Zhang Ying, Zhang Han, Li Pin
Department of Endocrinology, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, China.
Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, China.
J Pediatr Endocrinol Metab. 2019 Jul 26;32(7):699-705. doi: 10.1515/jpem-2018-0382.
Objective Cardiovascular disease is a major complication among children with type 1 diabetes mellitus (T1DM). This prospective study aimed at examining the presence of cardiovascular risk factors in children with T1DM. Methods We evaluated several cardiovascular risk factors, including atherosclerosis, artery intima-media thickness (IMT) and metabolic responses, in 175 children with T1DM, with 150 non-diabetic children as normal controls. Results The diabetic children had significantly higher carotid IMT (cIMT) and aortic IMT (aIMT), higher values for diastolic wall stress (DWS), incremental elastic modulus (IEM), and flow-mediated dilatation (FMD) than the controls. The levels of tumor necrosis factor-α (TNF-α), interleukin-4 (IL4), high-sensitivity C-reactive protein (hs-CRP) and leptin were significantly higher in T1DM patients. In T1DM children, the cIMT and aIMT were correlated with several risk factors, including age, weight, body mass index (BMI), duration of diabetes, waist/hip ratio, as well as levels of total cholesterol, triglycerides and apolipoprotein B (apoB). In addition to common risk factors, cIMT was also associated with systolic blood pressure (BP). Other risk factors, such as height, diastolic BP, low-density lipoprotein (LDL)/high-density lipoprotein (HDL)-cholesterol ratio, apolipoprotein A1 (apoA1) and S-creatinine levels, were not all independent risk factors of cardiovascular disease in T1DM children. Conclusions T1DM is associated with early impairment of the common carotid and aortic artery structure and function, and the diabetic state may be the main risk factor for arterial wall stiffening and thickening.
目的 心血管疾病是1型糖尿病（T1DM）患儿的主要并发症。本前瞻性研究旨在检查T1DM患儿心血管危险因素的存在情况。方法 我们评估了175例T1DM患儿的多种心血管危险因素，包括动脉粥样硬化、动脉内膜中层厚度（IMT）和代谢反应，以150例非糖尿病患儿作为正常对照。结果 糖尿病患儿的颈动脉IMT（cIMT）和主动脉IMT（aIMT）显著高于对照组，舒张期壁应力（DWS）、增量弹性模量（IEM）和血流介导的扩张（FMD）值也更高。T1DM患者的肿瘤坏死因子-α（TNF-α）、白细胞介素-4（IL4）、高敏C反应蛋白（hs-CRP）和瘦素水平显著更高。在T1DM患儿中，cIMT和aIMT与多种危险因素相关，包括年龄、体重、体重指数（BMI）、糖尿病病程、腰臀比以及总胆固醇、甘油三酯和载脂蛋白B（apoB）水平。除常见危险因素外，cIMT还与收缩压（BP）相关。其他危险因素，如身高、舒张压、低密度脂蛋白（LDL）/高密度脂蛋白（HDL）胆固醇比值、载脂蛋白A1（apoA1）和血肌酐水平，并非都是T1DM患儿心血管疾病的独立危险因素。结论 T1DM与颈总动脉和主动脉结构及功能的早期损害相关，糖尿病状态可能是动脉壁僵硬和增厚的主要危险因素。
