原发性高血压患者颈动脉斑块及动脉僵硬度与血清尿酸水平的关系*

 目的：研究原发性高血压（essential hypertension,EH）患者颈动脉斑块性质及动脉僵硬度与血清尿酸（uric acid,UA）水平的关系。方法：选择EH患者92例,健康对照组30例;对所有研究对象行相关血液生化检查,检测颈总动脉内中膜厚度（IMT）、颈动脉斑块和颈股动脉脉搏波传导速度（CFPWV）。结果：EH组的血清UA明显高于对照组［（361.51±83.81)μmol/L vs (317.03±62.22) μmol/L,P<0.05］;EH组IMT及异常检出率较对照组明显升高［(0.69±0.14) mm vs (0.60±0.12) mm,42.39% vs 10.00%,P<0.05］;45例EH患者检出颈动脉斑块,随着颈动脉斑块严重程度增高,血清UA水平依次增高［（285.25±78.41) μmol/L、(341.19±63.99) μmol/L和(401.33±88.49) μmol/L,P<0.05］;软斑块组（n=11）的血清UA水平较硬斑块组（n=34）显著增高［（389.00±69.45) μmol/L vs (323.03±72.71) μmol/L,P<0.05］。多元线性逐步回归分析显示CFPWV与年龄（r=0.414）、收缩压（r=0.224）、脉压（r=0.270）和血清UA（r=0.219）呈显著正相关（P<0.05）。结论：血清UA水平增高是EH发病的危险因素之一,血清UA水平可反映颈动脉斑块的严重程度及稳定性,EH患者随着血清UA水平增高大动脉弹性减退。     

应用超声射频信号技术软件评估高甘油三脂患者颈动脉结构和功能的早期改变

目的 应用超声射频信号技术评价高甘油三脂血症(HTG)患者颈动脉内中膜厚度及弹性功能早期改变的临床意义.方法 将48例HTG患者(甘油三脂≥1.8 mmol/L)作为受试组,应用超声射频信号血管内中膜厚度定量分析(QIMT)及动脉僵硬度定量分析(QAS)技术,观察颈动脉内中膜厚度(IMT)及弹性指标的改变,包括颈动脉内径(D)、管壁扩张系数(DC)、顺应系数(CC)、弹性系数(α)、弹性系数(β)及脉搏波传播速度(PWV);并将50例健康人作为对照组.分析上述参数在2组间的差别及弹性指标之间的相关性.结果 HTC组的2侧颈动脉IMT、α、β及PWV的弹性指标均高于对照组,DC、CC较对照组降低,其差异有统计学意义(P＜0.05).组内2侧颈动脉弹性指标之间存在差异,CCL＞CCR,αL＞αR,βL＞βR,PWVL＞PWVR.CC与α、β、PWV呈负相关(P＜0.05),α、β、PWV之间呈正相关(P＜0.05).2组颈动脉内径(D)比较差异无统计学意义(P＞0.05).结论 动脉弹性异常早于形态学的改变,应用超声射频信号技术能提供HTG患者早期颈总动脉结构和弹性功能改变的信息,对其临床早期诊疗具有一定意义.     

脑中风患者彩色多普勒超声特征研究

目的用彩色多普勒超声观察中老年人脑中风患者颅内及颈动脉形态、结构和血流动力学改变. 方法应用2.5MHz探头和10MHz线阵探头分别观察155例不同类型脑中风患者和80例正常人颈动脉内中膜厚度、斑块情况及颅内与颈动脉血流动力学改变情况. 结果 (1)各型脑中风组颈总动脉(CCA)内中膜厚度均较对照组明显增厚,斑块有109例出现(70.3%),而对照组仅4例(5.0%)出现斑块;(2)各型脑中风组颈内动脉时间平均流速(TAVICA)较正常组减低、阻力指数(RI)、搏动指数(PI)较正常组明显升高;(3)脑梗死组大脑中动脉时间平均流速(TAVMCA)较正常组低,脑出血组TAVMCA较正常组明显升高,混合性中风组可出现TAVMCA升高或降低两种情况. 结论中老年人各型脑中风患者颈动脉粥样硬化程度加重,斑块出现率高及斑块所引起的颈动脉狭窄,对脑中风有直接的因果关系,联合检查颅内动脉和颈动脉血流动力学改变可协助诊断不同类型脑中风,对其疗效观察,预防复发有一定的指导作用.     

