糖代谢异常者臂-踝脉搏波传导速度与颈动脉内膜中层厚度的变化

目的 研究糖调节功能正常、糖调节功能减低和糖尿病患者中,颈动脉内膜中层厚度(IMT)及臂-踝脉搏波传导速度(baPWV)的变化,探讨其与糖尿病早期动脉粥样硬化的关系.方法 收集糖尿病患者42例、糖调节功能减低者45例、正常对照者30例的临床资料,每例均采用全自动动脉硬化仪测定baPWV及超声检测IMT,将三组的数据进行比较分析.结果 从正常对照者、糖调节功能减低者至糖尿病患者,随着糖代谢异常程度的加重,颈动脉内膜中层逐渐增厚(P＜0.05),baPWV逐渐升高(P＜0.05).结论 在糖代谢异常的早期baPWV与IMT即发生明显改变,二者对筛查糖尿病动脉粥样硬化并发症有一定的价值.     

不同糖代谢状态人群的肥胖指标与动脉硬化的相关性

目的研究北京市社区不同糖代谢状态人群的肥胖指标与动脉硬化的相关性。方法用臂-踝脉搏波传导速度(baPWV)反映动脉硬化程度。对北京市石景山区两个社区大于或等于40岁居民进行体格检查,测量体重(weight)、腰围(WC)、体重指数(BMI)、腰臀比(WHR)、腰围升高比(WHtR)及标准化问卷调查、生化和糖化血红蛋白检测、75 g葡萄糖耐量实验及baPWV测量。对数据资料完整及BMI大于或等于18.5 kg/m2的9 080名人员根据75OGTT试验及糖尿病史分为NGT、IGR和DM组,分析BMI、WC、WHR、WHtR与baPWV之间的关系。结果在NGT、IGR、DM组,根据WC、WHR、WHtR分成亚组,中心型肥胖组的baPWV明显高于正常组(P0.01),在DM组内,以BMI作为肥胖标准,baPWV仅在NGT和IGR组内有统计学意义,在DM组无显著差异(P0.05)。在NGT、IGR和DM组内,中心型肥胖指标(WC、WHR、WHtR)与baPWV呈显著正相关(P0.05),BMI仅在NGT组内与baPWV呈正相关,在IGR和DM组内无明显相关(P0.05)。校正年龄、性别、心血管危险因素,通过多元回归分析发现,WHR和WHtR每增加0.1,baPWV则随之升高40.6 cm/s和55.3 cm/s。结论在糖代谢异常人群中,中心性肥胖指标(WC、WHR、WHtR)与动脉硬化呈正相关,较BMI更能反映动脉硬化程度。     

健康人群中血压增高伴Hcy增高的流行病学调查

本文旨在了解体检人群中血压增高者伴同型半胱氨酸(Hcy)增高的现状,并分析此类人群的特征,为预防和治疗此类人群提供佐证。1资料和方法1.1一般资料:选择从2011年5月～2012年5月在本院体检中选择年龄(20～80)岁的人群。人群入选标准为:①年龄分布属于正态分布;②男女比例接近1∶1;③无吸烟史;④无既往史;⑤无症状的体检人群。排除标准为:①年龄<20岁或>80岁;②有吸烟史(包括曾经吸烟);③曾经有诊断是冠     

