血清胱抑素C和糖化血红蛋白水平变化与颈动脉粥样硬化的相关性分析

目的探讨血清胱抑素C(CysC)、糖化血红蛋白(HbA1c)水平变化与颈动脉粥样硬化的相关性。方法采用多普勒颈动脉超声测量107例住院患者的颈动脉中膜厚度(IMT),根据测量结果分为IMT增厚组(48例)和斑块组(59例),同时选取同期49例健康体检者作为健康对照组,对比分析各组血清CysC、HbA1c及血脂水平的差异。采用Spearman相关分析血清CysC、HbA1c的相关性,血脂水平与IMT的相关性,并采用受试者工作特征(ROC)曲线分析CysC、HbA1c对颈动脉中膜异常联合诊断的价值。结果 3组的血清CysC、HbA1c、总胆固醇(CHO)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)和IMT比较,差异均有统计学意义(P0.05)。斑块组CysC、LDL-C及IMT水平明显高于增厚组(P0.05)。相关性分析显示,CysC、HbA1c与IMT均呈正相关(P0.05),CysC及两项指标联合检测诊断优于HbA1c(Z=2.218,P=0.027;Z=3.761,P=0.000)。CysC和联合检测对诊断IMT异常的最佳临界值为1.010和0.453,敏感度为87.85%和94.39%,特异度为81.63%和79.59%。结论血清CysC、HbA1c与IMT异常相关,两者联合检测对疾病的早期监测及风险评估有重要的参考意义。     

颈动脉粥样硬化斑块及其相关因素与脑梗死的关系

目的 探讨颈动脉粥样硬化（CAS）斑块及血脂、血糖（BG）、纤维蛋白原（Fbg）水平与脑梗死的关系。方法 对2007年11月—2008年12月入院的91例脑梗死患者,应用彩色多普勒检测其颈动脉内 中膜厚度（IMT）、斑块数和性状,同时检测血脂、血糖、纤维蛋白原水平,并与正常对照组比较。结果 ①与正常对照组比较,脑梗死组IMT明显增厚、CAS斑块检出率、软斑百分比明显增高（P〈005）。②血清总胆固醇（TC）、低密度脂蛋白（LDL）、BG及Fbg水平脑梗死组明显高于正常对照组（P〈005）;脑梗死有斑块亚组明显高于无斑块亚组（P〈005）。③脑梗死组IMT与TC、LDL、BG、Fbg水平（r分别为0.32、0.34、0.30、0.36,P〈005）。结论 脑梗死患者IMT增厚,CAS斑块及软斑发生率高。BG、TC、LDL及Fbg水平增高是脑梗死及CAS斑块发生的危险因素。     

糖耐量低减患者颈动脉内膜中层厚度与胰岛素敏感性的关系研究

目的:探讨糖耐量低减(IGT)患者颈动脉内膜中层厚度(IMT)值与机体胰岛素敏感性和胰岛素分泌功能的关系。方法:对47例按世界卫生组织1999年标准确诊的IGT患者和20名健康对照者进行研究。运用高分辨率B型超声仪检测受试者的颈动脉IMT,同时检测血糖、血清胰岛素、糖基化血红蛋白(HbA1c)、尿微量白蛋白排泌率(UAER)和血脂,并计算HOMA胰岛素抵抗指数(HOMAIR)和胰岛B细胞分泌指数(HOMAIS)以分别反映机体的胰岛素敏感性和胰岛素分泌功能。结果:IGT患者的颈动脉IMT值显著高于正常对照(P<0.01),HOMAIR指数和HOMAIS指数均低于正常对照(P<0.01)。进一步将患者分为合并空腹血糖异常(IFG)组(IGT1组)和单纯IGT组(IGT2组)后发现,IGT1组的颈动脉IMT值显著高于血糖相对较低的IGT2组(P<0.05)。线性相关分析显示,IGT患者的颈动脉IMT值均与HbA1c、空腹血糖、BMI、舒张压和HOMAIR指数呈显著正相关(P<0.5)。结论:IGT患者颈动脉IMT值高于正常人,而且与糖尿病患者胰岛素抵抗发生、发展有密切的关系。     

