颈动脉内膜中层厚度对维持性血透患者冠状动脉硬化的意义

心血管疾病已成为慢性肾衰竭患者死亡的主要原因之一.我国透析患者中冠状动脉疾病的患病率达19%[1].动脉内膜中层厚度（AIMT）增加被视为早期动脉粥样硬化的标志之一,有研究发现慢性肾损伤患者的颈动脉内膜中层厚度（CAIMT）明显增加[2~4].本文旨在分析血液透析患者CAIMT与缺血性心脏病及动脉粥样硬化经典危险因素之间的关系,以评估CAIMT作为终末期肾衰竭患者冠状动脉粥样硬化辅助指标的可行性.     

高血压病患者颈动脉内膜中层厚度与静息心率的关系

目的探讨高血压患者颈动脉内膜中层厚度（IMT）与静息心率（RHR）的相关性。方法入选的高血压病患者92例，按RHR水平分为三组，RHR1组：〈70次／min（26例），RHR2组：70次／min≤RHR〈80次／rain（34例），RHR3组：RHR≥80次／min（32例）。对入选患者询问病史及体格检查并做以下检查：心电图、颈动脉超声、血脂、血糖等生化指标。结果（1）三组患者在年龄、病程方面差异无统计学意义（P〉0．01）。（2）随着RHR的增加，IMT也逐渐增厚，各组间比较差异有统计学意义（P〈0．01）。RHR2组和RHR3组的IMT、颈动脉内径（CAD）均高于RHR1组（P〈0．01）。（3）RHR与IMT、颈动脉内径呈正相关（r分别为0．432、0．389，P〈0．01）。（4）血糖、胆固醇和甘油三酯随着RHR的增加有升高趋势，与RHR呈正相关，其r值分别为0．659、0．479和0．266，P均〈0．01。结论高血压患者随着静息心率的增加，发生颈动脉内膜中层厚度增加的机会也在增加，静息心率水平升高是颈动脉内膜中层增厚的危险因素。     

血液透析患者颈动脉内中膜厚度影响因素及其临床意义

动脉粥样硬化性心血管疾病在维持性血液透析患者中发病率较高,发病机制复杂.近年来的研究表明,颈动脉内膜中层厚度可作为一种反映动脉粥样硬化的无创性指标.认识和了解颈动脉IMT对预防和治疗该类疾病.提高维持性血液透析患者的长期存活率及生活质量具有重要意义.本文就血液透析患者颈动脉内中膜厚度的影响因素及其相关临床意义作一综述.     

颈动脉内膜中层厚度和绝经后妇女骨密度相关性研究

目的探讨绝经后骨质疏松症患者颈动脉内膜中层厚度(CIMT)的差异及CIMT和斑块增大的风险。方法进行横断面研究,包括60位绝经后骨质疏松症妇女和60位非骨质疏松症绝经后妇女。CIMT采用B型超声测量。结果绝经后骨质疏松症妇女与无骨质疏松症妇女的平均CIMT差异无统计学意义(P 0.05)。骨质疏松症组CIMT升高的风险与非骨质疏松症组相似。骨质疏松症妇女斑块出现的风险是正常人的三倍。然而,调整了易使妇女患有心血管疾病的年龄和基础疾病后,两组之间斑块的存在并无显着差异(校正比值比=0.85;95%可信区间0.10～6.464)。结论绝经后妇女与无骨质疏松症患者的平均CIMT无差异。绝经后骨质疏松症女性的CIMT升高风险与无骨质疏松症的绝经后妇女相当。两组之间斑块的存在没有显着差异。     

糖尿病肾脏病患者中医证型与颈动脉内膜中层厚度相关性

目的:通过观察糖尿病肾脏病(DKD)患者不同中医证型与颈动脉内膜中层厚度的相关性,采用相应的中医辨证治疗方法,对预防及延缓DKD患者心血管事件的发生发展提供一定临床价值.方法:选取北京中医药大学东直门医院近5年的DKD患者326例和T2DM组患者36例,同时选取东直门医院国家部体检科健康者30例,测定所有入组患者的血脂...     

