Ho Hung-Chi, Lo Fu-Sung, Lee Jen-Kuang, Tsai Wen-Yu, Su Ta-Chen
Department of Internal Medicine and Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung 404327, Taiwan.
Division of Pediatric Endocrinology, Department of Pediatrics, Chang Gung Memorial Hospital, Chung Gung University College of Medicine, Kweishan, Guishan District, Taoyuan City 33423, Taiwan.
Pediatr Diabetes. 2023 Mar 31;2023:6471597. doi: 10.1155/2023/6471597. eCollection 2023.
In healthy adults, the association between the glycated hemoglobin A1c (HbA1c) level and intima-media thickness (IMT) is stronger in the femoral artery than that in the carotid artery. However, whether this differential strength of association also applies to adolescents with type 1 diabetes (T1D) is unknown. Therefore, this study aimed to examine whether IMT increases in extracarotid arteries (specifically in the lower extremities) prior to the carotid artery. In total, 286 adolescents with T1D (15.9 ± 4.9 years; 42.0% male participants) were enrolled, and the B-mode ultrasonographic measurement of IMT in the carotid, femoral, and popliteal arteries was performed. Cardiovascular risk factors, including blood pressure (BP), body mass index, lipid levels, and glycemic parameters, were evaluated. To evaluate the site-dependent relationship between IMT and cardiovascular risk factors, a linear mixed-effects model was developed with repeated IMT measurements at various arterial sites as fixed effects and participants as random effects. Glycemic parameters, lipids, uric acid, high-sensitivity C-reactive protein, and advanced glycation end-products were some cardiovascular risk factors that worsened with increasing HbA1c levels. Patients with a higher HbA1c level (>10% vs. ≤10%) had thicker IMT in the femoral artery but not in the carotid or popliteal arteries. Patients with poorer diabetic control exhibited significant changes in certain cardiovascular functions, including central systolic BP, left ventricular (LV) ejection time, LV dp/dt max, stroke volume, and brachial artery compliance. A standard mediation analysis revealed that none of the aforementioned cardiovascular functions mediated the relationship between higher HbA1c level and greater femoral IMT. In adolescents with T1D, cardiovascular risk factors deteriorate with worsening blood glucose control. In the early stages of T1D, femoral IMT may serve as a more sensitive surrogate marker for hyperglycemia-induced subclinical atherosclerosis, an effect that may not be mediated by alterations in cardiovascular functions.
在健康成年人中，糖化血红蛋白A1c（HbA1c）水平与股动脉内膜中层厚度（IMT）之间的关联比与颈动脉内膜中层厚度的关联更强。然而，这种关联强度差异是否也适用于1型糖尿病（T1D）青少年尚不清楚。因此，本研究旨在探讨IMT是否在颈动脉之前就已在颈外动脉（特别是下肢）中增加。总共招募了286名T1D青少年（15.9±4.9岁；42.0%为男性参与者），并对颈动脉、股动脉和腘动脉进行了IMT的B型超声测量。评估了包括血压（BP）、体重指数、血脂水平和血糖参数在内的心血管危险因素。为了评估IMT与心血管危险因素之间的部位依赖性关系，建立了一个线性混合效应模型，将不同动脉部位的重复IMT测量作为固定效应，参与者作为随机效应。血糖参数、血脂、尿酸、高敏C反应蛋白和晚期糖基化终产物是随着HbA1c水平升高而恶化的一些心血管危险因素。HbA1c水平较高（>10% vs.≤10%）的患者股动脉IMT较厚，但颈动脉或腘动脉并非如此。糖尿病控制较差的患者在某些心血管功能方面表现出显著变化,包括中心收缩压、左心室（LV）射血时间、LV dp/dt max、每搏输出量和肱动脉顺应性。一项标准中介分析显示，上述心血管功能均未介导较高HbA1c水平与较大股动脉IMT之间的关系。在T1D青少年中，心血管危险因素随着血糖控制恶化而恶化。在T1D的早期阶段，股动脉IMT可能作为高血糖诱导的亚临床动脉粥样硬化的更敏感替代标志物，这种效应可能不是由心血管功能改变介导的。
