BMC Endocrine Disorders | |
Altered Platelets’ morphological parameters in children with type 1 diabetes – a case-control study | |
Wojciech Fendler1  Wojciech Mlynarski1  Olga Wegner1  Anna Baranowska-Jazwiecka1  Agnieszka Szadkowska1  Bartlomiej Tomasik1  Beata Malachowska1  | |
[1] Department of Paediatrics, Oncology, Haematology and Diabetology, Medical University of Lodz, 36/50 Sporna St., Lodz, 91-738, Poland | |
关键词: Children; Type 1 diabetes; Mean platelet volume; Platelets; | |
Others : 1160553 DOI : 10.1186/s12902-015-0011-8 |
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received in 2014-09-01, accepted in 2015-03-26, 发布年份 2015 | |
【 摘 要 】
Background
Platelet hyperreactivity is a factor which contributes towards increased risk of cardiovascular events in adults with type 2 diabetes (T2DM). However, little is known about platelets’ disturbances among children with type 1 diabetes (T1DM). The aim of the study was to investigate whether platelets’ morphology or function are altered in children with type 1 diabetes, potentially predisposing them to cardiovascular events in the future.
Methods
The study group consisted of 389 children with T1DM during the 2008–2010 period. Patients with acute diabetes complications and ongoing infections were excluded from the study. An equinumerous (N = 389), age and sex-matched control group was assembled from children undergoing routine, minor surgical procedures in the same hospital. Platelet: count (PLT), mean volume (MPV), distribution width (PDW) and platelet large cell ratio (P-LCR) as well as HbA1c levels were measured. For statistical analysis we used Chi-square tests, the student’s t-test, one-way analysis of variance (ANOVA), the Pearson’s correlation coefficient and linear regression models in order to adjust for covariates.
Results
MPV, PDW and P-LCR were significantly higher among children with diabetes in comparison with the control group (MPV 10.47+/−0.85 fL vs 10.23+/−0.94 fL, p = 0.0007; PDW 12.09+/−1.80% vs 11.66+/−1.90%, p = 0.0032; P-LCR 28.21+/−6.15% vs 26.29+/−6.38%, p < 0.0001). PLT however, were shown to be similar (263.55+/−60.04 vs 268.77+/−65.78 103/μl; p = 0.5637). In both cases and controls age was inversely correlated with platelet count (for study group: r = −0.30, p < 0.0001; for control group: r = −0.34, p < 0.0001), positively correlated with MPVs (r = 0.20, p < 0.0001; r = 0.26, p < 0.0001), PDW (r = 0.25, p < 0.0001 and r = 0.24, p < 0.0001) and P-LCR (r = 0.26, p < 0.0001; r = 0.26, p < 0.0001). After adjustment for confounding factors, higher platelet counts were associated with poorer metabolic control (beta = 0.20; 0.0001).
Conclusions
Platelets of paediatric patients with T1DM show morphological evidence of hyperreactivity (higher MPV, PDW and P-LCR), while poorer metabolic control increases their number potentially predisposing the patients to future cardiovascular events.
【 授权许可】
2015 Malachowska et al.; licensee BioMed Central.
【 预 览 】
Files | Size | Format | View |
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20150411014213881.pdf | 1558KB | download | |
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Figure 1. | 143KB | Image | download |
【 图 表 】
Figure 1.
Figure 2.
【 参考文献 】
- [1]Jarosz-Chobot P, Polanska J, Szadkowska A, Kretowski A, Bandurska-Stankiewicz E, Ciechanowska M, Deja G, Mysliwiec M, Peczynska J, Rutkowska J, et al.: Rapid increase in the incidence of type 1 diabetes in Polish children from 1989 to 2004, and predictions for 2010 to 2025. Diabetologia 2011, 54(3):508-515.
- [2]Nathan DM: Long-term complications of diabetes mellitus. N Engl J Med 1993, 328(23):1676-1685.
- [3]Krishnan S, Short KR: Prevalence and significance of cardiometabolic risk factors in children with type 1 diabetes. J Cardiometab Syndr 2009, 4(1):50-56.
- [4]Colwell JA, Nesto RW: The platelet in diabetes: focus on prevention of ischemic events. Diabetes Care 2003, 26(7):2181-2188.
- [5]Watala C: Blood platelet reactivity and its pharmacological modulation in (people with) diabetes mellitus. Curr Pharm Des 2005, 11(18):2331-2365.
- [6]Greisenegger S, Endler G, Hsieh K, Tentschert S, Mannhalter C, Lalouschek W: Is elevated mean platelet volume associated with a worse outcome in patients with acute ischemic cerebrovascular events? Stroke 2004, 35(7):1688-1691.
- [7]Hekimsoy Z, Payzin B, Ornek T, Kandogan G: Mean platelet volume in Type 2 diabetic patients. J Diabetes Complications 2004, 18(3):173-176.
- [8]Smith NM, Pathansali R, Bath PM: Platelets and stroke. Vasc Med 1999, 4(3):165-172.
- [9]Tschoepe D, Roesen P, Esser J, Schwippert B, Nieuwenhuis HK, Kehrel B, Gries FA: Large platelets circulate in an activated state in diabetes mellitus. Semin Thromb Hemost 1991, 17(4):433-438.
