小动脉闭塞性脑卒中患者发生轻度认知功能障碍的危险因素分析

目的探讨小动脉闭塞性脑卒中患者出现轻度认知功能障碍的危险因素。方法采用回顾性方法选取1356例TOAST分型为小动脉闭塞性脑卒中患者,根据认知功能筛查结果分为认知功能正常组1279例和轻度认知功能障碍组(MCI组)77例。收集并分析2组患者一般资料、病史、神经心理量表评估和血液学指标。结果 MCI组较认知功能正常组高血压病史(84.42%vs 67.08%)、久坐生活方式(22.08%vs 11.81%)比例高,差异有统计学意义(P=0.002,P=0.008),2组文化程度比较差异有统计学意义(P=0.035)。2组年龄、TG、TC、HDL-C、LDL-C、FPG等比较,差异无统计学意义(P>0.05)。logistic回归分析显示,有高血压病史的患者发生MCI是无高血压病史患者的2.589倍(P=0.003),有久坐生活方式的患者发生MCI的概率是无久坐生活方式患者的2.161倍(P=0.008)。结论高血压和久坐生活方式与SAO患者发生MCI具有较强的相关性,是其独立的危险因素。     

Risk factors for aortic complications in adults with coarctation of the aorta

OBJECTIVES: We sought to determine the prevalence and predisposing condition for aortic wall complications in adults with either repaired or non-repaired coarctation of the aorta. BACKGROUND: Aortic wall complications may develop in adults with coarctation of the aorta, despite successful surgical repair in childhood. METHODS: A total of 235 adults with coarctation (mean age 27 +/- 13 years) were retrospectively reviewed. Treatment had been performed by surgery in 181 patients (group I) or by balloon angioplasty or stenting in 28 patients (group II). No previous intervention had been carried out in 26 patients with mild coarctation at diagnosis (group III). RESULTS: Forty-four aortic wall complications were found in 37 patients (16%). There were no differences among the three groups with respect to total complications (15%, 18%, and 15%, respectively), ascending aortic aneurysms (9%, 11%, and 12%), or descending aortic aneurysms (4% in all three groups). Multivariate analysis did not show a significant relationship between previous repair, type of repair, age at repair, residual Doppler pressure gradient, or systemic hypertension and the occurrence of aortic complications. Only aging (risk ratio [RR] 1.4 per decade of age, 95% confidence interval [CI] 1.1 to 1.8, p = 0.002) and bicuspid aortic valve (RR 3.2, 95% CI 1.3 to 7.5, p = 0.005) were significantly related to these complications. CONCLUSIONS: Aortic wall complications are frequent in adults with coarctation of the aorta beyond that attributable to associated hemodynamic derangement or previous repair. The only independent risk factors appear to be advanced age and bicuspid aortic valve.     

社区老年2型糖尿病患者合并轻度认知功能障碍危险因素分析

目的探讨分析2型糖尿病患者轻度认知功能障碍（mild cognitive impairment,MCI）的相关危险因素。方法以简易智能精神状态量表（MMSE）对社区老年2型糖尿病患者进行认知功能测评,收集MCI患者82例（MCI组）,认知功能正常者86例（NC组）。问卷调查受试者病史、年龄、糖尿病肾病、糖尿病足等资料;测定受试者血压、身高、体质量、血脂、血糖、胰岛素（Ins）、糖化血红蛋白（HbA1c）;计算胰岛素抵抗指数（HOMA-IR）、胰岛素分泌指数（HOMA-β）、体质量指数（BMI）、腰臀比（WHR）并筛查其危险因素。结果（1）与NC组比较,MCI组患者糖尿病病程、糖尿病肾病、空腹血糖（FBG）、餐后2h血糖（2hPBG）、空腹胰岛素（Fins）、HbA1c、HOMA—IR水平显著升高;而2组间年龄、糖尿病足、BMI、WHR、血压、餐后2h胰岛素（2hlns）、HOMA-B及血脂水平比较,差异均无统计学意义。（2）MCI患者MMSE量表评分与糖尿病病程、FBG、2hPBG、Fins、HOMA—IR具有相关性;而NC组仅发现与糖尿病病程、FBG相关。（3）Logistic回归分析显示糖尿病病程、FBG、HOMA-IR可能与糖尿病患者MCI独立相关。结论糖尿病病程、血糖控制水平、胰岛素抵抗程度等可能与2型糖尿病患者发生MCI密切相关,有效控制各危险因素有助于预防认知功能障碍的发生发展。     

