1型糖尿病青少年中，主动脉应变和扩张性降低的磁共振成像测量结果与胰岛素抵抗成正比。
Magnetic resonance imaging measures of decreased aortic strain and distensibility are proportionate to insulin resistance in adolescents with type 1 diabetes mellitus.
作者信息
McCulloch Michael A, Mauras Nelly, Canas Jose A, Hossain Jobayer, Sikes Kaitlin M, Damaso Ligeia C, Redheuil Alban, Ross Judith L, Gidding Samuel S
机构信息
Nemours Cardiac Center, AI duPont Hospital for Children, Wilmington, DE, USA.
出版信息
Pediatr Diabetes. 2015 Mar;16(2):90-7. doi: 10.1111/pedi.12241. Epub 2014 Dec 18.
OBJECTIVES
To determine whether children with type 1 diabetes mellitus (T1DM) have evidence of increased aortic stiffness or early atherosclerosis as measured by magnetic resonance imaging (MRI).
BACKGROUND
T1DM increases risk for cardiovascular disease in adults but whether this process starts in childhood is unknown.
SUBJECTS
A total of 54 T1DM patients (15.4 ± 2.6 yr) and 30 age-matched controls (14.8 ± 2.7 yr) participated.
METHODS
MRI was performed to assess aortic arch pulse wave velocity (PWV), strain, and distensibility of the ascending and descending thoracic aorta and measures of atherosclerosis.
RESULTS
Groups were well-matched for age, pulse pressure, and gender. Low-density lipoprotein-cholesterol (LDL-C) was higher in T1DM (119.3 ± 50 vs. 76.1 ± 13.5 mg/dL, p < 0.0001). There was a trend toward decreased strain and distensibility in T1DM vs. controls in the ascending (distensibility: T1DM 62.2 ± 19.9 kPa⁻¹ × 10⁻³, control 71.6 ± 26.4 kPa⁻¹ × 10⁻³, p = 0.08) and descending aorta (strain: T1DM 25.8 ± 6.2% vs. control 28.3 ± 6.8%, p = 0.09). There was no difference in arch PWV. Advancing age and male gender was negatively associated with aortic stiffness. Hemoglobin A1c (HbA1c) was inversely related to descending aorta strain and distensibility (p < 0.05). Children with diabetes in the lowest two tertiles of insulin sensitivity demonstrated thoracic descending aortas with significantly lower strain (p = 0.027) and distensibility (p = 0.039) and increased measures of wall irregularity (p = 0.005). There were no differences in measurements of atherosclerosis between the two groups.
CONCLUSIONS
Adolescents with T1DM, especially those with lower insulin sensitivity, demonstrated a trend toward stiffer, less compliant thoracic aortas, which was inversely associated with diabetes control. These data suggest large vessel aortopathy starts early in T1DM.
目的
通过磁共振成像（MRI）测定1型糖尿病（T1DM）患儿是否有主动脉僵硬度增加或早期动脉粥样硬化的证据。
背景
T1DM会增加成人患心血管疾病的风险，但该过程是否始于儿童期尚不清楚。
研究对象
共有54例T1DM患者（15.4±2.6岁）和30例年龄匹配的对照者（14.8±2.7岁）参与研究。
方法
采用MRI评估主动脉弓脉搏波速度（PWV）、应变以及升主动脉和降主动脉的扩张性，并测量动脉粥样硬化情况。
结果
两组在年龄、脉压和性别方面匹配良好。T1DM患者的低密度脂蛋白胆固醇（LDL-C）水平较高（119.3±50 vs. 76.1±13.5mg/dL，p<0.0001）。与对照组相比，T1DM患者升主动脉（扩张性：T1DM 62.2±19.9kPa⁻¹×10⁻³，对照组71.6±26.4kPa⁻¹×10⁻³，p=0.08）和降主动脉（应变：T1DM 25.8±6.2% vs.对照组28.3±6.8%，p=0.09）的应变和扩张性有降低趋势。主动脉弓PWV无差异。年龄增长和男性与主动脉僵硬度呈负相关。糖化血红蛋白（HbA1c）与降主动脉应变和扩张性呈负相关（p<0.05）。胰岛素敏感性处于最低两个三分位数的糖尿病患儿，其胸降主动脉的应变（p=0.027）和扩张性（p=0.039）显著降低，血管壁不规则性测量值增加（p=0.005）。两组间动脉粥样硬化测量值无差异。
结论
T1DM青少年，尤其是胰岛素敏感性较低者，其胸主动脉有僵硬度增加、顺应性降低的趋势，且与糖尿病控制呈负相关。这些数据表明T1DM患者的大血管病变始于早期。
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