非经典型先天性肾上腺皮质增生症女性的心血管风险
Cardiovascular Risk in Women With Nonclassical Congenital Adrenal Hyperplasia.
作者信息
Costa Fernanda Cavalieri, Gomes Larissa Garcia, de Lima Thais Martins, Bortolotto Luiz Aparecido, Hong Valeria, Verardino Renata, de Souza Rocha Manoel, Ueda Serli Kiyomi Nakao, de Miranda Mirela Costa, de Souza Heraldo Possolo, Latronico Ana Claudia, Mendonca Berenice Bilharinho, Bachega Tania A S S
机构信息
Laboratório de Hormônios e Genética Molecular- LIM/42, Departamento de Clínica Médica, Disciplina de Endocrinologia e Metabologia, Unidade de Adrenal, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, 05403-000 São Paulo, Brazil.
Laboratório de Emergências Clínicas (LIM 51), Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, 05403-000 São Paulo, Brazil.
出版信息
J Clin Endocrinol Metab. 2024 Dec 18;110(1):e72-e79. doi: 10.1210/clinem/dgae155.
CONTEXT
The outcomes related to cardiovascular risk (CVR) in patients with the nonclassical form of congenital adrenal hyperplasia (NCAH) are unknown, especially those related to therapeutic options, including low doses of glucocorticoids or oral contraceptive pills.
OBJECTIVES
To analyze CVR by markers of atherosclerosis in females with the nonclassical form according to therapeutic options.
DESIGN AND SETTING
A cross-sectional study at a tertiary center.
PATIENTS AND METHODS
Forty-seven females with NCAH (33.4 ± 10 years) were subdivided into group 1 (G1) (n = 28) treated with dexamethasone (0.14 ± 0.05 mg/m2/day), group 2 (G2) (n = 19) treated with oral contraceptive pills, and group 3 (G3) (30 matched controls). CVR was analyzed through serum lipids, the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), inflammatory cytokines levels, and quantitative image evaluations [pulse wave velocity (PWV), endothelial function by flow-mediated dilatation (FMD), carotid intima media thickness (CIMT), and visceral fat (VAT) by abdominal tomography].
RESULTS
There were no statistically significant differences in BMI, HOMA-IR, high-density lipoprotein-cholesterol, or triglyceride levels among groups (P > .05). Serum interleukin 6 (IL-6) levels were higher in G1 than in G2 (P = .048), and interleukin 8 (IL-8) levels were higher in G1 than in G2/3 (P = .008). There were no statistically significant differences in VAT, PWV, FMD, or CIMT among groups (P > .05). In multivariable regression analysis, there was no statistically significant association between glucocorticoid dose and evaluated outcomes.
CONCLUSION
Adult females with NCAH did not show increased CVR using methodologies for detection of precocious atherosclerosis. Although patients receiving dexamethasone therapy had increased IL-6 and IL-8 levels, these data were not associated with radiological markers of atherosclerosis. Our cohort was composed of young adults and should be reevaluated in a long-term follow-up.
背景
非经典型先天性肾上腺皮质增生症（NCAH）患者心血管风险（CVR）相关的结果尚不清楚，尤其是与治疗方案相关的结果，包括低剂量糖皮质激素或口服避孕药。
目的
根据治疗方案，通过动脉粥样硬化标志物分析非经典型女性的CVR。
设计与地点
在一家三级中心进行的横断面研究。
患者与方法
47名NCAH女性（33.4±10岁）被分为第1组（G1）（n = 28），接受地塞米松治疗（0.14±0.05 mg/m2/天）；第2组（G2）（n = 19），接受口服避孕药治疗；以及第3组（G3）（30名匹配对照）。通过血清脂质、胰岛素抵抗稳态模型评估（HOMA-IR）、炎症细胞因子水平和定量图像评估[脉搏波速度（PWV）、血流介导的扩张（FMD）评估的内皮功能、颈动脉内膜中层厚度（CIMT）以及腹部断层扫描评估的内脏脂肪（VAT）]分析CVR。
结果
各组间体重指数、HOMA-IR、高密度脂蛋白胆固醇或甘油三酯水平无统计学显著差异（P>.05）。G1组血清白细胞介素6（IL-6）水平高于G2组（P = .048），G1组白细胞介素8（IL-8）水平高于G2/G3组（P = .008）。各组间VAT、PWV、FMD或CIMT无统计学显著差异（P>.05）。在多变量回归分析中，糖皮质激素剂量与评估结果之间无统计学显著关联。
结论
使用早熟动脉粥样硬化检测方法，NCAH成年女性未显示CVR增加。尽管接受地塞米松治疗的患者IL-6和IL-8水平升高，但这些数据与动脉粥样硬化的放射学标志物无关。我们的队列由年轻成年人组成，应在长期随访中重新评估。
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