超声探讨糖尿病患者颈动脉血管弹性的研究

目的应用超声探讨早期定量评价糖尿病患者颈动脉血管弹性。方法随机选取2013年度体检者168人,分为对照组36例及糖尿病组132例。测定体质量指数(BMI)、收缩压、舒张压、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、三酰甘油(TG)、空腹血糖(FPG)、空腹胰岛素(FINS)、糖化血红蛋白(Hb A1c)、高敏C反应蛋白(hs-CRP)、同型半胱氨酸(Hcy)、尿微量白蛋白(U-MA)、餐后2 h血糖(P2h BG)及餐后2 h胰岛素(PINS)等指标。应用血管回声跟踪技术(ET)测量内-中膜厚度(IMT)、僵硬度(β)、弹性系数(EP)、顺应性(AC)、膨大指数(AI)以及脉搏波传导速度(PWVβ)。比较对照组与糖尿病组、糖尿病组中正常与异常Hb A1c的颈动脉弹性指标,Spearman分析糖尿病组中血糖相关指标与颈动脉血管弹性指标的相关性。结果糖尿病组与对照组的双侧IMT、β、Ep、PWVβ差异有统计学意义;糖尿病组中Hb A1c正常组与异常组的β、Ep、AC、PWVβ差异有统计学意义;糖尿病组颈动脉的β、Ep、PWVβ与FINS、PBG、PINS成正相关,β、PWVβ与Hb A1c成正相关,AC与PBG成负相关。结论 ET可用于检测糖尿病患者的动脉弹性,对血管内皮功能作出早期评估,在糖尿病患者早期动脉粥样硬化的诊断、治疗和预防中有重要的应用价值。     

血管回声跟踪技术评价单纯性肥胖儿童颈动脉弹性的研究

目的 应用血管回声跟踪技术(E-Tracking技术)评价单纯性肥胖儿童颈动脉弹性.方法 采集50例单纯性肥胖儿童(肥胖组)及50例健康儿童(对照组)双侧颈总动脉的超声图像,测量内膜-中层厚度(IMT)、阻力指数(RI)、搏动指数(PI)及收缩期与舒张期比值(S/D),应用E-Tracking技术自动测量颈总动脉收缩末期内径(Ds)、舒张末期内径(Dd)、压力应变弹性指数(E ρ)、硬度指数(β)、顺应性(AC)、增大指数(AI)、单点脉搏波传导速度(PWV β).结果肥胖组IMT较对照组明显增厚[左侧颈总动脉(0.60±0.07)mm比(0.46±0.04)mm;右侧颈总动脉(0.61±0.05)mm比(0.47±0.03)mm,P<0.01],两组Ds、Dd、RI、PI、S/D和Al比较差异无统计学意义(P>0.05).而肥胖组Eρ、β、PWVβ均明显高于对照组,AC显著低于对照组(P<0.05).结论 单纯性肥胖儿童颈动脉有早期动脉粥样硬化趋势,应用E-Tracking技术能快速、无创、准确地定量评价颈动脉弹性.     

眼血流动力学参数对2型糖尿病视网膜病变的早期诊断价值

目的探讨眼血流动力学参数对2型糖尿病患者视网膜病变的早期诊断价值。方法采用彩色多普勒血流成像（CDFI）技术检测40例（80眼）2型糖尿病患者和40个（80眼）正常健康人视网膜中央动脉（CRA）的收缩期峰值流速（PSV）、舒张末期峰值流速（EDV）及阻力指数（RI）,并比较上述血流动力学参数的结果。结果两组患者视网膜中央动脉PSV、EDV、RI间差异均有统计学意义（P〈0.05）。结论 2型糖尿病视网膜病变患者眼血流动力学参数有明显的变化,采用CDFI技术检测眼血流动力学参数对糖尿病视网膜病变的早期诊治具有重要的临床意义。     

肾内血流动力学检测在早发型重度先兆子痫中的应用价值评价

目的评价肾内血流动力学指标检测在早发型重度先兆子痫孕妇中的临床应用价值。方法回顾性分析132例接受彩色多普勒超声检测的早发型重度先兆子痫孕妇的临床资料,根据是否存在肾功能障碍分为：研究组,共64例,合并有肾功能障碍;对照组,共68例,未合并有肾功能障碍。应用彩色多普勒超声检测及比较两组患者的肾内血流动力学指标,即搏动指数（PI）、阻力指数（RI）、收缩期舒张期比值（S／D）、收缩期峰值流速（Psv）及舒张末期流速（EDv）;检测及比较两组患者的肾功能、No及ET-1水平;应用Pearson相关分析分别评估肾内血流动力学指标（PSV、EDV、S／D、PI、RI）与肾功能、No及ET-1水平的相关性。结果与对照组相比,研究组的PI、RI及s／D较高（P〈0．05）,而PSV及EDv则较低（P〈0．05）;研究组的BUN、Cr、24h尿蛋白定量、ET-1水平及NO较高（P〈0．05）,以上差异均有统计学意义。肾内血流动力学指标S／D、PI、RI与肾功能、NO及ET-1水平均呈正相关关系（P〈0．05）。结论肾内血流动力学指标检测能反映早发型重度先兆子痫患者肾损害,具有临床应用价值。     

