Klonowska Bożenna, Charemska Dorota, Jabłońska Jolanta, Banach Agnieszka, Kącka Anna, Szynkarczuk Edyta, Konopka Malwina, Jarocka-Cyrta Elżbieta, Załuski Dariusz, Głowińska-Olszewska Barbara
Department of Clinical Pediatrics, Faculty of Medical Sciences, University of Warmia and Mazury in Olsztyn, Provincial Specialist Children's Hospital, Olsztyn, Poland.
Department of Plant Breeding and Seed Production, University of Warmia and Mazury in Olsztyn.
Pediatr Endocrinol Diabetes Metab. 2016;22(3). doi: 10.18544/PEDM-22.03.0057.
Atherosclerosis, which is the cause of diseases of the cardiovascular system, and frequent and serious complications of type 1 diabetes (T1DM), has an autoimmune origin. Some diseases of this type, as rheumatoid arthritis, but also Hashimoto thyroiditis or celiac disease are associated with a higher incidence of heart disease. So far no studies evaluated the preclinical phase of development of atherosclerosis (cIMT) in young patients with T1DM and the comorbid additional autoimmune diseases.
was evaluation of cIMT (carotid intima media thickness) carotid arteries and the risk factors of atherosclerosis in young patients with type 1 diabetes according to the comorbid autoimmune diseases and a comparison group of patients with known vascular complications and a group of healthy people.
The study involved a group of 90 adolescents and young adults with T1DM in middle age 17,1±3years, with an average disease duration of 10,5±3,3 years. Diabetes patients were divided into 4 groups - diabetes without complications - C, diabetes with celiac disease - CC, diabetes with Hashimoto's thyroiditis - CH, diabetes with vascular complications - CN. The control group (K) consisted of 22 healthy age-matched volunteers. In statistical analysis rated: average A1C of all the years of illness, BMI, blood pressure, lipid values, duration of illness, presence of diabetes complications, daily insulin dose and cIMT thickness of the common carotid artery.
cIMT of T1DM patients was significantly higher: 0,470 mm than in healthy: 0,409 mm. In the group with vascular complications of diabetes was found the highest rate of cIMT: 0,501 mm in comparison to the group of diabetes without complications: 0,462 mm, diabetes with celiac disease: 0,462 mm, and diabetes with Hashimoto's thyroiditis: 0,453 mm. HbA1c was highest in the group CN: 9,84±1,5%, compared to CH: 9,04± 1,2%, CC: 8,84±1,8% and C without complications: 8,55±1,2%. BMI was highest in the group CN: 23,3± 4,4kg/m2and CH: 22,6 ± 2,4 kg/m2. It was the same with waist circumference: CN: 79,33± 9,39and CH: 79,2 ± 9,56 cm. Patients with vascular complications were characterized by the higher value of blood pressure and lipids compared to patients with additional autoimmune disease. Coexistence of celiac disease was not associated with a greater value of cIMT and cardiovascular risk factors in young patients with type 1 diabetes.
动脉粥样硬化是心血管系统疾病以及1型糖尿病（T1DM）常见且严重并发症的病因，具有自身免疫起源。这类疾病中的一些，如类风湿性关节炎，还有桥本甲状腺炎或乳糜泻，都与心脏病的较高发病率相关。到目前为止，尚无研究评估T1DM年轻患者以及合并其他自身免疫性疾病时动脉粥样硬化（颈动脉内膜中层厚度，cIMT）的临床前期发展情况。
根据合并的自身免疫性疾病，评估1型糖尿病年轻患者颈动脉的cIMT（颈动脉内膜中层厚度）以及动脉粥样硬化的危险因素，并与已知血管并发症患者组和健康人群组进行比较。
该研究纳入了一组90名青少年和青年T1DM患者，平均年龄17.1±3岁，平均病程10.5±3.3年。糖尿病患者分为4组——无并发症糖尿病组（C组）、合并乳糜泻糖尿病组（CC组）、合并桥本甲状腺炎糖尿病组（CH组）、合并血管并发症糖尿病组（CN组）。对照组（K组）由22名年龄匹配的健康志愿者组成。在统计分析中评估了：所有患病年份的平均糖化血红蛋白（A1C）、体重指数（BMI）、血压值、血脂值、病程、糖尿病并发症的存在情况、每日胰岛素剂量以及颈总动脉的cIMT厚度。
T1DM患者的cIMT显著高于健康人：分别为0.470毫米和0.409毫米。在糖尿病合并血管并发症组中发现cIMT率最高：为0.501毫米，相比之下，无并发症糖尿病组为0.462毫米，合并乳糜泻糖尿病组为0.462毫米，合并桥本甲状腺炎糖尿病组为0.453毫米。糖化血红蛋白（HbA1c）在CN组中最高：为9.84±1.5%，相比之下，CH组为9.04±1.2%，CC组为8.84±1.8%，无并发症C组为8.55±1.2%。BMI在CN组中最高：为23.3±4.4千克/平方米，CH组为22.6±2.4千克/平方米。腰围情况相同：CN组为79.33±9.39，CH组为79.2±9.56厘米。与合并其他自身免疫性疾病的患者相比，合并血管并发症的患者血压和血脂值更高。乳糜泻的共存与1型糖尿病年轻患者中更高的cIMT值和心血管危险因素无关。
