应重视对血管亚临床病变的控制

心血管病各种危险因素 ,如高血压、高血糖、高血脂、肥胖及吸烟等 ,通常通过损害血管的结构和功能导致心、脑、肾等器官并发症的发生。临床上反映血管亚临床病变的指标主要为动脉弹性异常并常见于如下几个方面 :( 1)动脉的扩张性降低 ;( 2 )动脉壁增厚及硬度增加 ;( 3)动脉顺应性下降 ;( 4)动脉内的斑块形成等。脉压增大常提示动脉弹性明显减退 ,而内皮功能不良常反映早、中期的动脉弹性异常。因此早期检测动脉的结构及功能异常对于预测血管的亚临床及临床疾病具有重要意义。一、临床上检测动脉弹性的指标及仪器1 CVProfilorDO 2 0 2 0桡…     

如何进行血管亚临床病变的早期检测?

黄贤锡(汕头市汕头大学医学院第一附属医院心内科,广东汕头 515041)目前有如下几种方法可对血管病变进行早期检测:1)脉压的测定:正常值为30～40 mm Hg,脉压增大常提示动脉管壁硬化,顺应性变小。2)超声测定的肱动脉内皮功能:血流介导的血管扩张(FMPD)=(动脉反应性充血后内径-动脉基础内径)÷动脉基础内     

如何进行血管亚临床病变的早期检测？

目前有如下几种方法可对血管病变进行早期检测:1)脉压的测定:正常值为30～40 mm Hg,脉压增大常提示动脉管壁硬化,顺应性变小.     

高频超声检测脑梗死与短暂性脑缺血发作患者血管内皮功能的探讨

目的:研究脑梗死、短暂性脑缺血发作(TIA)患者颈动脉内-中膜厚度、血管弹性与肱动脉血管内皮功能.方法:研究对象分为3组:脑梗死患者、TIA患者、正常同龄人,每组各30例.用高频超声测量颈动脉内-中膜厚度、收缩期颈动脉内径(DS)、舒张期颈动脉内径(DD),计算颈总动脉壁弹性的相关参数:可扩张度(DC)、顺应性(CC)...     

早期发现和检测亚临床血管病变

心血管事件链（cardiovascular continuum）是现代心血管病（CVD）发生和防治的重要理论基础。心、脑血管病事件的发生,不仅危险因素相同,而且主要的病理生理环节和基本病变也近似,发生事件前已经有亚临床血管病变。亚临床血管病变是指尚无心、脑血管病临床表现的血管损害和结构改变,包括大动脉粥样硬化和纤维性硬化、小动脉硬化和微循环障碍。心、脑血管病事件实际上是大、小血管结构重构和功能障碍的后果。     

高血压血管病变及其心血管预后

心肌梗死、脑卒中及心血管死亡是3个主要临床心血管事件,是各种心血管病最严重的不良后果。高血压被公认为临床心血管事件最重要的危险因素和人类的最大杀手,其既可独立、又可放大其他诸多心血管危险因素的作用。从     

2型糖尿病下肢血管病变形态学特点研究

目的了解糖尿病下肢血管病变的形态学特征。方法选择门诊或住院糖尿病患者，采用彩色多普勒超声检查，由专人观察糖尿病患者下肢血管的内膜-中层厚度、管壁的形态、内膜病变。结果(1)内膜-中层厚度增加为43．94％，内膜病变65．15％；(2)内膜-中层厚度增加与内膜病变无明显相关性，内膜病变并不依内膜-中层厚度增加而增加；(3)2型糖尿病下肢血管内膜-中层厚度表现为节段性增加，增厚节段之间可以厚度正常，其中41．75％表现为非均匀性、非同心圆性增厚。结论2型糖尿病下肢血管病变以内膜-中层厚度增加为特征性改变，这种改变加速了内膜斑块的形成。     

