高血压、糖尿病患者颈动脉粥样硬化斑块发生率的临床意义

目的观察不同年龄段高血压、糖尿病患者颈动脉粥样硬化斑块的发生率,探讨不同年龄段高血压、糖尿病患者超声检测颈动脉硬化斑块的临床意义。方法将2010年8月～2010年12月笔者所在医院门诊及住院128例高血压患者、53例糖尿病患者,按年龄分为5组（糖尿病患者为4组,除去第1组）,第1组40～49岁,第2组50～59岁,第3组60～69岁,第4组70～79岁,第5组80岁以上,进行颈部动脉彩色多普勒检查,观察有无斑块形成及斑块的情况。结果 40～49岁的高血压患者颈动脉粥样硬化斑块发生率为16.7;50～59岁的高血压患者发生率为47.1,糖尿病患者发生率为50.0;60～69岁的高血压患者发生率为73.5,糖尿病患者发生率为81.8;70～79岁的高血压患者发生率为87.5,糖尿病患者发生率为94.7;80岁以上的高血压患者发生率为96.8,糖尿病患者发生率为100。结论将颈动脉斑块超声检测作为社区40岁以上高血压、糖尿病患者有无靶器官损害的筛选指标,对于早期预防、早期治疗,减少缺血性脑卒中的发生,具有十分重要的临床意义。     

骨质疏松与颈动脉粥样斑块相关研究

目的分析骨质疏松与颈动脉粥样斑块的相关性。方法采用美国LUNAR双能x线骨密度科研型（LUNARPRODIGY型）测定腰椎及股骨颈、word’三角、大转子的骨密度。双颈动脉彩色超声波采用美国生产SEQUOLA512型进行双侧颈总动脉起始部，颈内外动脉分叉处及颈内颈外动脉检测。结果检测67例有颈动脉粥样斑块的患者（包括双侧或单侧颈动脉）再测骨密度，都有不同程度的骨质疏松，T值-1．0至〉-2．5SD不等。结论骨代谢与血管结构改变有相关性，过去认为骨质疏松与颈动脉粥样斑块是各自独立的疾病，实际上在老年人群中多同时存在，他们有着相同的病理生理机制，对他们的防治可开拓新路径。     

加味四妙勇安汤治疗脑梗死患者颈动脉粥样硬化斑块的临床研究

目的:观察加味四妙勇安汤对脑梗死患者颈动脉粥样硬化斑块的治疗作用.方法:脑梗死患者随机分为四妙勇安汤组(35例),血脂康组(31例),对照组(30例),四妙勇安汤组给予四妙勇安汤1付每日1次口服,随症加减,血脂康组给予血脂康片2片/次,每日3次口服,对照组采用饮食控制.分别于入院时,治疗后3个月、6个月动态监测3组患者血脂水平,并进行颈动脉超声检查评估颈动脉斑块积分.比较3组患者血脂和颈动脉斑块积分的变化.结果:3组间血脂变化差异无显著性(P＞0.05),但各组自身用药前后血脂变化比较有显著性(P＜0.05),而颈动脉斑块积分在研究6个月时四妙勇安汤组积分下降,对照组积分增加(P＜0.05),血脂康组斑块积分无明显变化.四妙勇安汤组、对照组颈动脉斑块积分(随诊6个月后)与初诊结果相比均有显著性差异(均p＜0.05),血脂康组与初诊时相比无显著性差异(P＞()05).四妙勇安汤组、血脂康组均未发现有严重不良反应.结论:加味四妙勇安汤具有较好的降脂作用同时还能延缓减轻动脉粥样硬化的作用,在使用过程中未发现不良反应可长期安全的用药.     

