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Ubale pakati pa thanzi labwino la mtima ndi mitsempha yamagazi ya amayi onenepa kwambiri ndi ana awo azaka 6
Olemba: Litwin L, Sundholm JKM, Meinilä J, Kulmala J, Tammelin TH, Rönö K, Koivusalo SB, Eriksson JG, Sarkola T
Linda Litwin,1,2 Johnny KM Sundholm,1,3 Jelena Meinilä,4 Janne Kulmala,5 Tuija H Tammelin,5 Kristiina Rönö,6 Saila B Koivusalo,6 Johan G Eriksson,7–10 Taisto Sarkola1,31Children's Hospital, University of University of Helsinki ndi Helsinki University Hospitals, Helsinki, Finland;2 Dipatimenti ya Congenital Heart Defects ndi Pediatric Cardiology, Silesian Medical University, Katowice, Poland, Zabrze FMS;3 Minerva Foundation Medical Research Institute, Helsinki, Finland;4 Dipatimenti ya Chakudya ndi Chakudya, Yunivesite ya Helsinki, Helsinki, Finland;5LIKES Sports Activity ndi Health Research Center, Jyvaskyla, Finland;6 University of Helsinki Women's Hospital ndi Helsinki University Hospital ku Helsinki, Finland;7 Folkhälsan Research Center, Helsinki, Finland;8 University of Helsinki ndi Helsinki Dipatimenti ya General Practice ndi Primary Health Care, University Hospital, Helsinki, Finland;9 Human Potential Transformation Research Program ndi Dipatimenti ya Obstetrics ndi Gynecology, Yang Luling School of Medicine, National University of Singapore, Singapore;10 Singapore Institute of Clinical Sciences (SICS), Science, Technology and Research Bureau (A*STAR), Singapore Communications: Linda Litwin Department of Congenital Heart Defects and Pediatric Cardiology, Zabrze FMS, Silesian Medical University, M.Sklodowskiej-Curie 9, Zabrze, 41-800, Poland Tel +48 322713401 Fax +48 322713401 Imelo [email protected] Mbiri: Genetics ndi moyo wogawana mabanja ukhoza kuyambitsa ngozi yamtima, koma momwe zimakhudzira kapangidwe kake ndi magwiridwe antchito a mitsempha muubwana ndi zosadziwika bwino.Tinali ndi cholinga chowunika mgwirizano pakati pa thanzi labwino la mtima mwa ana ndi amayi, maternal subclinical atherosclerosis, ndi arterial phenotypes mwa ana.Njira: Kuchokera ku Finnish Gestational Diabetes Prevention Study (RADIEL) longitudinal cohort, kusanthula kwapakati pa ana 201 a amayi azaka za 6.1 ± 0.5 wazaka adayesa thanzi labwino la mtima (BMI, kuthamanga kwa magazi, kusala shuga wamagazi, cholesterol yonse), kadyedwe kabwino, Zochita zolimbitsa thupi, kusuta), kapangidwe ka thupi, carotid Ultra-high frequency ultrasound (25 ndi 35 MHz) komanso kuthamanga kwa mafunde.Zotsatira: Tinapeza kuti panalibe mgwirizano pakati pa thanzi labwino la mtima wa mwana ndi mayi, koma lipoti umboni wa mgwirizano wa zizindikiro zenizeni: cholesterol chonse (r=0.24, P=0.003), BMI (r=0.17, P =0.02), Diastolic blood pressure (r=0.15, P=0.03) ndi khalidwe lazakudya (r=0.22, P=0.002).Matenda a arterial phenotype alibe chochita ndi thanzi labwino lamtima la mwana kapena mayi.Munjira yotanthauziridwa mosiyanasiyana yosinthira jenda, zaka, kuthamanga kwa magazi kwa ana, kunenepa kwambiri, kuchuluka kwamafuta amthupi, makulidwe a mitsempha ya carotid intima-media mwa ana idangolumikizidwa paokha ndi makulidwe a mitsempha ya carotid ya amayi. -media (kuwonjezeka kwa 0.1 mm [95 %] CI 0.05, 0.21, P=0.001] Kuchuluka kwa mitsempha ya carotid ya intima-media inakula ndi 1 mm).Ana a amayi omwe ali ndi subclinical atherosclerosis amachepetsa kuchepa kwa mitsempha ya carotid (1.1 ± 0.2 vs 1.2 ± 0.2% / 10 mmHg, P = 0.01) komanso kuwonjezeka kwa mtsempha wa carotid intima-media makulidwe (0.37 ± 0.04 vs 0.35) ± 0.06 mm, P = 0.04 mm) Kutsiliza: Zizindikiro zabwino za mtima wabwino zimagwirizana mosiyanasiyana ndi amayi ndi mwana omwe ali aang'ono.Sitinapeze umboni wa zotsatira za thanzi labwino la mtima la ana kapena la amayi pa ana a arterial phenotypes.Maternal carotid artery intima-media makulidwe amatha kulosera makulidwe a mtsempha wa carotid intima-media mwa ana, koma momwe zimakhalira sizikudziwikabe.Maternal subclinical atherosulinosis imakhudzana ndi kuuma kwa mitsempha ya carotid kuyambira ali mwana.Keywords: matenda a mtima, atherosulinosis, carotid artery intima-media makulidwe, zowopsa, ana
