血清脂联素与2型糖尿病及其大血管病变的相关性研究

Objective To understand the serum adiponectin levels in normal subjects and type 2 diabetes patients with macrovascular complications, to investigate the correlation between adipnectin and macrovascular complications in type 2 diabetes patients. Methods One hundred and two normal subjects, 116 type 2 diabetes patients and 123 type 2 diabetic patients with macrovascular complications were recruited in the current study. The serum adiponectin levels among three groups were compared, and the factors affecting the serum adiponectin were investigated. Results ①The serum adiponectin level was significantly lower in type 2 diabetic patients (8. 62 ± 2. 97) mg/L than that in normal subjects (10. 03 ± 4.41) mg/L, and was the lowest in type 2 diabetic patients with macrovascular complications(6. 17 ± 2. 55) mg/L(P < 0.05). ②Serum adiponetin level was negatively correlated with BMI,WHR,HOMA-IR,fasting insulin level, HbAlC and TG(r = -0.492, -0. 581, -0. 813, -0. 754, -0.619, -0.387, P<0.05). ③In a general multivariate regression, HOMA-IR fasting insulin and HbAlc.were negatively correlated with serum adipnectin level (r = - 0. 828, - 0. 769, - 0. 631, P < 0. 01). Conclusions The serum adiponectin level in type 2 diabetic patients is significantly decreased and even more in type 2 diabetic patients with macrovascular complications. These results suggest that lower serum adiponectin level is related to macrovascular complications in type 2 diabetic patients and maybe plays an important role in atherosclerosis in type 2 diabetic patients.     

血清脂联素与2型糖尿病及其大血管病变的相关性研究

Objective To understand the serum adiponectin levels in normal subjects and type 2 diabetes patients with macrovascular complications, to investigate the correlation between adipnectin and macrovascular complications in type 2 diabetes patients. Methods One hundred and two normal subjects, 116 type 2 diabetes patients and 123 type 2 diabetic patients with macrovascular complications were recruited in the current study. The serum adiponectin levels among three groups were compared, and the factors affecting the serum adiponectin were investigated. Results ①The serum adiponectin level was significantly lower in type 2 diabetic patients (8. 62 ± 2. 97) mg/L than that in normal subjects (10. 03 ± 4.41) mg/L, and was the lowest in type 2 diabetic patients with macrovascular complications(6. 17 ± 2. 55) mg/L(P < 0.05). ②Serum adiponetin level was negatively correlated with BMI,WHR,HOMA-IR,fasting insulin level, HbAlC and TG(r = -0.492, -0. 581, -0. 813, -0. 754, -0.619, -0.387, P<0.05). ③In a general multivariate regression, HOMA-IR fasting insulin and HbAlc.were negatively correlated with serum adipnectin level (r = - 0. 828, - 0. 769, - 0. 631, P < 0. 01). Conclusions The serum adiponectin level in type 2 diabetic patients is significantly decreased and even more in type 2 diabetic patients with macrovascular complications. These results suggest that lower serum adiponectin level is related to macrovascular complications in type 2 diabetic patients and maybe plays an important role in atherosclerosis in type 2 diabetic patients.     

血清基质金属蛋白酶-9与2型糖尿病颈动脉粥样硬化的关系

目的 探讨血清基质金属蛋白酶-9(MMP-9)与2型糖尿病(T2DM)患者颈动脉粥样硬化的关系.方法 选择93例T2DM患者作为研究对象,测量患者颈动脉内中膜厚度(IMT)、斑块情况.根据IMT值将选取T2DM患者分为3组:单纯糖尿病组32例(糖尿病组),糖尿病颈动脉内中膜增厚组31例(中膜增厚组),糖尿病颈动脉粥样硬化斑块形成组30例(斑块组);另选健康查体者30名作为对照组.测定血清MMP-9浓度并进行相关分析.结果 糖尿病组血清MMP-9为(550.26±269.28)μg/L,显著高于对照组(359.70±215.62)μg/L,差异有统计学意义(t=2.23,P＜0.05);中膜增厚组MMP-9为(712.15±340.47)μg/L明显高于对照组(t=4.53,P＜0.01)和单纯糖尿病组(t=2.40,P＜0.05);斑块组MMP-9为(889.08±247.80)μg/L明显高于对照组(t=7.01,P＜0.01)、糖尿病组(t=4.89,P＜0.01)和中膜增厚组(t=2.53,P＜0.05).结论 血清MMP-9升高与颈动脉粥样硬化的病变程度密切相关.

