颈动脉内膜中层厚度在尿白蛋白正常的不同糖耐量人群中的变化及相关危险因素探讨

目的观察尿白蛋白排泄率(AER)在临床正常值范围内的不同糖耐量人群颈动脉内膜中层厚度(IMT)变化情况并分析其相关危险因素。方法选取AER在临床正常值范围内的正常糖耐量(NGT)25例、糖耐量减低(IGT)29例和新诊断2型糖尿病(T2DM)163例受试者,检测其颈动脉IMT及分析相关心血管危险因素。结果 T2DM组患者AER较非糖尿病组高(P<0.001);其颈动脉IMT比NGT组厚(P=0.03)。IGT组患者异常颈动脉IMT与空腹血糖正相关,调整了年龄和性别因素影响后相关性依然良好(r=0.461,P=0.020);空腹血糖升高致其发生异常颈动脉IMT的优势比(OR)达8.06(95%CI1.09～59.49)。结论 T2DM患者AER较非糖尿病患者高,且已出现亚临床性心血管疾病。IGT患者的空腹血糖水平与异常颈动脉IMT的发生独立相关,可作为心血管疾病危险预测因子。     

超声评价糖尿病合并微量蛋白尿患者下肢动脉硬化

目的 探讨超声评价2型糖尿病(T2DM)合并微量白蛋白尿(MA)患者的下肢动脉硬化的临床价值。方法 收集58例T2DM患者及40名正常对照,根据尿白蛋白排泄率(UAER)将T2DM患者分为T2DM合并MA组(T2DM1组)30例和T2DM未合并MA组(T2DM2组)28例,利用高频超声检测两组下肢股动脉内-中膜厚度(IMT)和粥样硬化斑块形成情况。结果 T2DM组IMT明显高于正常对照组,T2DM1组IMT高于T2DM2组(P均<0.05)。Pearson相关分析显示T2DM组IMT与UAER及病程呈正相关(r=0.311、0.441,P均<0.05);多元线性回归分析显示,病程、UAER是IMT的独立影响因素。T2DM组股动脉IMT>腘动脉IMT>末梢动脉IMT;股动脉及腘动脉以不均质回声斑块为主;股浅动脉远端、下肢末梢动脉以点状强回声斑块为主,当腘动脉IMT增厚明显时,末梢动脉点状强回声更加密集。结论 T2DM患者下肢动脉IMT与硬化斑块形成情况与UAER密切相关。超声能够快捷、准确地检测T2DM合并MA患者下肢动脉硬化。     

中老年男性2型糖尿病患者下肢动脉粥样硬化斑块与骨密度的关系

目的探讨中老年(年龄≥45岁)男性2型糖尿病(type 2diabetes mellitus,T2DM)患者下肢动脉粥样硬化斑块与骨密度(bone mineral density,BMD)的关系,分析其发生低骨量的危险因素。方法中老年男性T2DM患者237例,均进行下肢动脉彩超检查,并根据有无下肢动脉粥样硬化斑块分为斑块组171例和无斑块组66例;测量患者腰椎、股骨颈和髋关节BMD,并分为骨量正常组160例和低骨量组77例;采用Pearson相关分析下肢动脉粥样硬化斑块与BMD的相关性;采用多因素logistic回归分析中老年男性T2DM患者发生低骨量的危险因素。结果斑块组患者股骨颈、髋关节BMD值[(0.924±0.142)、(1.027±0.157)g/cm~2]均低于无斑块组[(0.970±0.137)、(1.071±0.133)g/cm~2)](P0.05);低骨量组患者下肢动脉粥样硬化斑块发生率(81.8%)高于骨量正常组(67.5%)(P0.05);下肢动脉粥样硬化斑块的发生与股骨颈、髋关节BMD值呈负相关(r=-0.144,P=0.028;r=-0.130,P=0.047);高龄(OR=1.064,95%CI:1.022～1.109,P=0.003)、空腹血糖升高(OR=1.226,95%CI:1.050～1.431,P=0.010)及下肢动脉斑块形成(OR=2.445,95%CI:1.090～5.483,P=0.030)是中老年男性T2DM患者发生低骨量的危险因素(P0.05),体质量指数增高(OR=0.822,95%CI:0.731～0.925,P=0.001)是中老年男性T2DM患者发生低骨量的保护因素。结论下肢动脉粥样硬化斑块是中老年男性T2DM患者发生低骨量的危险因素。     