Zomwe zimayambitsa matenda amtima zimathandizira kuti pakhale chitukuko cha atherosulinosis.1,2 Zinthu zowopsa zimakonda kuphatikizika pamodzi, ndipo kuphatikiza kwawo kumawoneka kuti ndikodziwikiratu za chiopsezo cha mtima wamunthu.3
American Heart Association imatanthawuza thanzi labwino la mtima (ICVH) monga zizindikiro zisanu ndi ziwiri za thanzi (body mass index (BMI), kuthamanga kwa magazi (BP), kusala kudya kwa magazi, cholesterol chonse, khalidwe la zakudya, masewera olimbitsa thupi, kusuta fodya) kupewa Matenda a mtima mwa ana ndi akulu.4 ICVH imalumikizidwa molakwika ndi subclinical atherosclerosis akakula.5 ICVH ndi adverse vascular phenotypes ndizodalirika zowonetsera zochitika zamtima ndi imfa kwa akuluakulu.6-8
Matenda a mtima a makolo amawonjezera chiopsezo cha zochitika zamtima mwa ana.9 Zinthu zachilengedwe zokhudzana ndi majini ndi moyo wamba zonse zimatengedwa ngati njira zomwe zingatheke, koma zopereka zawo sizinatsimikizidwebe.10, 11
Kugwirizana pakati pa kholo ndi mwana ICVH kumawonekera kale mwa ana azaka 11-12.Panthawiyi, ICVH ya ana imagwirizana ndi kusungunuka kwa mitsempha ya carotid komanso yokhudzana ndi khomo lachiberekero la femoral pulse wave velocity (PWV), koma sikuwoneka mu carotid artery intima-media makulidwe (IMT).12 Komabe, chiopsezo cha mtima pakati pa zaka za 12-18 chikugwirizana ndi kuwonjezeka kwa carotid IMT m'zaka zapakati pazaka zapakati, ndipo sizikugwirizana ndi zochitika zoopsa panthawi yomweyi.13 Umboni wosonyeza kulimba kwa mayanjano ameneŵa ali wamng’ono ulibe.
M'ntchito yathu yapitayi, sitinapeze zotsatira za matenda a shuga a gestational kapena machitidwe a moyo wa amayi pa anthropometry yaubwana, kapangidwe ka thupi kapena kukula kwa mitsempha ndi ntchito.14 Cholinga cha kusanthula uku ndizochitika zapadziko lonse za kuphatikizika kwa chiopsezo cha mtima.Kalasi ndi zotsatira zake pa ochepa phenotype ana.Timalingalira kuti ICVH ya amayi ndi zolowa m'malo mwa mitsempha ya mtima zidzawonetsedwa muubwana wa ICVH ndi arterial phenotypes ali mwana.
Deta yapakatikati ikuchokera kukutsatira kwazaka zisanu ndi chimodzi kwa Finnish Gestational Diabetes Prevention Study (RADIEL).Mapangidwe oyambira ofufuza adaperekedwa kwina.15 Mwachidule, amayi omwe akukonzekera kutenga pakati kapena omwe ali mu theka loyamba la mimba ndipo ali ndi chiopsezo chowonjezeka cha matenda a shuga (kunenepa kwambiri ndi/kapena mbiri ya matenda a shuga) adalembedwa (N=728).Kutsata kwamtima kwazaka zisanu ndi chimodzi kudapangidwa ngati kafukufuku wowunika wa awiriawiri a amayi ndi makanda, okhala ndi chiwerengero chofanana cha amayi omwe ali ndi matenda a shuga a gestational komanso opanda, okhala ndi gulu lodziwika kale (~200).Kuchokera mu June 2015 mpaka May 2017, kuyitanira kosalekeza kunatumizidwa kwa otenga nawo mbali mpaka malire afika, ndipo 201 awiriawiri awiri awiri adalembedwa.Kutsatira kumapangidwira ana azaka zapakati pa 5-6 kuti atsimikizire mgwirizano popanda sedation, kuphatikizapo kuwunika kwamagulu a amayi ndi makanda a kukula kwa thupi ndi kapangidwe kake, kuthamanga kwa magazi, kusala kudya kwa shuga m'magazi ndi lipids zamagazi, kuchita masewera olimbitsa thupi pogwiritsa ntchito ma accelerometers, zakudya zamakhalidwe ndi zakudya. mafunso osuta fodya (amayi), mitsempha ya magazi Ultrasound ndi intraocular pressure measurement ndi echocardiography mwa ana.Kupezeka kwa data kumalembedwa mu Supplementary Table S1.Komiti ya Ethics of Obstetrics and Gynecology, Pediatrics and Psychiatry ya Helsinki University Hospital inavomereza ndondomeko ya kafukufuku (20/13/03/03/2015) kuti iwunikenso zaka zisanu ndi chimodzi.Chilolezo cholembedwa cha amayi onse chodziwitsidwa chinapezedwa panthawi yolembetsa.Phunzirolo linachitidwa motsatira Declaration of Helsinki.