探讨同型半胱氨酸血脂及血液流变学在糖尿病视网膜病变中的意义

目的：探讨同型半胱氨酸（HCY）、血脂及血液流变学在糖尿病视网膜病变患者中的变化及临床意义。方法121例糖尿病患者,其中有视网膜病变组52例,无视网膜病变组69例,另设健康对照组50例,进行HCY、空腹血糖（FBG）、糖化血红蛋白（HbA1c）、胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）及血液流变学各项指标检测。结果（1）与健康对照组比较,糖尿病两组患者HCY、FBG、HbA1c、TC、TG、LDL-C和血液流变学各项指标均明显升高（P＜0．01）;（2）糖尿病视网膜病变组HCY、HbA1c、TC、TG、LDL-C和血液流变学各项指标明显高于无视网膜病变组（P＜0．01）;（3）各组HDL-C比较,差异无统计学意义（P＞0．05）。结论糖尿病视网膜病变患者存在高HCY血症、脂代谢紊乱和血液流变学异常,检测糖尿病患者HCY、血脂及血液流变学指标的变化有助于早期发现糖尿病患者视网膜病变。     

脑梗死患者糖化血红蛋白与颈动脉粥样硬化的关系探讨

目的探讨血液糖化血红蛋白（GHbA1c）水平与颈动脉粥样硬化（AS）的关系。方法选择病程在1周之内的急性脑梗死患者52例作为脑梗死组,30例健康查体者作为对照组,采用高效液相离子交换层析法测定血液GHbA1c浓度,应用彩色电脑声像仪进行颈动脉超声检查,测量颈动脉内-中膜厚度（IMT）、观察AS斑块数和性质及其位置。结果脑梗死组血液GHbA1c水平和颈动脉IMT、斑块数升高,与对照组比较有统计学意义（P〈0.01）,两组血液GHbA1c水平均与颈动脉IMT呈正相关。结论GHbA1c可能促进了AS的发生和发展,降低血液GHbA1c含量对AS的防治有益。     

中年抑郁症患者颈动脉粥样硬化风险的研究

【目的】研究探讨中年抑郁症患者发生颈动脉粥样硬化的风险。【方法】以本院门诊收治的78例首诊抑郁症患者及85例健康对照患者为研究对象,测量颈动脉内膜中层厚度（IMT）,记录吸烟史、糖尿病史及高血压病史,测量体重指数（BMD、空腹血糖、低密度脂蛋白胆固醇（LDL—C）水平,比较两组患者IMT平均值的差异及抑郁对IMT的影响。【结果】抑郁组IMT平均值为0．852mm,高于对照组0．753mm（P=0．027）;抑郁组颈动脉粥样硬化（IMT≥0．9mm）37例,占47．74％,高于对照组26例（30．59％）,OR值=2．048,95％CI为1．079～3．886（P=0．036）,Logistic回归分析显示提示吸烟、糖尿病、LDL-C及抑郁可能为颈动脉粥样硬化的独立危险因素。【结论】中年抑郁症患者患颈动脉粥样硬化的风险升高,积极防治抑郁并筛查颈动脉超声可能有助于预防颈动脉粥样硬化、甚至中年脑梗死的发生。     

高频超声评价糖化血红蛋白对2型糖尿病患者颈动脉内-中膜厚度及动脉粥样硬化血管重构的影响

目的 探讨应用高频超声评价糖化血红蛋白(HbA1c)对2型糖尿病(T2DM)患者颈动脉内-中膜厚度(IMT)及颈动脉粥样硬化血管重构的影响。方法 将100例T2DM患者根据HbA1c水平分为两组:HbA1c＜9%为A组(51例),HbA1c≥9%为B组(49例)。C组为50名正常人。应用高频超声测量颈动脉IMT、斑块部位的血管总面积(TVA)及管腔面积(LA),计算重构指数(RI)及斑块总积分。实验室检测HbA1c;分析其与颈动脉IMT的关系。结果 A组和B组颈总动脉干、颈总动脉分叉处、颈内动脉IMT、颈动脉平均IMT及斑块总积分均高于C组(P均＜0.05);B组颈总动脉干、颈总动脉分叉处、颈内动脉IMT、颈动脉平均IMT及斑块总积分高于A组(P均＜0.05)。A组及B组HbA1c与颈动脉平均IMT呈正相关(P＜0.05)。A组、B组的重构发生率均高于C组(P均＜0.01);A组与B组的重构发生率差异无统计学意义(P＞0.05)。B组的负性重构发生率高于A组及C组(P均＜0.05);A组与C组间重构类型的差异无统计学意义(P＞0.05)。A组与C组正性重构发生率高于负性重构发生率(P均＜0.05);B组负性重构率高于正性重构发生率(P＜0.05)。结论 T2DM 患者的HbA1c水平与颈动脉IMT密切相关,HbA1c可能影响颈动脉血管重构;应用高频超声可较为准确地评价T2DM患者HbA1c与颈动脉IMT及血管重构的关系。     

