Serum cholesterols have a more important role than triglycerides in determining intima-media thickness of the common carotid artery in subjects younger than 55 years of age.

OBJECTIVE: The role of serum cholesterol and triglycerides in carotid artery atherosclerosis is controversial. We measured carotid artery intima-media thickness (IMT), a marker of atherosclerosis in subjects younger than 55 years of age with a 6-fold range of serum cholesterol levels (3.93-25.03 mmol/L) and a 200-fold range of triglyceride levels (0.36-75.97 mmol/L). METHODS: Eighty-six patients with increased serum lipid values and 30 subjects with normal lipid values were included. Serum lipids were measured after an overnight fast. High-resolution sonographic investigations of the carotid arteries of all patients were videotaped. Intima-media thickness was measured offline at 1-mm increments in the distal 10-mm segments of both common carotid arteries by a reader blinded to patient characteristics. First, IMT was compared among groups defined by their cholesterol and triglyceride levels with the use of traditional cutoff values. Next, all subjects were pooled, and general regression analysis was performed to identify significant predictors of IMT with age, body mass index, lipid values, sex, diabetes, hypertension, and smoking status as independent variables. RESULTS: Intima-media thickness was larger in patient groups with high cholesterol levels (ie, the hypercholesterolemic and combined hyperlipidemic groups) than in the control, borderline, and isolated hypertriglyceridemic groups (P < .01). In the general multiple regression model, IMT correlated positively with total cholesterol level (beta = 0.343; P = .002) and age (beta = 0.3; P = .006) but not with triglyceride level. CONCLUSIONS: Both the group comparisons and the general regression analysis of the pooled data suggest that hypercholesterolemia has an important role in early onset IMT changes in the common carotid artery, whereas hypertriglyceridemia does not have an appreciable role.     

Xanthelasma is not associated with increased risk of carotid atherosclerosis in normolipidaemia

OBJECTIVES: Extracranial carotid artery (ECCA) atherosclerosis is well known to be associated with cardiovascular diseases. This study aims to investigate the difference of ECCA atherosclerosis between patients with xanthelasma and control subjects in normolipidaemia. METHODS: Carotid atherosclerosis (CA) of 41 (8 males and 33 females) patients with xanthelasma and normolipidaemia, defined as levels of cholesterol below 6.21 mmol/l and triglyceride below 2.26 mmol/l, recruited from Department of Dermatology was compared with that of 85 age- and gender-matched control subjects. The extent and severity of CA were measured by high-resolution B-mode ultrasound and expressed as the mean intima-media thickness (IMT) of the common carotid artery (CCA) and ECCA plaque score. Mixed-effects model and multivariate logistic regression analyses were used to estimate the association between xanthelasma and CA. RESULTS: Patients with xanthelasma showed significantly higher levels of low-density lipoprotein cholesterol (LDL-C) levels and higher body mass index (BMI) compared with the control group. Mixed models identified age, male gender, smoking and subjects of hypertension with medication, but not the presence of xanthelasma, were associated with an increase of CCA IMT. Multivariate logistic regression analysis revealed subjects of male gender, and hypertension with medication, but not the presence of xanthelasma, associated with thicker IMT, defined as IMT >or= 75th percentile, or ECCA plaque score >or= 3. CONCLUSIONS: Normolipidaemia with xanthelasma is not significantly associated with CA, but did relate with adverse cardiovascular profiles, such as higher BMI, waist circumference and LDL-C levels.     

Carotid intima-media thickness in HIV patients treated with antiretroviral therapy

INTRODUCTION: Increased cardiovascular risk in HIV patients in antiretroviral therapy (ART) may be due to HIV infection, direct effect of ART or dyslipidaemia induced by ART. Our aim was to study the relative importance of HIV, ART and dyslipidaemia on atherosclerosis, assessed by the comparison of carotid artery intima-media thickness (IMT) in non-smoking HIV patients with high or low serum cholesterol levels as well as in healthy volunteers. METHODS: HIV patients in ART with normal cholesterol (or=6 x 5 mmol l(-1); n=12) as well as healthy controls (n=14) were included. All were non-smokers and had never received medication for dyslipidaemia or hypertension. IMT was measured by ultrasonography. RESULTS: In HIV patients with normal cholesterol (or=6 x 5 mmol l(-1)) and in controls (5 x 1 +/- 0 x 9 mmol l(-1)) IMT were 683 +/- 119, 656 +/- 99 and 657 +/- 99 microm, respectively. Thus no difference in IMT was found between the three groups. IMT values did not differ between patients receiving and not receiving protease inhibitors (658 +/- 117 microm versus 687 +/- 97 microm, P>0 x 05). In HIV patients IMT correlated inversely with HDL cholesterol levels (r=-0 x 50; P=0 x 01), whereas no correlation was found with total cholesterol or LDL cholesterol. CONCLUSIONS: In non-smoking HIV patients receiving ART no sign of accelerated atherosclerosis was found as assessed by IMT even not in hypercholesterolaemic HIV patients. IMT correlated with HDL cholesterol but not with LDL cholesterol. Based on these observations, one could speculate whether selective lowering of LDL cholesterol will be successful in reducing cardiovascular risk in non-smoking HIV patients.     