血液透析患者血8-羟基脱氧鸟苷与血管内皮功能、颈动脉内膜中层厚度的关系

目的检测血液透析(hemodialysis,HD)患者血8-羟基脱氧鸟苷(8-hydroxydeoxyguanosine,8-OHdG)、血内皮素1(endothelinm-1,ET-1)、内皮型一氧化氮合酶(endotheliat nitric oxide synthase,eNOS)水平及颈动脉内膜中层厚度,探讨氧化应激在HD患者血管内皮功能障碍、动脉粥样硬化中的作用。方法选择2014年10月至2015年4月在河北省迁安市人民医院行血液透析治疗3个月以上的非糖尿病尿毒症患者52例为HD组;另设本院体检健康者45例为对照组。采用ELISA法测定血8-OHdG浓度,放射免疫法测定血ET-1含量,硝酸酶还原法进行血eNOS活力测定。采用多普勒超声检测颈动脉内膜中层厚度(carotid intimal-medial thickness,CIMT)。结果与对照组比较,HD组患者CIMT明显增厚[(1.31±0.29)mTmrn比(0.82±0.21)rm,P0.013。HD组患者动脉硬化的发生率为78.85%。与对照组比较,HD组患者血8-OHdG水平明显升高[(38.30±9.34)ng/ml比(7.24±0.87)ng/ml,P0.01);HD组患者血ET-1水平明显升高[(138.35±31.12)pg/ml比(16.40±1.21)pg/ml,P0.01];HD组患者血eNOS水平降低[(12.67±1.66)U/ml比(14.05±1.56)U/ml,P0.013。HD组患者血8-OHdG水平与年龄、透析时间、超敏C反应蛋白(high sensitivity C-reactive protein,hs-CRP)、收缩压、舒张压、ET-1呈正相关(r=0.697、0.752、0.532、0.350、0.269、0.753,P0.05),与尿素清除指数(Kt/V)、eNOS呈负相关(r=-0.367、-0.723,P0.01)。多元线性逐步回归分析,显示血8-OHdG水平是HD患者CIMT的独立危险因素(B=0.044,P=0.001)。结论 HD患者存在明显的氧化应激状态和血管内皮功能障碍。HD患者的氧化应激参与了血管内皮功能障碍的发生。血8-OHdG水平是HD患者动脉粥样硬化的独立危险因素。     

雄激素和雄激素受体与老年男性颈动脉内膜中层厚度的相关研究

目的 探讨老年男性颈动脉内膜中层厚度与雄激素和雄激素受体水平变化的相关性. 方法 入组老年男性89例,根据颈动脉内膜中层厚度分为内膜正常组、内膜增厚组、斑块形成组、管腔狭窄组,采用化学发光法检测血清中黄体生成素、卵泡刺激素、总睾酮和雌二醇.使用流式细胞技术测定外周淋巴细胞内雄激素受体水平. 结果 与内膜正常组比较,内膜增厚组VLDL-c显著升高;斑块形成组HDL-c显著降低,LDL-c显著增加;管腔狭窄组收缩压、舒张压和LDL-c均显著增加.老年男性中斑块形成组和管腔狭窄组与内膜正常组比较总睾酮水平和雄激素受体荧光强度明显下降. 结论 老年男性颈动脉内膜中层厚度的增加伴随着总睾酮和雄激素受体水平明显降低.雄激素受体水平的下降可能与动脉粥样硬化的发生发展相关.     

维持性血液透析患者医院感染临床分析

血液透析患者常存在免疫功能紊乱、抵抗力差、易并发感染,且感染已成为血透患者主要的死亡原因之一.医院感染近年来已引起国内外医学界的极大重视,血透患者是医院感染的高危人群,因而探讨血透患者医院感染的特点,从而有效防止医院感染尤为重要.我们对近3年132例住院维持性血透患者发生的医院感染进行回顾性分析.     

