减重对肥胖患者下肢血管功能的影响

目的：探讨减重与肥胖患者下肢血管功能踝／肱指数（ABI）改善的关系。方法：挑选100例年龄在25-55岁的肥胖患者,采用综合减重方法进行减重干预一年,减重前后测定体重指数（BMI）、踝／肱指数（ABI）,通过BMI评价减重效果,并通过ABI评价下肢血管功能。结果：经综合减重后,肥胖患者的BMI明显下降,ABI上升。结论：综合减重可以使肥胖患者的下肢血管功能ABI得到有效改善。     

他达拉非联合心理干预对勃起功能障碍患者不良情绪和血管内皮功能的影响

目的 探讨他达拉非联合心理干预治疗勃起功能障碍(ED)的疗效。方法 选择2020年6月至2020年12月ED患者60例随机分成对照组(30例)和观察组(30例),对照组给予他达拉非5 mg/d,持续用药3个月;观察组在口服他达拉非药物基础上加以心理干预。分别在治疗3个月和6个月后,比较两组患者的不良情绪和血管内皮功能。结果 治疗3个月后,两组患者血管内皮功能指标一氧化氮(NO)、内皮素-1 (ET-1)和肱动脉血流介导的血管扩张功能(flow mediated dilation,FMD)均较治疗前改善(P<0.05),但两组间比较差异无统计学意义。不良情绪方面,两组患者治疗后在PHQ-9、GAD-7和IIEF-5评分方面均较治疗前改善(P<0.05),且观察组患者治疗后IIEF-5评分改善优于对照组(P<0.05)。结论 他达拉非可以改善患者的血管内皮功能,与心理干预联合还可以明显改善患者的不良情绪。     

单纯肥胖症患者血管内皮功能障碍的早期预测与干预研究

肥胖作为人类健康的一大威胁，引起了医学界的普遍关注。据美国疾病预防中心估计，该国每年因肥胖致病而死亡者约为30万。肥胖与脂质异常血症、高胰岛素血症等密切相关，严重者可导致动脉粥样硬化、高血压等心脑血管疾病。研究表明血管内皮功能障碍是上述病变的启动环节，是引起成人动脉粥样硬化的独立高危因素。血管内皮作为血管壁的重要组成部分，起屏障作用；     

他汀对血管内皮功能的影响

他汀被誉为新世纪的阿司匹林,广泛用于冠心病的一级预防,二级预防,急性冠状动脉综合征,糖尿病,脑卒中预防等领域,近年来,在4S研究中发现他汀还可预防心力衰竭的发生与发展他汀类药物属3-羟-3甲基戊二醇辅酶A还原酶抑制剂,除具有强效降脂作用外,其抗炎、激活一氧化氮合酶（NOS）、增加低密度脂蛋白胆固醇（LDL-C）氧化阻力等改善血管内皮功能的作用倍受临床工作者的关注。     

肥胖人群应用彩超检测血管内皮功能的临床意义

目的应用高分辨率彩超检测血管内皮功能，探讨血管内皮功能与肥胖的关系。方法应用彩超检测血管内皮功能，测量并计算体重指数、腰臀比。结果血管内皮功能障碍组体重指数、腰臀比高于正常组（P〈0．05）。结论体重指数、腰臀比与血管内皮功能有关；应用高分辨率彩超检测肥胖人群血管内皮功能的方法简单准确，临床易于推广。     

强化饮食和运动干预对2型糖尿病患者血管内皮功能的影响

目的探讨强化饮食和运动干预对2型糖尿病患者血管内皮功能的影响。方法选择无运动禁忌证的2型糖尿病（T2DM）患者65例作为干预组,在原有药物治疗的前提下进行强化饮食和运动干预,运动治疗6个月后对体重、体重指数（BMI）、空腹血糖（FBG）、餐后2 h血糖（2 h PBG）、收缩压（SBP）、舒张压（DPB）、总胆固醇（TC）、甘油三酯（TG）、糖化血红蛋白（HbA1c）、血管内皮功能进行检测,并以另外65例作为对照组。结果干预组治疗6个月后各项指标明显下降（P〈0.05）,反应性充血血管内径和含服硝酸甘油后血管内径增加,对照组无明显变化。结论强化饮食和运动干预能改善2型糖尿病患者血管内皮功能。     

超声对高血压病患者血管内皮功能的研究

目的：用高分辨率超声测定高血压患肱动脉血管的内皮依赖性舒张反应。评价高血压患的血管内皮功能；方法：研究对象包括49例高血压患和22例正常对照组。所有对象均进行了肱动脉充气加压前后血管内径变化。血管直径和血流速度变化的检测情况，用以评价肱动脉的内皮依赖性血管扩张反应。结果：高血压患肱动脉加压前后的血管直径和血流速度变化百分比明显小于正常对照组；结论：高血压患存在着血管内皮功能的下降；多普勒超声评价血管内皮功能是一种简便准确的方法。     

