新生儿坏死性小肠结肠炎防治的研究进展

新生儿坏死性小肠结肠炎(neonatal necrotizing enterocolitis,NEC)是新生儿较常见的胃肠道疾病,是早产儿死亡的主要原因,其发病机制目前尚不明确.近年来,国内外学者对NEC的危险因素、发病机制、治疗及预防作了大量的深入研究,试图从喂养方式、微生态制剂的应用、病原菌感染的控制、营养因子或细胞因子的干预等手段来减少NEC的发病率和病死率.     

新生儿坏死性小肠结肠炎防治的研究进展

新生儿坏死性小肠结肠炎(neonatal necrotizing enterocolitis,NEC)是新生儿较常见的胃肠道疾病,是早产儿死亡的主要原因,其发病机制目前尚不明确.近年来,国内外学者对NEC的危险因素、发病机制、治疗及预防作了大量的深入研究,试图从喂养方式、微生态制剂的应用、病原菌感染的控制、营养因子或细胞因子的干预等手段来减少NEC的发病率和病死率.     

细胞体外药敏试验与急性淋巴细胞白血病患儿临床治疗及预后的研究

目的 分析在临床危险因素分型基础上,依据细胞体外药物敏感性确定个体化治疗方案治疗儿童ALL的可行性.方法留取50例ALL患儿治疗前骨髓/外周血液标本,行细胞体外药敏试验;将白血病细胞对泼尼松 (PRED)、长春新碱 (VCR)、门冬酰胺酶 (ASP)3种药物敏感程度进行积分(PVA-积分).每种药物的积分为1分(高度敏感)、2分(中度敏感)、3分(不敏感/耐药),3种药物总积分分为3+4分(高度敏感)、5～7分(中度敏感)、8+9分(不敏感/耐药);临床按传统危险因素分型之后,依据PVA-积分为患儿制定个体化治疗方案.结果 50例患儿全部完成诱导缓解治疗,完全缓解(CR)率100%.中位随访时间63个月.复发、死亡14例,无事件生存(EFS)率64.3%; PVA-积分3+4分24例,死亡1例,EFS率96.1%;PVA-积分5～7分15例,死亡4例,EFS率79.7%(t=3.737,P=0.002);PVA-积分8+9分11例,死亡9例,EFS率54.2%(t=2.448,P=0.028).结论在危险因素分型基础上,依据PVA-积分确定个体化治疗方案不仅避免标危ALL患儿因耐药使化疗方案强度不足,CR之后易复发,导致生存期缩短,而且可避免高危ALL患儿因过强化疗后的治疗相关毒性及死亡.PVA-积分是对ALL传统危险因素分型的补充.     

婴幼儿先心病术后急性肾功能衰竭的腹膜透析治疗

目的 总结腹膜透析(PD)治疗小儿心脏手术后并发急性肾功能衰竭( ARF)的临床经验.方法 回顾总结我科2009年3月至2011年12月行腹膜透析的21例患儿的临床资料,其中男17例,女4例.年龄13d至3岁,平均(9.78±7.72)个月;体重2.6～13.5 kg,平均(7.43±2.74) kg.全组皆因少尿或无尿高钾行腹膜透析治疗.腹透期间动态监测血气分析、电解质、血清肌酐(Cr)、尿素氮(BUN)的变化,并分析影响预后的危险因素.结果 全组死亡4例(病死率19.05％),死亡原因分别为多器官功能衰竭2例,心律失常1例,气道出血1例.其中1例尿量及肾功能已恢复,术后2周死于3度房室传导阻滞.治愈17例,治愈患儿在出院时,尿量、血BUN、血Cr等指标均完全恢复正常.随访2个月至6年,肾功能正常.将死亡组与治愈组相关数据进行比较,发现死亡组合并心跳骤停及多器官功能衰竭的比率明显高于治愈组.结论 小儿心脏手术后ARF早期行PD疗效肯定、安全,操作方便,可降低病死率.腹透前发生过心跳骤停及合并多器官功能衰竭是影响预后的重要因素.     