Abstract：

Objective To investigated the relationship between serum matrix metalloproteinase-9(MMP-9) and carotid atherosclerosis(AS) in type 2 diabetes mellitus(T2DM).Methods A total of 93 patients with T2DM were recruited to our study.The intima-media thickness(IMT) and plaques of carotid artery were measured.These patients were divided into 3 groups according to their IMT values: diabetes mellitus(DM) group(n=32),carotid artery intima thicken group(n=31) and carotid artery intima plaque group(n=30).At the same time,30 healthy individuals were selected as control.Serum level of MMP-9 were determined and analyzed.Results The serum MMP-9 in DM group was significantly higher than that in healthy controls([550.26±269.28]μg/L vs.[359.70±215.62]μg/L,t=2.23,P＜0.05).The serum MMP-9 level of intima thicken group(712.15±340.47)μg/L was significantly higher than that in healthy controls(t=4.53,P＜0.01) and DM group(t=2.40,P＜0.05).The serum MMP-9 level of plaque group([889.08±247.80]μg/L) was even more significantly higher than DM group(t=4.89,P＜0.01),IMT group(t=2.53,P＜0.05) and healthy controls(t=7.01,P＜0.01).Conclusion The severity of carotid atherosclerosis in T2DM is closely associated with the serum MMP-9 level.     

高频超声测量心外膜脂肪组织厚度与冠心病危险因素的相关性分析

Objective To explore the correlation between epicardial adipose tissue(EAT) thickness and cardiovascular risk factors in patients with coronary artery disease.Methods According to the results of coronary angiography,84 cases of patients undergone coronary angiography were divided into the normal control group(28 patients),coronary artery disease group with single-vessel lesion (28 patients),coronary artery disease group with multi-vessels lesion(28 patients),respectively,then measured the EAT thickness and carotid intima-media thickness(IMT) by high-frequency ultrasound.A correlation analysis was carried out between the EAT and IMT and cardiovascular risk factors.Results In either coronary artery disease group with single-vessel lesion or multi-vessels lesion,the thicknesses of EAT and IMT were significantly higher than those in the normal control group(P ＜0.01),and the difference between group of single-vessel lesion and multi-vessels lesion was also statistically significant (P ＜0.01).A correlation analysis between the EAT and IMT and cardiovascular risk factors showed that there were significantly positive correlations between EAT and the IMT,age,weight,waist circumference,body mass index,low-density lipoprotein,Creactive protein (r = 0.124～0.790,P ＜0.05 or P ＜0.01),and the significantly negative correlation between EAT and high-density lipoprotein (r = - 0.203,P ＜ 0.05).Correlation between EAT and the IMT was 0.678,0.713,0.737 in the normal control group,group with single-vessel lesion,group with multivessels lesion,respectively.Conclusions There were favorable correlation between EAT and carotid IMT in cardiovascular risk factors.The more severity of coronary heart disease,the more high correlations of EAT and IMT.EAT can be a valuable index in evaluating coronary artery disease.     

兔动脉硬化早期腹主动脉应变储备的实验研究

目的 探讨速度向量成像(VVI)技术联合硝酸甘油舒张负荷试验评价兔动脉硬化早期腹主动脉应变储备(SR)的价值.方法 52只雄性新西兰兔,随机选12只为正常对照组(A组);40只制作动脉硬化模型,分别在高脂喂养4周、8周后,随机选20只应用VVI技术联合硝酸甘油舒张负荷试验对动脉短轴的SR进行分析,行病理组织学检查,按病理结果分为内皮损伤组(B组)、病理性内膜增厚组(C组).结果 B组有18只,C组有13只.与A组比较,B组、C组动脉管壁的SR依次减低,差异均具有统计学意义[4.13±1.21＞2.31±0.89＞1.22±0.77,Z=-2.978,P=0.003;Z=1.959,P=0.001];与A组比较,C组的内中膜厚度(IMT)明显升高,差异有统计学意义(Z=-3.108,P=0.002),C组的周向应变峰值(S)明显减低,差异有统计学意义(Z=-2.415,P=0.016);其余各组之间的S、IMT比较,差异均无统计学意义(P>0.05).应用ROC分析发现SR截断值为 3.67 时,其诊断动脉粥样硬化内皮功能损伤的灵敏度为70%,特异度为 92.3%.提示SR可作为评价早期动脉硬化的较好指标.结论 动脉硬化早期动脉弹性的变化可以表现为SR的变化,VVI技术联合硝酸甘油舒张负荷试验可用于定量评价兔腹主动脉硬化早期血管壁的力学特性.