襄樊地区公务员动脉粥样硬化相关危险因素的研究

目的 进行公务员动脉粥样硬化发病相关危险因素的调查.方法 2007年10～11月对襄樊地区公务员采用日本动脉硬化测量仪通过测定四肢动脉脉搏图计算出反应血管弹性的参数,包括踝臂指数(ABI)、脉搏波传导速度[bapww]、脉搏波波形[wave formes]、体重指数[BMI].四肢血压,及抽血化验血糖、血脂,分析襄樊地区公务员的动脉弹性特点.结果 共调查506例,其中男性269例,女性237例,年40～78岁,发现有动脉粥样硬化者436例[86.2%],其中轻度118例[27.1%),中度252例[57.8%],重度66例[15.1%].动脉粥样硬化在男性中比例更高,体检者年龄、工作年限、吸烟、高血压、高血脂、高血糖、超重、久坐、是发病危险因数,而身高、喝茶与之无关.高血压者患重度动脉粥样硬化患者37例,高于非高血压组;糖尿病者患重度动脉硬化者13例,高于非糖尿病组;既有高血压又有糖尿病者患重度动脉粥样硬化8例,高于正常组.此外还有一个体检者ABI小于0.9表示有下肢血管阻塞.动脉弹性有随血压、血脂、血糖升高而降低的趋势,而动脉弹性功能参数在不同的年龄、性别存在不同的变化.结论 男性、高龄、吸烟、高血压、高血脂、高血糖、超重、久坐是发病的危险因素.     

高同型半胱氨酸血症对动脉粥样硬化的影响机制及脑血流图评价

高同型半胱氨酸血症作为导致心脑血管疾病的独立危险因素之一而被广泛重视,但是其致病机制尚未完全阐明。目前研究显示高同型半胱氨酸血症可以影响动脉粥样硬化发生发展的多个环节,提示对高危人群早期筛查、早期诊断和有效干预高同型半胱氨酸血型,将预防心脑血管疾病的发生。脑血流图可以评价脑动脉硬化的程度。     

不同水平的低密度脂蛋白胆固醇人群的动脉弹性

目的 观察不同水平的低密度脂蛋白胆固醇(LDL-C)人群动脉弹性的变化.方法 对象为2008年1月至2009年12月在本院体检中心体检者315例,平均年龄(51±11)岁,男性175例,女性140例.根据美国国家胆固醇教育计划(NCEP-Ⅲ)标准,按照血清LDL-C水平分为4组:LDL-C正常组(C组,n=88,LDL-C:2.63～3.41 mmol/L);LDL-C临界升高组(H1组,n=37,LDL-C:3.42～4.20mmol/L);LDL-C升高组(H2组,n=69,LDL-C:4.21～4.97mmol/L);LDL-C显著升高组(H3组,n=121,LDL-C≥4.98 mmol/L).应用动脉硬化测定仪检测各组体检者的脉搏波传导速度(PWV)和踝臂指数(ABI),并行组间比较.结果 C组和H1组体检者的PWV值处于正常范围,H2组和H3组则轻度升高,与C组、H1组差异有统计学意义[H2组:(1623±115)cm/s,H3组:(1720±100)cm/s,C组:(1288±103)cm/s,H1组:(1266±112)cm/s,P＜0.05].各组ABI值正常,差异无统计学意义.结论 低密度脂蛋白胆固醇升高者早期动脉血管弹性下降,PWV检测有助于发现LDL-C升高的早期动脉粥样硬化.     

初诊2型糖尿病患者踝肱指数异常率及相关因素分析

目的了解初诊2型糖尿病患者踝肱指数异常率及其影响因素。方法采用多普勒血流探测仪测定85例初诊2型糖尿病患者踝肱指数（ABI）并进行分组,ABI〈0.9为糖尿病下肢血管病变组（低ABI组）,0.9≤ABI〈1.3为非糖尿病下肢血管病变组（正常组）,ABI≥1.3为下肢动脉硬化组（高ABI组）,记录各组患者年龄、性别体重指数、血压、吸烟史等一般情况,并检测糖脂等代谢指标,通过回归分析探讨影响ABI的危险因素。结果初诊2型糖尿病患者的异常ABI为21.2%,与正常组比较,低ABI组和高ABI组年龄、吸烟率、HbA1c、TG、收缩压、UA均明显升高,其糖尿病视网膜病变、糖尿病肾病、糖尿病周围神经病变发生率亦明显升高。结论初诊糖尿病患者有较高的外周动脉病变（PAD）患病率;高龄、高血压、长期血糖控制不佳、脂质代谢紊乱是糖尿病下肢血管病变的危险因素。     

