Bruzzi Patrizia, Predieri Barbara, Patianna Viviana Dora, Salvini Annamaria, Rossi Rosario, Modena Maria Grazia, Iughetti Lorenzo
Department of Pediatrics, University of Modena and Reggio Emilia, Modena, Italy.
Pediatr Int. 2014 Apr;56(2):188-95. doi: 10.1111/ped.12220. Epub 2014 Jan 28.
Type 1 diabetes (T1DM) predisposes to cardiovascular disease, increasing the risk to develop atherosclerosis. In the pediatric population, the cardiovascular risk may be evaluated examining endothelial function by a non-invasive ultrasound technique, namely flow-mediated dilation (FMD) of the brachial artery. The aims of this study were the longitudinal evaluation of the potential change in the endothelium-dependent vasomotor function in children and adolescents with T1DM and the identification of clinical and laboratory data correlated to modifications.
We studied 39 T1DM patients (20 girls and 19 boys; aged 11.2 ± 3.72 years). FMD and blood samples were obtained from all patients at baseline (time 0) and after a follow up of at least 1 year (time 1). FMD was also evaluated in 45 healthy controls (22 boys, 23 girls) aged 10.2 ± 3.05 years.
At time 0, 43.6% of T1DM patients presented an impaired FMD. FMD at time 1 revealed a dramatic impairment of endothelial function: altered FMD values were shown in 61.5% of patients and it got worse in 74.3% of them. Longitudinally, boys had a greater impairment of FMD than girls. At baseline, multivariate analysis identified only sex as significant predictor of FMD (β = 0.470, P = 0.029).
Because endothelial dysfunction appears earlier in diabetic children, they are at higher risk to develop atherosclerosis. Our results suggest the usefulness of FMD as a tool to stratify pediatric T1DM patients according to their cardiovascular risk and to follow them up longitudinally.
1型糖尿病（T1DM）易引发心血管疾病，增加动脉粥样硬化的发病风险。在儿科人群中，可通过一种非侵入性超声技术，即肱动脉血流介导的血管舒张功能（FMD）来评估心血管风险。本研究的目的是对T1DM儿童和青少年内皮依赖性血管舒缩功能的潜在变化进行纵向评估，并确定与这些变化相关的临床和实验室数据。
我们研究了39例T1DM患者（20名女孩和19名男孩；年龄11.2±3.72岁）。在基线时（时间0）以及至少随访1年后（时间1），采集所有患者的FMD数据和血样。还对45名年龄为10.2±3.05岁的健康对照者（22名男孩，23名女孩）进行了FMD评估。
在时间0时，43.6%的T1DM患者FMD受损。时间1时的FMD显示内皮功能严重受损：61.5%的患者FMD值发生改变，其中74.3%的患者病情加重。纵向来看，男孩的FMD受损程度比女孩更严重。在基线时，多变量分析仅确定性别是FMD的显著预测因素（β = 0.470，P = 0.029）。
由于糖尿病儿童内皮功能障碍出现得更早，他们发生动脉粥样硬化的风险更高。我们的结果表明，FMD作为一种工具，可根据心血管风险对儿科T1DM患者进行分层，并对他们进行纵向随访。