颈动脉粥样硬化斑块超微血管成像技术研究进展

斑块破裂可以激活血小板并形成血栓导致心脑血管事件的发生,斑块的破裂与斑块中新生血管形成密切相关.超微血管成像技术(SMI)无需造影剂即可显示斑块内的微血管及低速血流,可评价颈动脉粥样硬化斑块中新生血管情况,对相关疾病作出早期诊断,同时还可避免造影剂产生的不良反应.本文查阅国内外文献,对SMI在颈动脉粥样硬化斑块领域中的...     

颈动脉粥样斑块的MRI诊断价值

目的：探讨颈动脉粥样斑块的MRI影像特点,以提高对颈动脉粥样斑块成分及性质的认识。方法回顾性分析2013年11月～2014年5月期间13例颈动脉粥样斑块的MRI病例资料,并与颈动脉内膜剥脱术的病理结果相对照,总结其影像信号特点。结果13个病例共18个粥样硬化斑块,颈动脉内膜剥脱术取出13个斑块;13例斑块存在脂质坏死池;6例纤维帽撕裂;7例斑块内出血;11例斑块内钙化;4例炎性细胞浸润。结论颈动脉粥样斑块的磁共振信号具有特征性,磁共振成像能有效评估斑块的稳定性。     

初诊女性狼疮性肾炎患者颈动脉粥样硬化发生率及相关因素分析

目的：研究初诊女性狼疮性肾炎（1upus nephritis,LN）患者颈动脉粥样硬化发生率及其影响因素。方法：以35例女性健康者为对照组（A组）,68例女性初诊LN患者按B超所测颈总动脉（CCA）内中膜厚度（IMT）,分成两组,即B组（无颈动脉粥样硬化LN35例）、C组（颈动脉粥样硬化LN33例）,用SPSS13．0进行三组间资料的比较分析。结果：女性初诊LN中颈动脉粥样硬化的发生率高达48．53％,而在正常女性健康者中未发现有颈动脉粥样硬化;这些患者的CCA—IMT值与肾小球滤过率（CFR）呈负相关（P〈0．01）,与24h尿蛋白总量（UTP）和血尿酸（UA）呈正相关（P〈0．01和P〈0.05）;A、B、C三组,CCA—IMT值呈渐进性增高,各组间均有统计学意义。结论：初诊女性LN患者已出现颈动脉粥样硬化,GFR、UTP、UA是颈动脉粥样硬化的独立危险因素,应积极干预危险因素,防治冠心病。     

中老年手术患者右颈动脉斑块的危险因素分析

目的观察中老年择期手术患者右侧颈动脉斑块发生率、位置及性质,探讨其发生的独立危险因素。方法选择中老年择期手术患者738例,年龄40~78岁,ASAⅠ~Ⅲ级,右侧颈部无血肿、破溃或中心静脉置管,行右侧颈动脉超声检查,按是否观察到颈动脉斑块,将患者分为斑块组(PW组)及非斑块组(NPW组),并采集相关病史,记录颈动脉斑块的发生率、位置和性质分布,分析颈动脉斑块发生的危险因素。结果颈动脉斑块的发生率为194例(26.3%)(PW组),PW组中斑块的发生位置分布:高位斑块148例(76.3%),中位斑块124例(63.9%),低位斑块48例(24.7%);斑块的性质分布:软斑16例(8%),硬斑88例(45.4%),混合斑98例(50.5%)。年龄、高血压史、冠心病史、高脂血症史、糖尿病史及吸烟史为颈动脉斑块发生的独立危险因素(P0.05)。结论年龄、高血压史、冠心病史、高脂血症史、糖尿病史及吸烟史与颈动脉斑块发生相关。患者颈动脉斑块高发部位为颈膨大处至环状软骨平面之间,斑块性质以不稳定斑块为主。     