Abstract：

Objective To explore the value of abdominal aorta strain reserve(SR) of rabbits during the period of early atherosclerosis using velocity vector imaging(VVI) techniques combined with nitroglycerin (NTG) vasodilation experiment.Methods Fifty-two male New Zealand White rabbits were used in this experiment.Group A(n=12) was the normal control group.Forty rabbits were made into atherosclerosis models.The SR of abdominal aortas of all rabbits were analyzed in short axis views using VVI and NTG vasodilation experiment at the forth week and the eighth week after feeding.The period of atherosclerosis into endothelial injury stage(group B) and intima thickening stage(group C) were divided.Results There were eighteen rabbits at the endothelial injury stage in group B and thirteen at the intima thickening stage in group C.Compared with control group,arterial SR values of group B and group C were significantly decreased in turn [4.13±1.21＞2.31±0.89＞1.22±0.77,Z=-2.978,P=0.003;Z=1.959,P=0.001],IMT of group C was significantly higher than that of group A(Z=-3.108,P=0.002),strain of group C was significantly lower than that of group A(Z=-2.415,P=0.016),the strain and IMT had no significant difference among three groups except group A and group C (P>0.05).A cut-off value was 3.67 of SR for diagnosing the endothelial injury aretary had a sensitivity of 70% and spectificity of 92.3% respectively obtained by the area under the ROC curve.The agreement of this diagnosis was very good.Conclusions The variable of the SR could stand for the variable of the vascular elasticity during the period of the early atherosclerosis.VVI and NTG vasodilation experiment could quantitatively assess SR of abdominal aortas of rabbits.     

Foot nursing of patients with diabetes

Incidence of atherosclerosis was higher in patients with diabetes.Atherosclerosis of peripheral limbs mainly affect artery of lower limbs and abnormal feeling of foot and intermittent limping was the manifestation.To explore nursing methods of foot in patients with diabetes.     

中青年原发性高血压患者循环内皮祖细胞CD34+水平与颈动脉粥样硬化的相关性研究

Objective To explore the relationship between the level of circulating endothelial progenitor cells (EPCs) CD34+with the Framingham cardiovascular risk factors, or with the carotid artery intima-madia thickness (IMT), and to evaluate the value of circulating EPCs CD34+level as a cytologicalmarker of early vascular lesion in youth and middle aged essential hypertension (EH) patients.Methods A total of 62 patients with EH aged between 25 to 45 were enrolled as study group and 20 healthy people were enrolled as control group.EH patients were stratified with cardiovascular risk factors according to Framingham risk factors score into low-risk group with 18 cases, mid-risk group with 14 cases, high-risk group with 17 cases, and extremely high-risk group with 13 cases.The level of circulating EPCs CD34+,carotid artery IMT were respectively measured.The relationship between the level of circulating EPCsCD34+ and Framingham cardiovascular risk factors score, carotid artery IMT was analyzed.Results The level of circulating EPCs CD34+ was gradually decreased with an increase of the Framingham risk factors score in each hypertensive subgroup [low-risk group:(0.12±0.02)%, mid-risk group:(0.07±0.03)%,high-risk group:(0.04±0.03)%, extremely high-risk group:(0.01±0.01)%], and they were significantly lower than that in control group [(0.15±0.03)%], and there was a significant difference among hypertensive subgroups (P＜0.05 or P＜0.01).Carotid artery IMT was significantly thicker among hypertensive subgroups [low-risk group:(0.80±0.07)mm, mid-risk group:(1.11±0.08)mm, high-risk group: (1.26±0.10)mm, extremely high-risk group:(1.45±0.09)mm], and there was a significant difference between each hypertensive group and that of control group [(0.73±0.08)mm, all P＜0.01].There was also statistical significance among hypertensive subgroups(P＜0.05 or P＜0.01).There was a negative correlation between the level of circulating EPCs CD34+and Framingham risk factors score (r=-0.875, P＜0.01), and also a negative correlation with carotid artery IMT (r=-0.852, P＜0.01).Conclusion There was a significant correlation between the level of circulating EPCs CD34+with Framingham risk factors score and also carotid artery IMT in EH patients.Circulating EPCs CD34+could be a cytological marker of early vascular lesion in hypertension patients.     