有氧训练联合耳穴贴压在降低颈动脉粥样硬化患者血糖、血脂水平中的应用

目的探讨有氧训练联合耳穴贴压改善颈动脉粥样硬化患者血糖、血脂水平的效果。方法选取2017年1~12月在该院确诊为动脉粥样硬化患者200例,根据随机数字表将患者分为观察组和对照组,各100例。对照组确诊后行日常生活指导,观察组在对照组基础实施有氧训练联合耳穴贴压,干预时间为6个月,比较两组患者干预前后颈动脉内膜中层厚度(IMT)、体质量(BMI)、腰臀比(WHR)、血糖、血脂水平。结果观察组患者干预后IMT、BMI、WHR水平均明显低于对照组,差异有统计学意义(均P<0.05)。观察组干预后空腹血糖(FPG)、餐后2 h血糖(2hFPG)、糖化血红蛋白(HBA1c)、血清总胆固醇(TC)、甘油三脂(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平均明显低于对照组,差异有统计学意义(均P<0.05)。观察组随访1年中冠心病、脑卒中发生率均明显低于对照组,差异有统计学意义(均P<0.05)。结论有氧训练联合耳穴贴压能有效控制动脉粥样硬化患者血糖、血脂水平,能有效预防心脑血管疾病的发生。     

Coronary artery disease and carotid artery intima-media thickness in Japanese type 2 diabetic patients

OBJECTIVE: To investigate the association between carotid atherosclerosis, measured as intima-media thickness (IMT), and cardiovascular morbidity in type 2 diabetic patients. RESEARCH DESIGN AND METHODS: We investigated the relationship between IMT and coronary artery disease (CAD) in 40 type 2 diabetic patients and 40 control subjects. Diabetic patients with CAD determined by coronary angiography were consecutively recruited, whereas the control subjects were recruited from among diabetic outpatients without CAD at the same institution. IMT was measured in both carotid arteries using B-mode ultrasonography. RESULTS: Carotid IMT was significantly greater in the diabetic patients than in the control subjects (1.27 +/- 0.07 vs. 1.03 +/- 0.04 mm, P < 0.05). IMT was associated with CAD by logistic regression analysis using all independent variables (P = 0.062). When the 40 patients with CAD were divided into a group of 20 patients with coronary artery bypass grafting (CABG) and another 20 patients without CABG, the IMT was significantly greater in the CABG group than in the non-CABG group (1.47 +/- 0.11 vs. 1.07 +/- 0.07 mm, P < 0.05). CONCLUSIONS: These results indicate that the presence of carotid atherosclerosis implies a high probability of coronary involvement in Japanese nonobese subjects with type 2 diabetes.     

Elevated C-reactive protein associates with early-stage carotid atherosclerosis in young subjects with type 1 diabetes

OBJECTIVE: To evaluate whether low-grade inflammation contributes to early-stage advanced carotid atherosclerosis in young subjects with type 1 diabetes. RESEARCH DESIGN AND METHODS: The mean and maximum (max) intima-media thicknesses (IMT) of the carotid artery were assessed using ultrasound B-mode imaging in 55 patients with type 1 diabetes (22 men and 33 women, aged 22.1 +/- 3.6 years (+/- SD), duration of diabetes 14.2 +/- 5.7 years) and 75 age-matched healthy nondiabetic subjects (28 men and 47 women). High-sensitive C-reactive protein (hs-CRP) levels were measured with a latex-enhanced immunonephelometer. RESULTS: The patients with type 1 diabetes had significantly higher hs-CRP levels (median 0.35, range 0.05-1.47 mg/l vs. median 0.14, range 0.05-1.44 mg/l; P = 0.001) as well as significantly higher mean IMT and max IMT than the nondiabetic subjects (mean IMT 0.76 +/- 0.09 vs. 0.72 +/- 0.04 mm, P = 0.003; max IMT 0.84 +/- 0.11 vs. 0.77 +/- 0.06 mm, P < 0.0001). Hs-CRP levels were significantly correlated with the mean and max IMT of patients with type 1 diabetes and with the max IMT of nondiabetic patients. Multivariate regression analyses for both diabetic and nondiabetic subjects as a single group showed that hs-CRP levels are independently correlated with the mean IMT and max IMT levels (P = 0.002 and P = 0.023, respectively) as well as with diastolic blood pressure, sex, and duration of diabetes. CONCLUSIONS: Our data indicate that hs-CRP levels are elevated in young patients with type 1 diabetes, possibly corresponding with early-stage advanced carotid atherosclerosis.     

