F Chiarelli, D Di Marzio

Abstract

Objective: To review currently available evidence on the molecular mechanisms, risk factors and outcomes of mico- and macrovascular complications in children with type 1 diabetes mellitus. Data sources and study selection: Medline, Pubmed, and Cochrane Library searches of internationally published English language journals, from 1985 to February 2010 using the terms "diabetes", "children", "complications", "angiopathy" and "management". Data extraction: All articles involving diabetes vascular complications in children were included in the review. Data synthesis: During the natural history of diabetes several molecular, receptorial and cellular factors provide a continuous mechanism of vascular damage. In children with diabetes this state is present at an early age so that accelerated atherosclerosis is associated with an increased risk of micro- and macrovascular complications as compared to the non-diabetic paediatric population. The major long term complications of diabetes can be divided into micro- (nephropathy, retinopathy and neuropathy) and macrovascular complications. Childhood remains a period during which intensive education and treatment may prevent or delay the onset and progression of these complications. Conclusions: Although the prognosis has improved considerably in recent years due to the advances in the therapeutic interventions, systematic regular screening continues to have a pivotal role in the management of complications in diabetic children. Primary prevention to all risk factors for vascular complications is essential and intervention is indicated if necessary even in childhood.

目的：回顧分析1型糖尿病兒童的微血管及大血管合併症在分子機制、風險因素及結局方面的現有徵象。數據源及病例選擇：應用關鍵詞"diabetes"、 "children"、 "complications"、 "angiopathy" 和"management"，搜索1985年至2010年2月在Medline、Pubmed和Cochrane國家圖書館發表的英文文献。資料提取：所有涉及兒童糖尿病血管合併症的文章均包括在該分析內。數據合成：在糖尿病的自然進程中，某些分子、受體和細胞因數為血管損傷提供了一個持續的機制。患有糖尿病的兒童，這一過程開始於年齡很小時，因此與非糖尿病的兒童相比，其動脈粥樣硬化加速，同時合併了更高的微血管及大血管合併症的風險。糖尿病主要的長期合併症可以分為微血管（腎病、視網膜病變和神經病變）和大血管合併症。兒童時期是一個重要的階段，在這一時期內進行密集的教育和治療可以防止或延遲這些併發症的出現和進展。結論：雖然，近年來治療措施的不斷發展在一定程度上改善了該病變的預後，但是，系統性的定期檢查在糖尿病兒童合併症的防治方面仍有關鍵作用。早期預防血管合併症的所有風險因素是必要的，而且必要的時候，甚至在兒童時期，就應採取干預措施。