原发性高血压患者维生素D与动脉僵硬度的相关性研究

目的探讨原发性高血压患者维生素D水平与动脉僵硬程度的相关性。方法选取2010年12月-2012年10月在新疆医科大学第一附属医院高血压科确诊的原发性高血压患者195例为研究对象,根据25(OH)D水平分为维生素D缺乏组(n=124)和维生素D非缺乏组(n=71),进行临床资料的数据采集,测定踝臂指数(ABI)、踝臂脉搏波传导速度(baPWV)、颈动脉内膜-中层厚度(IMT),分析维生素D与动脉僵硬度的相关性。结果维生素D缺乏组与维生素D非缺乏组25(OH)D水平差异有统计学意义(P<0.05)。维生素D缺乏组与维生素D非缺乏组ABI、baPWV、IMT比较差异有统计学意义(P<0.05)。维生素D缺乏组与维生素D非缺乏组立位血管紧张素水平比较差异有统计学意义(P<0.05)。维生素D与ABI、颈动脉IMT呈负性相关。多元回归分析显示,ABI与血清25(OH)D独立相关(β=-0.227,P<0.05),颈动脉IMT与血清25(OH)D独立相关(β=-0.175,P<0.05)。结论原发性高血压伴维生素D缺乏患者动脉僵硬度增加,血清25(OH)D浓度是ABI、颈动脉IMT增加的独立危险因素,维生素D与动脉僵硬度之间可能存在负性相关关系。     

高血压前期患者的心脏自主神经功能异常及其危险因素分析

目的 评估高血压前期(PHT)患者心脏自主神经功能及探讨其相关危险因素.方法 选择2015年1月至2016年5月在我院诊断的80例符合《中国高血压防治指南(2010)》PHT诊断标准的PHT患者作为PHT组,同期血压正常的健康人70例作为对照组,监测窦性心率变异性(HRV)参数,包括所有窦性R-R间期标准差(SDNN)、相邻窦性R-R间期差值均方根(RMSSD)、相邻窦性R-R间期差值超过50 ms心搏百分比(pNN50)和窦性心率震荡(HRT)参数包括震荡初始(TO)、震荡斜率(TS),对比两组的临床特征,用Spearman相关分析和多元线性回归分析寻找影响HRV和HRT的危险因素.结果 与对照组比较,PHT组患者的年龄、体质指数、腰围、空腹血糖、收缩压、舒张压、血甘油三酯、TO较高,高密度脂蛋白胆固醇、SDNN、RMSSD、pNN50、TS较低,差异均有统计学意义(P<0.05);PHT患者中,SDNN的影响因素为年龄(β=-0.261,P<0.01)、收缩压(β=-0.252,P<0.01)、空腹血糖(β=-0.286,P<0.01)和血甘油三酯(β=-0.184,P<0.05);RMSSD的影响因素为收缩压(β=-0.232,P<0.05)、空腹血糖(β=-0.192,P<0.05);pNN50的影响因素为收缩压(β=-0.224,P<0.01)、空腹血糖(β=-0.224,P<0.05);TO的影响因素为年龄(β=0.220,P<0.05)、收缩压(β=0.203,P<0.05)、空腹血糖(β=-0.197,P<0.05);TS的影响因素为年龄(β=-0.395,P<0.01)、收缩压(β=-0.197,P=0.01)、空腹血糖(β=-0.195,P<0.05).结论 PHT患者心脏迷走神经活性降低,交感神经活性增强,空腹血糖、收缩压、年龄、甘油三酯水平可能是心脏自主神经病变的危险因素.     