青少年新诊断2型糖尿病患者胰岛素抵抗与动脉僵硬度的关系

目的观察青少年新诊断2型糖尿病(T2DM)患者胰岛素抵抗(IR)与动脉僵硬度的关系。方法共纳入98例年龄在10~24岁的新诊断T2DM患者,收集一般资料、主要病史及人体测量学指标,检测血糖、血脂及糖化血红蛋白(Hb A1c)等,以简易稳态模型法计算胰岛素抵抗指数(HOMA-IR)反映IR,使用Sphygmo Cor脉搏波分析系统测定颈股动脉脉搏波速度(CF-PWV)反映动脉僵硬度。结果按照HOMA-IR三分位分组,CF-PWV、体质量指数(BMI)、收缩压(SBP)、舒张压(DBP)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)等指标组间差异有统计学意义(均P<0.05或P<0.01);患者年龄、性别、空腹血糖(FPG)及Hb A1c等差异未达到统计学意义;相关分析显示CF-PWV与HOMA-IR(r=0.453)、BMI(r=0.327)、SBP(r=0.261)、DBP(r=0.213)、TG(r=0.182)、TC(r=0.221)、LDL-C(r=0.234)及HDL-C(r=-0.137)等呈显著相关(均P<0.05或P<0.01),与年龄(r=0.012)、性别(r=0.009)、FPG(r=0.013)及Hb A1c(r=0.017)等无显著性相关。以CF-PWV为因变量,HOMA-IR为自变量,其偏回归系数在校正BMI、SBP、DBP、TG、TC、LDL-C及HDL-C等危险因素前后分别为3.543(95%CI:2.001~5.989,P<0.01)及1.776(95%CI:0.723~4.209,P<0.05)。结论青少年新诊断T2DM患者HOMA-IR与动脉僵硬度增加独立相关,可能是其独立危险因素。     

急性结石性胆囊炎腹腔镜胆囊切除中转开腹影响因素分析

目的:探讨急性结石性胆囊炎行腹腔镜胆囊切除术过程中转开腹的影响因素。方法:回顾性分析3191例急性结石性胆囊炎行腹腔镜胆囊切除术患者的临床资料,按术中是否中转开腹胆囊切除术分为中转组和非中转组,通过多元回归模式对患者性别、年龄、BMI、既往病史(糖尿病病史、高血压病史及既往腹部外科手术史)、术前实验室检查(WBC、PCT、CRP及INR)、术前胆囊B超特征(胆囊结石数量、胆囊壁厚度)及手术时间等因素进行统计学分析。结果:资料数据经多元logistic回归分析显示,BMI、糖尿病病史、术前白细胞计数、PCT、CRP、结石数量、胆囊壁厚度是影响急性结石性胆囊炎患者行腹腔镜胆囊切除中转开腹的因素(P<0.05);BMI(OR=1.784;95%CI:1.621~1.973;P<0.001)、糖尿病病史(OR=21.79;95%CI:13.49~34.90;P<0.001)、WBC(OR=1.330;95%CI:1.254~1.410;P<0.001)、PCT(OR=1.839;95%CI:1.631~2.079;P=0.004)、CRP(OR=2.025;95%CI:1.019~4.031;P=0.004)升高及胆囊壁增厚(OR=1.680;95%CI:1.520~1.859;P<0.001)为中转开腹的独立危险因素,而结石数量(OR=0.422;95%CI:0.273~0.643;P=0.0005)为中转开腹的保护因素。结论:急性结石性胆囊炎患者实施腹腔镜胆囊切除术时,对BMI超标、术前有糖尿病病史、术前WBC、PCT及CRP较高或B超显示胆囊壁增厚、结石单发的患者,应考虑术中中转开腹手术可能。     

