糖尿病合并冠心病患者血浆组织蛋白酶S和血小板反应蛋白-1浓度与心力衰竭的关系

目的探讨糖尿病合并冠状动脉粥样硬化性心脏病(冠心病)患者血浆组织蛋白酶S(cathepsin S,CatS)和血小板反应蛋白-1(thrombospondin-1,TSP-1)浓度与心力衰竭的关系。方法将浦东新区人民医院2016年9月至2019年1月间收治的197例糖尿病患者根据临床情况及冠状动脉造影检查结果院体检健康者80名为对照组。测定各组低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)、高密度脂蛋白胆固醇(highdensity lipoprotein cholesterol,HDL-C)、糖化血红蛋白(hemoglobin A1c,HbA1c)、总胆固醇(total cholesterol,TC)、三酰甘油(triglyceride,TG)、收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、空腹血糖(fasting plasma glucose,FPG)、餐后2 h血糖(2 h postprandial blood sugar,2 hPBG)浓度、射血分数(ejection fraction,EF)、左心室舒张末期容积(end-diastolic volume,EDV)、左心室收缩末容积(end systole vol⁃ume,ESV)及血浆CatS和TSP-1浓度,并对两组相关指标进行比较和相关性分析。结果与对照组相比,合并组及单纯组患者ESV、EDV、HbA1c、LDL-C、FPG、2 hPBG、TC、TG、DBP、SBP显著升高,EF、HDL-C则明显下降,差异有统计学意义(P<0.05)。合并组与单纯组比较,除LDL-C、FPG、SBP比较差异无统计学意义(P>0.05)外,合并组ESV、EDV、HbA1c、HDL-C、2 hPBG、TC、TG及DBP均较单纯组高,EF较单纯组低,差异均有统计学意义(P<0.05)。单纯组及合并组CatS和TSP-1浓度高于对照组,差异有统计学意义(P<0.05);合并组CatS和TSP-1浓度明显高于单纯组,差异有统计学意义(P<0.05)。相关分析结果:TSP-1与LDL-C(r=0.453,P<0.01)、HbA1c(r=0.629,P<0.01)、HDL-C(r=0.435,P<0.01)、EDV(r=0.364,P<0.01)、ESV(r=0.408,P<0.01)呈正相关;与EF(r=-0.317,P<0.01)呈负相关。CatS与LDL-C(r=0.426,P<0.01)、HbA1c(r=0.530,P<0.01)、HDL-C(r=0.345,P<0.01)、EDV(r=0.380,P<0.01)、ESV(r=0.395,P<0.01)呈正相关;与EF(r=-0.465,P<0.01)呈负相关。结论糖尿病合并冠心病及心力衰竭患者血浆CatS和TSP-1浓度较单纯糖尿病患者高,可通过检测血浆CatS和TSP-1浓度来预测患者的心功能情况。     

高血压患者血脂和脂蛋白水平与冠状动脉狭窄的关系

目的探讨高血压患者血脂和脂蛋白水平与冠状动脉狭窄的关系。方法本研究回顾性分析1140例因胸痛住院接受冠状动脉造影且规则接受药物治疗的高血压病患者的血清总胆固醇(TC)、低密度脂蛋白胆固醇(LDL C)水平与冠状动脉狭窄的相关性。结果①除高密度脂蛋白胆固醇(HDL C)外,高血压病患者严重冠状动脉狭窄的发生与年龄、病程、收缩压(SBP)、舒张压(DBP)、血糖、体重指数(BMI)、吸烟和TC、LDL-C相关(P<0.001)。②随着TC、LDL-C水平增高,冠状动脉狭窄级数、狭窄≥75%血管支数和狭窄≥75%的例数均明显增加(P<0.01)。③Logistic回归分析显示,TC、LDL-C与高血压病患者严重冠状动脉狭窄(≥75%)发生存在明显的相关性,TC、LDL-C每增加0.51mmol/L(分别以5.17mmol/L和3.10mmol/L为基线),严重冠状动脉狭窄发生率增加32%及33%(95%CI:1.25～1.39及1.23～1.43,P均<0.0001);在对年龄、性别、SBP、DBP、高血压病程、吸烟、糖尿病进行校对后,TC、LDL-C每增加0.51mmol/L仍显示增加严重冠状动脉狭窄发生率19%及21%(95%CI:1.12～1.23及1.15～1.27,P均<0.0001)。结论高血压合并高血脂患者血清TC、LDL-C水平与冠状动脉狭窄呈正相关关系,在高血压合并高血脂防治中,应重视血压的降低及TC、LDL C水平的改善。     