2型糖尿病患者血清LDL-C CysC水平与动脉粥样硬化的相关性分析

目的 探讨2型糖尿病(T2DM)患者血清低密度脂蛋白胆固醇(LDL-C)、胱抑素C(CysC)与动脉粥样硬化(AS)的相关性.方法 选择2014年6月—2016年6月我院内分泌科住院的T2DM患者228例,根据颈动脉内膜中膜厚度(IMT)分为非AS组(n=79)和AS组(n=149),对AS的相关危险因素进行分析.结果 单因素分析示,非AS组和AS组2组间LDL-C、CysC、总胆固醇(TC)、甘油三脂(TG)、年龄、收缩压间差异有统计学意义(P<0.05);多因素Logistic回归分析示,LDL-C、CysC、年龄及收缩压是T2DM并AS的独立危险因素(P<0.05).结论 LDL-C与CysC水平是T2DM并AS的独立危险因素.     

持续非卧床腹膜透析患者大动脉僵硬度影响因素分析

目的探讨持续非卧床腹膜透析（CAPD）患者大动脉僵硬度的影响因素。方法选取241例CAPD患者为研究对象。大动脉僵硬度通过自动PWV分析仪检测颈股脉搏波速度（C F PWV）进行评估,容量负荷用体成分分析仪（BCM,德国）测定,常规标准测量血压和尿酸、血白蛋白、C 反应蛋白、血肌酐、甘油三酯、胆固醇等相关生化指标。每个患者的指标均在同一天内常规测量。对相应指标行相关及多元回归分析,筛选出PWV的影响因素。结果显示PWV与糖尿病、年龄、收缩压、脉压、容量负荷相关。多元回归分析显示糖尿病（1=是,0=否 β=0.307, P =0.001）］、年龄（β=0.329, P =0.001）、尿酸（β=0．274,P=0．001)、收缩压（β=0.188, P=0.002）、透析龄（β=0．129,P=0．027）是PWV增加的独立危险因素。结论除糖尿病、年龄、收缩压外,尿酸、透析龄也是影响腹膜透析患者大动脉僵硬度的独立危险因素。     

原发性高脂血症患者大动脉僵硬度及顺应性调查与分析

目的探讨高脂血症合并高血压和2型糖尿病时动脉僵硬度和顺应性的变化及影响因素。方法82例原发性高脂血症患者被分为:亚组1:单纯高脂血症组(n=25),亚组2:高脂血症合并高血压组(n=43),亚组3:高脂血症合并高血压同时合并2型糖尿病组(n=14)。另选46例年龄相仿健康人为对照组。测量入选者颈股动脉脉搏波传导速度(pulse wave velocity,PWV),作为反映大动脉僵硬度指标;应用超声技术测定每搏输出量(SV),以每搏输出量除以脉压(SV/PP)所得出的动脉僵硬度指数为动脉顺应性指标。结果病例组与对照组比较,PWV明显增高(P<0.01),SV/PP明显降低(P<0.05);PWV在各亚组之间比较差异均有统计学意义(P<0.05),随合并危险因素的增加,差异加大;SV/PP在亚组3和亚组1之间差异有统计学意义(P<0.05);多元逐步回归分析显示:PWV与收缩压(SBP)、年龄(Age)、空腹血糖(FBS)呈正相关,回归方程为PWV=1.98+0.055(Age)+0.024(SBP)+0.023(FBS);SV/PP与PP、高密度脂蛋白胆固醇(HDL-C)呈负相关,回归方程为SV/PP=5.178-0.020(SBP)-0.016(HDL-C)。结论PWV可作为原发性高脂血症合并高血压与2型糖尿病引起早期血管功能改变的敏感指标之一;SBP、FBS、HDL-C均是与动脉僵硬度增加和顺应性减低密切相关的危险因素。     