颈部血管超声检查对急性脑卒中患者术后不良心脑血管事件的预测价值研究

目的 探讨颈部血管超声检查对急性脑卒中患者术后不良心脑血管事件的预测价值。方法 96例急性脑卒中患者均行颈部血管超声检查,根据术后1年内是否发生不良心脑血管事件分为发生组和未发生组,比较两组动脉管腔内径-内中膜厚度（IMT）及血流参数[收缩期峰值流速（VS）、舒张期末流速（VD）、搏动指数（PI）、阻力指数（RI）]。绘制ROC曲线分析各指标对急性脑卒中患者术后不良心脑血管事件的预测价值。结果 发生组的动脉粥样硬化占比及IMT均高于未发生组（P <0.05）。发生组颈内动脉和颈外动脉的VS、 VD均低于未发生组,颈内动脉和颈外动脉的PI均高于未发生组（P <0.05）。ROC曲线分析显示,IMT及颈内动脉和颈外动脉的VS、 VD、 PI对急性脑卒中患者术后不良心脑血管事件均具有显著的预测价值（P <0.05）。结论 颈部血管超声检查可有效反映颈动脉血流特征,对急性脑卒中患者术后不良心脑血管事件具有显著的预测价值。     

2型糖尿病患者踝肱指数异常相关危险因素分析

目的 了解踝肱指数fankle—braehialindex,ABI）和左右臂踝脉搏波传播速度（brachial—anklepulsewavevelocity,baPWV）对诊断糖尿病下肢动脉病变的意义及ABI异常的相关危险因素。方法收集住院的2型糖尿病（T2DM）患者100例,检测其ABI和baPWV,根据ABl分为两组,ABI〈0．9为糖尿病下肢外周动脉病变（peripheralarterialdisease,PAD）组、ABI≥0．9为非PAD组,测量身高、体重、血压、血脂、尿微量白蛋白、血肌酐水平,行双下肢血管彩色多普勒超声和超声心动图检查。对与ABI相关的因素行多重线性回归分析,筛选ABI的独立危险因素。结果100例2型糖尿病患者中,ABI≥0．9组82例（占82％）,ABI〈0．9组18例（占18％）。ABI〈0．9组患者的年龄、糖尿病病程、左右baPWV绝对差值、下肢动脉血管狭窄程度、24h尿微量白蛋白（MAU）、血肌酐及高血压、冠心病、糖尿病肾病发病率均高于ABI≥0．9组患者,差异有统计学意义（P〈0．05）。多重线性回归分析显示,ABI与下肢动脉血管狭窄程度β=-0．429,P=0．023）、左右baPWV绝对差值（β=-0．131,P=0．012）独立相关。结论下肢动脉血管狭窄程度、左右baPWV绝对差值是ABI的独立危险因素,临床上可以联合左右baPWV绝对差值和ABI共同筛选PAD患者,从而减少假阳性和假阴性率。     

彩超对糖尿病眼底血管血流动力学改变的观察研究

目的：观察糖尿病（DM）患者眼底视网膜中央动、静脉血流动力学改变。方法选取本院已确诊DM 患者40例,与相同年龄段健康人群40例,分别测量视网膜中央动脉（CRA）峰值流速（PSV）、阻力指数（RI）及视网膜中央静脉（CRV）血流速度（Vmin）的血流动力学参数进行对比。结果 DM患者CRA的PSV较同龄人均有不同程度下降对照组（9.68±1.43） cm/s,DM组（7.99±1.45） cm/s, DM患者RI均有不同程度增高对照组（0.62±0.06）,DM组（0.80±0.08）,P〈0.01,差异有显著性;而CRV的血流速度则有不同程度增高,P〈0.01,差异有显著性。结论糖尿病DM患者CRA、CRV存在明显血流动力学改变,提示血管硬化,其改变程度与患者血糖升高程度正相关应用彩色多普勒检查可以体现这一改变。     

