Study On Serum Predictors Of Vascular Complications In Children With Type 1 Diabetes

ObjectiveBy analyzing the relationship between type 1 diabetes mellitus(T1DM)children’s serum advanced glycation end products(AGEs),soluble receptor of advanced glycation end products(sRAGE),arginase 1(Argl)levels,inducible nitric oxide synthase(iNOS)activity,AGEs/sRAGE and urinary albumin/creatinine ratio(UACR),blood flow-mediated dilatation(FMD)function,to explore the feasibility of AGEs,Argl,iNOS and AGEs/sRAGE as predictors of early microvascular complications and macrovascular complications in T1DM children.The relationship between glycosylated hemoglobin Alc(HbA1c),standard deviation of blood glucose(SDBG),course of disease and levels of AGEs,sRAGE,Argl,iNOS activity and AGEs/sRAGE also were analyzed to clarify the importance of early strengthening of blood glucose control and keep blood glucose relatively stable in children with T1DM.Methods48 children were collected,who visited the Pediatrics of Northern Jiangsu People’s Hospital from January 2018 to December 2019.Then they were divided into T1DM group(33 patients)and healthy control group(15 children).ELISA was used to detect serum AGEs,sRAGE,Argl levels,iNOS activity,and age,height,weight,data of self-monitoring of blood glucose(SMBG)test values,glycohemoglobin A1c(HbA1c),course of disease,urinary albumin/creatinine ratio(UACR),blood flow-mediated dilatation functions(FMD)had also been collected.SPSS 23.0 software was used to compare the differences between the two groups in each indicator,and analyze the relationships between AGEs,sRAGE,Argl levels,iNOS activity,AGEs/sRAGE and blood glucose control indexes HbAlc and SDBG,disease course,age,body mass index(BMI),UACR and FMD.Results1.There was no difference in age,BMI and FMD between the T1DM group and the healthy control group(P>0.05),while there were differences in HbAlc,AGEs,sRAGE,AGEs/sRAGE,Arg1,iNOS,and UACR between the two groups(P<0.05).2.AGEs,iNOS,AGEs/sRAGE were positively correlated with UACR(r=0.504,r=0.656,r=0.501)(P<0.05),Linear regression analysis:UACR=-38.702+0.046 ×AGEs+0.087×iNOS,but there was a negative correlation with FMD(r=-0.544,r=-0.394,r=-0.405)(P<0.05),Linear regression analysis:FMD=41.7140.063 × AGEs.3.No correlations were found between Argl,sRAGE and UACR,FMD(P>0.05)4.FMD was negatively correlated with SDBG(r=-0.404,P<0.05),but not correlated with HbAlc or course of disease(P>0.05).UACR was positively correlated with HbA1c(r=0.412,P<0.05),but there were no correlation with the SDBG and course of disease(P>0.05).5.There were positive correlations between AGEs and HbAlc,SDBG(r=0.495,r=0.672)(P<0.05),Linear regression analysis:AGEs=255.256+7.709×HbAlc+25.835×SDBG,but there was no correlation with the course of disease,age and BMI(P>0.05).6.iNOS was positively correlated with HbAlc and SDBG(r=0.393,r=0.595)(P<0.05),Linear regression analysis:iNOS=355.830+21.179×SDBG,but there was no correlation between iNOS and disease course,age and BMI(P>0.05).7.Argl was positively correlated with HbAlc(r=0.359,P=0.04),but had no correlation with SDBG and disease course,age and BMI(P>0.05).8.There were no correlations between sRAGE,AGEs/sRAGE and HbAlc,SDBG,and disease course,age and BMI(P>0.05).Conclusion1.The long-term blood glucose control index HbAlc of children with T1DM is positively correlated with serum AGEs,iNOS,and Argl.The worse blood glucose control is,the higher serum AGEs,Argl levels and iNOS activity are.The short-term blood glucose fluctuation index SDBG has a greater effect on the serum AGEs level and iNOS activity.The greater the blood glucose fluctuation is,the higher the serum AGEs level and iNOS activity is.2.There is a positive correlation between UACR and HbAlc in children with T1DM.The worse the long-term blood glucose control is,the higher the micro vascular lesion index UACR,and the greater harmful to diabetic microvascular are.3.FMD of T1DM in children is negatively correlated with SDBG.The larger the short-term blood glucose fluctuation is,the lower the vascular lesion index FMD,and the greater the damage to diabetic large blood vessels are.4.UACR and FMD of children with T1DM are correlated with serum AGEs level,iNOS activity and AGEs/sRAGE.With the increase of serum AGEs level,iNOS activity and AGEs/sRAGE,UACR increases and FMD decreases in diabetic patients.The effect of serum iNOS activity on UACR is greater,while the effect of AGEs level on FMD is more significant.Serum AGEs level,iNOS activity and AGEs/sRAGE may be used as predictors of early microvascular and macrovascular complications in T1DM children.