Alian Zahra, Hashemipour Mahin, Dehkordi Elham Hashemi, Hovsepian Silva, Amini Massoud, Moadab Mohammad Hassan, Javanmard Shaghayegh Haghjooy
Department of Pediatrics, School of Medicine, Child Health Promotion Research Center, Isfahan University of Medical Sciences, Isfahan, Endocrine and Metabolism Research Center, Isfahan, Iran.
Med Arh. 2012;66(1):12-5. doi: 10.5455/medarh.2012.66.12-15.
Endothelial dysfunction is considered as a fundamental and also preventable factor in the progression of vascular complications among type 1 diabetic patient. It occurs before the clinical manifestation of the mentioned complications. The aim of this study was to evaluate the effects of folic acid on endothelial function by measurements of adhesion molecules and von Willebrand factor (vWF) in patients with type 1 diabetes in Isfahan, Iran.
This double blind, placebo-controlled crossover trial included type 1 diabetic patients aged 5-20 years old. Selected patients were randomized into two groups of A and B to receive folic acid 5 mg daily or placebo for 8 weeks. After a 2-week washout period, patients in the two groups were swapped to receive placebo or folic acid, respectively, for another 8 weeks. Blood and urine samples were taken to evaluate glycosylated hemoglobin (HbAlc), folic acid, vWF, intracellular adhesion molecule (ICAM), vascular cell adhesion molecule (VCAM), and microalbuminuria levels. Results of these measurements were compared in the two groups before and after folic acid and placebo administrations.
Fifty five type 1 diabetic patients aged 12.1 +/- 3.4 years with diabetes duration of 3.9 +/- 2.1 years were enrolled. Mean of folic acid level in the two studied groups was increased significantly (10.1 +/- 3.8 vs. 21.2 +/- 1.1 in group A and 15.5 +/- 1.9 vs. 19.9 +/- 2.8 in group B, p < 0.05). Mean of VCAM and microalbuminuria was decreased significantly after folic acid administration in the two groups (p < 0.05). Mean of HbA1c, ICAM and vWF did not significantly change after folic acid administration in the two groups (p > 0.05).
Folic acid administration decreased the level of endothelial dysfunction measured by adhesion molecules, especially VCAM and microalbuminuria. However, it did not significantly affect vWF. Further studies with larger sample size and long-term administration of folic acid are necessary for making precise decisions in this field. Key words: endothelial function, Diabetes Mellitus, folic acid.
内皮功能障碍被认为是1型糖尿病患者血管并发症进展中的一个基本且可预防的因素。它在上述并发症的临床表现出现之前就已发生。本研究的目的是通过测量伊朗伊斯法罕1型糖尿病患者的黏附分子和血管性血友病因子（vWF）来评估叶酸对内皮功能的影响。
这项双盲、安慰剂对照的交叉试验纳入了5至20岁的1型糖尿病患者。将入选患者随机分为A组和B组，分别每日服用5毫克叶酸或安慰剂，为期8周。经过2周的洗脱期后，两组患者交换，分别接受安慰剂或叶酸，再持续8周。采集血液和尿液样本以评估糖化血红蛋白（HbAlc）、叶酸、vWF、细胞间黏附分子（ICAM）、血管细胞黏附分子（VCAM）和微量白蛋白尿水平。在叶酸和安慰剂给药前后，对两组这些测量结果进行比较。
纳入了55名1型糖尿病患者，年龄为12.1±3.4岁，糖尿病病程为3.9±2.1年。两个研究组的叶酸水平均值均显著升高（A组为10.1±3.8对21.2±1.1，B组为15.5±1.9对19.9±2.8，p<0.05）。两组在服用叶酸后，VCAM均值和微量白蛋白尿均显著降低（p<0.05）。两组在服用叶酸后，HbA1c、ICAM和vWF均值无显著变化（p>0.05）。
服用叶酸可降低通过黏附分子测量的内皮功能障碍水平，尤其是VCAM和微量白蛋白尿。然而，它对vWF没有显著影响。需要进行更大样本量和长期服用叶酸的进一步研究，以便在该领域做出精确决策。关键词：内皮功能、糖尿病、叶酸
