踝臂指数在下肢动脉粥样硬化疾病中的诊断价值

下肢动脉粥样硬化疾病(lower extremity atherosclerotic disease)是指下肢动脉粥样硬化导致动脉狭窄甚至闭塞,使下肢组织出现慢性或急性缺血症状的疾病,是冠心病的等危症.踝臂指数(ABI)是目前诊断下肢动脉硬化疾病最常用、最普遍的无创性辅助检查,低ABI值(＜0.9)对评估下肢动脉硬化疾病的病变程度、病程进展、预后判断均具有重要价值[1].     

踝臂指数在下肢动脉粥样硬化疾病中的诊断价值

下肢动脉粥样硬化疾病(lower extremity atherosclerotic disease)是指下肢动脉粥样硬化导致动脉狭窄甚至闭塞,使下肢组织出现慢性或急性缺血症状的疾病,是冠心病的等危症.踝臂指数(ABI)是目前诊断下肢动脉硬化疾病最常用、最普遍的无创性辅助检查,低ABI值(＜0.9)对评估下肢动脉硬化疾病的病变程度、病程进展、预后判断均具有重要价值[1].     

踝臂指数在下肢动脉粥样硬化疾病中的诊断价值

下肢动脉粥样硬化疾病(lower extremity atherosclerotic disease)是指下肢动脉粥样硬化导致动脉狭窄甚至闭塞,使下肢组织出现慢性或急性缺血症状的疾病,是冠心病的等危症.踝臂指数(ABI)是目前诊断下肢动脉硬化疾病最常用、最普遍的无创性辅助检查,低ABI值(＜0.9)对评估下肢动脉硬化疾病的病变程度、病程进展、预后判断均具有重要价值[1].     

经皮氧分压评估下肢动脉硬化闭塞症经皮血管腔内成形术疗效的研究

目的 通过比较下肢动脉硬化闭塞症(ASO)经皮血管腔内成形术(PTA)前后的经皮氧分压(TcPO2)、踝肱指数(ABI)、趾肱指数(TBI)的变化,评价TcPO2在评估下肢ASO患者PTA疗效的临床价值.方法 ASO患者101例,下肢ASO患肢111例,行PTA术后2～9 d复查TcPO2、ABI及TBI.根据有无T2...     

血府逐瘀汤治疗下肢动脉硬化闭塞症临床观察

目的观察血府逐瘀汤(XFZY)和前列地尔脂微球载体E1(PGE1)注射液治疗下肢动脉硬化闭塞症(ASO)的疗效。方法动脉狭窄程度及踝/肱指数(ankle-brachial index,ABI)。结果 XFZY组显效率为82.9%,对照组为54.8%(P<0.05);两组治疗后凝血功能、动脉狭窄程度等指标均有改善,XFZY组较治疗前可明显提高ABI(P<0.05)。结论血府逐瘀汤和前列地尔脂微球载体制剂注射液合用能显著改善ASO患者肢体缺血症状,增加组织灌流量。     

脂蛋白相关磷脂酶A2水平与下肢动脉硬化闭塞症严重程度的相关性分析

［摘要］　目的　分析血浆脂蛋白相关磷脂酶A2(Lp-PLA2)水平与下肢动脉硬化闭塞症（ASO）的相关性。方法　选择2018年11月至2019年1月在郑州大学第二附属医院就诊的108例拟诊为ASO的患者作为研究对象,根据踝肱指数（ABI）结果将其分为非ASO组（对照组,32例）和ASO组（研究组,76例）。收集两组患者基线资料、实验室数据,并对研究组行双下肢动脉CT血管成像（CTA）。使用二分类logistic回归分析影响患者发生ASO的因素。对研究组行Fontaine分期,根据CTA结果行泛大西洋学会联盟Ⅱ（TASCⅡ）严重程度分级,就血浆Lp-PLA2水平与研究组下肢闭塞严重程度之间进行相关性分析。结果　研究组男性、年龄、有吸烟史所占比例高于对照组,差异有统计学意义（P<0.05）。研究组同型半胱氨酸（Hcy）水平和血浆Lp-PLA2水平高于对照组,差异有统计学意义（P<0.05）。logistic回归分析显示,高年龄（OR=1.139,95%CI：1.036～1.252）和高水平的血浆Lp-PLA2（OR=1.025,95%CI：1.010～1.040）是发生ASO的危险因素。相关性分析表明,研究组血浆Lp-PLA2水平与ASO严重程度呈正相关（P<0.05）。结论　血浆Lp-PLA2是影响ASO发生的危险因素,且随着其血浆浓度的升高,下肢动脉硬化闭塞的程度加重,血浆Lp-PLA2可作为评估ASO的早期检测指标。     