外周动脉导管相关血流性感染的影响因素分析

目的分析外周动脉导管相关血流性感染(CRBSI)的影响因素, 为临床医护人员控制CRBSI提供理论依据。方法采用横断面调查方法, 便利抽样法选取2021年1月至2022年1月在中国人民武装警察部队特色医学中心动脉置管的331例患者为研究对象, 收集研究对象一般资料、导管相关感染情况、局部皮肤异常情况、置管状况等资料, 以患者拔管后导管尖端微生物培养细菌阳性作为结局指标, 分析外周动脉CRBSI的影响因素。结果 CRBSI发生率为8.15%(27/331)。调整后Logistic回归显示年龄(OR=3.013, 95%CI 1.158～14.365)、局部异常(OR=3.357, 95%CI 1.670～9.269)、置管时长(OR=2.338, 95%CI 1.127～4.183)、置管位置(下肢)(OR=3.325, 95%CI 1.007～3.954 )为外周动脉CRBSI的危险因素(均P<0.05)。结论在ICU中年龄≥65岁、局部皮肤异常、置管天数≥14 d及置管部位在下肢的患者易发生外周动脉CRBSI, 关注老年人、注意穿刺部位无菌屏障的完整、缩短置管天数及避免下肢穿刺...     

重度血小板减少症患者预后列线图的构建和验证

目的 探讨列线图模型预测重度血小板减少症患者死亡风险的价值。方法 回顾性总结2020年5月—2022年5月在本院确诊重度血小板减少症的340例患者临床资料,按7∶3的比例随机分为模型组238例和验证组102例。对模型组死亡与存活患者的临床资料进行单因素和多因素Logistic回归分析以筛选主要危险因素,应用R软件构建列线图模型。结果 模型组病死率为34.0%(81/238),验证组为29.4%(30/102),差异无统计学意义(P=0.405)。多因素Logistic回归分析显示,脑血管疾病(OR=1.986, 95%CI:1.524～2.659,P<0.001)、恶性肿瘤(OR=2.056, 95%CI:1.744～2.789,P<0.001)、机械通气(OR=2.324, 95%CI:1.856～3.121,P<0.001)、血管升压药(OR=2.759, 95%CI:2.425～3.562,P<0.001)、持续肾脏替代治疗(OR=2.421, 95%CI:2.012～3.123,P<0.001)和凝血时间延长(OR=1.649, 95%CI:1.2...     

糖化血红蛋白变异指数与糖尿病周围神经病变的相关性分析

目的讨论2型糖尿病(type 2 diabetes mellitus, T2DM)患者糖化血红蛋白变异指数(hemoglobin glycation index, HGI)与糖尿病周围神经病变(diabetic peripheral neuropathy, DPN)的相关性及临床意义。方法 776例T2DM患者,以中位HGI(-0.35)为临界值,分为低HGI(HGI-0.35)组388例和高HGI(HGI≥-0.35)组388例。比较2组临床资料,分析HGI与DPN的相关性,采用多因素logistic回归分析T2DM患者发生DPN的危险因素。结果 2组性别比例、年龄、三酰甘油、高密度脂蛋白胆固醇、载脂蛋白A、脂蛋白a、γ-谷氨酰转肽酶比较差异无统计学意义(P0.05);高HGI组糖化血红蛋白、空腹血糖、HGI、总胆固醇、低密度脂蛋白胆固醇、载脂蛋白B、乳酸脱氢酶、糖尿病病程10 a者比率、DPN患病率、他汀类药物及胰岛素使用比率高于低HGI组(P0.05),总胆红素水平低于低HGI组(P0.05);T2DM患者糖化血红蛋白和空腹血糖呈正相关(r=0.52,P0.001);HGI≥-0.35 (OR=1.112,95%CI:1.007～1.229,P=0.037)、年龄大(OR=1.050,95%CI:1.031～1.068,P0.001)、糖尿病病程10 a(OR=10.271,95%CI:6.318～16.698,P0.001)为T2DM患者发生DPN的危险因素。结论高HGI与T2DM患者DPN发病风险增加相关,HGI有可能成为DPN的预测因子。     