超重或肥胖人群动脉僵硬度与心血管疾病危险因素的相关性研究

目的评估上海市浦东新区陆家嘴社区超重或肥胖人群动脉僵硬度与心血管疾病危险因素之间的关系。方法本研究于2009年7月至8月底选取自然人群2095例;通过体重指数（Body Mass Index,BMI）评价超重或肥胖,将其中达到超重或肥胖诊断标准的939例作为研究对象;以踝臂脉搏波传导速度（ankle-brachial pulse wave velocity,baPWV）评价动脉僵硬度;以Pearson相关系数评估与baPWV呈线性相关关系的心血管危险因素;以二分类logistic回归分析评估动脉僵硬度的独立危险因素。结果 （1）高动脉僵硬度组与动脉僵硬度正常组在年龄、性别构成、腹围、收缩压、舒张压等变量间均存在差异。（2）与baPWV呈线性相关关系的变量有：年龄（r=0.546,P=0.000）、腹围（r=0.148,P=0.000）、收缩压（r=0.520,P=0.000）、舒张压（r=0.275,P=0.000）、总胆固醇（r=0.126,P=0.000）、空腹血糖（r=0.218,P=0.000）、糖化血红蛋白（r=0.172,P=0.000）等。（3）在调整性别、BMI、糖尿病史、血脂异常史、肾功能后,与baPWV呈独立相关的变量是高血压史（OR=3.996,P=0.000,95%CI：2.821~5.661）、甘油三酯（OR=1.428,P=0.000,95%CI：1.201~1.698）、年龄（老年与非老年）（OR=5.35,P=0.000,95%CI：3.728~7.676）。结论年龄、高血压史、三酰甘油是超重或肥胖人群动脉僵硬度增加的独立危险因素;baPWV的升高可在一定程度上预测心血管疾病的发病风险。     

2型糖尿病并发非酒精性脂肪肝的危险因素及其与糖尿病大血管病变的相关性研究

目的探讨2型糖尿病(T2DM)合并非酒精性脂肪肝(NAFLD)的危险因素,及其与糖尿病大血管病变的相关性。方法选取住院T2DM患者214例,根据肝脏B超检查结果分为NAFLD组和非NAFLD组,回顾性分析了两组患者的临床指标和大血管病变发生情况,采用Logistic多元回归分析筛选危险因素。结果有116例住院T2DM患者合并NAFLD(54.2%),98例未合并NAFLD(45.8%)。NAFLD组较非NAFLD组体质指数(BMI)、收缩压(SBP)、舒张压(DBP)、血三酰甘油(TG)、γ-谷氨酰转移酶(GGT)、丙氨酸氨基转移酶(ALT)显著增高(P<0.05);且大血管病变发生率显著高于非NAFLD组(P<0.05)。Logistic多元回归分析显示,SBP、TG、GGT是糖尿病发生NAFLD的独立危险因素(P<0.05);NAFLD、年龄、总胆固醇(TC)水平是糖尿病发生大血管病变的独立危险因素(P<0.01)。结论 SBP、TG、GGT是T2DM并NAFLD的独立危险因素,NAFLD与糖尿病大血管病变高风险密切相关。     

慢性舒张性心力衰竭患者动脉僵硬度影响因素分析

目的探讨慢性舒张性心力衰竭患者动脉僵硬度的影响因素.方法选取慢性舒张性心力衰竭患者354例,测量身高、体重、血压,计算BMI,采集空腹静脉血分析血脂、血糖、血浆B型脑钠肽(BNP)等指标,超声心动图检查各项指标,采用动脉硬化检测仪测量CAVI,分析CAVI与各临床特征的相关性.结果单因素相关分析结果显示,CAVI与年龄、收缩压、BNP呈明显正相关(r=0.3664、0.1193、0.2591,P<0.05或0.01),与BMI、E/A呈显著负相关(r=0.2040、0.1759,均P<0.01);多元逐步回归分析显示,高龄、女性、吸烟史、BMI、BNP、E/A是CAVI的独立影响因素(β=0.0443、0.2617、-0.0675、0.3904、0.4939、-0.7899,P<0.05或0.01),且E/A比值作用最强(P<0.05).结论老龄、女性、吸烟、BMI、BNP、E/A是影响慢性舒张性心力衰竭患者动脉僵硬度的主要危险因素.     