亚临床甲状腺功能减退对2型糖尿病患者高敏C反应蛋白水平与大血管病变的影响

目的 观察亚临床甲状腺功能减退（SCH）对T2DM患者血清高敏C反应蛋白（hsC-RP）水平及大血管病变的影响. 方法 将328例T2DM患者分为T2DM合并SCH（T2DM＋ SCH）组及单纯T2DM（T2DM）组,测定BMI、WC、促甲状腺激素（TSH）、血清游离甲状腺素（FT4）、血清游离三碘甲腺原氨酸（FT3）、FPG、FC-P、TC、TG、LDL-C、HDL-C、HbA1c、血清hsC-RP水平、颈动脉内-中膜厚度（CI-MT）、颈动脉斑块发生率、踝肱指数（ABI）及评估大血管病变发生率. 结果 T2DM＋ SCH组女性患者比例、BMI、WC、TSH、TC、TG、LDL-C、hsGRP水平均高于T2DM组（P＜0.05）;T2DM＋ SCH组CI-MT增厚,颈动脉斑块、大血管病变发生率增加,高血压病、脑血管病、冠心病患病率均高于T2DM组（57.7％ vs 36.6％、40.4％ vs 25.0％、42.3％ vs 19.2％,P均＜0.05）,而ABI低于T2DM组（P＜0.05）;Logistic回归分析结果显示,SCH是糖尿病大血管病变发生的独立危险因素. 结论 T2DM合并SCH患者颈动脉斑块及大血管病变发生率增加,脂代谢异常及炎性反应参与了颈动脉斑块及大血管病变的形成.     

无创动脉检测联合血管彩超在早期糖尿病周围血管病变中的诊断价值

目的探讨无创动脉检测联合血管彩超在早期糖尿病周围血管病变中的诊断价值。方法选取2011年5月—2013年5月来该院治疗的早期糖尿病周围血管病变患者72例,随机分为两组,对照组36例采用常规的血管彩超,实验组36例则采用无创动脉检测联合血管彩超(包括踝肱脉搏波传导速度(PWV)及踝臂指数(ABI))的治疗手段。对两组患者的周围血管的弹性,功能等各方面情况进行检查并比较两组检查的结果。结果两组患者的检查结果中,PWV与血管彩超结果呈现正相关,ABI与动脉狭窄程度无明显相关,(P0.05)差异具有统计学意义。结论两种检查均对早期糖尿病具有诊断意义,但无创伤动脉检测更具重要价值。     

糖尿病患者下肢动脉病变无创检查的临床评估

下肢动脉病变（PAD）是糖尿病的慢性并发症之一,表现为下肢疼痛、感觉异常和间歇性跛行,严重供血不足可导致坏疽,甚至被迫截肢,所以早期诊断和治疗非常重要。PAD病变多发生于膝以下的远端动脉,呈多部位节段性,病理改变为动脉粥样硬化。     

无创性动脉顺应性的评估方法及其临床意义

目前认为 ,心血管疾病的本质是血管结构与功能的异常 ,防治心血管疾病的重点在于防治血管病变。用于评价血管功能的动脉顺应性的定义为在单位压力改变下 ,血管面积、直径或体积的改变。它依赖于血管的几何和机械特性。动脉的扩张性、僵硬度、弹性与动脉顺应性意义相近。动脉顺应性与遗传因素有关 ,随年龄的增长而降低 ,吸烟、高盐饮食、胰岛素抵抗、高血压是引起动脉顺应性下降的重要因素 ,同时越来越多的证据表明动脉顺应性的降低是心血管疾病的重要危险因素 ,动脉顺应性的降低可先以有临床表现的心血管疾病的发生[1] ,因此动脉顺应性的降…     

代谢综合征与动脉顺应性、颈动脉内膜中层厚度关系的研究

目的探讨代谢综合征(metabolicsyndromeMS)与大小动脉顺应性和颈动脉内膜中层厚度(IMT,intima-mediathickness)改变的关系及其临床意义。方法根据美国ATPⅢ指南MS的诊断标准,将221例受试者分为对照组46例、代谢综合征组亚组1(有1项异常,n=94)、亚组2(有2项异常,n=58)和亚组3(有3项以上异常,n=29)。采用美国HDICVProfilorDO2020动脉波形分析仪和HP5500超声仪检测各组大小动脉顺应性(C1、C2)和颈动脉IMT。结果代谢综合征各亚组随着组份聚集的增多,C1和C2逐渐降低,颈动脉IMT逐渐增厚。其中与对照组比较,C1和颈动脉IMT与亚组2和亚组3有统计学差异(P<005、P<001),但与亚组1均无差异(P>005);而C2与各亚组之间均有统计学差异(P<005、P<001)。等级相关分析显示HOMAIR、颈动脉IMT与代谢综合征组份聚集程度呈正相关(rs=0493,rs=0261,P均<001),C1、C2与其负相关(rs=-0138,P<005,rs=-0195,P<001)。结论C1、C2降低,颈动脉IMT增厚与MS及其各组份的聚集程度密切相关;C2减退可作为反映胰岛素抵抗引起的血管早期病变-内皮功能障碍的敏感指标之一。     

