Department of Mother and Child Health, Sapienza University of Rome, Rome, Italy.
Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy.
Front Endocrinol (Lausanne). 2020 Sep 24;11:574216. doi: 10.3389/fendo.2020.574216. eCollection 2020.
Emerging evidence suggests that structural adventitial modifications and perivascular adipose tissue (PAT) may have a role in early atherogenesis. In a cohort of children and adolescents, we explored (1) the association of carotid extra-media thickness (cEMT), an ultrasound measure whose main determinants are arterial adventitia and PAT, with obesity and its cardiometabolic complications; and (2) the interplay between cEMT and endothelial function. The study participants included 286 youths (age, 6-16 years; 154 boys, and 132 girls). Anthropometric and laboratory parameters, liver ultrasound, vascular structure measures [cEMT and carotid intima-media thickness (cIMT)], endothelial function [brachial artery flow-mediated dilation (FMD)] were obtained in all subjects. Non-alcoholic fatty liver disease (NAFLD) was diagnosed in the presence of hepatic fat on ultrasonography, in the absence of other causes of liver disease. Diagnosis of metabolic syndrome (MetS) was established on the basis of three or more of the following cardiovascular disease (CVD) risk variables: abdominal obesity, high triglycerides, low high-density lipoprotein cholesterol, elevated blood pressure (BP), and impaired fasting glucose. cEMT demonstrated significant associations with body-mass index (BMI) and waist circumference (WC), BP, insulin resistance, NAFLD, and inflammation. No association was found between cEMT and lipid values, and between cEMT and MetS. A stepwise multivariate linear regression analysis indicated that WC (β coefficient, 0.35; < 0.0001) was the only determinant of cEMT, independently of other major cardiometabolic risk factors. Further adjustment for cIMT did not significantly alter this association. FMD was correlated to age, Tanner stage, total and abdominal obesity, BP, NAFLD, and cEMT. The association between FMD and cEMT was independent of age, sex, Tanner stage, WC, and BMI (β coefficient, -0.14; = 0.027). After controlling for CVD risk factors and basal brachial artery diameter, cEMT remained associated with FMD (β coefficient, -0.11; = 0.049). In youths, cEMT is associated with abdominal fat, a well-established body fat depot with important implications for cardiovascular diseases. Furthermore, cEMT is related to FMD, suggesting that arterial adventitia and PAT may be involved in the early changes in endothelial function.
新出现的证据表明，结构性外膜修饰和血管周围脂肪组织（PAT）可能在动脉粥样硬化的早期发生中起作用。在一组儿童和青少年中，我们探讨了（1）颈动脉外膜厚度（cEMT）与肥胖及其代谢并发症的关系，cEMT 是一种超声测量指标，其主要决定因素是动脉外膜和 PAT；（2）cEMT 与内皮功能之间的相互作用。研究参与者包括 286 名青少年（年龄 6-16 岁；男性 154 名，女性 132 名）。所有受试者均获得了人体测量和实验室参数、肝脏超声、血管结构测量（cEMT 和颈动脉内膜-中膜厚度[cIMT]）、内皮功能[肱动脉血流介导的扩张（FMD）]。在超声检查存在肝脂肪的情况下诊断为非酒精性脂肪性肝病（NAFLD），排除其他肝脏疾病的原因。代谢综合征（MetS）的诊断基于以下心血管疾病（CVD）风险变量中的三个或更多：腹部肥胖、高甘油三酯、低高密度脂蛋白胆固醇、血压升高和空腹血糖受损。cEMT 与体重指数（BMI）和腰围（WC）、血压、胰岛素抵抗、NAFLD 和炎症显著相关。cEMT 与血脂值之间以及与 MetS 之间没有相关性。逐步多元线性回归分析表明，WC（β系数，0.35； < 0.0001）是 cEMT 的唯一决定因素，独立于其他主要的心血管代谢危险因素。进一步调整 cIMT 并未显著改变这种关联。FMD 与年龄、Tanner 分期、全身和腹部肥胖、血压、NAFLD 和 cEMT 相关。FMD 与 cEMT 之间的关联独立于年龄、性别、Tanner 分期、WC 和 BMI（β系数，-0.14； = 0.027）。在控制 CVD 危险因素和基础肱动脉直径后，cEMT 仍与 FMD 相关（β系数，-0.11； = 0.049）。在青少年中，cEMT 与腹部脂肪相关，腹部脂肪是一种公认的体脂库，对心血管疾病有重要影响。此外，cEMT 与 FMD 相关，提示动脉外膜和 PAT 可能参与内皮功能的早期变化。
