脂联素与足背动脉内膜中膜厚度

目的探讨人血清脂联素与2型糖尿病动脉粥样硬化病变程度的关系。方法收集正常人(NC组)33例、2型糖尿病非动脉粥样硬化患者(NAS组)61例、2型糖尿病动脉粥样硬化患者(AS组)66例的临床资料,分别以彩色多普勒超声测定其足背动脉血管内膜中膜厚度(IMT),采集其静脉血测定其血清脂联素及各代谢指标。结果1)IMT在AS组显著高于NC组及NAS组(P值均<0.01)。血清脂联素在AS组显著低于NAS组及NC组(P值均<0.01),进行协方差分析后,其修正均数值AS组显著低于NAS组和NC组,差异均有统计学意义(P<0.05)。2)多元逐步回归表明,三酰甘油、体质量指数、IMT、收缩压、餐后血糖、尿酸分别为血清脂联素的独立相关因素,表现为负性相关影响。结论血管IMT作为动脉粥样硬化的良好客观指标,其与脂联素具有明显的负相关。     

Intima Media Thickness and Endothelial Function in Chronic Hemodialysis Patients

The purpose of our study was to evaluate the intima‐media thickness (IMT) of the carotid and brachial arteries, flow‐mediated dilatation (FMD), and nitroglycerin‐mediated dilatation (NMD) in diabetic and non‐diabetic hemodialysis patients. We also examined the effects of traditional and other risk factors on carotid and brachial IMT, FMD and NMD in all hemodialysis patients. Fifty‐eight adult hemodialysis patients, 14 of whom had diabetes, were studied. They had been on hemodialysis for 1–340 months. Using B‐mode ultrasonography, we measured the carotid and brachial IMT, FMD and NMD, and correlated the values with cardiovascular risk factors. FMD and NMD were significantly lower in diabetic patients (FMD 4.01 ± 0.99 vs. 6.69 ± 2.37 mm; NMD 9.1 ± 1.95 vs. 11.23 ± 2.86 mm), while no such differences were found between the two groups with respect to carotid or brachial IMT. In all patients with respect to age a positive correlation was found with carotid and brachial IMT, and a negative one with FMD and NMD. With respect to hypertension as well as diabetes, a negative correlation was found with FMD and NMD. Age is the most important factor that significantly affected all studied markers of atherosclerosis in hemodialysis patients. The endothelial and smooth vascular functions are significantly impaired in diabetic and hypertensive hemodialysis patients, and hypertension is shown to be an independent risk factor for smooth vascular dysfunction in hemodialysis patients. According to our results, intensive antihypertensive treatment is recommended in hypertensive chronic hemodialysis patients.     

颈动脉内中膜厚度与代谢综合征关系的研究

目的:研究颈动脉内中膜厚度(IMT)与代谢综合征(MS)的关系,为MS的防治提供依据。 方法:按NCEP ATPⅢ标准,对其中腰围按国内增大切点加以修改,诊断MS患者80例(MS组),男42例,女38例,平均年龄(53.9±6.2)岁。非MS患者80例(对照组),男38例,女42例,平均年龄(52.6±4.7)岁。两组均用B超高频探头测量颈总动脉及颈内动脉IMT,然后进行统计分析。 结果:MS组颈总动脉IMT明显厚于对照组(P<0.001);颈内动脉IMT也明显厚于对照组(P<0.001)。性别对颈动脉IMT无影响。相关分析示颈动脉IMT与年龄、腰围及收缩压呈显著正相关(P<0.05)。颈内动脉IMT增厚率,MS组高于对照组(P<0.05)。 结论:MS易引起动脉粥样硬化,应常规检测MS患者的颈动脉IMT。     

Blood Pressure Measurements and Carotid Intima Media Thickness in Hemodialysis Patients