Atherosclerosis of the aorta in patients with acute thoracic aortic dissection

BACKGROUND: The role of atherosclerosis in thoracic aortic dissection has not been established yet. Transesophageal echocardiography (TEE) is an imaging modality widely used in the diagnostic evaluation of thoracic aortic dissection, and it can detect aortic atherosclerotic plaques and assess their size and specific characteristics. METHODS AND RESULTS: One hundred consecutive patients with thoracic aortic dissection and adequate imaging of the thoracic aorta by TEE were studied. The type of dissection (proximal or distal) and the presence and the degree of aortic atherosclerosis were defined. Proximal aortic dissection (Stanford type A) was found in 64 patients. Patients with proximal dissection were younger than those with distal (type B; 58+/-13 vs 67+/-11 years, p<0.001). The prevalence of arterial hypertension was higher in patients with distal dissection compared with those with proximal. Aortic atherosclerosis was present in less patients with proximal than with distal dissection (67% vs 94%, p<0.002). Logistic regression analysis revealed that patients with severe atherosclerosis were 7.6-fold more probable to have type B than type A dissection (p<0.001). CONCLUSION: Aortic atherosclerosis is more associated with distal than with proximal aortic dissection.     

Report of 37 patients with traumatic rupture of the thoracic aorta

The records of 37 patients with ruptured thoracic aorta were reviewed. Twenty-six were operated on, and 11 died before they could reach the operating room. Three patients died in the postoperative period: one of massive pulmonary contusion, one of pulmonary insufficiency secondary to fat emboli, and one of massive central nervous system damage. The operative complication of most concern was the anterior spinal syndrome, which occurred in three patients. Twenty-three patients survived with no sequelae from their aortic injury.     

Chest wall stiffness in patients with chronic respiratory muscle weakness

Using the weighted spirometer technique we studied chest wall compliance (Cw) in 16 nonobese patients with chronic weakness of the respiratory muscles and 20 healthy control subjects. In order to evaluate the validity of the technique, while Cw was being measured, we monitored thoracoabdominal configuration with 2 pairs of linearized magnetometers and electrical activity of the external oblique with a concentric needle electrode in 3 healthy subjects and 4 patients; in addition, we recorded in 3 subjects the electrical activity from the intercostal muscles and diaphragm throughout the procedure. The method was reproducible within 5.8% and provided Cw values that compared well with those yielded by the relaxation technique. In each subject, the weight-induced shifts in end-expiratory lung volume showed a very good linear correlation with the changes in transrespiratory pressure at end-expiration (r greater than or equal to 0.91). In addition, in none of the subjects tested did the electromyograms reveal any intercostal, diaphragmatic, or abdominal muscle activity at end-expiration, nor did the end-expiratory level ever show a significant departure from the relaxed thoracoabdominal configuration, thus suggesting adequate respiratory muscle relaxation. The reduction in inspiratory muscle force in the patients ranged from 17 to 94% of predicted (mean +/- SE, 43 +/- 6). The decrease in vital capacity, total lung capacity, and functional residual capacity averaged 59, 34, and 15% of predicted, respectively. Both the patient and the control groups showed a large interindividual variability regarding Cw. It varied from 0.117 to 0.258 L/cm H2O (mean +/- SE, 0.162 +/- 0.012) in the patients and from 0.163 to 0.366 L/cm H2O (mean +/- SE, 0.248 +/- 0.013) in the healthy subjects.(ABSTRACT TRUNCATED AT 250 WORDS)     

