番茄红素对动脉粥样硬化兔血浆内源性纤溶活性及一氧化氮的影响

目的观察番茄红素对高脂喂饲所致动脉粥样硬化兔模型内源性纤溶活性及一氧化氮的影响。方法采用高脂喂饲模型，将30只新西兰家兔随机分为3组：对照组、高脂模型组和番茄红素组，分别给予普通饲料（正常对照组）和高脂饲料（其它2组）喂养，番茄红素组另加用番茄红素；于实验开始前1d和开始后第8周末取空腹血测定血浆t-PA、PAI-1活性和含量以及血清一氧化氮含量。实验结束后，观察主动脉血管病理变化。结果与正常对照组相比，高脂模型组t-PA活性与含量减低，PAI-1活性与含量增加，NO含量减低；与高脂模型组相比，番茄红素组t-PA、PAI-1活性与含量差异无统计学意义；但一氧化氮含量增加（t=2．05，P〈0．05），主动脉脂质斑块面积减少（t=1．94，P〈0．05）。结论动脉粥样硬化兔纤溶活性减低，番茄红素对动脉粥样硬化病变形成具有较好的保护作用。其保护作用与改善内源性纤溶活性无关；与抗氧化损伤，维持一氧化氮分泌，保护血管内皮功能有关。     

冠心病患者血脂水平与左心功能的关系

目的：探讨冠心病（CHD）患者血脂水平与左心功能的关系。方法：对236例CHD住院患者均行心脏超声心动图检查，心功能测定以左室射血分数（EF值）为标准分为三组EF≥45％，45％〉EF〉35％，EF≤35％。用酶法测定血脂水平．将心功能与血脂水平作相关性分析。结果：血清TG、TC浓度随左心功能的降低而降低（P〈0.05）；心功能指标EF与TC、TG均呈正相关（r=0．19．P〈0.01．r=0．13，P〈0．05）。结论：CHD患者心功能与血脂水平相关，血脂水平可能成为判断CHF的预后的指标之一，但二者的关系尚须进一步研究。     

白细胞介素10基因启动子-1082A/G多态性与终末期肾病患者微炎症和动脉硬化的关系

目的 探讨抗炎白介素-10（IL-10）基因启动子-1082A／G多态性与终末期肾病（ESRD）患者微炎症状态及动脉粥样硬化（AS）的关系。方法 采用PCR—RFLP方法,检测870例终末期肾病患者和正常对照组1000例IL-10基因．1082A／G多态位点各种基因型的分布及与微炎症状态、动脉粥样硬化相关的指标,并分析该基因在保护终末期肾病患者免受微炎症及动脉粥样硬化侵害中的作用机制。结果 终末期肾病组与对照组相比CRP、TNF-α、CHS0、C3、IL-10、Alb水平在正常范围内,但仍显著高于对照组,而（IL-10、Alb水平均低,P均〈0．05）;正常人及终末期肾病患者IL-10A／G基因各基因型分布及等位基因频率差异无统计学意义（P均〉0．05）;具有IL-10A／A基因型的终末期肾病患者CRP、TNF．仅、CHS0的水平均显著高于G／G、G／A型（P均〈0．05）,IL-10、Alb水平非常显著降低（P〈0．01）;IL-10A／A基因型患者血清IL-10水平显著低于A／G和G／G基因型患者（P〈0．01）;IL-10基因-1082A／A型患者动脉粥样硬化的发病率显著高于G／G、G／A型患者（P〈0．01）,动脉粥样硬化发病率的增高与血清IL-10水平的降低及血清CRP、Fib的升高一致。结论 IL-10A／A基因为终末期肾病患者微炎症状态及动脉粥样硬化疾病高发的预测因子;终末期肾病患者是通过IL-10G／G基因调控血清IL-10“高产”,下调炎症反应,来保护其免受微炎症及动脉粥样硬化的侵害。     