维持性血液透析患者营养不良的影响因素

营养不良是影响维持性血液透析(血透 )患者生活质量和增加病死率的重要因素[1] 。我们拟从膳食摄入、代谢性酸中毒、透析充分性、透析膜的生物相容性、ｒＨｕＥＰＯ和肉毒硷的使用等方面分析与营养不良的相关性。一、资料和方法1.研究对象 :48例维持性血透患者 ,男 2 5例 ,女 2 3例 ,平均年龄 5 4.1岁 (2 6～77岁 ) ,透析时间 8～ 2 42月 ,平均 2 6月。另取 40名健康成人作对照 ,男 2 2人 ,女18人 ,平均年龄 5 6 .2岁 (2 3～ 75岁 )。2 .方法 :(1)膳食摄入分析。 (2 )评价营养状况的客观指标 :尿素清除率相对体重 (ＲＢＷ ) ,肱三头肌皮皱厚…     

Carotid intima-media thickness and plaques in hemodialysis patients

Atherosclerosis is accelerated in hemodialysis patients. Using B-mode ultrasonography, we compared intima-media thickness (IMT) and the prevalence of plaques in the common carotid and internal carotid arteries in 28 randomly selected hemodialysis patients with that in 28 age- and sex-matched normal controls. The IMT values of the common carotid and internal carotid arteries were higher in hemodialysis patients than in controls with more hemodialysis patients having plaques. In hemodialysis patients, there was a relationship between age and IMT in the common carotid arteries, in the area of bifurcation, and in the internal carotid arteries. We found no relationship between IMT and atherosclerotic risk factors or duration of hemodialysis treatment. IMT at all sites correlated with the number of plaques. Age was the only significant determinant for number of plaques. The results indicate that hemodialysis patients showed advanced atherosclerosis in the carotid arteries compared with age- and sex-matched normal subjects.     

胰岛素抵抗与非糖尿病维持性血液透析患者颈动脉粥样硬化相关性分析

目的探讨维持性血液透析患者胰岛素抵抗与颈动脉粥样硬化的相关性。方法将78例非糖尿病肾脏疾病的维持性血液透析患者,根据胰岛素敏感度分为胰岛素抵抗组（A组）和胰岛素敏感组（B组）,比较2组颈动脉粥样硬化发生率和各相关因素指标;同时,对颈动脉粥样硬化影响因素进行Logistics回归分析,胰岛素抵抗与颈动脉粥样硬化相关因素进行单因素回归分析。结果A组血脂、血磷、同型半胱氨酸、超敏c反应蛋白（hs—CRP）、白细胞介素6（IL-6）、甲状旁腺素（iPTH）、颈动脉粥样硬化发生率与B组存在明显差异（P〈0．05）,对胰岛素敏感性与各危险因素进行Logistic回归分析,发现胰岛素抵抗与高血脂、微炎症相关（P〈0．05）。结论胰岛素抵抗是颈动脉粥样硬化的危险因素,其机制可能与微炎症、脂代谢异常有关。     

Relationship between insulin resistance and increased carotid artery intima-media thickness in non-diabetic kidney disease patients

