高龄脑梗死患者同型半胱氨酸与颈动脉粥样硬化的特征分析

目的研究高龄脑梗死患者同型半胱氨酸(Hcy)与颈动脉粥样硬化的关系。方法选择85例高龄脑梗死患者(年龄≥80岁)为高龄组,同时随机选取年龄80岁的急性脑梗死患者110例作为对照组。患者均行双侧颈部血管超声检查,并检测血脂、血Hcy、叶酸及VitB_(12)水平,进行相关分析。结果高龄组颈动脉粥样硬化的发生率为94.12%,显著高于对照组的69.09%(χ~2=22.971,P=0.000),高龄组动脉粥样硬化程度较对照组严重(P=0.000)。高龄组血Hcy为(21.08±1 5.22)μmol/L,显著高于对照组(15.99±9.19)μmol/L,差异有统计学意义(P=0.004)。颈动脉粥样硬化程度与血Hcy呈正相关(r=0.572,P=0.000)。结论高龄脑梗死患者颈动脉粥样硬化的发生率增高,与高Hcy血症密切相关。     

Homocysteine and coronary atherosclerosis

Homocysteine is increasingly recognized as a risk factor for coronary artery disease. An understanding of its metabolism and of the importance of vitamins B₆and B₁₂and folate as well as enzyme levels in its regulation will aid the development of therapeutic strategies that, by lowering circulating concentrations, may also lower risk. Possible mechanisms by which elevated homocysteine levels lead to the development and progression of vascular disease include effects on platelets, clotting factors and endothelium. This review presents the clinical and basic scientific evidence supporting the risk and mechanisms of vascular disease associated with elevated homocysteine concentrations as well as the results of preliminary therapeutic trials.     

颈动脉粥样硬化影响内皮祖细胞功能的研究进展

动脉粥样硬化是威胁人类健康的最严重的心脑血管疾病之一,阐明动脉粥样硬化发生机制和防治动脉粥样硬化已成为医学界研究的热点。颈动脉粥样硬化在一定程度上可反映全身动脉粥样硬化斑块发展状况,由于颈动脉位置表浅,易于探及检查,已被证实可作为了解和评估全身动脉粥样硬化的"窗口"。经研究证实,内皮祖细胞可修复受损内膜,延缓动脉粥样硬化的发生发展。本文针对颈动脉粥样硬化患者内皮祖细胞数量和功能的变化,以及内皮祖细胞对该病发生发展的作用进行概括和总结,为动脉粥样硬化的治疗与防治提供新的策略。     

Homocysteine, circulating vascular cell adhesion molecule and carotid atherosclerosis in postmenopausal vegetarian women and omnivores

Since the adoption of vegetarian diets as a healthy lifestyle has become popular, the cardiovascular effects of long-term vegetarianism need to be explored. The present study aimed to compare the presence and severity of carotid atherosclerosis (CA), and the blood levels of Vitamin B12, homocysteine (Hcy) and soluble vascular cell adhesion molecule-1 (sVCAM-1) between 57 healthy postmenopausal vegetarians and 61 age-matched omnivores. Carotid atherosclerosis, as measured by ultrasound, was found to be of no significant difference between the two groups. Yet, fasting blood glucose, low-density lipoprotein cholesterol, and Vitamin B12 were significantly lower, while Hcy and sVCAM-1 were higher in the vegetarians as comparing with the omnivores. Multivariate regression analysis showed that the level of Vitamin B12 was negatively associated with the level of Hcy. Vegetarianism itself and Hcy level were significantly associated with sVCAM-1 level in univariate analysis; however, after adjustment for covariates, we identified age but not vegetarianism as the determinant of sVCAM-1 level. Multiple linear regression analysis identified age and systolic blood pressure, but not vegetarianism, as determinants of common carotid artery IMT. In conclusion, there was no significant difference in CA between apparently healthy postmenopausal vegetarians and omnivores. The findings of elevated Hcy in vegetarians indicate the importance of prevention of Vitamin B12 deficiency.     