Wofufuza waluso (TS) amagwiritsa ntchito ma transducer a 25 MHz ndi 35 MHz okhala ndi dongosolo la Vevo 770, ndipo amagwiritsa ntchito UHF22, UHF48 (ma frequency ofanana apakati) ndi dongosolo la Vevo MD (VisualSonics, Toronto, Canada) monga ma 52 awiri omaliza a amayi ndi mwana.Mtsempha wamba wa carotid udawonetsedwa 1 cm motalikirana ndi mababu amtundu wa carotid, ndipo malo opumirawo anali pamalo apamwamba.Gwiritsani ntchito ma frequency apamwamba kwambiri omwe amatha kuwona khoma lakutali kuti mupeze zithunzi zamakanema apamwamba kwambiri zozungulira 3-4 zamtima.Gwiritsani ntchito Vevo 3.0.0 (Vevo 770) yokhala ndi ma calipers apamanja apamanja ndi pulogalamu ya VevoLab (Vevo MD) kuti musanthule zithunzizi popanda intaneti.16 Lumen m'mimba mwake ndi IMT adayesedwa ndi wowonera wodziwa bwino (JKMS) kumapeto kwa diastole pogwiritsa ntchito njira zochepetsera), osadziwa za nkhani (Supplementary Figure S1).Tidanenapo kale kuti intra-observer coefficient of variation yoyezedwa ndi Ultra-high-resolution ultrasound mwa ana ndi akulu ndi 1.2-3.7% mu lumen diameter, IMT ndi 6.9-9.8%, ndi inter-observer coefficient of variation ndi 1.5-4.6% m'mimba mwake mwa lumen., 6.0-10.4% ya IMT.Chiwerengero cha carotid IMT Z chosinthidwa malinga ndi zaka komanso jenda chidawerengedwa pogwiritsa ntchito mawu a ana athanzi oyera osanenepa.17
Carotid mtsempha wa lumen m'mimba mwake anayesedwa pachimake systole ndi mapeto diastole kuyesa carotid mtsempha wa β stiffness index ndi carotid kukulitsa mtsempha wamagazi coefficient.Pogwiritsa ntchito khafu yoyenerera bwino, njira ya oscillometric (Dinamap ProCare 200, GE) idagwiritsidwa ntchito polemba kuthamanga kwa magazi kwa systolic ndi diastolic powerengera magwiridwe antchito panthawi ya kujambula kwa ultrasound pampando wa mkono wakumanja.The carotid artery expansion coefficient ndi carotid β-stiffness index amawerengedwa kuchokera ku carotid artery pogwiritsa ntchito njira iyi:
Pakati pawo, CCALAS ndi CCALAD ndizodziwika bwino za carotid artery lumen area panthawi ya systole ndi diastole motsatira;CCALDS ndi CCALDD ndizodziwika bwino za mitsempha ya carotid lumen m'mimba mwake pa systole ndi diastole motsatira;SBP ndi DBP ndi systolic ndi diastolic magazi.18 Chigawo cha kusiyana kwa chiwerengero cha kukula kwa mitsempha ya carotid mu wowonera ndi 5.4%, chiwerengero cha kusiyana kwa mitsempha ya carotid β stiffness index ndi 5.9%, ndi inter-observer coefficient of kusiyana kwa kukula kwa mitsempha ya carotid ndi 11.9% coefficient ndi 12.8% ya mtsempha wa carotid β stiffness index.
Ultrasound high-resolution ultrasound Vivid 7 (GE) yokhala ndi 12 MHz linear transducer idagwiritsidwa ntchito kuti iwonetsetse mtsempha wa carotid wa amayi wa plaque.Kuyambira mtsempha wamba wa carotid pafupi ndi babu, mtsempha wa carotid umayang'aniridwa mowirikiza kudzera mu bifurcation ndi mbali yozungulira ya mkati ndi kunja kwa mitsempha ya carotid.Malingana ndi mgwirizano wa Mannheim, plaque imatanthauzidwa ngati 1. Kukula kwapakati pa khoma la chombo ndi 0.5 mm kapena 50% ya IMT yozungulira kapena 2. Kuchuluka kwa khoma la mitsempha kumaposa 1.5 mm.19 Kukhalapo kwa zolembera kunayesedwa ndi dichotomy.Woyang'anira wamkulu (JKMS) amadzipangira yekha miyeso yobwerezabwereza pazithunzi (N = 40) kuti ayese kusiyana kwa intra-observer, ndipo wowonera wachiwiri (TS) amayesa kusinthasintha kwapakati-observer.The Cohen κ ya kusiyana kwa intra-observer ndi kusiyana kwapakati-observer kunali 0.89 ndi 0.83, motero.