2型糖尿病患者合并勃起功能障碍对心血管病风险预测的研究

目的:了解2型糖尿病患者合并勃起功能障碍(ED)时是否有心血管病的风险. 方法:对2型糖尿病合并勃起功能障碍组(ED组)71例,2型糖尿病无勃起功能障碍组(非ED组)45例,测量其颈内动脉内膜中层厚度(IMT),同时测量身高、体重、血压、血脂、血糖、C肽等.比较两组间平均颈内动脉IMT及血糖、血脂等代谢指标. 结果:平均颈内动脉IMT比较:ED组明显厚于非ED组(P<0.05);血清总胆固醇、低密度脂蛋白胆固醇:ED组明显高于非ED组(p<0.05);在2型糖尿病患者中,ED评分与颈内动脉IMT呈负相关(r=-0.321,P=0.000). 结论:2型糖尿病患者合并ED时其患动脉粥样硬化的危险性要高于不合并ED者,2型糖尿病合并ED可能是心血管病的一个早期预警信号.     

冠脉搭桥术患者术后认知功能障碍的研究现状

冠脉搭桥术患者术后早期和晚期的认知功能障碍已逐渐受到重视,目前的研究结果仍存在争议.现就其发生率、原因、危险因素等作一综述,并分析其研究结果差异、结论矛盾等可能原因.     

Carotid Artery Wall Alterations as Intermediate End Points

Carotid artery wall alterations can now be measured in a quantitative, well reproducible way by B-mode ultrasound. The thickness of the intima-media complex (IMT) is commonly measured at three levels along the carotid tree. Well standardized protocols to use in randomized prospective trials are available. It is argued that IMT measurements can be used as intermediate end points of antihypertensive treatment trials as 1) IMT alterations are frequent in hypertension and closely correlated to systolic and pulse pressures; 2) IMT alterations are predictive of an increased risk of cardiovascular events; 3) changes in IMT occur during antihypertensive treatment; 4) at least one study has shown differential effects of different antihypertensive agents on IMT (VHAS: verapamil better than chlorthalidone); 5) in this study a greater effect on IMT has been accompanied by a reduced cardiovascular event rates. Larger studies are desirable to confirm these conclusions.     

颈动脉内中膜厚度及斑块与冠心病的相关性

目的探讨颈动脉内中膜厚度(IMT)及斑块与冠状动脉造影(CAG)结果的相关性,了解IMT在预测冠心病方面的价值。方法研究对象116名经CAG分为冠心病组和非冠心病组,超声观察颈动脉IMT及有无斑块形成并与CAG结果比较。结果非冠心病组与冠心病组比较患者颈动脉IMT、斑块指数均存在显著性差异(P<0．01),颈动脉IMT与冠状动脉狭窄程度呈正相关(r= 0．634,P<0．01)。颈动脉IMT对冠心病诊断有较高的敏感性及特异性。结论颈动脉超声可能是冠心病诊断的一项重要的辅助检查手段。     

补体C3、C4、备解素及补体调节蛋白CD55、CD59与颈动脉内膜中层厚度的关系研究

目的:探讨补体及补体调节蛋白与颈动脉内膜中层厚度(IMT)的关系。方法:选高脂血症患者57例(高脂血症组),正常对照20人(正常对照组),测定补体C3、C4、备解素(Pf)水平、补体凋节蛋白CD55、CD59的表达及颈动脉IMT,分析其关系。结果:与正常对照组比较,高脂血症组补体C3、C4及备解素、颈动脉IMI、明显升高,补体调节蛋白CD55阳性淋巴细胞平均荧光强度减低;IMT与年龄、收缩压、腰臀比值、高敏C反应蛋白正相关,与补体调节蛋白CD55阳性淋巴细胞平均荧光强度负相关,与补体C3、C4、备解素及补体调节蛋白CD59不相关。结论:颈动脉IMT增厚与补体调节蛋白CD55表达降低相关,而与补体C3、C4、备解素、补体调节蛋白CD59无直接关系。     