超声评价高血压患者颈动脉弹性52例报告

目的应用超声评价高血压患者的颈动脉弹性。方法以M型超声测定52例高血压患者和40名健康受检者的颈总动脉硬度指数β、扩张性系数（DC）、顺应性（AC）及压力应变弹性系数（EP）等弹性参数指标,并分析这些指标与患者年龄、血压及颈总动脉内中膜厚度（IMT）的相关性。结果与对照组比较,高血压组β、EP明显增高（均P〈0.01）,DC、AC明显降低（均P〈0.05）;年龄、脉压（PP）、IMT分别与β、EP成正相关,与DC、AC成负相关（P〈0.05或0.01）。结论 M型超声是评价高血压患者颈动脉弹性的一种实用技术。     

新版血管回声跟踪技术对2型糖尿病患者颈总动脉弹性功能的测定

目的: 探讨新版血管回声跟踪(echo-tracking,ET)技术在定量评价2型糖尿病患者颈总动脉弹性功能中的价值.方法: 应用血管回声跟踪技术实时跟踪描记2型糖尿病患者68例及健康志愿者45例颈总动脉(CCA)的运动轨迹,测量其内-中膜厚度(IMT),僵硬度(β) 、弹性系数 ( E ρ) 、顺应性 (AC) 、膨大指数(AI)以及脉搏波传导速度(PWVβ),并对2型糖尿病组上述参数进行相关性分析.结果: 2型糖尿病组较正常对照组E ρ,β, IMT及PWVβ增高,AC减低,差异均有统计学意义(P<0.01);两组AI差异无统计学意义(P>0.05).2型糖尿病组PWVβ与E ρ、β和IMT呈正相关,与AC呈负相关,AI与E ρ,β, IMT和AC无明显相关.结论: 新版血管回声跟踪技术客观反映了2型糖尿病患者外周血管的改变,以E ρ、β、 IMT、 PWVβ、AC及IMT作为2型糖尿病患者颈总动脉硬化参数评价的准确性较高,是无创诊断糖尿病患者动脉硬化的简便而有效的方法.     

维持性血液透析患者血脂情况调查

目的了解维持性血液透析(maintenance hemodialysis,MHD)患者脂代谢紊乱的患病率和特点,并探讨其危险因素。方法对北京朝阳医院血液净化中心205例MHD患者进行横断面研究;收集其临床资料和血脂指标。结果205例MHD患者中有145例(70.7%)存在脂质代谢异常,主要表现为高密度脂蛋白胆固醇(HDL-C)降低、低密度脂蛋白胆固醇(LDL-C)增高和三酰甘油(TG)增高,患病率分别为53.2%、28.3%和26.8%。②以45岁为界,将患者分为青年组(51例)和中老年组(154例)。青年组脂代谢异常患病率(36/51,70.6%)与中老年组(109/154,70.8%)相比差异无统计学意义。③脂代谢异常者透析龄、性别和移植肾衰竭的比例明显高于无脂代谢异常者;而2组在年龄、血白蛋白、脂蛋白a、原发病方面差异无统计学意义。Logistic回归分析显示,男性、透析龄和移植肾衰竭是MHD患者并发脂代谢紊乱的独立危险因素。结论MHD患者脂代谢紊乱的患病率高,主要表现为HDL-C降低、LDL-C增高和TG增高。青年透析患者脂蛋白紊乱的患病率与中老年透析患者相似。男性、透析龄和移植肾衰竭是MHD患者并发脂代谢紊乱的独立危险因素。     

