Babar Ghufran, Clements Mark, Dai Hongying, Raghuveer Geetha
Children's Mercy Hospitals and Clinics, Kansas City, MO, USA.
J Pediatr Endocrinol Metab. 2019 Feb 25;32(2):109-113. doi: 10.1515/jpem-2018-0192.
Background Type-1 diabetes mellitus (T1DM) causes endothelial dysfunction and early atherosclerosis, which can result in premature coronary artery disease. The aim of this study was to determine the impact of glycemic control, vascular oxidative stress and inflammation on vascular health in adolescents with T1DM. Methods This was a cross-sectional study in adolescents with age- and sex-matched T1DM who were ≥12 years and were at least 2 years post-diagnosis. Recruitment was balanced to include individuals with hemoglobin A1c (HbA1c) ≤8.5% (n=27) or with HbA1c ≥9.5% (n=25). Biomarkers of inflammation were measured in the blood including C-reactive protein (CRP), interleukin-6 (IL-6), intercellular adhesion molecule-1 (ICAM-1), E-selectin, fibrinogen and tumor necrosis factor-α (TNF-α). Carotid intima media thickness (cIMT) and peripheral arterial tonometry (PAT) were assessed. Results Plasma E-selectin level was significantly different between the two groups with higher levels in the group with HbA1c ≥9.5% (65.0±27.7 ng/mL vs. 48.8±21.5 ng/mL, p=0.02). Though cIMT and PAT were not significantly different between the groups, Pearson correlation showed a significant direct relationship between rising HbA1c and mean right cIMT (p=0.02; r=0.37), PAT (p=0.03, r=0.31) and fibrinogen (p=0.03, r=0.03). Conclusions Elevated E-selectin level is an early marker of oxidative stress in T1DM patients with an elevated HbA1c level. Suboptimal glycemic control as evidenced by a rising HbA1c causes early atherosclerosis.
背景 1 型糖尿病（T1DM）可导致内皮功能障碍和早期动脉粥样硬化，进而引发早发性冠状动脉疾病。本研究旨在确定血糖控制、血管氧化应激和炎症对 T1DM 青少年血管健康的影响。方法 这是一项横断面研究，研究对象为年龄和性别匹配、年龄≥12 岁且确诊至少 2 年的 T1DM 青少年。招募过程中进行了平衡，纳入糖化血红蛋白（HbA1c）≤8.5%的个体（n = 27）或 HbA1c≥9.5%的个体（n = 25）。检测血液中的炎症生物标志物，包括 C 反应蛋白（CRP）、白细胞介素-6（IL-6）、细胞间黏附分子-1（ICAM-1）、E 选择素、纤维蛋白原和肿瘤坏死因子-α（TNF-α）。评估颈动脉内膜中层厚度（cIMT）和外周动脉张力测定（PAT）。结果 两组之间血浆 E 选择素水平存在显著差异，HbA1c≥9.5%组的水平更高（65.0±27.7 ng/mL 对 48.8±21.5 ng/mL，p = 0.02）。尽管两组之间 cIMT 和 PAT 无显著差异，但 Pearson 相关性分析显示，HbA1c 升高与右侧平均 cIMT（p = 0.02；r = 0.37）、PAT（p = 0.03，r = 0.31）和纤维蛋白原（p = 0.03，r = 0.03）之间存在显著的直接关系。结论 E 选择素水平升高是 HbA1c 水平升高的 T1DM 患者氧化应激的早期标志物。HbA1c 升高所证明的血糖控制不佳会导致早期动脉粥样硬化。
