高同型半胱氨酸血症与颈动脉粥样硬化的相关性研究

目的探讨同型半胱氨酸水平与颈动脉粥样硬化及危险因素的关系。方法回顾性分析我院筛查的95例血浆同型半胱氨酸升高患者,63例血浆同型半胱氨酸正常患者为对照组。比较2组高血压、糖尿病、高胆固醇血症、吸烟、饮酒及颈动脉粥样硬化情况。结果高Hcy组与对照组血浆Hcy分别为(26.52±5.42)μmol/L和(11.65±3.57)μmol/L,2组比较差异有统计学意义(t=4.27,P<0.001)。2组颈动脉粥样硬化比较,高Hcy组(78.9%)明显高于对照组(47.6%),差异有统计学意义(P<0.01)。高Hcy组6例患者Hcy值>50μmol/L,且均有吸烟、饮酒史,颈动脉粥样硬化均为双侧。结论高同型半胱氨酸血症与颈动脉粥样硬化及斑块形成有关。     

高血压患者颈动脉粥样硬化的危险因素分析

1 资料与方法 1.1 一般资料 选取2012-01-2013-05间住院治疗的高血压患者110例,男78例,女32例,年龄61～86岁,平均（73±8.5）岁,病程5～23 a,平均病程（16±11.5）a.合并脑梗死66例,合并冠心病65例,合并糖尿病32例.本组患者按颈动脉内膜中层是否增厚分为观察组（70例）与正常组（40例）.     

缺血性脑血管病与颈动脉粥样硬化及其危险因素的关系

目的探讨缺血性脑血管病(ICVD)与颈动脉粥样硬化及其危险因素的关系。方法对186例ICVD患者与194例非脑血管病患者和正常体检者(对照组)行颈部血管超声检查和血液生化检查;比较两组间的颈动脉硬化程度及脑卒中危险因素的差异。结果ICVD组年龄[(69±7)岁]和患有高血压(66.1%)、糖尿病(53.4%)、代谢综合征患者(44.6%)的比率非常明显高于对照组[(61±5)岁、48.8%、15.2%、12.9%](均P<0.001)。ICVD组颈动脉粥样硬化分级计分≥2分(斑块发生率)、≥3分(血管狭窄发生率)分别为69.3%、20.4%,明显高于对照组的33.5%和5.1%(均P<0.05)。结论颈动脉粥样硬化是ICVD的危险因素之一;各种危险因素的聚集对ICVD的发生起重要作用。     

脑梗死患者颈动脉粥样硬化斑块的相关危险因素分析

目的探讨脑梗死患者的颈动脉粥样硬化发生情况及其主要危险因素。方法对170例脑梗死患者应用彩超进行颈动脉检查,观察动脉粥样硬化的发生情况和记录相关危险因素的资料,同时实验室检测血脂、血糖、纤维蛋白原水平。结果脑梗死患者有颈动脉粥样硬化斑块者131例(77.1%),颈动脉狭窄11例(6.5%)。经Logistic回归分析发现,年龄(OR 1.352,95%CI:1.087~1.569)、吸烟(OR 1.854,95%CI:1.362~2.258)及糖尿病(OR 2.774,95%CI:1.612~5.956)可能是导致斑块发生的独立危险因素。颈动脉有斑块组其总胆固醇、低密度脂蛋白、血糖及纤维蛋白原水平较无斑块组显著增高(P<0.01)。结论年龄、吸烟和糖尿病是发生脑梗死颈动脉粥样硬化斑块的独立危险因素,应对存在多种危险因素的患者进行积极干预。     

中年人群颈动脉粥样硬化危险因素分析

目的分析中年人群颈动脉粥样硬化的相关危险因素,以便有针对性实施预防干预措施。方法回顾性分析我院诊断缺血性脑血管病158例,筛查出符合颈动脉粥样硬化105例,分成中年组及老年组,比较其危险因素。结果中年组高血压(50%)、高脂血症(33%)、糖尿病(19%)、吸烟(36%)、饮酒(31%);老年组高血压(60%)、高脂血症(46%)、糖尿病(24%)、吸烟(16%)、饮酒(8%)。结论中年人颈动脉粥样硬化的危险因素与吸烟、饮酒等不良生活嗜好关系更为密切,同时高血压、糖尿病及高胆固醇血症也是重要的危险因素。     