高敏C反应蛋白与糖尿病患者动脉粥样硬化的相关性分析

目的了解炎性反应标志物超敏C反应蛋白(hypersensitivity C-reaction protein,hsCRP)与糖尿病患者中颈动脉粥样硬化发生之间的关系,加深对糖尿病导致外周血管病变的认识。方法对入选的150例糖尿病患者进行颈动脉超声检查,测量颈总动脉内中膜厚度(IMT),观察有无斑块形成,以判定是否出现颈动脉粥样硬化,并进行血清hsCRP定量检测。对血清hsCRP与颈动脉粥样硬化、颈总动脉内中膜增厚、及斑块形成进行相关性分析。结果①2型糖尿病患者中合并颈动脉粥样硬化者血清hsCRP异常比例明显高于无颈动脉病变者(P<0.01),颈总动脉内中膜增厚者血清hsCRP异常率与正常者相比差异有统计学意义(P=0.000),与颈动脉斑块形成者比较血清hsCRP异常率差异也有统计学意义(P=0.02);②吸烟与非吸烟患者血清hsCRP异常率差异无统计学意义;③伴有高血压者血清hsCRP异常率与无高血压者的差异有统计学意义(P<0.05);④按颈动脉IMT厚度将受试者分为正常和异常2组进行Logistic回归分析发现:年龄(OR=1.023,P=0.00)、hsCRP(OR=1.012,P=0.00)、LDL-C(OR=2.553,P=0.00)、HDL-C(OR=0.146,P=0.00)、高血压(OR=3.465,P=0.00)和吸烟史(OR=2.276,P=0.00)与颈动脉粥样硬化相关。结论血清hsCRP含量与糖尿病颈动脉粥样硬化的发生有一定相关性,合并颈动脉粥样硬化尤其是伴有颈动脉斑块患者的血清hsCRP异常率显著高于无颈动脉病变患者,高血压对血清hsCRP与颈动脉粥样硬化之间的相关性可能产生影响。     

维持性血液透析患者高瘦素血症与动脉粥样硬化的关系

目的研究维持性血液透析患者血清瘦素(Leptin)水平与颈动脉粥样硬化及动脉舒张功能的关系。方法选择维持性血液透析患者50例和年龄性别相当的健康对照者30例,采用双抗体夹心酶联免疫吸附(ABC-ELISA)技术检测血清瘦素水平,用高分辨二维颈动脉超声技术检测颈动脉内-中膜厚度(IMT)、粥样硬化斑块、肱动脉内径及反应性充血后肱动脉内径的变化。结果无论男性或女性血液透析患者血清瘦素水平均明显高于相应的正常对照组(P<0.01),透析患者平均IMT值、IMT增厚率和颈动脉粥样斑块检出率明显高于对照组,肱动脉反应性充血后内径增加率明显低于正常对照组(P<0.01)。多因素逐步回归分析显示,血清瘦素水平是影响IMT和反应性充血后肱动脉内径变化率的独立危险因素。结论血清瘦素与血透患者的动脉粥样硬化病变及肱动脉舒张功能障碍有关,可能是加速其动脉粥样硬化的危险因素。     

维持性血液透析患者血清OPN及ucMGP浓度与心血管钙化的关系

目的探讨骨相关蛋白中骨桥蛋白(OPN)和非活性基质Gla蛋白(ucMGP)在维持性血液透析(MHD)患者合并动脉粥样硬化和心脏瓣膜钙化中的关系。方法55例MHD患者和22例正常对照者作为研究对象。采用ELISA法测定2组受试者血中OPN和ucMGP含量。测定颈动脉分叉处内-中膜厚度(IMT),用超声心动图检测心脏瓣膜是否出现钙化,分析骨相关蛋白水平与动脉粥样硬化和心脏瓣膜钙化之间的关系。结果MHD患者血中OPN及ucMGP显著升高。MGP在伴有颈动脉斑块和心脏瓣膜钙化组显著增高,其中OPN含量与颈动脉内膜厚度呈正相关关系(r=0.55,P<0.05)。结论MHD患者血中OPN及ucMGP的增高伴随动脉粥样硬化和心脏瓣膜钙化的发生,可作为心血管钙化程度的检测指标。     

Cardiovascular risk factors in childhood and carotid artery intima-media thickness in adulthood: the Cardiovascular Risk in Young Finns Study