In hemodialysis (HD) patients, routine dialysis center blood pressure (BP) measurements may be a poor indicator of BP control. Ambulatory blood pressure monitoring (ABPM) improves the predictability of BP as a risk factor for target organ damage. Carotid intima‐media thickness (IMT) is an important indicator of asymptomatic atherosclerosis and a predictor of cardiovascular events. The purpose of our study was to evaluate the possible association between different BP measurements and carotid IMT in HD patients. Eighty‐five HD patients were included in our study. BP was measured with a standard mercury sphygmomanometer before and after each HD session. The average one‐monthly values of routine BP measurements were also analyzed. 24‐ and 48‐h ABPM was performed after the end of each HD session using non‐invasive ABPM. The average values of systolic and diastolic BP were analyzed separately for the first (HD) and second (interdialytic) days ABPM, and for both days together. Using B‐mode ultrasonography, carotid IMT was measured and plaque occurrence investigated. We found a statistically significant correlation between carotid IMT and the average one‐monthly pre‐HD diastolic BP (P < 0.05), diastolic BP on the HD‐day ABPM, the interdialytic‐day ABPM, and during 48‐h ABPM (P < 0.05). By multiple regression analysis, we found a statistically significant correlation only between carotid IMT and diastolic BP on the HD‐day ABPM, the interdialytic‐day ABPM, and during 48‐h ABPM (P < 0.05). Only longer BP measurements (24‐ and 48‐h ABPM) were associated with carotid IMT in HD patients.     

高血压患者血清抵抗素水平与颈动脉内膜-中层厚度的相关性研究

目的:抵抗素是一种脂肪细胞因子,并且它是一种富含半胱氨酸的分泌蛋白.本研究主要探讨高血压患者血清抵抗素水平与颈动脉内膜-中层厚度(IMT)的相关性.方法:入选272例原发性高血压患者,根据他们的血清抵抗素水平由低到高平均分为3组,第一组(血清抵抗素水平1.233~3.701 ng/ml)91人,第二组(血清抵抗素水平3.728~8.777 ng/ml)91人,第三组(血清抵抗素水平8.809~28.658 ng/ml)90人.结果:第三组的颈动脉IMT和颈动脉最大IMT均大于第一组和第二组(P均<0.05).多元线性回归分析示,在控制了年龄、血糖、尿酸、低密度脂蛋白胆固醇、收缩压、舒张压等因素之后,血清抵抗素水平与颈动脉IMT(β=0.220,t=5.793,P=0.000)呈独立的显著正相关.在控制了年龄、血糖、体重指数、舒张压、糖尿病、血清高敏C反应蛋白、总胆固醇、甘油三酯之后,血清抵抗素水平与颈动脉最大IMT(β=0.189,t=4.733,P=0.000)也呈独立的显著正相关.结论:在原发性高血压的患者,血清抵抗素水平与增厚的颈动脉IMT独立相关.     

老年原发性高血压患者颈动脉病变与动态脉压指数

目的探讨老年原发性高血压(EH)患者颈动脉病变与动态脉压指数(PPI)的相关性。方法对103例老年 EH 患者行颈动脉超声和动态血压测定,PPI=24 h 脉压(PP)均值/24 h 收缩压(SBP)均值,按 PPI 值分为 A组(PPI<0.40,n=15)、B 组(PPI:0.40～0.49,n=48)、C 组(PPI≥0.50,n=40)3组,观察各组颈动脉内膜中膜厚度(IMT)的水平。结果 B 组IMT[(0.15±0.07)mm]水平高于 A 组[(0.12±0.04)mm,P<0.05],C 组 IMT[(0.16±0.05)mm]水平高于 B 组(P<0.05),并显著高于 A 组(P%0.01),随着 PPI 逐渐增大,IMT 明显增加(P<0.05);老年 EH 患者颈动脉内膜增厚的发生与 PP 及 PPI 相关(P<0.05);Logistic 回归分析显示,在矫正总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、血尿酸、SBP、DBP 与 PP 后,PPI 仍然是颈动脉内膜中膜厚度增厚主要决定因素(P=0.009)。结论老年 EH 患者 PPI 和 PP 与颈动脉病变呈正相关,...     