社区轻度认知功能障碍的患病影响因素研究

目的探索社区轻度认知功能障碍(MCI)患病的相关影响因素。方法对2009年广州地区城乡MCI患病率流行病学调查时诊断为MCI的患者299例(MCI组)和认知正常老人1682例(对照组)进行分析。影响因素调查内容包括患者的一般人口学资料、血管性疾病、生活方式等。采用多因素条件logistic回归分析其患病的相关因素。结果 MCI组与对照组在男性(31.4%vs 43.0%)、年龄[(79.7±6.4)岁vs(74.7±6.2)岁]、受教育程度[(1.5±2.8)年vs(4.6±4.6)年]、城市居民[58.2%vs 73.7%]等分布特征上差异有统计学意义(P<0.01)。单因素分析显示,冠心病、高血压、糖尿病、高脂血症、吸烟、饮酒对MCI患病无显著影响(P>0.05);而脑卒中(含脑梗死、脑出血)、喝茶、运动对MCI的患病与否差异有统计学意义(P<0.01)。多因素条件logistic回归分析显示,年龄(OR=1.102,95%CI:1.079~1.125)、教育程度(OR=0.825,95%CI:0.785~0.866)、脑卒中(OR=2.693,95%CI:1.804~4.018)、运动(OR=0.464,95%CI:0.343~0.627)是MCI的影响因素(P<0.01)。结论教育程度高和经常运动是MCI的保护性因素,而增龄和脑卒中是MCI的危险因素。     

Significance of the intima-media thickness of the thoracic aorta in patients with coronary atherosclerosis

BACKGROUND: The prevalence and clinical significance of atherosclerotic aortic disease have now been documented in a variety of patient populations by use of transesophageal echocardiography (TEE). There are many reports that atherosclerotic aortic plaques detected by TEE are a marker for coronary artery disease (CAD). HYPOTHESIS: The study was undertaken to evaluate the significance of the intima-media thickness (IMT) and formation of atherosclerotic plaques of the thoracic aorta (TA) in patients with CAD, especially in terms of a correlation between the IMT of the TA and the extent of coronary atherosclerosis. METHODS: The IMT of the TA was measured using TEE. The study population comprised 100 patients (68 men, mean age 59 years). The extent of coronary atherosclerosis was divided into four groups (0, 1, 2, 3) according to the number of coronary arteries narrowed > or = 50%. RESULTS: There was no significant difference in the IMT of the ascending TA according to the presence of significant (> 50% narrowed) coronary stenosis, but there was a significant difference in the IMT of the descending TA (1.39 vs. 1.88 mm, p = 0.005). There was a significant correlation between the extent of coronary atherosclerosis and the IMT of the ascending and descending TA (r = 0.24, p < 0.05; r = 0.352, p < 0.001, respectively). The plaques in the TA were seen in 7, 41, 52, and 65% of patients in Groups 0, 1, 2, and 3, respectively. Among atherosclerosis risk factors, hyperlipidemia was the only factor analyzed that affected the IMT of the descending TA (2.11 vs. 1.78 mm, p < 0.05). CONCLUSION: The IMT of the TA correlates significantly with coronary atherosclerosis, and correlation of the descending TA IMT with coronary atherosclerosis is better than that of ascending TA IMT. Age is associated with coronary atherosclerosis, and TA IMT and hyperlipidemia are associated with descending TA IMT. Therefore, although TEE is not recommended for measuring TA IMT or for evaluating aortic plaques in patients with CAD, measurement of TA IMT as well as carotid artery IMT is very helpful for understanding the extent of coronary atherosclerosis.     

Flow in the thoracic aorta

Pulsed ultrasonic Doppler velocimetry and theoretical flow analysis have been combined to improve the knowledge and understanding of aortic velocity profiles and wall shear. From the theoretical point of view, particular aspects of the flow were developed, concerning the vorticity in the aorta, the interior velocity distribution, the boundary layer, the flow after separation and the effects of the branches. The experimental approach was performed on dogs, using pulsed ultrasonic Doppler velocimeter providing real-time acquisition of the instantaneous velocity distribution along vascular diameters and perivascular probes designed for bidimensional measurement of velocity distribution. The good agreement found between theory and the experimental velocity profiles has led to comparison of the assessments of axial shear. The peak of the measured shear agrees well with the calculated one; the largest observed shear, obtained at the level of the initial part of the descending thoracic aorta, varies from 4.5 Pa to 7.5 Pa depending on the cardiac output. Finally initial attempts have been made to correlate atheromatous wall lesion localisation with the flow and shear variation.     