脑中风患者彩色多普勒超声特征研究

目的 用彩色多普勒超声观察中老年人脑中风患者颅内及颈动脉形态、结构和血流动力学改变。方法 应用2．5MHz线阵探头分别观察155例不同类型脑中风患者和80例正常人颈动脉内中膜厚度、斑块情况及颅内与颈动脉血流动力学改变情况。结果 （1）各型脑中风组颈总动脉（CCA）内中膜厚度均较对照组明显增厚,斑块有109例出现（70．3％）,而对照组仅4例（5．0％）出现斑块;（2）各型脑中风组颈内动脉时间平均流速（TAVICA）较正常组减低、阻力指数（RI）、搏动指数（PI）较正常组明显升高;（3）脑梗死组大脑中动脉时间平均流速（TAVMCA）较正常组低,脑出血组TAVMCA较正常组明显升高,混合性中风组可出现TAVMCA升高或降低两种情况。结论 中老年人各型脑中风患者颈动脉粥样硬化程度加重,斑块出现率高及斑块所引起的颈动脉狭窄,对脑中风有直接的因果关系,联合检查颅内动脉和颈动脉血流动力学改变可协助诊断不同类型脑中风,对其疗效观察,预防复发有一定的指导作用。     

瞬时波强在判断颈动脉硬化早期的临床意义

目的研究瞬时波强（WI）在动脉硬化早期改变的特点、诊断意义及影响因素。方法分析颈总动脉的WI、动脉内中膜厚度（IMT）、动脉硬化指标、血生化指标等的相关关系。建立IMT增厚诊断的ROC曲线。根据瞬时波强等指标,建立IMT的多元回归方程。结果 IMT与W1、β、Ep、PWVβ显著相关（P〈0.01）。IMT增厚组的W1、β、Ep、PWVβ、PWV_WI较对照组显著升高（P〈0.01）。IMT增厚诊断的ROC曲线下面积W1、β、PWVβ分别为0.875、0.723、0.763;WI、IMT和动脉硬化指标与多种因素显著相关（P〈0.05）。IMT预测的回归方程为Y（IMT）=-0.246＋0.024＊W1＋0.297＊年龄＋0.010＊ApoB（P〈0.01）。结论 WI能敏感反映动脉硬化早期改变,能较好地诊断和预测动脉硬化,为进一步临床研究和诊断治疗提供参考。     

颈动脉超声对冠状动脉粥样硬化性心脏病评估价值研究

目的:探讨颈动脉超声对冠状动脉粥样硬化性心脏病评估价值。方法:选择2018年2月至2019年9月的疑似冠心病患者107例进行研究。患者入组后均行冠状动脉造影剂颈动脉超声检查,根据冠状动脉造影结果将患者分为阴性组(n=33)、单支病变组(n=31)、双支病变组(n=27)及三支病变组(n=16)。对比各组血管内中膜厚度(Intimate-media thickness,IMT))、脉搏波传导速度(Pulse wave velocity,PWV)及硬度指数β(Lβ),并将颈动脉超声参数与冠状动脉病变程度进行相关性分析进行相关性分析。以ROC法评估各指标诊断价值。结果:不同组患者IMT、PWV及Lβ对比差异均具有统计学意义,且均随病变严重程度增加而增加(P0.05)。各颈动脉超声参数与冠状动脉病变支数呈显著正相关关系(P0.05)。ROC分析结果显示:联合诊断灵敏度和特异度均显著高于单独诊断(P0.05)。结论:颈动脉超声检查IMT、PWV及Lβ对冠状动脉心脏病均有较高的诊断灵敏度、特异度,联合诊断后灵敏度、特异度更高。     