维持性血液透析患者颈动脉粥样硬化发生危险因素分析

目的:观察维持性血液透析(MHD)患者颈动脉粥样硬化(AS)的患病率并分析其危险因素。方法:收集我院维持性血液透析患者146例,均采用意大利百胜Technos MPX DU6型彩色多普勒超声诊断仪检测患者颈动脉粥样硬化情况,并将患者分为AS组和无AS组,比较两组临床有关参数的变化,探讨相关危险因素。结果:维持性血液透析患者AS的患病率为49.3%(72/146),并且随着年龄增长,MHD患者AS的患病率逐渐增加(P<0.05),男性患者AS的患病率较女性患者显著升高(P<0.05)。与无AS组相比,AS组年龄、男性比例、吸烟比例、糖尿病比例显著增高,此外AS组透析病程较无AS组长、透析充分达标率低,而高密度脂蛋白(HDL)、白蛋白显著降低。AS组虽然血钙、血磷、钙磷乘积、甲状旁腺激素(PTH)和无AS组差异无统计学意义,但前者应用药物纠正钙磷紊乱的比例显著高于无AS组。多因素分析显示AS与年龄、透析病程呈显著正相关,与HDL、Alb呈显著负相关,合并糖尿病、透析不充分时AS进一步加重。结论:维持性血液透析患者颈动脉粥样硬化的发生与年龄、性别、吸烟、糖尿病、血脂异常及透析病程、透析充分性、营养不良等因素有关。     

MRI诊断颈动脉粥样硬化斑块成分的Meta分析

目的通过Meta分析方法评价MRI判断颈动脉粥样硬化斑块成分的价值。方法系统检索2017年10月前发表的与MRI颈动脉粥样硬化斑块成分分析相关,并以病理学诊断为金标准的中、英文研究文献。文献纳入与排除标准参考Cochrane协作网所推荐的内容确定。采用RevMan 5.3软件对纳入文献的研究资料进行统计学分析,并以诊断性试验准确性质量评价(QUADAS)标准进行质量评价。结果最终纳入文献7篇,共包含813个颈动脉粥样硬化斑块。以病理结果为金标准,MRI识别颈动脉粥样硬化斑块脂质核心的95%CI为(0.80,1.27),比值比(OR)为1.01,Z值为0.06,P值为0.95;识别钙化成分的95%CI为(0.64,1.11),OR为0.85,Z值为1.19,P值为0.23。结论 MRI用以识别颈动脉粥样硬化斑块中的脂质核心及钙化成分具有较高临床价值。     

慢性肾脏病患者的颈动脉粥样硬化及心脏瓣膜钙化

颈动脉粥样硬化与心脏瓣膜钙化是慢性肾脏病（chronic renal disease,CKD）患者心血管疾病（cardiovascular disease,CVD）发病和死亡的重要危险因素。因此,研究动脉粥样硬化及心脏瓣膜钙化的防治措施将有助于降低慢性肾脏病患者的死亡率、延长生存时间。本文就CKD患者颈动脉粥样硬化及心脏瓣膜钙化的流行病学、危险因素、诊断及治疗情况作一综述。     

Association of carotid artery atheromatous plaque types with cerebral perfusion

Background: In an attempt to define the association of internal carotid artery atheromatous plaque morphology with potential cerebral ischaemia, we have investigated the relationship of different carotid plaque types with defects in cerebral perfusion. Methods: In 130 patients requiring surgical correction of internal carotid artery stenoses greater than 70%, defects in cerebral perfusion due to both haemodynamic insufficiency and intracerebral vessel occlusion were identified using single photon emission computed tomography scans (SPECT). Carotid artery plaques in these patients were classified as homogeneous or heterogeneous based on preoperative Doppler Duplex Scanning and on the macroscopic characteristics of the plaques recorded by the surgeon during carotid endarterectomy, with sub‐classification into potentially embolus‐generating and non‐ embolus‐generating plaques. In individual patients, plaque types were then correlated with the perfusion defects found in the SPECT scans. Results: Of 130 patients, 112 (86%) had cerebral perfusion defects. In 56 asymptomatic patients in the study, 48 (85.7%) had perfusion defects as did 64 (86.5%) of 74 symptomatic patients. Cerebral infarcts were seen in 41 (31.5%). Occlusive infarcts (66%) were twice as frequent as haemodynamic insufficiency infarcts (34%). Eighteen patients with small cerebral infarcts on SPECT scanning gave no medical history of cerebral symptoms. Statistical analysis of the results revealed that there was no statistically identifiable association between carotid plaque type and the generation of cerebral symptoms or infarction. Conclusion: This study found that internal carotid plaque morphology has no statistically significant association with perfusion defects, symptoms or cerebral infarction in patients with significant internal carotid artery stenosis. Also, it is suggested that haemodynamic cerebral infarction may be more common that previously believed (34% of infarcts identified in the study). Further, it is suggested that plaque morphology alone is not an indication for carotid endarterectomy.     