单纯性肥胖成人同型半胱氨酸水平及其代谢途径与冠心病关系

目的探讨单纯性肥胖人群同型半胱氨酸(homocysteine,Hcy)水平与其代谢途径在冠心病的诊断、预后判断方面的临床价值。方法采用循环酶法对234例健康体检者的血清Hcy进行了检测分析。结果单纯性肥胖组Hcy水平显著高于正常对照组(P<0.01),Hcy水平与体质指数相关,r=0.3176(P<0.01);不同性别健康或单纯性肥胖男女成人Hcy浓度无明显差别(P>0.05);单纯性肥胖成人体质指数(BMI)、同型半胱氨酸(Hcy)、总胆固醇(CHO)、甘油三脂(TG)、低密度脂蛋白胆固醇(LDL-C)与健康对照组相比较有明显增高(P<0.01),高密度脂蛋白胆固醇(HDL-C)叶酸(folic acid,FA)、维生素B12(Vitmin B12,Vit B12)浓度明显降低(P<0.01),与血糖(blood glucose,BS)水平无明显差异(P>0.05)。结论单纯性肥胖有明显的脂质代谢异常,同型半胱氨酸(Hcy)水平升高,而叶酸、维生素B12水平降低。在单纯性肥胖人群中体重指数是同型半胱氨酸(Hcy)的独立危险因素,应重视肥胖人群的血清Hcy检测及其对冠心病的诊断和预后判断的临床价值。     

利用生物电阻抗法对进藏工作汉族男性成年人群与西藏藏族男性成年人群脂肪含量进行比较分析

目的 运用生物电阻抗分析法,通过测量得出进藏工作汉族男性成年人群与西藏藏族男性成年人群脂肪含量的数值,并对两者进行对比分析,进而探讨进藏工作汉族男性成年人群与西藏藏族男性成年人群脂肪含量及分布的不同。 方法 在知情同意的情况下,整体随机抽取进藏工作汉族男性与西藏藏族男性健康成人作为研究对象,共选取337人(汉族男性为164例,藏族男性为173例),应用体成分分析仪,对所有受试者进行检测,得出脂肪总量、左上肢（左下肢、右上肢、右下肢、躯干）脂肪量,进而推算出体脂肪率、左上肢（左下肢、右上肢、右下肢、躯干）脂肪率。所有结果输入SPSS19.0统计软件包,进行独立样本t检验和方差分析统计学处理。 结果 进藏工作汉族男性成年人群的各项脂肪含量数值均小于西藏藏族男性成年人群,而且差异具有显著性（P＜0.01或P＜0.05）。进藏工作汉族男性成年人群与西藏藏族男性成年人群的脂肪含量随年龄变化的趋势基本一致,各部位的脂肪含量和脂肪率均随年龄增加而增大。脂肪量的增加均在30岁年龄组到40岁年龄组增加明显,此后体脂含量增加减慢,甚至50岁年龄组的汉族人群的下肢脂肪含量出现了轻度下降。结论 整体上,进藏工作汉族男性成年人群的各项脂肪含量数值均小于西藏藏族男性成年人群。进藏工作汉族男性成年人群和西藏藏族男性成年人群脂肪含量随年龄的增长发生变化,总体呈上升趋势,但不同部位的脂肪变化趋势略有不同。     

甘肃天祝藏族自治县居民血脂水平调查

目的 了解甘肃天祝藏族自治县居民血脂水平及血脂异常发生率。 方法 采用整群随机抽样方法,选择长期居住该县境内的18～74岁汉族和藏族居民479人为研究对象。按年龄分为：18～34岁、35～44岁、45～54岁、55～64岁、65岁以上5个年龄组。所有调查对象均进行血脂等指标测定,并根据2007年中国成人血脂异常防治指南血脂测定标准对血脂异常与否进行判断。 结果 1.该地区居民血脂异常发生率为42.17%,血脂异常类型主要以高TG、低HDL–C为主。2.血脂异常发生率以45～54岁组最高。包括男女性高TC血症、高TG血症、高LDL- C血症均为人群最高发生率。3.血脂异常率表现为男性随年龄增长持续降低,女性随年龄增长总体呈上升趋势。45岁以上女性血脂水平及血脂异常发生率增长速度均快于男性。4.汉族和藏族血脂异常发生率以及4项血脂指标异常率比较均无差异。 结论 甘肃天祝藏族自治县居民具有较高的血脂异常发病率,不同性别的血脂异常发病率和类型有较大差异。     