中青年原发性高血压患者循环内皮祖细胞CD34+水平与颈动脉粥样硬化的相关性研究

Objective To explore the relationship between the level of circulating endothelial progenitor cells (EPCs) CD34+with the Framingham cardiovascular risk factors, or with the carotid artery intima-madia thickness (IMT), and to evaluate the value of circulating EPCs CD34+level as a cytologicalmarker of early vascular lesion in youth and middle aged essential hypertension (EH) patients.Methods A total of 62 patients with EH aged between 25 to 45 were enrolled as study group and 20 healthy people were enrolled as control group.EH patients were stratified with cardiovascular risk factors according to Framingham risk factors score into low-risk group with 18 cases, mid-risk group with 14 cases, high-risk group with 17 cases, and extremely high-risk group with 13 cases.The level of circulating EPCs CD34+,carotid artery IMT were respectively measured.The relationship between the level of circulating EPCsCD34+ and Framingham cardiovascular risk factors score, carotid artery IMT was analyzed.Results The level of circulating EPCs CD34+ was gradually decreased with an increase of the Framingham risk factors score in each hypertensive subgroup [low-risk group:(0.12±0.02)%, mid-risk group:(0.07±0.03)%,high-risk group:(0.04±0.03)%, extremely high-risk group:(0.01±0.01)%], and they were significantly lower than that in control group [(0.15±0.03)%], and there was a significant difference among hypertensive subgroups (P＜0.05 or P＜0.01).Carotid artery IMT was significantly thicker among hypertensive subgroups [low-risk group:(0.80±0.07)mm, mid-risk group:(1.11±0.08)mm, high-risk group: (1.26±0.10)mm, extremely high-risk group:(1.45±0.09)mm], and there was a significant difference between each hypertensive group and that of control group [(0.73±0.08)mm, all P＜0.01].There was also statistical significance among hypertensive subgroups(P＜0.05 or P＜0.01).There was a negative correlation between the level of circulating EPCs CD34+and Framingham risk factors score (r=-0.875, P＜0.01), and also a negative correlation with carotid artery IMT (r=-0.852, P＜0.01).Conclusion There was a significant correlation between the level of circulating EPCs CD34+with Framingham risk factors score and also carotid artery IMT in EH patients.Circulating EPCs CD34+could be a cytological marker of early vascular lesion in hypertension patients.     

aVR导联QRS波形态对下壁心肌梗死的鉴别诊断意义

Objective To investigate the value of differential diagnosis of the configuration of QRS complex in lead aVR in patients with inferior wall myocardial infarction. Methods The configuration of QRS in 52 patients with pathological Q-wave both in lead Ⅲ and aVF were analyzed and the result of selective coronary arteriography was compared. Results 13 patients with the configuration of QRS in lead aVR appeared rS ( s), while 10 patients appeared QS(qs) and 29 Q(q)r,correlated with 12,4 and 0 patients with coronary arteriography showed stenosis or occlusion lesion in fight coronary artery or left circumflex artery (χ2 = 35.56, P = 0.000). Conclusions The con-figuration of QRS in lead aVR is helpful to differential diagnosis of the patients with pathological Q-wave both in lead Ⅲ and aVF. Patients with the configuration of QRS in lead aVR appear rS(s) could be diagnosed as old myocardial infarction,but excluded from old myocardial infarction while appearing Q(q)r.     

心肌梗死合并糖尿病患者QT间期和QT离散度的改变及不同治疗方法对其的影响

Objective To compare the QTc and QTcd between type 2 diabetic and non-diabetic patients with post-myocardial infarction (post-MI) ,and to compare the QTcd in type 2 diabetic patients with post-MI treated with insulin,sulfonylurea,mefformin,or diet alone. Methods We measured the QTc and QTcd through simultaneous 12-lead Electrocardiogram in 138 post-MI patients,including 70 type 2 diabetic (of which,23 were assigned to re-ceive insulin,20 glipizide,16 mefformin,11 diet control) and 68 non-diabetic patients. Result Compared with post-MI patients without diabetes,those with type 2 diabetes had significantly higher QTc [(377.2±24.3) ms vs (342.9±27.5)ms,t=7.79,P<0.01] and QTcd [(48.8±19.7)ms vs (40.3±26.6)ms,t=2.14,P<0.05]. There were no significant difference between the mefformin group and the diet control group (P>0.05). The QTc and QTcd in the insulin group were significantly higher than those in the other three group s(P<0.05),and the QTc and QTcd in the glipizide group were higher than those in the mefformin group or diet control group(P<0.05,and P<0.01,respectively). Conclusion Type 2 diabetes is associated with an additional increase in the QTcd in post-MI patients,suggesting higher mortality risk in post-MI patients with type 2 diabetes. Insulin and glipizide may in-crease the QTc and QTcd in post-MI patients with diabetes. These effects were more significant in the insulin therapy group.     