Possible risk factors of carotid artery atherosclerosis in the Japanese population: a primary prevention study in non-diabetic subjects

OBJECTIVE: Hyperinsulinemia has been associated with the risk of coronary heart disease, stroke, and renal disease in nondiabetic subjects. However, direct evidence that hyperinsulinemia per se is directly associated with atherosclerosis has been conflicting. The present study was designed to investigate the cross-sectional association of carotid artery atherosclerosis with insulin, independent of well-known cardiovascular risk factors, in nondiabetic subjects. METHODS AND SUBJECTS: Between 1996 and 1997, 1,335 subjects (620 men and 715 women) were recruited from one Japanese community, interviewed, and examined. Clinical measurements in the study included intimal-medial thickness (IMT) of the carotid artery, fasting plasma insulin, serum total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), fasting plasma glucose (FPG), hemoglobin type HbA1c, systolic blood pressure (SBP), diastolic blood pressure (DBP), and body mass index (BMI). We divided the subjects of both genders into three subgroups according to age (40-49 years of age; 50-59; and 60-69). RESULTS: Using simple regression analysis, we found that IMT was significantly correlated with at least one of TC, LDL-C, HbA1c, SBP, DBP, and BMI in each subgroup. The results of multivariate analysis showed that IMT was independently correlated with TC, HDL-C, LDL-C, SBP and BMI in males and with TC, TG, HDL-C, LDL-C, HbA1c, SBP, DBP, and BMI in females. Insulin levels showed no correlation with IMT in either males or females. CONCLUSION: Fasting hyperinsulinemia does not appear to be correlated with carotid artery atherosclerosis based on the present cross-sectional results.     

Renal Denervation in the Management of Hypertension: A Meta-Analysis of Sham-Controlled Trials

IntroductionSympathetic renal denervation (RD) can potentially reduce blood pressure (BP) in people with resistant hypertension (RH) and uncontrolled hypertension (UH). While a large sham-controlled trial (SCT) showed similar outcomes of RD vs. sham control, in the recent trials, RD was effective in reducing BP in hypertensive people. We performed a meta-analysis of SCTs of RD vs. sham in hypertensive patients.MethodsMultiple electronic databases were searched since inception through September 2018 for SCTs that compared RD vs. sham. Change in 24-hour, daytime and nighttime ambulatory and office BP were efficacy outcomes. Various adverse events were safety outcomes.ResultsA total of 7 SCTs were included in the analysis. RD vs. sham significantly reduced 24-hour ambulatory SBP by 3.45 mmHg [95% CI (−5.01, −1.88); P < 0.0001] and DBP by 1.87 mmHg [(−3.59, −0.15); P = 0.01], office DBP by 2.97 mmHg [(−4.76, −1.18); P = 0.001] and daytime ambulatory SBP by 4.03 mmHg [(−6.37, −1.68); P = 0.0008] and DBP by 1.53 mmHg [(−2.69, −0.37); P = 0.01]. RD vs. sham caused non-significant reduction in office SBP by 3.99 mmHg [(−8.10, 0.11); P = 0.06] and nighttime ambulatory SBP by 3.05 mmHg [(−6.86, 0.75), P = 0.12] and DBP by 1.03 mmHg [(−3.01, 0.96); P = 0.31]. There was no difference in the risk of hypertensive crisis/emergency [0.62; 0.24–1.60; P = 0.33] between the two strategies.ConclusionsCurrent meta-analysis shows that RD reduces ambulatory BP and office DBP in patients with hypertension. Future trials with longer follow-up should confirm these findings.     