Context  Exposure to cardiovascular risk factors during childhood and adolescence may be associated with the development of atherosclerosis later in life. Objective  To study the relationship between cardiovascular risk factors measured in childhood and adolescence and common carotid artery intima-media thickness (IMT), a marker of preclinical atherosclerosis, measured in adulthood. Design, Setting, and Participants  Population-based, prospective cohort study conducted at 5 centers in Finland among 2229 white adults aged 24 to 39 years who were examined in childhood and adolescence at ages 3 to 18 years in 1980 and reexamined 21 years later, between September 2001 and January 2002. Main Outcome Measures  Association between cardiovascular risk variables (levels of low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], and triglycerides; LDL-C/HDL-C ratio; systolic and diastolic blood pressure; body mass index; smoking) measured in childhood and adulthood and common carotid artery IMT measured in adulthood. Results  In multivariable models adjusted for age and sex, IMT in adulthood was significantly associated with childhood LDL-C levels (P = .001), systolic blood pressure (P<.001), body mass index (P = .007), and smoking (P = .02), and with adult systolic blood pressure (P<.001), body mass index (P<.001), and smoking (P = .004). The number of risk factors measured in 12- to 18-year-old adolescents, including high levels (ie, extreme age- and sex-specific 80th percentile) of LDL-C, systolic blood pressure, body mass index, and cigarette smoking, were directly related to carotid IMT measured in young adults at ages 33 through 39 years (P<.001 for both men and women), and remained significant after adjustment for contemporaneous risk variables. The number of risk factors measured at ages 3 to 9 years demonstrated a weak direct relationship with carotid IMT at ages 24 to 30 years in men (P = .02) but not in women (P = .63). Conclusions  Risk factor profile assessed in 12- to 18-year-old adolescents predicts adult common carotid artery IMT independently of contemporaneous risk factors. These findings suggest that exposure to cardiovascular risk factors early in life may induce changes in arteries that contribute to the development of atherosclerosis.      

Effect of combining different calcium concentration dialysate on calcium balance in peritoneal dialysis patients

Background  Calcium and phosphorus metabolic disturbance are common in dialysis patients and associated with increased morbidity and mortality. Therefore, maintaining the balance of calcium and phosphate metabolism and suitable intact parathyroid hormone (iPTH) level has become the focus of attention. We investigated the effects of different peritoneal dialysate calcium concentrations on calcium phosphate metabolism and iPTH in continuous ambulatory peritoneal dialysis (CAPD) patients.

Methods  Forty stable CAPD patients with normal serum calcium were followed for six months of treatment with 1.25 mmol/L calcium dialysate (DCa1.25, PD4, 22 patients) or a combination of 1.75 mmol/L calcium dialysate (DCa1.75, PD2) and PD4 (18 patients) twice a day respectively. Total serum calcium (after albumin correction), serum phosphorus, iPTH, alkaline phosphatase (ALP) and blood pressure were recorded before and 1, 3 and 6 months after treatment commenced.

Results  No significant difference was found in baseline serum calcium, phosphorus between the two patient groups, but the levels of iPTH were significantly different. No significant changes were found in the dosage of calcium carbonate and active vitamin D during 6 months. In the PD4 group, serum calcium level at the 1st, 3rd, 6th months were significantly lower than the baseline (P <0.05). There was no significant difference in serum phosphorus after 6 months treatment. iPTH was significantly higher (P <0.001) at the 1st, 3rd, and 6th months compared with the baseline. No differences were seen in ALP and blood pressure. In the PD4+PD2 group, no significant changes in serum calcium, phosphorus, iPTH, ALP and BP during the 6-month follow-up period.

Conclusions  Treatment with 1.25 mmol/L calcium dialysate for six months can decrease serum calcium, increase iPTH, without change in serum phosphorus, ALP, and BP. The combining of PD4 and PD2 can stabilize the serum calcium and avoid fluctuations in iPTH levels.