不同超声手段在2型糖尿病患者足背动脉病变检测中的应用

【目的】探讨超声检测糖尿病患者足背动脉的临床价值。【方法】用彩色超声分别检测50例2型糖尿病患者及50例对照组的足背动脉。根据病程分为两组：病程〈10年为Ⅰ组;病程≥10年为Ⅱ组。根据入院时RPG分为两组：RPG〈15mmol／L为A组;RPG≥15mmol／L为B组。二雏超声观察足背动脉血管走行、管壁回声强度、内膜光滑程度、管腔内径、管壁厚度。CDFI观察腔内彩色血流信号状态,PW测量Vs、Vd、RI、PI。【结果】正常对照组足背动脉内膜呈平行的细线状强回声,内壁光滑不厚、连续性好。CDFI显示血流充盈良好,PW显示三相血流频谱,频带较窄。2型糖尿痛组足背动脉管壁增厚,呈点状不均匀强回声,内膜毛糙,部分可见斑块附着,管腔变窄,连续性差,走行迂曲。CDFI显示管腔内彩色血流变细,充盈缺损以及无彩色血流显示,PW呈双相波,频带宽,少数为三相波。糖尿病患者足背动脉血流速度减慢,Vs及Vd均较正常人降低（P〈0．05）,RI、PI增高（P〈0．01）。不同病程组（Vs：27．9±9．71vs2b．9±8．71;Vd：10．2±3．21vs7．56±3．46;RI：1．11±0．19vs1．29±0．26;PI：2．50±0．40vs2．90±0．45）与血糖组（Vs：27．0±10．5vs21．3±8．15;Vd：10．4±2．97vs7．64±2．84;RI：1．09±0．27vs1．30±0．26;PI：2．51±0．38vs2．89±0．45）比较,其差异也具有统计学意义（P〈0．05）。【结论】超声能够客观准确地反映2型糖尿病患者足背动脉随着病程的延长及血糖的升高在病理方面的改变,CDFI能准确地反映足背动脉的损伤程度及在血流动力学方面的改变,尤其为早期无症状的病人提供了较可靠的诊断数据。     

老年2型糖尿病与动脉粥样硬化关系的研究

目的 探讨老年2型糖尿病与动脉粥样硬化的关系.方法 对2005年4月至2007年10月住院的277例大于60岁的老年患者的临床资料进行回顾性分析,将其分为糖尿病伴颈动脉粥样硬化组(A组119例)、糖尿病不伴颈动脉粥样硬化组(B组30例)、非糖尿病伴颈动脉粥样硬化组(C组32例)和非糖尿病不伴颈动脉粥样硬化组(D组96例),分析颈动脉斑块与各因素的相关性.结果 ①A组与C组比较显示空腹血糖[(7.14±2.49)mmoL/L与(5.21±0.87mmol/L)],TG[(1.41±0.78)mmol/L与(0.95±0.39)mmol/L],左、右颈动脉内膜-中层厚度[(0.85±0.11)mm与(0.79±0.08)mm,(0.85±0.11)mm与(0.78±0.09)mm]、斑块指数(1.37±1.16与0.50±0.80)明显增高(P均<0.01),HDL-C[(1.29±0.32)mmol/L与(1.58±0.45)mmol/L]明显降低(P<0.01);②A组与B组比较显示左、右颈动脉内膜-中层厚度[(0.85±0.11)mm与(0.80±0.11)mm,(0.85±0.11)mm与(0.80±0.12)mm]、斑块指数(1.37±1.16与0.00±0.00)及脑卒中发病率[34.5%(41/119)与13.3%(4/30)]明显增高(P<0.05或P<0.01);③颈动脉斑块与糖尿病史(r=0.551,P<0.01)、高血压病史(r=0.169,P<0.01)、冠心病史(r=0.109,P<0.05)、脑卒中史(r=0.136,P<0.05)、脂肪肝(r=0.340,P<0.01)、FBG(r=0.339,P<0.01)、TG(r=0.195,P<0.01)、ApoB(r=0.152,P<0.05)呈直线正相关,与HDL-C(r=-0.143,P<0.05)呈直线负相关.结论老年2型糖尿病患者发生动脉粥样硬化的危险性高于非糖尿病患者,伴有动脉粥样硬化的糖尿病患者脑卒中发病率高于不伴动脉粥样硬化的糖尿病患者,颈动脉斑块的发生与糖尿病史、高血压病史、冠心病史、脑卒中史、脂肪肝、FBG、TG、ApoB呈正相关,与HDL-C呈负相关.     