高甲状旁腺激素腹膜透析者颈动脉斑块发生率及其影响因素

目的 探讨高甲状旁腺激素腹膜透析者颈动脉斑块的发生率及影响因素.方法 根据甲状旁腺激素水平将受试者分为甲状旁腺激素正常组及甲状旁腺激素升高组.应用二维超声检测受试者颈动脉斑块,选用Logistic分析评估颈动脉斑块的危险因素.结果 共145例腹膜透析者纳入研究,其中甲状旁腺激素正常组69例（47.7％）,甲状旁腺激素升高组76例（39.1％）.与甲状旁腺激素正常组相比,甲状旁腺激素升高组颈动脉斑块发生率明显升高（50.3％ vs 30.5％,P＜0.001）.在甲状旁腺激素升高组,校正各种混杂因素后,高龄[比值比（OR）=1.04,95％可信区间（CI）1.02～ 1.06]、糖尿病（OR=3.31,95％ CI 1.92～6.43）、高血磷（OR=1.02,95％ CI 1.01 ～ 1.03）、高钙磷乘积（OR=1.27,95％ CI 1.10～4.54）为颈动脉斑块形成的独立危险因素.结论 高甲状旁腺激素的腹膜透析者颈动脉斑块发生率高,高龄、糖尿病、高血磷及高钙磷乘积是其动脉斑块形成的独立危险因素.     

Impact of plaque dilation before carotid artery stent deployment

ObjectivePlaque stability is of utmost importance for stroke prevention in the perioperative period (within 24 hours) following carotid artery stenting (CAS). Although carotid plaque is entrapped between stent struts after stent deployment, postdilation can cause a scissoring effect on the plaque, increasing the risk of postprocedural embolic events due to plaque prolapse. Maximum carotid plaque dilation before stent deployment may reduce this risk. This study analyzed the effect of maximum dilation of the carotid plaque before stent deployment (max-pre-SD) or after stent deployment (post-SD) on macroscopic plaque debris, hemodynamic depression (HD), and immediate major adverse events.MethodsThis prospective nonrandomized multicenter study analyzed patients treated for carotid artery stenosis with CAS from January 2014 to August 2016. Clinical and morphologic characteristics and operative details were analyzed with logistic regression analysis for macroscopic debris and HD. The number of microembolic signals (MESs) was assessed by transcranial Doppler and analyzed.ResultsA total of 309 patients were enrolled and treated with standard CAS performed using a proximal occlusion cerebral embolic protection device; 149 received max-pre-SD and 160 were treated with post-SD. Technical success was achieved in 100% of cases. Macroscopic debris and HD were significantly different between the two groups in favor of max-pre-SD (P < .001). A significant difference in intraprocedural MESs between the groups was detected. Compared with post-SD, max-pre-SD significantly reduced mean MES counts (8.1% vs 68.1%; P < .001). Patients treated with post-SD had a significantly increased risk of MESs in the immediate postoperative period compared with patients treated with max-pre-SD (41.9% vs 1.3%; P < .001).This result was mainly due to the small number of events encountered. Patients treated with post-SD had a 12-fold increased risk of macroscopic debris collection (odds ratio [OR], 12.36; 95% confidence interval [CI], 5.68-26.87; P < .001) and an 18 times increase in HD risk (OR, 17.80; 95% CI, 5.27-60.17; P < .001) compared with patients treated with max-pre-SD. The heterogeneous, mainly echolucent plaque type significantly highly increased the risk of macroscopic debris (OR, 78.45; 95% CI, 8.70-707.09; P < .001) while acting as a protective factor against HD (OR, 0.02; 95% CI, 0.006-0.11; P < .001) along with echogenic or echolucent complex plaques with irregular surface plaque types (OR, 0.10; 95% CI, 0.031-0.336; P < .001). No significant differences between groups (max-pre-SD group and post-SD) were detected in immediate major adverse events (minor stroke, 2.0% and 2.5% [P = .461]; major stroke, 0% and 0.6% [P = .334], respectively).ConclusionsMax-pre-SD seems to be a safe and feasible technical modification to the CAS procedure. Macroscopic debris, HD, and MESs are significantly reduced compared with CAS with post-SD. Further research with larger, randomized cohorts of patients is required to establish the superiority of this technical modification.     