血清同型半胱氨酸与糖尿病合并颈动脉斑块形成的关系及预后研究

目的探讨血清同型半胱氨酸(Hey)与糖尿病合并颈动脉斑块形成的关系及预后。方法以我院2016年3月至2017年7月的172例2型糖尿病(T2DM)患者为研究对象,依据患者是否合并颈动脉斑块分为斑块组72和无斑块组100例,另以我院同期健康体检人群100例作为对照组。对比3组人群Hey、载脂蛋白A(APOA)、载脂蛋白B(APOB)、颈动脉斑块厚度(IMT)、三酰甘油(TG)、体质指数(BMI)等指标。结果斑块组患者血清Hcy、APOB、IMT、TG、BMI与无斑块组和对照组相比均明显升高,而APOA明显下降(P <0.05);血清Hey水平与IMT值、APOB、IMT、BMI、TG变化呈正相关,而与APOA值呈负相关(P<0.05);一年后,斑块组患者发生糖尿病下肢微血管病变、合并肾病、眼部病变发生率明显高于其他两组(P <0.05);血清Hey水平高者预后更差。结论血清Hey水平对T2DM合并颈动脉斑块的发生具有一定的辅助诊断价值,且对患者的不良预后具有一定的预测作用。     

颈动脉彩色多普勒超声对老年高血压患者颈动脉病变情况诊断价值

目的探讨颈动脉彩色多普勒超声对老年高血压患者颈动脉病变情况诊断价值。方法抽取60例老年高血压患者与57例健康者分别设为病例组与对照组,均行颈动脉彩色多普勒超声,比较两组检查结果。结果病例组颈动脉狭窄率为88.3%,斑块形成率为80.00%,内膜中层厚度(IMT)、颈动脉内径(D)、阻力指数(RI)均较对照组高(P <0.05);病例组颈内动脉、颈总动脉最大剪切率(SR)以及收缩期峰值流速(PSV)均低于对照组(P <0.05)。结论颈动脉彩色多普勒超声对老年高血压患者颈动脉病变具有较高诊断价值,值得推广。     

基于单个颈动脉压力波形获取主动脉脉搏波速度的可行性研究

目的评估基于单个颈动脉压力波形分解以获取主动脉脉搏波速度(aortic pulse wave velocity,ao PWV)的可行性,验证该方法是否适用于动脉硬化的早期筛查。方法研究对象为53名无明显心血管病的健康人群[男性22人,女性31人,(58.6±13.7)岁]。利用压力传感器同步获取颈动脉和股动脉脉搏波形,计算颈股动脉脉搏波传导时间(carotid-femoral pulse transit time,cf PTT)和传导速度(carotid-femoral pulse wave velocity,cf PWV)。利用阻抗分析技术将颈动脉压力波形分解为前向波和反向波。通过对前向波和反向波进行相关分析获得主动脉脉搏波传导时间(aortic pulse transit time,ao PTT)和传导速度(aortic pulse wave velocity ao PWV)。评估ao PTT与cf PTT以及ao PWV与cf PWV之间的相关性和一致性。结果基于单个颈动脉压力波形分解获得的ao PTT与实测的cf PTT显著相关(r=0.624,P0.001),组内相关系数为0.621;ao PWV与cf PWV之间的相关系数为0.476(P0.001),组内相关系数等于0.452。老年人(年龄≥60岁,29人)ao PWV与cf PWV间的相关性显著低于中青年人(0.267 vs 0.549,P0.001)。结论基于单个颈动脉压力波形分解获取ao PWV与实测的cf PWV之间只具有中度的相关性和一致性,且在老年人中相关性更低。该方法可能不适用于老年人的ao PWV检测。     

应用自我血糖监测评估血脂正常的2型糖尿病患者下肢动脉硬化与血糖波动的关系

目的：应用自我血糖监测(SMBG)的方法评估下分析血脂正常的2型糖尿病(T2DM)患者下肢动脉硬化与血糖波动的关系。方法174例入选患者根据下肢动脉超声结果分为三组院内膜正常组61例；内膜增厚组55例；斑块组58例。进行1次/w自我血糖监测,观察3月,收集数据。结果下肢动脉内膜增厚组和斑块组驻MMBG、MPMG明显高于内膜正常组(P<0.01)；斑块组驻MMBG、MPMG也明显高于内膜增厚组(P<0.05)；内膜增厚组和斑块组下肢动脉内中膜厚度(IMT)与驻MMBG、MPMG均呈正相关(=0.382、0.353；0.437、0.396,<0.05)。结论血脂正常的T2DM患者下肢动脉硬化与血糖波动相关,血糖波动可能促进下肢动脉硬化的发生与发展。 SMBG能及时准确地反映T2DM患者的血糖波动,提示SMBG是评估血糖波动的实用方法。     