老年肥厚型心肌病患者并发肺高血压的影响因素及其预测模型的预测价值研究

背景老年肥厚型心肌病(HCM)并肺高血压患者的病死率高,预后差,而目前有关老年HCM患者并发肺高血压的影响因素报道较少。目的分析老年HCM患者并发肺高血压的影响因素及其预测模型的预测价值。方法选取2016年6月-2018年12月于青海省人民医院收治的老年HCM患者80例,根据是否并发肺高血压分为观察组(HCM并肺高血压患者,n=22)和对照组(单纯性HCM患者,n=58)。比较两组患者一般资料{包括性别、年龄、体质指数、病程、收缩压(SBP)、舒张压(DBP)、基础疾病〔包括慢性阻塞性肺疾病(COPD)、高血压、糖尿病〕}、心功能指标〔包括左心室舒张末期内径(LVEDD)、左心房内径(LAD)、左心室收缩末期内径(LVEDS)、左心室射血分数(LVEF)、纽约心脏病协会(NYHA)分级〕、实验室检查指标〔包括总胆固醇(TC)、白蛋白(Alb)、超敏C反应蛋白(hs-CRP)、N末端脑钠肽前体(NT-proBNP)、胱抑素C(Cyc-C)〕。老年HCM患者并发肺高血压的影响因素分析采用多因素Logistic回归分析;绘制受试者特征工作曲线(ROC曲线)以分析预测模型对老年HCM并发肺高血压的预测价值。结果两组患者性别、体质指数、病程、SBP、DBP、基础疾病、LVEDS、TC比较,差异无统计学意义(P>0.05);观察组患者年龄、hs-CRP、NT-proBNP、Cyc-C高于对照组,LVEDD、LAD长于对照组,LVEF、Alb低于对照组,NYHA分级劣于对照组(P<0.05)。多因素Logistic回归分析结果显示,LVEDD〔OR=1.773,95%CI(1.205,2.609)〕、LVEF〔OR=0.716,95%CI(0.585,0.876)〕、NYHA分级〔OR=1.907,95%CI(1.354,2.686)〕、NT-proBNP〔OR=3.117,95%CI(1.329,7.311)〕是老年HCM患者并发肺高血压的影响因素(P<0.05)。根据多因素Logistic回归分析结果建立预测模型:P=1/〔1+e(7.041-0.573X2+0.334X4-0.646X5-1.137X9)〕,e为自然对数,X2为LVEDD,X4为LVEF,X5为NYHA分级,X9为NT-proBNP。预测模型预测老年HCM患者并发肺高血压的ROC曲线下面积(AUC)为0.755〔95%CI(0.645,0.866)〕,灵敏度为0.727,特异度为0.603。结论LVEDD、LVEF、NYHA分级、NT-proBNP是老年HCM患者并发肺高血压的影响因素,且预测模型对患者具有一定预测价值。     

代谢综合征患者C-反应蛋白与心血管病危险因素关系

目的 了解代谢综合征病人C反应蛋白与心血管病危险因素之间的关系.方法 回顾分析代谢综合征175例,根据C反应蛋白水平分为高C反应蛋白组和正常C反应蛋白组.检测两组体质量指数、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、总胆固醇、甘油三酯、空腹血糖、餐后2小时血糖、糖化血红蛋白、收缩压和舒张压.结果 高C反应蛋白组的体质量指数、低密度脂蛋白胆固醇、总胆固醇、甘油三酯、空腹血糖、餐后2小时血糖、糖化血红蛋白、收缩压、舒张压均显著高于正常C反应蛋白组,而高密度脂蛋白胆固醇水平显著低于后者（P＜0.01）;C反应蛋白水平与体质量指数、甘油三酯、低密度脂蛋白胆固醇、糖化血红蛋白、舒张压、空腹血糖及餐后2小时血糖水平呈正相关（P＜0.05）,与高密度脂蛋白胆固醇呈负相关（P＜0.05）.结论 代谢综合征病人中C反应蛋白升高者往往伴随多种代谢紊乱加重,心血管病的危险因素亦随之加重,故对此类病人更要加强防治措施.     

