Brunvand Leif, Heier Martin, Brunborg Cathrine, Hanssen Kristian F, Fugelseth Drude, Stensaeth Knut Haakon, Dahl-Jørgensen Knut, Margeirsdottir Hanna Dis
Department of Pediatrics, Oslo University Hospital, Oslo, Norway.
Oslo Diabetes Research Centre, Oslo, Norway.
BMC Cardiovasc Disord. 2017 May 25;17(1):133. doi: 10.1186/s12872-017-0551-0.
Reduced diastolic function is an early sign of diabetes cardiomyopathy in adults and is associated with elevated levels of HbA1c and advanced glycation end products (AGEs).
To assess the associations between early reduced diastolic function and elevated levels of HbA1c and AGEs in children and adolescents with type 1 diabetes (T1D).
One hundred fourty six T1D patients (age 8-18 years) without known diabetic complications were examined with tissue Doppler imaging and stratified into two groups according to diastolic function. A clinical examination and ultrasound of the common carotid arteries were performed. Methylglyoxal-derived hydroimidazolone-1 (MG-H1) was measured by immunoassay.
At inclusion, 36 (25%) participants were stratified into a low diastolic function group (E'/A'-ratio < 2.0). Compared to the rest of the T1D children, these participants had higher body mass index (BMI), 22.8 (SD = 4.0) vs. 20.1 (SD = 3.4) kg/m, p < 0.001, higher systolic blood pressure 104.2 (SD = 8.7) vs. 99.7 (SD = 9.3) mmHg, p = 0.010, and higher diastolic blood pressure, 63.6 (SD = 8.3) vs. 59.9 (SD = 7.9) mmHg, p = 0.016. The distensibility coefficient was lower, 0.035 (SD = 0.010) vs. 0.042 (SD = 0.02) kPa, p = 0.013, Young's modulus higher, 429 (SD = 106) vs. 365 (SD = 143), p = 0.009, and MG-H1 higher, 163.9 (SD = 39.2) vs. 150.3 (SD = 33.4) U/ml, p = 0.046. There was no difference in carotid intima-media thickness between the groups. There were no associations between reduced diastolic function and years from diagnosis, HBA1c, mean HBA1c, CRP or calculated glycemic burden. Logistic regression analysis showed that BMI was an independent risk factor for E'/A'-ratio as well as a non-significant, but relatively large effect size for MG-H1, indicating a possible role for AGEs.
Early signs of reduced diastolic function in children and adolescents with T1D had higher BMI, but not higher HbA1c. They also had elevated serum levels of the advanced glycation end product MG-H1, higher blood pressure and increased stiffness of the common carotid artery, but these associations did not reach statistical significance when tested in a logistic regression model.
舒张功能降低是成人糖尿病性心肌病的早期迹象，且与糖化血红蛋白（HbA1c）水平升高及晚期糖基化终产物（AGEs）有关。
评估1型糖尿病（T1D）儿童和青少年早期舒张功能降低与HbA1c及AGEs水平升高之间的关联。
对146例无已知糖尿病并发症的T1D患者（年龄8 - 18岁）进行组织多普勒成像检查，并根据舒张功能分为两组。进行了临床检查及颈总动脉超声检查。通过免疫测定法检测甲基乙二醛衍生的氢咪唑酮-1（MG-H1）。
纳入时，36例（25%）参与者被分层至舒张功能低下组（E'/A'比值<2.0）。与其余T1D儿童相比，这些参与者的体重指数（BMI）更高，分别为22.8（标准差=4.0）与20.1（标准差=3.4）kg/m²，p<0.001；收缩压更高，分别为104.2（标准差=8.7）与99.7（标准差=9.3）mmHg，p = 0.010；舒张压更高，分别为63.6（标准差=8.3）与59.9（标准差=7.9）mmHg，p = 0.016。扩张系数更低，分别为[0.035（标准差=0.010）与0.042（标准差=0.02）kPa，p = 0.013]；杨氏模量更高，分别为429（标准差=106）与365（标准差=143），p = 0.009；MG-H1更高，分别为163.9（标准差=39.2）与150.3（标准差=33.4）U/ml，p = 0.046。两组间颈动脉内膜中层厚度无差异。舒张功能降低与诊断后的病程、HBA1c、平均HBA1c、CRP或计算得出的血糖负担之间无关联。逻辑回归分析表明，BMI是E'/A'比值的独立危险因素，对MG-H1虽无显著影响，但效应量相对较大，提示AGEs可能发挥作用。
T1D儿童和青少年舒张功能降低的早期迹象表现为BMI较高，但HbA1c不高。他们还存在晚期糖基化终产物MG-H1血清水平升高、血压升高及颈总动脉僵硬度增加的情况，但在逻辑回归模型中进行检验时，这些关联未达到统计学显著性。