PWV inayesedwa ndi namwino wophunzitsidwa bwino wofufuza kuti awone kuuma kwa mitsempha ya m'madera pogwiritsa ntchito makina opangira makina (Complior Analyse, Alam Medical, Saint-Quentin-Fallavier, France) akupumula pa malo ogona.20 Zomverera zimayikidwa pamtsempha wakumanja wa carotid, mtsempha wakumanja wakumanja, ndi mtsempha wakumanja wachikazi kuti awunike chapakati (mtsempha wapakati wa carotid-femoral artery) ndi zotumphukira (mtsempha wakumanja wa carotid-radial artery) nthawi yodutsa.Gwiritsani ntchito tepi kuyeza mtunda wolunjika pakati pa malo ojambulira mpaka pafupi ndi 0.1 cm.Mtunda wolondola wa carotid femoral artery umachulukitsidwa ndi 0,8 ndiyeno umagwiritsidwa ntchito pakati pa kuwerengera kwa PWV.Bwerezani zojambulira mu malo ogona.Zolemba ziwiri zinapezedwa pamene zolemba zachitatu zinkachitidwa pamalo pomwe kusiyana pakati pa miyeso kunali kwakukulu kuposa 0.5 m / s (10%).Pamiyeso yopitilira iwiri, chotsatira chokhala ndi mtengo wololera wochepa chimagwiritsidwa ntchito posanthula.Kulekerera ndi gawo labwino lomwe limawerengera kusinthasintha kwa mafunde a pulse panthawi yojambulira.Gwiritsani ntchito miyeso yosachepera iwiri pomaliza.PWV ya ana 168 imatha kuyeza.Kuchuluka kwa kusiyana kwa miyeso yobwerezabwereza kunali 3.5% kwa carotid-femoral artery PWV ndi 4.8% ya carotid-radial artery PWV (N = 55).
Zizindikiro zitatu zamabina zimagwiritsidwa ntchito kuwonetsa subclinical atherosulinosis ya mayi: kukhalapo kwa mitsempha ya carotid, mtsempha wa carotid IMT kusintha zaka ndikupitilira 90th percentile mu zitsanzo zathu, ndi zoposa 90 peresenti PWV ya khosi ndi femur ikugwirizana. ndi zaka komanso kuthamanga kwa magazi moyenera.makumi awiri ndi mphambu imodzi
ICVH ndi gulu la 7 zizindikiro za binary zomwe zimakhala ndi chiwerengero chochokera ku 0 mpaka 7 (kuchuluka kwa zigoli, kumagwirizana kwambiri ndi malangizo).Zizindikiro za 4 za ICVH zomwe zimagwiritsidwa ntchito mu phunziroli zimagwirizana ndi tanthauzo loyambirira (zosinthidwa zitatu zapangidwa) -Supplementary Table S2) ndikuphatikizapo:
Ubwino wa zakudya umawunikidwa ndi mwana wa Finnish Child Healthy Eating Index (oyambira 1-42) ndi index ya chakudya cha amayi chathanzi (zosiyanasiyana 0-17).Ma index onsewa amaphatikiza 4 mwa magulu 5 omwe akuphatikizidwa pachiwonetsero choyambirira chazakudya (kupatula kudya kwa sodium).23,24 Phindu lofunika kwambiri la zakudya zabwino komanso zopanda thanzi zimatanthauzidwa kuti 60% kapena zambiri kuti zisonyeze ubwino wa zakudya zoyambirira.Tanthauzo lachizindikiritso (ndiloyenera ngati zoposa 3 mwa njira 5 zakwaniritsidwa).Ponena za kuchuluka kwa ana omwe ali ndi thanzi labwino ku Finnish (87.7% kwa atsikana, 78.2% kwa anyamata), ngati malire okhudzana ndi jenda kwa ana onenepa kwambiri apitilira, BMI ya mwana imatanthauzidwa kuti si yabwino, yomwe ndi yosiyana pang'ono ndi 85. % ya anthu aku Finnish.22 Chifukwa cha chiwerengero chochuluka cha osiya sukulu komanso mtengo wotsika kwambiri wa tsankho (Supplementary Table S1, 96% ya amayi amakwaniritsa zofunikira za ICVH), kuchita masewera olimbitsa thupi kwa amayi omwe ali ndi pakati ndi ogona anachotsedwa.ICVH imagawidwa m'magulu otsatirawa: otsika (ana 0-3, amayi 0-2), apakati (ana 4, amayi 3-4) ndi apamwamba (ana ndi amayi 5-6), kupereka mwayi woyerekezera magulu osiyanasiyana. .