Anethum graveolens L. (Dill) Effect on Human Lipid Profile: An Updated Systematic Review

Dill is an aromatic edible herb, belongs to the genus Anethum in the celery family (Apiaceae or Umbelliferae) with a long history of cultivation from ancient times and two closely related cultivated species, European dill (Anethum graveolens) and Indian dill (Anethum Sowa). We wanted to do this systematic review on the effect of Anethum graveolens intake on lipid profile because the outcomes of multiple research and meta-analyses in this regard were inconsistent. A systematic search for English published randomized controlled trials (RCTs) covering PubMed, EMBASE, Scopus, and Coherence library. The pooled weighted mean difference (MD) and its 95% confidence interval (CI) were calculated and pooled using a random-effects model. Pooled data of 6 RCTs involving 171 intervention cases indicated that dill supplementation was associated with a significant reduction in mean serum total cholesterol (MD 95% CI= -3.71(-5.71,-1.70); P < 0.001), low-density lipoprotein cholesterol (LDL-C) (MD 95% CI= -1.51(-2.65,-0.47); P = 0.005), TG (triglycerides) (MD 95% CI= -2.48(-3.98,-0.98); P = 0.001) and interestingly high-density lipoprotein cholesterol level (HDL-C) (MD 95% CI= -2.19(-3.58,-0.81); P = 0.002). Subgroup analysis showed that dill use was more effective in lowering triglyceride in both hyperlipidemic patients, MD 95% CI= -3.54(-6.49,-0.60); P = 0.02) and type 2 diabetes (MD 95% CI= -3.64(-5.69,-1.58); P = 0.001). Dill use reduced the LDL levels more effectively in patients with type 2 diabetes (MD 95% CI= -3.54(-6.49,-0.60); P = 0.03). Dill supplementation significantly improved LDL-C, TG, and Total cholesterol (TC) levels but not HDL-C. Further high quality controlled clinical trials on human is needed for more accurate and confirm conclusion.     

静息心率与老年冠心病关系的研究

目的探讨静息心率对冠心痛发生的预测价值及临床意义。方法选择老年冠心病患者429例为冠心病组,另选同期体检的非冠心病患者60例为非冠心病组。2组患者均测量血压及生化指标检测,并行12导联心电图检查,分析静息心率与冠心病发生是否存在相关性。结果冠心病组的收缩压、TC、TG、LDL-C、静息心率明显高于非冠心痛组(P<0.05,P<0.01)。logistic回归分析显示,校正了舒张压、TC、HDL-C、LDL-C、空腹血糖等因素后,静息心率、收缩压、TG是冠心病的独立危险因素(OR=1.046,95%CI:1.005～1.088,P<0.05)。结论静息心率是冠心病发病的独立危险因素。     

珠三角地区民营企业家胰岛素抵抗的调查

目的 了解民营企业家胰岛素抵抗的患病情况.方法 人群分为民营企业家组和职工组,检测血压、身高、体重、血糖、血胰岛素、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、血尿酸、C反应蛋白及肝肾功能.结果 与职工组比较,民营企业家组体质量指数、血糖、血胰岛素、总胆固醇较高,差异有统计学意义（P＜0.01）;收缩压、血胰岛素与血糖比值、胰岛素抵抗指数、甘油三酯、低密度脂蛋白胆固醇、C反应蛋白增高,差异有统计学意义（P＜0.05）;但舒张压、高密度脂蛋白胆固醇、血尿酸、尿素氮、血肌酐差异无统计学意义（P＞0.05）.结论 民营企业家较职工更容易出现值得关注的胰岛素抵抗倾向,应及早采取预防措施.     

The ongoing role of serum uric acid in blood pressure

Positive association between blood pressure (BP) and uric acid is evident, but specific effect size of serum uric acid (SUA) at different levels on BP is unclear, and interaction effect of SUA with other metabolic factors on BP was rarely reported. A cross-sectional study was conducted by making use of data from an epidemic investigation. A total of 3658 subjects were enrolled in our data analysis. In male subjects, for each 1 mg/dL increase in the SUA level, systolic blood pressure (SBP) and diastolic blood pressure (DBP) increased by 1.339 mmHg [95% CI: 0.552–2.126] and 0.515 mmHg [95% CI: 0.013–1.016], respectively, after adjusting for age, fasting plasma glucose (FPG), triglyceride (TG), total cholesterol (TC), estimated-glomerular filtration rate (eGFR), body mass index (BMI), drinking, smoking, and waist–hip ratio (WHR). And in female subjects, for each 1 mg/dL increase in the SUA level, SBP and DBP increased by 1.180 mmHg [95% CI: 0.401–1.959] and 0.549 mmHg [95% CI: 0.086–1.011], respectively, after adjusting the same factors. In males, in subjects with SUA < 6 mg/dL, SBP increased by 0.585 mmHg [95% CI: ?0.976 to 2.146] for each 1 mg/dL increase in the SUA level, while in subjects with SUA ≥ 6 mg/dL, SBP increased by 3.271 mmHg [95% CI: 1.244–5.297] (p interaction = 0.0369), after adjusting age, BMI, smoking, drinking, TG, TC, FPG, eGFR, and WHR. This difference was not observed in DBP and females. Interaction effects between SUA and BMI, TG, FPG on BP were discovered. In conclusion, higher level of SUA has a stronger effect on BP and other metabolic factors: FPG, TG, and BMI could strengthen the effect of SUA on BP.     