颈动脉窦粥样硬化与冠状动脉粥样硬化程度的相关性

背景:颈动脉内中膜厚度可用作冠状动脉粥样硬化的替代指标,但它与冠状动脉事件的关系尚未得到充分研究。目的:探讨颈动脉内中膜厚度在预测冠状动脉粥样硬化性心脏病及其程度中的价值。设计:病例分析。单位:解放军总医院心内科。对象:实验于2000-01/2002-01在解放军总医院完成。将285例可疑冠状动脉粥样硬化性心脏病患者按造影结果分为0支组,1支组,2支组,3支组4组,年龄33～74岁,平均(54.48±9.44)岁,其中男164例,女121例。方法:①测量体质量、身高,计算体质量指数(BMI)=体质量(kg)/身高(m)2。②测量卧位左臂血压。③采静脉血检测血脂。④用高分辨率B型超声,10MHz线性探头检测颈总动脉,颈内动脉,颈外动脉和颈动脉窦。将颈动脉内中膜厚度≥1.0mm定义为颈动脉粥样硬化。用标准的Judkins技术作冠状动脉造影。根据管腔狭窄≥50%的病变血管支数将冠状动脉粥样硬化性心脏病的程度记录为0,1,2,3。左主干狭窄≥50%定义为2支病变,左主干合并右冠病变定义为3支病变。主要观察指标:①不同冠状动脉病变程度患者不同测量位点的内中膜厚度。②冠状动脉粥样硬化性心脏病严重程度的预测因子。③颈动脉不同位点内中膜厚度值对冠状动脉粥样硬化性心脏病的预测价值。④不同危险因子与内中膜厚度的关系。结果:285例患者全部完成实验进入结果分析。①不同冠状动脉病变程度患者不同测量位点的内中膜厚度经卡方检验,左、右颈动脉窦的F值最大,分别为65.64和63.24。左、右颈动脉窦的内中膜厚度值随冠状动脉病变程度的加重而增厚。②对冠状动脉粥样硬化性心脏病严重程度的预测因子进行回归分析表明,男性、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、左颈动脉窦、右颈动脉窦、右颈内动脉、右颈外动脉的内中膜厚度为冠状动脉粥样硬化性心脏病严重程度的独立预测因子。左颈动脉窦和右颈动脉窦是冠状动脉粥样硬化性心脏病的最重要的预测因子(t=3.61,P=0.391;t=2.58,P=0.247)。③颈动脉不同位点内中膜厚度值对冠状动脉粥样硬化性心脏病的预测价值中左右颈动脉窦的阳性预测值最高,分别为是89.9%,88.8%。④对不同危险因子与内中膜厚度的关系行多元回归分析,其结果是:年龄,体质量指数,胆固醇,三酰甘油,高密度脂蛋白胆固醇和低密度脂蛋白胆固醇是左颈动脉窦处动脉粥样硬化的危险因子。结论:颈动脉窦内中膜厚度与冠状动脉粥样硬化性心脏病程度明显相关。二者有共同的病理与血液动力学基础。颈动脉窦内中膜厚度可以作为筛选冠状动脉粥样硬化性心脏病的指标。     