脉搏波速度在高血压病早期干预中的临床意义

目的探讨脉搏波传导速度（PWV）与高血压病早期干预的相关性及其相关因素。方法应用脉搏波速度自动测量系统对104例健康人和397例高血压病患者进行肱动脉-踝动脉脉搏波传导速度（baPWV）检测。结果高血压患者的脉搏波传导速度显著高于健康人（P〈0.01）。年龄是影响健康人大动脉弹性功能最主要的因素,年龄、收缩压和脉压与高血压患者的大动脉弹性功能密切相关。结论脉搏波传导速度是敏感反映高血压大动脉弹性的重要指标,年龄、收缩压和脉压是影响baPWV值的主要因素,可作为心血管疾病的一个危险信号,以指导早期预防干预。     

The study on the correlation of pulse wave velocity and ankle-brachial index to ischemic stroke in patients

We measured the ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) and ABI in 97 ischemic stroke patients and 93 control subjects to investigate the relationship between baPWV, ABI and risk factors of ischemic stroke. The stroke patients were grouped according to the results of MRA and Carotid artery color Doppler ultrasound. The correlation of baPWV and ABI to the arteriosclerosis was discussed. There was a significant difference in the patients with hypertension, diabetes mellitus, baPWV and ABI between ischemic stroke patients and control subjects. baPWV was the most sensitive risk factor for ischemic stroke. ABI and diabetes mellitus were the relatively sensitive risk factors for ischemic stroke. baPWV were found to have a positive correlation with common carotid arteriosclerosis (gamma=0.215, P=0.048), while ABI had a negative correlation with intracranial arteriosclerosis (gamma=-0.237, P<0.05). BaPWV and ABI may closely relate to severity of ischemic stroke. Simple measurements of baPWV and ABI in patients could be a useful tool for evaluating the risk of ischemic stroke.     

A high triglyceride-glucose index is associated with left ventricular dysfunction and atherosclerosis

Background: The triglyceride-glucose (TyG) index has been reported to be a simple and reliable surrogate marker of insulin resistance. The aim of this study was to investigate associations between the TyG index and echocardiographic parameters including left ventricular mass (LVM), left atrial diameter (LAD) and left ventricular ejection fraction (LVEF), and markers of peripheral artery disease, ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV).Methods: A total of 823 (483 males and 340 females) patients were enrolled from 2007 to 2011 at a regional hospital in southern Taiwan. Multivariable stepwise linear regression analysis was performed to identify the factors related to echocardiographic parameters and peripheral artery disease.Results: The patients were stratified into four groups according to TyG index quartile. Multivariable stepwise linear regression analysis showed that a higher TyG index was associated with elevated observed/predicted LVM (p = 0.081), increased LAD (p = 0.004), decreased LVEF (p = 0.003) and lower ABI (p = 0.030), but not observed/predicted LVM and baPWV.Conclusions: A high TyG index was significantly associated with high LAD, low LVEF and low ABI. However, the TyG index was not significantly associated with inappropriate LVM or baPWV. The results suggest that the TyG index, as a simple indicator of insulin resistance, may reflect cardiac remodeling and dysfunction and atherosclerosis.     

