糖耐量减低患者胰岛素抵抗与颈动脉粥样斑块的相关性分析

目的　探讨胰岛素抵抗 (IR)在糖耐量减低 (IGT)大血管并发症中的作用。方法　测定 1 2 0名IGT患者和 96名糖耐量正常(NGT)对照者的空腹血糖 (FBG)、胆固醇 (TC)、甘油三酯 (TG)、胰岛素 (FINS)及餐后 2h血糖 (PBG) ,并测量身高、体重、腰围、臀围 ,计算相对胰岛素敏感指数 (RISI)、体重指数 (BMI)、腰臀比 (WHR) ,结合其颈动脉多普勒超声检测结果进行对比分析。结果　IGT组及NGT组颈动脉粥样斑块发生率有显著性差异 (P <0 .0 0 1 ) ,斑块面积与RISI呈负相关 (r =- 0 .45 ,P <0 .0 1 ) ,与餐后 2h血糖 (r =0 .39,P <0 .0 1 )、BMI(r=0 .48,P <0 .0 1 )及WHR(r=0 .41 ,P <0 .0 1 )正相关 ,而与TG、FBG、TC、FINS无相关性 (P >0 .0 5)。IGT组患者有斑块和无斑块者之间RISI、WHR、BMI、餐后 2h血糖、TG之间也存在显著性差异 (P <0 .0 1 )。结论　胰岛素抵抗与颈动脉粥样硬化的发生密切相关 ,是IGT患者发生大血管并发症的重要原因。     

腔内超声对颈动脉支架成形术的评估

目的评估血管腔内超声(IVUS)在颈动脉狭窄血管内支架成形术中的应用价值。方法应用IVUS对18例颈动脉狭窄患者进行颈动脉内壁病变判断,指导支架置入并观察血管内支架置入前后血管形态学改变。并以8个正常患者的颈动脉管壁IVUS图像作为对照组。结果IVUS清晰显示血管壁的形态结构,精确测量血管狭窄程度。本组18例均接受血管内支架成形手术,成功置入支架18枚;经6-52个月随访(平均28个月),除2例于术后30d内TIA发作外,无一例脑梗死和再狭窄发生。结论IVUS比DSA更精确判断颈动脉病变性质、狭窄程度以及血管内支架术后的管腔变化,指导选择合适的球囊扩张管腔。IVUS引导支架置入可能有效预防再狭窄的发生。     

18F-氟脱氧葡萄糖PET-CT诊断主动脉壁粥样硬化斑块的价值探讨

目的通过PET-CT明确18F-氟脱氧葡萄糖在主动脉壁粥样硬化斑块中摄取程度,探讨其临床价值。方法60例受检者,包括正常对照者6例,大动脉粥样硬化病例54例。测定主动脉壁粥样硬化部位标准化摄取值（SUV）和CT值,并依据CT值将54例主动脉壁局部18F-FDG高摄取的动脉粥样硬化病例分成3组,软斑块组CT值小于60HU,中等斑块组CT值介于60￣100HU之间,钙化斑块组CT值大于100HU。第4组为正常对照组。结果软斑块组42个测量部位的平均SUV为1.553±0.486;中等斑块组30个测量部位的平均SUV为1.393±0.296;钙化斑块组36个测量部位的平均SUV为1.354±0.189;正常对照组33个测量部位的平均SUV为1.102±0.141。多组之间比较差异具有统计学意义（F=678.909,P=0.000）;正常组与各斑块组比较差异具有统计学意义。结论18F-FDG在主动脉粥样硬化斑块中具有不同程度的摄取,其中软斑块对18F-FDG的摄取最高,提示18F-FDG PET-CT是诊断不稳定性主动脉粥样硬化斑块的有价值方法。     

小檗碱对兔颈动脉粥样硬化中内膜增生和巨噬细胞趋化作用的影响

目的观察小檗碱对家兔颈动脉粥样硬化的内膜中膜比和巨噬细胞变化的影响。方法24只雄性日本大耳白兔随机分为3个试验组,正常组每天肌肉注射生理盐水,普通饲料喂养,对照组高脂喂养,1周后行颈动脉内膜空气干燥术并每日肌肉注射生理盐水,小檗碱干预组高脂喂养,1周后行颈动脉内膜空气干燥术并肌肉注射小檗碱,5周时取手术侧的颈动脉做弹力纤维染色,计算内膜中膜比;巨噬细胞免疫组化检测巨噬细胞在颈动脉粥样硬化病变中的变化,计算巨噬细胞的阳性率。结果对照组内膜厚度明显增加,中膜萎缩变薄,经计算I/M为1.20±0.007,小檗碱组的I/M为0.65±0.008。两组间有显著差异(P<0.01);巨噬细胞免疫组化染色对照组内膜下和中膜有大量巨噬细胞,小檗碱干预组内膜和中膜下也可以见有巨噬细胞沉积,通过计算巨噬细胞阳性率,小檗碱干预组的巨噬细胞阳性率明显小于对照组(P<0.01)。结论小檗碱可以降低家兔颈动脉粥样硬化中的血管内膜厚度、减少粥样斑块中的巨噬细胞数目,从而干预颈动脉粥样硬化的形成。     

Localized pleural plaques and lung cancer.

