Schwab Karl Otfried, Doerfer Jürgen, Hallermann Kristiane, Krebs Andreas, Schorb Elisabeth, Krebs Kristin, Winkler Karl
Department of Pediatrics and Adolescents Medicine, University Hospital, Freiburg, Germany.
Int J Adolesc Med Health. 2008 Jul-Sep;20(3):285-92. doi: 10.1515/ijamh.2008.20.3.285.
Type 1 diabetes is a generally accepted atherogenic risk factor, and diabetic patients who smoke markedly accelerate the atherosclerotic process. The main intentions of our investigation were to ascertain differences between juvenile active/passive smokers and non-smokers with type 1 diabetes regarding the number and spectrum of cardiovascular risk factors and their associations with smoking. Ninety-two patients were enrolled comprising 19 active/passive smokers (median age 15.9 years) and 73 non-smokers (median age 12.3 years). To determine age-dependent influences we compared age- and gender-matched groups of 12 smokers with 12 non-smokers. Smokers had significantly higher HbA1c, fructosamine, total cholesterol, LDL cholesterol, apolipoprotein B, serum P-selectin, and lower serum L-selectin than non-smokers. However, L-selectin levels were not different between the age-matched smoker and non-smoker groups. A significant positive relation (Spearman rank correlation) was found between smoking and age, HbAlc, fructosamine, total cholesterol, apolipoprotein B, and P-selectin; a negative relationship between smoking and L-selectin. We conclude that smoking in children and adolescents with type 1 diabetes increases the cardiovascular risk through the deterioration of glucose metabolism, lipid profile, and endothelial function. Therefore, smoking diabetic juveniles may increase their number of cardiovascular risk factors from 1, diabetes, by another four factors, i.e. smoking, hyperglycemia, dyslipidemia, and endothelial perturbation.
1型糖尿病是一种公认的动脉粥样硬化风险因素，吸烟的糖尿病患者会显著加速动脉粥样硬化进程。我们调查的主要目的是确定1型糖尿病的青少年主动/被动吸烟者与非吸烟者在心血管危险因素的数量和范围方面的差异，以及这些因素与吸烟的关联。研究共纳入92例患者，其中19例为主动/被动吸烟者（中位年龄15.9岁），73例为非吸烟者（中位年龄12.3岁）。为了确定年龄相关的影响，我们比较了12名吸烟者和12名非吸烟者年龄和性别匹配的组。吸烟者的糖化血红蛋白、果糖胺、总胆固醇、低密度脂蛋白胆固醇、载脂蛋白B、血清P选择素水平显著高于非吸烟者，而血清L选择素水平则较低。然而，年龄匹配的吸烟者和非吸烟者组之间的L选择素水平没有差异。吸烟与年龄、糖化血红蛋白、果糖胺、总胆固醇、载脂蛋白B和P选择素之间存在显著的正相关关系（Spearman等级相关性）；吸烟与L选择素之间存在负相关关系。我们得出结论，1型糖尿病儿童和青少年吸烟会通过葡萄糖代谢、血脂谱和内皮功能的恶化增加心血管风险。因此，吸烟的糖尿病青少年可能会使其心血管危险因素的数量从1个（糖尿病）增加到另外4个，即吸烟、高血糖、血脂异常和内皮功能紊乱。