98例慢性心力衰竭患者血浆BNP和血脂变化及意义

目的：探讨98例慢性心力衰竭（CHF）患者的血浆脑钠素（BNP）和血脂分析早期诊断和治疗的临床意义。方法：化学发光免疫分析测定了98例CHF患者（其中Ⅱ级心功能38例,Ⅲ级心功能30例,Ⅳ心功能30例）血浆中的BNP水平。48例CHF（其中Ⅲ级心功能24例,Ⅳ级心功能24例）测定了抗CHF药物综合治疗后的血浆BNP水平并与治疗前进行了对比性分析。生化法测定了98例CHF患者的血脂水平,包括总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）和低密度脂蛋白胆固醇（LDL-C）并与60例正常对照组进行了比较性分析。结果：98例CHF患者血浆BNP水平较之60例正常对照组明显增高（P〈0.01）,并随CHF心功能的恶化,血浆BNP水平呈上升趋势,而LVEF呈下降趋势;抗CHF药物综合治疗后,血浆BNP水平明显降低（P〈0.05）。血脂分析表明,98例CHF患者较之60例正常对照组,血清TC、TG和HDL-C水平明显降低（P〈0.05～0.01）,而LDL-C水平明显增高（P〈0.05～0.01）,CHF患者Ⅱ～Ⅳ级心功能之间血脂无明显差异（P〉0.05）。结论：CHF中血浆BNP水平和血脂分析不仅是CHF急诊早期诊断的有效指标,而且血浆BNP水平的动态观察是CHF疗效考核的良好佐证。     

踝肱和趾肱指数在预测2型糖尿病微血管并发症与大血管并发症发生风险中的价值对比

目的 对比分析踝肱和趾肱指数在预测2型糖尿病微血管并发症与大血管并发症发生风险中的价值.方法 收集比较受试对象既往踝肱和趾肱指数水平及相关影响因素并进行讨论和分析,应用SPSS 20.0统计软件分析.结果 不同性别、不同血糖控制水平患者间ABI与TBI分布特征的比较提示,无论男女均可见单纯糖尿病组患者ABI和TBI异常比例最低.血糖控制优良的患者中,三组患者ABI和TBI异常的比例均显示微血管病变和大血管病变患者比例高于单纯糖尿病组患者,P<0.05;在血糖控制不佳的患者中也见到类似趋势;三组患者血糖控制不佳者ABI和TBI异常的比例均分别高于血糖控制良好者,P<0.05;回归分析提示ABI和TBI异常均为三种并发状态发生的危险因素,均有P<0.05;调整了性别年龄、血糖控制水平后仍均表现为危险因素,P<0.05.结论 ABI与TBI的异常可以作为预测2型糖尿病患者微血管以及大血管病变的预测因子在临床中起到重要作用.     

Diagnostic and Prognostic Value of Low Density Lipoprotein-Containing Circulating Immune Complexes in Atherosclerosis

Recently, it has been shown that increased level of LDL-containing circulating immune complexes (LDL-CIC) possess high diagnostic significance in clinically manifested atherosclerosis, but little is known about its diagnostic and prognostic significance in early atherosclerosis. Two-years prospective study was performed in 98 asymptomatic men aged 40–74. The rate of atherosclerosis progression was estimated by high-resolution B-mode ultrasonography as the increase in intima-media thickness (IMT) of common carotid arteries. The patients with elevated baseline levels of LDL-CIC were characterized by significantly higher levels of total and LDL cholesterol as well as significantly increased mean IMT of common carotid arteries. Among all baseline lipid parameters, only LDL-CIC and LDL cholesterol were contingent with the extent of early carotid atherosclerosis (p?=?0.042 and p?=?0.049, respectively) and had the highest levels of relative risk and odds ratio. During the follow up, significant IMT increase was registered in 53.1 % (n?=?52) patients, IMT significant reduction was observed in 21.4 % (n?=?21) patients. The increased levels of LDL-CIC, total serum cholesterol and LDL cholesterol had similar prognostic significance with the respect of atherosclerosis progression. The normal level of LDL-CIC (below than 16.0 μg/ml) was the only lipid parameter that predicted the absence of carotid atherosclerosis progression for two following years at prognostic value of 78.3 %. The results of the study allow assuming that LDL-CIC level may be employed not only as a marker of early atherosclerosis, but also has a sufficient prognostic value for clinical implications.     

