Gökşen Damla, Levent Ertürk, Kar Sakine, Ozen Samim, Darcan Sükran
Ege University School of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey. E-mail:
J Clin Res Pediatr Endocrinol. 2013 Sep 10;5(3):174-81. doi: 10.4274/Jcrpe.1003.
Adiponectin and high-sensitivity C-reactive protein (hsCRP) can be used as early biochemical markers of cardiovascular diseases (CVDs). Radiologically, non-invasive flow-mediated dilation (FMD) of the brachial artery and carotid intima-media thickness (CIMT) measurements may be used as indicators in the early diagnosis of CVDs. To compare the biochemical markers of atherosclerosis with radiological markers of CVDs (CIMT, FMD, ventricular systolic and diastolic functions) and to assess the relationship of these parameters with metabolic control in diabetic children and adolescents.
A total of 55 patients with type 1 diabetes mellitus (T1DM) of at least 5-year duration and 30 healthy subjects were included in the study. Serum adiponectin, hsCRP, hemoglobin A1c (HbA1c), and lipid levels were evaluated in the patients and in the controls. CIMT, FMD, ventricular systolic and diastolic functions were assessed by echocardiography.
Mean age of the patients with diabetes was 17.6 years; mean diabetes duration was 10.4 years. Mean serum hsCRP was elevated in children with diabetes (0.21±0.31 vs. 0.10±0.16 μg/mL, p=0.00), while no significant difference from the controls was found in adiponectin levels. Mean CIMT was significantly higher in diabetic children compared to the control group (0.53±0.11 vs. 0.34±0.46 mm, p=0.00). Mean FMD of the diabetic children was significantly lower than that of the controls (6.86±2.85% vs. 12.13±1.99%, p=0.00). Diabetes duration was positively correlated with CIMT and negatively correlated with FMD. Right ventricular (RV) and left ventricular (LV) myocardial performance index (MPI) were higher in the patient group (p=0.00).
Our data suggest that in addition to standard echocardiography, tissue Doppler echocardiography, FMD, and CIMT can be used as early-stage radiological markers and hsCRP as an early-stage biochemical marker of atherosclerosis in the routine follow-up of T1DM patients.
脂联素和高敏C反应蛋白（hsCRP）可作为心血管疾病（CVD）的早期生化标志物。在放射学方面，肱动脉的无创血流介导的血管舒张（FMD）和颈动脉内膜中层厚度（CIMT）测量可作为CVD早期诊断的指标。比较动脉粥样硬化的生化标志物与CVD的放射学标志物（CIMT、FMD、心室收缩和舒张功能），并评估这些参数与糖尿病儿童和青少年代谢控制的关系。
本研究共纳入55例病程至少5年的1型糖尿病（T1DM）患者和30名健康受试者。对患者和对照组进行血清脂联素、hsCRP、糖化血红蛋白（HbA1c）和血脂水平评估。通过超声心动图评估CIMT、FMD、心室收缩和舒张功能。
糖尿病患者的平均年龄为17.6岁；平均糖尿病病程为10.4年。糖尿病儿童的平均血清hsCRP升高（0.21±0.31 vs. 0.10±0.16μg/mL，p = 0.00），而脂联素水平与对照组无显著差异。糖尿病儿童的平均CIMT显著高于对照组（0.53±0.11 vs. 0.34±0.46mm，p = 0.00）。糖尿病儿童的平均FMD显著低于对照组（6.86±2.85% vs. 12.13±1.99%，p = 0.00）。糖尿病病程与CIMT呈正相关，与FMD呈负相关。患者组的右心室（RV）和左心室（LV）心肌性能指数（MPI）较高（p = 0.00）。
我们的数据表明，在T1DM患者的常规随访中，除了标准超声心动图外，组织多普勒超声心动图、FMD和CIMT可作为动脉粥样硬化早期放射学标志物，hsCRP可作为早期生化标志物。