脑梗死患者颈动脉粥样硬化的危险因素分析

目的探讨急性脑梗死患者颈动脉粥样硬化的危险因素以及影响斑块稳定性的因素。方法入选2005~2006年间住院的急性脑梗死患者644例,超声检查其颈动脉内膜-中层厚度(intima-media thickness,IMT)及颈动脉斑块情况,并与血管性危险因素和代谢因素进行相关分析。结果年龄、吸烟、糖尿病史、收缩压、总胆固醇及血清尿酸增高与颈动脉IMT增厚存在独立相关性,而年龄、收缩压、总胆固醇及脂蛋白(a)增高则可独立预测颈动脉斑块的形成。性别、高血压史、总胆固醇及高密度脂蛋白和颈动脉斑块的稳定性之间存在独立相关性。结论年龄、吸烟、糖尿病史、收缩压、总胆固醇、脂蛋白(a)及血清尿酸增高可独立预测颈动脉粥样硬化。     

同型半胱氨酸与颈动脉粥样硬化、脑梗死的关系

目的研究同型半胱氨酸(Hcy)与颈动脉粥样硬化(AS)的关系,探讨其对缺血性脑卒中事件预测的临床意义。方法对85例脑梗死患者(病例组)与30倒健康体检者(对照组)采用高效色谱分析法进行Hcy水平测定,并进行彩色多普勒超声进行颈动脉检测。结果病例组和对照组空腹血浆Hcy升高分别有29例和4例,占34．2％和13．3％,血浆Hcy浓度分别为 (19．28±4．33)μmol/L和(11．32±3．86)μmol/L,差异有统计学意义(P<0．001);对照组有颈AS 3例,平均血浆Hcy浓度 (18．55±3．66)μmol/L;无颈AS 27例,平均血浆Hcy浓度(10．13±3．50)μmol/L,差异有统计学意义(P<0．05);44例正常Hcy 脑梗死患者发生颈AS28例,轻度15例,中度8例,重度5例,颈动脉狭窄程度轻度18例,中度5例,重度5例;41例高Hcy脑梗死患者发生颈AS 25例,轻度6例,中度12例,重度7例,颈动脉狭窄程度轻度4例,中度10例,重度11例。结论高同型半胱氨酸血症是动脉硬化期的一个独立危险因素,也是缺血性脑卒中的一个独立危险因素。     

脑卒中高危人群中颈动脉粥样硬化的现况调查及危险因素分析

目的了解脑卒中高危人群颈动脉粥样硬化(Carotid atherosclerosis,CAS)的发病情况及相关的危险因素。方法对海口市美兰区40岁以上的居民筛查,筛选出脑卒中高危人群进一步颈部血管超声检查、实验室检查。分CAS组和非CAS组,统计分析CAS的发病率及相关危险因素。结果 CAS检出率44.7%。性别、年龄、吸烟、肥胖、高血压、高血脂、糖尿病、既往脑卒中史,高Hcy和FBS在2组比较差异有统计学意义(P<0.05)。结论年龄、男性、吸烟、超重、高血压、高血脂、糖尿病、既往脑卒中史,高Hcy和FBS均为海口市美兰区脑卒中高危患者CAS的独立危险因素。     

高分辨磁共振检查对颈动脉粥样硬化斑块稳定性的危险因素分析

目的探讨通过高分辨磁共振检查发现不稳定型颈动脉粥样硬化斑块的危险因素。方法回顾性分析2018-01—2019-08就诊于新乡医学院第一附属医院74例缺血性脑血管症状的住院及门诊病人的临床资料。根据高分辨磁共振检查结果,分稳定斑块组34例,不稳定斑块组40例,筛选影响颈动脉粥样硬化斑块稳定性的危险因素。结果单因素分析发现:年龄、性别、吸烟、饮酒、血TC、TG、LDL、Hcy是影响颈动脉粥样硬化斑块稳定性的危险因素,差异有统计学意义(P0.05)。多因素回归分析显示:年龄、Hcy、TC、LDL同时是不稳定型颈动脉粥样硬化斑块的独立危险因素,差异有统计学意义(P0.05)。结论影响颈动脉粥样硬化斑块稳定性的危险因素较多:年龄、性别、吸烟、饮酒、血脂异常、Hcy等,因此应注意早期识别及干预,进一步减少脑血管病的发生。     

