严重肥胖的青少年心血管（CV）风险高于 1 型糖尿病患者：一项具有皮肤晚期糖基化终产物和内中膜厚度评估的研究。

Adolescents with severe obesity show a higher cardiovascular (CV) risk than those with type 1 diabetes: a study with skin advanced glycation end products and intima media thickness evaluation.

机构信息

Department of Woman, Child and Urologic Diseases, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy.

University of Modena and Reggio Emilia, Modena, Italy.

出版信息

Acta Diabetol. 2020 Nov;57(11):1297-1305. doi: 10.1007/s00592-020-01537-1. Epub 2020 Jun 5.

DOI:10.1007/s00592-020-01537-1

PMID:32504306

Abstract

AIMS

Type 1 diabetes (T1D) and obesity are strongly associated with cardiovascular (CV) risk and can start in the paediatric age. The CV risk profile of two groups of adolescents was compared through the evaluation of sAGE, IMT and known variables associated with CV risk. The first group was affected by T1D with duration of disease of at least 5 years or 3 years since puberty onset, and the second by severe obesity for more than 3 years.

METHODS

A total of 116 patients were prospectively enrolled in the study (71 T1D, 33 males and 38 females; 45 obese, 18 males and 27 females), and their sAGE, IMT, waist/height ratio, LDL cholesterol, triglycerides/cholesterol HDL ratio, BMI, HbA1c and blood pressure were measured.

RESULTS

An IMT value > 0.7 mm, cut-off value to define CV risk, was present in 28% of the obese patients and in no T1D patients. Age-adjusted sAGE and HbA1c levels were higher T1D patients, whereas a higher percentage of pathological values was present in most of the remaining studied variables. In T1D patients, there was a higher percentage of females with waist/height ratio > 0.5, LDL cholesterol > 100 mg/dL, triglycerides/HDL cholesterol ratio > 2 and BMI > 99° centile and a higher percentage of males with HbA1c > 7%. On the contrary, in obese patients there were no differences between males and females. Multiple analysis is identified BMI SDS as the only variable with a significant influence on IMT in both groups. Furthermore, it showed that HbA1c and gender affected sAGE in T1D patients, whereas only age and gender in the obese patients.

CONCLUSIONS

Our study demonstrates that our adolescents with severe obesity carry a much higher CV risk than adolescents with T1D unless in bad metabolic control. Apart from lower sAGE levels, most of the variables considered to define CV risk were higher in the obese group than in the T1D group. Gender seems to have a significant impact on sAGE levels but not on IMT.

摘要

目的

1 型糖尿病（T1D）和肥胖与心血管（CV）风险密切相关，并且可能在儿童期就开始出现。本研究旨在通过评估 sAGE、IMT 和与 CV 风险相关的已知变量，比较两组青少年的 CV 风险状况。第一组为患有 T1D 且病程至少 5 年或青春期开始后 3 年，第二组为患有严重肥胖症且病程超过 3 年。

方法

本研究共纳入 116 名青少年患者（71 例 T1D，33 名男性，38 名女性；45 例肥胖症，18 名男性，27 名女性），并测量了他们的 sAGE、IMT、腰高比、LDL 胆固醇、甘油三酯/胆固醇 HDL 比值、BMI、HbA1c 和血压。

结果

在肥胖症患者中，28%的患者 IMT 值>0.7mm，这是定义 CV 风险的截断值，但在 T1D 患者中并未出现这种情况。调整年龄后，T1D 患者的 sAGE 和 HbA1c 水平较高，而其余大多数研究变量的异常值比例也较高。在 T1D 患者中，女性的腰高比>0.5、LDL 胆固醇>100mg/dL、甘油三酯/HDL 胆固醇比值>2、BMI>99 百分位的比例较高，男性的 HbA1c>7%的比例较高。相反，在肥胖症患者中，男女之间没有差异。多因素分析确定 BMI SDS 是两组患者 IMT 唯一有显著影响的变量。此外，分析还表明，HbA1c 和性别影响 T1D 患者的 sAGE，而年龄和性别仅影响肥胖症患者的 sAGE。