Cho Y H, Craig M E, Januszewski A S, Benitez-Aguirre P, Hing S, Jenkins A J, Donaghue K C
Institute of Endocrinology and Diabetes, Children's Hospital at Westmead, Westmead, Australia.
Discipline of Child and Adolescent Health, University of Sydney, Westmead, Australia.
Diabet Med. 2017 Apr;34(4):543-550. doi: 10.1111/dme.13280. Epub 2016 Nov 18.
To test the hypothesis that non-invasive skin autofluorescence, a measure of advanced glycation end products, would provide a surrogate measure of long-term glycaemia and be associated with early markers of microvascular complications in adolescents with Type 1 diabetes.
Forearm skin autofluorescence (arbitrary units) was measured in a cross-sectional study of 135 adolescents with Type 1 diabetes [mean ± sd age 15.6 ± 2.1 years, diabetes duration 8.7 ± 3.5 years, HbA 72 ± 16 mmol/mol (8.7 ± 1.5%)]. Retinopathy, assessed using seven-field stereoscopic fundal photography, was defined as ≥1 microaneurysm or haemorrhage. Cardiac autonomic function was measured by standard deviation of consecutive RR intervals on a 10-min continuous electrocardiogram recording, as a measure of heart rate variability.
Skin autofluorescence was significantly associated with age (R = 0.15; P < 0.001). Age- and gender-adjusted skin autofluorescence was associated with concurrent HbA (R = 0.32; P < 0.001) and HbA over the previous 2.5-10 years (R = 0.34-0.43; P < 0.002). Age- and gender-adjusted mean skin autofluorescence was higher in adolescents with retinopathy vs those without retinopathy [mean 1.38 (95% CI 1.29, 1.48) vs 1.22 (95% CI 1.17, 1.26) arbitrary units; P = 0.002]. In multivariable analysis, retinopathy was significantly associated with skin autofluorescence, adjusted for duration (R = 0.19; P = 0.03). Cardiac autonomic dysfunction was also independently associated with skin autofluorescence (R = 0.11; P = 0.006).
Higher skin autofluorescence is associated with retinopathy and cardiac autonomic dysfunction in adolescents with Type 1 diabetes. The relationship between skin autofluorescence and previous glycaemia may provide insight into metabolic memory. Longitudinal studies will determine the utility of skin autofluorescence as a non-invasive screening tool to predict future microvascular complications.
检验以下假设，即作为晚期糖基化终产物指标的非侵入性皮肤自发荧光，可作为长期血糖水平的替代指标，并与1型糖尿病青少年微血管并发症的早期标志物相关。
在一项横断面研究中，对135名1型糖尿病青少年[平均±标准差年龄15.6±2.1岁，糖尿病病程8.7±3.5年，糖化血红蛋白72±16 mmol/mol（8.7±1.5%）]测量前臂皮肤自发荧光（任意单位）。使用七视野立体眼底照相术评估视网膜病变，定义为≥1个微动脉瘤或出血。通过10分钟连续心电图记录中连续RR间期的标准差测量心脏自主神经功能，作为心率变异性的指标。
皮肤自发荧光与年龄显著相关（R = 0.15；P < 0.001）。经年龄和性别调整后的皮肤自发荧光与同期糖化血红蛋白相关（R = 0.32；P < 0.001），以及与过去2.5至10年的糖化血红蛋白相关（R = 0.34 - 0.43；P < 0.002）。与无视网膜病变的青少年相比，有视网膜病变的青少年经年龄和性别调整后的平均皮肤自发荧光更高[平均1.38（95%置信区间1.29，1.48）对1.22（95%置信区间1.17，1.26）任意单位；P = 0.002]。在多变量分析中，经病程调整后，视网膜病变与皮肤自发荧光显著相关（R = 0.19；P = 0.03）。心脏自主神经功能障碍也与皮肤自发荧光独立相关（R = 0.11；P = 0.006）。
1型糖尿病青少年中较高的皮肤自发荧光与视网膜病变和心脏自主神经功能障碍相关。皮肤自发荧光与既往血糖水平之间的关系可能有助于深入了解代谢记忆。纵向研究将确定皮肤自发荧光作为预测未来微血管并发症的非侵入性筛查工具的效用。