冠心病合并颈动脉狭窄的围术期处理

背景 冠心病(coronary artery bypass grafting,CABG)合并颈动脉狭窄者临床上并不少见.如何正确处理CABG患者并存颈动脉狭窄的问题应引起重视.目的 为了探索CABG患者并存颈动脉狭窄的最佳处理方法,此文将CABG患者并存颈动脉狭窄的外科治疗及麻醉处理进行了分析汇总.内窖对于合并颈动脉狭...     

慢性肾脏病患者心血管钙化的影响因素分析

慢性肾脏病(chronic kidney disease,CKD)患者因高龄、高血压、高血脂、糖尿病、吸烟、男性等传统心血管钙化危险因素,加上CKD特有因素:矿物质代谢紊乱、含钙磷结合剂及活性维生素D的不合理使用、微炎症状态、氧化应激等常引起严重的心血管钙化,病情进一步发展会加速心血管事件的发生,影响CKD患者的预后。使用磷结合剂、活性维生素D及其类似物、西那卡塞等药物控制高钙、高磷、高PTH对预防心血管钙化至关重要。药物治疗无效或在治疗过程中出现不能控制的矿物质代谢异常,则要考虑手术切除甲状旁腺。甲状旁腺切除术(parathyroidectomy,PTX)作为难治性继发性甲状旁腺功能亢进患者的有效治疗之一,可迅速降低甲状旁腺素(parathyroid hormone,PTH)和血清钙磷水平,减少活性维生素D等药物的使用,缓解骨痛、瘙痒、肌无力等症状,但PTX后是否可以减轻心血管钙化?术后长期的低PTH状态与心血管钙化的关系如何?目前还没有明确的结论,本文就CKD患者心血管钙化的影响因素,尤其是PTX对CKD患者心血管钙化的影响作一综述。     

慢性肾脏病患者心血管疾病危险因素探讨

目的探讨慢性肾脏病（CKD）患者心血管疾病的危险因素。方法收集我院542例住院CKD患者的病史、实验室检查和辅助检查结果,将患者根据有无心血管疾病分为2组,根据Logistic回归分析结果探讨心血管疾病的危险因素。结果高龄、高血压、高尿酸血症、贫血、蛋白尿是CKD患者心血管疾病的危险因素;CKD1～5期患者心血管疾病的危险因素各不相同。结论CKD进展和CKD患者心血管疾病的发生拥有部分相同的危险因素;在CKD早期以传统危险因素为主,随着肾功能的恶化,非传统危险因素起主导的作用。     

A development of atheromatous plaque is restricted by characteristic arterial wall structure at the carotid bifurcation