Heart Rate Significantly Influences the Relationship between Atrial Fibrillation and Arterial Stiffness

Background. Atrial fibrillation (AF) and vascular disease share several risk factors and the two diseases often coexist. Heart rate (HR) is reported to be a major determinant of arterial stiffness. AF patients often have a transiently or persistently rapid HR. Hence, this study was to assess whether AF was significantly associated with arterial stiffness and HR could significantly influence the relationship between AF and arterial stiffness. Besides, we also determine the main correlates of arterial stiffness in AF patients and see whether HR was correlated with arterial stiffness in these patients.Methods. We included 166 AF and 1336 non-AF patients from subjects arranged for echocardiographic examinations. Arterial stiffness was assessed by brachial-ankle pulse wave velocity (baPWV).Results. Compared to non-AF patients, AF patients had a higher baPWV (p <0.001). In a multivariate model, including covariates of age, sex, blood pressures and so on, the presence of AF was significantly associated with baPWV (β = 0.079, P = 0.001). However, further adjustment for HR made this association disappear (β = 0.005, P = 0.832). In addition to age and systolic blood pressure, increased HR (β = 0.309, p <0.001) was a major determinant of increased baPWV in our AF patients.Conclusions. This study demonstrated the presence of AF was associated with increased baPWV, but this association became insignificant after further adjustment for HR, which suggested HR could significantly influence the relationship between AF and baPWV. Besides, HR was positively correlated with arterial stiffness in our AF patients.     

Determinants of Brachial-Ankle Pulse Wave Velocity in Normotensive Young Adults with Type 2 Diabetes Mellitus

Brachial-ankle pulse wave velocity (baPWV) is simple, noninvasive method which correlates well with arterial stiffness. Herein, we assessed the determinants of baPWV in normotensive young adults with type 2 diabetes. We retrospectively enrolled 103 consecutive type 2 diabetic patients aged between 30 and 39 yr who measured baPWV with noninvasive pulse wave analyzer. The anthropometric parameters, blood pressure, pulse rate, fasting plasma glucose, fasting insulin, fasting C-peptide, HbA1c, lipid profile, hs-CRP, albuminuria status, AST/ALT, γ-GTP were checked concurrently. Also, we investigated history of smoking, alcohol drinking and medications by questionnaire. We found that maximal baPWV was positively correlated with mean blood pressure (r = 0.404, P < 0.001), heart rate (r = 0.285, P = 0.004), AST (r = 0.409, P < 0.001), ALT (r = 0.329, P = 0.001), γ-GTP (r = 0.273, P = 0.006), Urine albumin/creatinine ratio (r = 0.321, P = 0.003). By multiple linear regression, mean blood pressure and heart rate were significantly associated with maximal baPWV in male and total group. In female group, mean blood pressure was the only variable associated with maximal baPWV. These factors can be surrogate markers of arterial stiffness in this population.     

Immuno-metabolic factors in schistosomal hepatic fibrosis modulating atherogenesis.

Clinical expression of atherosclerosis is infrequent among patients with schistosomal hepatic fibrosis (SHF), besides, the latter disease is a disease with many immunological expressions. The aim of the present work was to search for a possible immunological and metabolic interaction which would modulate atherogenic mechanisms. The study was carried out on 31 patients with SHF and 20 non-schistosomal subjects (10 with evident clinical atherosclerosis and 10 without). All investigated subjects were males aged above 40 years, and were subjected to the following: serum lipoprotein pattern, total cholesterol, phospholipids, triglycerides, ApoA, ApoB, IgG, IgM, IgA, C3 + circulating immune complexes (CICs) and passive haemagglutination using S mansoni adult worm antigens. The results showed low levels of blood lipids in patients with SHF especially in those with porto-systemic collaterals; serum levels of IgG and IgM were significantly increased in all patients with SHF, while IgA was only increased in patients with collaterals who in turn showed the least incidence of clinically evident atherosclerosis; serum C3 was increased in patients with clinical atherosclerosis, both schistosomal and non-schistosomal. CICs have been higher in patients with SHF without atherosclerosis while decreased in atherosclerosis patients, both schistosomal and non-schistosomal. Our results may consolidate the view of a protective role of liver affection against atherogenesis as well as the important contribution of the immune mechanisms in this context.