速度向量成像技术对2型糖尿病患者足背动脉管壁运动的初步评价

目的应用速度向量成像技术（VVI）探讨2型糖尿病（T2DM）患者足背动脉的管壁长轴方向运动速度、应变及应变率的特点。方法使用西门子公司ACUSON Sequoia 512彩色多普勒超声诊断系统,结合同步心电图描记,声学采集条件下分别获取2型糖尿病足背动脉无形态学改变患者20例（T2DM1组）、糖尿病足背动脉有形态学改变患者26例（T2DM2组）和20例无糖尿病健康人（正常对照组）足背动脉的长轴二维图像,并进行动态存储。测量足背动脉平均内中膜厚度（IMT）,收缩末内径（Ds）,收缩期峰值流速（PSV）;并运用VVI软件进行脱机分析,测量足背动脉管壁长轴方向上的最大纵向运动速度（Vmax）、最大应变（Smax）及最大应变率（SRmax）,并进行比较。结果T2DM1组患者足背动脉IMT、Ds和PSV测值与正常人相比差异均无显著性意义（P〉0.05）,而Vmax、Smax、SRmax测值与正常人相比显著减低（P〈0.05或0.01）。T2DM2组患者足背动脉IMT、Ds、PSV测值和Vmax、Smax、SRmax测值与T2DM1组及正常对照组各测值相比差异均有显著性意义（P〈0.05或0.01）。结论VVI技术可用于T2DM足背动脉病变的分析,尤其对于临床未发现血管病变的糖尿病患者的内皮功能障碍可较早地进行检测。     

Coronary artery disease and carotid artery intima-media thickness in Japanese type 2 diabetic patients

OBJECTIVE: To investigate the association between carotid atherosclerosis, measured as intima-media thickness (IMT), and cardiovascular morbidity in type 2 diabetic patients. RESEARCH DESIGN AND METHODS: We investigated the relationship between IMT and coronary artery disease (CAD) in 40 type 2 diabetic patients and 40 control subjects. Diabetic patients with CAD determined by coronary angiography were consecutively recruited, whereas the control subjects were recruited from among diabetic outpatients without CAD at the same institution. IMT was measured in both carotid arteries using B-mode ultrasonography. RESULTS: Carotid IMT was significantly greater in the diabetic patients than in the control subjects (1.27 +/- 0.07 vs. 1.03 +/- 0.04 mm, P < 0.05). IMT was associated with CAD by logistic regression analysis using all independent variables (P = 0.062). When the 40 patients with CAD were divided into a group of 20 patients with coronary artery bypass grafting (CABG) and another 20 patients without CABG, the IMT was significantly greater in the CABG group than in the non-CABG group (1.47 +/- 0.11 vs. 1.07 +/- 0.07 mm, P < 0.05). CONCLUSIONS: These results indicate that the presence of carotid atherosclerosis implies a high probability of coronary involvement in Japanese nonobese subjects with type 2 diabetes.     

Elevated C-reactive protein associates with early-stage carotid atherosclerosis in young subjects with type 1 diabetes

OBJECTIVE: To evaluate whether low-grade inflammation contributes to early-stage advanced carotid atherosclerosis in young subjects with type 1 diabetes. RESEARCH DESIGN AND METHODS: The mean and maximum (max) intima-media thicknesses (IMT) of the carotid artery were assessed using ultrasound B-mode imaging in 55 patients with type 1 diabetes (22 men and 33 women, aged 22.1 +/- 3.6 years (+/- SD), duration of diabetes 14.2 +/- 5.7 years) and 75 age-matched healthy nondiabetic subjects (28 men and 47 women). High-sensitive C-reactive protein (hs-CRP) levels were measured with a latex-enhanced immunonephelometer. RESULTS: The patients with type 1 diabetes had significantly higher hs-CRP levels (median 0.35, range 0.05-1.47 mg/l vs. median 0.14, range 0.05-1.44 mg/l; P = 0.001) as well as significantly higher mean IMT and max IMT than the nondiabetic subjects (mean IMT 0.76 +/- 0.09 vs. 0.72 +/- 0.04 mm, P = 0.003; max IMT 0.84 +/- 0.11 vs. 0.77 +/- 0.06 mm, P < 0.0001). Hs-CRP levels were significantly correlated with the mean and max IMT of patients with type 1 diabetes and with the max IMT of nondiabetic patients. Multivariate regression analyses for both diabetic and nondiabetic subjects as a single group showed that hs-CRP levels are independently correlated with the mean IMT and max IMT levels (P = 0.002 and P = 0.023, respectively) as well as with diastolic blood pressure, sex, and duration of diabetes. CONCLUSIONS: Our data indicate that hs-CRP levels are elevated in young patients with type 1 diabetes, possibly corresponding with early-stage advanced carotid atherosclerosis.     