阴道彩色多普勒超声对卵巢肿瘤血管生成的预测作用

目的探讨经阴道彩色多普勒超声（transvaginalcolorDopplerultrasound,TV-CDU）血流动力学参数与卵巢肿瘤微血管密度（microvesseldensity,MVD）的相关性,预测卵巢肿瘤的良、恶性及恶性肿瘤的临床分期、组织学分级、有无淋巴结转移等。方法对2004年1月至2005年12月本院收治的82例卵巢肿瘤患者,于术前行经阴道彩色多普勒超声检查,记录血流动力学参数：搏动指数（pulsatilityindexPI）、阻力指数（resistiveindex,RI）、收缩期峰速率（peaksystolicvelocity,Vps）、血管数目（vesselsnumber,VN）。术后采集血流丰富对应区域组织标本进行免疫组化染色,检测其微血管密度。结果阻力指数、血管数目与微血管密度有相关关系（P〈0．01）,阻力指数与微血管密度呈负相关,血管数目与微血管密度呈正相关。卵巢恶性肿瘤的阻力指数较良性肿瘤低,血管数目较良性肿瘤高（P〈0．05）。卵巢恶性肿瘤的组织学分级中,低分化组血管数目比高、中分化组低（P〈0．05）,阻力指数比较,则差异无显著意义（P〉0．05）;在有无淋巴结转移组之间,有淋巴结转移组阻力指数低于无淋巴结转移组,血管数目则高于无淋巴结转移组（P〈0．05）。而恶性肿瘤的国际妇产科联盟（InternationalFederationofGynecologyandObstetrics,FIGO）临床分期中,Ⅰ期患者与其他较晚期患者之间阻力指数、血管数目比较,差异无显著意义（P〉0．05）。结论低阻力指数、高血管数目反映了组织内的高微血管密度状态,并且与卵巢恶性肿瘤的组织学分级、有无淋巴结转移有关。     

肝硬化病人肾血流变化的临床研究

目的研究肝硬化患者肾脏血液动力学的变化.方法对49例肝硬化病人采用彩色多普勒超声测定肾叶间动脉及弓形动脉搏动指数(PI)、阻力指数(RI)及收缩期最高峰值/舒张期最低峰值(PS/PD)等指数,并同时监测患者的血内皮素情况.结果肝功能越差,搏动指数和阻力指数越高,尤以RI为著;随腹水量的增加,肝硬化病人的PI、RI等亦有明显增高.肝硬化血内皮素(ET)的增高与PI及RI增高密切相关.结论通过多普勒超声发现肝硬化患者肾血流与肝功能有直接相关性,肝硬化腹水和肾血流亦有相关性,而顽固性腹水PI、RI的演变可能有助于早期发现肝肾综合征(HRS);血内皮素水平在肝硬化病人中明显增高,且与肾血管阻力的增加呈正相关,因而内皮素可能是参与肝硬化病人肾血管收缩的重要活性因子.     

肝硬化病人肾血流变化的临床研究

目的　研究肝硬化患者肾脏血液动力学的变化。方法　对 49例肝硬化病人采用彩色多普勒超声测定肾叶间动脉及弓形动脉搏动指数 (PI)、阻力指数 (RI)及收缩期最高峰值 /舒张期最低峰值 (PS/PD)等指数 ,并同时监测患者的血内皮素情况。结果　肝功能越差 ,搏动指数和阻力指数越高 ,尤以RI为著 ;随腹水量的增加 ,肝硬化病人的PI、RI等亦有明显增高。肝硬化血内皮素 (ET)的增高与PI及RI增高密切相关。结论　通过多普勒超声发现肝硬化患者肾血流与肝功能有直接相关性 ,肝硬化腹水和肾血流亦有相关性 ,而顽固性腹水PI、RI的演变可能有助于早期发现肝肾综合征 (HRS) ;血内皮素水平在肝硬化病人中明显增高 ,且与肾血管阻力的增加呈正相关 ,因而内皮素可能是参与肝硬化病人肾血管收缩的重要活性因子     

3．0T磁共振动态血管成像技术的方法探讨

目的：探讨3．0T磁共振动态血管成像（TRICKS）的技术方法及临床应用价值。方法：采用3．0T高场强磁共振检查仪，对30例病人进行靶血管TRICKS检查。其中脑动脉5例，颈动脉7例，肺动脉2例，胸、腹主动脉5例，上肢动脉2例，股动脉9N。增强后与增强前的图像数据自动进行减影，得到血管图像，制作成动画。结果清晰地动态显示靶血管的解剖结构及病变情况。23例经数字减影血管造影（DSA）或手术证实。结论：合适的注药速率及注药量，合理选择扫描参数可以得到高质量的类似DSA的动态血管图像。     

