Bharathy Palanisamy Shanmugasundaram, Delhikumar C G, Rajappa Medha, Sahoo Jayaprakash, Anantharaj Avinash
Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India.
Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
Indian J Pediatr. 2023 Mar;90(3):227-232. doi: 10.1007/s12098-022-04314-w. Epub 2022 Aug 13.
To detect early atherosclerosis changes using flow-mediated dilation (FMD) of the brachial artery, carotid intima-media thickness (CIMT), inflammatory markers (hs-CRP, IL-6), and endothelial markers (sICAM and sVCAM).
The authors recruited 4 to 18-y-old children with type 1 diabetes mellitus (T1DM) and age- and sex-matched normal children, excluding those with familial hypercholesterolemia, syndromic disorders, and cardiovascular disease. CIMT and FMD were measured in both the groups. Biomarkers hs-CRP, IL-6, sICAM, and sVCAM, were analyzed in the T1DM group.
Forty T1DM children and 40 controls with 27 (67.5%) girls were enrolled in each group. The mean age was 9.68 y. The T1DM group had 4 (10%) obese and 4 (10%) overweight children. Among cases, 9 (22.5%) had diabetes for > 5 y, 24 (60%) required daily insulin between 0.8 and 1.2 IU/kg/d and 26 (65%) had HbA1c > 10 g/dL. The CIMT values were significantly higher in cases (0.69 mm) than in controls (0.59 mm); 29 (72.5%) cases had abnormal combined CIMT values. FMD was lesser in cases than in controls but not significant. The median values of hs-CRP, IL-6, sICAM, sVCAM were 0.81 mg/L, 6.27 pg/mL, 46.33 ng/mL and 668.81 ng/mL, respectively. A significant correlation of IL-6 with CIMT (r = 0.543, p = < 0.001) and sICAM with FMD (r = -0.397, p = 0.011) was observed. VCAM was low in the obese and overweight children.
Children with type 1 diabetes had higher CIMT than normal children, whereas FMD did not differ. The association between elevated inflammatory markers with high CIMT and low FMD indicates that inflammation plays an essential role in endothelial dysfunction.
利用肱动脉血流介导的血管舒张功能（FMD）、颈动脉内膜中层厚度（CIMT）、炎症标志物（高敏C反应蛋白、白细胞介素-6）和内皮标志物（可溶性细胞间黏附分子和可溶性血管细胞黏附分子）检测早期动脉粥样硬化变化。
作者招募了4至18岁的1型糖尿病（T1DM）儿童以及年龄和性别匹配的正常儿童，排除患有家族性高胆固醇血症、综合征性疾病和心血管疾病的儿童。对两组儿童均测量了CIMT和FMD。对T1DM组分析了生物标志物高敏C反应蛋白、白细胞介素-6、可溶性细胞间黏附分子和可溶性血管细胞黏附分子。
每组纳入40名T1DM儿童和40名对照儿童，其中女孩27名（67.5%）。平均年龄为9.68岁。T1DM组有4名（10%）肥胖儿童和4名（10%）超重儿童。在病例中，9名（22.5%）患糖尿病超过5年，24名（60%）每天需要0.8至1.2 IU/kg/d的胰岛素，26名（65%）糖化血红蛋白>10 g/dL。病例组的CIMT值（0.69 mm）显著高于对照组（0.59 mm）；29名（72.5%）病例的CIMT综合值异常。病例组的FMD低于对照组，但差异无统计学意义。高敏C反应蛋白、白细胞介素-6、可溶性细胞间黏附分子、可溶性血管细胞黏附分子的中位数分别为0.81 mg/L、6.27 pg/mL、46.33 ng/mL和668.81 ng/mL。观察到白细胞介素-6与CIMT有显著相关性（r = 0.543，p = <0.001），可溶性细胞间黏附分子与FMD有显著相关性（r = -0.397，p = 0.011）。肥胖和超重儿童的血管细胞黏附分子水平较低。
1型糖尿病儿童的CIMT高于正常儿童，而FMD无差异。炎症标志物升高与高CIMT和低FMD之间的关联表明炎症在内皮功能障碍中起重要作用。