早期减重训练对脑卒中偏瘫患者下肢功能的影响

目的观察减重训练（PBWS）对脑卒中偏瘫患者下肢功能的影响以及在不同时期进行减重训练的疗效，探讨对脑卒中偏瘫患者进行减重训练的最佳时间。方法40例脑卒中患者随机分为A、B、C 3组，早期均运用常规康复治疗方法，其中A组（14例）整个康复过程均运用常规康复治疗；B组（13例）在常规康复治疗2周后加减重训练；C组（13例）在常规康复治疗5周后加减重训练；3组治疗时间均为8周。在治疗前后分别用Fugl-Meyer评定表、Barthel指数和Berg平衡量表进行评定分析。结果治疗前3组患者各评测指标无显著性差异（P〉0．05），治疗后3组患者下肢功能均有不同程度的改善（P〈0．05～0．001），但治疗后B组与A、C组比较大部分评测指标有显著性差异（P〈0．05～0．01）；C组与A组比较也有显著性差异（P〈0．05）。结论早期介入减重训练可进一步改善偏瘫患者下肢功能的恢复。     

超声对初诊中老年阴茎勃起功能障碍患者血管内皮功能状况的临床评价

目的 应用超声检测初诊中老年阴茎勃起功能障碍（ED）患者的肱动脉血管内皮功能状况。 方法 研究对象选取为2013年12月~2014年9月之间我院收治的44例初诊中老年ED患者,设为研究组,并选取同期的50例健康志愿者作为对照组,采用超声检测两组受检者在静息状态下、反应性充血后、舌下含服硝酸甘油后的肱动脉内径,计算3种状态下2组患者肱动脉内径的变化率。 结果 两组受检者的肱动脉基础内径对比无显著差异（P＞0.05）,但研究组患者的反应性充血诱发的肱动脉内径变化率显著低于对照组（P＜0.05）,2组受检者舌下含服硝酸甘油后再次进行诱发,结果显示2组受检者的肱动脉内径变化率无显著差异（P＞0.05）。 结论 初诊中老年ED患者的肱动脉内皮功能显著降低,采用超声检测能够有效确定患者的血管内皮功能,尽早发现无症状的心血管疾病,具有较好的临床应用价值。      

社会心理干预对减重手术患者心理功能和生活质量影响的Meta分析

目的评价社会心理干预对减重手术患者心理功能和生活质量的影响。方法系统检索Web of Science,Cochrane Library,PubMed,Embase,CINAHL及中国生物医学文献数据库、中国期刊全文数据库、维普数据库、万方数据库中关于社会心理干预方法对减重手术患者的心理功能和生活质量影响的随机对照试验（randomized controlled trial,RCT）,按照Cochrane 5.1.0质量评价标准对文献进行质量评价,使用Revman 5.3进行Meta分析。结果 共纳入12篇文献,共908例患者。Meta分析结果显示,社会心理干预可降低减重手术患者抑郁[标准化均数差(standardized mean difference,SMD)=-0.26,P<0.05,95%CI(-0.42,-0.10)]、可降低减重手术患者焦虑[SMD=-0.42,P<0.05,95%CI(-2.83,-0.14)]、可改善减重手术患者心理生活质量[SMD=-0.19,P<0.05,95%CI(0.01,0.37)],但在改善总生活质量[SMD=0.04,P=0...     

体质量管理对肥胖型多囊卵巢综合征女性的内分泌激素水平和辅助生育结局的影响

目的 探讨体质量管理对肥胖型多囊卵巢综合征（PCOS）不孕症女性的内分泌激素水平和辅助生育结局的影响。方法 收集62例进行辅助生殖技术（ART）治疗的肥胖型PCOS不孕症患者的临床资料,选择接受常规辅助生育治疗的28例患者为对照组,在常规辅助生育治疗的基础上接受定期体质量管理的34例患者为体质量管理组。比较2组患者的内分泌激素水平和辅助生育结局。结果 减重后,体质量管理组肥胖型PCOS患者的体质量、BMI、体脂、腰臀均较减重前以及对照组降低（P均< 0.05）。减重后,体质量管理组肥胖型PCOS患者的空腹胰岛素[（13.2 ± 4.2）mU/L]均较减重前[（21.5 ± 6.1）mU/L]以及对照组[（20.3 ± 5.8）mU/L]降低（P < 0.001）。体质量管理组的人工授精累积临床妊娠率（25% vs. 13%）和首次胚胎移植后的临床妊娠率（61% vs. 39%）略高于对照组,但组间比较差异均无统计学意义（P均> 0.05）。结论 体质量管理可以有效降低肥胖型PCOS不孕症患者的BMI、空腹胰岛素水平,可能潜在地改善其辅助生育的妊娠结局。     

