合并微量白蛋白尿的老年糖尿病患者颈动脉内膜中层厚度的变化分析

目的探讨伴有微量白蛋白尿(MAU)的老年2型糖尿病(T2DM)患者颈动脉内膜中层厚度(C-IMT)的变化情况。方法入选成飞医院心血管内科的老年T2DM患者180例,依据是否合并MAU分为两组:MAU组(n=60)和非MAU组(n=120)。检测并对比两组患者的临床资料及相关指标。结果与非MAU组相比,MAU组患者的甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、血尿酸(UA)、血肌酐(Scr)、斑块发生率、C-IMT、血管阻力指数(RI)和血管博动指数(PI)均显著增高,而肾小球滤过率、管腔内径、颈动脉收缩期峰值血流速度(PSV)和舒张末期血流速度(EDV)均显著降低,差异均具有统计学意义(P0.05)。随着采用硬化斑块指数(CAS)分期的增高,患者MAU水平呈递增趋势(F=29.874,P0.001)。多元线性回归分析结果表明,合并MAU老年T2DM患者的C-IMT与MAU呈正相关。结论伴有MAU的老年T2DM患者C-IMT与MAU密切相关,检测T2DM患者的MAU可以对其心脑血管病变进行早期诊断。     

Distribution of Cervicocephalic Atherosclerotic Lesions and Their Correlation with Cardiovascular Risk Factors in a Population of Amerindians. The Atahualpa Project

Background

No information is available on the distribution of cervicocephalic atherosclerosis in Amerindians. We aimed to assess the distribution of these lesions and their correlation with cardiovascular risk factors in Amerindians living in rural Ecuador.

高频超声对不同级别原发性高血压与颈动脉内中膜厚度关系的探讨

目的 利用高频彩色多普勒探讨不同级别原发性高血压与颈动脉内中膜厚度（IMT）的关系.方法 高血压病患者65例,健康查体者（正常对照组）60例.按高血压水平分为1级高血压组、2级高血压组和3级高血压组.应用高频线阵探头测量双侧颈动脉IMT,分析颈动脉与原发高血压分级的关系.结果 1级高血压组,IMT（0.83±0.17）mm,2级高血压组（1.38±0.15）mm,3级高血压组（1.6±0.35）mm,正常对照组（0.48±0.1）mm,原发性高血压病患者颈动脉IMT与原发性高血压病分级呈正相关.结论 随着高血压分级水平的增高,IMT逐步增厚.     

瑞舒伐他汀对轻度胆固醇升高原发性高血压患者左心功能及动脉粥样硬化的影响

目的探讨他汀类药物瑞舒伐他汀对合并轻度胆固醇升高的原发性高血压患者左心功能及动脉粥样硬化的影响。方法入选50～79岁原发性高血压伴心血管危险因素者79例,随机分分两组:他汀组40例及非他汀组39例,他汀组在使用氨氯地平+替米沙坦基础上加用瑞舒伐他汀(阿斯利康制药有限公司10～20mg/d,睡前),非他汀组在使用氨氯地平+替米沙坦基础上不用他汀类药物。入组时,两组患者低密度脂蛋白胆固醇(LDL-C)为2.6～3.6mmol/L。入组时和12个月后行超声心动图、核素心血池和64排螺旋CT冠状动脉钙化检查及测定血浆高敏C-反应蛋白(hs-CRP),比较治疗前后血浆hs-CRP、左室功能指数、冠状动脉钙化积分(LN)及颈动脉内膜中层厚度(IMT)。结果他汀组12月后,LDL-C较入组时下降33.2%,非他汀组较入组时无变化。他汀组12个月后,左室高峰充盈率(LVPFR)较入组时明显增加(P值<0.05);而高敏C-反应蛋白、LN及IMT显著下降(P值均<0.05)。结论对于轻度LDL-C升高的原发性高血压患者,常规降压药物基础上加用瑞舒伐他汀能明显改善左心室舒张功能及稳定或逆转动脉粥样硬化斑块。     

The relationship between calcification inhibitor levels in chronic kidney disease and the development of atherosclerosis

AimWe aimed to investigate the factors affecting the development of atherosclerosis and the role of calcification inhibitors fetuin-A, matrix-Gla protein (MGP), osteoprotegerin (OPG) in atherosclerosis progress.Material and methodsThe study was planned to investigate the relationship of serum OPG, MGP and fetuin-A levels with the development of atherosclerosis in the stage 2–3–4–5 chronic kidney disease (CKD) patients who did not require dialysis treatment.Results32 (17 female, 15 male) healthy individuals and 92 (49 females, 43 males) CKD patients were included. The mean carotid intima-media thickness (CIMT), C-reactive protein (CRP), fetuin-A, OPG and MGP of the two groups were compared statistically. In CKD patients, age, body mass index (BMI), CRP, triglyceride, urea, systolic blood pressure (SBP), fasting blood sugar have a positive linear relationship, fetuin-A, OPG, GFR have a negative linear relationship with CIMT. The mean CIMT, right CIMT, left CIMT, blood urea, CRP, urinary albumin excretion creatinine and age show a negative linear relationship with fetuin-A.ConclusionFetuin-A levels begin to decline from the early stages of CKD and are significantly lower in patients with atherosclerosis as expressed with CIMT. This suggests that fetuin-A may be used as an early marker in CKD for increased cardiovascular risk. Early recognition of these risk factors is important and large-scale studies on vascular calcification inhibitors are needed.     

Malignant mesothelioma of the tunica vaginalis and epididymis

Malignant mesothelioma of the para-testis is a rare cancer which may be clinically undiagnosed for several years and found incidentally at cut up for presumed benign disease. It has a number of histological presentations to be aware of and pitfalls to avoid. It is important to be able to reliably distinguish para-testicular MM from various other less aggressive entities which have significantly different management strategies. We present a case of epididymis and tunica vaginalis MM that was incidentally diagnosed on histological examination following a hydrocelectomy.     

Measures of carotid atherosclerosis and fall-related hospitalization risk: The Perth Longitudinal Study of Ageing Women

Background and aimsWe and others have identified links between cardiovascular conditions and poor musculoskeletal health. However, the relationship between measures of carotid atherosclerosis such as focal carotid plaque and common carotid intima media thickness (CCA-IMT) and falls remains understudied. This study examined the association between measures of carotid atherosclerosis and fall-related hospitalization over 11.5 years in community dwelling older women.Methods and results1116 older women recruited in 1998 to a five-year randomized controlled trial to examine the effect of calcium supplementation in preventing fracture and who had undertaken B-mode ultrasound in 2001 (three years after the baseline clinical visit) were included in this study. The participants were followed for over 11.5 years as Perth Longitudinal Study of Ageing Women (PLSAW). Over the follow up period, 428 (38.4%) women experienced a fall-related hospitalization. Older women with carotid plaque had 44% a higher relative hazard for fall-related hospitalization (HR 1.44; 95%CI, 1.18 to 1.76) compared to those without carotid plaque. The association persisted after adjustment for established falls risk factors such as measures of muscle strength and physical function.Each SD increase in the mean and maximum CCA-IMT was also associated with a higher risk of fall-related hospitalizations (HR 1.10; 95%CI, 1.00 to 1.21 and HR 1.11; 95%CI, 1.01 to 1.22, respectively).ConclusionsMeasures of carotid atherosclerosis are associated with a higher risk of fall-related hospitalization independent of established falls risk factors. These findings suggest the importance of vascular health when considering falls risk.