缺血性脑卒中患者血清胱抑素C与颈动脉粥样硬化的关系分析

目的探讨缺血性脑卒中患者血清胱抑素C与颈动脉粥样硬化的关系。方法选择2019年9月至2020年3月收治的306例缺血性脑卒中患者作为研究对象,均进行颈部血管超声检查。根据颈动脉内中膜厚度(IMT)检查结果将患者分为观察组(IMT≥1.2 mm或IMT>周围正常值50%以上,动脉硬化,n=193)和对照组(IMT<1.2 mm,非动脉硬化,n=113)。比较两组的各项实验室指标(总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、尿酸及胱抑素C)水平及双侧颈内动脉、颈总动脉的IMT。比较观察组中不同斑块严重程度、不同斑块性质患者的胱抑素C水平。结果观察组的总胆固醇、甘油三酯、低密度脂蛋白、尿酸及胱抑素C水平均高于对照组,高密度脂蛋白水平低于对照组(P<0.05)。观察组严重斑块患者的胱抑素C水平高于轻、中度斑块患者(P<0.05)。经Spearman相关性水平分析,脑缺血患者斑块严重程度与胱抑素C水平呈正相关(r=0.3145,P<0.05)。观察组硬斑、软斑、混合斑患者的胱抑素C水平比较,差异无统计学意义(P>0.05)。观察组双侧颈内动脉、颈总动脉的IMT均大于对照组(P<0.05)。结论缺血性脑卒中患者合并颈动脉粥样硬化时颈动脉IMT会明显增大,检测血清胱抑素C水平可用于预判缺血性脑卒中患者颈动脉粥样硬化发生及严重程度,以便及时治疗,防止产生不可逆损伤。     

The effects of extended-release niacin on carotid intimal media thickness, endothelial function and inflammatory markers in patients with the metabolic syndrome

BACKGROUND: Niacin is an agent that significantly increases high-density lipoprotein cholesterol (HDL-C), but its effects on surrogate markers of atherosclerosis and inflammatory markers are less clear. We studied the effects of niacin on carotid intimal media thickness (IMT), brachial artery reactivity as well as markers of inflammation and the metabolic profile of patients with metabolic syndrome. METHODS AND RESULTS: Fifty patients with the metabolic syndrome (Adult Treatment Panel (ATP) III criteria) were randomised to either extended-release niacin (1000 mg/day) or placebo. After 52 weeks of treatment, there was a change of carotid IMT of +0.009 +/- 0.003 mm in the placebo group and -0.005 +/- 0.002 mm in the niacin group (p = 0.021 between groups). Endothelial function improved by 22% in the group treated with niacin (p < 0.001), whereas no significant changes were seen in the placebo group. High sensitivity C-reactive protein decreased by 20% in the group treated with niacin for 52 weeks (p = 0.013). Niacin increased HDL-C (p < 0.001) and decreased low-density lipoprotein cholesterol and triglycerides (p < 0.001) significantly, and there were no adverse effects on fasting glucose levels after 52 weeks of treatment. CONCLUSION: Extended-release niacin therapy effects a regression in carotid intimal medial thickness and improvement in metabolic parameters (increased HDL and reduced triglycerides). Furthermore, extended-release niacin may demonstrate an anti-atherogenic effect in the metabolic syndrome by improving endothelial function and decreasing vascular inflammation.     

Preclinical atherosclerosis and inflammation in 61-year-old men with newly diagnosed diabetes and established diabetes

OBJECTIVE: The aim of this study was to investigate the occurrence of subclinical atherosclerosis and underlying mechanisms in men with newly diagnosed diabetes and established diabetes compared with healthy control subjects. RESEARCH DESIGN AND METHODS: In a population-based study of 61-year-old Caucasian men (n = 271) with established diabetes (n = 50) and newly diagnosed diabetes (n = 24) and healthy control subjects (n = 197), standard risk factors and highly sensitive (hs) C-reactive protein (CRP) were measured. Ultrasound measurements of intima-media thickness (IMT) were performed bilaterally in the common carotid artery, and a composite measure was calculated from common carotid and carotid bulb IMT (composite IMT). The plaque status was assessed. RESULTS: Composite IMT and carotid plaque size increased gradually among the healthy control subjects, newly diagnosed diabetic patients, and established diabetic patients (P for trend < or =0.001, respectively). CRP was higher in newly and established diabetes (NS between diabetes groups) compared with healthy control subjects (P < 0.001). Total cholesterol levels were lower in newly diagnosed diabetes (5.51 +/- 1.13 mmol/l, P < 0.05) and established diabetes (5.45 +/- 1.15 mmol/l, P < 0.01) compared with those of healthy control subjects (5.77 +/- 1.03 mmol/l). In men with diabetes (n = 74), diabetes onset status (newly diagnosed versus established), waist-to-hip ratio (WHR), and serum triglycerides, but not CRP, explained 16% of the variance in composite IMT. CONCLUSIONS: This is the first study to show increased preclinical atherosclerotic changes (IMT and plaque size) and increased inflammation (hs-CRP) in men with newly diagnosed diabetes as well as in patients with established diabetes compared with healthy control subjects. WHR, diabetes onset status (newly diagnosed versus established), and triglycerides, but not CRP, were independent correlates of carotid artery IMT in men with diabetes.     