早期股骨头缺血坏死介入治疗的临床研究

目的通过对早期股骨头缺血坏死介入治疗的临床分析,评价该手术方法的临床意义。方法对28例早期股骨头缺血坏死患者(共计28个髋),采用超选择性股骨头供血血管灌注具有扩张血管、溶栓、改善微循环作用的药物进行治疗。结果患者治疗后股骨头区域血管增加,疼痛缓解至消失,28例患者经1～2年追踪观察,有效率达89.3%(25/28)。结论血管内介入治疗早期股骨头缺血坏死能显著地改善股骨头的局部血液循环,减轻临床症状,改善髋关节功能,具有积极的临床价值。     

三例家族性高胆固醇血症患者动脉血管超声检查随访

目的探讨家族性高胆固醇血症(FH)的腹部及外周动脉血管动态的变化。方法对3个FH家系中3名子女(先证者)进行血管超声检查，观察动脉内-中膜厚度(IMT)、管腔狭窄程度、血液动力学改变、有无斑块以及斑块数量。结果3名FH患者的颈动脉斑块较前增多，颈总动脉、股总动脉IMT亦明显增厚，而锁骨下动脉、椎动脉、腹主动脉、肾动脉、髂动脉、月国动脉治疗前后均未见明显内膜增厚结论无创伤性血管超声检查可以作为观察FH血管改变的首选影像学的随访方法。     

早期股骨头缺血坏死介入治疗的临床研究

目的通过对早期股骨头缺血坏死介入治疗的临床分析,评价该手术方法的临床意义。方法对28例早期股骨头缺血坏死患者（共计28个髋）,采用超选择性股骨头供血血管灌注具有扩张血管、溶栓、改善微循环作用的药物进行治疗。结果患者治疗后股骨头区域血管增加,疼痛缓解至消失,28例患者经1～2年追踪观察,有效率达89．3％（25／28）。结论血管内介入治疗早期股骨头缺血坏死能显著地改善股骨头的局部血液循环,减轻临床症状,改善髋关节功能,具有积极的临床价值。     

Pro- vs anti-stenotic capacities of type-I vs type-II human induced pluripotent-derived endothelial cells

AIM: To verify in vivo relevance of the categorization of human vascular endothelial cells (VECs) into type-I (pro-proliferative) and type-II (anti-proliferative). METHODS: Endothelial layers of murine femoral arteries were removed by wire injury (WI) operation, a common technique to induce arteriostenosis. Type-I and type-II VECs produced from human induced pluripotent stem cells (iPSCs), whose characters were previously determined by their effects on the proliferation of vascular smooth muscle cells in in vitro co-culture experiments, were mixed with Matrigel^® Matrix. The mixtures were injected into subcutaneous spaces around WI-operated femoral arteries for the transplanted human iPSC-derived VECs (iPSdECs) to take a route to the luminal surface via vasa vasorum, a nutrient microvessel for larger arteries. Histologies of the femoral arteries were examined over time. The presence of human iPSdECs was checked by immunostaining studies using an antibody that specifically recognizes human VECs. Degrees of stenosis of the femoral arteries were calculated after three weeks. To determine the optimal experimental condition, xenotransplantation experiments were performed under various conditions using immunocompromised mice as well as immunocompetent mice with or without administration of immunosuppressants. RESULTS: Because immunocompromised mice showed unexpected resistance to WI-induced arteriostenosis, we performed xenotransplantation experiments using immunocompetent mice along with immunosuppressant administrations. After one week, luminal surfaces of the WI-operated arteries were completely covered by human iPSdECs, showing the efficacy of our novel transplantation technique. After three weeks, type-I-iPSdECs-transplanted arteries underwent total stenosis, while type-II-iPSdECs-transplanted arteries remained intact. However, untransplanted arteries of immunosuppressant-treated mice also remained intact by unknown reasons. We found that transplanted human VECs had already been replaced by murine endothelial cells by this time, indicating that a transient existence of human type-II-iPSdECs on arterial luminal surfaces can sufficiently prevent the development of stenosis. Thus, we re-performed xenotransplantation experiments using immunocompetent mice without administrating immunosuppressants and found that arteriostenosis was accelerated or prevented by transplantation of type-I or type-II iPSdECs, respectively. Similar results were obtained from the experiments using human embryonic stem cell-derived VECs at early passages (i.e., type-II) and late passages (i.e., type-I). CONCLUSION: Pro- and anti-stenosis capacities of type-I and type-II human iPSdECs were verified, respectively, promising a therapeutic application of allogenic iPSdECs.     

