Kochummen Elna, Umpaichitra Vatcharapan, Marwa Albara, Joshi Krittika, Chin Vivian L, Perez-Colon Sheila
Department of Pediatrics, Division of Pediatric Endocrinolology, SUNY Downstate Medical Center, New York, United States.
Department of Pediatrics, SUNY Downstate Medical Center, New York, United States.
Int J Endocrinol Metab. 2019 Dec 29;18(1):e90094. doi: 10.5812/ijem.90094. eCollection 2020 Jan.
Endothelial dysfunction (ED) is a marker of vascular damage. Glycated hemoglobin (A1C) predicts vascular complications. The EndoPAT (peripheral arterial tonometry) device calculates the reactive hyperemic index (RHI), a measure of endothelial function. The greater the vasodilation, the higher the RHI. We hypothesized that children with poorly-controlled diabetes mellitus (DM) and non-diabetes mellitus (NDM) obese children have ED.
A cross-sectional study using the EndoPAT device was performed on children with poorly-controlled DM and NDM children. ANOVA, -test, Mann-Whitney U test, multiple linear regression and Spearman correlation were used.
Of 58 children that completed the study (aged 13.1 ± 3.42 years), 33 with type 1 diabetes (T1DM), 8 with type 2 diabetes (T2DM) and 17 were NDM obese children. Eighty-five percent were African-American, 60% were female and 79% entered puberty. The RHI of children with DM (1.42 ± 0.48) versus NDM obese group (1.40 ± 0.34) was not different (P = 0.86) regardless of the type of DM or body mass index. In the DM group, for every 1% increase in latest A1C, the RHI decreased by 0.097 (P = 0.01) after adjusting for age, gender, and type of DM. The RHI of DM patients with latest A1C of < 10% (1.70 ± 0.58) versus those with A1C ≥10% (1.21 ± 0.19) was statistically different (P = 0.02). In the total study population, males had significantly lower RHI (1.28 ± 0.36) when compared to females (1.51 ± 0.46), P = 0.04 but this difference disappeared when considering pubertal status and type of diabetes.
Our data showed that patients with poorly-controlled DM as reflected by latest A1C of ≥ 10% had worse endothelial function as reflected by lower RHI score.
内皮功能障碍（ED）是血管损伤的一个指标。糖化血红蛋白（A1C）可预测血管并发症。EndoPAT（外周动脉张力测量）设备可计算反应性充血指数（RHI），这是一种衡量内皮功能的指标。血管舒张程度越大，RHI越高。我们假设糖尿病（DM）控制不佳的儿童和非糖尿病（NDM）肥胖儿童存在内皮功能障碍。
使用EndoPAT设备对DM控制不佳的儿童和NDM儿童进行了一项横断面研究。采用方差分析、t检验、曼-惠特尼U检验、多元线性回归和斯皮尔曼相关性分析。
在完成研究的58名儿童（年龄13.1±3.42岁）中，33名患有1型糖尿病（T1DM），8名患有2型糖尿病（T2DM），17名是NDM肥胖儿童。85%为非裔美国人，60%为女性，79%进入青春期。无论DM类型或体重指数如何，DM儿童（1.42±0.48）与NDM肥胖组（1.40±0.34）的RHI无差异（P = 0.86）。在DM组中，在调整年龄、性别和DM类型后，最新A1C每增加1%，RHI下降0.097（P = 0.01）。最新A1C<10%的DM患者的RHI（1.70±0.58）与A1C≥10%的患者（1.21±0.19）有统计学差异（P = 0.02）。在整个研究人群中，男性的RHI（1.28±0.36）显著低于女性（1.51±0.46），P = 0.04，但在考虑青春期状态和糖尿病类型时，这种差异消失。
我们的数据表明，以最新A1C≥10%反映的DM控制不佳的患者，以内皮功能障碍更严重，这由较低的RHI评分反映。