儿童期动脉粥样硬化的防治研究

儿童和青少年意外死亡尸检的病理研究,证实在儿童和青少年存在动脉粥样硬化(AS)病变,其程度及表现与儿童期的可检测性危险因素相关。显著的AS危险预测因子,包括儿童期肥胖、高血压和糖尿病等可由儿童期追踪到成人,所以,控制这些危险因素以防治AS及其继发心血管疾病应开始于儿童。我们就近年来有关儿童期AS危险因素、高危儿童的早期检测与防治策略的研究作一综述。     

血清学指标对噬血细胞综合征患儿死亡预测价值的临床研究

目的 探讨噬血细胞综合征(hemophagocytic syndrome,HPS)患儿诊断时的血清学指标与死亡的关系及对死亡的早期预测价值.方法 采用回顾性病例对照研究方法,对2005年7月至2012年7月广州市妇女儿童医疗中心收治的108例HPS患儿血清学、病理学改变及预后资料进行系统分析.按随访患儿的生存情况分为存活组和死亡组,应用COX模型对可能与HPS死亡相关的危险因素进行分析;应用决策树探讨各指标对HPS死亡的预测价值.结果 108例HPS患儿中,死亡33例,病死率30.6％,且90.3％在发病后8周内死亡.多因素分析显示白细胞＜5×109/L(HR =9.08,95％ CI3.07 ～26.87)、血红蛋白＜80 g/L(HR =6.15,95％ CI 1.68 ～ 22.49)、白蛋白＜28g/L(HR=4.63,95％CI 1.12 ～7.39)、铁蛋白＞1 100 μg/L(HR =3.05,95％ CI 1.28 ～ 16.75)、甘油三酯≥4 mmol/L(HR=2.88,95％CI 1.51 ～8.60)、凝血酶原时间≥16s(HR=3.60,95％CI 1.28 ～7.24)和发热持续2周以上(HR =5.39,95％CI 1.97～14.66)是造成HPS患儿死亡的独立危险因子.决策树分析显示白细胞＜5×109/L合并血红蛋白＜80 g/L的情况下患儿死亡概率达100％;即使在白细胞≥5×109/L的情况下,若合并发热持续2周以上且总胆固醇≥4 mmol/L,死亡概率亦达66.7％.结论 发病后最初8周是治疗HPS的关键期,HPS患儿死亡与多种因素相关,合并白细胞＜5×109/L且血红蛋白＜80 g/L时,病情极其凶险,及早诊断并采取有针对性的治疗对降低HPS患儿病死率至关重要.     

影响大动脉调转术治疗完全性大动脉转位患儿死亡的危险因素

目的 探讨影响大动脉调转术(ASO)治疗完全性大动脉转位(D-TGA)患儿死亡的危险因素,以提高手术治愈率.方法 选择本院2001年9月-2009年3月行ASO、≤4月龄D-TGA婴儿135例,确定潜在危险因素后收集其临床资料,利用单因素分析及多因素Logistic回归分析,最终确立ASO术中及术后30 d内死亡的危险因素.结果 D-TGA患儿术中或术后30 d内死亡27例,病死率为20%(27/135例),其中2001-2003年死亡4/8例(50%),2004-2006年死亡16/44例(36.4%),2007-2009年死亡7/83例(8.4%).Logistic回归分析提示冠状动脉异常(OR=22.476,P=0.041)、体外循环时间(OR=1.024,P=0.000)、主动脉阻断时间(OR=0.982,P=0.019)、术后严重低心排综合征(OR=8.166,P=0.023)、术后肾衰竭(OR=9.809,P=0.046)是行ASO治疗D-TGA患儿死亡的主要影响因素.结论 伴有冠状动脉异常、体外循环及主动脉阻断时间长、术后并发严重低心排综合征和肾衰竭是预测行ASO治疗D-TGA患儿死亡的重要指标.     

婴幼儿重症百日咳死亡相关因素分析

目的探讨婴幼儿重症百日咳死亡相关因素。方法回顾分析2015年1月1日至2019年10月31日收治的婴幼儿百日咳25例病死病例(死亡组)及80例同期收治的重症存活病例(存活组)的临床资料。结果死亡组男性5例(20.0%),中位发病日龄77天,20例(80.0%)未接种百日咳疫苗;存活组男性47例(58.8%),中位发病日龄83天,63例(78.8%)未接种疫苗。与存活组相比,死亡组男性少、痉挛性咳嗽发生率低、肺实变(或肺不张)发生率高、外周血白细胞(WBC)增多更显著、肺动脉高压发生率高、使用丙种球蛋白比例低,差异均有统计学意义(P0.05)。多元logistic回归分析发现,男性、使用丙种球蛋白(OR=0.03、0.03)为重症百日咳死亡的保护因素,WBC最高值高、肺动脉高压(OR=1.10、13.31)为死亡的危险因素,有痉挛性咳嗽患儿死亡概率更小(OR=0.02)。预测死亡的WBC最高值的最佳临界值为55.37×10~9/L,AUC=0.83(95%CI:0.73～0.93)P0.001。结论未接种疫苗、高WBC血症、肺动脉高压明显增加婴幼儿重症百日咳的病死率,使用丙种球蛋白、早期换血减轻高WBC血症可能改善其预后,慎用激素。     