周围动脉内膜-中层增厚的诊断和药物干预的研究

目的 探讨颈动脉、股动脉、胸主动脉粥样硬化的超声诊断标准、自然演变及药物的干预作用。方法 研究对象包括259名正常人和102例动脉粥样硬化(AS)患者。在125名正常人及AS患者中进行了体表高频超声技术检查,在134名正常人中进行了经食管超声检查。将AS患者随机分为辛伐他汀组、普罗布考组、卡托普利组,测量颈动脉和股动脉后壁正常部位内膜-中层厚度(IMT)包括正常部位IMT值(IMTA),最大IMT(IMTB),4条动脉最大IMT平均值(IMTC),4条动脉中单个最大IMT(IMTD),分别服用辛伐他汀、普罗布考、卡托普利,3年后复查。结果 随年龄增加,胸主动脉、颈动脉及股动脉IMT呈增加趋势;正常人颈动脉、股动脉和胸主动脉IMT分别为0.63 mm±0.15 mm、0.68 mm±0.21 mm、1.02 mm±0.22 mm,上限分别为0.93 mm、1.10 mm、1.46 mm。IMTA的平均年增长速度为0.023 mm。各组治疗前后斑块部位IMT有增加趋势,但各治疗组IMT。增加的幅度显著低于对照组。结论 正常人颈动脉、股动脉及胸主动脉的IMT呈增龄性改变。建议颈动脉、股动脉和胸主动脉IMT增厚的超声诊断标准应分别为>0.93 mm,>1.10 mm和>1.46 mm。药物治疗具有延缓动脉粥样硬化进展的作用,高频超声技术能够可靠的观察颈动脉和股动脉动脉粥样硬化的消长改变。     

Peripheral vascular disease in antiphospholipid syndrome

Atherosclerosis has been considered an inflammatory disease based on the finding that atherosclerotic lesion contains activated T lymphocytes reacting with oxidized low-density lipoproteins (oxLDL) and heat shock proteins (HSP); it also contains autoantigens like β₂GPI, a target of antibodies occurring in an immune-mediated thrombophilia called antiphospholipid syndrome (APS). Further support to this hypothesis comes from the cross-reactivity, which occurs between antiphospholipid antibodies (aPL) and antibodies to oxLDL. Animal experiments have shown that aPL are associated with atheroma. In addition, accelerated atherosclerosis has been detected in patients with a prototype systemic autoimmune disease, such as systemic lupus erythematosus (SLE). However, the association of APS or aPL with atherosclerosis is a matter of debate due to the small numbers of patients studied, and the fact that traditional risk factors for atherosclerosis coexist. The prevalence of APS ranges from 1.7% to 6%, and that of aPL reaches to 14% among patients with peripheral vascular disease defined on the basis of clinical outcomes. On the other hand, the prevalence of asymptomatic atherosclerosis, defined in terms of plaques in ultrasonography, reaches to 15% of patients with APS compared to 9% of SLE patients and 3% of normal controls. Among SLE patients with aPL, the prevalence of plaques ranges from 6% in premenopausal women to 31% in unselected patients. Less than 10% of APS patients express premature atherosclerosis in the absence of other risk factors. Which APS patient will develop atherosclerosis is unpredictable.     

Acute and "chronic" phase reaction-a mother of disease

The world is increasingly threatened by a global epidemic of chronic diseases. Almost half of the global morbidity and almost two thirds of global mortality is due to these diseases-approximately 35 million die each year from chronic diseases. And they continue to increase. Increasing evidence suggest that these diseases are associated with lifestyle, stress, lack of physical exercise, over-consumption of calorie-condensed foods rich in saturated fat, sugar and starch, but also under-consumption of antioxidant-rich fruits and vegetables. As a result the function of the innate immune system is severe impaired. This review discusses the changes induced in response to mental and physical stress and their association with the subsequent development of metabolic syndrome, and its association with various chronic diseases. The endothelial cells and their function appears to be of great importance, and the function of their cellular membranes of special importance to the function of the underlying cells; their ability to obtain nutrients and antioxidants and to eliminate waste products. The abdominal adipocytes seen to play a key role, as they have the ability to in stressful situations release much of proinflammatory cytokines, PAI-1 and free fatty acids compared to elsewhere in the body. The load on the liver of these various substances in often of greater magnitude than the liver can handle. Some of the most common chronic diseases and their potential association with acute and "chronic" phase response, and with metabolic syndrome are discussed separately. The need for studies with lifestyle modifications is especially emphasized.     