影响颈动脉粥样硬化易损斑块对称性分布的危险因素分析

目的探讨影响颈动脉粥样硬化斑块对称性分布的危险因素。方法前瞻性入组81例缺血性卒中患者作为研究对象,均进行了颈动脉多对比序列、黑血、高分辨磁共振成像(magnetic resonance imaging,MRI)。根据MRI结果将患者分为颈动脉无易损斑块组(40例)、单侧易损斑块组(26例)和双侧易损斑块组(15例)。记录患者年龄、性别、高血压、糖尿病、目前吸烟史、血压值、脉压、体质指数(body mass index,BMI)和血脂水平等临床资料。采用Logistic回归分析颈动脉易损斑块形成的危险因素。结果单因素分析显示,无易损斑块组、单侧易损斑块组和双侧易损斑块组患者在高血压病史、目前吸烟史、体质指数、收缩压等方面差异具有显著性。多因素Logistic回归分析显示,目前吸烟史是易损斑块对称性分布的独立影响因素[比值比(odds ratio,OR)3.136,95%可信区间(confidence interval,CI)1.122~8.766,P=0.03]。结论目前吸烟史与颈动脉易损斑块的对称性分布有相关性。     

他汀类药物与颈动脉粥样硬化斑块

卒中,尤其是缺血性卒中的发病率居高不下,颈动脉粥样硬化斑块作为缺血性卒中的重要危险因素,成为近年研究的热点,积极治疗颈动脉粥样硬化斑块成为防治缺血性卒中的重要手段之一。他汀类药物的调脂、稳定及逆转斑块的作用,得到了多项临床试验的肯定,并在临床应用上逐渐推广：下面结合动脉粥样硬化的发病机制,对他汀类药物治疗颈动脉粥样硬化斑块的机制进行综述。     

Comparison of Carotid Atherosclerosis between Patients at High Altitude and Sea Level: A Chinese Atherosclerosis Risk Evaluation Study

Objectives: To investigate the differences in characteristics of carotid plaques between patients Xining at high altitude and Jinan at sea level using magnetic resonance (MR) imaging. Methods: Subjects were recruited from a cross-sectional, observational, multicenter imaging study of CARE-II study. Forty-nine (mean age 63.3 ± 12.0 years, 33 males) and 51 (mean age 64.5 ± 12.0 years, 34 males) patients were recruited from a site located in a high altitude region and a site located near sea level, respectively. All patients underwent multicontrast MR vessel wall imaging for carotid arteries on 3.0 T MR scanner. The carotid plaques features were compared between 2 patient groups. Results: Compared with patients at sea level, those at high altitude had significantly greater lumen area (58.5 ± 17.8 mm² versus 50.0 ± 19.6 mm², P = .008), smaller maximum normalized wall index (48.6% ± 14.2% versus 57.8% ± 16.3%, P = .002), and smaller percentage volume of calcium (0.9% versus 5.6%, P < .001) in the symptomatic carotid artery. After adjustment for clinical risk factors including age, sex, systolic blood pressure, LDL-C, and statin use, these differences in plaque morphology and composition remained statistically significant. After further adjustment for normalized wall index as a measure of plaque burden, percentage volume of calcification was still significantly smaller in patients at high altitude area than that in patients at sea level area (P = .047). Conclusion: Symptomatic subjects from a high altitude area have lower plaque burden and less calcification in the carotid artery compared to those from an area near sea level.     

Risk Factors Differ for Carotid Artery Plaque With and Without Acoustic Shadowing

To investigate the association of gender, ethnicity, and several cardiovascular risk factors with carotid artery plaque and plaque with acoustic shadowing in a population-based sample, high-resolution B-mode ultrasonography was used to characterize lesions in the common and internal carotid arteries, and at the carotid bifurcation in 12,796 US men and women, aged 45 to 64 years, participating in the Atherosclerosis Risk in Communities Study (ARIC) baseline survey. In multiple logistic regression analyses, male gender (odds ratio and 95% confidence interval: 1.52 [1.39–1.67]) and increased total (1.47 [1.32–1.63]) and low-density-lipoprotein cholesterol (1.49 [1.34–1.65]) levels were statistically significantly associated only with the presence of plaque. In contradistinction, smoking (2.22 [1.79–2.75]) and hypertension (1.54 [1.30–1.82]) were additionally associated with acoustic shadowing. Hyperfibrinogenemia (1.33 [1.12–1.59]) was associated only with lesions accompanied by acoustic shadowing. While ethnicity associations with plaque alone varied across the artery segments, among those with plaque, being white was uniformly associated with acoustic shadowing. After multivariable adjustment, high-density-lipoprotein cholesterol was not associated with either manifestation of atherosclerosis. In conclusion, differences were seen in the associations of established cardiovascular risk factors with discretely characterized carotid artery plaque lesions, according to the presence or absence of acoustic shadowing suggestive of mineralization of plaque.     

