Cardiovascular risk factors and increased carotid intima-media thickness in young patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency

ABSTRACT Objective Increased arterial intima-media thickness has been observed in adults with congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency (21-OHD). CAH has also been associated with obesity, insulin resistance, and hypertension. The aim of the present study was to compare youths with CAH with healthy, normal-weight individuals, evaluating carotid intima-media thickness (CIMT) and indicative factors of cardiovascular risk to seek for abnormalities in the CAH group. Subjects and methods Clinical, biochemical, and ultrasonographic evaluations, according to published criteria, were performed in 113 subjects (5 to 20 years old): 40 patients with 21-OHD and 73 healthy individuals matched for gender, pubertal status, and age. Results Most CAH patients were female (80%), salt-losers (72.5%), and pubescent (80%); 10 (25%) patients were overweight. An increase in CIMT was observed both on the right (p = 0.0240) and left (p = 0.0003) sides in 38 CAH patients compared with the healthy individuals. The body mass index, BMI/age Z score, and systolic blood pressure (SBP) were higher in patients compared with controls (p摘要 目的 因21-羟化酶缺乏症（21-hydroxylase deficiency, 21-OHD）所致的先天性肾上腺皮质增生症（congenital adrenal hyperplasia, CAH）成人患者中已被观察到动脉内膜中层厚度增加。此外，CAH还与肥胖、胰岛素抵抗及高血压存在相关性。本研究旨在对比21-OHD型CAH青少年患者与健康正常体重个体，评估颈动脉内膜中层厚度（carotid intima-media thickness, CIMT）及心血管风险相关指示因子，以探寻CAH患者群体的心血管异常情况。 对象与方法 依据已发表的评估标准，对113名年龄5至20岁的受试者开展临床、生化及超声评估：其中40名21-OHD型CAH患者，73名在性别、青春期发育状态及年龄上与患者组相匹配的健康对照个体。 结果 本研究中多数CAH患者为女性（80%）、失盐型（72.5%）且处于青春期（80%）；10名（25%）患者存在超重。与健康对照组相比，38名CAH患者的双侧颈动脉内膜中层厚度均显著升高（右侧：p=0.0240，左侧：p=0.0003）。患者组的体重指数、BMI年龄Z评分及收缩压（systolic blood pressure, SBP）均高于对照组（p