Gwiritsani ntchito zipangizo zamagetsi (Seca GmbH & Co. KG, Germany) kuti muyese kutalika ndi kulemera kwa pafupi ndi 0.1 cm ndi 0.1 kg.Ziwerengero za BMI Z za Ana zimapangidwa potengera kuchuluka kwaposachedwa kwambiri kwa anthu aku Finnish.22 Kapangidwe ka thupi kapambana mayeso a bioelectrical impedance (InBody 720, InBody Bldg, South Korea).
Kupumula kwa magazi kunayesedwa ndi njira ya oscillometric kuchokera kudzanja lamanja pamalo okhala (Omron M6W, Omron Healthcare Europe BV, The Netherlands) yokhala ndi khafu yokwanira.Kuthamanga kwa magazi kwa systolic ndi diastolic kumawerengedwa kuchokera ku miyeso iwiri yotsika kwambiri (miyezo yochepera itatu).Kuthamanga kwa magazi kwa ana a Z mtengo kumawerengedwa motsatira malangizo.25
Zitsanzo za magazi a plasma glucose ndi lipids adasonkhanitsidwa pansi pa kusala kudya.Zotsatira zochokera kwa ana atatu omwe amatsatira mosakayikira kusala kudya (kuchuluka kwa triglycerides, shuga wamagazi osala kudya, ndi glycosylated hemoglobin A1c (HbA1c)) sanaphatikizidwe pakuwunika.Cholesterol chonse, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol ndi triglycerides zimatsimikiziridwa ndi njira ya enzymatic, plasma glucose ndi enzymatic hexokinase determination, ndi HbA1c ndi immunoturbidimetric analyzer (Roche Diagnostics, Basel, Switzerland) pofufuza .
Kudya kwa amayi kunayesedwa ndi mafunso afupipafupi a chakudya ndikuwunikidwanso ndi ndondomeko ya zakudya zopatsa thanzi.The Healthy Food Intake Index idatsimikiziridwa kale ngati chida chothandizira kuwonetsa kutsata Nordic Nutrition Recommendation 26 mu gulu loyambirira la RADIEL.24 Mwachidule, lili ndi zosakaniza 11, zomwe zikuphatikiza kudya masamba, zipatso ndi zipatso, tirigu wambiri, nsomba, mkaka, tchizi, mafuta ophikira, sosi zamafuta, zokhwasula-khwasula, zakumwa zotsekemera komanso zakudya zofulumira.Kukwera kwa magole kumawonetsa kuchuluka kwa kutsatiridwa ndi malingaliro.Ubwino wa zakudya za ana udawunikidwa kudzera muzolemba zazakudya zamasiku atatu ndikuwunikanso ndi Finnish Children's Healthy Eating Index.Mndandanda wa Zakudya Zathanzi za Ana a ku Finnish adatsimikiziridwa kale mu chiwerengero cha ana a ku Finnish.23 Mulinso mitundu isanu ya zakudya: masamba, zipatso ndi zipatso;mafuta ndi margarine;zakudya zokhala ndi shuga wambiri;nsomba ndi nsomba ndi masamba;ndi mkaka wosakanizidwa.Chakudyacho chimaperekedwa kuti chikhale chokwera kwambiri, chikhale chokwera kwambiri.Kupatula zakudya zomwe zili ndi shuga wambiri, zotsatira zake zimasinthidwa.Musanayambe kugoletsa, sinthani kuchuluka kwa mphamvu pogawa (magalamu) ndi mphamvu (kcal).Apamwamba mphambu, bwino khalidwe la zakudya ana.
Zochita zolimbitsa thupi zolimbitsa thupi kwambiri (MVPA) zidayezedwa pogwiritsa ntchito accelerometer ya m'chiuno (ActiGraph GT3X, ActiGraph, Pensacola, USA) ndi bamba ya amayi (SenseWear ArmBand Pro 3).Analangizidwa kuvala chowunikira pa nthawi yogalamuka komanso yogona, koma nthawi yogona sinaphatikizidwe pakuwunika.Woyang'anira ana amasonkhanitsa deta pamlingo wa 30 Hz.Deta nthawi zambiri imasefedwa, imasinthidwa kukhala 10-second epoch count, ndikuwunikidwa pogwiritsa ntchito malo odulidwa a Evenson (2008) (≥2296 cpm).27 Woyang'anira amayi amasonkhanitsa ma MET mu nthawi ya 60-sekondi.MVPA imawerengedwa ngati mtengo wa MET umaposa 3. Kuyeza kogwira mtima kumatanthauzidwa ngati masiku osachepera a 2 ndi 1 kumapeto kwa sabata (kulemba osachepera mphindi 480 patsiku) ndi 3 masiku ogwira ntchito ndi 1 mlungu (kulemba osachepera mphindi 720 patsiku) kwa amayi.Nthawi ya MVPA imawerengedwa ngati yolemetsa [(pafupifupi mphindi za MVPA / tsiku mkati mwa sabata × 5 + pafupifupi mphindi za MVPA / tsiku kumapeto kwa sabata × 2) / 7], kuwonjezera, ngati peresenti ya nthawi yovala yonse.Zomwe zachitika posachedwa kwambiri za anthu aku Finnish zidagwiritsidwa ntchito ngati zofotokozera.28
Mafunsowo anagwiritsidwa ntchito kuti apeze zambiri zokhudza kusuta kwa amayi, matenda aakulu, mankhwala, ndi maphunziro.
