Department of Respiratory Medicine, Sydney Children's Hospital, Randwick, NSW, Australia; School of Women's and Children's Health, Medicine, The University of New South Wales, Randwick, NSW, Australia; Molecular and Integrative Cystic Fibrosis Research Centre (miCF_RC), Sydney, Australia.
School of Women's and Children's Health, Medicine, The University of New South Wales, Randwick, NSW, Australia; Molecular and Integrative Cystic Fibrosis Research Centre (miCF_RC), Sydney, Australia; Department of Gastroenterology, Sydney Children's Hospital, Randwick, NSW, Australia.
J Cyst Fibros. 2019 Nov;18(6):869-873. doi: 10.1016/j.jcf.2019.03.010. Epub 2019 Apr 26.
Children with CF are insulin deficient from infancy but very little is known about the impact of glucose abnormalities in early life. We aimed to identify and describe interstitial glucose levels in CF children <6 years and to evaluate the association with pulmonary infection and inflammation.
We assessed 18 children (5 females) with median age of 3.2 years (range 0·9-5.5) with Continuous Glucose Monitoring for 3 days. Bronchoalveolar lavage (BAL) fluid was cultured for known pathogenic microbial agents and assessed for total white blood cells, percentage of neutrophils and IL-8 level.
Peak sensor glucose (SG) was >11.1 mmol/L in 39% of participants. The percentage neutrophil count on BAL was positively correlated with elevated SG (peak SG r = 0.48, p = .044) and with glucose variability (SG standard deviation r = 0.62, β = 38.5, p = .006). BAL IL-8 level was significantly correlated with all measures of CGM hyperglycemia including % time > 7.8 mmol/L (p = .008) and standard deviation (p < .001). Participants with a history of Pseudomonas aeruginosa had a higher % time > 7.8 mmol/L glucose (16% versus 3%, p = .015).
Children with CF frequently demonstrate elevated SG levels before age 6 years, which are associated with increased pulmonary inflammation and Pseudomonas aeruginosa infection. Transient SG elevations into the diabetic range (≥11.1 mmol/L) were identified in children from 1 year of age.
患有 CF 的儿童从婴儿期就胰岛素不足，但对于生命早期葡萄糖异常的影响知之甚少。我们旨在确定和描述 CF 儿童<6 岁的间质葡萄糖水平，并评估其与肺部感染和炎症的关系。
我们评估了 18 名（5 名女性）中位年龄为 3.2 岁（范围 0·9-5.5）的儿童，他们使用连续血糖监测仪进行了 3 天的监测。对支气管肺泡灌洗液（BAL）进行了培养，以检测已知的致病微生物，并评估总白细胞数、中性粒细胞百分比和 IL-8 水平。
39%的参与者峰值传感器血糖（SG）>11.1mmol/L。BAL 中的中性粒细胞计数百分比与升高的 SG 呈正相关（峰值 SG r=0.48，p=0.044），与葡萄糖变异性（SG 标准差 r=0.62，β=38.5，p=0.006）呈正相关。BAL IL-8 水平与 CGM 高血糖的所有测量值均显著相关，包括%时间>7.8mmol/L（p=0.008）和标准差（p<0.001）。有铜绿假单胞菌感染史的参与者，%时间>7.8mmol/L 血糖的比例更高（16%比 3%，p=0.015）。
患有 CF 的儿童在 6 岁之前经常出现 SG 水平升高，这与肺部炎症和铜绿假单胞菌感染增加有关。在 1 岁的儿童中，发现了短暂的 SG 升高到糖尿病范围（≥11.1mmol/L）。