糖代谢异常者臂-踝脉搏波传导速度与颈动脉内膜中层厚度的变化

目的 研究糖调节功能正常、糖调节功能减低和糖尿病患者中,颈动脉内膜中层厚度(IMT)及臂-踝脉搏波传导速度(baPWV)的变化,探讨其与糖尿病早期动脉粥样硬化的关系.方法 收集糖尿病患者42例、糖调节功能减低者45例、正常对照者30例的临床资料,每例均采用全自动动脉硬化仪测定baPWV及超声检测IMT,将三组的数据进行比较分析.结果 从正常对照者、糖调节功能减低者至糖尿病患者,随着糖代谢异常程度的加重,颈动脉内膜中层逐渐增厚(P＜0.05),baPWV逐渐升高(P＜0.05).结论 在糖代谢异常的早期baPWV与IMT即发生明显改变,二者对筛查糖尿病动脉粥样硬化并发症有一定的价值.     

Association of interleukin‐10 promoter region polymorphisms with risk factors of Atherosclerosis

Atherosclerosis is considered as an inflammatory disease, and carotid artery intima‐media thickness (IMT) and carotid plaque are generally used as intermediated phenotype of atherosclerosis. The aim of this study was to investigate whether carotid IMT and plaque are associated with promoter region polymorphisms of interleukin 10 (IL‐10) gene. We recruited 135 subjects from a rural area of south‐eastern part of South Korea. Three polymorphisms in the promoter region of IL‐10 (?1082 A/G, ?819 T/C and ?592 A/C) were genotyped by pyrosequencing. Carotid IMT was measured at common carotid arteries, and carotid bulbs and cardiovascular risk factors such as cholesterol, blood pressure, uric acid and homocysteine were measured using blood samples. Subjects with the minor allele (C) of ?819 T/C or the minor allele (C) of ?592A/C showed lower values in carotid IMT than those with major allele homozygote of each polymorphism (P = 0.018 and P = 0.031, respectively). Subjects with carotid plaque were significantly older and showed higher values in carotid IMT, uric acid and homocysteine than those without plaque (P < 0.01, respectively). In conclusion, the promoter region polymorphisms of IL‐10 gene associate with carotid IMT and plaque. Further studies with larger samples are needed to provide stronger evidence to justify anti‐atheromatous properties of IL‐10.     

Coronary artery calcification, common carotid artery intima-media thickness and aortic pulse wave velocity in patients on peritoneal dialysis

An increasing body of evidence suggests that atherosclerosis in patients with uremia differs from that found in general population in terms of advancement and localization of vascular lesions. It has also been suggested that different non-invasive techniques of vascular system evaluation are designed to show different types of lesions (i.e. vascular calcification, stiffness or 'classical' atherosclerosis). The aim of the study was to search for possible associations between results obtained with three different non-invasive methods of vascular system assessment in three different vascular sites in patients treated with peritoneal dialysis (PD). 61 patients (28 F, 33 M), mean age of 50.4+/-13.6 years, on maintenance PD for a median period of 10 months (range 1-96 months) were included. Coronary artery disease (CAD) was present in 21 subjects. In all subjects coronary artery calcification score (CaSc) using multi-row spiral computed tomography (MSCT), aortic pulse wave velocity (AoPWV) and ultrasound-based common carotid artery intima-media thickness (CCA-IMT) were performed as methods for assessing coronary calcium burden, arterial stiffness and atherosclerosis, respectively. Median value of CaSc equaled 11.5 Agatston units (range 0-5502.8 units). Median AoPWV was 10.4 m/s (range 7.56-18.1 m/s), and median CCA-IMT-0.6 mm (range 0.3-1.0 mm). In 16 patients (26.2%) at least one plaque in at least one common carotid artery was found on ultrasound. CaSc correlated with AoPWV (R=0.32, p<0.01) and with CCA-IMT (R=0.35, p<0.005), whereas no association was found between AoPWV and CCA-IMT. AoPWV, but not CaSc nor IMT correlated with blood pressure. The values of CCA-IMT and AoPWV increased together with consecutive Agatston categories (with p<0.001 for differences in AoPWV and p<0.05 for CCA-IMT). Patients with at least one plaque found in at least one CCA and patients with CAD were characterized with significantly higher values of CaSc, IMT and PWV, when compared to plaque-free and CAD- negative subjects, respectively. Association between CaSc and both IMT and PWV may suggest that the mechanism of three assessed vascular pathologies may be based, to some extent, on the process of pathologic calcium-phosphate deposition. Lack of correlation found between PWV and IMT may suggest that aortic stiffness and carotid atherosclerosis may partially differ in their pathologic background and/or are dissociated in time.     