Homocysteine: Role and implications in atherosclerosis

Hyperhomocysteinemia promotes atherosclerosis and is most commonly caused by B-vitamin deficiencies, especially folic acid, B₆, and B₁₂; genetic disorders; certain drugs; and renal impairment. Elevated homocysteine promotes atherosclerosis through increased oxidant stress, impaired endothelial function, and induction of thrombosis. Prospective studies have shown that elevated plasma homocysteine concentrations increase risk of cardiovascular disease by twofold and risk of cerebrovascular disease to a lesser degree. Hyperhomocysteinemia should be identified in patients with progressive or unexplained atherosclerosis and treated appropriately. Treatment of hyperhomocysteinemia is primarily through vitamin supplementation; folic acid and vitamins B₆ and B₁₂ are the mainstay of therapy. Betaine and 5-methyl tetrahydrofolate are also effective in lowering homocysteine levels. Treatment of moderately elevated plasma homocysteine in patients without atherosclerosis should be deferred until the completion of randomized outcome trials.     

同型半胱氨酸、炎症与动脉粥样硬化

高同型半胱氨酸血症是动脉粥样硬化形成的一种独立危险因素。动脉粥样硬化是一种慢性炎症过程,从炎症角度出发研究同型半胱氨酸与动脉粥样硬化的关系也得到了人们的关注。现就炎症在同型半胱氨酸致动脉粥样硬化的作用及其机制方面的研究进展作一综述。     

Renal function, plasma homocysteine and carotid atherosclerosis in elderly people

Although epidemiological studies suggest that people with minor impairment of renal function are at higher risk of stroke and coronary heart disease, the mechanisms underlying this relation are unclear. One explanation may lie with observations that deterioration in renal function is accompanied by elevations in plasma homocysteine concentrations. There is evidence that moderate hyperhomocysteinemia may play a causal role in atherosclerotic disease. We investigated the relations between renal function, plasma homocysteine and atherosclerosis of the carotid arteries in 128 men and women aged 69-74 years. Renal function was assessed by creatinine clearance and serum creatinine. Duplex ultrasonography was used to quantify the degree of stenosis in the extracranial carotid arteries. Severity of carotid atherosclerosis was greatest in men and women with the poorest renal function, whether measured by creatinine clearance or serum creatinine. After adjustment for plasma homocysteine, pulse pressure and other cardiovascular risk factors, the odds ratio for having carotid stenosis >30% was 4.3 (95% CI 1.4-12.9) in those whose creatinine clearance rate was 55 ml/min or less compared with those whose creatinine clearance rate was >73 ml/min. Even small decrements in renal function were associated with increased risk; people whose creatinine clearance rate was between 56 and 73 ml/min had an odds ratio of 3.8 (95% CI 1.2-11.9). Plasma homocysteine concentrations were significantly higher in people with poorer renal function, but they did not explain the associations we found between carotid atherosclerosis and creatinine clearance or serum creatinine.     

冠状动脉与颈、肾、髂动脉粥样硬化病变的相关性

目的：通过冠状动脉造影的同时行非选择性颈、肾、骼动脉造影，从而研究冠状动脉与颈、肾及髂动脉粥样硬化病变的相关性。方法：共纳入103例在冠状动脉造影后即刻行颈、肾及髂动脉非选择性造影的病人，分析颈、肾及髂动脉粥样病变的检出率、危险因素及与冠状动脉粥样病变的相关性。结果：颈、肾、及髂动脉粥样病变的总检出率分别为14．6％（15／103）、21．4％（22／103）、20．4％（21／103）；冠心病患者中颈、肾及髂动脉粥样病变的发病率明显高于非冠心病组（P〈0．05）；随着冠脉病变程度的增加，颈、肾及髂动脉粥样病变的发生率随之增加（P〈0．05）。结论：颈、肾及髂动脉粥样病变与冠心病密切相关，对于有脑血管病症状、顽固性高血压、下肢缺血性病变的冠心病患者，应在冠脉造影后行颈、肾及髂动脉造影，除外周围血管病变。     