     

An international study of patient compliance with hemodialysis

Context  International differences in compliance of patients undergoing hemodialysis are poorly characterized and could contribute to international survival differences. Objective  To compare international differences in patient compliance with hemodialysis treatments. Design  A prospective observational study of patients undergoing hemodialysis in 1995 and a cross-sectional survey of health care professionals caring for hemodialyzed patients in 1996. Setting and Patients  Four dialysis centers in the southeastern United States with 415 patients undergoing hemodialysis, 1 center in Sweden with 84 patients, and 4 centers in Japan with 194 patients participated in the prospective observational study. In the cross-sectional survey, nurses and nephrologists from the United States (n=49), Japan (n=21), and Sweden (n=16) responded to questions regarding the compliance of their patients undergoing hemodialysis. Main Outcome Measures  Percentage of patients who miss a dialysis treatment and number of missed dialysis treatments. Results  Of 415 US patients, 147 missed 699 treatments over a 6-month period (28.1 missed treatments per 100 patient-months or 2.3% of all prescribed treatments). During a 3-month period, there were 0 missed treatments per 100 patient-months for patients from Japan and 0 missed treatments per 100 patient-months for patients from Sweden (P<.001). In the cross-sectional survey, the mean (SD) estimated percentage of patients missing a treatment per month was 4% (3%) for the United States, 0% for Japan, and 0.1% (3%) for Sweden (P<.001). Conclusions  Noncompliance is much more common in US patients undergoing hemodialysis than Swedish and Japanese patients. The implications of these results for international differences in survival deserve further study.      

高通量血液透析对非糖尿病患者血清颗粒蛋白前体及胰岛素抵抗的影响

目的探讨高通量血液透析对非糖尿病维持性血液透析(MHD)患者血清颗粒蛋白前体(PGRN)及胰岛素抵抗的影响。方法入选非糖尿病MHD患者60例,随机分为高通量透析组(n=30)和普通透析组(n=30),同时选择年龄、性别相匹配的20例健康体检者作为对照组。两透析组随访6个月,使用稳态模型胰岛素抵抗指数(HOMA-IR)评估胰岛素抵抗,采用ELISA法测定治疗前后血PGRN、白细胞介素-6(IL-6)水平,并记录超敏C反应蛋白(hs-CRP)、血总钙、血磷、甲状旁腺素(PTH)、血脂、单室模型尿素清除指数(sp Kt/V)等指标的变化。结果与对照组相比,高通量透析组和普通透析组患者HOMA-IR均明显升高(P0.05)。治疗后高通量透析组的HOMAIR、PGRN、IL-6、hs-CRP、血磷、甘油三酯、总胆固醇较治疗前显著下降(P0.05),亦明显低于普通透析组(P0.05)。而普通透析组的HOMA-IR、PGRN、IL-6、hs-CRP、血磷、甘油三酯、总胆固醇等指标治疗前后差异无统计学意义(P0.05)。结论高通量透析能降低非糖尿病MHD患者血清PGRN水平,改善机体炎症状态及胰岛素抵抗。     

Effect of a Garlic Oil Preparation on Serum Lipoproteins and Cholesterol Metabolism: A Randomized Controlled Trial