Objective To evaluate the relationship of insulin resistance (IR) and carotid artery intima-media thickness (CA-IMT), plaque status in non-diabetic non-dialysis chronic kidney disease (CKD) patients with different stages. Methods One hundred and seventeen non-diabetes non-dialysis CKD patients were enrolled into this cross-sectional observational study. Insulin resistance index (HOME-IR) was assessed by the homeostasis model assessment. Patients with HOME-IR≥1.73 were defined as insulin resistance. And patients with CA-IMT≥0.9 mm were defined as thickening. The blood pressure measurement, heart Doppler ultrasound, bilateral carotid artery ultrasound examination, blood biochemistry and urine protein test were performed, eGFR was calculated by EPI formula. Results The prevalence of IR was 47.01% in 117 non-diabetic non-dialysis CKD patients, and it was 35.71%, 50.00% and 54.55% in eGFR≥60ml•min-1•(1.73 m2)-1 group, 30≤eGFR＜60ml•min-1•(1.73 m2)-1 group, and eGFR＜30ml•min-1•(1.73 m2)-1 group separately. In eGFR＜30ml•min-1•(1.73 m2)-1 group, cystain C, homocysteine, parathyroid hormone, Scr, BUN, uric acid, interventricular septal thickness, left ventricular dimension, left ventricular posterior wall thickness were significantly higher than that in the other two groups (P＜0.01), while the level of hemoglobin was significantly lower (P＜0.01); then the levels of serum albumin and systolic pressure were higher than that in the eGFR≥60ml•min-1•(1.73 m2)-1 group, however, the levels of total cholesterol and low-density lipoprotein-cholesterol were lower than that in the eGFR≥60ml•min-1•(1.73 m2)-1 group. Correlation analysis showed that insulin resistance index was significantly correlated with CA-IMT (r=0.444, P=0.006）in the eGFR＜30ml•min-1•(1.73 m2)-1 group, however, there wasn’t correlation in other two groups. And although insulin resistance wasn’t correlated with soft plaque, it was significantly correlated with hard plaque (χ2=6.476, P=0.011) in the eGFR＜30ml•min-1•(1.73 m2)-1 group. The Logistic regression analysis results displayed aging increase was the independent risk factor of the CA-IMT thickening for non-diabetes non-dialysis CKD patients but not insulin resistance. Conclusions HOMA-IR is correlated with CA-IMT and hard plaque when eGFR＜30ml•min-1•(1.73 m2)-1 in non-diabetes non-dialysis CKD patients. However, the insulin resistance isn’t the independent risk factor of the CA-IMT thickening for non-diabetes non-dialysis CKD patients.     

Left ventricular systolic and diastolic function and carotid intima-media thickness in pediatric dialysis patients

Background  Cardiovascular complications are common in patients with end-stage renal disease (ESRD). We aimed to investigate left ventricular (LV) function and carotid intima-media thickness (cIMT) in children and adolescents with ESRD. Methods  This study included 38 ESRD patients (15 hemodialysis and 23 peritoneal dialysis) and 17 age- and sex-matched healthy subjects. Results  The ESRD patients had significantly lower mean mitral E/A ratio, and higher left ventricular mass index (LVMI) and cIMT than the control group. Compared with PD patients, HD patients had worse LV diastolic function. In stepwise linear regression analysis, LVMI (P = 0.043) and hemoglobin (P = 0.015) turned out to be independent variables for predicting diastolic dysfunction (reduced E/A ratio), and the only significant predictor of cIMT was indexed diastolic blood pressure (DBP) (P = 0.035). Conclusion  Cardiovascular structure and function abnormalities are also common in pediatric dialysis patients, as in adults. Furthermore our data indicated that hemodialysis was disadvantageous for preserving LV diastolic function as compared with peritoneal dialysis.     

Magnesium supplementation helps to improve carotid intima media thickness in patients on hemodialysis

Background  The atherosclerotic process progresses more dynamically in hemodialysis (HD) patients than in the general population. In HD patients, lower magnesium levels were reported to be associated with increased atherosclerosis of the common carotid artery. We tested the hypotheses that magnesium supplementation helps to improve carotid intima media thickness (IMT) in HD patients. Materials and methods  A total of 47 patients on HD were included in the study. Patients were randomly divided into two groups: group A (Mg group), in which patients were given magnesium citrate orally at a dosage of 610 mg every other day for 2 months and group B (control group), in which patients received only calcium acetate therapy as a phosphate binder. At baseline and 2 months later, all patients underwent a carotid artery ultrasound scan to measure carotid IMT. Results  At the end of 2 months, mean serum calcium, phosphorus, and calcium × phosphorus product were not changed in both groups. As expected, mean serum Mg level significantly increased in the Mg group at the end of 2 months. In addition, serum parathyroid hormone (PTH) level significantly decreased in the Mg group at the end of 2 months (P = 0.003). Baseline carotid IMT was similar between the groups. Bilateral carotid IMT was significantly improved in patients treated with magnesium citrate compared to initial values (P = 0.001 for left, P = 0.002 for right). Conclusion  Based on the present data, magnesium may play an important protective role in the progression of atherosclerosis in patients on dialysis. Further studies are needed to assess more accurately the role of magnesium in atherosclerotic regression in dialysis patients.     

