QAS及X-strain技术评价系统性红斑狼疮患者颈动脉弹性

目的 应用血管硬度检测（QAS）技术及应变和应变率成像（X-strain）技术定量评价系统性红斑狼疮（SLE）患者颈动脉弹性。方法 根据病史将77例SLE患者分为SLE 1组（病史<5年,46例）和SLE 2组（病史≥5年,31例）,另选取40名健康志愿者作为对照组。采用常规超声、QAS技术和X-strain技术检测双侧颈动脉,比较各组间常规超声参数、QAS技术和X-strain技术参数差异,分析各参数间的相关性。结果 SLE 1组与对照组内-中膜厚度（IMT）、弹性系数α、弹性系数β、脉搏波速度和动脉反射波增强指数差异无统计学意义（P均>0.05）,SLE 2组上述参数与对照组和SLE 1组相比明显增高（P均<0.05）;3组间最大圆周应变及圆周应变率比较差异均有统计学意义（P均<0.05）,且随病程延长逐渐减低;颈动脉IMT与QAS参数、X-strain参数之间具有明显相关性。结论 应用QAS和X-strain技术能早期检测SLE患者颈动脉弹性功能改变,对预防和干预SLE患者心血管事件非常重要。     

A Summary and Critical Assessment of the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Disease Risk in Adults: Filling the Gaps

The American College of Cardiology/American Heart Association (ACC/AHA) Task Force on Practice Guidelines has recently released the new cholesterol treatment guideline. This update was based on a systematic review of the evidence and replaces the previous guidelines from 2002 that were widely accepted and implemented in clinical practice. The new cholesterol treatment guideline emphasizes matching the intensity of statin treatment to the level of atherosclerotic cardiovascular disease (ASCVD) risk and replaces the old paradigm of pursuing low-density lipoprotein cholesterol targets. The new guideline also emphasizes the primacy of the evidence base for statin therapy for ASCVD risk reduction and lists several patient groups that will not benefit from statin treatment despite their high cardiovascular risk, such as those with heart failure (New York Heart Association class II-IV) and patients undergoing hemodialysis. The guideline has been received with mixed reviews and significant controversy. Because of the evidence-based nature of the guideline, there is room for several questions and uncertainties on when and how to use lipid-lowering therapy in clinical practice. The goal of the Mayo Clinic Task Force in the assessment, interpretation, and expansion of the ACC/AHA cholesterol treatment guideline is to address gaps in information and some of the controversial aspects of the newly released cholesterol management guideline using additional sources of evidence and expert opinion as needed to guide clinicians on key aspects of ASCVD risk reduction.     

中老年2型糖尿病患者血清骨钙素与 颈动脉粥样硬化病变的关系

ABSTRACT Objective To investigate the relationship between serum osteocalcin (OC) and carotid atherosclerosis (CAS) in middle-aged and elderly patients with T2DM. Methods A total of 430 middle-aged and elderly patients with T2DM were selected in the Department of Endocrinology in our hospital. Color Doppler ultrasound was used to detect the intima-media thickness (CIMT) of the bilateral carotid arteries, including 112 patients with normal CIMT (CIMT normal group), 106 patients with CIMT thickening (CIMT thickening group), and carotid atherosclerotic plaques There were 212 cases of lumps (CAS plaque group), and the differences in serum OC levels in each group were compared. Analyze the relationship between OC and CIMT thickening and the occurrence of CAS plaque. Results The mean OC in the CIMT thickening group (11.51±5.02) ng/ml and the mean OC in the CAS plaque group (11.59±4.23) ng/ml were significantly lower than the mean OC in the CIMT normal group (14.16±5.56) ng/ml, the difference was both There is statistical significance (P<0.01). Multivariate logistic regression analysis showed that the decrease of OC level is a risk factor for CIMT thickening and CAS plaque in middle-aged and elderly patients with T2DM. Conclusion Middle-aged and elderly T2DM patients with reduced OC levels are closely related to the risk of carotid atherosclerosis. Patients with significantly reduced OC levels should be reminded to undergo CAS screening early. KEY WORDS diabetes, type 2; middle-aged and elderly; osteocalcin; carotid artery intima-media thickness; atherosclerotic plaque     

Reduced carotid intima–media thickness in systemic lupus erythematosus patients treated with cyclosporine A

Abstract

Background Patients with systemic lupus erythematosus (SLE) are at risk of atherosclerosis. An increased carotid intima–media thickness (IMT) is considered to be a marker of early atherosclerosis.

Objective To determine influential factors for increased carotid IMT in SLE patients.

Methods We evaluated the impact of conventional risk factors for atherosclerosis on carotid IMT in 427 healthy controls and of clinical factors on carotid IMT in 94 SLE patients. Carotid IMT was measured by using a newly developed computer-automated system. Unconditional logistic regression was used to assess the adjusted odds ratios (ORs) and 95 % confidence intervals (95 % CI).

Results Multivariate-adjusted mean carotid IMT (mm) was significantly reduced in SLE patients (0.51, 95 % CI = 0.36–0.66) compared to healthy controls (0.55, 95 % CI = 0.40–0.70) (P = 0.003). The SLE Disease Activity Index (SLEDAI) was associated with carotid IMT in a dose-dependent manner (P_trend = 0.041). The current use of cyclosporine A (adjusted OR = 0.02, 95 % CI = 0.01–0.40, P = 0.011) and a history of steroid pulse therapy (adjusted OR = 0.01, 95 % CI = 0.01–0.25, P = 0.006) were significantly associated with a decreased risk of increased carotid IMT.

