降脂治疗仍有待确定。因此，我们用B型超声评估了201名家族性高胆固醇血症杂合子儿童和80名未受影响的同胞（年龄均在8 - 18岁之间），以测量颈动脉壁内膜中层厚度。杂合子的平均颈动脉内膜中层厚度显著大于未受影响的同胞（0.494毫米[标准差0.051]对0.472[标准差0.049]，p = 0.002）。在家族性高胆固醇血症儿童中，从12岁起就注意到内膜中层厚度有显著偏差。多变量分析结果显示，低密度脂蛋白胆固醇、年龄和性别是内膜中层厚度的强有力且独立的预测因素。由于升高的低密度脂蛋白胆固醇浓度可以有效降低，因此需要进行临床研究来调查他汀类药物治疗家族性高胆固醇血症儿童的长期安全性和有效性。