Relationship between carotid artery intima-media thickness and renal function in patients with diabetes mellitus

Objective To investigate the relationship between carotid artery intima-media thickness and renal function in patients with diabetes mellitus. Methods 424 patients of type 2 diabetes without dialysis were enrolled in a cross-sectional study. According to their artery intima-media thickness (IMT), the patients were divided into normal group and higher IMT group. All patients according to UAER or 24h urinary protein were divided into normal proteinuria group, micro-proteinuria group and clinical proteinuria group. The biochemical examination, eGFR, and atherosclerotic plaque of different groups were compared. Pearson or spearman correlation was used to analyze the relationship between eGFR, IMT and other parameters. Risk factors for eGFR decline were analyzed by binary logistic regression. Results Compared with normal group, patients in the higher IMT group were older [(63.3±10.2) year vs (52.5±10.6) year, P﹤0.05], and underwent longer duration of diabetes [(8.9±6.7) year vs (6.2±5.7) year, P﹤0.05]. Their level of eGFR was decreased [(75.92±28.00) ml/min vs (91.64±24.05) ml/min, P﹤0.05], while plaque incidence (71.3% vs 18.3%,χ2=112.42, P﹤0.01) and prevalence of hypertension (56.4% vs 29.6%, χ2=27.22, P﹤0.01) increased. Correlation analysis showed that IMT was positively correlated with age (r=0.503, P﹤0.01), duration of diabetes (r=0.204, P﹤0.01), 24 h urine protein (rs=0.175, P﹤0.05), plaque (rs=0.562, P﹤0.01), and hypertension (rs=0.193, P﹤0.01), but negatively correlated with eGFR (r=-0.307, P﹤0.01). Logistic regression analysis showed that age, serum uric acid, 24 h urine protein and carotid artery intima-media thickness were independent risk factors for eGFR decline [OR=1.115, 95%CI(1.053, 1.165), P﹤0.001; OR=1.008,95%CI (1.002, 1.014), P=0.006; OR=1.492, 95%CI(1.170,1.903), P=0.001; OR=1.619, 95%CI(1.121, 2.339), P=0.010]. Conclusion Carotid artery intima-media thickness is an independent risk factor for kidney function decline in patients of diabetes.     

可溶性Klotho蛋白对维持性血液透析患者血管硬化的影响

目的 探讨维持性血液透析(maintenance hemodialysis,MHD)患者血管硬化与可溶性Klotho蛋白(serum soluble Klotho,sKL)之间的关系.方法 收集60例MHD患者的临床资料,采用ELISA法检测sKL浓度.检测MHD患者踝一臂脉搏波传导速度(brachial-ankle pulse wave velocity,baPWV)和颈动脉内中膜厚度(intima-media thickness,IMT),以评价MHD患者血管硬化的程度.用Logistic回归分析法分析MHD患者发生血管硬化的危险因素;用Pearson相关分析法分析sKL浓度与baPWV、IMT的相关性.结果 60例MHD患者中,47例患者baPWV≥1 400 cm/s,血管硬化者占78.3％.根据患者血sKL水平分布范围的四分位数分为4组,Ⅰ组sKL＜405 ng/L,Ⅱ组sKL范围为405～624 ng/L,Ⅲ组sKL范围为624～832 ng/L,Ⅳ组sKL＞832 ng/L;各组的baPWV、Max IMT随着sKL水平的降低而升高(P＜0.01);sKL浓度与baPWV呈负相关(r=-0.115,P＜0.01),血清sKL浓度与Max IMT呈负相关(r=-0.224,P＜0.01),差异有统计学意义.Logistic回归分析法分析结果显示,血清sKL浓度降低(OR=2.336,95％ CI 1.153～7.315)和吸烟(OR =4.025,95％ CI 2.305～11.234)是MHD患者血管硬化的独立危险因素.结论 血清sKL浓度下降与血管硬化相关,血清sKL浓度的测定可能有助于血管硬化的诊断.     