糖尿病患者颈动脉超声改变的相关性研究

目的 通过测量颈动脉的内膜-中层厚度(IMT)和阻力指数(RI)来探讨颈动脉粥样硬化和糖尿病的关系。 方法 选择糖尿病患者作为观察组(50人)进行常规体检及血生化检查,排除了高血压、高血脂、脑梗等疾病后,应用血管超声技术测量颈动脉的IMT及阻力指数。并选用非相关疾病患者(50人)作为对照组。 结果 在两组患者的年龄、性别、体重指数、收缩压、舒张压、总胆固醇、甘油三酯、高密度脂蛋白、低高密度脂蛋白等指标均无明显差异的情况下(p>0.05),糖尿病组的颈动脉的IMT及RI值均显著高于对照组(p<0.05)。 结论 通过颈动脉超声检查颈动脉的内膜-中层厚度和阻力指数显示糖尿病患者颈动脉粥样硬化的高发生率。     

The effect of cholesterol lowering on carotid and femoral artery wall stiffness and thickness in patients with familial hypercholesterolaemia

BACKGROUND: Early in the process of atherosclerosis, changes in vessel wall stiffness and thickness may occur. The present study evaluates the effect of cholesterol reduction on artery wall stiffness and intima media thickness in patients with familial hypercholesterolaemia (FH). MATERIALS AND METHODS: Forty-five patients with familial hypercholesterolaemia (mean age 46+/-10 years) with untreated LDL cholesterol concentration > 9 mmol L(-1), were studied before and after one year of cholesterol lowering therapy with statins (simvastatin, atorvastatin 40-80 mg day(-1). The distensibility (DC in 10-3 kPa(-1) and compliance (CC in mm2. kPa(-1) of the common carotid artery (CCA) (right and left side) and common femoral artery (CFA) (right side) were determined by a wall track system (Pie Medical). The intima media thickness (IMT) (both right and left) of the CCA, bulb (BUL), internal carotid artery (ICA) and CFA were measured in mm by high-resolution ultrasound (Biosound). RESULTS: The mean concentration of total cholesterol (TC), LDL-cholesterol (LDL-C) and triglycerides (TG) were reduced significantly by 43%, 51% and 25%, respectively, whereas HDL-cholesterol (HDL-C) increased by 13% (P<0.001). In the CFA, the DC and CC increased significantly (DC from 7.9+/-3.0 to 9.1+/-3.7 in 10(-3) kPa(-1); CC 0.5+/-0.2-0.6+/-0.3 in mm2. kPa(-1), whereas the DC and CC did not change in the CCA. In contrast, the IMT of the CCA decreased significantly in both men and women whereas an IMT decrease was also seen in the BUL and ICA in premenopausal women. A LDL-cholesterol reduction of 44.8% and 45.4% was necessary to induce significant decreases in IMT and increases in DC and CC. CONCLUSIONS: One year of cholesterol lowering therapy in FH decreases the wall stiffness in the CFA and the arterial wall thickness in the CCA.     

Association of angiotensin II type 1 receptor gene polymorphism with carotid atherosclerosis.

BACKGROUND: Polymorphisms of the angiotensin II type 1 receptor (AGTR1) gene are associated with essential hypertension and cardiovascular disease, but the correlation between AGTR1 A1166C polymorphism and carotid intima-media thickness (IMT) remains unclear. We sought to demonstrate correlation between AGTR1 gene polymorphism and carotid atherosclerosis in a Chinese population. METHOD: A total of 150 patients diagnosed with essential hypertension were included in this study. The AGTR1 A1166C polymorphism was detected by restriction analysis of the polymerase chain reaction product with Ddel digestion. Carotid IMT was measured by B-mode ultrasonography. RESULTS: The AC genotype frequency and the C1166 allele frequency of the AGTR1 gene in essential hypertensive patients were significantly higher than in controls (22.00% vs. 6.00% for AC, p < 0.01; 18.67% vs. 8.00% for the C allele, p < 0.05). Hypertensive subjects with the AC genotype had increased carotid artery IMT and IMT/D (common carotid artery diameter) ratio compared with the AA genotype (IMT 1.14 +/- 0.39 vs. 0.88 +/- 0.16, p < 0.05; IMT/D 14.08 +/- 2.88 vs. 10.51 +/- 1.94, p < 0.01). CONCLUSION: These results suggest that the AGTR1 A1166C polymorphism is associated with essential hypertension and carotid atherosclerosis in a Chinese population.     