The assessment of arteriolosclerosis by serum lipids data, and carotid ultrasonography and pulse wave velocity, and its evaluation as a tool for preventive medicine: II. Carotid ultrasonography and pulse wave velocity for hyperlipemia and diabetes mellitus

We studied the test results of carotid ultrasonography and pulse wave velocity against a sample of hyperlipemia and diabetes mellitus. Sixty four hyperlipemia samples (HL), 85 diabetes mellitus samples (DS), and 27 complicated samples (CS) were compared with 56 healthy samples (HS). Hyperlipemia samples were selected from cholesterol under 300 mg/dl, and neutral fat under 300 mg/dl. Diabetes mellitus samples were selected from fasting plasma glucose (FBS) under 200 mg/dl. Samples from severe conditions with various disease were excluded. Ratio over 1.1 mm intima-media thickness (IMT) was 0% in HS, 48% in HL, 40% in DS and 33% in CS. PWV value was max 1896cm/s in CS. There was no significant correlation within IMT, serum lipid(Total Cholesterol, Neutral Fat, HDL-Cholesterol, LDL-Cholesterol) and FBS. For early treatment or accurate diagnosis of arteriosclerosis in hyperlipemia or diabetes mellitus patients, who are at high risk of developing arteriosclerosis, to vital function tests (carotid ultrasonography and pulse wave velocity) should be performed, in addition to normal blood tests.     

Relationship between of carotid ultrasonography in Japanese hypertensive subjects for intima-media thickness and plaque, and candidate gene polymorphism--possibility of early detection of arteriosclerotic disease

The purpose of this study was to determine the relationship between organic changes in carotid artery walls and candidate gene polymorphism in Japanese sufferers of essential hypertension. Carotid Ultrasonography was used to measure intima-media thickness (IMT) and presence of plaque formation. Patients were divided into two groups; a hypertension (HT) group and a healthy control (C). Group HT consisted of 273 subjects (56.5 +/- 11.3y) and group C consisted of 500 subjects (55.6 +/- 11.4y). 5HTR2A (T102C, A-1438G) and beta3-AR (Trp64Arg) genetic polymorphism for genetic analysis were performed on 43 subjects (63.5 +/- 8.5y) in group HT and 24 subjects (60.3 +/- 6.8y) in group C. IMT showed 0.81 +/- 0.28mm in Group C and 1.05 +/- 0.22mm in Group HT in patients aged 50 or above, respectively. The thickening was significantly greater in Group HT than in Group C (p < 0.01). Plaque was present in 45.1% in Group C and 70.2% in Group HT in patients aged 50 or above, respectively. It was significantly present greater in Group HT than in Group C (p < 0.01). Results of genetic analysis showed no difference between Group HT and Group C for either genotype of allele frequency of T102C and A-1438G, or of beta3-AR. It is suggested that increase of IMT and formation of plaque are risk factors in patients aged 50 or above with hypertension, and that careful observation of the carotid artery will be effective for early detection of arteriosclerosis, and to predict the symptoms thereof.     

中青年冠状动脉粥样硬化患者颈动脉硬化的超声特征

目的 探讨中青年冠状动脉粥样硬化（CHD）患者颈动脉超声特征。方法 根据冠状动脉造影结果,将我院170例患者分为CHD组105例和对照组65例,再将CHD组分为单支病变组32例、双支病变组34例和三支病变组39例。所有患者年龄均在60岁以下,全部受检者行颈动脉彩色多普勒超声检查,运用统计软件分析所检测的颈动脉声像图参数。结果 中青年冠状动脉粥样硬化患者颈动脉斑块60%为中低回声斑块。CHD组颈动脉内中膜厚度、IMT增厚率及斑块检出率均高于对照组,三支病变组斑块检出率高于单支病变组,颈动脉IMT情况与     

Influence of the Angiotensin II Type I Receptor Gene 1166A > C Polymorphism on BP and Aortic Pulse Wave Velocity Among Malays