匹伐他汀与阿托伐他汀对冠状动脉疾病、血脂异常、糖耐量异常患者血脂指标、血糖指标影响的Meta分析

目的比较匹伐他汀与阿托伐他汀对冠状动脉疾病、血脂异常、糖耐量异常患者血脂指标、血糖指标的影响。方法计算机检索EMBase、PubMed、The Cochrane Library、万方数据知识服务平台、中国知网和维普网,检索时间为建库至2018年12月,筛选关于匹伐他汀与阿托伐他汀对冠状动脉疾病、血脂异常、糖耐量异常患者血脂指标、血糖指标影响的随机对照试验(RCT),其中采用匹伐他汀治疗者作为PTV组,采用阿托伐他汀治疗者作为AVT组。采用RevMan 5.3软件进行Meta分析,比较两组患者治疗后血脂指标[包括总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]、血糖指标[包括空腹血糖(FBG)、糖化血红蛋白(HbA1c)]。结果最终纳入14篇文献,共1 067例患者。Meta分析结果显示,治疗后PVT组患者TC[MD=1.18,95%CI(0.37,1.99)]、HDL-C[MD=0.12,95%CI(0.03,0.22)]高于AVT组,FBG[MD=-0.71,95%CI(-1.06,0.36)]、HbA1c[MD=-0.34,95%CI(-0.53,-0.15)]低于AVT组(P<0.05);两组患者治疗后TG[MD=0.04,95%CI(-0.03,0.11)]、LDL-C[MD=-0.00,95%CI(-0.08,0.07)]比较,差异无统计学意义(P>0.05)。绘制报道HbA1c文献发表偏倚的倒漏斗图发现,分布于直线两侧的散点不对称,提示可能存在发表偏倚;绘制报道TG文献发表偏倚的倒漏斗图发现,分布于直线两侧的散点对称,提示无发表偏倚。结论现有文献证据表明,匹伐他汀与阿托伐汀对冠状动脉疾病、血脂异常、糖耐量异常患者TG、LDL-C的影响相似,而与阿托伐他汀相比,匹伐他汀能更有效地降低患者FBG、HbA1c,升高患者HDL-C,但降低患者TC的效果不如阿托伐他汀。     

老年2型糖尿病患者纤维蛋白原与尿微量白蛋白的相关性研究

目的探讨老年2型糖尿病患者正常范围内血浆纤维蛋白原(FIB)与尿微量白蛋白(UMA)的相关性。方法收集2012年10月至2014年10月上海市第五人民医院收治的869例老年2型糖尿病患者的临床资料。将患者按FIB四分位数分为Q1组(<2.42 g/L)、Q2组(2.42~2.89 g/L)、Q3组(2.90~3.61 g/L)、Q4组(≥3.62 g/L),分析FIB与尿白蛋白与肌酐比值(UACR)的相关性。结果随着FIB水平升高,UACR水平显著升高(P<0.05)。Pearson相关分析显示,在男性和女性患者中FIB与年龄、糖尿病病程、肌酐和UACR均呈显著正相关(P<0.01)。多元逐步回归分析显示FIB是UACR的独立影响因素(P<0.01)。Logistic多元回归分析显示,在校正性别、年龄、糖尿病病程、体重指数(BMI)、收缩压、舒张压、空腹血糖(FPG)、HbAlC、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、肌酐、丙氨酸氨基转移酶(ALT)、吸烟史和饮酒史因素后,Q4组发生微量白蛋白尿和大量白蛋白尿的危险性分别是Q1组的4.536倍(95%CI 2.516~8.175,P<0.01)和13.314倍(95%CI 2.925~60.612,P<0.01),Q3组发生微量白蛋白尿和大量白蛋白尿的危险性分别是Q1组的2.177倍(95%CI 1.273~3.724,P<0.01)和4.098倍(95%CI 1.101~19.226,P<0.05)。以UACR 30 mg/g和300 mg/g为分界值,分别行FIB与UACR的ROC曲线所得FIB的最佳切点值分别为3.18 g/L和3.22 g/L。结论老年2型糖尿病患者血浆FIB与UMA密切相关,可能是糖尿病肾病的预测指标之一。     