Homocysteine and renal disease

Hyperhomocysteinemia refers to an elevated circulating level of the sulfur-containing amino acid homocysteine and has been shown to be a risk factor for vascular disease in the general population. In patients with renal failure, hyperhomocysteinemia is a common feature. The underlying pathophysiological mechanism for this phenomenon is unknown. Proposed mechanisms include reduced renal elimination of homocysteine and impaired nonrenal disposal, possibly because of inhibition of crucial enzymes in the methionine-homocysteine metabolism by the uremic milieu. Absolute or relative deficiencies of folate, vitamin B6, or vitamin B12 may also play a role. Several case-control and prospective studies have now indicated that hyperhomocystenemia is an independent risk factor for atherothrombotic disease in patients with predialysis and end-stage renal disease. In renal patients, plasma homocysteine concentration can be reduced by administration of folic acid in doses ranging from 1 to 15 mg per day. In more than 50% of the cases, however, the homocysteine concentration remains above 15 micromol/L. The effects of vitamin B12 or vitamin B6 are unclear. Large intervention trials are now needed to establish whether homocysteine-lowering therapy will reduce atherothrombotic events in patients with renal failure. These studies are now planned or are ongoing.     

卡托普利对高血压患者颈动脉粥样硬化的消退作用

目的:探讨卡托普利对高血压患者颈动脉粥样硬化(AS)的逆转作用。方法:将70例经彩色多普勒超声证实有颈AS的高血压患者随机均分为治疗组和对照组,治疗组35例在对照组常规治疗基础上服用卡托普利12．5 mg,tid,治疗6个月及12个月经彩色多普勒超声测定颈动脉内膜中膜厚度(IMT)、斑块病变类型、血管内径及血流参数,并与治疗前对比。结果:①2组患者血脂水平治疗前后无明显改变。②治疗组中Ⅰ型患者治疗后12个月从治疗前的57．14％减少到20％(P<0．05),而对照组无明显改变;治疗组患者治疗前后相比,或与同期对照组比较差异有统计学意义(P<0．05),2组Ⅱ-Ⅳ型患者治疗前后均无明显改变。③治疗组治疗后1MT 降低,血管内径增加;且随疗程延长,效果更明显,而对照组却无相应变化。④治疗组治疗后颈总动脉、颈内动脉的血管阻力指数均较治疗前明显降低,收缩期峰速度、舒张期末速度和血管搏动指数则较治疗前呈显著性增加, 且随疗程延长,有进一步降低或增加趋势,但对照组却无类似变化。结论:卡托普利可减轻血管IMT,改善血管的顺应性,降低血管阻力,改善颈动脉血流,随着治疗时间延长其效应更为显著。     

糖尿病合并颈动脉硬化患者认知功能的研究

目的 探讨糖尿病合并颈动脉硬化患者认知功能的改变情况.方法 收集86例糖尿病颈动脉硬化患者,使用简易智能状态检查表(MMSE)对患者认知功能进行检查;对患者作颈动脉超声检查并按动脉硬化的程度分组,比较糖尿病患者颈动脉硬化程度血清与认知功能的关系,并与40例健康人进行比较.结果 糖尿病颈动脉增厚患者在注意力和计算力及总分方面显著低于对照组(P＜0.05);糖尿病颈动脉斑块患者在定向力、注意力和计算力、记忆力、语言和总分方面显著低于对照组(P＜0.05,P＜0.01).血糖与颈动脉硬化程度呈显著正相关(P＜0.05);血糖与记忆力和总分呈显著负相关(P＜0.05);颈动脉硬化程度与注意力和计算力、记忆力、语言和总分呈显著负相关(P＜0.05).结论 糖尿病患者也存在一定程度的认知功能下降,认知障碍表现为语言、记忆和计算能力下降等.     