Zambiri zimawonetsedwa ngati ± SD, median (interquartile range) kapena kuwerengera (peresenti).Unikani kugawa kwanthawi zonse kwamitundu yonse yosalekeza kutengera histogram ndi chiwembu chokhazikika cha QQ.
Mayeso odziyimira pawokha a mayeso a t, mayeso a Mann-Whitney U, kusanthula kwa njira imodzi ya kusiyanasiyana, Kruskal-Wallis, ndi mayeso a chi-square adagwiritsidwa ntchito moyenera pofananiza magulu (amayi ndi mwana, mnyamata ndi mtsikana, kapena otsika ndi apakatikati ndi apamwamba ICVH). ).
Pearson kapena Spearman rank coefficient corelation coefficient idagwiritsidwa ntchito pofufuza mgwirizano wosasintha pakati pa mikhalidwe ya mwana ndi mayi.
Njira yosinthira mizere yama multivariate idagwiritsidwa ntchito kukhazikitsa chitsanzo chofotokozera ana a HDL cholesterol ndi carotid IMT.Kusankha kosinthika kumatengera kulumikizana komanso kuweruza kwakanthawi kwachipatala, kumapewa kuphatikizika kwamitundumitundu muchitsanzocho, ndikuphatikizanso zinthu zomwe zingasokoneze.Multicollinearity imawunikidwa pogwiritsa ntchito kusiyana kwa inflation factor, ndi mtengo wapatali wa 1.9.Multivariate linear regression idagwiritsidwa ntchito kusanthula kuyanjana.
P ≤ 0.05 yokhala ndi michira iwiri idayikidwa kuti ikhale yofunikira, kupatula pakuwunika kolumikizana kwazomwe zimadziwika ndi mitsempha ya carotid IMT mwa ana omwe ali ndi P ≤ 0.01.
Makhalidwe a ophunzira akuwonetsedwa mu Table 1 ndi Supplementary Table S3.Poyerekeza ndi chiwerengero cha anthu, chiwerengero cha ana a BMI Z ndi BP Z chikuwonjezeka.Ntchito yathu yapitayi idafotokoza zambiri za arterial morphology mwa ana.14 Ana a 15 (12%) okha ndi amayi a 5 (2.7%) adakwaniritsa zofunikira zonse za ICVH (Supplementary Figures 2 ndi 3, Supplementary Tables S4-S6).
Kuchuluka kwa ICVH kwa amayi ndi makanda kumangogwirizana ndi anyamata (anyamata: rs=0.32, P=0.01; atsikana: rs=-0.18, P=0.2).Mukawunikiridwa ngati kusinthasintha kosalekeza, kusanthula kwa mayi ndi mwana wosabadwayo kumakhala ndi tanthauzo lalikulu pakuyezera magazi lipids, HbA1C, kunenepa kwambiri, kuthamanga kwa magazi kwa diastolic, komanso zakudya zabwino (Supplementary Figures S4-S10).
LDL, HDL ya ana ndi amayi, ndi mafuta a kolesterolini onse n’zogwirizana (r=0.23, P=0.003; r=0.35, P<0.0001; r=0.24, P=0.003, Chithunzi 1).Potsatiridwa ndi jenda la mwana, kulumikizana pakati pa LDL ya mwana ndi mayi ndi cholesterol yonse idakhalabe yofunika mwa anyamata okha (Supplementary Table S7).Ma triglycerides ndi HDL cholesterol amalumikizidwa ndi kuchuluka kwamafuta amthupi la atsikana (rs = 0.34, P = 0.004; r = -0.37, P = 0.002, motsatana, Chithunzi 1, Supplementary Table S8).
Chithunzi 1 Ubale wapakati pa lipids wamwazi wa mwana ndi mayi.Chiwembu chomwaza chokhala ndi mzere wowongolera (95% nthawi yodalirika);(AC) misinkhu yamagazi ya amayi ndi makanda;(D) kuchuluka kwamafuta amthupi la atsikana ndi cholesterol yochuluka kwambiri ya lipoprotein.Zotsatira zazikulu zikuwonetsedwa molimba mtima (P ≤ 0.05).
Mwachidule: LDL, low-density lipoprotein;HDL, high-density lipoprotein;r, Pearson corelation coefficient.