代谢综合征患者颈动脉内膜-中层厚度变化及与动脉粥样硬化程度的关系

目的探讨代谢综合征(MS)患者颈动脉内膜-中层厚度(CAMT)的改变,及其与各种危险因素的关系。方法51例代谢综合征患者,按其血糖水平分为糖耐量减低(MS-IGT)组27例和2型糖尿病(MS-DM)组24例;另选25例健康者为对照组。均行超声检查,测定CAMT,并做血脂、血糖等检查。结果代谢综合征组CAMT高于对照组(P<0.01)。CAMT与年龄、收缩压(SBP)、舒张压(DBP)、体重指数(BMI)、空腹血糖(FPG)、餐后2h血糖(2hPG)、空腹胰岛素(FINS)、2h胰岛素(2hINS)、血总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白-B(Apo-B)呈正相关(P<0.01)。多元逐步回归分析,年龄、SBP、DBP、BMI、FPG、2hPG、2hINS、TC、LDL-C与CAMT关系较为密切。结论代谢综合征患者可加速动脉粥样硬化的进展。CAMT能在早期反映高血压、高血糖和高血脂对动脉粥样硬化的促进作用。     

Association Between Visit-to-Visit Lipid Variability and Incident Cancer: A Population-based Cohort Study

Dyslipidemia is associated with increased cancer risk. However, the prognostic value of visit-to-visit lipid variability (VVLV) is unexplored in this regard. To investigate the associations between the VVLV and the risk of incident cancer, we conducted a retrospective cohort study on adult patients attending a family medicine clinic in Hong Kong during 2000-2003, excluding those with <3 tests for low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides, and total cholesterol (TC) each, those with prior cancer diagnosis, and those with <1 year of follow-up. Visit-to-visit LDL-C, HDL-C, TC, and triglycerides variabilities were measured by the coefficient of variation (CV). Patients were followed up until 31st December 2019 for the primary outcome of incident cancer. Altogether, 69,186 patients were included (26,679 males (38.6%); mean age 60 ± 13 years; mean follow-up 16 ± 3 years); 7958 patients (11.5%) had incident cancer. Higher variability of LDL-C, HDL-C, TC, and TG was associated with higher risk of incident cancer. Patients in the third tercile of the CV of LDL-C (adjusted hazard ratio (aHR) against first tercile 1.06 [1.00, 1.12], P = 0.049), HDL-C (aHR 1.37 [1.29, 1.44], P< 0.001), TC (aHR 1.10 [1.04, 1.17], P = 0.001), and TG (aHR 1.11 [1.06, 1.18], P < 0.001) had the highest risks of incident cancer. Among these, only HDL-C variability remained associated with the risk of incident cancer in users of statins/fibrates. To conclude, higher VVLV was associated with significantly higher long-term risks of incident cancer. VVLV may be a clinically useful tool for cancer risk stratification.     

老年糖尿病患者微血管并发症的患病率及危险因素

目的 探讨老年糖尿病患者微血管并发症的患病率,并分析发生微血管病变的危险因素。方法 回顾性分析北京协和医院2020年1月至2022年12月收治的495例老年糖尿病患者的临床资料,收集患者基线资料和生化指标,统计糖尿病视网膜病变、糖尿病肾病、周围神经病变等微血管并发症的患病率。根据微血管并发症的类型将患者分为4组：糖尿病视网膜病变组(n=107)、糖尿病肾病组(n=81)、周围神经病变组(n=169)及非并发症组(n=138)。采用SPSS 22.0统计软件进行数据分析。根据数据类型,分别采用方差分析或χ²检验进行组间比较。采用多因素logistic回归分析糖尿病微血管病变发生的危险因素。结果 495例老年糖尿病患者中共357例发生微血管并发症,总患病率为72.12%,其中糖尿病视网膜病变占21.62%(107/495),糖尿病肾病占16.36%(81/495),周围神经病变占34.14%(169/495)。与非并发症组患者比较,糖尿病视网膜病变组患者糖尿病病程更长,收缩压(SBP)和糖化血红蛋白(HbA1c)水平更高,低密度脂蛋白胆固醇(LDL-C)水平较低;糖尿...     