ACEI(ARB)、辛伐他汀、阿司匹林联用早期干预下肢动脉粥样硬化血管闭塞症的临床研究

目的 探讨早期联用血管紧张素转换酶抑制剂(ACEI)、辛伐他汀、阿司匹林对下肢动脉粥样硬化血管闭塞症(ASO)的疗效及预防心脑血管事件的作用.方法 将144例患者随机分为治疗组(73例)与对照组(71例),治疗组采用ACEI、辛伐他汀、阿司匹林联用;对照组单用阿司匹林.结果 治疗组改善ASO症状总有效率为78.1％,高于对照组的56.3％ (P＜0.05).治疗组转外科介入或手术、心脑血管事件共4例(5.5％),对照组血管重建或截肢、心脑血管事件共11例(15.5％),治疗组明显低于对照组(P＜0.05).结论 早期下肢动脉粥样硬化血管闭塞症干预应ACEI+他汀+阿司匹林联用,特别是合并其他动脉硬化包括冠心病、高血压、高血脂、糖尿病.     

miR-4463在下肢动脉硬化闭塞症中的表达及意义

目的观察microRNA-4463(miR-4463)在下肢动脉硬化闭塞症(ASO)患者血浆和组织中的表达变化,推测其可能意义。方法采用miRNA芯片方法筛选ASO患者和对照人群血浆中差异表达miRNA,Real time PCR技术验证ASO患者和对照人群中miR-4463的表达水平,并进行临床分期比较。靶基因预测软件分析miR-4463靶基因,Gene Ontology和KEGG数据库分析靶基因的功能和信号通路。结果与对照组相比,ASO患者血浆中有51个miRNA变化超过1.5倍(P0.05)。miR-4463在ASO患者血浆和病变血管内膜组织中表达均显著降低,并随Fontaine分期呈逐渐下降趋势。生物信息学分析发现miR-4463靶基因与细胞迁移、脂质代谢、内吞作用等相关。结论 miR-4463参与了ASO的病程,其表达下降可能提示ASO的发生。     

西洛他唑联合尼可地尔治疗下肢动脉硬化闭塞症的疗效

目的:观察西洛他唑联合尼可地尔治疗下肢动脉硬化闭塞症(LEAOD)的疗效。方法:入选2013年10月~2014年10月在我院住院的冠心病合并LEAOD患者84例。根据随机数字表法,患者被随机均分为西洛他唑组(接受抗血小板、调脂治疗的同时接受西洛他唑治疗)和联合治疗组(在西洛他唑组基础上加用尼可地尔治疗),两组均治疗3个月。观察比较两组治疗前后足背动脉血流量和踝臂指数(ABI)的变化。结果:治疗前两组患者的足背动脉血流量和ABI均无显著差异(P均0.05)。与治疗前比较,两组治疗后足背动脉血流量和ABI均显著升高(P均0.01),且与西洛他唑组比较,联合治疗组足背动脉血流量[(0.60±0.05)m·s~(-1)·cm~(-2)比(0.80±0.07)m·s~(-1)·cm~(-2)]和ABI[(0.84±0.21)比(1.03±0.22)]升高更显著(P均0.01)。结论:西洛他唑联合尼可地尔治疗下肢动脉硬化闭塞症效果显著,值得推广。     

下肢动脉硬化闭塞症居家管理模式的构建及初步实践

目的探讨下肢动脉硬化闭塞症(ASO)患者居家管理模式的构建及初步实践的效果。方法选取2016年5月至2018年4月在宜宾市第一人民医院血管外科治疗并出院的81例下肢ASO患者为研究对象,按出院后管理模式的不同分为对照组40例和实验组41例。对照组患者在出院后1个月和12个月分别进行1次电话随访,实验组行居家管理模式,即居家管理小组通过电话随访+微信干预方式在患者出院后1、2、3、6、9、12个月对患者的遵医行为(服药、戒烟、饮食、康复运动、患肢保护、家属支持、定期复查)进行监督及指导。记录并比较2组患者各项遵医行为、复发和截肢比例,及ASO Fontaine分期改善情况。使用SPSS 19.0软件进行统计分析。组间比较采用卡方检验。结果实验组出院时FontaineⅠ～Ⅳ期依次有10、19、10、2例,出院12个月后依次有23、13、5、0例。对照组出院时FontaineⅠ～Ⅳ期依次有9、17、12、2例,出院12个月后依次有7、16、13、4例。出院时2组患者Fontaine分期构成比差异无统计学意义(P0.05)。出院12个月后,2组患者Fontaine分期构成比差异有统计学意义(P0.05)。与出院时比较,出院12个月后实验组患者ASO症状明显改善(P0.05),而对照组患者ASO症状明显加重。与对照组比较,实验组患者出院12个月后,各项遵医行为好的比例显著增加,复发和截肢比例显著下降,差异有统计学意义(P0.05)。结论对下肢ASO实行居家模式管理能够提高患者依从性,改善下肢缺血情况,降低疾病复发率和截肢率。     