- [10]Glassman AB: Platelet abnormalities in diabetes mellitus. Ann Clin Lab Sci 1993, 23(1):47-50.
- [11]Sharpe PC, Trinick T: Mean platelet volume in diabetes mellitus. Q J Med 1993, 86(11):739-742.
- [12]Lattanzio S, Santilli F, Liani R, Vazzana N, Ueland T, Di Fulvio P, et al. Circulating dickkopf-1 in diabetes mellitus: association with platelet activation and effects of improved metabolic control and low-dose aspirin. J Am Heart Assoc. 2014; doi: 10.1161/JAHA.114.001000.
- [13]Singer J, Weissler Snir A, Leshem-Lev D, Rigler M, Kornowski R, Lev EI: Effect of intensive glycemic control on platelet reactivity in patients with long-standing uncontrolled diabetes. Thromb Res 2014, 134(1):121-124.
- [14]Wolfsdorf JI: The International Society of Pediatric and Adolescent Diabetes guidelines for management of diabetic ketoacidosis: do the guidelines need to be modified? Pediatr Diabetes 2014, 15(4):277-286.
- [15]Ly TT, Maahs DM, Rewers A, Dunger D, Oduwole A, Jones TW: Assessment and management of hypoglycemia in children and adolescents with diabetes. Pediatr Diabetes 2014, 15(Suppl 20):180-192.
- [16]Standards of medical care in diabetes-2014. Diabetes Care. 2014;37(Suppl 1):S14-80.
- [17]Pirgon O, Tanju IA, Erikci AA: Association of mean platelet volume between glucose regulation in children with type 1 diabetes. J Trop Pediatr 2009, 55(1):63-64.
- [18]Unubol M, Ayhan M, Guney E: The relationship between mean platelet volume with microalbuminuria and glycemic control in patients with type II diabetes mellitus. Platelets 2012, 23(6):475-480.
- [19]Ulutas KT, Dokuyucu R, Sefil F, Yengil E, Sumbul AT, Rizaoglu H, Ustun I, Yula E, Sabuncu T, Gokce C: Evaluation of mean platelet volume in patients with type 2 diabetes mellitus and blood glucose regulation: a marker for atherosclerosis? Int J Clin Exp Med 2014, 7(4):955-961.
- [20]Rubenstein DA, Maria Z, Yin W: Combined incubation of platelets and endothelial cells with glycated albumin: Altered thrombogenic and inflammatory responses. Diab Vasc Dis Res 2014, 11(4):235-242.
- [21]Sobol AB, Watala C: The role of platelets in diabetes-related vascular complications. Diabetes Res Clin Pract 2000, 50(1):1-16.
- [22]Tschope D, Langer E, Schauseil S, Rosen P, Kaufmann L, Gries FA: Increased platelet volume–sign of impaired thrombopoiesis in diabetes mellitus. Klin Wochenschr 1989, 67(4):253-259.
- [23]Watala C, Boncler M, Pietrucha T, Trojanowski Z: Possible mechanisms of the altered platelet volume distribution in type 2 diabetes: does increased platelet activation contribute to platelet size heterogeneity? Platelets 1999, 10(1):52-60.
- [24]Wong T, Pedvis L, Frojmovic M: Platelet size affects both micro- and macro-aggregation: contributions of platelet number, volume fraction and cell surface. Thromb Haemost 1989, 62(2):733-741.
- [25]Winocour PD: Platelet turnover in advanced diabetes. Eur J Clin Invest 1994, 24(Suppl 1):34-37.
- [26]Debili N, Masse JM, Katz A, Guichard J, Breton-Gorius J, Vainchenker W: Effects of the recombinant hematopoietic growth factors interleukin-3, interleukin-6, stem cell factor, and leukemia inhibitory factor on the megakaryocytic differentiation of CD34+ cells. Blood 1993, 82(1):84-95.
- [27]Brown AS, Hong Y, de Belder A, Beacon H, Beeso J, Sherwood R, Edmonds M, Martin JF, Erusalimsky JD: Megakaryocyte ploidy and platelet changes in human diabetes and atherosclerosis. Arterioscler Thromb Vasc Biol 1997, 17(4):802-807.
- [28]Ryba-Stanislawowska M, Skrzypkowska M, Mysliwska J, Mysliwiec M: The serum IL-6 profile and Treg/Th17 peripheral cell populations in patients with type 1 diabetes. Mediators Inflamm 2013, 2013:205284.
- [29]Kahler P, Grevstad B, Almdal T, Gluud C, Wetterslev J, Vaag A, Hemmingsen B: Targeting intensive versus conventional glycaemic control for type 1 diabetes mellitus: a systematic review with meta-analyses and trial sequential analyses of randomised clinical trials. BMJ Open 2014, 4(8):e004806.
- [30]Lachin JM, Orchard TJ, Nathan DM: Update on cardiovascular outcomes at 30 years of the diabetes control and complications trial/epidemiology of diabetes interventions and complications study. Diabetes Care 2014, 37(1):39-43.