BACKGROUND: It is said atheromatous plaque is located very focally, but there have been few reports regarding this matter. Various aspects of the pathogenesis of the development of atheromatous plaque at the carotid bifurcation have previously been discussed. We have noted the correlation of plaque localization with characteristics of the cervical carotid artery wall. METHODS: Morphological and histopathologic changes in the carotid bifurcation were examined in 72 cadaver cases with or without atheromatous plaque. We determined the level at which the wall structure changed to muscular artery from elastic artery and analyzed its influence on the development of atheromatous plaque. RESULT: Atheromatous plaques at the distal site of the ICA extended within 0 to 37 mm from the carotid bifurcation. The proximal side of the CCA more than 5 mm away from the bifurcation was elastic artery, whereas the distal side of the ICA more than 15 mm from the bifurcation was muscular artery. The area of the carotid bifurcation between elastic artery and muscular artery was a transitional zone. Approximately 80% of them were located within 15 mm, and these areas were coincident with the transitional zone. CONCLUSION: Most atheromatous plaque was located in the transitional zone. The arterial wall structure is related to the development of atheromatous plaque at the cervical carotid bifurcation.     

慢性肾脏病患者高血压的控制及其相关因素

目的 研究并发高血压的住院慢性肾脏病（CKD）患者的降压药使用和血压控制情况,以及其相关因素。 方法 对象为2009年3月至2010年4月期间于本院住院的并发高血压的CKD患者共726例,记录其基本资料、血压、降压药使用及其他相关资料,分析其用药方案及血压控制率。 结果 91.74%患者接受了降压治疗,分别有21.21%、22.59%、19.56%、28.37%患者使用1、2、3、≥4种降压药。CKD患者总体高血压控制率为42.4%,平均血压为（137.86±20.75）/（76.30±11.35） mm Hg。CKD1+2、3、4+5期（未透析）、透析组的高血压控制率分别为50.8%、46.7%、42.0%、33.5%,各组间差异有统计学意义（P < 0.05）。非透析组高血压控制率（<130/80 mm Hg）显著高于透析组（<140/90 mm Hg）（44.9%比33.5%,P < 0.05）。血透组与腹透组高血压控制率差异无统计学意义（32.3%比38.7%,P > 0.05）。多因素Logistic回归分析显示,女性（优势比OR=1.787,95%CI 1.045~3.056）和应用ACEI类降压药（OR=4.378,95%CI 1.830~10.472）是高血压控制的有利因素;而脉压差增大（OR=0.847,95%CI 0.811~0.885）和并发糖尿病（OR=0.415,95%CI 0.188~0.919）是高血压控制的不利因素。 结论 住院CKD患者的高血压治疗率很高,但控制率仍较低。女性、ACEI类降压药是CKD患者血压控制的有利因素,而脉压差大、糖尿病是血压控制不良的独立危险因素。     

带cuff导管血液透析患者微炎症状态、氧化应激与颈动脉硬化的关系

目的探讨带cuff导管的维持性血液透析（MHD）患者微炎症状态、氧化应激对颈动脉内中膜厚度（IMT）的影响。方法选择MHD患者54例,其中带cuff导管血液透析患者24例为导管组,内瘘透析患者30例为内瘘组,另设健康志愿者30名为对照组。测定所有患者C反应蛋白（CRP）、血浆丙二醛（MDA）、超氧化物歧化酶（SOD）、血沉、血红蛋白（Hb）、血白细胞（WBC）及生化等指标。采用多元逐步回归法分析IMT与各指标间,CRP与血浆丙二醛（MDA）、SOD、血浆谷胱甘肽过氧化物酶（GSH-PxD）间的相关性。结果导管组CRP、MDA、SOD、GSH-Px、IMT与内瘘组差异非常显著（P〈0．01）。回归分析CRP与SOD（t：一2．299,P〈0．026）、MDA（t=4．055,P〈0．001）、GSH-Px（t=一2．887,P〈0．006）相关。IMT与CRP相关（t=7．353,Pd0．001）。结论导管组存在明显炎症、氧化应激,炎症与氧化应激相关,CRP与颈动脉硬化相关。