Tidapeza kuti panali kulumikizana kwakukulu pakati pa HbA1C ya mwana ndi mayi (r=0.27, P=0.004), koma sizinali zokhudzana ndi kusala kudya shuga (P=0.4).Kuchuluka kwa BMI Z kwa ana, koma osati kuchuluka kwamafuta amthupi, kumalumikizidwa mofooka ndi BMI ya amayi ndi chiŵerengero cha m'chiuno ndi m'chiuno (r=0.17, P=0.02; r=0.18, P=0.02, motsatana).Mtengo wa Z wa kuthamanga kwa magazi kwa diastolic kwa ana umalumikizidwa mofooka ndi kuthamanga kwa magazi kwa mayi (r=0.15, P=0.03).Mlozera wa zakudya zathanzi za ana aku Finnish umagwirizana ndi chakudya cha amayi chomwe chili ndi thanzi labwino (r=0.22, P 0.002).Ubalewu unkawonedwa mwa anyamata okha (r=0.31, P=0.001).
Pambuyo popatula amayi omwe adalandira chithandizo cha matenda a kuthamanga kwa magazi, hypercholesterolemia, kapena hyperglycemia, zotsatira zake zinali zofanana.
Tsatanetsatane wa arterial phenotype ikuwonetsedwa mu Supplementary Table S9.Mitsempha ya ana imakhala yodziyimira pawokha pazikhalidwe za ana (Supplementary Table S10).Sitinawone mgwirizano uliwonse pakati pa ubwana wa ICVH ndi dongosolo la mitsempha kapena ntchito.Pakuwunika kwa ana opangidwa ndi ma ICVH, tidawona kuti ma carotid IMT Z a ana omwe ali ndi ziwerengero zocheperako adakwera poyerekeza ndi ana omwe ali ndi zochepera (kutanthauza ± SD; zolimbitsa thupi 0.41 ± 0.63 vs low score- 0.07 ± 0.71, P = 0.03, Supplementary Table S11).
Maternal ICVH sagwirizana ndi vascular phenotype ya ana (Supplementary Tables S10 ndi S12).Ana ndi mtsempha wa carotid wa amayi wa IMT amalumikizana (Chithunzi 2), koma mgwirizano wa amayi ndi mwana pakati pa kuuma kwa mitsempha yosiyana siyana sikofunikira kwenikweni (Zowonjezera Table 9, Supplementary Figure S11).Munjira yotanthauzira mosiyanasiyana yosinthira jenda, zaka, kuthamanga kwa magazi kwa ana, kuchepa kwa thupi, ndi kuchuluka kwamafuta amthupi, carotid ya amayi IMT ndiyo yokhayo yodziyimira payokha ya carotid IMT ya ana (yosinthidwa R2 = 0.08).Pakuwonjezeka kulikonse kwa 1 mm mu IMT ya carotid ya amayi, carotid ya ubwana IMT imakula ndi 0.1 mm (95% CI 0.05, 0.21, P = 0.001) (Supplementary Table S13).Jenda la mwanayo silinachepetse izi.
Chithunzi 2 Kulumikizana pakati pa makulidwe a carotid artery intima-media mwa ana ndi amayi.Chiwembu chomwaza chokhala ndi mzere wowongolera (95% nthawi yodalirika);(A) maternal and child carotid IMT, (B) maternal carotid IMT percentile and child carotid IMT z-score.Zotsatira zazikulu zikuwonetsedwa molimba mtima (P ≤ 0.05).
Kuchuluka kwa mitsempha yamagazi ya amayi kumayenderana ndi kuchuluka kwa mtsempha wa carotid ndi β stiffness index mwa ana (rs=-0.21, P=0.007, rs=0.16, P=0.04, Supplementary Table S10, motsatira).Ana obadwa kwa amayi omwe ali ndi mitsempha ya 1-3 amakhala ndi chiwerengero chochepa cha kukula kwa mtsempha wa carotid kusiyana ndi omwe amabadwa kwa amayi omwe ali ndi chiwerengero cha 0 (kutanthauza ± kupatuka, 1.1 ± 0.2 vs 1.2 ± 0.2%/10 mmHg, P= 0.01) ndipo pali chizolowezi chowonjezera chiwerengero cha carotid β stiffness index (median (IQR), 3.0 (0.7) ndi 2.8 (0.7), P = 0.052) ndi mtsempha wa carotid IMT (kutanthauza ± SD, 0.37 ± 0.04 ± 0.04 ndi 0.3 ± 0.3 mm, P=0.06) (Chithunzi 3), Supplementary Table S14).