Association of Carotid Plaques and Common Carotid Intima-media Thickness with Modifiable Cardiovascular Risk Factors

ObjectiveTo assess the association of carotid plaques and common carotid artery intima-media thickness with traditional modifiable cardiovascular risk factors.MethodsWe examined 4,266 participants aged 35–74years in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline. The presence of plaques at all carotid arteries sites was evaluated. The mean far wall common carotid artery intima-media thickness was measured. To evaluate the association of cardiovascular risk factors with plaques and plaque burden, we applied logistic regression models presented as crude, adjusted by sociodemographic variables, along with multivariate further adjustment for hypertension, diabetes, hypercholesterolemia, and smoking. For the association of cardiovascular risk factors and common carotid artery intima-media thickness, linear regression models were used with the same adjustments.ResultsMedian age was 51 years (interquartile range: 45–58 years; 54.5% of females). Plaque prevalence in at least one segment of the carotid arteries was 35.9%. Mean common carotid artery intima-media thickness of the far walls was 0.609 ± 0.133 mm. In the multivariate model for plaque presence, the odds ratios were:1.39 (1.19–1.63) for hypertension;1.58 (1.36–1.82) for hypercholesterolemia; 2.00 (1.65–2.43),1.19 (1.02–1.40) for current and past smoking, and 1.13 (0.95–1.35) for diabetes. In the multivariate linear regression models, common carotid artery intima-media thickness beta-coefficients were: 0.035 mm (0.027–0.043) for hypertension; 0.020 mm (0.013–0.027) for hypercholesterolemia; 0.020 mm (0.010–0.029), 0.012 mm (0.004–0.020) for current and past smoking, and 0.024 mm (0.015–0.033) for diabetes.ConclusionCardiovascular risk factors were independently associated with increasing common carotid artery intima-media thickness, plaque prevalence, and plaque scores. Diabetes did not show an independent association with plaques in the multivariate model.     

颈动脉几何形态——60岁及以下无高危因素人群颅内动脉粥样硬化的潜在预测指标

目的 基于头颈联合HR-MRI技术,探讨在60岁及以下无传统心脑血管高危因素的人群中,颈动脉几何形态与大脑中动脉（middle cerebral artery,MCA）粥样硬化的相关性,寻找MCA粥样硬化的潜在预测指标。方法 回顾性分析来自60岁及以下无传统心脑血管高危因素患者的150个同侧前循环动脉单位,根据MCA是否存在动脉粥样硬化斑块将其分为MCA粥样硬化（+）组和MCA粥样硬化（-）组。分析两组间颈动脉分叉夹角、颈动脉管腔面积比值和颈内动脉颅外段及颅内段的形态分型,并采用多因素logistic回归探索MCA粥样硬化的独立相关因素,绘制ROC曲线分析颈动脉几何形态对MCA粥样硬化的预测效能。结果 与MCA粥样硬化（-）组（113个）相比,MCA粥样硬化（+）组（37个）颈动脉分叉夹角更大[41.2°（28.8°～56.5°）vs. 32.6°（24.7°～46.2°）,P=0.026],而流出道与流入道管腔面积比值更大、颈内动脉颅外段形态平滑型更少、迂曲型和扭折型更多、颅内段形态钝角型更少、直角型和锐角型更多,但差异无统计学意义。多因素logistic回归分析结果显示,颈动脉分叉夹角与MCA粥样硬化独立相关（每增加10°,OR 1.232,95%CI 1.007～1.507,P=0.042）,逐步退后logistic回归分析结果相同（每增加10°,OR 1.276,95%CI 1.050～1.550,P=0.014）;ROC曲线显示,颈动脉分叉夹角预测MCA粥样硬化的AUC为0.622（95%CI 0.515～0.730）,最佳截断值为37.0°,敏感度为57.5%,特异度为64.9%。结论 对于60岁及以下无传统心脑血管高危因素人群,颈动脉分叉夹角与MCA粥样硬化独立相关,有望成为颅内动脉粥样硬化的有效影像学标志物。