血液透析患者低钠透析后血管内皮舒张功能异常因素分析

目的 探讨维持性血液透析(maintenance hemodialysis,MHD)患者低钠浓度透析后内皮舒张功能障碍(endothelial dysfunction,ED)的影响因素。方法 纳入2019年1月—2023年2月余姚市人民医院行MHD治疗的患者,设定透析液钠离子浓度为137 mmol/L,比较低钠透析6个月后肱动脉反应性舒张直径增长百分率;Logistic回归分析危险因素;建立列线图模型,自抽样法验证,受试者工作特征(ROC)曲线和校准曲线评价区分度与准确性。结果 共纳入80例患者,其中ED轻度异常42例,重度异常18例。多因素Logistic回归显示：透析龄(OR=1.429,95%CI:1.241～1.657,P<0.001)、肱动脉血流量(OR=1.611,95%CI:1.472～1.713,P<0.001)、超敏C反应蛋白(OR=1.376,95%CI:1.194～1.582,P<0.001)、丙二醛(OR=1.518,95%CI:1.407～1.684,P<0.001)是ED的独立危险因素,白蛋白(OR=0.472,95%CI:0.318...     

维持性血液透析患者外周动脉疾病的危险因素分析

目的探究维持性血液透析患者外周动脉疾病的患病情况及危险因素。方法纳入青岛大学附属医院血液净化中心254例维持性血液透析患者,对其进行临床资料的收集、体格检查、实验室检查及踝肱指数的测量。以任何一侧踝肱指数0.90作为下肢外周动脉疾病的诊断标准。结果血液透析患者外周动脉疾病的患病率为22.04%(56/254),男女患病率无差异。多元Logistic回归分析显示年龄(OR 5.888,95%CI 1.822~19.029,P=0.003),透析龄(OR 1.080,95%CI 1.035~1.127,P0.001),糖尿病(OR 3.138,95%CI 1.070~9.200,P=0.037),低白蛋白水平(OR 12.138,95%CI3.472~24.16,P0.001),尿素清除指数不达标(低于1.2)(OR 24.615,95%CI 2.235~553.415,P=0.011),脑血管疾病(OR 13.374,95%CI 1.338~38.654,P=0.002),腹型肥胖(OR 7.285,95%CI2.149~24.689,P=0.001),高三酰甘油(OR 3.257,95%CI 1.050~10.102,P=0.041),碱性磷酸酶(OR4.599,95%CI 1.249~16.635,P=0.022),C-反应蛋白(OR 5.098,95%CI 1.383~18.793,P=0.014)为外周动脉疾病的独立危险因素。结论维持性血液透析患者外周血管疾病患病率较高,老年、透析龄、腹型肥胖、糖尿病、脑血管疾病史、低白蛋白水平、高三酰甘油血症、尿素清除指数不达标、碱性磷酸酶、C-反应蛋白为此人群外周血管疾病的独立危险因素。     

Carotid intima-media thickness in Japanese type 2 diabetic subjects: predictors of progression and relationship with incident coronary heart disease

OBJECTIVE: To examine carotid intima-media thickness (IMT), predictors of its progression, and its relationship with incident coronary heart disease (CHD) in type 2 diabetic Japanese patients. RESEARCH DESIGN AND METHODS: Carotid IMT of 287 subjects with type 2 diabetes (mean age 61.6 years) without CHD or cerebrovascular disease was examined at baseline and after a mean follow-up of 3.1 years. RESULTS: The annual progression of IMT (means +/- SEM) was 0.04+/-0.004 mm/year. Stepwise multivariate analysis demonstrated that independent risk factors for progress of IMT were the initial IMT (P<0.001), the average HbA1c level (P<0.001), and age (P = 0.001). Both the initial IMT (odds ratio [OR] 4.9, 95% CI 1.7-14.1) and a low average HDL cholesterol (OR 0.2, 0.1-0.8) were identified as predictors of incident nonfatal CHD (angina pectoris or nonfatal myocardial infarction; 3-year incidence 10.1%) after adjusting for age, sex, average HbA1c, and other risk factors. CONCLUSIONS: The predictors of the progression of carotid IMT in Japanese type 2 diabetic subjects were its baseline thickness and the average HbA1c during the follow-up. Baseline carotid IMT and low HDL cholesterol predicted the incidence of nonfatal CHD.     