微粒化非诺贝特对原发性高血压颈动脉内膜中层厚度与脑血流动力学的影响

目的　探讨微粒化非诺贝特对原发性高血压患者颈动脉内膜中层厚度 (IMT)与脑循环动力学 (CVA)的影响。方法　分别对 2 0 7例原发性高血压患者应用微粒化非诺贝特进行为期 2 4个月的治疗和对照 ,观察治疗前后患者颈动脉超声、脑循环动力学及血脂等指标的变化。结果　治疗组 2 4个月后颈动脉IMT基本保持稳定 ,IMT/内径 (D)比率及颈动脉粥样硬化斑块发生率均比治疗前有明显降低 (P <0 0 5 ) ;脑循环动力学指标较治疗前明显改善。结论　在有效降压治疗的同时加用微粒化非诺贝特治疗 ,对原发性高血压患者延缓颈动脉粥样硬化的进展和改善脑循环动力学有良好效果。     

Evaluation of Metabolic Syndrome Frequency and Carotid Artery Intima-media Thickness as Risk Factors for Atherosclerosis in Patients with Nonalcoholic Fatty Liver Disease

Aim The aim of this study was to evaluate metabolic syndrome (MetS) frequency and carotid artery intima-media thickness (IMT) as risk factors for atherosclerosis in patients with nonalcoholic fatty liver disease. Methods A case-control study was conducted on 40 biopsy-proven NAFLD patients and 40 age-matched healthy control subjects. Common carotid artery IMT and MetS criteria [according to the Third Report of the National Cholesterol Education Expert Panel on Detection, evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP-ATPIII), the International Diabetes Federation (IDF), the American Heart Association in conjunction with the National Heart, Lung, and Blood Institute (AHA/NHLBI)] were evaluated for all study subjects. Results MetS according to NCEP-ATPIII, IDF and AHA/NHLBI criteria was present in 55, 67.5 and 62.5% of NAFLD patients, respectively. The mean IMT was significantly higher in NAFLD patients (0.646 ± 0.091 mm) than control subjects (0.544 ± 0.067 mm), (P < 0.001). Among the vascular risk factors evaluated, the diagnosis of NAFLD and increased body mass index were significant independent predictors of increased IMT. Conclusions As cardiovascular risk factors, both MetS and increased IMT occur frequently among NAFLD patients. Screening for both conditions might be beneficial for assessment of future atherosclerotic complications.     

Subclinical cardiovascular target organ damage manifestations of ankylosing spondylitis in young adult patients

Aim

Although it is known that ankylosing spondylitis (AS) is associated with cardiovascular complications, the extent of these complications has not been clearly demonstrated in young adult patients. We have therefore investigated myocardial diastolic functions, carotid intima-media thickness (CIMT), and aortic elastic properties of young adult patients diagnosed with AS.

Method

Sixty-six AS patients and 21 age/gender-matched healthy subjects were enrolled in the study. Spectral and tissue Doppler echocardiography, CIMT, aortic strain and distensibility, and serum B-type natriuretic peptide values were compared with disease activity indexes of AS, including the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and the role of other variables, such as anti-tumor necrosis factor-alpha (anti-TNF-α) treatment, lipid parameters, erythrocyte sedimentation rate, and C-reactive protein.

Results

Both mitral early diastolic flow speed (mE) and late diastolic flow speed (mA) scores were lower among patients than among the control subjects (p = 0.015 and p = 0.035, respectively). The Em ratio of the patients was remarkably lower than that of the control subjects (p = 0.044). BASDAI scores of >4 were used to identify patients with more active disease. The mA and mE/mA ratios were significantly different between patients with a BASDAI score of >4 and those with a BASDAI score of <4 (p = 0.026 and p = 0.021, respectively). While aortic elasticity were not significantly different between the groups, AS patients treated with anti-TNF-α had significantly improved aortic strain and distensibility values (p = 0.022 and p = 0.014, respectively) compared to those treated with non-steroidal anti-inflammatory drugs (NSAIDs).

Conclusion

Myocardial diastolic functions were significantly deteriorated in the AS patients, and disease activity and myocardial diastolic functions were associated. An interesting finding was that patients receiving anti-TNF-α had better aortic elasticity than those treated with NSAIDs.