2型糖尿病患者脉搏波传导速度、踝臂指数和颈动脉粥样硬化的相关性研究

目的 探讨2型糖尿病人群大动脉顺应性和颈动脉粥样硬化的情况及相关性.方法 随机抽取我院2型糖尿病患者以及正常对照各80例作为研究对象.使用动脉硬化诊断装置VP-1000检测肱踝脉搏波传导速度(BaPWV)和踝臂指数(ABI),采用多普勒彩色超声观察颈总动脉内膜-中层厚度(IMT)以及斑块形成情况,比较两组合并颈动脉斑块时脉搏波传导速度的变化情况,分析颈动脉IMT与BaPWV和ABI的相关性.结果 糖尿病组BaPWV[(1752±213)cm/s]较正常对照组[(1279±159)cm/s]升高(t=28.09,P＜0.01);糖尿病组ABI(0.95±0.13)与正常对照组(1.28±0.17)相比差异有统计学意义(t =32.11,P＜0.01).糖尿病组颈动脉IMT增厚率(45.0％)及斑块发生率(35.0％)与正常对照组(分别为27.5％和10.8％)相比差异有统计学意义(x2值分别为4.16、4.14,P均＜0.01);糖尿病组合并颈动脉斑块者BaPWV[(1810±296)cm/s]较无颈动脉斑块[(1480±304)cm/s]者升高(t=15.86,P＜0.01).糖尿病患者BaPWV与颈总动脉IMT呈正相关(r=0.271,P＜0.05),ABI与IMT呈负相关(r=-0.406,P＜0.05).结论 BaPWV与糖尿病患者颈动脉IMT呈正相关,ABI与IMT呈负相关,BaPWV和ABI可作为评估糖尿病外周动脉硬化情况有效且简便易行的指标.     

非高密度脂蛋白胆固醇与系统性红斑狼疮颈动脉内膜中层厚度的相关性研究

目的探讨血清非高密度脂蛋白胆固醇（non-HDL-C）与系统性红斑狼疮（SLE）颈动脉内膜中层厚度（IMT）之间的关系。方法对42例SLE患者进行颈动脉超声检测IMT,按照IMT结果将其分为IMT阳性组（1MT≥0．85mm）和IMT阴性组（IMT〈0．85mm）;选取30例健康者为对照组。分别测定2组总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL—C）及低密度脂蛋白胆固醇（LDL-C）,通过Frost法计算出non-HDL-C,并进行比较分析。结果①与对照组相比,SLE组呈现出高TG（t’=2．92,P=0．03）、高TC（t’=2．72,P=0．005）、低HDL-C（t=-6．221。P=0．000）,且non-HDL-c（t=4．875,P=0．000）值明显升高。②IMT阳性组血清HDL-C及non-HDL-C值明显高于IMT阴性组（P〈0．01）。③SLE患者的IMT与non-HDL-C呈正相关（r=0．426,P=0．000）,与HDL-C呈负相关（r=-2．450,P=0．018）,其中以non-HDL-C相关性最强。结论高血清non-HDL-C是SLE动脉粥样硬化的危险指标,血清non-HDL-C检测是评价和预测SLE动脉粥样硬化的可信指标。     

彩色多普勒超声对高血压和糖尿病患者下肢动脉硬化特征的研究

目的比较高血压和糖尿病患者下肢动脉病变的分布及严重程度。方法对164例高血压患者及178例糖尿病患者进行下肢动脉检查（包括股动脉、胭动脉、胫前、后动脉及足背动脉）,观察二维超声表现及CDFI表现。结果糖尿病组与高血压组相比：股总动脉、股浅动脉、股深动脉粥样硬化斑块、中层钙化的发生率无显著性差异（p〉0．05）;胭动脉、胫前动脉、足背动脉中层钙化及胭动脉粥样硬化斑块的发生率则存在差异（p〈0．05）;胫前动脉、胫后动脉、足背动脉粥样硬化斑块、胫后动脉中层钙化的发生率差别非常显著（p〈0．01）;膝以上动脉狭窄、闭塞率无显著性差异（p〉0．05）,膝以下（包括胭动脉、胫前、后动脉、足背动脉）动脉狭窄、闭塞率则差别非常显著（p〈0．01）。结论糖尿病患者下肢膝以下小动脉的损害较高血压组更为严重。     

