Mahmoud Samia Salah El-Din, Ismail Nagwa Abdallah, Farag Yomna Mohamed, Hashem Rania Hamdy, Ibrahim Mona Hamed, Salah Mohab Mohamed, Tous Andrew Nasif
Department of Pediatrics, Cairo University, Cairo, Egypt.
Department of Pediatrics, National Research Centre, Dokki, Egypt.
Arch Med Sci Atheroscler Dis. 2018 Aug 7;3:e106-e111. doi: 10.5114/amsad.2018.77545. eCollection 2018.
Familial Mediterranean fever (FMF) is an autosomal recessive disease. It is characterized by recurrent crises of fever and serosal inflammation. Although FMF patients are symptom free in between attacks, subclinical inflammation continues during the attack-free period. Such patients with inflammatory status have an increased risk of atherosclerotic cardiovascular complications. We attempted to elucidate the role of arterial wall thickening as a predictor of early atherosclerosis in children affected by FMF and to clarify the links between carotid intima media thickness and the markers of subclinical inflammation serum amyloid A (SAA), erythrocyte sedimentation rate (ESR), neutrophil-to-lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR).
It is a case control study. The study comprised 45 Egyptian children diagnosed with FMF and 45 healthy children of matched age and sex who served as controls, without family history or clinical manifestations suggestive of FMF. Laboratory investigations included complete blood count, NLR, PLR, ESR, C-reactive protein and lipid profile. Serum amyloid A levels were determined in both groups using enzyme linked immunosorbent assay. Assessment of the common carotid artery intima media thickness (CIMT) in the FMF patients was carried out.
The level of SAA was significantly higher in patients than the control subjects with a mean value of 38.30 ng/ml and 23.43 ng/ml respectively ( < 0.001). Our patients showed significantly higher PLR when compared to controls ( < 0.001). The mean right and left carotid intima media thickness in patient and control groups showed a highly significant difference ( = 0.005 and 0.036 respectively).
The mean carotid intima media thickness is higher in cases than the control group. Hence carotid intima media thickness may be used as a tool in the prediction of any atherosclerotic burden in those children.
家族性地中海热（FMF）是一种常染色体隐性疾病。其特征为发热和浆膜炎症反复发作。尽管FMF患者在发作间期无症状，但在无发作期仍存在亚临床炎症。处于这种炎症状态的患者发生动脉粥样硬化性心血管并发症的风险增加。我们试图阐明动脉壁增厚在FMF患儿早期动脉粥样硬化预测中的作用，并明确颈动脉内膜中层厚度与亚临床炎症标志物血清淀粉样蛋白A（SAA）、红细胞沉降率（ESR）、中性粒细胞与淋巴细胞比值（NLR）及血小板与淋巴细胞比值（PLR）之间的联系。
这是一项病例对照研究。该研究纳入45名诊断为FMF的埃及儿童以及45名年龄和性别匹配的健康儿童作为对照，这些对照儿童无家族病史或提示FMF的临床表现。实验室检查包括全血细胞计数、NLR、PLR、ESR、C反应蛋白和血脂谱。两组均采用酶联免疫吸附测定法测定血清淀粉样蛋白A水平。对FMF患者的颈总动脉内膜中层厚度（CIMT）进行评估。
患者组SAA水平显著高于对照组，均值分别为38.30 ng/ml和23.43 ng/ml（<0.001）。与对照组相比，我们的患者PLR显著更高（<0.001）。患者组和对照组的右侧和左侧颈动脉内膜中层平均厚度显示出高度显著差异（分别为=0.005和0.036）。
病例组的颈动脉内膜中层平均厚度高于对照组。因此，颈动脉内膜中层厚度可作为预测这些儿童动脉粥样硬化负担的一种工具。