2型糖尿病患者心率变异与颈动脉内膜增厚

目的 探讨2型糖尿病患者心率变异(HRV)与颈动脉内膜增厚的关系及其临床意义.方法 2型糖尿病患者132例按颈动脉内膜一中膜厚度(IMT)分T1组(36例,IMT＜1.0 mm),T2组(54例,IMT 1.1～1.3 ram),T3组(42例,IMT≥1.3 mm)及30例正常对照者(TO组)作为研究对象.Holter HRV时域、频域指标评估心脏自主神经调节功能.结果 1)2型糖尿病有或无颈动脉内膜增厚组各HRV指标(SDNN,SDANN,RMSSD,PNN50,SDNN指数)均较正常对照组低(P＜0.05或P＜0.01).2)2型糖尿病合并颈动脉内膜增厚者HRV指数较无病变者有进一步的下降,而且HRV指数与IMT呈负相关.结论 HRV是2型糖尿病颈动脉粥样硬化的独立相关因素,可对大血管并发症作出早期的诊断,改善预后.     

2型糖尿病患者心率变异与颈动脉内膜增厚

目的探讨2型糖尿病患者心率变异(HRV)与颈动脉内膜增厚的关系及其临床意义。方法2型糖尿病患者132例按颈动脉内膜-中膜厚度(IMT)分T1组(36例,IMT<1·0mm),T2组(54例,IMT1·1～1·3mm),T3组(42例,IMT≥1·3mm)及30例正常对照者(T0组)作为研究对象。HolterHRV时域、频域指标评估心脏自主神经调节功能。结果1)2型糖尿病有或无颈动脉内膜增厚组各HRV指标(SDNN,SDANN,RMSSD,PNN50,SDNN指数)均较正常对照组低(P<0·05或P<0·01)。2)2型糖尿病合并颈动脉内膜增厚者HRV指数较无病变者有进一步的下降,而且HRV指数与IMT呈负相关。结论HRV是2型糖尿病颈动脉粥样硬化的独立相关因素,可对大血管并发症作出早期的诊断,改善预后。     

脂联素与足背动脉内膜中膜厚度

目的 探讨人血清脂联素与2型糖尿病动脉粥样硬化病变程度的关系.方法 收集正常人(NC组)33例、2型糖尿病非动脉粥样硬化患者(NAS组)61例、2型糖尿病动脉粥样硬化患者(AS组)66例的临床资料,分别以彩色多普勒超声测定其足背动脉血管内膜中膜厚度(IMT),采集其静脉血测定其血清脂联素及各代谢指标.结果 1)IMT在AS组显著高于NC组及NAS组(P值均＜0.01).血清脂联素在AS组显著低于NAS组及NC组(P值均＜0.01),进行协方差分析后,其修正均数值AS组显著低于NAS组和NC组,差异均有统计学意义(P＜0.05).2)多元逐步回归表明,三酰甘油、体质量指数、IMT、收缩压、餐后血糖、尿酸分别为血清脂联素的独立相关因素,表现为负性相关影响.结论 血管IMT作为动脉粥样硬化的良好客观指标,其与脂联素具有明显的负相关.     

Insulin Sensitivity as a Risk Factor for Common Carotid Intima Media Thickness (IMT): Its Relation to Atherosclerosis

Introduction. The relationship between insulin resistance and atherosclerosis (ATH) in non-diabetic hypertensive patients from the Asian Indian population remains poorly understood. To resolve this issue, the present study was designed to analyze whether insulin sensitivity in a non-diabetic individual is related to the development of ATH.(by using IMT as an index) and whether this relationship is dependent on the presence of other cardiovascular disease (CVD) risk factors such as dyslipidemia and hypertension. Methodology. This study included 68 healthy controls with no diabetes and hypertension and 41 hypertensive patients who underwent four-point oral glucose tolerance test (OGTT) and intravenous glucose tolerance test (IVGTT). A biochemical profile, β mode ultrasonography for intima media thickness of carotid artery, and ECG determination was carried out. Results. Hypertensive patients in our study exhibited significantly increased abdominal obesity. Blood pressure, fasting and 2 hr plasma glucose (4.62 ± 0.08 and 5.55 ± 0.17 mmol/l), and triglyceride (1.47 ± 0.067 mmol/l) levels were compared to those of control subjects (p < 0.05). The fasting insulin levels and HOMA-IR were also significantly increased and Composite Insulin Sensitivity Index (CISI) reduced compared to controls with p < 0.01. Intima media thickness of the left (0.08 ± 0.01) and right (0.069 ± 0.008) CA were both significantly increased in hypertensives (p < 0.01). Correlation analysis showed that IMT of the left carotid artery was significantly associated with triglyceride levels (r?=?0.813, p < 0.05) but not with insulin measures such as HOMA-IR and CISI. Conclusion. Hyperinsulinemia was observed in our non-diabetic hypertensive patients, but no association was found between IMT and insulin resistance. That IMT of hypertensives was associated with triglyceride levels suggests that high levels of insulin may be related to the development of ATH indirectly through its effects on lipid metabolism in our population.     

