Impaired endothelial and smooth muscle functions and arterial stiffness appear before puberty in obese children and are associated with elevated ambulatory blood pressure
Impaired endothelial and smooth muscle functions and arterial stiffness appear before puberty in obese children and are associated with elevated ambulatory blood pressure
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DOI：
10.1093/eurheartj/ehm633
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发表时间：
2008-03-01
影响因子：
39.3
通讯作者：
Beghetti, Maurice
中科院分区：
文献类型：
--
作者：
Aggoun, Yacine;Farpour-Lambert, Nathalie J.;Beghetti, Maurice
目的是确定受损的肱动脉内皮细胞是否（流量介导的扩张，FMD）和平滑肌功能（硝酸甘油介导的扩张，NTGMD）和颈总动脉（CCA）的重塑在肥胖儿童青春期前发展。通过高分辨率超声测量了48名肥胖和23名消瘦的青春期前儿童（8.8 ± 1.5岁）的FMD和NTGMD。我们通过DXA评估了中心脉压、增量弹性模量（Einc）、偶然和动态收缩压（SBP）和舒张压（DBP）以及体脂。肥胖儿童的FMD显著降低（4.5 +/- 4.0 vs. 8.3 +/- 1.7%），NTGMD（19.0 +/- 9.0 vs. 25.8 +/- 6.1%），Einc增加（13.9 ± 5.2 vs. 10.4 ± 5.2 mmHg/10（2）），动态SBP（121.3 +/- 12.6 vs. 106.6 +/- 7.1，mmHg）和DBP（69.1 +/- 5.7 vs. 63.7 +/- 4.5），而IMT没有增加。47%的肥胖受试者存在动态收缩期高血压。FMD、NTGMD和Einc与肥胖、体重指数和血压（BP）相关。结论肥胖儿童在青春期前出现血管内皮和平滑肌功能受损和血管壁物质改变，但CCA重塑尚未出现。动脉功能障碍可能被认为是动脉粥样硬化的第一个标志，并与血压升高有关。动态血压监测可能是改善肥胖儿童危险分层的潜在工具。
Aims To determine whether impaired brachial endothelial (flow-mediated dilation, FMD) and smooth muscle function (nitroglycerin-mediated dilation, NTGMD), and remodelling of the common carotid artery (CCA) develop before puberty in obese children.Methods and results Arterial intima-media thickness (IMT), FMD and NTGMD were measured by high-resolution ultrasound in 48 obese and 23 lean pre-pubertal children (8.8 +/- 1.5 years old). We assessed central pulse pressure, incremental elastic modulus (Einc), casual and ambulatory systolic (SBP) and diastolic blood pressure (DBP), and body fatness by DXA. Obese children had significantly lower FMD (4.5 +/- 4.0 vs. 8.3 +/- 1.7%), NTGMD (19.0 +/- 9.0 vs. 25.8 +/- 6.1%), and increased Einc (13.9 +/- 5.2 vs. 10.4 +/- 5.2 mmHg/10(2)), ambulatory SBP (121.3 +/- 12.6 vs. 106.6 +/- 7.1, mmHg), and DBP (69.1 +/- 5.7 vs. 63.7 +/- 4.5) than lean subjects, whereas IMT was not augmented. Ambulatory systolic hypertension was present in 47% of obese subjects. FMD, NTGMD, and Einc were correlated with body fatness, body mass index, and blood pressure (BP).Conclusion Impaired endothelial and smooth muscle functions and altered wall material develop before puberty in obese children, however remodelling of the CCA is not yet present. Arterial dysfunction may be considered as the first marker of atherosclerosis and is associated with elevated BP. Ambulatory blood pressure monitoring may be a potential tool to improve risk stratification in obese children.