Association of conventional risk factors for cardiovascular disease with IMT in middle-aged and elderly Chinese

To study the association between known risk factors for cardiovascular disease and intima-media thickness (IMT) in the carotid and popliteal arteries in middle-aged and elderly Chinese adults. 686 middle aged and elderly Chinese adults from the China Da Qing Diabetes Prevention Study who had full clinical, laboratory, ultrasound examination results were enrolled in the study. Common carotid artery (CCA) and popliteal artery (PA) IMT were obtained using high resolution ultrasound machine. Pearson’s or Spearman’s correlation analysis and logistic regression analysis were used to determine association between risk factors [age, gender, tobacco smoking, body mass index (BMI), diabetes mellitus (DM), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol, total triglyceride, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, glycosylated hemoglobin (HbA_1c)] and CCA- or PA–IMT. The age range of the study population was 45–87 years, 384 of them (56 %) were women. The prevalence of high blood pressure and DM was 60.6 and 68.8 %, respectively. Participants in DM group tended to be older, had greater value for SBP, HbA_1c and PA–IMT, but smaller value for DBP than those in control group. Smoke status, BMI, blood lipids and CCA–IMT were not statistically different between groups. Pearson’s or Spearman’s rank correlation analysis showed that CCA–IMT had a positive correlation with age, gender, DM, SBP, BMI and HbA_1c, negative correlation with HDL-C. PA–IMT showed a positive correlation with age, gender and SBP. Univariate logistic regression analysis showed that elevation of age, SBP, BMI, HbA_1c and having DM were significant predictors of CCA–IMT thickening, so was reduction of HDL-C. Risk factors that predicted significant thickening of PA–IMT were age, gender, tobacco smoking. After adjusted for age and gender, except HDL-C, the other four risk factors (SBP, BMI, HbA_1c and having DM) that predicted CCA-IMT thickening remained significant; however none of the risk factors predicted PA–IMT thickening after adjusted for age and gender. The current results provide evidence that CCA–IMT is a superior marker for atherosclerosis compared with PA–IMT. Aggressive control of SBP, HbA_1c and proper control of weight may postpone thickening of CCA–IMT.     

Correlation between the intima-media thickness of the carotid artery and aortic pulse-wave velocity in patients with type 2 diabetes. Vessel wall properties in type 2 diabetes.

OBJECTIVE: The aim of this study was to assess the relationship between atherotic (structural) and sclerotic (functional) changes in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: Aortic distensibility and carotid intimal-media thickness (IMT) were evaluated using carotid-femoral aortic pulse-wave velocity (a-PWV) and high-resolution B-mode ultrasonography in 271 patients with type 2 diabetes and 285 age-matched control subjects. RESULTS: a-PWV and carotid IMT were significantly higher in the patients than in the control subjects in all age-groups (P < 0.0001, respectively). The carotid IMT and a-PWV were significantly correlated with age in both the patients with type 2 diabetes and control subjects. There was a significant positive relationship between the carotid IMT and a-PWV in both the patients (r = 0.482, P < 0.0001) and control subjects (r = 0.424, P < 0.0001). The slope of the regression line for the carotid IMT to the a-PWV was significantly steeper in the diabetic patients than in the control subjects (P < 0.05). Multiple regression analysis in all subjects showed that age, diabetic state, and cigarette smoking were independently common risk factors for the increase in carotid IMT and a-PWV. In the diabetic patients, the independent risk factors associated with the carotid IMT were age, hyperlipidemia, and duration of diabetes (R2 = 0.232, P < 0.0001), while those associated with a-PWV were age and duration of diabetes (R2 = 0.334, P < 0.0001). CONCLUSIONS: The results indicated that diabetic patients showed more advanced changes in atherosis than that in sclerosis as compared with age- and sex-matched control subjects. Such atherotic changes in diabetic patients may be associated with hyperlipidemia.     

Prevalence of carotid atherosclerosis in diabetic patients. Ultrasound high-resolution B-mode imaging on carotid arteries.

OBJECTIVE--To quantitatively assess atherosclerosis of the carotid artery in subjects with and without diabetes. RESEARCH DESIGN AND METHODS--Ultrasound high resolution B-mode imaging of carotid arteries was conducted on 71 nondiabetic subjects without hyperlipidemia or hypertension and 295 diabetic patients to determine IMT of the arterial wall. RESULTS--IMT was linearly related with age in nondiabetic (IMT = [0.0087 x age] + 0.3318) and diabetic subjects (IMT = [0.0155 x age] + 0.32450). The regression coefficient for age was significantly greater in diabetic than nondiabetic subjects. IMT (mean +/- SD) of diabetic subjects aged 20-29 was significantly greater than that of nondiabetic subjects aged 20-29 (0.73 +/- 0.27 vs. 0.52 +/- 0.07 mm, P less than 0.01). Multivariate regression analysis of 275 NIDDM patients indicated smoking, hyperlipidemia, duration of diabetes, hypertension, and age were factors determining thickness of the carotid arterial wall. CONCLUSIONS--Diabetes, along with age, hyperlipidemia, smoking, and hypertension, aggravates carotid atherosclerosis.     

