Children's Hospital at Montefiore, Bronx, NY, USA.
Albert Einstein College of Medicine, Bronx, NY, USA.
Pediatr Rheumatol Online J. 2020 Mar 18;18(1):25. doi: 10.1186/s12969-020-0415-5.
Children with juvenile dermatomyositis (JDM), the most common inflammatory myopathy of childhood, may be at increased risk of premature atherosclerosis given a host of traditional and non-traditional risk factors. The primary aim of this study was to determine the underlying frequency of premature atherosclerosis in children with JDM compared to pediatric controls using flow-mediated dilation as a measure of endothelial function.
Children and adolescents with and without JDM were evaluated for traditional atherosclerotic risk factors and assessment of endothelial function, using Endothelial Pulse Amplitude Testing (Endo-PAT).
In this study, 75% of pediatric controls were of Black or Hispanic descent (compared to 55% in the JDM group) and 70% were found to live in a household with a medium income less than $50,000/year (compared to 45% in the JDM group). Among traditional atherogenic risk factors, lipoprotein A appeared to be different between controls and JDM patients (66 nmol/L and 16.5 nmol/L, respectively). Using a reactive hyperemia index (RHI) < 1.67 as evidence of endothelial dysfunction, 75% of controls were defined as having endothelial dysfunction compared to 50% in JDM group. When controlled for lipoprotein A as an atherogenic confounder, JDM patients were found to have a 41% increase in RHI, thus indicating less endothelial dysfunction compared to controls.
In this study, we have shown that atherogenic risk factors are present in the pediatric population and may be associated with endothelial dysfunction, even at very young ages. Despite increasing concerns that children with rheumatologic disorders may be at increased risk of developing premature atherosclerosis, traditional and sociodemographic features may play a greater role in the ultimate development of cardiovascular disease.
儿童皮肌炎（JDM）是儿童中最常见的炎症性肌病，由于存在许多传统和非传统的危险因素，儿童皮肌炎患者可能有过早发生动脉粥样硬化的风险。本研究的主要目的是通过血流介导的扩张来评估内皮功能，从而确定 JDM 患儿与儿科对照组相比，早期动脉粥样硬化的潜在频率。
评估有无 JDM 的儿童和青少年的传统动脉粥样硬化危险因素，并使用内皮脉搏幅度测试（Endo-PAT）评估内皮功能。
在这项研究中，75%的儿科对照组为黑人和西班牙裔（而 JDM 组为 55%），70%的人居住在年收入低于 50,000 美元的中等收入家庭（而 JDM 组为 45%）。在传统的动脉粥样硬化危险因素中，脂蛋白 A 似乎在对照组和 JDM 患者之间存在差异（分别为 66nmol/L 和 16.5nmol/L）。使用反应性充血指数（RHI）<1.67 作为内皮功能障碍的证据，75%的对照组被定义为内皮功能障碍，而 JDM 组为 50%。当控制脂蛋白 A 作为动脉粥样硬化混杂因素时，发现 JDM 患者的 RHI 增加了 41%，这表明与对照组相比，内皮功能障碍程度较低。
在这项研究中，我们表明，动脉粥样硬化危险因素存在于儿科人群中，并且可能与内皮功能障碍有关，即使在非常年轻的年龄。尽管越来越多的人担心风湿性疾病患儿可能有过早发生动脉粥样硬化的风险，但传统和社会人口统计学特征可能在心血管疾病的最终发展中发挥更大的作用。