新生儿气腹症72例临床特点及预后分析

目的 探讨新生儿气腹症的临床特点和影响其预后的相关因素,以指导临床对新生儿气腹症的救治.方法 回顾性分析本院2000年1月至2009年6月新生儿气腹症的临床资料.对早产、原发疾病、就诊时间、手术时间等与预后相关的因素进行Logistic回归分析.结果 共72例气腹症,腹胀、呕吐为其早期和常见症状,腹壁发红及红肿高度提示气腹症,及时腹部直立住X线检查和腹腔穿刺有助诊断;手术治疗64例,其中62例为消化道穿孔,2例为非消化道穿孔,8例放弃治疗出院;手术患儿中治愈37例,治愈率57.8%;死亡27例,病死率42.2%.不同原发疾病痛死率不同,以坏死性小肠结肠炎病死率最高,达78.3%.对死亡的危险因素进行Logistic多元回归分析,手术时间(P<0.05)、早产(P<0.05)、多脏器功能受损(P<0.01)、坏死性小肠结肠炎(P<0.01)是死亡的相关危险因素.发病24 h内手术者疗效较佳(P<0.01).结论 新生儿气腹症中绝大多数为消化道穿孔性气腹,病死率高,死亡危险因素包括手术时间、早产,坏死性小肠结肠炎、多脏器功能受损等,早期诊断和早期治疗可改善预后.     

小儿严重脓毒症并发多器官功能障碍综合征的研究

目的 小儿脓毒症是PICU的常见疾病,具有较高的病死率.本研究旨在了解小儿脓毒症的临床特点及转归,探寻儿童严重脓毒症的死亡危险因素.方法 分析2008年1月至12月收入我院PICU的脓毒症病例,对严重脓毒症患儿作单因素分析,并建立Logistic回归模型,探寻儿童严重脓毒症的死亡危险因素.结果 纳入脓毒症患儿103例,病死率16.5%.严重脓毒症45例,其死亡危险因素是PRISM Ⅲ评分(OR 1.502;95%CI 1.131～1.995)和病程中外周血血小板计数最高值(OR 0.991;95%CI0.982～1.000).小儿严重脓毒症伴随1、2、3、4个及4个以上脏器功能障碍的病死率分别为10.0%、11.1%、44.4%、68.8%,差异具有非常显著性(P＜0.001).最常受累的是心血管系统(75.6%)和呼吸系统(66.7%),严重脓毒症伴发MODS死亡危险因素是呼吸系统(OR 23.179;95%CI2.095～256.522)和肾脏(OR 9.637;95%CI 1.698～54.703)功能受累.结论 小儿严重脓毒症的死亡危险因素是PRISM Ⅲ评分和病程中外周血血小板计数最高值.小儿脓毒症合并MODS提示预后不良,其病死率与发生功能障碍的脏器数目呈正相关,呼吸系统和肾脏功能受累是儿童脓毒症死亡的危险因素.     

Advanced intrauterine growth restriction is associated with reduced excretion of asymmetric dimethylarginine

Background

High blood levels of asymmetric dimethylarginine (ADMA) are associated with future development of adverse cardiovascular events. The ADMA/symmetric dimethylarginine (SDMA) ratio is a marker of ADMA catabolism, with a high ADMA/SDMA ratio being suggestive of reduced ADMA excretion.

Aims

This study aimed a) to verify the presence of a statistically significant difference between ADMA/SDMA ratio levels in a group of young adult subjects who were born preterm with an extremely low birth weight (ex-ELBW) and a group of healthy adults born at term and b) to seek correlations between ADMA/SDMA ratio levels in ex-ELBW and anthropometric and clinical parameters (gender, chronological age, gestational age, birth weight, and length of stay in the Neonatal Intensive Care Unit).