Relationship between thyroid function and carotid atherosclerosis in patients on maintenance hemodialysis

Objective To investigate the changes of thyroid function and carotid atherosclerosis in patients on maintenance hemodialysis (MHD). Methods A total of 110 stable MHD patients undergoing hemodialysis for at least three months were enrolled in the study. Serum free-T3 (FT3), free-T4 (FT4) and thyroid stimulating hormone (TSH) concentrations were measured by electrochemiluminescence．Plasma levels of homocysteine (Hcy) and C-reactive protein (CRP) were detected. Clinical data and biochemical indicators were collected. These patients were divided into thyroid dysfunction group and euthyroidism group. Prevalence of atherosclerosis was detected by carotid ultrasonography. The associations between the changes of thyroid function and carotid atherosclerosis were analyzed by Logistic regression model. Results Among these 110 patients, 42 (38.18%) patients had thyroid dysfunction. Hcy and CRP concentrations were significantly higher in thyroid dysfunction group than those in euthyroidism group (P＜0.05). The intima-media thickness, number of plague and arteriostenosis of carotid were higher in thyroid dysfunction group than those in euthyroidism group (P＜0.05). Multivariate logistic regression analysis showed that increased Hcy and CRP, decreased serum FT3 were independent risk factors for carotid atherosclerosis. Conclusions Thyroid dysfunction with low serum FT3 is frequently found in MHD patients. In MHD patients, FT3 is closely correlated to carotid atherosclerosis.     

Comparison of usefulness of the wall thickness of the left anterior descending coronary artery, determined by transthoracic echocardiography, and carotid intima-media thickness in predicting multivessel coronary artery disease

Background  Wall thickness in the distal part of the left anterior descending coronary artery (LAD) can be measured by using two-dimensional high-resolution transthoracic echocardiography (2DHTTE). The objective of this study was to compare the diagnostic accuracy of measuring carotid intima-media thickness (IMT) and distal LAD wall thickness for prediction of multivessel coronary artery disease (MVD). Methods  We measured wall thickness in the distal LAD using 2DHTTE and carotid IMT using B-mode ultrasound in 100 patients who subsequently underwent coronary angiography (CAG). Patients were classified into three groups based on the results of CAG—no significant stenosis (group N), single-vessel disease (group S), or multivessel disease (group M). Results  Successful measurements of LAD wall thickness were accomplished in 96 patients. Distal LAD wall thickness was significantly greater in group M (0.92 ± 0.20 mm) than in group N (0.72 ± 0.11 mm, P < 0.01) and group S (0.76 ± 0.19 mm, P < 0.01). Carotid IMT was significantly greater in group M (0.90 ± 0.24 mm) than in group N (0.75 ± 0.21 mm, P < 0.05) and group S (0.80 ± 0.17 mm, P < 0.05). Distal LAD wall thickness >0.8 mm had a sensitivity of 75% and a specificity of 67% in predicting MVD, whereas carotid IMT >0.8 mm was 63% sensitive and 67% specific in the prediction of MVD. There was a weak but significant correlation between distal LAD wall thickness and IMT (r = 0.31, P < 0.01). Conclusions  Non-invasive measurement of distal LAD wall thickness by 2DHTTE is feasible, and has equivalent diagnostic accuracy to IMT measurements for predicting MVD.