Carotid Intima Media Thickness Versus Carotid Plaque in Cardiovascular Risk Evaluation

Cardiovascular (CV) risk (ie, coronary heart disease [CHD] risk + stroke risk) prediction can be improved with the use of imaging modalities. Carotid intima media thickness (CIMT) and carotid plaque have been used as markers of atherosclerosis and also as predictors of incident CV events. It has been shown that adding either or both to traditional risk prediction models improves CHD risk prediction. There are limited data comparing CIMT and carotid plaque and currently it appears that combining both CIMT and carotid plaque best improves CHD risk prediction. Improvements in ultrasound technology may allow for improved assessment of CIMT, and quantifying and possibly characterizing atherosclerotic plaque in the near future. Whether quantifying plaque will be superior to CIMT measurements or if the combination of both will be the best way to improve CVD (CHD + stroke) risk prediction with ultrasound remains to be seen.     

Effect of Probucol and/or Cilostazol on Carotid Intima Media Thickness in Patients with Coronary Heart Disease: A Randomized,Multicenter, Multinational Study

Aim: In a prospective randomized multinational open blinded endpoint study, the long-term effects of probucol or probucol and cilostazol with statin on carotid mean intima media thickness (IMT) were evaluated for the first time.Methods: Hypercholesterolemic patients with coronary artery disease were randomized to three groups and received study drugs for 3 years: the control with statin alone; the probucol group with statin and probucol; and the combo group with statin, probucol, and cilostazol. Primary efficacy endpoint was changes of mean carotid IMT at 3 years. Biomarkers, major adverse cerebro-cardiovascular events (MACCEs) and safety were secondary endpoints.Results: Two hundred eighty-one patients were randomized into three groups. All three groups showed significant regression of carotid IMT at 3 years compared with baseline. Decrease in mean carotid IMT was significantly greater in the combo group than in the control group at 1 year. However, there were no significant differences in changes of mean carotid IMT between groups at 3 years (control; −0.12 ± 0.36 mm vs. probucol; −0.11 ± 0.32 mm vs. combo; −0.16 ± 0.38 mm). MACCEs were frequent in the control group, but the difference was not significant (control; 10.8% vs. probucol; 4.4% vs. combo; 6.9%, p = 0.35). Probucol and cilostazol were well tolerated in long-term treatment without serious drug-related adverse reactions.Conclusion: Probucol or probucol and cilostazol with statin did not reduce carotid IMT in comparison with statin alone in this study. However, the clinical outcome of probucol-based treatment with current standard statin treatment may need further studies.     

颈动脉内膜中层厚度及动态动脉硬化指数与抑郁症的关系研究

目的探讨颈动脉内膜中层厚度(CIMT)及动态动脉硬化指数(AASI)与抑郁症的关系。方法选取2012—2014年在广东省肇庆市人民医院体检中心进行常规体检的510例体检者,均进行贝克抑郁量表(BDI-Ⅱ)筛查,根据得分情况分为3组:10分为无抑郁组(n=306),10~18分为轻度抑郁组(n=136),≥19分为中-重度抑郁组(n=68)。比较3组受试者一般资料〔性别、年龄、体质指数(BMI)、高血压发生率、吸烟率及2型糖尿病发生率〕、生化指标〔总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、超敏C反应蛋白(hs-CRP)、白介素6(IL-6)〕、CIMT及AASI,并分析其与抑郁症的关系。结果 3组受试者年龄、BMI、高血压发生率、吸烟率、2型糖尿病发生率、HDL-C水平比较,差异无统计学意义(P0.05);中-重度抑郁组女性患者比例大于无抑郁组,TC水平低于无抑郁组,LDL-C、hs-CRP、IL-6水平及AASI均高于无抑郁组,CIMT大于无抑郁组及轻度抑郁组(P0.05)。轻度抑郁组患者hs-CRP水平高于无抑郁组(P0.05)。轻度抑郁组及中-重度抑郁组女性患者CIMT大于男性,AASI高于男性(P0.05)。多因素Logistic回归分析结果显示,女性〔OR=2.13,95%CI(1.62,3.95)〕、hs-CRP〔OR=1.79,95%CI(1.56,2.43)〕、IL-6〔OR=2.46,95%CI(1.59,3.02)〕、CIMT〔OR=3.78,95%CI(2.01,4.21)〕和AASI〔OR=2.26,95%CI(1.73,3.14)〕是抑郁症的危险因素(P0.05)。结论 CIMT和AASI是抑郁症的危险因素,临床筛查抑郁症时可参考该指标。     

