Szadkowska Agnieszka, Pietrzak Iwona, Mianowska Beata, Czerniawska Elzbieta, Bodalska-Lipińska Joanna, Chrul Sławomir, Markuszewski Leszek, Bodalski Jerzy
Klinika Chorób Dzieci I Katedry Pediatrii UM w Łodzi, Łódź.
Endokrynol Diabetol Chor Przemiany Materii Wieku Rozw. 2006;12(4):286-91.
The elevated blood pressure is one of the most important risk factors of diabetic micro- and macroangiopathy.
Evaluation of the prevalence of prehypertension and relationship between prehypertension, metabolic control and chronic complications in children and adolescents with type 1 diabetes mellitus.
83 patients aged 12.0-18.9 years, with a duration of diabetes 0.5-17.3 years, without evidence of arterial hypertension were recruited. In all patients 24-hour automatic blood pressure monitoring was performed with oscillometric device. The individuals with >40% of systolic and/or diastolic blood pressure >120/80 mmHg were defined as prehypertensive. HbA(1)c was measured by HPLC, plasma lipid levels--by an enzymatic method and urinary albumin excretion rate by chemiluminescent enzyme immunoassay method. Body mass index (BMI) and daily dose of insulin were calculated. Ophthalmoscopic examination and power spectral analysis of heart rate variation were performed.
In 30 individuals (36.1%) prehypertension was diagnosed. The prehypertension group had older age (17.5+/-1.1 vs. 15.9+/-2.3 years; p<0.001) and longer duration of the disease (7.3+/-4.7 vs. 4.7+/-3.4 years; p=0.005) as compared with the group with normal blood pressure. There were no significant differences between groups in HbA1c, daily dose of insulin, BMI-SDS, lipids profile, prevalence of microalbuminuria and retinopathy. In the patients with prehypertension the a greater activity of sympathetic activation was observed (LF/HF: 1.00+/-0.06 vs. 0.78+/-0.04, p=0.018).
Prehypertension is frequently recognized in type 1 diabetic children and adolescents. The prevalence of prehypertension is associated with older age, longer duration of diabetes and the shift of the sympatho-vagal balance toward sympathetic activation. There is no relationship between prehypertension and metabolic control or the prevalence of microvascular complications.
血压升高是糖尿病微血管和大血管病变最重要的危险因素之一。
评估1型糖尿病儿童和青少年中高血压前期的患病率以及高血压前期、代谢控制和慢性并发症之间的关系。
招募83例年龄在12.0 - 18.9岁、糖尿病病程为0.5 - 17.3年且无动脉高血压证据的患者。所有患者均使用示波装置进行24小时自动血压监测。收缩压和/或舒张压>120/80 mmHg的比例>40%的个体被定义为高血压前期。通过高效液相色谱法测量糖化血红蛋白（HbA1c），采用酶法测量血脂水平，通过化学发光酶免疫分析法测量尿白蛋白排泄率。计算体重指数（BMI）和胰岛素日剂量。进行眼科检查和心率变异性的功率谱分析。
30例个体（36.1%）被诊断为高血压前期。与血压正常组相比，高血压前期组年龄更大（17.5±1.1岁 vs. 15.9±2.3岁；p<0.001）且病程更长（7.3±4.7年 vs. 4.7±3.4年；p = 0.005）。两组在糖化血红蛋白、胰岛素日剂量、BMI标准差分值、血脂谱、微量白蛋白尿患病率和视网膜病变方面无显著差异。在高血压前期患者中观察到交感神经激活活性更高（低频/高频：1.00±0.06 vs. 0.78±0.04，p = 0.018）。
1型糖尿病儿童和青少年中高血压前期较为常见。高血压前期的患病率与年龄较大、糖尿病病程较长以及交感 - 迷走神经平衡向交感神经激活的转变有关。高血压前期与代谢控制或微血管并发症的患病率之间没有关系。