糖化血红蛋白与血脂检测在糖尿病监测中的意义

目的探讨糖化血红蛋白（HbA1c）及血糖、血脂检测在糖尿病（DM）监测中的意义。方法对40例糖耐量正常者（NGT组）、45例血糖调节受损者（IGR组）和44例DM患者（DM组）进行HbA1c及空腹血糖（FPG）、血脂（TC、TG、HDL-C、LDL-C）测定，并进行结果分析。结果IGR组及DM组HbA1c、FPG、TC、TG、LDL-C水平明显高于NGT组，HDL—C水平明显低于NGT组，差异均有统计学意义（P〈0.01或P〈0．05）。结论DM前期阶段患者HbA1c及血糖、血脂水平较糖耐量正常者有明显变化，其检测可作为监测早期DM发生和发展的指标之一。     

缺血性脑卒中患者颈动脉粥样硬化斑块危险因素的分析

目的 探讨缺血性脑卒中颈动脉粥样硬化斑块形成的危险因素。方法 将148例缺血性脑卒中患者，经颈动脉彩超检查分为有斑块组80例和无斑块组68例。分别检测颈动脉内膜一中层厚度（IMT）、血糖、血压、血脂、纤维蛋白原、C-反应蛋白、胰岛素样生长因子-1，先进行单因素比较，然后进行非条件logistic多元回归分析。结果 斑块组年龄、颈动脉IMT、总胆同醇、低密度脂蛋白、纤维蛋白原、C-反应蛋白水平及高血压、糖尿病比例高于无斑块组（P≤0．05）：logistic多元回归分析表明，C反应蛋白（OR=3．546，P=0．035）、纤维蛋白原（OR=1．074，P=-0．012）是颈动脉粥样硬化斑块形成的最危险因素。结论 在缺血性脑卒中，颈动脉IMT增厚可反应颈动脉硬化程度；高龄、高血压、高血糖、高脂血症、纤维蛋白原增高、C-反应蛋白增高可能是颈动脉粥样硬化斑块形成的危险因素；C-反应蛋白、纤维蛋白原在颈动脉粥样硬化斑块的发生发展中起了重要作用。     

血脂与脑梗死患者颈动脉粥样硬化的关系

目的了解血脂与脑梗死患者颈动脉粥样硬化的关系。方法对344例脑梗死疑似患者进行三酰甘油（TG）、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）、载脂蛋白A—I（apo A—I）、载脂蛋白B（apo B）、脂蛋白（a）[Lp（a）]检测,同时用计算机断层扫描（CT）、B超检测颈动脉病变。结果344例脑梗死疑似患者中有303例经临床及CT检查诊断为脑梗死,其余41例作为对照组。303例确诊患者中颈动脉管壁内膜-中层厚度（IMT）〉0．9mm或有斑块者206例,占68．0％;其余97例无病变,占32．0％。脑梗死患者LDL—C水平无论有无颈动脉病变均高于对照组（P〈0．05）。无脑梗死的颈动脉粥样硬化患者apo A—I水平低于对照组（P〈0．05）。结论LDL-C、apo A—I是发生脑梗死和颈动脉硬化病变重要的危险因素和诊疗的观察指标,B超检测颈动脉粥样硬化再结合血脂检查,对于脑血管疾病的预防、早期诊断、指导治疗以及观察疗效具有一定的临床价值。     

Safety and feasibility of carotid revascularization in patients with cerebral embolic strokes associated with carotid webs and histopathology revisited