Subjects, study design, outcome measures

Thirty-seven ex-ELBW subjects (11 males [M] and 26 females [F], aged 17–28 years, mean age: 22.2 ± 1.8 years) were compared with 37 controls (11 M and 26 F). ADMA/SDMA ratio levels were assessed for each patient included in the study.

Results

ADMA/SDMA ratio in ex-ELBW subjects was higher compared to controls (1.42 ± 0.31 vs 0.95 ± 0.14, p < 0.002) and inversely correlated with birth weight (r = − 0.68, p < 0.0001) and gestational age (r = − 0.54, p < 0.0005).

Conclusions

ADMA catabolism is significantly decreased in ex-ELBW subjects compared to controls, underlining a probable correlation with restriction of intrauterine growth. These results suggest the onset of early circulatory dysfunction predictive of increased cardiovascular risk in ex-ELBW.     

Serum asymmetric dimethylarginine (ADMA), homocysteine,vitamin B<Subscript>12</Subscript>, folate levels,and lipid profiles in epileptic children treated with valproic acid

Recent reports have demonstrated elevated serum homocysteine (Hcy) levels in children receiving valproic acid (VPA) therapy. Elevated Hcy levels might play a potential role in the resistance to antiepileptic drugs, and might lead to an increased risk for a vascular disease. It has been reported that elevated total homocysteine (tHcy) levels are associated with elevated asymmetric dimethylarginine (ADMA) levels, which are factors that may be better indicators of endothelial dysfunction compared to serum homocysteine levels, because they are less sensitive to changes, such as fasting status, physical activity, and other factors. In this study, we aim to evaluate serum ADMA, Hcy, lipid, folate, and vitamin B₁₂ levels in epileptic children, receiving VPA monotherapy. Forty-four epileptic children, receiving VPA monotherapy for at least 6 months and 28 healthy children aged between 4 and 16 years, were recruited. Serum lipids, lipoproteins, folate, vitamin B₁₂, Hcy, and ADMA levels were analyzed in both study groups. Serum Hcy, ADMA, and vitamin B₁₂ levels were higher in patients than in controls (p < 0.001 for tHcy and ADMA levels; p < 0.05 for vitamin B₁₂ levels); however, serum lipid, lipoprotein, and folate levels were similar. According to the duration of epilepsy, serum tHcy, ADMA, and triglyceride (TG) levels were higher in patients with epilepsy for ≥2 years than in patients with epilepsy for <2 years (p < 0.001 for serum ADMA levels, p < 0.01 for tHcy levels, and p < 0.05 for serum TG levels). Similarly, with respect to the duration of VPA therapy, serum tHcy, ADMA, and TG levels were higher in patients who had received VPA therapy for more than 2 years (p < 0.001 for serum ADMA levels, p < 0.05 for serum tHcy levels, p < 0.01 for TG levels). Serum ADMA levels were significantly higher in patients receiving VPA at the dose of 25–30 mg/kg/day than in those receiving 20 mg/kg/day (p < 0.01). In conclusion, our study found increased serum ADMA levels and increased tHcy levels in epileptic children receiving VPA monotherapy. Increased serum ADMA levels were demonstrated in epileptic children who have had a seizure history greater than 2 years, and have used VPA therapy for more than 2 years, and have received higher doses of VPA. Routine monitoring of serum ADMA and tHcy levels might have beneficial effects for patients receiving long-term VPA therapy, especially in children who have other potential risk factors for vascular diseases. Further studies are needed to investigate serum ADMA and Hcy levels, and the presence of vascular disease, as well as the potential interactions between serum ADMA levels and seizure control.     

The levels of asymmetric dimethylarginine, homocysteine and carotid intima-media thickness in hypercholesterolemic children

The aim of this study was to examine the intima-media thickness (IMT) of carotid arteries and endothelial function parameters such as plasma asymmetric dimethylarginine (ADMA) and homocysteine levels in hypercholesterolemic children and to investigate the relations of these parameters with hypercholesterolemia. Fifty-seven hypercholesterolemic and 37 healthy children were included in the study. Hypercholesterolemia was defined as 155 mg/dl and above for low-density lipoprotein (LDL)-cholesterol. Plasma concentrations of ADMA and homocysteine were measured and the measurement of carotid IMT was determined. Both carotid IMT and plasma ADMA levels were significantly higher in hypercholesterolemic children than healthy children (p<0.01). No significant difference was determined in homocysteine concentration between hypercholesterolemic children and the control group (p>0.05). No significant correlation was observed between lipid profiles and the levels of ADMA and homocysteine. However, a significant positive correlation was found between carotid IMT and total and LDL-cholesterol levels and between the levels of ADMA and LDL-cholesterol. In conclusion, the progressive increase in ADMA levels and carotid IMT and the positive relationship between carotid IMT and serum cholesterol levels support that plasma ADMA levels and carotid IMT can be indicators of early atherosclerosis in hypercholesterolemic children.     