Conclusions Our findings suggest that the current use of cyclosporine A can protect against increased carotid IMT, leading to a decreased risk of arteriosclerosis. Future studies with a larger sample size need to confirm that this association holds longitudinally.     

高血压病患者血清chemerin与颈动脉粥样硬化的关系

目的 研究高血压患者血清chemerin水平与颈动脉粥样硬化的相关性.方法 选择80例无糖尿病病史的高血压病患者和40例体检正常者,收集一般临床资料,测量血压、腰围、臀围,测定空腹血糖、空腹胰岛素和超敏C-反应蛋白（hs-CRP）等生化指标,采用ELISA法测定血清chemerin水平,用胰岛素抵抗指数（IRI）作为胰岛素敏感性评价指标,颈动脉超声检测颈动脉内-中膜平均厚度（IMT）.将高血压病患者分为斑块组（IMT≥1.5 mm）40例和无斑块组（IMT＜1.5 mm）40例.结果 腰围、低密度脂蛋白、空腹胰岛素、IRI、hs-CRP、chemerin及颈动脉IMT,高血压颈动脉斑块组、无颈动脉斑块组和对照组之间差异有统计学意义（P＜0.05）.高血压斑块组及无斑块组患者血浆ehemerin水平均与hs-CRP、IRI及IMT呈正相关（P＜0.05）.经单因素及多因素分析发现,IRI、hs-CRP及ehemerin与高血压发生颈动脉粥样硬化密切相关（OR值分别是2.134、2.248、1.101,P均＜0.05）.结论 高血压病患者chemerin与胰岛素抵抗及超敏C-反应蛋白密切相关,且chemerin是高血压病患者发生颈动脉粥样硬化的危险因素,提示chemerin可能通过胰岛素抵抗及非特异性炎症在高血压颈动脉粥样硬化发病过程中起重要作用.     

血尿酸与2型糖尿病颈动脉粥样硬化的相关性分析

目的 探讨T2DM患者SUA水平与颈动脉粥样硬化（CAS）的关系. 方法 纳入T2DM患者1411例,根据有无CAS将其分为颈动脉粥样硬化（A）组和非颈动脉粥样硬化（B）组,比较两组间的临床资料.并以颈动脉内膜-中层厚度（IMT）为因变量,以其他指标为自变量对合并后两组进行Spearman相关分析和Logistic回归分析. 结果 A组IMT、SUA、TG水平高于B组（P＜0.05）.Lo-gistic回归分析结果显示,SUA水平与IMT增厚相关（r=0.131,OR：1.021,95％CI：1.003～1.205）.结论 T2DM患者SUA水平升高是CAS的独立危险因素.     

白三烯B4和MMP-9与颈动脉斑块稳定性的相关性探讨

目的探讨血浆白三烯-B4(LT-B4)、MMP-9的水平与颈动脉不稳定斑块的关系。方法根据超声将352例颈动脉斑块的患者,稳定斑块组(127例)和不稳定斑块组(225例),无颈动脉斑块患者125例为对照组。应用ELISA法测定患者外周血浆LT-B4、基质金属蛋白酶-9(MMP-9)。结果颈动脉斑块组患者血清LT-B4、MMP-9水平均高于对照组,差异有统计学意义(P<0.05);不稳定斑块组患者血清LT-B4、MMP-9浓度水平均高于稳定斑块组,差异有统计学意义(P<0.01);LT-B4水平升高是颈动脉不稳定斑块的危险因素(OR=2.104,95%CI:1.526~3.015)。结论血清白三烯B4、MMP-9与不稳定的颈动脉斑块有关。     

Excitatory Amino Acid Receptors in the Paraventricular Hypothalamic Nucleus Mediate Pressor Response Induced by Carotid Body Chemoreceptor Stimulation in Rats

In urethane-anesthetized rats with spinal transection, antagonists of excitatory amino acid receptors, P2 purinoceptors and adrenoceptors were microinjected into the paraventricular hypothalamic nucleus (PVN) and their effects on the pressor response evoked by carotid body chemoreceptor stimulation were examined. Microinjections of the non-selective excitatory amino acid antagonist kynurenate, the non-NMDA receptor antagonist CNQX and the NMDA antagonist 2-     

瑞舒伐他汀钙对高血压患者颈动脉内膜中层厚度及血清高敏C反应蛋白影响的研究

目的观察高血压人群中,在常规降压治疗的同时联用他汀类药物,通过对血脂指标、hs—CRP、颈动脉内膜中层厚度（IMT）及斑块的的检测,探讨他汀类药物及早应用能否更好的控制动脉粥样硬化的进展。方法选取高血压的患者405例,分为对照组（202例）,研究组（203例）均接受降压药物治疗,研究组同时予以瑞舒伐他汀钙10mg／日,研究周期为18个月,检测基线、6月、12月、嘏月时高敏c反应蛋白（hsCRP）、血脂系列;同时检查基线及18个月颈动脉内膜中层厚度（IMT）及颈动脉斑块。结果他汀组TC、TG、LDL—C、hsCRP在6、12、18个月检测指标均有下降,组内、组间比较（P〈0．05）,HDL—C较对照组及基线均有升高（P〈0．05）,差异有统计学意义,18个月IMT及斑块检出率较对照组及基线均有统计学差异（P〈0.05）。结论瑞舒伐他汀钙具有良好的调脂、抗炎和抗颈动脉粥样硬化作用。