mimmunМедицинская иммунологияMedical Immunology (Russia)1563-06252313-741XSPb RAACI10.15789/1563-0625-FOT-2584mimmun-2584Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESОсобенности цитокинового профиля у подростков с микрососудистыми осложнениями сахарного диабета 1 типаFeatures of the cytokine profile in adolescents with microvascular complications of type 1 diabetes mellitusЛевковичМ. А.LevkovichM. A.

Левкович Марина Аркадьевна – доктор медицинских наук, доцент, ведущий научный сотрудник отдела аллергических и аутоиммунных заболеваний в педиатрии.

344012, Ростов-на-Дону, ул. Мечникова, 43

Тел.: 8 (918) 570-64-36

Marina A. Levkovich - PhD, MD (Medicine), Associate Professor, Leading Research Associate, Department of Allergic and Autoimmune Diseases in Pediatrics, Research Institute of Obstetrics and Pediatrics, Rostov State Medical University.

43 Mechnikov St Rostov-on-Don 344012

Phone: +7 (918) 570-64-36

xlma@mail.ruГалкинаГ. А.GalkinaG. A.

Галкина Галина Александровна – доктор медицинских наук, профессор кафедры эндокринологии (с курсом детской эндокринологии) РостГМУ МЗ РФ; заведующая эндокринологическим отделением НИИАП РостГМУ МЗ РФ.

344012, Ростов-на-Дону, ул. Мечникова, 43

PhD, MD (Medicine), Professor, Department of Endocrinology (with a Course in Pediatric Endocrinology), Rostov State Medical University; Head, Department of Endocrinology, Research Institute of Obstetrics and Pediatrics, Rostov State Medical University.

43 Mechnikov St Rostov-on-Don 344012

goli-an@yandex.ruВоропайА. А.VoropaiA. A.

Воропай Ангелина Александровна – врач – детский эндокринолог.

344012, Ростов-на-Дону, ул. Мечникова, 43

Pediatric Endocrinologist, Federal State Budgetary Educational Institution of Higher Education, Rostov State Medical University, Research Institute of Obstetrics and Pediatrics, Rostov State Medical University.

43 Mechnikov St Rostov-on-Don 344012

goli-an@yandex.ruКомковаМ. В.KomkovaM. V.

Комкова Марина Викторовна – кандидат медицинских наук, врач – детский эндокринолог.

344012, Ростов-на-Дону, ул. Мечникова, 43

PhD (Medicine), Pediatric Endocrinologist, Research Institute of Obstetrics and Pediatrics, Rostov State Medical University.

43 Mechnikov St Rostov-on-Don 344012

mvkomkova2016@yandex.ruМорозоваН. В.MorozovaN. V.

Морозова Наталья Викторовна – кандидат медицинских наук, врач – детский эндокринолог.

344012, Ростов-на-Дону, ул. Мечникова, 43

PhD (Medicine), Pediatric Endocrinologist, Research Institute of Obstetrics and Pediatrics, Rostov State Medical University.

43 Mechnikov St Rostov-on-Don 344012

monata12@yandex.ruКравченкоЛ. В.KravchenkoL. V.

Кравченко Лариса Вахтанговна – доктор медицинских наук, ведущий научный сотрудник педиатрического отдела.

344012, Ростов-на-Дону, ул. Мечникова, 43

PhD, MD (Medicine), Leading Research Associate, Pediatric Department, Research Institute of Obstetrics and Pediatrics, Rostov State Medical University.

43 Mechnikov St Rostov-on-Don 344012

xlma@mail.ruКрукиерИ. И.KrukierI. I.

Крукиер Ирина Ивановна – доктор биологических наук, ведущий научный сотрудник акушерско-гинекологического отдела.

344012, Ростов-на-Дону, ул. Мечникова, 43

PhD, MD (Biology), Leading Research Associate, Obstetrics and Gynecology Department, Research Institute of Obstetrics and Pediatrics, Rostov State Medical University.

43 Mechnikov St Rostov-on-Don 344012

secretary@rniiap.ruАндрееваВ. О.AndreevaV. O.

Андреева Вера Олеговна – доктор медицинских наук, главный научный сотрудник акушерско-гинекологического отдела.

344012, Ростов-на-Дону, ул. Мечникова, 43

PhD, MD (Medicine), Chief Research Associate, Obstetrics and Gynecology Department, Research Institute of Obstetrics and Pediatrics, Rostov State Medical University.

43 Mechnikov St Rostov-on-Don 344012

secretary@rniiap.ruПогореловаТ. Н.PogorelovaT. N.

Погорелова Татьяна Николаевна – доктор биологических наук, главный научный сотрудник акушерско-гинекологического отдела.

344012, Ростов-на-Дону, ул. Мечникова, 43

PhD, MD (Biology), Chief Research Associate, Obstetrics and Gynecology Department, Research Institute of Obstetrics and Pediatrics, Rostov State Medical University.

