Robinson Research Institute and Discipline of Paediatrics, The University of Adelaide, Adelaide, South Australia, Australia; Endocrinology and Diabetes Centre, Women's and Children's Hospital, North Adelaide, South Australia, Australia.
Robinson Research Institute and Discipline of Paediatrics, The University of Adelaide, Adelaide, South Australia, Australia; Endocrinology and Diabetes Centre, Women's and Children's Hospital, North Adelaide, South Australia, Australia.
Can J Diabetes. 2018 Jun;42(3):276-280. doi: 10.1016/j.jcjd.2017.06.011. Epub 2017 Jul 25.
Children with type 1 diabetes have accelerated atherosclerosis with early endothelial dysfunction as measured by reduced flow-mediated dilation (FMD) at 60 seconds postischemic stress (early FMD). Delayed dilation may also occur in the presence of cardiovascular risk factors and may be a more sensitive marker. No data exist that evaluate FMD beyond 60 seconds (delayed FMD) in children with type 1 diabetes. We aimed to compare early and delayed FMD in children with type 1 diabetes and in healthy children.
We studied 66 children 13.5±2.8 years of age; 29 were males. Of the 66 children, 38 had type 1 diabetes, and 28 were healthy age- and gender-matched controls. Evaluation of brachial artery FMD was performed at 60 seconds (FMD) and 120 seconds (FMD) postischemic stress. Early FMD was defined as peak FMD and delayed FMD as peak FMD RESULTS: Children with type 1 diabetes had diabetes durations of 5.4±4.6 years and median glycated hemoglobin levels of 8.8 (6.6 to 14)% (73 [49 to 130] mmol/mol). Of the children, 8 with type 1 diabetes and 1 healthy child had delayed FMD; a relationship was seen between the prevalence of early FMD and delayed FMD in children with type 1 diabetes and healthy children, respectively (p=0.019). Children with type 1 diabetes and delayed FMD had lower FMD than children without delayed FMD (2.50±3.61 vs. 6.14±3.83 percentage units; p=0.02). Children with type 1 diabetes had lower FMD than healthy children (5.38±4.0 percentage units; p=0.03) but not FMD (7.56±3.5 percentage units; p=0.47).
Delayed FMD patterns occur in children with type 1 diabetes and detect children who have more severe vascular abnormalities. The standard FMD remains the better marker to identify children at increased risk for cardiovascular disease.
1 型糖尿病患儿存在动脉粥样硬化加速，其内皮功能障碍可通过缺血后 60 秒时的血流介导的扩张（FMD）减少来衡量（早期 FMD）。在存在心血管危险因素的情况下，可能也会发生延迟扩张，并且可能是一个更敏感的标志物。目前尚无评估 1 型糖尿病患儿 60 秒后（延迟 FMD）的 FMD 的数据。我们旨在比较 1 型糖尿病患儿和健康儿童的早期和延迟 FMD。
我们研究了 66 名年龄为 13.5±2.8 岁的儿童；其中 29 名为男性。66 名儿童中，38 名为 1 型糖尿病患儿，28 名为年龄和性别匹配的健康对照组。在缺血后 60 秒（FMD）和 120 秒（FMD）时对肱动脉 FMD 进行评估。早期 FMD 定义为 FMD 峰值，延迟 FMD 定义为 FMD 峰值。
1 型糖尿病患儿的糖尿病病程为 5.4±4.6 年，中位糖化血红蛋白水平为 8.8（6.6 至 14）%（73 [49 至 130] mmol/mol）。其中，8 名 1 型糖尿病患儿和 1 名健康儿童存在延迟 FMD；1 型糖尿病患儿和健康儿童的早期 FMD 和延迟 FMD 的发生率呈正相关（p=0.019）。患有延迟 FMD 的 1 型糖尿病患儿的 FMD 低于无延迟 FMD 的患儿（2.50±3.61 与 6.14±3.83 个百分点；p=0.02）。患有 1 型糖尿病的患儿的 FMD 低于健康儿童（5.38±4.0 个百分点；p=0.03），但 FMD 无差异（7.56±3.5 个百分点；p=0.47）。
1 型糖尿病患儿存在延迟 FMD 模式，可检测到血管异常更严重的患儿。标准 FMD 仍然是识别心血管疾病风险增加的更好标志物。