IntroductionCarotid web is increasingly recognized as the cause of ischemic embolic strokes in younger patients. The best way to treat carotid web is debatable and carotid artery stenting (CAS) has been reported as a treatment for the carotid web in only a few case series. In this study we evaluate the safety and feasibility of CAS in symptomatic carotid webs and examined the histopathology of a carotid web.Materials and methodsAt our institution between 2017 and 2019, 10 consecutive patients with symptomatic carotid webs were treated. We retrospectively analyzed the data for patient demographics, clinical presentation, imaging, treatment methodology and follow up.ResultsAll the patients had presented with ipsilateral embolic stroke. The mean age at presentation was 50 years (range 37–71) with seven female and three male patients. All patients underwent CAS except one patient who underwent carotid endarterectomy (CEA). In one stented patient, there was significant hypotension in the post-procedural period lasting a week. The patients were followed for a mean of 5.5 months (range one day-12 months). No recurrent stroke or transient ischemic attack (TIA) occurred. Surgical pathological studies confirmed fibromuscular dysplasia in one specimen.ConclusionIn our experience CAS for carotid web is feasible and safe in patients presenting with ischemic embolic strokes.     

Management of patients with concomitant coronary and carotid artery disease

Introduction: Ideal management of concomitant carotid and coronary artery occlusive disease remains under investigation. Although researchers have advocated the potential benefits of varying treatment strategies based on either concomitant or staged surgical treatment, there is no consensus in treatment guidelines. With emerging data suggesting favorable outcome of carotid artery stenting (CAS) compared to carotid endarterectomy (CEA) in patients with critical coronary artery disease, physicians must consider these diverging therapeutic options.

Areas covered: This review presents current evidence regarding the prevalence of carotid stenosis in patients with coronary artery disease, the common pathophysiologic links with an emphasis on the diverse mechanisms of stroke in the coronary artery bypass grafting (CABG) setting and discusses the contemporary registries and observational studies comparing outcomes of various revascularization strategies in high-risk patients. Authors conducted a literature search in two bibliographic databases including papers published from 1983 until 2018 (PubMed, Scopus).

Expert opinion: Symptoms should drive the need to intervene on carotid stenosis in patients undergoing coronary revascularization. Carotid artery stenting has gained significant ground, especially among those individuals considered of high surgical risk. PCI may be considered as an alternative option for the management of severe concurrent coronary disease.     

Optimal management of patients with symptomatic and asymptomatic carotid artery stenosis: work in progress

The optimal management of patients with symptomatic and asymptomatic carotid artery stenosis remains a subject of extensive debate. Several international societies and associations have published guidelines for the management of carotid patients. Although these recommendations are based on the same randomized trials, differences in interpretation of available knowledge have often led to different (or even conflicting) recommendations. This special report summarizes the current evidence-based optimal management of patients with symptomatic and asymptomatic carotid stenosis and compares key international guidelines. Finally, issues requiring further research are identified and discussed.     

缺血性脑血管病患者的颈动脉粥样硬化临床研究

目的分析国人颈动脉粥样硬化（CAS）斑块发病特征及与缺血性脑血管病的相关性。方法以2006年6月至2009年6月在安徽铜陵有色职工总医院神经内科住院的164例急性缺血性脑血管病患者为研究对象,应用超声诊断仪检测双侧颈动脉,评价粥样硬化斑块的发病部位、形态、大小与数目,采用非条件多元逻辑回归分析颈动脉粥样硬化的危险因素及与缺血性脑血管病的关系。结果85.9%（141/164）患者存在不同程度颈动脉粥样硬化。颈动脉粥样硬化病变特点以斑块多见（134/164,81.7%）,中重度狭窄发生率较低（26/164,15.8%）;颈动脉斑块以颈总动脉分叉处最多见（69/134,51.4%）。斑块发生率及颅外段颈动脉狭窄程度与脑血管病危险因素有明显相关性。结论缺血性脑血管疾病患者颈动脉粥样硬化病变可能以斑块居多,颈动脉粥样硬化与缺血性脑血管病有关。     