维持性血液透析患者贫血与动脉硬化的关系

目的探讨维持性血液透析（maintenance hemodialysis,MHD）患者贫血与动脉硬化的关系。方法选取82名病情稳定的非糖尿病肾病MHD患者为研究对象,根据血红蛋白（Hb）浓度分组,A组,Hb浓度〈100g/L,45例;B组,Hb浓度≥100g/L,37例。应用高分辨二维超声测量透析患者颈动脉内膜-中层厚度（IMT）。记录各患者的临床观察指标,透前采血测定患者循环丙二醛（MDA）、超氧化物歧化酶（SOD）及其他生化指标,评估两组患者的Kt/V值,进行相关及多元回归分析以判断相应指标之间的关系,筛选颈动脉IMT的影响因素。结果A组患者颈动脉IMT、收缩压、脉压及MDA水平高于B组（P〈0.01）,A组SOD及白蛋白水平低于B组（P〈0.01）。Pearson相关分析显示MDA（r=-0.567,P=0.000）及SOD水平（r=0.482,P=0.000）与Hb浓度显著相关;颈动脉IMT与年龄（r=0.658,P=0.000）、收缩压（r=0.441,P=0.000）、Hb浓度（r=-0.398,P=0.000）、白蛋白（r=-0.483,P=0.000）及MDA（r=0.278,P=0.011）水平显著相关。多元线性逐步回归分析显示,Hb浓度、年龄、收缩压、白蛋白水平是影响颈动脉IMT的危险因素（R2=0.646,P〈0.001）。结论贫血与颈动脉IMT增厚密切相关,贫血是MHD患者颈动脉IMT增厚的独立危险因素。贫血可能通过氧化应激加重动脉硬化的发生。     

糖尿病患者心踝血管指数与颈动脉硬化的相关性及其危险因素分析

目的 探讨糖尿病患者心踝血管指数( CAVI)与颈动脉硬化的相关性及其危险因素.方法 入选60例2型糖尿病患者以及同期入院治疗的60例非糖尿病患者,对受试者进行病史采集,检测血糖、血脂等生化指标,行颈动脉彩色多普勒超声检查及CAVI测定,分析CAVI与颈动脉硬化的相关性;以CAVI为因变量,年龄、血压、体质量指数、血脂、空腹血糖、糖化血红蛋白(HbAlc)等指标为自变量进行多元线性回归分析.结果 糖尿病组患者体质量指数、甘油三酯、空腹血糖、HbAlc、颈动脉内膜中层厚度(IMT)、CAVI值及颈动脉斑块发生率均显著高于非糖尿病组[(27.6±3.6)、(25.3±3.3)kg/m2,(2.26±1.12)、(1.74±0.97) mmol/L,(8.86±2.64)、(5.26±0.92)mmol/L,(8.28±1.28)、(5.38±0.86),(1.16±0.16)、(0.86±0.14) mm,(9.55±1.13)、(8.54±0.94),46.7％ (28/60)与25.0％(15/60)],两组间差异均有统计学意义(t值分别为3.648、2.719、9.974、14.567、10.930、5.323,x2=6.125,P均＜0.05);CAVI与受试者颈动脉IMT呈正相关(r=0.435,P＜0.01);多元线性回归显示,CAVI与年龄(β=0.458,P＜0.01)、甘油三酯(β=0.058,P=0.012)、空腹血糖(β=0.168,P=0.002)、HbAlc(β =0.228,P=0.003)存在显著正相关.结论 CAVI与糖尿病患者颈动脉IMT呈正相关,糖尿病患者年龄、甘油三酯、空腹血糖及HbAlc是动脉僵硬的独立危险因素.     