In a mass chest radiography survey conducted in 1971 for 7,986 residents of three Finnish communities, 604 subjects (7.6%) with pleural plaques but not other asbestos-related radiographic signs were identified. The same number of referents, each individually matched to each plaque carrier on sex, birth year, and community, was selected from among persons in the same source population with no pleural plaques. The two groups were followed for investigation of incidence of lung cancer during 1972-1989. Twenty-eight of those with plaques and 25 referents contracted lung cancer (crude conditional RR = 1.1; CL95 = 0.7, 1.9). The application of the proportional hazards model, with adjustment for sex, age, and residence, resulted in a hazard ratio of 1.1 (CL = 0.6, 1.8). The risk ratio estimate may be biased; hence, the result is inconclusive in regard to the predictive assessment of lung cancer risk among carriers of pleural plaques.     

动脉粥样硬化对兔心功能变化的初步观察

本研究采用损伤性心功能测定方法,观察动粥兔和正常兔在前负荷条件下心功能变化。在前负荷前两组兔的MAP,LVSP,+dp/dt_(max)和-dp/dt_(max)无明显差异;在前负荷后10min动粥兔表现+dp/dt_(max)和-dp/dt_(max)明显障碍(P<0.001,P<0.002,P<0.01),正常兔表现无变化。初步观察表明,动粥兔在心电ST段变化之前,心脏的贮备功能已有明显障碍。     

CT angiography in carotid stenosis

Purpose: Prospective evaluation of the accuracy of CT angiography (CTA) with different postprocessing for extracranial carotid artery in comparison with DSA. Method: one hundred patients were studied with standarized CTA. For postprocessing, MPR, MIP, and 3D reconstruction based on segmentation with upper and lower threshold were used. Intravascular density profiles were considered. All CTA studies were correlated with intra-arterial angiography. The degree and classification of stenoses was determined using the guidelines established by the NASCET collaborators. Results: Measurement of stenosis was possible by MPR in 82.5 %, by MIP in 85 %, and 3D in 100 %. Correct classification was found in 65.5 % for MPR, 66 % for MIP and 88.5 % for 3D. The sensitivity for severe stenoses was 74 % for MPR, 82 % for MIP, and 93 % for 3D. The specificity of these methods was 98 %, 96 %, and 97 %, respectively. All carotid occlusions were correctly identified, no carotid artery was wrongly classified as occluded. Conclusions: CT angiography allows reliable examinations in carotid artery stenoses and occlusions. 3D reconstruction based on threshold segmentation is superior to MPR and MIP. In some circumstances, e.g., carotid occlusion, further investigation by invasive procedures is not necessary.      

准分子激光冠脉成形术─—附8例报道

本文报道准分子激光冠脉成形术（ＥＬＣＡ）８例，均为男性，年龄平均６１岁。心梗４例（２例有梗塞后心绞痛），４例仅表现为心绞痛。冠脉造影显示ＬＡＤ狭窄６支，ＬＣＸ狭窄４支，ＲＣＡ狭窄４支。按ＡＣＣ／ＡＨＡ分型Ｂ型５例，Ｃ型３例。均用ＥＬＣＡ＋ＰＴＣＡ。根据血管直径选用１．３ｍｍ（能量密度１４．５ｍＪ）和１．６ｍｍ（能量密度２１．０ｍＪ）激光导管，频率２０Ｈｚ。１例导引钢丝未能通过狭窄，ＥＬＣＡ失败，另１例二次心梗，经旁路移植后仍有心绞痛发作，心功能较差，其ＥＬＣＡ虽获成功，但因病情严重死亡。８例中ＥＬＣＡ成功７例，手术成功６例。     

自发性颈动脉海绵窦瘘的介入治疗

目的 探讨自发性颈动脉海绵窦瘘的诊治方法。方法 9例单纯颈内动脉供血,其中6例采取球囊瘘内闭塞术,3例采用瘘口一同闭塞的颈内动脉闭塞术。11例采用微导管超选择性插管,行瘘的供血动脉及瘘口栓塞。栓塞后7例仍有供血者3例经压颈1个月瘘口消失,2例疗效不满意,患者未再来治疗,2例采取经岩下窦途径和经眼静脉途径。1例单纯由颈内动脉脑膜支供血的行γ刀治疗。结果 13例栓塞后造影瘘口完全闭塞,7例栓塞后造影瘘口有显影,术后采取压迫患侧颈总动脉1个月,半年后3例造影瘘口消失,2例疗效不满意,失去随访,2例经眼静脉、岩下窦栓塞海绵窦取得成功。γ刀治疗1例,症状消失。19例随访6个月未见瘘口再通。结论 介入栓塞是治疗自发性颈动脉海绵窦瘘行之有效的方法。     

高分辨MRI对颈动脉粥样硬化斑块成分显示的病理对照研究

目的分析和评价高分辨MRI对颈动脉粥样硬化斑块不同成分的显示效果,为颈动脉内膜切除术术前判断斑块稳定性提供参考。方法对26例行颈动脉内膜切除术的颈动脉粥样硬化性狭窄患者术前高分辨MRI 4种不同序列的影像(T1WI、T2WI、PDWI和3D TOF)与斑块标本病理进行逐层对照,分析斑块内不同成分的MRI影像特点。结果获得斑块28块,切为238段,主要分布于颈总动脉和颈内动脉,以复杂斑块为特征的Ⅳ～Ⅴ型58段(24.37%)和Ⅵ型79段(33.19%)为主;斑块内纤维帽主要表现为TOF序列的带状低信号,钙化和纤维化组织分别表现为在各序列影像上的不规则低信号和不特定信号,脂质池和坏死核呈T1WI、PDWI和3D TOF序列的等至稍高信号,近期出血表现为T1WI、T2WI和PDWI序列的明显高信号。结论高分辨MRI不仅可以清晰显示动脉粥样硬化斑块,进行动脉管腔狭窄程度的测定,通过多序列影像联合分析还可以分辨斑块内部不同成分,有助于术前对斑块稳定性的判断。