年轻 1 型糖尿病患者血管壁厚度和僵硬程度异常：前沿超声技术的新见解。
Abnormal vascular thickness and stiffness in young adults with type 1 diabetes: new insights from cutting-edge ultrasound modalities.
机构信息
Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Department of Pediatrics, Division of Endocrinology and Metabolism, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
出版信息
Cardiovasc Diabetol. 2024 May 24;23(1):178. doi: 10.1186/s12933-024-02280-5.
BACKGROUND
Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in patients with Type 1 Diabetes (T1D). Early markers of CVD include increased carotid intima-media thickness (CIMT) and pulse wave velocity (PWV), but these existing ultrasound technologies show limited spatial and temporal resolution in young adults. The purpose of this study is to evaluate the utility of high-resolution ultrasound modalities, including high frequency ultrasound CIMT (hfCIMT) and ultrafast ultrasound PWV (ufPWV), in young adults with Type 1 Diabetes.
METHODS
This is a prospective single-center observational cohort study including 39 participants with T1D and 25 age and sex matched controls. All participants underwent hfCIMT and ufPWV measurements. hfCIMT and ufPWV measures of T1D were compared with controls and associations with age, sex, BMI, A1c, blood pressure, and lipids were studied.
RESULTS
Mean age was 24.1 years old in both groups. T1D had a greater body mass index (27.7 [5.7] vs 23.1 [3.2] kg/m), LDL Cholesterol, and estimated GFR, and had a mean A1c of 7.4 [1.0] % (57 mmol/mol) and diabetes duration of 16.1 [3.7] years with 56% using insulin pumps. In T1D, hfCIMT was significantly increased as compared to controls (0.435 ± 0.06 mm vs 0.379 ± 0.06 mm respectively, p < 0.01). ufPWV measures were significantly increased in T1D (systolic foot PWV: 5.29 ± 0.23 m/s vs 5.50 ± 0.37 m/s, p < 0.01; dicrotic notch PWV = 7.54 ± 0.46 m/s vs 7.92 ± 0.41 m/s, p < 0.01). Further, there was an impact of A1c-measured glycemia on hfCIMT, but this relationship was not seen with ufPWV. No significant statistical correlations between hfCIMT and ufPWV measures in either T1D or healthy controls were observed.
CONCLUSION
Young adults with T1D present with differences in arterial thickness and stiffness when compared with controls. Use of novel high-resolution ultrasound measures describe important relationships between early structural and vascular pathophysiologic changes and are promising tools to evaluate pre-clinical CVD risk in youth with T1D.
TRIAL REGISTRATION
ISRCTN91419926.
背景
心血管疾病（CVD）仍然是 1 型糖尿病（T1D）患者发病率和死亡率的主要原因。CVD 的早期标志物包括颈动脉内膜中层厚度（CIMT）增加和脉搏波速度（PWV）增加，但这些现有的超声技术在年轻人中显示出有限的空间和时间分辨率。本研究旨在评估高分辨率超声模式（包括高频超声 CIMT（hfCIMT）和超快超声 PWV（ufPWV））在年轻的 1 型糖尿病患者中的效用。
方法
这是一项前瞻性单中心观察队列研究，包括 39 名 T1D 患者和 25 名年龄和性别匹配的对照者。所有参与者均接受 hfCIMT 和 ufPWV 测量。将 T1D 的 hfCIMT 和 ufPWV 测量值与对照组进行比较，并研究其与年龄、性别、BMI、A1c、血压和血脂的相关性。
结果
两组的平均年龄均为 24.1 岁。T1D 的体重指数（27.7 [5.7] vs 23.1 [3.2] kg/m）、LDL 胆固醇和估计肾小球滤过率更高，A1c 平均为 7.4 [1.0]%（57 mmol/mol），糖尿病病程为 16.1 [3.7]年，56%的患者使用胰岛素泵。与对照组相比，T1D 的 hfCIMT 明显增加（分别为 0.435 ± 0.06mm 和 0.379 ± 0.06mm，p<0.01）。T1D 的 ufPWV 测量值显著升高（收缩期足 PWV：5.29 ± 0.23m/s vs 5.50 ± 0.37m/s，p<0.01；双切迹 PWV=7.54 ± 0.46m/s vs 7.92 ± 0.41m/s，p<0.01）。此外，A1c 测量的血糖对 hfCIMT 有影响，但这种关系在 ufPWV 中没有观察到。在 T1D 或健康对照组中，均未观察到 hfCIMT 和 ufPWV 测量值之间存在显著的统计学相关性。
结论
与对照组相比，年轻的 1 型糖尿病患者的动脉厚度和僵硬度存在差异。使用新型高分辨率超声测量方法描述了早期结构和血管病理生理变化之间的重要关系，是评估 1 型糖尿病青少年临床前 CVD 风险的有前途的工具。
试验注册
ISRCTN91419926。
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