Department of Paediatrics, Endocrinology, Diabetology with Cardiology Division, Medical University of Białystok, Białystok University Children's Hospital, Białystok, Poland.
J Hum Hypertens. 2013 Mar;27(3):191-6. doi: 10.1038/jhh.2012.11. Epub 2012 Mar 29.
The objective of this study was to investigate the vascular status, left-ventricular mass and biomarkers of endothelial activation in hypertensive (HT) adolescents, with particular attention to comparing nonobese with obese patients. Seventy-nine newly diagnosed HT adolescents aged 15.1±2.1 years (divided into 34 nonobese and 45 obese) were compared with 35 healthy volunteers. Intima-media thickness (IMT), flow-mediated dilation (FMD) and left-ventricular mass index (LVMi) were determined using ultrasound. Adhesion molecules and inflammatory interleukins (ILs), together with lipids and insulin resistance (HOMA), were also studied. HT obese adolescents had higher triglycerides, HOMA, and elevated levels of interleukin-6, tumor necrosis factor-α, soluble intercellular adhesion molecule-1 and soluble E-selectin compared with controls and nonobese HT patients. FMD was lower in HT groups (8.5±4.5% in nonobese, P=0.004; 8.1±4.9%, P=0.01 in obese vs 12.5±4.9%; in control), and IMT was higher (0.52±0.06 mm, P<0.001 in nonobese; 0.54±0.05 mm, P<0.001 in obese vs 0.42±0.05 mm in control). Higher LVMi was found in both HT groups, with the highest value in the nonobese group being 37.8±5.3 g m(-2.7) vs 28.4±5.3 g m(-2.7) in controls (P=0.003). In conclusion, nonobese HT adolescents had the same early cardiovascular deteriorations assessed ultrasonographically as their obese HT peers, although metabolic alterations and endothelial activation measured as plasma biomarkers were more pronounced in obese individuals. The potential mechanisms of early atherosclerosis in nonobese HT adolescents need further evaluation in prospective studies because these factors may differ considerably from those found in young obese individuals with HT.
本研究旨在探讨高血压青少年的血管状态、左心室质量和内皮激活生物标志物，特别关注比较非肥胖和肥胖患者。将 79 例年龄 15.1±2.1 岁的新诊断高血压青少年（分为 34 例非肥胖和 45 例肥胖）与 35 例健康志愿者进行比较。使用超声测量内膜中层厚度（IMT）、血流介导的扩张（FMD）和左心室质量指数（LVMi）。还研究了黏附分子和炎症细胞因子（ILs），以及血脂和胰岛素抵抗（HOMA）。与对照组和非肥胖 HT 患者相比，HT 肥胖青少年的甘油三酯、HOMA 以及白细胞介素-6、肿瘤坏死因子-α、可溶性细胞间黏附分子-1 和可溶性 E-选择素水平升高。HT 组的 FMD 较低（非肥胖组 8.5±4.5%，P=0.004；肥胖组 8.1±4.9%，P=0.01 与对照组 12.5±4.9%；在控制），IMT 更高（非肥胖组 0.52±0.06mm，P<0.001；肥胖组 0.54±0.05mm，P<0.001 与对照组 0.42±0.05mm）。两个 HT 组的 LVMi 均较高，其中非肥胖组的最高值为 37.8±5.3g m(-2.7)比对照组 28.4±5.3g m(-2.7)（P=0.003）。总之，尽管非肥胖 HT 青少年的代谢改变和内皮激活等血浆生物标志物比肥胖 HT 青少年更为明显，但通过超声评估，他们与肥胖 HT 青少年一样存在早期心血管恶化。需要进一步评估非肥胖 HT 青少年早期动脉粥样硬化的潜在机制，因为这些因素可能与年轻肥胖 HT 患者有很大不同。