Tandem coarctation of the thoracic aorta with hypoplasia of the abdominal aorta

After resection of the coarctation in a 3-year-old child with end-to-end anastomosis, a second membrane was found 1.5 cm lower. After a successful reoperation with an aortoplasty using Gore-Tex weak femoral pulses persisted. At catheterization, an area of irregular narrowing of the abdominal aorta just distal to the superior mesenteric artery was found with hypoplasia of the iliac and femoral arteries. In addition, this child had a two-sided cheilo-gnatho-palatoschisis, vesicoureteral reflux and absence of gall bladder and hepato-duodenal ligament. It is worthwhile considering that a second or third aortic abnormality can be hidden by a coarctation of the aorta.     

卒中患者脑白质疏松的危险因素

目的 探讨脑白质疏松(leukoaraiosis,LA)的危险因素.方法 回顾性收集卒中患者的临床和影像学资料,根据MRI结果将脑白质疏松分为脑室周围LA和皮质下LA,并进行计分和分级.结果 共纳入113例卒中患者,其中男性74例,女性39例,平均(61.33±1.32)岁.有脑室周围LA患者(n=86)的年龄[(65...     

Current surgical treatment and results for aneurysm of the thoracic aorta in elderly patients

During the period from January, 1983 to December, 1986, a total of 199 patients with thoracic aortic aneurysm underwent surgical treatment in our Cardiovascular Surgical Service. During this period, criteria for surgical indications were established and general surgical principles and techniques were standardized. As a consequence, surgical results appeared to stabilize during this period. It was clearly established that the surgical result for patients over 65 years was poor with high mortality compared to the younger age group (38.6% vs 7.2%). This tendency was in sharp contrast to that of abdominal aortic aneurysm surgery where low mortality (3%) was obtained regardless of age. Other factors influencing high mortality were as follows: 1) atherosclerosis as an etiological background, 2) aneurysm situated at the aortic arch, 3) Urgency for surgery, 4) pre- and postoperative status of respiratory and renal function. Late follow-up results showed that 25% of patients died, while 66% are in fair condition.     

Cardio-ankle vascular index (CAVI) correlates with aortic stiffness in the thoracic aorta using ECG-gated multi-detector row computed tomography

Background

The cardio-ankle vascular index (CAVI) is an arterial stiffness index based on the stiffness parameter β, which is essentially independent of blood pressure. The objective of this study was to determine whether CAVI correlates with the regional stiffness parameter β and pulse wave velocity (PWV) in the thoracic aorta calculated from ECG-gated multi-detector row computed tomography (MDCT).

Methods and results

Forty-nine patients who underwent coronary MDCT for suspicious coronary artery disease were recruited. The largest and smallest vessel luminal cross-sectional areas of the thoracic aorta were measured from MDCT images to calculate PWV and stiffness parameter β of the ascending and descending aorta. CAVI was also measured by VaSera VS-1000.In univariate analysis, CAVI significantly correlated with regional stiffness parameter β and PWV, which was influenced by the inevitable part of the aging process in the ascending (r = 0.485, P < 0.001; r = 0.483, P < 0.001) and descending aortas (r = 0.304, P = 0.034; r = 0.327, P = 0.022), respectively. The regional stiffness parameter β did not correlate with systolic blood pressure (SBP), although the PWV correlated with SBP. In multivariate analysis, CAVI independently correlated with the stiffness parameter β, but not with the PWV.

Conclusion

These data suggest that CAVI, which correlated with stiffness parameter β in the thoracic aorta, has a potential role in evaluating integrated arterial stiffness including that of the central aorta.     

MRI of the thoracic aorta

Diseases of the thoracic aorta cause significant morbidity and mortality and can result in potentially catastrophic consequences. Conventional digital subtraction angiography (DSA) has been the gold standard for imaging for many years; however, this is associated with adverse effects and provides only limited information about vessel morphology. DSA is used primarily as a first-line investigation in the setting of trauma. Several other techniques also have been used in recent years, including CT and MRI. This article focuses primarily on the latter.