高尿酸血症与冠心病及危险因素的相关性分析

目的 通过对高尿酸血症与冠心病及危险因素的横断面研究,分析高尿酸血症与冠心病及危险因素的相关性.方法 入选太原市中心医院心内科符合标准患者150例,依据尿酸水平分为高尿酸血症组(80例)及非高尿酸血症组(70例).记录年龄、性别、身高、体重、腰围、臀围、血压及血生化指标等基本资料,通过横断面研究高尿酸血症与冠心病及危险因素的关系.结果 高尿酸血症组与非高尿酸血症组比较,在吸烟年限、收缩压(SBP)、舒张压(DBP)、腰围、腰臀比、体重指数(BMI)、三酰甘油、总胆固醇、空腹血糖等均有统计学意义(P＜0.05).高尿酸与冠心病间存在相关性.针对高尿酸血症危险因素空腹血糖(FBG)、低密度脂蛋白胆固醇(LDL - C)、BMI以及代谢综合征(MS)四者进行多元Logistic回归分析,并校正年龄、性别、吸烟、饮酒后分析表明,MS(校正前OR=1.110,校正后OR=1.111,P＜0.001)及FBG(校正前OR=2.586,校正后OR=2.685,P＜0.001)是高尿酸血症的独立危险因素,而LDL -C(校正前OR=0.638,校正后OR=0.642,P＜0.05)则是高尿酸血症的保护因素.BMI的Logistic回归分析无统计学意义(校正前OR=0.795,校正后OR=0.757).结论 高尿酸血症与冠心病存在一定的协同作用;在高尿酸血症的危险因素中MS、FBG是高尿酸血症的独立危险因素,LDL -C是高尿酸血症的保护因素.     

老年人群血清谷氨酰转移酶与代谢综合征的相关性研究

目的探讨老年人群血清谷氨酰转移酶（GGT）水平与代谢综合征（MS）的关系。方法调查在华中科技大学同济医学院附属协和医院进行常规体检的1444例老年人群,检测体质量指数（BMI）、收缩压（SBP）、舒张压（DBP）、空腹血糖（FBG）、甘油三酯（TG）、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）、谷氨酰转移酶（GGT）、丙氨酸转氨酶（ALT）、尿酸（UA）等。结果与非MS组相比,MS组GGT、BMI、SBP、DBP、TG、ALT、UA均明显升高（P〈0．01）,HDL-C显著减低（P〈0．01）;随着GGT四分位间距的递增,MS发生率、MS各组分（肥胖、血压异常、血糖异常、血脂异常）的发生率均显著增加,差异具有统计学意义（P〈0．01）;多元线性回归分析提示,GGT与DBP、TG、ALT、uA、MS组分个数呈正相关（P〈0．01）,而与HDL-C呈负相关（P〈0．05）：多因素Logistic回归分析表明GGT是MS发生的危险因素之一（OR=1．008,95％CI1．0001．024,P=0．046）。结论老年人群血清GGT水平与MS关系密切,其水平的升高能够反映MS的发生风险;在排除肝脏疾病以后GGT可以作为MS发生风险的筛选指标。     

