脑性瘫痪患儿存在心血管疾病的早期征象。
Early indicators of cardiovascular disease are evident in children and adolescents with cerebral palsy.
机构信息
Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada; Department of Rheumatology and Rehabilitation, Faculty of Medicine, Assiut University, Assiut, Egypt; Department of Rheumatology, University of California San Francisco, CA, USA.
Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada; Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
出版信息
Disabil Health J. 2021 Oct;14(4):101112. doi: 10.1016/j.dhjo.2021.101112. Epub 2021 May 5.
BACKGROUND
Cardiovascular disease (CVD) is a leading cause of early mortality among young adults with cerebral palsy. While low physical activity in childhood has been hypothesized as a potential contributor to increased CVD risk in early adulthood, little is known about timing of vascular disease progression and the presence of subclinical atherosclerosis has not been extensively evaluated in children with cerebral palsy.
OBJECTIVE
The aim of this study was to determine if measures of vascular structure and function are different between children and adolescents with and without cerebral palsy.
METHODS
In this cross-sectional study, we measured carotid intima-media thickness (CIMT), and brachial artery flow-mediated dilation (FMD) of children with and without cerebral palsy. Group means for CIMT and brachial artery FMD absolute (FMDA) and percent of relative change (FMDR%) were compared using Wilcoxon rank-sum tests.
RESULTS
A total of 26 children and adolescents with cerebral palsy (46.1% girls, mean age = 15.0 ± 2.0 years) and 19 controls (68.4% girls, mean age = 13.3 ± 2.6 years) participated. Children with cerebral palsy had significantly greater average CIMT (0.43 ± 0.02 mm) than children without cerebral palsy (0.41 ± 0.01 mm, p = 0.04), and lower FMDA (0.16 ± 0.15 mm vs. 0.29 ± 0.20 mm; respectively, p = 0.03).
CONCLUSIONS
Children and adolescents with cerebral palsy may exhibit impairments in vascular structure and function which represent an increased risk of premature atherosclerosis compared to children without cerebral palsy. Additional research to identify risk factors specific to children with cerebral palsy that would support the development of effective screening processes for early identification would enable clinicians to implement targeted preventive strategies.
背景
心血管疾病（CVD）是脑瘫青少年早期死亡的主要原因。虽然儿童时期身体活动水平低被假设为导致成年早期 CVD 风险增加的一个潜在因素，但对于血管疾病进展的时间以及脑瘫儿童亚临床动脉粥样硬化的存在，人们知之甚少。
目的
本研究旨在确定脑瘫儿童和青少年与无脑瘫儿童和青少年之间的血管结构和功能是否存在差异。
方法
在这项横断面研究中，我们测量了脑瘫儿童和无脑瘫儿童的颈动脉内膜中层厚度（CIMT）和肱动脉血流介导的扩张（FMD）。使用 Wilcoxon 秩和检验比较 CIMT 和肱动脉 FMD 绝对值（FMDA）和相对变化百分比（FMDR%）的组均值。
结果
共有 26 名脑瘫儿童和青少年（46.1%为女孩，平均年龄 15.0 ± 2.0 岁）和 19 名对照儿童（68.4%为女孩，平均年龄 13.3 ± 2.6 岁）参与了研究。脑瘫儿童的平均 CIMT（0.43 ± 0.02 mm）明显大于无脑瘫儿童（0.41 ± 0.01 mm，p = 0.04），FMDA 更低（0.16 ± 0.15 mm 比 0.29 ± 0.20 mm；p = 0.03）。
结论
与无脑瘫儿童相比，脑瘫儿童和青少年可能存在血管结构和功能受损的情况，这表明他们发生早发性动脉粥样硬化的风险增加。需要进一步研究确定脑瘫儿童特有的风险因素，以支持制定有效的早期识别筛查流程，从而使临床医生能够实施有针对性的预防策略。
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