Guven Baris, Demirpence Savas, Yilmazer Murat Muhtar, Carti Ozgur Umac, Tavli Vedide, Mese Timur, Oner Taliha
Department of Pediatric Cardiology, Izmir Dr Behcet Uz Children's Hospital, Izmir, Turkey.
Pediatr Int. 2013 Dec;55(6):696-702. doi: 10.1111/ped.12177. Epub 2013 Sep 20.
Limited data are available related to the effects of cardiovascular risk factors on abdominal arterial stiffness using carotid and brachial artery indices. Therefore, we aimed to determine arterial changes in obese children and investigate any relation with cardiovascular risk factors.
Thirty-eight obese children (mean body mass index: 28.35 ± 4.65 kg/m(2) ) and 34 age- and sex-matched healthy subjects underwent ultrasound measurements of abdominal, carotid and brachial arteries. Aortic strain, pressure strain elastic modulus (Ep), pressure strain normalized by diastolic blood pressure (Ep*), carotid intima-media thickness, carotid artery compliance, brachial artery flow-mediated dilatation, and well-known cardiovascular risk factors were assessed in the obese children.
Obese children had significantly higher Ep and Ep* parameters than the healthy controls (mean: 242.6 [107.1-666.6], 164.2 [110.6-231.5]; P < 0.001, and mean: 3.39 [1.76-7.5], 2.64 [1.46-4.2]; P < 0.001, respectively). Ep and Ep* were significantly correlated with the homeostasis model assessment of insulin resistance (r = 0.587, P = 0.001; r = 0.467, P = 0.004, respectively). Receiver-operator curve analysis of Ep for identification of children with cardiovascular risk factors showed that the area under the curve for hyperinsulinemia was 0.80 (P < 0.001) and for hypertriglyceridemia was 0.62 (P < 0.01).
Abdominal arterial stiffness parameters as well as carotid intima-media thickness and brachial arterial flow-mediated dilatation assessment were similarly useful in identifying obese children with cardiovascular risk factors. Insulin resistance is related with the augmented rigidity of the aortic wall in obese children.
关于使用颈动脉和肱动脉指数评估心血管危险因素对腹部动脉僵硬度影响的数据有限。因此，我们旨在确定肥胖儿童的动脉变化，并研究其与心血管危险因素的关系。
38名肥胖儿童（平均体重指数：28.35±4.65kg/m²）和34名年龄及性别匹配的健康受试者接受了腹部、颈动脉和肱动脉的超声测量。对肥胖儿童评估了主动脉应变、压力应变弹性模量（Ep）、经舒张压归一化的压力应变（Ep*）、颈动脉内膜中层厚度、颈动脉顺应性、肱动脉血流介导的扩张以及众所周知的心血管危险因素。
肥胖儿童的Ep和Ep参数显著高于健康对照组（平均值分别为：242.6[107.1 - 666.6]，164.2[110.6 - 231.5]；P<0.001，以及平均值分别为：3.39[1.76 - 7.5]，2.64[1.46 - 4.2]；P<0.001）。Ep和Ep与胰岛素抵抗的稳态模型评估显著相关（r = 0.587，P = 0.001；r = 0.467，P = 0.004）。用于识别有心血管危险因素儿童的Ep的受试者工作特征曲线分析表明，高胰岛素血症的曲线下面积为0.80（P<0.001），高甘油三酯血症的曲线下面积为0.62（P<0.01）。
腹部动脉僵硬度参数以及颈动脉内膜中层厚度和肱动脉血流介导的扩张评估在识别有心血管危险因素的肥胖儿童方面同样有用。胰岛素抵抗与肥胖儿童主动脉壁硬度增加有关。
