U.O.C. B. Trambusti, Giovanni XXIII Hospital, Bari, Italy.
Department of biomedicine and Human Oncology, Pediatric Section, University "A.Moro" of Bari, Bari, Italy.
Int J Cardiol. 2014 Jun 15;174(2):343-7. doi: 10.1016/j.ijcard.2014.04.115. Epub 2014 Apr 18.
Insulin resistance (IR) impairs cellular response to insulin due to a dysfunction in glucose metabolism, associated with an increased cardiovascular risk. The aim of our study was to investigate the relationship among homeostasis model assessment index (HOMA index), endothelial function and vascular morphology in order to better stratify cardiovascular risk in children and adolescents.
A total of 150 children and adolescents (55 pre-pubertal, mean age 10.4 ± 3.1 years) were enrolled. Anthropometric [body mass index (BMI), waist circumference (WC)], laboratory [blood lipids, inflammatory markers, insulinemia, glycemia], HOMA index and ultrasound parameters [flow-mediated dilatation (FMD), common carotid intima-media thickness (cIMT) and antero-posterior diameter of infra-renal abdominal aorta (APAO)] were assessed.
cIMT was positively related to age (r=0.274, p<0.01), BMI (r=0.318, p<0.01), WC (r=0.315, p<0.01) and triglycerides (r=0.230, p<0.01). APAO measurements showed a linear positive correlation with age (r=0.435, p<0.01), BMI (r=0.505, p<0.01), WC (r=0.487, p<0.01), triglycerides (r=0.280, p<0.01), C-reactive protein (r=0.209, p<0.05), fasting insulin (r=0.378, p<0.01) and HOMA index (r=0.345, p<0.01). FMD was inversely related to age (r=-0.251, p<0.01), rough BMI (r=-0.318, p<0.01), WC (r=-0.340, p<0.01), fasting insulin (r=-0.281, p<0.01) and HOMA index (r=-0.282, p<0.01). Multiple regression analysis found no influence of HOMA index on APAO and cIMT. HOMA index was an independent predictor for brachial artery FMD worsening after the statistical adjustment.
HOMA index increase induced a worsening in endothelial function since childhood.
胰岛素抵抗（IR）会导致葡萄糖代谢功能障碍，使细胞对胰岛素的反应受损，从而增加心血管风险。本研究旨在探讨稳态模型评估指数（HOMA 指数）与内皮功能和血管形态之间的关系，以便更好地对儿童和青少年的心血管风险进行分层。
共纳入 150 名儿童和青少年（55 名青春期前，平均年龄 10.4±3.1 岁）。评估了人体测量学[体重指数（BMI）、腰围（WC）]、实验室[血脂、炎症标志物、胰岛素血症、血糖]、HOMA 指数和超声参数[血流介导的舒张功能（FMD）、颈总动脉内膜-中层厚度（cIMT）和肾下腹主动脉前后直径（APAO）]。
cIMT 与年龄（r=0.274，p<0.01）、BMI（r=0.318，p<0.01）、WC（r=0.315，p<0.01）和甘油三酯（r=0.230，p<0.01）呈正相关。APAO 测量值与年龄（r=0.435，p<0.01）、BMI（r=0.505，p<0.01）、WC（r=0.487，p<0.01）、甘油三酯（r=0.280，p<0.01）、C 反应蛋白（r=0.209，p<0.05）、空腹胰岛素（r=0.378，p<0.01）和 HOMA 指数（r=0.345，p<0.01）呈线性正相关。FMD 与年龄（r=-0.251，p<0.01）、粗略 BMI（r=-0.318，p<0.01）、WC（r=-0.340，p<0.01）、空腹胰岛素（r=-0.281，p<0.01）和 HOMA 指数（r=-0.282，p<0.01）呈负相关。多元回归分析发现 HOMA 指数对 APAO 和 cIMT 无影响。在进行统计学调整后，HOMA 指数是肱动脉 FMD 恶化的独立预测因子。
HOMA 指数升高会导致儿童时期内皮功能恶化。
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