Ribeiro Alessandra C R, Lyra Arthur, Bonfitto Alexandre J, Tostes Filho Gilmar V, Zanesco Leonardo, Fleury Eduardo F C, Ferreira Aleksandro B, Longui Carlos A, Monte Osmar, Kochi Cristiane
Department of Radiology, Santa Casa de Sao Paulo School of Medical Sciences, São Paulo, SP, Brazil.
Pediatric Endocrinology Unit, Santa Casa de Sao Paulo School of Medical Sciences, São Paulo, SP, Brazil.
J Pediatr Endocrinol Metab. 2020 Mar 26;33(3):339-345. doi: 10.1515/jpem-2019-0254.
Background The intima-media thickness of the carotid artery (cIMT) and endothelial dysfunction are associated with cardiovascular (CV) disease. Objectives To evaluate the correlation between cIMT, brachial intraluminal diameter and flow-mediated vasodilation on the reactive hyperemia phase in adolescents with obesity with predictors of CV risk. Methods Seventy-three pubertal patients with overweight or obesity were evaluated (45 girls) with a mean (standard deviation [SD]) age of 12.9 (2.5) years. Patients underwent anthropometric measurements and had the lipid profile, oral glucose tolerance test (oGTT) and serum intercellular adhesion molecule-1 (sICAM-1) levels analyzed. The ratios of the waist circumference (WC)/height (WHtR) and triglycerides (TG)/high-density lipoprotein cholesterol (HDL-C), homeostatic model assessment of insulin resistance (HOMA-IR), the Matsuda index and insulin area under the curve (AUC) were calculated. All patients were evaluated for cIMT and arterial blood flow velocity of the brachial artery. Results 75.3% of the patients had high cIMT values. We found a positive correlation between WHtR and cIMT (r = 0.233; p = 0.050). There was a positive correlation between sICAM-1 and insulin AUC (r = 0.323; p = 0.012) and WHtR (r = 0.258; p = 0.047). Patients with abnormal arterial dilation had higher sICAM-1 values (p = 0.02) despite having smaller WHtR (p = 0.046). Conclusions These adolescents with obesity had high cIMT values. Insulin resistance was associated with sICAM-1. Endothelial dysfunction was positively correlated with sICAM-1. There is no consensus about what the best laboratorial approach to evaluate insulin resistance in adolescents is, and the cutoff values of each method are arbitrary. So, as we saw earlier, the association between anthropometric data (WHtR) and ultrasound findings could be useful to evaluate the CV risk of these adolescents with obesity, because of its practical, direct and low-cost value.
颈动脉内膜中层厚度（cIMT）和内皮功能障碍与心血管（CV）疾病相关。目的：评估肥胖青少年在反应性充血期cIMT、肱动脉管腔内径和血流介导的血管舒张与心血管风险预测指标之间的相关性。方法：对73例青春期超重或肥胖患者（45例女孩）进行评估，平均（标准差[SD]）年龄为12.9（2.5）岁。对患者进行人体测量，并分析血脂谱、口服葡萄糖耐量试验（oGTT）和血清细胞间黏附分子-1（sICAM-1）水平。计算腰围（WC）/身高（WHtR）、甘油三酯（TG）/高密度脂蛋白胆固醇（HDL-C）比值、胰岛素抵抗稳态模型评估（HOMA-IR）、松田指数和胰岛素曲线下面积（AUC）。对所有患者进行cIMT和肱动脉血流速度评估。结果：75.3%的患者cIMT值较高。我们发现WHtR与cIMT之间存在正相关（r = 0.233；p = 0.050）。sICAM-1与胰岛素AUC之间存在正相关（r = 0.323；p = 0.012），与WHtR之间也存在正相关（r = 0.258；p = 0.047）。尽管WHtR较小（p = 0.046），但动脉扩张异常的患者sICAM-1值较高（p = 0.02）。结论：这些肥胖青少年cIMT值较高。胰岛素抵抗与sICAM-1相关。内皮功能障碍与sICAM-1呈正相关。对于评估青少年胰岛素抵抗的最佳实验室方法尚无共识，且每种方法的临界值都是任意的。因此，如我们之前所见，人体测量数据（WHtR）与超声检查结果之间的关联因其实用、直接和低成本的价值，可能有助于评估这些肥胖青少年的心血管风险。
