Şiraz Ülkü Gül, Doğan Murat, Hatipoğlu Nihal, Muhtaroğlu Sabahattin, Kurtoğlu Selim
Erciyes University Faculty of Medicine, Department of Pediatric Endocrinology, Kayseri, Turkey.
Erciyes University Faculty of Medicine, Department of Biochemistry, Kayseri, Turkey.
J Clin Res Pediatr Endocrinol. 2017 Dec 15;9(4):293-299. doi: 10.4274/jcrpe.4532. Epub 2017 May 22.
Metabolic impairment in type 1 diabetes mellitus (T1DM) with poor glycemic control causes insulin resistance, non-alcoholic fatty liver disease (NAFLD), atherosclerosis, and increased carotid intima-media thickness (CIMT). Fetuin-A has a protective effect in cardiovascular disorders and is increased in hepatosteatosis. We aimed to investigate the reliability of fetuin-A levels in early detection of diabetic complications in children with T1DM and to identify a cut-off value that may show poor metabolic control.
The study included 80 patients who had T1DM for at least 5 years and who had no chronic complications or an auto-immune disorder. Blood samples were drawn to measure hemoglobin A1c (HbA1c), biochemical parameters, and fetuin-A levels. Anthropometric parameters were also measured. Percent body fat was calculated. Hepatosteatosis and CIMT were assessed by sonography.
Mean age of the patients was 13.5 years. Grade 1 hepatosteatosis was detected in 10%. Patients were stratified into 2 groups based on presence of NAFLD. Fetuin-A level was increased in patients with NAFLD. We identified a fetuin-A cut-off value (514.28 ng/mL; sensitivity: 47.34; specificity: 96.72) that may predict NAFLD. HbA1c and total cholesterol levels were found to be higher in patients with fetuin-A levels above higher the cut-off value.
Fetuin-A is a reliable parameter in the prediction of complications and poor glycemic control in patients with T1DM.
1型糖尿病（T1DM）患者若血糖控制不佳，其代谢功能受损会导致胰岛素抵抗、非酒精性脂肪性肝病（NAFLD）、动脉粥样硬化以及颈动脉内膜中层厚度（CIMT）增加。胎球蛋白A在心血管疾病中具有保护作用，且在肝脂肪变性时会升高。我们旨在研究胎球蛋白A水平在早期检测T1DM儿童糖尿病并发症中的可靠性，并确定一个可能表明代谢控制不佳的临界值。
该研究纳入了80例患有T1DM至少5年且无慢性并发症或自身免疫性疾病的患者。采集血样以测量糖化血红蛋白（HbA1c）、生化参数和胎球蛋白A水平。还测量了人体测量参数。计算体脂百分比。通过超声检查评估肝脂肪变性和CIMT。
患者的平均年龄为13.5岁。10%的患者检测出1级肝脂肪变性。根据是否存在NAFLD将患者分为2组。NAFLD患者的胎球蛋白A水平升高。我们确定了一个可能预测NAFLD的胎球蛋白A临界值（514.28 ng/mL；敏感性：47.34；特异性：96.72）。发现胎球蛋白A水平高于临界值的患者，其HbA1c和总胆固醇水平更高。
胎球蛋白A是预测T1DM患者并发症和血糖控制不佳的可靠参数。