辛伐他汀对颈动脉粥样硬化软斑块影响的临床研究

目的 通过辛伐他汀对颈动脉粥样硬化斑块中的软斑块的干预,观察其能否有效干预颈动脉粥样硬化斑块中软斑块的进展,从而达到防治脑血管疾病(CVD)的目的 .方法 将符合入选标准的300例患者随机分为治疗组和对照组,每组各150例.对照组采用氯吡格雷(75 mg/次,1次/d), 治疗组在氯吡格雷治疗的基础上加辛伐他汀(三精制药厂生产,20 mg/次,每晚1次),疗程均为6个月.两组患者治疗6个月后复查彩超,记录斑块性质、大小和数目等. 结果比较两组软斑块消退、软斑块数目减少、斑块稳定情况,治疗组显著优于对照组,差异有统计学意义(P<0.01).结论 辛伐他汀能逆转和稳定动脉粥样硬化斑块,从而减少脑血管事件的发生.     

代谢综合征对高血压患者血管内皮功能与颈动脉粥样硬化的影响

目的探讨代谢综合征（MS）对高血压患者血管内皮功能及颈动脉粥样硬化的影响。方法选取120例高血压患者，根据有无合并MS将其分为2组：MS组（65例）和非MS组（55例），彩色多普勒超声测定肱动脉反应性充血内径、颈动脉内膜厚度及斑块情况。选取健康体检者40名作为对照组（NC组）。结果①MS组的体重指数（BMI）、甘油三酯（TG）、空腹血糖（FPG）均高于非MS组和NC组，P〈0．05，P〈0．01。②内皮依赖性血管舒张功能（FMD％）：MS组明显低于非MS组和NC组[（7．15±2．46）％、（8．45±4．13）％和（12．23±5．12）％，P均〈0．05]。③三组颈动脉内膜厚度（IMT）依次为：（0．84±0．21）mm、（0．78±0．24）mm和（0．64±0．14）mm，P均〈0．01；颈动脉斑块发生率依次为29．3％、21．8％和5．0％，P均〈0．01。④相关分析显示，FMD％与年龄、SBP、TG、FPG呈负相关（r=-0．359、r=-0．357、r=-0．346、r=-0．413，P均〈0．01），与HDL—C呈正相关（r=0．341，P〈0．01）；IMT与年龄、SBP、BMI、TG呈正相关（r=0．431，r=0．442，r=0．315，r=0．342，P均〈0．01），与HDL—C呈负相关（r=-0．313，P〈0．01）。结论并发MS可加重高血压患者血管内皮功能失调及促进颈动脉粥样硬化的发生。     

Homocysteine and cognitive function

The prevention and treatment of age-related cognitive impairment and dementia is one of the greatest and most elusive challenges of our time. The prevalence of dementia increases exponentially with age, as does the prevalence of those with micronutrient deficiency. Several studies have shown that elevated homocysteine is correlated with cognitive decline and with cerebral atrophy and that it predicts the subsequent development of dementia in cognitively intact middle-aged and elderly individuals. If elevated homocysteine promotes cognitive dysfunction, then lowering homocysteine by means of B-vitamin supplementation may protect cognitive function by arresting or slowing the disease process.     

瑞舒伐他汀治疗脑梗死合并颈动脉粥样硬化患者的疗效

目的探讨瑞舒伐他汀对脑梗死患者颈动脉粥样硬化斑块的干预效果。方法选取80例脑梗死合并颈动脉粥样硬化斑块患者,随机分为对照组（n=40）和观察组（n=40）。对照组患者接受脑梗死常规治疗,观察组患者在常规治疗的基础上,加服12个月的瑞舒伐他汀（20mg,1次/晚）治疗。观察两组治疗前及治疗后3个月、6个月、12个月时的颈动脉粥样硬化斑块评分、血脂和C反应蛋白（CRP）水平变化。结果观察组患者治疗3个月、6个月、12个月时患者血清中胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、CRP水平较治疗前均有明显下降,同时高密度脂蛋白胆固醇（HDL-C）水平有所提高,与治疗前比较有显著统计学差异（P〈0.05）。对照组患者颈动脉粥样硬化斑块积分呈增加趋势,观察组患者颈动脉粥样硬化斑块积分呈降低趋势,两组患者在治疗6个月、12个月积分比较有统计学差异（P〈0.05）。结论瑞舒伐他汀对脑梗死合并颈动脉粥样动脉硬化斑块患者可起到强化降脂,促进斑块体积缩小的作用。