老年高血压患者颈动脉内膜-中膜层厚度的改变

目的　探讨老年高血压患者颈动脉内膜_中膜层厚度的改变。方法　应用彩色多普勒超声仪对比分析 12 7例老年高血压患者与 53例健康人颈动脉内膜_中膜层厚度的变化。结果　 1.老年高血压患者颈动脉的内膜_中膜层厚度 (IMT)值明显高于健康者 (P <0 0 1)。2 .在老年高血压组中有脑卒中的患者IMT值又明显高于无脑卒中的患者。结论　健康体检中 ,检测IMT值对预测老年高血压患者预后及脑卒中发生率有一定的临床价值。     

Intima media thickness as a surrogate marker for generalised atherosclerosis

Vascular markers of atherosclerotic burden allow atherosclerosis to be studied in the sub-clinical phase of the disease, and facilitate the assessment of new therapies for modifying coronary heart disease (CHD) risk factors. B-mode ultrasound enables non-invasive, direct visualization of the arterial wall. The intima media thickness of the carotid artery (CIMT) quantified using this technique, is a reliable marker of atherosclerotic burden. Furthermore, it demonstrates greater sensitivity in detecting early atherosclerosis compared with angiography.The validity of ultrasonographically-determined CIMT as a surrogate marker of atherosclerotic disease has been established; CIMT is positively associated with the incidence of coronary events, relates to atherosclerotic disease elsewhere in the arterial system and has common risk factors to the development of CHD. Furthermore, ultrasonographically-determined CIMT demonstrates good inter- and intra-observer reproducibility making it suitable for tracking the progression or regression of atherosclerotic disease over time.The validity of CIMT as a vascular marker of atherosclerosis progression has been demonstrated in clinical trials. Intervention studies have shown that modification of CHD risk factors can significantly reduce progression of CIMT. Hence, B-mode ultrasonography is being used increasingly to elucidate the efficacy of new therapies, enabling the benefits of treatment to be established more rapidly and with fewer patients compared with clinical outcome trials.     

经超声测量的内脏脂肪及心外膜脂肪组织厚度对代谢综合征的诊断预测价值

目的评价内脏脂肪厚度(VAT)和心外膜脂肪组织厚度(EAT)对代谢综合征(MS)的诊断预测价值。方法对210例符合入选标准的健康体检对象进行腰围、空腹血生化测定并用超声测量VAT、EAT。根据国际糖尿病联盟MS标准,分为MS组和非MS组,用SPSS12.0软件进行比较分析。结果男女VAT在MS组均高于非MS组(P<0.01),而EAT在男性MS组高于非MS组(P<0.05),女性则两组之间无显著差异;无论男女VAT和EAT均和腰围成正相关。经年龄、性别、腰围调整后,VAT和收缩压、舒张压、甘油三酯、载脂蛋白B、空腹胰岛素、胰岛素抵抗指数成正相关,和胰岛素敏感指数成负相关;EAT和空腹胰岛素、胰岛素抵抗指数成正相关,和胰岛素敏感指数成负相关。经超声测量的VAT、EAT诊断MS的ROC曲线下面积分别为男性为0.74、0.73,女性为0.79、0.63,诊断切点值分别为男性为43.5mm、5.53mm,女性为23.8mm、7.95mm。两种方法ROC曲线下面积比较,无论男女均无显著差异。结论由超声测量的VAT、EAT均可作为内脏型肥胖简便、可靠和实用的评价指标,和MS关系密切,可作为MS患者无创的协同诊断方法之一。