幽门螺杆菌感染对老年2型糖尿病患者糖脂代谢及胰岛功能的影响

目的探讨老年2型糖尿病患者幽门螺杆菌(Helicobacter pylori, Hp)感染情况及其对糖脂代谢、胰岛功能的影响。方法 320例老年2型糖尿病患者,均行13C呼气试验,记录Hp感染情况,并将320患者分为Hp感染组和Hp未感染组。比较2组血清总胆固醇(total cholesterol, TC)、三酰甘油(triacylglycerol, TG)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol, HDL-C)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol, LDL-C)、糖化血红蛋白(glycated hemoglobin, HbA1c)、空腹血糖(fasting plasma glucose, FPG)、餐后2 h血糖(2 h postprandial plasma glucose, 2hPG)、空腹胰岛素(fasting insulin, FINS)及稳态模型胰岛素抵抗指数(homeostasis model assessment of insulin resistance, HOMA-IR)、尿微量白蛋白肌酐比(urinary microalbumin-creatinine ratio, ACR)、颈动脉内中膜厚度(intima-media thickness, IMT);多因素logistic回归分析老年2型糖尿病患者发生Hp感染的影响因素。结果 320例中Hp感染132例,感染率为41.3%;Hp感染组血清TC[(4.89±1.10)mmol/L]、TG[(2.12±0.86)mmol/L]、LDL-C[(3.11±1.03)mmol/L]、FPG[(9.29±3.05)mmol/L]、2hPG[(14.52±2.38)mmol/L]、HbA1c[(8.30±1.59)%]、FINS[(12.08±2.38)u/L]、HOMA-IR(5.76±0.79)、ACR[(86±14)mg/g]均高于Hp未感染组[(4.32±1.35)mmol/L、(1.93±0.39)mmol/L、(2.73±0.90)mmol/L、(8.04±1.87)mmol/L、(10.25±1.88)mmol/L、(7.57±0.92)%、(18.72±3.29)u/L、4.25±0.98、(54±10)mg/g](P<0.05),颈动脉IMT[(1.3±0.4)mm]较Hp未感染组[(0.9±0.3)mm]增厚(P<0.05),HDL-C[(1.05±0.20)mmol/L]水平较Hp未感染组[(1.41±0.25)mmol/L]降低(P<0.05);多因素logistic回归分析结果显示,FINS(OR=2.778, 95%CI:2.156~3.400,P=0.001)、HbA1c(OR=3.621, 95%CI:2.895~4.342,P<0.001)和HOMA-IR(OR=2.084, 95%CI:1.485~2.658,P=0.002)是老年2型糖尿病患者发生Hp感染的影响因素。结论老年2型糖尿病患者Hp感染率较高,发生Hp感染者胰岛素抵抗、糖脂代谢紊乱、动脉粥样硬化程度加重。FINS、HbA1c、HOMA-IR与老年2型糖尿病患者发生Hp感染有关。     

原发性高血压患者骨桥蛋白与醛固酮、颈动脉内膜中层厚度的相关性研究

目的 探讨原发性高血压(EH)患者血浆骨桥蛋白(OPN)、血清醛固酮(ALD)水平与颈动脉内膜中层厚度(IMT)的关系.方法 选择EH患者91例,按IMT值分为EH无颈动脉硬化组50例和EH合并颈动脉硬化组41例.对照组为同期常规健康体检正常者39例.测定血浆OPN、血清ALD水平.同时做超声测量颈动脉IMT值.结果EH无颈动脉硬化组较对照组血浆OPN(31.56±4.06)μg/L vs (29.54±5.64) μg/L、血清ALD( 134.61±19.23)ng/L vs(125.04±21.77)ng/L水平升高(均P＜0.05);EH合并颈动脉硬化组较对照组升高更显著:血浆OPN(34.20±4.35)μg/L vs(29.54±5.64)μg/L、血清ALD(143.95±24.07) ng/L vs(125.04±21.77)ng/L(均P＜0.01).EH患者血浆OPN与血清ALD水平(r=0.594,P＜0.05)及颈动脉IMT(r=0.424,P＜0.01)存在正相关.结论EH患者血浆OPN水平升高,且与血清ALD水平及颈动脉IMT存在正相关;提示EH患者血浆OPN升高可能在其动脉粥样硬化发生发展中的作用.     