Ex vivo coronary atherosclerotic plaque characterization with multi-detector-row CT

Multi-detector-row CT angiography (CTA) is a new technology that allows for non-invasive investigation of coronary atherosclerosis in patients. The relation between the morphology of atherosclerotic plaques assessed by CTA and histopathology is unknown. We investigated 11 human cadaver heart specimens. A mixture of methylcellulose and CT contrast media was injected into the coronary arteries to achieve in-vivo-like contrast enhancement within the coronary artery lumen. The morphologic pattern of atherosclerotic lesions found on CTA images and the tissue attenuation of non-calcified plaques were determined. After CTA imaging, atherosclerotic lesions in the coronary arteries were macroscopically identified and characterized histopathologically according to American Heart Association criteria. A total of 50 and 40 lesions were found macroscopically and by CTA, respectively. Thirty-three lesions could have been compared directly. The sensitivity of CTA compared with macroscopic detection of atheromas, fibroatheromas, fibrocalcified, and calcified lesions was 73, 70, 86, and 100%, respectively. The mean CT attenuation of predominantly lipid-rich and fibrous-rich plaques was significantly different (47±9 and 104±28 HU, respectively; p<0.01). Atherosclerotic coronary plaques detected by CTA may represent different stages of coronary atherosclerosis. The tissue attenuation of non-calcified plaques may allow for assessment of their predominant component.     

Experimental and Clinical Studies Investigating the Efficacy of Distal Anastomosis with Patch Plasty in Bypass Operations with Expanded Polytetrafluoroethylene Grafts

Purpose: We investigated the efficiency of distal anastomosis with patch plasty (DAPP), both experimentally and clinically. Methods: In our experimental study, dogs were divided into two groups: a control group in which anastomosis was performed without DAPP (n = 7), and a DAPP group in which DAPP was performed at the distal anastomosis (n = 7). In our clinical study, 169 femoropopliteal bypasses were divided into three groups and analyzed. In one group, the saphenous vein was used (SVG group, n = 65); in one group, an expanded polytetrafluoroethylene (ePTFE) graft was used without DAPP (ePTFE group, n = 64); and in one group, an ePTFE graft was used with DAPP (DAPP group, n = 40). Results: In the experimental study, the ratio between the area of thrombus adherence and the entire area of the intraluminal surface of the graft, defined as the thrombus covering ratio, was 48.9% in the control group and 30.2% in the DAPP group. The ratio in the DAPP group was significantly lower than that in the control group. In the clinical study, although there were no significant differences among the three groups in cumulative patency rates of the femoral above-knee popliteal arterial bypasses, the patency in the DAPP group was excellent. The cumulative patency rates of the femoral below-knee popliteal arterial bypasses in the ePTFE group were significantly lower than those in the other two groups. Conclusion: There results suggest that the addition of DAPP may achieve excellent graft patency. Received: February 14, 2002 /Accepted: November 19, 2002 Reprint requests to: K. Dairaku     

彩色多普勒超声对糖尿病下肢动脉病变的诊断价值

目的:探讨彩色多普勒超声检查对糖尿病患者下肢动脉病变的诊断价值。方法:观察60例糖尿病患者组和60例正常人对照组的下肢动脉的内-中膜厚度,斑块,确定狭窄或闭塞部位,同时检测血流频谱的变化。结果:糖尿病组下肢动脉内-中膜厚度明显增厚,胫前动脉、足背动脉的斑块及最大峰值速度与对照组有明显差异。结论:彩色多普勒超声检查对糖尿病下肢动脉病变的早期诊断、预防和治疗具有重要的临床参考价值。