Chithunzi 3 Child vascular phenotype stratified ndi maternal vascular score.Zambiri zimawonetsedwa ngati + SD, P yokhala ndi mayeso odziyimira pawokha a t (A ndi C) ndi mayeso a Mann-Whitney U (B).Zotsatira zazikulu zikuwonetsedwa molimba mtima (P ≤ 0.05).Kuchuluka kwa mitsempha yamagazi ya amayi: 0-3, zizindikiro zitatu za binary: kupezeka kwa carotid plaque, makulidwe a carotid artery intima-media yosinthidwa ndi msinkhu ndikupitirira 90% mu zitsanzo zathu, ndi khomo lachiberekero-chikazi pulse wave. mayendedwe opitilira 90% amafanana ndi zaka komanso kuthamanga kwa magazi.makumi awiri ndi mphambu imodzi
Chiwerengero cha amayi (ICVH, vascular score) ndi kuphatikizika kwa ana ndi amayi apakati sizikugwirizana ndi zochitika zapamtima za ana (Supplementary Table S10).
Pakuwunika kwapakati pa amayi ndi ana awo azaka 6, tidafufuza mgwirizano pakati pa ubwana wa ICVH, ICVH ya amayi, ndi matenda a atherosulinosis a amayi omwe ali ndi mawonekedwe ndi magwiridwe antchito a mitsempha ya ana.Chachikulu anapeza kuti mayi yekha subclinical atherosclerosis, pamene ana ndi mayi ochiritsira mtima chiopsezo zinthu sizigwirizana ndi chokhwima kusintha mu ubwana wa mtima phenotypes.Kuzindikira kwatsopano kumeneku pakukula kwa mitsempha yaubwana kumawonjezera kumvetsetsa kwathu kwamitundu yosiyanasiyana ya subclinical atherosulinosis.
Timapereka umboni wa kuchepa kwa mtsempha wa carotid komanso momwe kulimba kwa mitsempha ya carotid beta komanso mtsempha wa carotid IMT mwa ana a amayi omwe ali ndi matenda a mtima ndi mitsempha yamagazi.Komabe, palibe kugwirizana kwachindunji pakati pa zizindikiro za mitsempha ya amayi ndi makanda.Timalingalira kuti kuphatikiza zolembera za amayi m'mitsempha yamagazi kumawonjezera mtengo wake wolosera.
Tawona mgwirizano wabwino pakati pa mitsempha ya carotid IMT mwa ana ndi amayi;komabe, makinawo sakudziwika bwino chifukwa mtsempha wa carotid IMT mwa ana umakhala wodziimira pa makhalidwe a mwanayo ndi mayi.Mgwirizano pakati pa chiwerengero cha ana a ICVH ndi carotid IMT unawonetsa kusagwirizana, chifukwa sitinawone kusiyana kulikonse pakati pa ICVH yochepa ndi ICVH yapamwamba.
Tikudziwa kuti zinthu zina zitha kukhala ndi gawo, kuphatikiza mutu wa ana, womwe ungakhale chidziwitso chofunikira cha kukula kwa mtsempha wa carotid kumayambiriro kwa kukula.Kuonjezera apo, zotsatira zathu zikhoza kukhala chifukwa cha zinthu zosayembekezeka zomwe zimakhudza kukula kwa mitsempha ya fetal.Komabe, tanena kale kuti mimba isanayambe kunenepa kwambiri / kunenepa kwambiri ndi matenda a shuga a gestational alibe mphamvu pa ubwana wa carotid IMT.14 Kafukufuku wowonjezereka ndi wofunikira kuti afufuze chikoka cha mapangidwe a mitsempha ndi ntchito pa kukula kwa ana ndi chibadwa.
Mabungwe omwe adanenedwawo akugwirizana ndi maphunziro am'mbuyomu omwe adachitika kwa achinyamata, omwe adapereka umboni wa mayanjano pakati pa makolo ndi ana a vascular phenotypes, kuphatikiza carotid IMT, ngakhale kukula kwa thupi sikunasinthidwe pakuwunika.29 Cholowa chochuluka cha carotid IMT chimatsimikiziranso izi ndi kuuma kwa mitsempha ya akuluakulu.30, 31
Kugwirizana komwe kunawonedwa pakati pa amayi apakati a atherosulinosis ndi ubwana wamtima phenotype sikunakulitsidwe ndi amayi a ICVH.Izi zikugwirizana ndi maphunziro apitalo omwe mbali yaikulu ya kusiyana kwa ana a mitsempha ya phenotype ikufotokozedwa ndi majini osagwirizana ndi zochitika zapamtima za makolo ndi ana.29
Komanso, anaona kusintha kwa mitsempha alibe chochita ndi ubwana ICVH, kusonyeza chikoka chachikulu cha chiyambi ubwana chibadwa.Kuthandizira kwazinthu zachilengedwe kumawoneka kuti kukusintha ndi zaka za ana, monga momwe kafukufuku wamkulu wam'mbuyo wa ana azaka zapakati pa 11-12 adawonetsa kuyanjana kwakukulu pakati pa ntchito ya mitsempha ya ana ndi ICVH.12
Nthawi yotumiza: Jul-14-2021