School of Medicine and the Department of Mathematics and Statistics, University of Missouri-Kansas City; and the Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, USA.
Circ Cardiovasc Imaging. 2010 Jan;3(1):8-14. doi: 10.1161/CIRCIMAGING.109.880070. Epub 2009 Nov 17.
Obesity and familial dyslipidemia in children are associated with accelerated atherosclerosis by pathological examination. We sought to determine whether these children had increased carotid artery intima-media thickness (CIMT), a measure of subclinical atherosclerosis similar to 45-year-old adults. Adult CIMT percentile tables were used for comparison because normative CIMT data for children are limited.
Seventy children, ages 6 to 19 years, with obesity- and atherosclerosis-promoting risk factors such as dyslipidemia, hypertension, insulin resistance, and tobacco smoke exposure, or with familial dyslipidemia, underwent carotid artery ultrasound. Advanced "vascular age" (VA) was defined as having maximum CIMT that was > or =25th percentile for race- and sex-matched 45-year-old adults. Mean age was 13.0+/-3.3 years. Forty (57%) of 70 children had body mass index > or =95th percentile for age and sex. Maximum CIMT for obese children was 0.53+/-0.05 mm and for familial dyslipidemic children was 0.52+/-0.04 mm. Advanced VA was seen in 30 (75%) of obese children and 22 (73%) of familial dyslipidemic children. Thirty (75%) of obese children had >3 mutable atherosclerosis-promoting risk factors; these children had a nonsignificantly higher maximum CIMT compared with obese children with < or =3 risk factors (0.54+/-0.06 mm versus 0.52+/-0.03 mm, P=0.07). Obese children with high fasting triglyceride levels were more likely to have advanced VA.
VA is advanced and comparable in obese children with atherosclerosis-promoting risk factors and in children with familial dyslipidemia. Advanced VA is prevalent in obese children with high fasting triglyceride levels.
通过病理学检查发现，儿童肥胖和家族性血脂异常与动脉粥样硬化加速有关。我们试图确定这些儿童是否存在颈动脉内膜中层厚度（CIMT）增加，这是一种与 45 岁成年人相似的亚临床动脉粥样硬化的测量指标。由于儿童的 CIMT 正常参考值数据有限，因此使用成人 CIMT 百分位表进行比较。
70 名年龄在 6 至 19 岁之间的儿童，患有肥胖和动脉粥样硬化促进危险因素，如血脂异常、高血压、胰岛素抵抗和吸烟，或患有家族性血脂异常，接受了颈动脉超声检查。高级“血管年龄”（VA）定义为最大 CIMT 大于或等于种族和性别匹配的 45 岁成年人第 25 百分位数。平均年龄为 13.0±3.3 岁。70 名儿童中，40 名（57%）的体重指数大于或等于年龄和性别匹配的第 95 百分位数。肥胖儿童的最大 CIMT 为 0.53±0.05mm，家族性血脂异常儿童的最大 CIMT 为 0.52±0.04mm。30 名（75%）肥胖儿童和 22 名（73%）家族性血脂异常儿童出现高级 VA。30 名（75%）肥胖儿童有≥3 个可改变的动脉粥样硬化促进危险因素；这些儿童的最大 CIMT 明显高于有≤3 个危险因素的肥胖儿童（0.54±0.06mm 与 0.52±0.03mm，P=0.07）。空腹甘油三酯水平较高的肥胖儿童更有可能出现高级 VA。
有动脉粥样硬化促进危险因素的肥胖儿童和家族性血脂异常儿童的 VA 提前且相似。空腹甘油三酯水平较高的肥胖儿童中，高级 VA 很常见。