不对称二甲基精氨酸与新生儿持续性肺动脉高压病理进程的相关性研究

目的 探讨不对称二甲基精氨酸(asymmetric dimethylarginine,ADMA)在新生儿持续性肺动脉高压(persistent pulmonary hypertension of the newborn,PPHN)足月儿循环系统中的变化规律及其与治疗响应的关系,探索其成为治疗靶标和治疗响应标志物的可能性...     

Plasma levels of asymmetric dimethylarginine in premature neonates: its possible involvement in developmental programming of chronic diseases

Aim: The endothel dysfunction in early life may play a role in developmental programming of cardiovascular morbidity. The changes of dimethylarginines' plasma levels during the first month among preterm infants and their determinants had been investigated in our study.
Methods: Twenty preterm infants of healthy mothers were studied. Mean (±SD) birth weight and gestational age were 919.5 ± 235.5 g and 26.7 ± 1.6 weeks, respectively. Blood samples were taken by venipuncture at the 3rd, 7th, 14th, 21st and 28th days. Plasma concentrations of L-arginine, asymmetric and symmetric dimethylarginine (SDMA) were measured by liquid chromatography-mass spectrometry method, evaluated by multivariate linear regression analysis.
Results: L-arginine (p < 0.001) and asymmetric dimethylarginine (ADMA) levels (p < 0.001) were positively associated with postnatal age. ADMA levels were negatively correlated with gestational age (p = 0.007), dopamine-need on the 3rd day of life (p = 0.015) and late infection (p = 0.038). The higher birth weight was associated with higher L-arginine (p = 0.052) and ADMA (p = 0.002) concentrations. The dopamine-need on the 7th day of life had a significant effect on postnatal elevation of SDMA levels (p = 0.035).
Conclusion: The progressive increase of ADMA levels described by our study among preterm infants suggests that early endothel dysfunction may take part in developmental programming of chronic adult diseases.     

Down syndrome patients with pulmonary hypertension have elevated plasma levels of asymmetric dimethylarginine

Down syndrome (DS) patients have an increased risk of developing pulmonary hypertension (PH). Increased plasma levels of asymmetric dimethylarginine (ADMA) may contribute to vascular dysfunction in adults with idiopathic pulmonary hypertension. Our goal was to test the hypothesis that DS patients with PH have higher plasma levels of ADMA than DS patients without PH. DS patients with definitive PH (n = 6) and DS patients with no evidence of PH (n = 12) were studied. Plasma levels of arginine, ADMA, and nitrite/nitrate (NOx; stable metabolites of nitric oxide (NO)) were measured. Plasma arginine concentration was lower (p < 0.05) in PH patients (23 ± 11 μM) versus non-PH patients (46 ± 24 μM). Plasma ADMA concentration was higher (p < 0.005) in PH patients (18.0 ± 4.2 μM) versus non-PH patients (8.6 ± 5.9 μM). Plasma NOx was lower (p < 0.05) in PH patients (4.5 ± 1.7 μM) versus non-PH patients (8.5 ± 7.3 μM). These results are consistent with ADMA contributing to lower NO production in DS patients with PH and suggest that ADMA levels may be a potential biomarker for PH in DS patients.     

