Kim Mimi S, Dao-Tran Anh, Davidowitz Elana, Tseng Teresa, Gilsanz Vicente, Ryabets-Lienhard Anna, Nguyen Eugene, Geffner Mitchell E
Division of Endocrinology, Diabetes, and Metabolism, Children's Hospital Los Angeles, Los Angeles, Calif., USA.
Horm Res Paediatr. 2016;85(4):242-9. doi: 10.1159/000444169. Epub 2016 Mar 3.
BACKGROUND/AIMS: Youth with congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency develop cardiovascular disease (CVD) risk factors of obesity and hypertension. Carotid intima-media thickness (CIMT), a marker of CVD risk, is increased in CAH young adults. We examined CIMT and its relationship with androgens and obesity in adolescents/young adults with CAH.
Twenty CAH subjects (age 16 ± 3.3 years, 50% female) and 20 matched controls were studied cross-sectionally. Eight additional obese patients with CAH were included in within-group comparisons. CIMT by high-resolution ultrasound, androgens, anthropometry, bone age (BA), and metabolic/inflammatory markers were assessed.
Within the CAH group, CIMT correlated with 17-hydroxyprogesterone (r = 0.48, p < 0.05) and androstenedione (r = 0.46, p < 0.05), and was greater in obese subjects. CIMT was greater in CAH males than females, but similar among CAH females with advanced BA, CAH males with normal BA, and control males. There was no difference in CIMT between CAH and controls, although high-density lipoprotein was inversely correlated with CIMT in both groups.
CIMT is associated with increased androgens in CAH adolescents and young adults, with loss of sex differences in CAH females with excess androgen exposure. Our findings highlight the importance of hormonal control for CVD prevention in CAH.
背景/目的：因21-羟化酶缺乏导致先天性肾上腺皮质增生（CAH）的青少年会出现肥胖和高血压等心血管疾病（CVD）风险因素。作为CVD风险标志物的颈动脉内膜中层厚度（CIMT）在CAH青年成人中有所增加。我们研究了CAH青少年/青年成人的CIMT及其与雄激素和肥胖的关系。
对20名CAH受试者（年龄16±3.3岁，50%为女性）和20名匹配的对照者进行横断面研究。另外8名肥胖的CAH患者纳入组内比较。通过高分辨率超声评估CIMT、雄激素、人体测量学指标、骨龄（BA）以及代谢/炎症标志物。
在CAH组中，CIMT与17-羟孕酮（r = 0.48，p < 0.05）和雄烯二酮（r = 0.46，p < 0.05）相关，且在肥胖受试者中更高。CAH男性的CIMT大于女性，但在BA提前的CAH女性、BA正常的CAH男性和对照男性中相似。CAH组和对照组之间的CIMT没有差异，尽管两组中高密度脂蛋白均与CIMT呈负相关。
CIMT与CAH青少年和青年成人雄激素增加有关，在雄激素暴露过多的CAH女性中性别差异消失。我们的研究结果突出了激素控制对CAH患者预防CVD的重要性。
