[Ultrasonographic evaluation of atherosclerotic changes in carotid and brachial arteries in children with type 1 diabetes].

Abstract

Introduction: According to very well documented onset of atherosclerosis in early childhood, scientists are looking for good diagnostic methods for evaluating first changes in arterial blood vessels noninvasively. We want to know more about the pathogenetic mechanisms and about changes in vessels especially in group of young people with risk factors of premature atherosclerosis. The significance of endothelial dysfunction in very early phase of this process is known very well so far. High resolution echocardiography seems to be a good method which allows to examine arteries in children and adolescents. Because of localization, brachial and carotid arteries are very good field for this kind of examinations. THE AIM of this study was the evaluation with high resolution echocardiography of endothelial function in type 1 diabetes children and adolescents. We also measured the intimal plus medial thickness in carotid communis arteries (IMT).

Material and methods: We examined a group of 64 children (29 boys and 35 girls) aged 14.8-16.2 yr (mean 15.5 yr) suffering from diabetes type 1. The control group consisted of 24 children (9 boys, 15 girls) in similar age. Using high resolution echocardiography, B-mode images, we measured in the diastole phase, distance "m-m" in brachial arteries (distance between two "m" lines which are borders among media and adventitia of near and far wall of the artery) at rest, during reactive hyperaemia (with increased flow causing endothelium-dependent dilatation FMD), again at rest and after sublingual glyceryl trinitrate (causing endothelium-independent dilatation NTGMD). Using Doppler technic we evaluated baseline flow and calculated the degree of reactive hyperemia. We also measured intimal plus medial thickness in every carotid artery three times and calculated mean value. In our analysis we estimated the concentrations of cholesterol, HDL- cholesterol, LDL-cholesterol and triglycerides.

Results: We noticed higher IMT values in the whole examined group compared to the control group (0.52 mm vs. 0.43 mm, p<0.05). In diabetic children the vessel size was similar to control group but FMD was significantly impaired (5.56% vs. 9.47%, p<0.05). The level of triglycerides and total cholesterol was higher in the examined group.

Conclusions: 1. The evaluation of IMT in the carotid arteries in patients with type 1 diabetes showed a more advanced degree of atherosclerotic changes in this group compared to healthy controls. 2. FMD evaluated in brachial artery is a usefull tool in assessing impaired endothelial function in people suffering from the risks factors of atherosclerosis. 3. Ultrasonographic methods of evaluating atherosclerotic changes in arterial vessels should be more often used in practice as relatively easy, noninvasive and inexpensive.