Context.— Garlic-containing drugs have been used in the treatment of hypercholesterolemia even though their efficacy is not generally established. Little is known about the mechanisms of action of the possible effects on cholesterol in humans. Objective.— To estimate the hypocholesterolemic effect of garlic oil and to investigate the possible mechanism of action. Design.— Double-blind, randomized, placebo-controlled trial. Setting.— Outpatient lipid clinic. Patients.— We investigated 25 patients (mean age, 58 years) with moderate hypercholesterolemia. Intervention.— Steam-distilled garlic oil preparation (5 mg twice a day) vs placebo each for 12 weeks with wash-out periods of 4 weeks. Main Outcome Measures.— Serum lipoprotein concentrations, cholesterol absorption, and cholesterol synthesis. Results.— Baseline lipoprotein profiles were (mean [SD]): total cholesterol, 7.53 (0.75) mmol/L (291 [29] mg/dL); low-density lipoprotein cholesterol (LDL-C), 5.35 (0.78) mmol/L (207 [30] mg/dL); high-density lipoprotein cholesterol (HDL-C), 1.50 (0.41) mmol/L (58 [16] mg/dL); and triglycerides, 1.45 (0.73) mmol/L (127 [64] mg/dL). Lipoprotein levels were virtually unchanged at the end of both treatment periods (mean difference [95% confidence interval]): total cholesterol, 0.085 (-0.201 to 0.372) mmol/L (3.3 [-7.8 to 14.4] mg/dL), P=.54; LDL-C, 0.001 (-0.242 to 0.245) mmol/L (0.04 [-9.4 to 9.5] mg/dL), P=.99; HDL-C, 0.050 (-0.028 to 0.128) mmol/L (1.9 [-1.1 to 4.9] mg/dL), P=.20; triclycerides, 0.047 (-0.229 to 0.135) mmol/L (4.2 [-20.3 to 12.0]) mg/dL, P=.60. Cholesterol absorption (37.5% [10.5%] vs 38.3% [10.7%], P=.58), cholesterol synthesis (12.7 [6.5] vs 13.4 [6.6] mg/kg of body weight per day, P=.64), mevalonic acid excretion (192 [66] vs 187 [66] µg/d, P=.78), and changes in the ratio of lathosterol to cholesterol in serum (4.4% [24.3%] vs 10.6% [21.1%], P=.62) were not different in garlic and placebo treatment. Conclusions.— The commercial garlic oil preparation investigated had no influence on serum lipoproteins, cholesterol absorption, or cholesterol synthesis. Garlic therapy for treatment of hypercholesterolemia cannot be recommended on the basis of this study.      

Effects of diet and simvastatin on serum lipids, insulin, and antioxidants in hypercholesterolemic men: a randomized controlled trial

Context  Limited information exists on the interaction between diet and 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) and the interaction's effect on serum lipid and lipoprotein levels, insulin sensitivity, and circulating antioxidant vitamin and provitamin levels. Objective  To evaluate the separate and combined effects of diet and simvastatin therapy on serum levels of lipids, lipoproteins, antioxidants, and insulin. Design, Setting, and Participants  Randomized, controlled crossover trial conducted from August 1997 to June 1998 in 120 previously untreated hypercholesterolemic men aged 35 to 64 years who were recruited from the community in Turku, southwestern Finland. Interventions  After a 4- to 6-week placebo run-in period, participants were randomly allocated to a habitual diet (n = 60) or dietary treatment group (n = 60), and each of these groups was further randomized in a double-blind crossover fashion to receive simvastatin (20 mg/d) or placebo, each for 12 weeks (n = 30 in each group). The main goals of the dietary treatment were to reduce energy intake from saturated plus trans-unsaturated fats to no more than 10% by replacing them partly with monounsaturated and polyunsaturated fats rich in omega-3 fatty acids and to increase intake of fruits, vegetables, and dietary fiber. Main Outcome Measures  Changes in levels of total, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) cholesterol; triglycerides; apolipoprotein B; insulin; glucose; and antioxidants at week 12 of each treatment period, compared among the 4 groups. Results  Dietary treatment decreased levels of total cholesterol by 7.6% (P<.001), LDL cholesterol by 10.8% (P<.001), HDL cholesterol by 4.9% (P = .01), apolipoprotein B by 5.7% (P = .003), serum insulin by 14.0% (P = .02), and -tocopherol by 3.5% (P = .04). Simvastatin decreased levels of total cholesterol by 20.8%, LDL cholesterol by 29.7%, triglycerides by 13.6%, apolipoprotein B by 22.4%, -tocopherol by 16.2%, -carotene by 19.5%, and ubiquinol-10 by 22.0% (P<.001 for all) and increased levels of HDL cholesterol by 7.0% (P<.001) and serum insulin by 13.2% (P = .005). Glucose levels remained unchanged in all groups. The effects of dietary treatment and simvastatin were independent and additive. Conclusions  A modified Mediterranean-type diet rich in omega-3 fatty acids efficiently potentiated the cholesterol-lowering effect of simvastatin, counteracted the fasting insulin–elevating effect of simvastatin, and, unlike simvastatin, did not decrease serum levels of -carotene and ubiquinol-10.