43 Mechnikov St Rostov-on-Don 344012

secretary@rniiap.ruНаучно-исследовательский институт акушерства и педиатрии Ростовского государственного медицинского университета Министерства здравоохранения РФРоссияResearch Institute of Obstetrics and Pediatrics Rostov State Medical UniversityRussian Federation202314112022251101110Copyright © Левкович М.А., Галкина Г.А., Воропай А.А., Комкова М.В., Морозова Н.В., Кравченко Л.В., Крукиер И.И., Андреева В.О., Погорелова Т.Н., 20232023Левкович М.А., Галкина Г.А., Воропай А.А., Комкова М.В., Морозова Н.В., Кравченко Л.В., Крукиер И.И., Андреева В.О., Погорелова Т.Н.Levkovich M.A., Galkina G.A., Voropai A.A., Komkova M.V., Morozova N.V., Kravchenko L.V., Krukier I.I., Andreeva V.O., Pogorelova T.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.mimmun.ru/mimmun/article/view/2584

Несмотря на достижения современной науки, серьезной проблемой в управлении сахарным диабетом 1-го типа (СД1) у детей и подростков является преодоление последствий, связанных     с осложнениями данного заболевания. Быстрое развитие микрососудистых диабетических осложнений (ретинопатии, нейропатии, нефропатии) остается существенным препятствием в поддержании высокого качества жизни и социальной адаптации молодых пациентов, что позволяет обратиться к изучению иммунных механизмов, участвующих в процессах повреждения микроциркуляторного русла в условиях дисметаболических отклонений, сопутствующих СД1.

Цель работы – оценить роль нарушений цитокинового баланса в сыворотке крови в формировании микроангиопатий у подростков с СД1.

Обследовано 140 подростков с СД1 возраста 14-18 лет,  которые были распределены на 2 группы:    I группа – пациенты с уровнем гликированного гемоглобина (HbA1c) более 9% (n = 65), и II группа – подростки с уровнем HbA1C ≤ 9,0% (n = 75). Каждая группа была подразделена на подгруппы:   Iа (n = 50), IIа (n = 38) – подростки с диабетической ретинопатией, нефропатией или нейропатией; Iб (n = 15), IIб (n = 37) – с неосложненным течением заболевания. Группу  контроля составили 36 подростков с нормальной массой тела, без нарушений углеводного обмена и отягощенной по сахарному диабету наследственности. Определение уровней TNFα, IL-1β, VCAM-1, фракталкина в сыворотке крови проводили методом иммуноферментного анализа с использованием тест-систем RayBiotech (США), BIOSCIENCE (США).

Формирование микроангиопатий у подростков с  различным  уровнем  гликемического  контроля ассоциировано с повышением сывороточной концентрации медиаторов, вовлеченных в неоангиогенез и процессы ремоделирования сосудистой стенки: TNFα, IL-1β, VCAM-1, при сравнении с группой контроля (p < 0,05) и статистически значимым снижением фракталкина у всех подростков с осложненным и неосложненным течением СД1. Проведенное исследование позволило установить, что развитие микрососудистых осложнений у подростков с СД1 сопряжено с нарушением иммунного реагирования с тенденцией направленности цитокинового баланса по Тh1-типу, усилением процессов межклеточного взаимодействия, дисбалансом биорегуляторных молекул и способствует формированию воспалительного режима иммунорегуляции.

Выявленные закономерности наряду с оценкой показателей метаболического контроля, позволят персонифицировать подходы к ранней диагностике микрососудистых осложнений у подростков  с СД1 и предотвратить их дальнейшую прогрессию.

Despite advances of modern medical science, the consequences associated with management of complications in type 1 diabetes mellitus (DM1) in children and adolescents represent a serious problem. Common development of microvascular diabetic complications (retinopathy, neuropathy, kidney damage) still remains a sufficient obstacle for achieving high quality of life and social adaptation in the young patients, thus promoting studies of immune mechanisms involved in genesis of microvasculature damage under the conditions of dysmetabolic abnormalities associated with DM1. Our goal was to assess the role of altered cytokine balance in blood serum in development of microangiopathies in adolescents with DM1.

140 adolescent patients with type 1 diabetes aged 14-18 years were examined being divided in 2 groups: group I included the patients with glycated hemoglobin (HbA1c) level of > 9.0% (n = 65), and group II which included adolescents with HbA1C level of ≤ 9.0% (n = 75). Each group was divided into subgroups: Ia (n = 50) and IIa (n = 38) included adolescents with diabetic retinopathy, nephropathy or neuropathy, whereas groups Ib (n = 15) and IIb (n = 37) were without microvascular complications. The control group consisted of 36 adolescents with normal body weight, without carbohydrate metabolic disorders, and family history of diabetes mellitus. Determination of TNFα, IL-1β, VCAM-1, fractalkine levels in blood serum was performed by enzyme immunoassay using test systems “RayBiotech” (USA), “BIOSCIENCE” (USA).

Development of microangiopathies in adolescents with different glycemic control is associated with increased serum concentration of the factors involved in neoangiogenesis and vascular wall remodeling, i.e., TNFα, IL-1β, VCAM-1, compared with control group (p < 0.05), and a statistically significant decrease in fractalkine level in adolescent patients with either complicated, or uncomplicated DM1. The study allowed us to suggest that occurrence of microvascular complications in adolescents with DM1 is associated with impaired immune response tending for altered cytokine balance towards Th1 type, enhanced intercellular interactions, imbalance of bioregulatory molecules, contributing to development of inflammatory immunoregulatory state. The revealed patterns of laboratory markers, along with assessment of metabolic indices, will enable personalized approaches to early diagnostics of microvascular complications in adolescents with DM1 and prevent their further progression.

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The authors declare that there are no conflicts of interest present.