Carotid intima-media thickness in Japanese type 2 diabetic subjects: predictors of progression and relationship with incident coronary heart disease

OBJECTIVE: To examine carotid intima-media thickness (IMT), predictors of its progression, and its relationship with incident coronary heart disease (CHD) in type 2 diabetic Japanese patients. RESEARCH DESIGN AND METHODS: Carotid IMT of 287 subjects with type 2 diabetes (mean age 61.6 years) without CHD or cerebrovascular disease was examined at baseline and after a mean follow-up of 3.1 years. RESULTS: The annual progression of IMT (means +/- SEM) was 0.04+/-0.004 mm/year. Stepwise multivariate analysis demonstrated that independent risk factors for progress of IMT were the initial IMT (P<0.001), the average HbA1c level (P<0.001), and age (P = 0.001). Both the initial IMT (odds ratio [OR] 4.9, 95% CI 1.7-14.1) and a low average HDL cholesterol (OR 0.2, 0.1-0.8) were identified as predictors of incident nonfatal CHD (angina pectoris or nonfatal myocardial infarction; 3-year incidence 10.1%) after adjusting for age, sex, average HbA1c, and other risk factors. CONCLUSIONS: The predictors of the progression of carotid IMT in Japanese type 2 diabetic subjects were its baseline thickness and the average HbA1c during the follow-up. Baseline carotid IMT and low HDL cholesterol predicted the incidence of nonfatal CHD.     

男性2型糖尿病血尿酸与颈动脉粥样硬化的相关性研究

目的探讨男性2型糖尿病(T2DM)血尿酸(SUA)水平与颈动脉粥样硬化(CAS)的关系.方法选取男性2型糖尿病患者80例,分为有颈动脉粥样硬化组(G1组)49例、无颈动脉粥样硬化组(G2组)31例,另选35例健康者为正常对照组(G3组).检测入选者的空腹血糖(FPG)、餐后2h血糖(2hPG)、总胆固醇(TC)、血清甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、SUA、尿微量白蛋白(uA1b).结果 G1组、G2组间FPG、2hPG、TC、HDL-C差异无统计学意义.三组间TC差异无统计学意义(P>0.05).三组间FPG、2hPG、TG、HDL-C、LDL-C、uA1b、SUA,差异有统计学意义(P<0.01或P<0.05).G1组SUA水平明显高于G2组和G3组(P<0.01),G2组高于G3组(P<0.05).对CAS危险因素的Logistic回归分析,先后入选的变量是SUA、HDL-C和uA1b.其中SUA的影响因子最为突出.结论男性2型糖尿病患者伴发CAS时SUA水平升高,颈动脉粥样硬化危险因素Logistic回归分析显示,SUA与CAS相关,SUA可能是男性T2DM及CAS形成的危险因素.     

老年缺血性卒中患者血胆红素水平与颈动脉粥样硬化的相关性

目的探讨急性缺血性卒中患者颈动脉粥样硬化与血清胆红素水平的关系。方法测定95例老年急性缺血性卒中患者的血清总胆红素(TBIL)、直接胆红素(DBIL)和间接胆红素(IBIL)胆红素水平,同时行颈部彩色多普勒血管超声检测,根据颈动脉内膜中层厚度(IMT)及形态分为无斑块组、动脉硬化组以及斑块形成组,观察三组间血清胆红素是否有差异。结果动脉硬化组的TBIL、DBIL和IBIL水平分别为(10.26±3.79)mmol/L、(2.76±1.97)mmol/L和(7.90±3.39)mmol/L,斑块形成组的TBIL、DBIL和IBIL水平分别为(10.87±2.55)mmol/L、(2.35±1.13)mmol/L和(8.53±1.99)mmol/L,无斑块组的TBIL、DBIL和IBIL水平分别为(13.69±4.62)mmol/L、(2.67±1.01)mmol/L和(11.03±4.05)mmol/L,动脉硬化组、斑块形成组的TBIL和IBIL水平均低于无斑块组(P<0.05),而动脉硬化组与斑块形成组间TIBL、IBIL及DBIL水平均差异无统计学意义(P>0.05)。Pearson相关分析示,颈动脉IMT值与TBIL(r=-0.272,P=0.008)和IBIL(r=-0.277,P=0.007)水平存在负相关。结论低水平胆红素可能是颈动脉粥样硬化的高危因素,增加缺血性卒中的发生风险,但颈动脉粥样硬化病变严重程度可能与胆红素的降低水平无关。     