踝臂指数与老年缺血性脑卒中关系的研究

目的探讨踝臂指数(ABI)与老年缺血性脑卒中的关系。方法选择74例老年缺血性脑卒中患者为病例组,其中大动脉硬化性(LAA)患者44例,小动脉闭塞型(SAO)患者30例;另选26例体检者为对照组。所有入选对象均进行ABI测量。结果与对照组比较,病例组ABI异常率明显升高(35.1%vs 7.7%,P<0.01),ABI值明显降低(0.94±0.15 vs 1.03±0.09,P<0.01);LAA患者ABI值明显低于SAO患者(0.88±0.16 vs 1.03±0.06,P<0.01)。结论 ABI与缺血性脑卒中发病有关,低ABI值增加缺血性脑卒中的风险;ABI与LAA发病有关,与SAO无关。     

老年H型高血压患者踝臂指数变化的临床意义

目的探讨老年H型高血压患者踝臂指数(ABI)的异常情况及临床意义。方法选择127例患者,根据血浆高同型半胱氨酸和诊室血压水平分为H型高血压组(HH组)65例、非H型高血压组(NHH组)32例和正常血压组(NT组)30例。测定ABI、高敏C反应蛋白(hs-CRP)、髓过氧化物酶(MPO)水平和血管内皮功能。结果与NT组比较,HH组和NHH组ABI明显降低(P<0.05,P<0.01);与NHH组比较,HH组ABI明显降低(P<0.05)。与NT组比较,HH组MPO、hs-CRP明显升高,内皮依赖性舒张功能(FMD)明显降低(P<0.05,P<0.01);与NHH组比较,HH组FMD明显降低(P<0.05)。相关分析显示,HH组ABI与hs-CRP和MPO呈负相关(r=-0.739、r=-0.723,P<0.01),与FMD呈正相关(r=0.927,P<0.01)。结论 ABI降低与炎性反应及血管内皮功能受损密切相关,对评估老年H型高血压患者动脉功能损害及识别高危患者有重要的临床意义。     

踝臂指数与老年缺血性脑卒中的相关性研究

目的观察踝臂指数(ABI)与老年缺血性脑卒中的相关性。方法选择住院的老年缺血性脑卒中患者(脑卒中组)180例及非脑卒中老年患者(非脑卒中组)100例,行ABI测量。收集2组患者相关危险因素和实验室检查资料,进行分析。结果脑卒中组和非脑卒中组患者ABI异常患病率分别为37.2%和9.0%;与非脑卒中组比较,脑卒中组患者ABI明显下降(0.95±0.21vs1.06±0.14,P0.01);脑卒中组患者血脂异常和高血压患病率明显高于非脑卒中组(P0.05,P0.01)。logistic回归分析显示,高血压(OR=1.824,95% CI:1.007～3.305,P0.05)和ABI异常(OR=5.292,95% CI:2.477～11.309,P0.01)与老年缺血性脑卒中明显相关。结论 ABI降低的老年患者缺血性脑卒中的发生增加,临床应重视老年患者ABI的检查。     

老年杓型与非杓型高血压患者踝臂指数变化的临床意义

目的探讨老年杓型与非杓型高血压患者踝臂指数(ankle brachial index,ABI)的异常情况及临床意义。方法选择老年原发性高血压患者79例进行24 h动态血压监测,分为非杓型组52例和杓型组27例。测定ABI、高敏C反应蛋白(high sensitive C-reactive protein,hs-CRP)、髓过氧化物酶(myeloperoxidase,MPO)水平和血管内皮功能。结果非杓型组ABI、肱动脉内皮依赖性舒张功能较杓型组明显降低,MPO、hs-CRP较杓型组明显升高,差异有统计学意义(P<0.05)。非杓型组患者ABI与hs-CRP和MPO呈负相关(r=-0.723,r=-0.71 9,P<0.01),与肱动脉内皮依赖性舒张功能呈正相关(r=0.91 7,P<0.01)。结论 ABI降低与斑块不稳定、炎性反应及血管内皮功能受损密切相关,对评价夜间老年高血压患者动脉结构、功能的损害程度、判断预后、指导合理治疗有重要的临床意义。     

