Department of Paediatrics, University Hospital Rostock, Germany.
Cardiovasc Diabetol. 2013 Aug 12;12:115. doi: 10.1186/1475-2840-12-115.
AIMS/HYPOTHESIS: We used Laser Doppler Fluximetry (LDF) to define "normal" endothelial function in a large cohort of healthy children and adolescents and to evaluate skin microcirculation in paediatric patients with type 1 diabetes mellitus.
LDF was performed in 102 healthy children (12.8 ± 3.3 years of age; 48 male) and 68 patients (12.9 ± 3.3 years of age; 33 male). Duration of disease was 5.0 ± 3.97 years. Each participant sequentially underwent three stimulation protocols (localized thermal hyperaemia with localized warming to maximum 40°C, iontophoretic delivery of pilocarpine hydrochloride (PCH) and sodium nitroprusside (SNP)). The maximum relative increase in skin blood flow and the total relative response, i.e. the area under the curve (AUC) to each stimulus (AUCheat, AUCPCH, AUCSNP) was determined. In addition, the area of a right-angled triangle summarizing the time to and the amplitude of the first peak, which represents the axon reflex mediated neurogenic vasodilation (ARR) was calculated.
In healthy controls, AUCheat, AUCPCH, AUCSNP, and ARR turned out to be independent of sex, age, and anthropometric values. Per parameter the 10th percentile generated from data of healthy controls was used as the lower threshold to define normal endothelial function. Diabetic patients showed significantly reduced vasodilatative response to either physical or pharmacological stimulation with SNP, whereas the response to PCH was comparable in both cohorts. In patients compared to controls i) a significantly higher frequency of impaired vasodilatation in response to heat and SNP was noted and ii) vascular response was classified as pathological in more than one of the parameters with significantly higher frequency.
CONCLUSIONS/INTERPRETATION: Skin microvascular endothelial dysfunction is already present in about 25% of paediatric type 1 diabetic patients suffering from type 1 diabetes for at least one year. Future studies are needed to assess the predictive value of endothelial dysfunction in the development of long-term (cardio)vascular comorbidity in these patients.
目的/假设：我们使用激光多普勒流量仪（LDF）来定义一大群健康儿童和青少年的“正常”内皮功能，并评估 1 型糖尿病患儿的皮肤微循环。
LDF 应用于 102 名健康儿童（年龄 12.8 ± 3.3 岁；男性 48 名）和 68 名患者（年龄 12.9 ± 3.3 岁；男性 33 名）。疾病持续时间为 5.0 ± 3.97 年。每个参与者依次进行三种刺激方案（局部热充血，局部加热至最大 40°C，盐酸毛果芸香碱（PCH）和硝普钠（SNP）离子电渗疗法）。确定皮肤血流量的最大相对增加和总相对反应，即每个刺激的曲线下面积（AUCheat、AUCPCH、AUCSNP）。此外，计算了总结第一次峰值的时间和幅度的直角三角形的面积，该面积代表轴突反射介导的神经血管舒张（ARR）。
在健康对照组中，AUCheat、AUCPCH、AUCSNP 和 ARR 独立于性别、年龄和人体测量值。每个参数的第 10 百分位数是从健康对照组的数据中得出的，用作定义正常内皮功能的下限。与对照组相比，糖尿病患者对 SNP 的物理或药物刺激的血管舒张反应明显降低，而两组患者对 PCH 的反应相似。与对照组相比，患者：i）对热和 SNP 的血管舒张反应受损的频率明显更高，ii）血管反应在一个以上参数中被归类为病理性，且频率显著更高。
结论/解释：至少患有 1 年 1 型糖尿病的儿童 1 型糖尿病患者中，皮肤微血管内皮功能障碍已经存在于约 25%的患者中。未来的研究需要评估内皮功能障碍在这些患者长期（心血管）并发症发展中的预测价值。