Umbilical vein plasma concentrations of asymmetrical dimethylarginine are increased in male but not female neonates delivered preterm: a pilot study

BACKGROUND: Infants born term have substantially elevated plasma concentrations of the endogenous nitric oxide synthase antagonist asymmetrical dimethylarginine (ADMA) that normalize with growth. The plasma levels of ADMA in preterm newborns are unknown. SUBJECTS AND METHODS: Plasma concentrations of ADMA, symmetrical dimethylarginine (SDMA) and L-arginine were analyzed from venous umbilical cord blood samples of 19 preterm and 21 term infants by high performance liquid chromatography. RESULTS: Male preterm newborns (n=11) had higher ADMA (median [95% confidence interval (CI)]: 1.90 [1.73-2.10] micromol/l) than females born preterm (n=8; 1.57 [1.24-1.69] micromol/l; p<0.005). In term born males (n=10) and females (n=11) ADMA was significantly lower than in preterm male infants (all p<0.005), and without sex differences. SDMA and L-arginine concentrations were comparable between all groups. ADMA correlated inversely with body weight in male preterm newborns (r=-0.67; p<0.03). CONCLUSION: Male neonates delivered preterm have significantly higher umbilical cord venous plasma concentrations of ADMA compared to female neonates and infants born term. The sex difference and the time course of elevated ADMA may play a role in development and warrant further investigation.     

同型半胱氨酸与肾脏病关系的研究进展

同型半胱氨酸(homocysteine,Hcy)是蛋氨酸代谢的中间产物,研究认为Hcy是心血管疾病的独立致病因素之一,且血Hcy水平与多种疾病密切相关.近年来发现肾脏病患者也存在不同程度的高同型半胱氨酸血症,Hcy可能与肾脏损害有关,而且使肾脏病患者罹患心血管疾病的风险增高.该文对Hcy与肾脏病的关系做一综述,以期为肾脏病及并发症的预防、诊治提供新依据.     

Birth by cesarean section is associated with elevated neonatal plasma levels of dimethylarginines

Background: This study was undertaken to compare the effects of vaginal delivery and cesarean section on the l‐arginine‐nitric oxide system by measuring levels of l‐arginine, an endogenous nitric oxide synthase antagonist asymmetric dimethylarginine (ADMA), and symmetric dimethylarginine (SDMA) in the cord blood and postnatally. Methods: Plasma samples were obtained from the umbilical vein and artery at birth and from peripheral venous blood on the second postnatal day in 30 full‐term newborn infants: 10 born vaginally and 20 born by cesarean section. Results: After vaginal delivery, ADMA concentration was higher in the umbilical vein than in the umbilical artery (mean 1.06 vs 0.90 µmol/L [P= 0.027]); and ADMA level fell after birth to 0.66 µmol/L on the second postnatal day (P= 0.007 vs umbilical artery). Newborns born by cesarean section had similar ADMA levels in umbilical arterial and venous blood, 1.19 and 1.18 µmol/L, and the ADMA level fell to 0.84 µmol/L by the second postnatal day (P < 0.001). Vaginal birth induced neither significant umbilical venoarterial difference nor a postnatal fall in SDMA. After cesarean section, SDMA was essentially the same in umbilical vein, umbilical artery and postnatal peripheral vein samples. At 2 days of age, both ADMA and SDMA levels stayed higher in infants born by cesarean section than in vaginally born infants. Conclusions: ADMA level falls after both vaginal and cesarean birth, whereas SDMA level does not. The higher ADMA level after cesarean birth compared with vaginal birth may contribute to decreased nitric oxide production and bioavailability in neonatal vascular beds.     

Carotid artery intima-media thickness and angiotensin-converting enzyme gene polymorphism in the offspring of parents with premature stroke

Aim: To determine some common cardiovascular risk factors, alterations in the measurements of intima-media thickness (IMT) and the distribution of the angiotensin-converting enzyme (ACE) polymorphism in children of parents with premature stroke, and to investigate the cardiovascular risk of these children and the potential need for some preventive measures.Methods: A family history of cardiovascular disease represents a cardiovascular risk factor in the offspring. This association has not yet been clearly determined for cerebrovascular accidents. New technology allows us to investigate the risk for cardiovascular disease at an early presymptomatic stage. We applied the measurement of IMT of carotid arteries by ultrasound imaging and the determination of the ACE insertion/deletion (I/D) polymorphism in blood to evaluate the predisposition for cerebrovascular disease in the offspring of patients with previous stroke. We investigated 58 subjects whose parents had experienced a cerebrovascular accident before the age of 45 y and compared them with a matched control group whose parents had not suffered a stroke. Results: The results of IMT at various sites of the carotid arteries and the genotype distribution of the ACE gene were not significantly different between the study group and the control group. In addition, no differences were found in the serum levels of lipid fractions or other biochemical variables.

Conclusion: We conclude that determination of the carotid IMT and of the ACE I/D polymorphism do not permit discrimination of the cardiovascular risk in children of parents with or without premature stroke.