Meyer Andreas Alexander, Kundt Günther, Steiner Michael, Schuff-Werner Peter, Kienast Wolfgang
Division of Pediatric Cardiology, Childrens Hospital, University of Rostock, Rostock, Germany.
Pediatrics. 2006 May;117(5):1560-7. doi: 10.1542/peds.2005-2140.
Childhood obesity contributes to the development of adult obesity and subsequent cardiovascular disease. The present study aimed to assess vascular status (flow-mediated vasodilation [FMD], intima-media thickness [IMT]) and to analyze plasma surrogate endothelial markers (von Willebrand factor [vWf], E-selectin, and thrombomodulin) in obese children as compared with controls. Associations between early morphologic and functional vascular changes, surrogate soluble markers of early atherosclerosis, and the cardiovascular risk profile were determined.
We examined 32 obese children versus 20 control subjects. All of the children underwent identical screening, comprehensive risk factor assessment, and measurements of E-selectin, vWf, thrombomodulin, FMD, and IMT.
Compared with controls, obese children demonstrated significantly impaired FMD and increased IMT. Concentrations of soluble E-selectin and thrombomodulin were significantly elevated in obese children, whereas vWf showed no significant differences between obese children and controls. FMD, IMT, E-selectin, and thrombomodulin were significantly associated with various risk factors, including the extent of obesity, arterial hypertension, fibrinogen, C-reactive protein, and low physical fitness.
The present study documented increased IMT, impaired endothelial function, and elevated plasma markers of endothelial activation and injury in obese children. Morbid obesity, arterial hypertension, subclinical inflammation, and low physical fitness formed a risk profile associated with the risk of early atherosclerosis in these children. Sonographic assessment of vascular status and the estimation of soluble endothelial plasma markers, combined with comprehensive risk factor screening, may form a rationale to identify high-risk children susceptible to early atherosclerotic disease and to monitor vascular changes during follow-up studies and therapeutic measures.
儿童肥胖会促进成人肥胖及后续心血管疾病的发展。本研究旨在评估肥胖儿童的血管状态（血流介导的血管舒张[FMD]、内膜中层厚度[IMT]），并分析与对照组相比肥胖儿童血浆替代内皮标志物（血管性血友病因子[vWf]、E-选择素和血栓调节蛋白）的情况。确定早期形态学和功能性血管变化、早期动脉粥样硬化的替代可溶性标志物与心血管风险概况之间的关联。
我们检查了32名肥胖儿童和20名对照受试者。所有儿童均接受相同的筛查、综合风险因素评估以及E-选择素、vWf、血栓调节蛋白、FMD和IMT的测量。
与对照组相比，肥胖儿童的FMD明显受损，IMT增加。肥胖儿童可溶性E-选择素和血栓调节蛋白的浓度显著升高，而肥胖儿童与对照组之间vWf无显著差异。FMD、IMT、E-选择素和血栓调节蛋白与各种风险因素显著相关，包括肥胖程度、动脉高血压、纤维蛋白原、C反应蛋白和低身体素质。
本研究记录了肥胖儿童IMT增加、内皮功能受损以及内皮激活和损伤的血浆标志物升高。病态肥胖、动脉高血压、亚临床炎症和低身体素质构成了与这些儿童早期动脉粥样硬化风险相关的风险概况。血管状态的超声评估和可溶性内皮血浆标志物的估计，结合综合风险因素筛查，可能为识别易患早期动脉粥样硬化疾病的高危儿童以及在随访研究和治疗措施期间监测血管变化提供依据。