老年单纯收缩期高血压患者血压昼夜节律异常与晨峰现象对动脉僵硬度的影响

目的探讨老年单纯收缩期高血压(ISH)患者血压昼夜节律异常与晨峰现象对动脉僵硬度的影响。方法回顾性分析, 入选年龄≥60岁未接受治疗的老年ISH患者300例, 采用无创便携袖带式动态血压计检测24 h动态血压, 全自动动脉硬化检测仪检测脉搏波传导速度(baPWV)和踝臂指数(ABI), 按夜间血压下降率分为杓型组95例、非杓型组177例和超杓型组28例, 按血压晨峰值分为晨峰组88例和非晨峰组212例, 比较各组间基线资料、血压昼夜节律、动脉硬化指标。采用偏相关和多元线性回归分析, 分析各参数对baPWV和ABI的影响。结果杓型组、非杓型组和超杓型组患者baPWV呈递增趋势, 分别为(1 402±234)cm/s、(1 467±114)cm/s和(1 538±140)cm/s(P<0.01);ABI超杓型组(0.98±0.10)较杓型组(1.05±0.12)降低(P<0.01), 较非杓型组(1.03±0.12)亦降低(P<0.05), 而杓型组和非杓型组间比较差异无统计学意义(P>0.05)。晨峰组较非晨峰组患者baPWV[(1 508±170)cm/s比(1...     

伴高同型半胱氨酸的老年女性高血压急症患者叶酸治疗的5年预后

目的研究伴高同型半胱氨酸(Hcy)老年女性高血压急症患者叶酸治疗的5年预后。方法入选伴高Hcy(>10μmol/L)血症的老年女性高血压急症患者319例,随机分低剂量组(叶酸0.4mg/d)159例和高剂量组(叶酸0.8mg/d)160例。嘱患者规律服药降压治疗,补充叶酸。出院后通过复诊或电话随访5年,记录相关事件,并进行分析。结果随访5年结束时,高剂量组缺血性脑卒中入院发生率明显低于低剂量组(41.0%vs 54.4%,P=0.02)。高剂量组直立性低血压发生率明显低于低剂量组(45.8%vs 68.4%,P=0.00)。高剂量组较低剂量组降低23.5%的缺血性脑卒中再住院发生率(P=0.021)。结论在稳定降压、限钠、补充维生素B12的基础上,补充叶酸0.8mg/d可更好的预防老年女性高血压急症患者的心脑血管事件。     

Osteoprotegerin plasma concentrations correlate with severity of peripheral artery disease

OBJECTIVE: Osteoprotegerin (OPG), a member of the tumor necrosis factor receptor family, is involved in the process of bone turnover and also in the pathogenesis of osteoporosis and premature calcification of the vascular system. In the present study on patients with peripheral artery disease (PAD), we correlated plasma OPG concentrations with severity of disease and the presence of cardiovascular risk factors. PATIENTS AND METHODS: Sixty-seven consecutive inpatients (26 females; mean age 70 years (S.D.: 12), undergoing percutaneous transluminal angioplasty (PTA) because of advanced symptomatic PAD of the lower extremities were studied. Severity grade of disease (clinical stage after "Fontaine", functional measurements in terms of the ankle brachial index (ABI) and "Bollinger score" of angiographies), biochemical parameters and a detailed cardiovascular risk profile were documented. Fasting plasma concentrations of OPG were measured by a commercial sandwich enzyme immunoassay. MAIN RESULTS: The mean plasma concentrations of OPG were 5.3 pmol/l (S.D.: 3.3). Plasma OPG concentrations in subjects with PAD, clinical stages III-IV (n=15) were 7.9 pmol/l (S.D.: 5.3) and were significantly higher than in patients without ischemic ulcerations (n=52; 4.6 pmol/l; S.D.: 2.0; p<0.01). The mean value of Bollinger score was 29.1 (S.D.: 19.8). OPG was positively correlated with Bollinger score of disease (r=0.31; p<0.02), age (r=0.58; p<0.01) and creatinine-values (r=0.32; p<0.01) and negatively correlated with ABI (r=-0.39; p<0.03). CONCLUSION: In patients with PAD, plasma OPG concentrations were significantly higher in subjects with ischemic ulcerations than in those without and were positively correlated with higher severity grade of disease, age and creatinine-values. Further studies are required to analyze the role of OPG as a diagnostic marker for severity of atherosclerotic disease and to assess a possible therapeutic potential as "vasculoprotegerin".     