IgA肾病肾血管病变危险因素的非条件logistic回归分析

目的 探讨IgA肾病肾血管病变的危险因素.方法 顾性分析2000年1月-2009年6月间经肾活检确诊的175例IgA肾病患者资料,其中有肾血管病变者93例,无肾血管病变者82例,进行对照研究.采用多因素非条件logistic回归模型分析影响IgA肾病肾血管病变的危险因素.结果 高血压[OR=11.593,P=0.001...     

Association between serum testosterone concentration and carotid atherosclerosis in men with type 2 diabetes

OBJECTIVE: There is evidence to suggest that low concentrations of testosterone are associated with an increased risk of cardiovascular disease in men. The aim of this study was to evaluate the relationship between serum testosterone concentration and carotid atherosclerosis as well as major cardiovascular risk factors in men with type 2 diabetes. RESEARCH DESIGN AND METHODS: Serum free and total testosterone concentrations were measured in 253 consecutive men with type 2 diabetes. The relationships between serum testosterone concentration and carotid atherosclerosis, determined by ultrasonographically evaluated intima-media thickness (IMT) and plaque score (PS) in a subgroup of 154 diabetic patients, as well as major cardiovascular risk factors, including age, blood pressure, and lipid concentrations, were evaluated. RESULTS: Inverse correlations were found between free testosterone (F-tes) concentration and IMT (r = -0.206, P = 0.0103) and between F-tes concentration and PS (r = -0.334, P < 0.001). The IMT and PS were significantly greater in patients with lower concentrations of F-tes (<10 pg/ml) than in patients with higher concentrations of F-tes (1.01 +/- 0.29 vs. 0.91 +/- 0.26 mm, P = 0.038; 4.5 +/- 3.8 vs. 2.4 +/- 3.2, P = 0.0003; respectively). An inverse correlation was found between serum F-tes concentration and age (r = -0.420, P < 0.0001). A positive correlation was found between serum F-tes and total cholesterol concentrations (r = 0.145, P = 0.0238). CONCLUSIONS: Serum F-tes concentration is inversely associated with carotid atherosclerosis determined by ultrasonographically evaluated IMT and PS in men with type 2 diabetes.     

慢性肾脏病3~5期患者冠状动脉钙化危险因素分析及其与铁代谢指标的相关性

目的探讨慢性肾脏病(chronic kidney diseases,CKD)3~5期患者冠状动脉钙化(coronary artery calcification,CAC)的危险因素以及铁代谢指标与CAC相关性。方法纳入安徽医科大学第二附属医院CKD 3~5期患者162例,收集临床资料及实验室指标,检测血清铁、铁蛋白、转铁蛋白、总铁结合力(total iron-binding capacity,TIBC),计算转铁蛋白饱和度(transferrin saturation,TSAT),铁蛋白>800μg/L和(或)TSAT>50%定义为铁超载。采用多层螺旋计算机断层扫描测定冠状动脉钙化积分(coronary artery calcification score,CACs),CACs>10为钙化组。分析CAC危险因素及其与铁代谢指标的相关性,探讨危险因素对CAC的预测价值。结果合并CAC的患者92例,占56.8%。转铁蛋白、TIBC与CACs负相关(r值分别为-0.293、-0.253,P值分别为<0.001、0.001)。二元Logistic回归分析显示高龄(OR=1.050,95%CI:1.013~1.088,P=0.007)、糖尿病(OR=4.712,95%:CI:1.445~15.371,P=0.010)、高中性粒细胞与淋巴细胞比值(neutrophil-lymphocyte,NLR)(OR=1.253,95%CI:1.025~1.533,P=0.028)、高血磷(OR=3.981,95%CI:1.791~8.849,P=0.001)以及转铁蛋白水平降低(OR=0.130,95%CI:0.044~0.378,P<0.001)是CAC的独立危险因素。ROC曲线显示,年龄、糖尿病、NLR、血磷、转铁蛋白联合预测CAC的曲线下面积为0.828(95%CI 0.766~0.891,P<0.001),灵敏度为79.3%,特异度为75.7%。结论CKD3~5期患者CAC发生率较高,高龄、糖尿病、高磷血症、高NLR和血转铁蛋白水平减低是CAC的独立危险因素,以上危险因素的联合指标对CAC的发生有较好的预测价值。