• Gajda
• Publikační činnost zaměstnanců nemocnice
• Publikující autoři
• Roky publikování
• VR soutěž Lékaři
• VR soutěž Nelékaři

Early Microvascular Changes with Loss of the Glycocalyx in Children with Type 1 Diabetes

Claudia Nussbaum, Ana Cavalcanti Fernandes Heringa, Zuzana Mormanova, Alexandra F. Puchwein-Schwepcke, Susanne Bechtold-Dalla Pozza, Orsolya Genzel-Boroviczény

DOI: 10.1016/j.jpeds.2013.11.016

Klíčová slova: Blood pressure, Endothelial dysfunction, Glycosylated hemoglobin A1c, Mean flow index, Sidestream dark field, Type 1 diabetes mellitus, Total vessel density

Anotace: Objective To evaluate the microcirculation of children with type 1 diabetes mellitus who demonstrate no clinicalZobrazit více »
signs of diabetic microangiopathy for the presence of microvascular alterations and glycocalyx perturbation.
Study design Images of sublingual vessels were obtained in 14 children with diabetes (ages 12.8
2.8 years,
diabetes duration 6.7
4.3 years) and 14 control patients (ages 11.8
2.8 years) by the use of sidestream dark
field imaging and analyzed for total vessel density, vessel surface coverage, vessel diameter distribution, mean
flow index, and glycocalyx thickness. Wilcoxon rank sum test and Pearson correlation were used for statistical
analysis.
Results We observed profound microcirculatory changes in children with diabetes compared with control
patients, with a significant reduction of glycocalyx thickness (0.38 mm vs 0.60 mm; P = .013), which was inversely
correlated with blood glucose levels (r = 0.55; P = .003). Furthermore, the percentage of large vessels (>20 mm
diameter) was significantly increased (11% vs 6%; P = .023) at the expense of capillaries (<10 mm diameter) with
consequent increase in total vessel surface coverage (30% vs 26.0%; P = .041). No differences were seen in total
vessel density and mean flow index.
Conclusions Microvascular alterations, including changes in microvessel distribution and loss of the glycocalyx,
can be detected in children with type 1 diabetes mellitus before clinically apparent vascular complications. Our
results disclose the glycocalyx as a possible monitoring measurement for earlier detection of diabetic microangiopathy
and may provide a basis for new therapeutic strategies aiming at protection or restoration of the glycocalyx.

Citace: NUSSBAUM, Claudia, Ana CAVALCANTI FERNANDES HERINGA, Zuzana MORMANOVA, Alexandra F. PUCHWEIN-SCHWEPCKE, Susanne BECHTOLD-DALLA POZZA a Orsolya GENZEL-BOROVICZÉNY. Early Microvascular Changes with Loss of the Glycocalyx in Children with Type 1 Diabetes. The Journal of Pediatrics: devoted to the problems and diseases of infancy and childhood. New York: Elsevier, 2014, 164(3), 584-589.e1. ISSN 0022-3476. Dostupné z: doi:10.1016/j.jpeds.2013.11.016

Uložit do Citace PRO