Angiotensin II type 1 receptor ( AGT1R ) gene 1166A > C polymorphism has been shown to be associated with essential hypertension and aortic stiffness as measured by carotid femoral pulse wave velocity (PWV). This study was carried out to investigate the association of the 1166A > C polymorphism with blood pressure (BP) and PWV among Malay hypertensive and normotensive subjects.
Two hundred and one hypertensive subjects without evidence of cardiovascular (CV) complications and 201 age- and sex-matched normotensive subjects were studied in a cross-sectional design. Blood pressures (BP) and PWV were measured, and 1166A > C genotype was determined by polymerase chain reaction followed by restriction enzyme digestion.
The 1166C allele frequency was 7.96% and 7.73% among Malay hypertensive and normotensive subjects, respectively. There was no association of the 1166A > C polymorphism with BP in the hypertensive, normotensive or overall Malay populations. PWV was significantly higher among 1166C allele carriers as compared to non-carriers (10.52 ± 1.82 vs. 10.15 ± 1.80, p = 0.040) in the overall population, but not in the hypertensive and normotensive populations separately. In conclusion, the frequency of 1166C polymorphism is similar among Malay hypertensive and normotensive subjects. This polymorphism has no association with BP but may have an influence on PWV in Malays, which needs further investigation.     

彩色多普勒超声对颈动脉粥样硬化与脑梗死的相关性分析

目的探讨颈动脉粥样硬化与脑梗死的关系。方法应用彩色多普勒超声检测82例脑梗死患者和46例非脑梗死患者颈动脉内-中膜厚度（intima-media thickness,IMT）、斑块检出率、管腔狭窄率,并观察斑块性质。结果脑梗死组斑块检出率及颈动脉内膜厚度较对照组明显增加,两组比较差异有统计学意义（P〈0.01）,脑梗死组斑块检出率（70.7%）明显高于对照组（32.6%）;脑梗死组颈总动脉（CCA）内膜厚度（1.38±0.14）明显高于对照组（0.89±0.16）,脑梗死组颈内动脉（ICA）内膜厚度（1.16±0.27）明显高于对照组（0.78±0.17）。斑块多发生于颈动脉分叉处（44.4%）,以软斑块、溃疡斑块（59.2%）居多。结论颈动脉粥样硬化程度与脑梗死的发病关系密切,彩超评估颈动脉粥样硬化程度,对脑梗死的早期预防和治疗具有重要的临床价值。     

Inspiratory muscle training attenuates the human respiratory muscle metaboreflex

We hypothesized that inspiratory muscle training (IMT) would attenuate the sympathetically mediated heart rate (HR) and mean arterial pressure (MAP) increases normally observed during fatiguing inspiratory muscle work. An experimental group (Exp, n = 8) performed IMT 6 days per week for 5 weeks at 50% of maximal inspiratory pressure (MIP), while a control group (Sham, n = 8) performed IMT at 10% MIP. Pre- and post-training, subjects underwent a eucapnic resistive breathing task (RBT) (breathing frequency = 15 breaths min⁻¹, duty cycle = 0.70) while HR and MAP were continuously monitored. Following IMT, MIP increased significantly ( P < 0.05) in the Exp group (−125 ± 10 to −146 ± 12 cmH₂O; mean ± s.e.m. ) but not in the Sham group (−141 ± 11 to −148 ± 11 cmH₂O). Prior to IMT, the RBT resulted in significant increases in HR (Sham: 59 ± 2 to 83 ± 4 beats min⁻¹; Exp: 62 ± 3 to 83 ± 4 beats min⁻¹) and MAP (Sham: 88 ± 2 to 106 ± 3 mmHg; Exp: 84 ± 1 to 99 ± 3 mmHg) in both groups relative to rest. Following IMT, the Sham group observed similar HR and MAP responses to the RBT while the Exp group failed to increase HR and MAP to the same extent as before (HR: 59 ± 3 to 74 ± 2 beats min⁻¹; MAP: 84 ± 1 to 89 ± 2 mmHg). This attenuated cardiovascular response suggests a blunted sympatho-excitation to resistive inspiratory work. We attribute our findings to a reduced activity of chemosensitive afferents within the inspiratory muscles and may provide a mechanism for some of the whole-body exercise endurance improvements associated with IMT.