16排螺旋CT血管成像在周围血管病的应用

目的:探讨16排螺旋CT血管成像在下肢动脉阻塞性病变诊断中的价值。方法:对48例疑有下肢动脉硬化、阻塞性病变患者在血管动脉期进行16排螺旋CT容积扫描,重建动脉血管的三维图像。结果:6例腹主动脉下段闭塞,11例髂动脉闭塞,21例股浅动脉闭塞,6例股浅动脉狭窄,4例动脉闭塞。结论:16排螺旋CT血管成像在评价下肢动脉阻塞性病变方面与DSA结果基本一致,是一项高度准确的成像技术和非侵袭性检查方法。     

Percutaneous recanalization of occluded upper leg arteries using laser treatment

Percutaneous transluminal laser recanalization was attempted in 21 patients with occluded superficial femoral arteries and 'life style limiting claudication'. Primary success was achieved in 20 (95%) of these total occlusions. In 7/21 no laser energy was required. At one month only 1 patient had claudication and the mean Doppler ankle/arm systolic pressure ratio had increased by 0.36 +/- 0.19 (p less than 0.001) at rest and 0.47 +/- 0.34 (p less than 0.001) after exercise. Complications directly attributable to the procedure were: perforation (1), peripheral embolic episodes (2), haematoma (1), transient vasospasm (2). All complications could be treated non-surgically. These preliminary data suggest that laser recanalization of relatively short occlusions of the superficial femoral artery, followed by balloon dilatation, may be accomplished with satisfactory acute and short-term results, but not without risk.     

A review of sitaxsentan sodium in patients with pulmonary arterial hypertension

Pulmonary arterial hypertension (PAH) is a life threatening, progressive condition which eventually leads to fatal right heart failure. Endothelin-1 (ET-1), a potent vasoconstrictor peptide, is increased in the pulmonary arteries of patients with pulmonary hypertension. Endothelin-1 acts through the stimulation of 2 subtypes of receptors (endothelin receptor subtypes A [ET(A)] and B [ET(B)]). In PAH patients, ETRAs block the deleterious vasoconstrictor effects of ET-1, and ETRA treatment in PAH patients has been shown to be safe and efficacious. Sitaxsentan is an orally active, highly ET(A) selective ETRA that, in clinical trials, has demonstrated improvements in exercise capacity, functional class and hemodynamics in PAH patients. Sitaxsentan has been shown to be safe, well tolerated, and associated with a lower incidence of liver toxicity than other approved ETRAs.     

Salivary endothelin and vascular disorders in vibration-exposed workers

OBJECTIVES: This study investigated the relation between salivary endothelin, vibration exposure, and vascular disorders in a group of forestry workers. METHODS: Altogether 54 forestry workers and 52 controls underwent a medical examination and a cold test with measurement of the percentage of change in finger systolic blood pressure after finger cooling from 30 degrees C to 10 degrees C (FSBP% (10 degrees)). Salivary endothelin concentration (ET(1-21), in fmol/ml) was measured by a commercially available enzyme-linked immunosorbent assay before and after the cold challenge. The anamnestic diagnosis of vibration-induced white finger (VWF), assisted by color charts, was based on the Stockholm Workshop criteria. RESULTS: Six forestry workers (11%) and one control (2%) reported white fingers. Before the cold challenge, the salivary ET(1-21) concentration was significantly greater in the VWF workers than in the controls (P=0.036). The cold response of digital arteries was stronger in the VWF workers than in the controls (P<0.001) and the asymptomatic forestry workers (P=0.008). After the cold test, there was a small, not significant, increase in the salivary ET(1-21) concentration in both the controls and the forestry workers. For the latter, the salivary ET(1-21) concentration was significantly associated with both daily and total operating time with vibrating tools. A significant inverse relation between FSBP% (10 degrees )and the salivary ET(1-21) concentration was observed for the forestry workers with an abnormal cold response in their digital arteries. CONCLUSIONS: This study showed an association between salivary ET(1-21) concentration, daily and cumulative vibration exposure, and vascular disorders in the fingers of professional forestry workers. Since ET(1-21) can induce powerful and long-lasting constriction of human vessels, these findings suggest a possible role of this vasopeptide in the pathogenesis of VWF.     

REGRESSION AND PROGRESSION OF FEMORAL ATHEROSCLEROSIS IN HUMAN BEINGS TREATED FOR HYPERLIPOPROTEINEMIA

Nine of 22 patients demonstrated regression of atherosclerotic lesions in their femoral arteries when they were treated with diet and drugs to control their hyperlipoproteinemic states. The patients had no symptoms of claudication, yet they had demonstrable atherosclerotic lesions in their femoral artery prior to study.