Abnormal capacity to induce cholesterol efflux and a new LpA-I pre-beta particle in type 2 diabetic patients

In this study, we first characterized the lipoprotein components of serum samples obtained from a group of well-controlled diabetic patients and from healthy subjects in fasting and postprandial states. We then explored some aspects of reverse cholesterol transport in the same population. Patients showed high levels of fasting triglycerides, postprandial triglyceride responses and LpC-III levels (3.18+/-0.86 vs 2.17+/-0.54 mg/dl, P < 0.001). There were also positive correlations between LpC-III and fasting triglycerides (r = 0.82, P < 0.001), total triglyceride area (r = 0.75, P < 0.001) and incremental triglyceride area (r = 0.54, P < 0.001). HDL-C and apo A-I were significantly decreased in diabetic patients due to a selective reduction in LpA-I subfraction, whose antiatherogenic role is generally accepted (37.4+/-8.0 vs 49.2+/-12.5 mg/dl, P < 0.001). In addition, HDL from patients proved to be triglyceride enriched and cholesteryl ester depleted, alterations which were further amplified in the postprandial state. The molar ratio HDL-C/apo A-I + apo A-II, already defined as a predictor of apo A-I fractional catabolic rate, was significantly diminished in the patient group (15.1+/-2.2 vs 20.8+/-3.3, P < 0.001), thus suggesting an accelerated catabolism of apo A-I. For the first time, we describe here the presence of a small apo A-I-containing particle, isolated by two-dimensional electrophoresis and characterized by immunoblotting, only in samples from diabetic patients. This particle that we named pre-beta0, has an apparent molecular weight of 40 kDa. As regards the capacity of serum samples to promote cholesterol efflux from [3H]cholesterol-labeled Fu5AH rat hepatoma cells, patient samples were found to induce significantly lower cholesterol efflux than controls only in the postprandial state (21.2+/-3.3 vs 23.8+/-1.8%, P = 0.012). The presence of pre-beta0 in samples from diabetic patients might therefore be associated to an altered capacity of these serum samples to promote cellular cholesterol efflux. Overall, these abnormalities may contribute to a delay in the reverse cholesterol transport pathway in type 2 diabetic patients.     

2型糖尿病患者血糖波动与颈动脉内膜中层厚度相关性研究

【目的】探讨2型糖尿病（T2DM）患者血糖（BG）波动与颈动脉内膜中层厚度（IMT）的相关性。【方法】选取本院长期随访的T2DM患者,根据彩超测定结果将病例分为颈动脉IMT增厚组（A组,IMT≥0．9mm）和颈动脉IMT正常组（B组,IMT〈0．9mm）,测量各组糖化血红蛋白（HbAlc）、空腹胰岛素（FINs）及餐后2h胰岛素（2hiNS）、空腹及餐后2hC肽、总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL—C）、低密度脂蛋白胆固醇（LDL—C）。采用自我血糖监测（SMBG）方式记录检测结果,共24周。【结果】两组患者空腹血糖（FBG）无统计学差异（P〉0．05）,但三餐后血糖（PBG）水平、空腹平均血糖标准差（SDBG）、餐后SDBG均有统计学差异（P〈0．05）。线性相关分析显示,IMT（转换后）与年龄、TC、TG、SBP、DBP、FBG、早餐后2hPBG、午餐后2hPBG、晚餐后午餐后2hPBG、空腹SDBG、餐后SDBG的线性相关关系显著（P〈0．05）,与性别、病程（转换后）、BMI、HbAlc（转换后）、HDL、LDL、FINS、2hFINS、空腹C肽、餐后2hC肽的相关关系不显著（P〉0．05）。偏相关分析显示IMT（转换后）与TC、TG、SBP、FBG、早餐后2hPBG、午餐后2hPBG、晚餐后午餐后2hPBG、空腹sDBG、餐后sDBG的相关关系显著（P〈0．05）,与DBP的相关关系不显著（P〉0．05）。以IMT（转换后）为因变量,多元逐步回归分析显示餐后sDBG、TC依次进入方程。【结论】血糖波动,尤其是餐后血糖波动与T2DM患者颈动脉IMT厚度密切相关。