Department of Paediatrics, Charité Universitätsmedizin Berlin, Berlin, Germany.
Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
Pediatr Diabetes. 2019 Dec;20(8):1118-1127. doi: 10.1111/pedi.12913. Epub 2019 Oct 2.
Inflammation is implicated in the pathogenesis of diabetes and its complications in adults. Little is known about the relative contribution of inflammation in common types of diabetes in youth: type 1 diabetes (T1D), type 2 diabetes (T2D), and cystic fibrosis-related diabetes (CFRD). This study investigates inflammatory markers by diabetes type and complication status, and assesses indicators of inflammation and complications.
A cross-sectional study of 134 T1D, 32 T2D, 32 CFRD and 48 subjects without diabetes (including 11 with CF and normal glucose tolerance) was undertaken. Inflammation was assessed by sE-selectin by ELISA, hsCRP by turbidimetry, WCC and ESR. Nephropathy was defined by albuminuria, autonomic neuropathy by heart rate variability, and peripheral neuropathy by vibration and thermal threshold testing and retinopathy by seven-field stereoscopic fundus photography. Descriptive statistics, parametric and non-parametric ANOVA and regression analyses were performed, with significance at P < .05.
Of 198 diabetic participants; 49% female, mean (SD) age, median diabetes duration and median HbA1c were 16 (2.5) and 6 (3-9) years, and 8.1 (6.9-9.3)%, respectively. All inflammatory markers were lower in T1D than in other diabetes groups (P < .05) but higher than in non-diabetic controls. T2D (n = 32) and CFRD (n = 32) subjects had comparable elevated levels of inflammation. Body mass index (BMI) was a strong independent explanatory variable of inflammation. In multivariate analysis, hsCRP and ESR were associated with complications in addition to HbA1c, BMI, and diastolic BP.
Circulating inflammatory markers are elevated in adolescents with diabetes, being higher and comparable in T2D and CFRD than in T1D. Inflammation is independently associated with diabetes complications, consistent with inflammation driving vascular pathology in diabetes.
炎症与成人糖尿病及其并发症的发病机制有关。关于炎症在青少年常见类型糖尿病（1 型糖尿病[T1D]、2 型糖尿病[T2D]和囊性纤维化相关糖尿病[CFRD]）中的相对作用知之甚少。本研究通过糖尿病类型和并发症状态调查炎症标志物，并评估炎症和并发症的指标。
对 134 例 T1D、32 例 T2D、32 例 CFRD 和 48 例无糖尿病（包括 11 例 CF 和正常糖耐量）的患者进行横断面研究。通过 ELISA 测定 sE-选择素、比浊法测定 hsCRP、WCC 和 ESR 评估炎症。白蛋白尿定义为肾病，心率变异性定义为自主神经病变，振动和热敏阈值检测定义为周围神经病变，七域立体眼底摄影定义为视网膜病变。采用描述性统计、参数和非参数 ANOVA 及回归分析，以 P<0.05 为差异有统计学意义。
198 例糖尿病患者中，女性占 49%，平均（SD）年龄、中位糖尿病病程和中位糖化血红蛋白分别为 16（2.5）、6（3-9）年和 8.1（6.9-9.3）%。与其他糖尿病组相比，T1D 患者的所有炎症标志物均较低（P<0.05），但高于非糖尿病对照组。T2D（n=32）和 CFRD（n=32）患者的炎症水平相当升高。体重指数（BMI）是炎症的一个强有力的独立解释变量。多元分析显示，除了糖化血红蛋白、BMI 和舒张压外，hsCRP 和 ESR 与并发症相关。
青少年糖尿病患者循环炎症标志物升高，T2D 和 CFRD 患者高于 T1D。炎症与糖尿病并发症独立相关，这与炎症导致糖尿病血管病变一致。
