[Selected immunologic and biochemical risk factors of the retinopathy and nephropathy development in children with diabetes mellitus type 1].

Małgorzata Myśliwiec, Anna Balcerska, Katarzyna Zorena, Jolanta Myśliwska, Mirosława Nowacka, Paweł Lipowski, Krystyna Raczyńska
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Abstract

Introduction: Despite that numerous investigations on the nature of diabetic microangiopathy were carried out, its pathomechanism remains unclear.

Objective: The aim of the study was to analyze the relation between early diabetic microangiopathy and the proinflammatory cytokines, NAG and its A and B isoforms in blood and urine in children diagnosed with diabetes mellitus type 1.

Material and methods: The study was carried out on the group of 56 children with diabetes mellitus 1 (age 13.6+/-3.74) and 35 healthy children selected as the controls. All the patients had 24 hrs albuminuria, HbA1c, C-peptide as well as the NAG enzyme and its A and B isoforms serum and urine activities measured. Additionally, all the children had TNF-a and IL6 level in serum measured. Each patient had 24 hrs blood pressure monitored and underwent ophthalmologic examination.

Results: Children with long-standing diabetes mellitus and retinopathy (group 1, n=15) were older and were characterized by a statistically significant longer duration of the disease and higher HbA1c level in comparison with the patients who presented with no sign of diabetic retinopathy (group 2, n=41). In the group 1 statistically significant higher TNF-alpha serum level (p=0.01), NAG (p=0.002) and its isoforms A (p=0.007) and B (p=0.001) urine activities were measured in relation to the group 2. Additionally the level of IL-6 and NAG and its isoforms A and B serum activities were higher in group 1 than in group 2, however the differences were of no statistical significance. Moreover the children from group 2 in comparison with the healthy controls showed statistically significant higher TNF-alpha serum activity (p=0.016) and NAG (p<0.001) and its A (p<0.001) and B (p<0.001) isoforms both serum and urine activities.

Conclusions: The occurrence of the detectable serum TNF-alpha activity in children with diabetes mellitus type 1 showing no sign of diabetic retinopathy and nephropathy and no microalbuminuria with the concomitant increase of NAG and its isoforms serum and urine activities might point toward prompt occurrence of these changes in the eye and the kidneys.

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[1型糖尿病儿童视网膜病变和肾病发展的免疫生化危险因素筛选]。
导读:尽管对糖尿病微血管病变的性质进行了大量的研究,但其病理机制仍不清楚。目的:分析1型糖尿病患儿早期糖尿病微血管病变与血、尿中促炎因子、NAG及其A、B亚型的关系。材料与方法:选取56例1型糖尿病儿童(年龄13.6+/-3.74)和35例健康儿童作为对照。所有患者均测定24小时尿白蛋白、糖化血红蛋白、c肽及NAG酶及其A、B异构体的血清和尿液活性。同时测定血清中TNF-a和il - 6水平。每例患者监测24小时血压并行眼科检查。结果:与无糖尿病视网膜病变体征的儿童(2组,n=41)相比,长期患有糖尿病和视网膜病变的儿童(1组,n=15)年龄更大,病程更长,HbA1c水平更高。1组血清tnf - α水平(p=0.01)、NAG (p=0.002)及其同工型A (p=0.007)和B (p=0.001)尿活性均高于2组,差异有统计学意义。血清中IL-6、NAG水平及A、B亚型活性1组高于2组,但差异无统计学意义。与健康对照组相比,2组患儿血清tnf - α活性(p=0.016)和NAG (p)均有统计学意义。在无糖尿病视网膜病变和肾病征象、无微量白蛋白尿的1型糖尿病患儿血清中检测到tnf - α活性,同时伴有NAG及其同型异构体血清和尿液活性的升高,可能提示这些变化在眼睛和肾脏中迅速发生。
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