急性脑梗死OCSP分型与颈动脉斑块的相关性

目的探讨急性脑梗死患者英国牛津郡社区脑卒中项目Bamford分型(OCSP)各亚型与颈动脉粥样硬化超声分型间的相关性。方法收集152例首发急性脑梗死患者早期OCSP分型和颈动脉斑块彩超检查结果。结果颈动脉斑块彩超检出率69．08％,其中不稳定斑块31．43％,105例颈动脉斑块检出者中脑梗死类型主要为腔隙性梗死(LACI)61．9％。结论急性脑梗死患者颈动脉斑块发生率高;对颈动脉彩超有斑块检出者应尽早进行干预。     

高龄颈动脉狭窄支架成形术病人的护理

[目的]探讨高龄颈动脉狭窄支架成形术病人的护理.[方法]对颈动脉造影并支架植入病人进行术前、术后心理干预、康复训练并加强基础护理,比较手术前后病人日常生活能力(ADL)改变情况.[结果]手术后2个月病人ADL能力明显提高,与术前比较有统计学意义(P＜0.05).[结论]术前、术后加强护理干预可促进病人的康复.     

颈动脉内膜剥脱术患者围术期的护理干预

目的总结颈动脉内膜切除术患者围术期的护理干预经验。方法回顾性分析总结18例颈动脉内膜切除术患者术前准备以及术后病情观察、切口护理、基础护理要点,评价围术期的护理措施。结果 18例患者出院时症状均得以不同程度改善,复查颈动脉超声示颈动脉通畅程度良好。结论预见性地为患者提供全面、个性化、专业化的护理能有效预防和减少术后并发症,提高手术效果,最大限度提高患者的生活质量。     

Role of sonography in the evaluation of carotid artery stents

PURPOSE: To study the ability and accuracy of sonography to visualize carotid artery stents and assess criteria for carotid artery stent stenosis. METHODS: Duplex Doppler sonographic examinations were performed on 143 patients in whom 158 carotid artery stents were placed. Follow-up sonography to evaluate 24 of these stents within 24 h of stent placement was compared with post-procedure angiography. Another 23 stents were evaluated with sonography and with follow-up angiography more than 24 h after the procedure. The remainder of the 111 stents were evaluated exclusively with sonography after stent placement. Sonography was used to evaluate stent visibility, stent-media separation, and degree of stent stenosis. RESULTS: Wallstents were the best-visualized stents and Acculink the worst, but the differences were not statistically significant. Of 4 patients with stent-media separation >3 mm, 2 (50%) developed stenosis (40%-59%) at 6 and 12 months from stent placement. The other 2 stents with stent-media separation had not developed stenosis at 6 months' follow-up. A comparison of angiography and sonography performed on the date of stent placement revealed 19 true-negative sonography studies, 4 false-positive studies, 1 true-positive study, and no false-negative studies. A comparison of follow-up angiograms performed more than 24 h after the procedure with follow-up sonography revealed 17 true-negative studies, 1 false-positive study, 5 true-positive studies, and no false-negative studies. CONCLUSIONS: Sonography allows accurate evaluation of stent placement within the vessel and visualization of stent-media distance. Stent-media separation may be an early detection sign for stent stenosis development. Velocity criteria developed for non-stented vessels, when applied to stented vessels, correlate well with angiographic findings. Doppler velocity measurements when compared with visible stent assessment may reduce false-positives.     

A survival case of painless chronic type A aortic dissection with a history of stroke and anticoagulant use

We report the case of a patient with completely painless chronic aortic dissection, who presented to another hospital with a left hemiparesia 3 months ago and received anticoagulation therapy with a diagnosis of ischemic stroke. Most of her symptoms had resolved when she presented to our outpatient clinic except for numbness of her left hand and dysphasia. Physical examination found a diastolic murmur at the left sternal border and a bruit over the right carotid artery. Transthoracic echocardiography and carotid sonography demonstrated aortic dissection with extension into the internal right carotid artery and severe aortic regurgitation. Surgery was performed successfully and the patient was discharged. This case emphasizes that the diagnosis of a completely painless aortic dissection with only neurologic symptoms at presentation can be extremely difficult and should always be considered as a cause of ischemic stroke to avoid catastrophic antithrombolytic or anticoagulation therapy. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound 38:454–456, 2010