代谢综合征患者餐后血脂与颈动脉内膜中层厚度关系的探讨

目的探讨代谢综合征(MS)患者餐后血脂代谢情况及其与颈动脉内中膜厚度(IMT)的相关性。方法选择40名健康人为对照组,60例MS患者为MS组。MS组以空腹甘油三酯为标准(≥1.7mmol/L)分为两个亚组:空腹甘油三酯正常组(MS1)与空腹高甘油三酯组(MS2)。禁食12h后,分别接受高脂肪饮食,于空腹、餐后2、4、6h测定血清总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)和高密度脂蛋白胆固醇(HDL-C)。使用彩超仪检测各组颈动脉IMT。结果餐后血清TG水平显著升高,浓度峰值是4h,TC、LDL-C、HDL-C无明显改变(P>0.05)。MS1组、MS2组餐后TG峰值浓度明显高于对照组(P<0.05)。MS组颈动脉IMT明显增厚,MS1、MS2颈动脉IMT与对照组相比,差异有统计学意义(P<0.05),但MS1与MS2之间差异无统计学意义(P>0.05)。直线相关分析示,年龄、体重指数、腰臀围比、TG0h、TG4h和收缩压均与颈动脉IMT呈显著正相关(r1=0.1513,r2=0.2111,r3=0.2312,r4=0.3441,r5=0.3765,r6=0.1839,P<0.05),且颈动脉IMT与TG4h的相关系数最大。结论MS患者脂肪餐后TG水平异常升高是其血脂代谢异常的重要内容之一,且餐后脂代谢异常常发生在空腹血脂异常之前,易引起动脉粥样硬化,故应常规检测MS患者的餐后血脂和颈动脉IMT。     

Genetic influence on blood pressure and lipid parameters in a sample of Polish twins

We studied 76 healthy monozygotic (MZ) and same-sex dizygotic (DZ) twin pairs (mean age 35 +/- 8 years, body mass index, BMI, 23.6 +/- 3.9 kg/m2) to determine genetic and environmental contributions to systolic (SBP) and diastolic (DBP) blood pressure, heart rate (HR) and serum lipids [total cholesterol (TC), low-density lipoprotein cholesterol (LDL-chol), high-density lipoprotein cholesterol (HDL-chol) and triglycerides (TG)I. SBP, DBP and HR were measured clinically and by ambulatory blood pressure monitoring (ABPM). Parameters of the genetic models for age-, sex- and BMI-adjusted data were estimated by model fitting and path analysis technique using LISREL 8. We found significant genetic effect on SBP and DBP for both clinical and ABP measurements, ranging from 37% for night-time ambulatory DBP to 79% for daytime ambulatory SBP. Estimates of genetic effects were higher for daytime than night-time ABP values, and higher for ambulatory 24-h SBP than office SBP measurements, with the reverse true for DBP. Significant genetic effect on HR ranged from 59% for office measurements to 69% for 24-h mean values. In summary, we also found genetic effect on TC, LDL-chol and HDL-chol with estimates ranging from 36% to 64%, but not on TG. Furthermore, a shared environmental component for TG was found, estimated at 36%. We showed significant genetic effect on both office and ambulatory BP and HR, with stronger genetic effect on daytime than night-time BP. We also found genetic effect on TC and lipoprotein fractions, but no significant genetic effect on TG. Environmental factors influencing serum TG, such as alcohol consumption, may explain the apparent lack of genetic effect in this healthy, non-obese population.     

血脂康对冠心病合并高脂血症患者疗效的Meta分析

目的评价血脂康治疗冠心病合并高脂血症患者的疗效。方法计算机检索PubMed、Cochrane图书馆、EBSCO host、中国学术期刊网络出版总库(CNKI)、万方医学数据库、维普中文科技期刊全文数据库(VIP),检查时间为2013年10月之前。纳入标准为血脂康治疗高脂血症的随机对照试验。采用Revman 5.2软件进行Meta分析。系统评价血脂康对血清总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)的影响。结果共纳入19项随机对照试验,包括6229例患者。Meta分析显示,在冠心病常规治疗的基础上,血脂康组较安慰剂组TC、TG、LDL-C显著降低[(WMD=-1.15,95%CI:-1.67~-0.64,P0.001)、(WMD=-0.51,95%CI:-0.83~-0.20,P=0.002)、(WMD=-0.99,95%CI:-1.38~-0.59,P0.001)],HDL-C明显升高(WMD=0.21,95%CI:0.05~0.38,P=0.01);血脂康组较单纯常规治疗组TC、TG、LDL-C显著降低[(WMD=-1.19,95%CI:-1.45~-0.93,P0.001)、(WMD=-1.19,95%CI:-1.45~-0.93,P0.001)、(WMD=-1.00,95%CI:-1.27~-0.73,P0.001)],HDL-C显著升高(WMD=0.17,95%CI:0.05~0.29,P=0.007)];血脂康与他汀类药物相比TC、TG、LDL-C、HDL-C差异均无统计学意义。结论在冠心病常规治疗的基础上,可有效调节血脂,与他汀类药物作用相当。