Telomere length and cardiovascular risk in hypertensive patients with left ventricular hypertrophy: the LIFE study

Short telomeres are associated with aging and age-related diseases. Our aim was to determine whether short leukocyte telomere length is associated with risk factors and cardiovascular diseases in a high-risk hypertensive population. We measured leukocyte telomere lengths at recruitment in 1271 subjects with hypertension and left ventricular hypertrophy (LVH) participating in the Lifestyle Interventions and Independence for Elders (LIFE) study. At baseline, short mean telomere length was associated with coronary artery disease in males (odds ratio (OR) 0.61, 95% confidence interval (CI) 0.39-0.95), and transient ischemic attack in females (OR 0.62 95% CI 0.39-0.99). Proportion of short telomeres (shorter than 5?kb) was associated with Framingham risk score (r=0.07, P<0.05), cerebrovascular disease (OR 1.18, 95% CI 1.01-1.15) and type 2 diabetes in men (OR 1.07, 95% CI 1.02-1.11). During follow-up, proportion of short telomeres was associated with combined cardiovascular mortality, stroke or angina pectoris (hazard ratio 1.04, 95% CI 1.01-1.07). Telomere length was not associated with smoking, body mass index, pulse pressure or self-reported use of alcohol. Our data suggest that reduced leukocyte telomere length is associated with cardiovascular risk factors and diseases as well as type 2 diabetes, and is a predictor of cardiovascular disease in elderly patients with hypertension and LVH.     

Undertreatment of dyslipidemia in peripheral arterial disease and other high-risk populations: an opportunity for cardiovascular disease reduction

Atherosclerosis is a form of arterial disease that manifests in the coronary circulation as coronary artery disease (CAD), in the carotid arteries as cerebrovascular disease, and in the aorta and lower extremity arteries as peripheral arterial disease (PAD). The systemic nature of the disease is reflected in the fact that individuals with PAD or carotid artery disease are more likely to have CAD than those without. Since individuals with PAD are at markedly increased risk of cardiovascular ischemic events, early identification of this population and more aggressive medical interventions could substantially improve both morbidity and survival. The incidence of PAD in the general population is high, and currently affects 8-10 million Americans. The risk of developing PAD is predicted by both age and common atherosclerosis risk factors (e.g., smoking and diabetes). Efficient office-based PAD detection depends on the application of objective techniques to establish this diagnosis. Objective noninvasive tests, such as measurement of the ankle-brachial index (ABI), are known to be more sensitive than traditional clinical assessments. Since the major threat to patients with PAD is from secondary cardiovascular ischemic events, a primary therapeutic goal is to modify atherosclerotic risk factors. While national recommendations mandate aggressive lowering of serum low-density lipoprotein cholesterol (LDL-C) levels as a primary treatment goal in all patients with overt atherosclerosis, as 'coronary heart disease risk equivalent' syndromes, individuals with PAD are less intensively treated than those with CAD. Statins are the most effective of current treatments in lowering LDL-C, and have proven efficacy in secondary prevention among patients with established CAD. The use of statin medications in high-risk groups such as PAD patients could prove particularly beneficial in reducing cardiovascular morbidity and mortality and therefore merits prospective clinical investigation.     

Prevalence of coronary artery disease, lower extremity peripheral arterial disease, and cerebrovascular disease in 110 men with an abdominal aortic aneurysm

Of 110 men (mean age 66 years) with an abdominal aortic aneurysm, 78 (71%) had coronary artery disease (CAD), 50 (46%) had lower extremity peripheral arterial disease (PAD), and 30 (27%) had cerebrovascular disease. Twenty-four percent of the patients with an abdominal aortic aneurysm had CAD plus lower extremity PAD plus cerebrovascular disease, 22% had CAD plus lower extremity PAD and no cerebrovascular disease, 22% had only CAD, 4% had CAD plus cerebrovascular disease and no lower extremity PAD, and 29% had no CAD, lower extremity PAD, or cerebrovascular disease.