儿童1型糖尿病血管并发症血清学预测指标的研究

Serologic predictors of vascular complications in children with type 1 diabetes mellitus

目的研究1型糖尿病(T1DM)患儿血清晚期糖基化终产物(AGEs)、诱导型一氧化氮合酶(iNOS)活性与血糖控制情况、病程及尿白蛋白肌酐比(UACR)、血流介导的血管扩张功能(FMD)的关系,探讨AGEs、iNOS作为T1DM患儿早期微血管及大血管并发症预测指标的可行性。方法收集2018年1月至2019年12月于江苏省苏北人民医院儿科就诊的患儿48例,分为T1DM组(33例)和健康对照组(15例)。采用酶联免疫法检测血清AGEs水平和iNOS活性,并收集年龄、身高、体重、自我指尖血糖检测值、糖化血红蛋白(HbA1c)、病程、UACR、FMD。比较两组间各指标的差异,并分析血清AGEs水平和iNOS活性与HbA1c、血糖标准差(SDBG)、病程、年龄、身体质量指数(BMI)及UACR、FMD的关系。结果T1DM组的HbA1c、AGEs、iNOS、UACR均高于健康对照组(t值分别为-5.274、-4.794、16.866、4.118,均P<0.05)。AGEs、iNOS与HbA1c均呈正相关(r值分别为0.495、0.393,均P<0.05);AGEs、iNOS与SDBG也均呈正相关(r值分别为0.672、0.595,均P<0.05);AGEs、iNOS与UACR亦均呈正相关(r值分别为0.504、0.656,均P<0.05);AGEs、iNOS与FMD均呈负相关(r值分别为-0.544、-0.394,均P<0.05)。结论儿童T1DM的血糖控制指标HbA1c、SDBG与血清AGEs水平及iNOS活性均呈正相关,血糖控制越差,血清AGEs水平、iNOS活性越高。儿童T1DM的UACR、FMD与血清AGEs水平、iNOS活性相关,随着血清AGEs水平及iNOS活性的增加,UACR升高、FMD降低。血清AGEs水平及iNOS活性可能成为T1DM患儿早期微血管和大血管并发症的预测指标。

Objective To study the relationship between serum advanced glycation end products(AGEs),inducible nitric oxide synthase(iNOS)activity and blood glucose control,disease course,urinary albumin/creatinine ratio(UACR),blood flow-mediated dilatation(FMD)function in children with type 1 diabetes mellitus(T1 DM),and to explore the feasibility that AGEs,iNOS as serologic predictors of early microvascular complications and macrovascular complications in children with T1 DM.Methods 48 children were collected,who visited the Pediatrics of Northern Jiangsu People’s Hospital from January 2018 to December 2019.Then they were divided into T1 DM group(33 patients)and healthy control group(15 children).ELISA was used to detect serum AGEs levels,iNOS activity.And the data of age,height,weight,self-monitoring of blood glucose(SMBG)test values,glycohemoglobin A1 c(HbA1 c),disease course,UACR,FMD were collected.The differences between the two groups of each indicator were compared,and the relationships between AGEs levels,iNOS activity and HbA1 c,standard deviation of blood glucose(SDBG),disease course,age,body mass index(BMI),UACR,FMD were analyzed.Results The level of HbA1 c,AGEs,iNOS,and UACR in the T1 DM group were higher than that in the healthy control group(t=5.274,-4.794,16.866 and 4.118,respectively,all P<0.05).There were positive correlations between AGEs,iNOS and HbA1 c(r=0.495 and 0.393,respectively,both P<0.05),also positively correlation with SDBG(r=0.672 and 0.595,respectively,both P<0.05).There were positive relationship between AGEs,iNOS and UACR(r=0.504 and 0.656,respectively,both P<0.05),but there were negative correlation between AGEs,iNOS and FMD(r=-0.544 and-0.394,respectively,both P<0.05).Conclusion The blood glucose control index HbA1 c,SDBG in children with T1 DM are positively correlated with serum AGEs,iNOS.The worse blood glucose control,the higher serum level of AGEs and iNOS activity.The UACR and FMD of children with T1 DM are correlated with serum level of AGEs and iNOS activity.As the higher serum level of AGEs and iNOS activity,UACR increases and FMD decreases.Serum level of AGEs and iNOS activity might become predictors of early microvascular and macrovascular complications in children with T1 DM.