Akyol Bedir, Boyraz Mehmet, Aysoy Cevriye
Turgut Özal University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, Ankara, Turkey. E-mail:
J Clin Res Pediatr Endocrinol. 2013 Sep 10;5(3):156-63. doi: 10.4274/Jcrpe.1064.
Epicardial adipose tissue thickness (EATT) is suggested as a new cardiometabolic risk factor. Carotid intima-media thickness (IMT) is a potential indicator of subclinical atherosclerosis in patients with metabolic syndrome (MS). We investigated the association of EATT with carotid IMT and cardiac functional changes in obese adolescents with MS.
One hundred thirty-eight obese adolescents and 63 lean subjects were enrolled in the study. The obese subjects were divided into two subgroups based on the presence or absence of MS (MS group and non-MS group). All subjects underwent transthoracic echocardiographic examination for determination of left ventricular (LV) function, LV mass index (LVMI), and myocardial performance index (MPI). EATT and carotid IMT were also measured during echocardiography.
The average LVMI measurements were higher in both MS and non-MS obese patients in comparison with the lean children. The MS group had significantly higher LVMI measurements than the non-MS and lean groups (88.5±23.0, 67.5±24.8 g/m2, and 62.4±18.2 g/m2, respectively; p<0.01). Carotid IMT was higher in both the MS and non-MS obese patients in comparison with the lean group. The MS group had significantly higher carotid IMT measurements than the non-MS and lean groups (0.91±0.23, 0.78±0.18, and 0.52±0.08 mm, respectively; p<0.01). The EATT was also increased significantly in patients with MS compared to lean adolescents (7.42±1.55 vs. 4.28±0.79mm; p=0.001). EATT was positively correlated with body mass index-SDS, waist circumference, fasting glucose, insulin, homeostasis model assessment-insulin resistance, triglyceride levels, LV thickness, LVMI, and MPI in the MS obese group. EATT was the only independent predictor of carotid IMT in the multivariate analysis (β= 0.69, p<0.001).
The findings of the present study demonstrate a close relationship of EATT with carotid IMT and early cardiac dysfunction in obese adolescents with MS. Assessment of EATT and carotid IMT in routine echocardiographic examinations is suggested as a feasible and reliable method for the evaluation of obesity with MS and its related cardiovascular risks in children and adolescents.
心外膜脂肪组织厚度（EATT）被认为是一种新的心脏代谢风险因素。颈动脉内膜中层厚度（IMT）是代谢综合征（MS）患者亚临床动脉粥样硬化的潜在指标。我们研究了MS肥胖青少年中EATT与颈动脉IMT及心脏功能变化之间的关联。
138名肥胖青少年和63名瘦的受试者参与了该研究。肥胖受试者根据是否患有MS分为两个亚组（MS组和非MS组）。所有受试者均接受经胸超声心动图检查，以测定左心室（LV）功能、左心室质量指数（LVMI）和心肌性能指数（MPI）。在超声心动图检查期间还测量了EATT和颈动脉IMT。
与瘦儿童相比，MS和非MS肥胖患者的平均LVMI测量值均较高。MS组的LVMI测量值显著高于非MS组和瘦组（分别为88.5±23.0、67.5±24.8 g/m²和62.4±18.2 g/m²；p<0.01）。与瘦组相比，MS和非MS肥胖患者的颈动脉IMT均较高。MS组的颈动脉IMT测量值显著高于非MS组和瘦组（分别为0.91±0.23、0.78±0.18和0.52±0.08 mm；p<0.01）。与瘦青少年相比，MS患者的EATT也显著增加（7.42±1.55对4.28±0.79mm；p = 0.001）。在MS肥胖组中，EATT与体重指数标准差评分、腰围、空腹血糖、胰岛素、稳态模型评估-胰岛素抵抗、甘油三酯水平、LV厚度、LVMI和MPI呈正相关。在多变量分析中，EATT是颈动脉IMT的唯一独立预测因子（β = 0.69，p<0.001）。
本研究结果表明，MS肥胖青少年中EATT与颈动脉IMT及早期心脏功能障碍密切相关。建议在常规超声心动图检查中评估EATT和颈动脉IMT，作为评估儿童和青少年MS肥胖及其相关心血管风险的一种可行且可靠的方法。
