Pelham James Heath, Hanks Lynae, Aslibekyan Stella, Dowla Shima, Ashraf Ambika P
Univerisity of Alabama School of Medicine, University of Alabama at Birmingham, 1720 2nd Ave South, Birmingham, AL 35294-0113, United States.
Department of Pediatrics/Division of Pediatric Endocrinology and Metabolism, Children's of Alabama, University of Alabama at Birmingham, CPPII M30, 1601 4th Ave S, Birmingham, AL 35233, United States.
J Clin Transl Endocrinol. 2018 Nov 30;15:30-34. doi: 10.1016/j.jcte.2018.11.006. eCollection 2019 Mar.
Significant knowledge gaps exist regarding lipoprotein profiles in children with type 2 diabetes mellitus (T2DM). The primary objective was to analyze the type and nature of lipoprotein abnormalities present in children with T2DM and to identify determinants of adverse lipoprotein profiles. The secondary objective was to assess associations with elevated glycated hemoglobin (HbA1C), i.e., <8% vs. ≥8.0% and pediatric dyslipidemias in the setting of T2DM.
This retrospective chart review included children with T2DM who had undergone lipoprotein analysis and were not on lipid lowering medications (n = 93).
The participants (mean age 15.2 ± 2.7y) were 71% female and 78% African American (AA). Adjusted for age, sex, and race, BMI z-score was positively associated with LDL-pattern B (pro-atherogenic profile with small dense LDL particles) (P = 0.01), and negatively associated with total HDL-C (P = 0.0003). HbA1C was robustly positively associated with the LDL-C, apoB and LDL pattern B (all P < 0.001). Patients with an HbA1C >8% had significantly higher total cholesterol (191.4 vs. 158.1 mg/dL, = 0.0004), LDL-C (117.77 vs. 92.3 mg/dL, = 0.002), apoB (99.5 vs. 80.9 mg/dL, = 0.002), non-HDL-C (141.5 vs. 112.5, = 0.002), and frequency of LDL pattern B (57% vs. 20%, = 0.0008).
HbA1C and BMI were associated with adverse lipoprotein profiles, and may represent two major modifiable cardiovascular risk factors in the pediatric T2DM population. Patients with an HbA1C higher than 8.0% had significantly worse atherogenic lipid profile, i.e., higher LDL-C, non-HDL-C, apoB and LDL pattern B, suggesting adequate glycemia may improve adverse lipoprotein profiles.
关于2型糖尿病（T2DM）患儿的脂蛋白谱存在重大知识空白。主要目标是分析T2DM患儿中存在的脂蛋白异常的类型和性质，并确定不良脂蛋白谱的决定因素。次要目标是评估糖化血红蛋白（HbA1C）升高（即<8%与≥8.0%）与T2DM背景下儿童血脂异常之间的关联。
这项回顾性病历审查纳入了接受脂蛋白分析且未服用降脂药物的T2DM患儿（n = 93）。
参与者（平均年龄15.2±2.7岁）中71%为女性，78%为非裔美国人（AA）。校正年龄、性别和种族后，BMI z评分与LDL模式B（具有小而密LDL颗粒的促动脉粥样硬化谱）呈正相关（P = 0.01），与总HDL-C呈负相关（P = 0.0003）。HbA1C与LDL-C、载脂蛋白B和LDL模式B呈显著正相关（所有P < 0.001）。HbA1C>8%的患者总胆固醇（191.4对158.1mg/dL， = 0.0004）、LDL-C（117.77对92.3mg/dL， = 0.002）、载脂蛋白B（99.5对80.9mg/dL, = 0.002）、非HDL-C（141.5对112.5, = 0.002）以及LDL模式B的频率（57%对20%， = 0.0008）显著更高。
HbA1C和BMI与不良脂蛋白谱相关，可能是儿童T2DM人群中两个主要的可改变心血管危险因素。HbA1C高于8.0%的患者动脉粥样硬化血脂谱明显更差即LDL-C、非HDL-C、载脂蛋白B和LDL模式B更高提示血糖控制良好可能改善不良脂蛋白谱。