诺和龙治疗2型糖尿病合并动脉粥样硬化患者的疗效观察

目的 观察诺和龙治疗2型糖尿病合并动脉粥样硬化患者的临床疗效.方法 将65例2型糖尿病合并动脉粥样硬化患者随机分为诺和龙组(36例)和优哒灵组(29例),诺和龙组患者降糖药均为诺和龙治疗,优哒灵组均为优哒灵治疗,观察疗程12个月,监测治疗前后的血糖含量和颈动脉内膜中层厚度.结果 诺和龙组能有效降低餐后血糖(1.99±1.06)mmol/L,优哒灵降低餐后血糖(0.99±0.54)mmol/L,2组比较差异有统计学意义(P＜0.05).诺和龙组治疗后颈动脉内膜中层厚度比治疗前减少[(1.02±0.08)、(1.11±0.07)mm](P＜0.05),优哒灵组治疗后颈动脉内膜中层厚度与治疗前比较无差异[(1.07±0.06)、(1.10±0.08)mm](P＞0.05).结论 诺和龙是一种安全、有效的降糖药物,适于2型糖尿病合并动脉粥样硬化患者的治疗.     

幽门螺杆菌感染对老年2型糖尿病患者糖脂代谢及胰岛功能的影响

目的探讨老年2型糖尿病患者幽门螺杆菌(Helicobacter pylori, Hp)感染情况及其对糖脂代谢、胰岛功能的影响。方法 320例老年2型糖尿病患者,均行13C呼气试验,记录Hp感染情况,并将320患者分为Hp感染组和Hp未感染组。比较2组血清总胆固醇(total cholesterol, TC)、三酰甘油(triacylglycerol, TG)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol, HDL-C)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol, LDL-C)、糖化血红蛋白(glycated hemoglobin, HbA1c)、空腹血糖(fasting plasma glucose, FPG)、餐后2 h血糖(2 h postprandial plasma glucose, 2hPG)、空腹胰岛素(fasting insulin, FINS)及稳态模型胰岛素抵抗指数(homeostasis model assessment of insulin resistance, HOMA-IR)、尿微量白蛋白肌酐比(urinary microalbumin-creatinine ratio, ACR)、颈动脉内中膜厚度(intima-media thickness, IMT);多因素logistic回归分析老年2型糖尿病患者发生Hp感染的影响因素。结果 320例中Hp感染132例,感染率为41.3%;Hp感染组血清TC[(4.89±1.10)mmol/L]、TG[(2.12±0.86)mmol/L]、LDL-C[(3.11±1.03)mmol/L]、FPG[(9.29±3.05)mmol/L]、2hPG[(14.52±2.38)mmol/L]、HbA1c[(8.30±1.59)%]、FINS[(12.08±2.38)u/L]、HOMA-IR(5.76±0.79)、ACR[(86±14)mg/g]均高于Hp未感染组[(4.32±1.35)mmol/L、(1.93±0.39)mmol/L、(2.73±0.90)mmol/L、(8.04±1.87)mmol/L、(10.25±1.88)mmol/L、(7.57±0.92)%、(18.72±3.29)u/L、4.25±0.98、(54±10)mg/g](P<0.05),颈动脉IMT[(1.3±0.4)mm]较Hp未感染组[(0.9±0.3)mm]增厚(P<0.05),HDL-C[(1.05±0.20)mmol/L]水平较Hp未感染组[(1.41±0.25)mmol/L]降低(P<0.05);多因素logistic回归分析结果显示,FINS(OR=2.778, 95%CI:2.156~3.400,P=0.001)、HbA1c(OR=3.621, 95%CI:2.895~4.342,P<0.001)和HOMA-IR(OR=2.084, 95%CI:1.485~2.658,P=0.002)是老年2型糖尿病患者发生Hp感染的影响因素。结论老年2型糖尿病患者Hp感染率较高,发生Hp感染者胰岛素抵抗、糖脂代谢紊乱、动脉粥样硬化程度加重。FINS、HbA1c、HOMA-IR与老年2型糖尿病患者发生Hp感染有关。