Effect of weight loss with lifestyle intervention on risk of diabetes

OBJECTIVE: Diabetes Prevention Program (DPP) participants randomized to the intensive lifestyle intervention (ILS) had significantly reduced risk of diabetes compared with placebo participants. We explored the contribution of changes in weight, diet, and physical activity on the risk of developing diabetes among ILS participants. RESEARCH DESIGN AND METHODS: For this study, we analyzed one arm of a randomized trial using Cox proportional hazards regression over 3.2 years of follow-up. RESULTS: A total of 1,079 participants were aged 25-84 years (mean 50.6 years, BMI 33.9 kg/m(2)). Weight loss was the dominant predictor of reduced diabetes incidence (hazard ratio per 5-kg weight loss 0.42 [95% CI 0.35-0.51]; P < 0.0001). For every kilogram of weight loss, there was a 16% reduction in risk, adjusted for changes in diet and activity. Lower percent of calories from fat and increased physical activity predicted weight loss. Increased physical activity was important to help sustain weight loss. Among 495 participants not meeting the weight loss goal at year 1, those who achieved the physical activity goal had 44% lower diabetes incidence. CONCLUSIONS: Interventions to reduce diabetes risk should primarily target weight reduction.     

Cardiac autonomic dysfunction in obese subjects

1. The prevalence of cardiac autonomic alterations was evaluated in 23 obese subjects with body mass index 37.2 +/- 3.03 kg/m2 (mean +/- SD), compared with 78 controls with body mass index 22.5 +/- 2.6 kg/m2 (P less than 0.001). 2. Cardiac autonomic function was assessed by four standard tests (heart rate response to deep breathing and to the Valsalva manoeuvre, systolic blood pressure fall after standing and diastolic pressure rise during handgrip) and by the cross-correlation test, a new method of computerized analysis of respiratory sinus arrhythmia based on spectral analysis of electrocardiographic and respiratory signal. 3. Considering tests indicative of parasympathetic function, only the heart rate response to the deep breathing and the cross-correlation test were significantly lower in the obese than in the control group [deep breathing = 13.95 +/- 8.65 beats/min (mean +/- SD) vs 24.5 +/- 7.65, P less than 0.001; cross-correlation 4.28 +/- 0.74 units vs 5.14 +/- 0.63, P less than 0.001]. Deep breathing and/or cross-correlation were abnormal in 10 (43.5%) obese subjects (deep breathing: seven subjects, cross-correlation: eight subjects). No significant difference between groups was found for the response to the Valsalva manoeuvre: the Valsalva ratio was 1.69 +/- 0.45 in obese subjects and 1.88 +/- 0.33 in controls (P = NS). The Valsalva ratio was abnormal in three obese subjects. 4. No significant differences were found between groups for tests indicative of sympathetic function.(ABSTRACT TRUNCATED AT 250 WORDS)     

Impact of a behavioral weight loss intervention on comorbidities in overweight and obese breast cancer survivors

Purpose

Comorbid medical conditions are common among breast cancer survivors, contribute to poorer long-term survival and increased overall mortality, and may be ameliorated by weight loss. This secondary analysis evaluated the impact of a weight loss intervention on comorbid medical conditions immediately following an intervention (12 months) and 1-year postintervention (24 months) using data from the Exercise and Nutrition to Enhance Recovery and Good health for You (ENERGY) trial—a phase III trial which was aimed at and successfully promoted weight loss.

Methods

ENERGY randomized 692 overweight/obese women who had completed treatment for early stage breast cancer to either a 1-year group-based behavioral intervention designed to achieve and maintain weight loss or to a less intensive control intervention. Minimal support was provided postintervention. New medical conditions, medical conditions in which non-cancer medications were prescribed, hospitalizations, and emergency room visits, were compared at baseline, year 1, and year 2. Changes over time were analyzed using chi-squared tests, Kaplan-Meier, and logistic regression analyses.

Results

At 12 months, women randomized to the intervention had fewer new medical conditions compared to the control group (19.6 vs. 32.2 %, p < 0.001); however, by 24 months, there was no longer a significant difference. No difference was observed in each of the four conditions for which non-cancer medications were prescribed, hospital visits, or emergency visits at either 12 or 24 months.

Conclusions

These results support a short-term benefit of modest weight loss on the likelihood of comorbid conditions; however, recidivism and weight regain likely explain no benefit at 1-year postintervention follow-up.

     

Effect of weight loss on cardiac synchronization and proinflammatory cytokines in premenopausal obese women

OBJECTIVE: Obesity is an important risk factor for heart failure in both women and men. Dyssynchrony between right and left ventricular contraction and relaxation has been identified as an independent predictor of heart failure. We examined the relationship of ventricular synchronization abnormalities with the concentration of proinflammatory cytokines in obese women at baseline and after sustained weight loss. RESEARCH DESIGN AND METHODS: Echocardiographic parameters of ventricular dyssynchrony, circulating levels of tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, IL-18, and C-reactive protein (CRP) were investigated in 67 healthy, premenopausal obese women and 40 age-matched normal-weight women. RESULTS: Compared with nonobese women, obese women had increased concentrations of CRP (P < 0.01), TNF-alpha (P < 0.01), IL-6 (P < 0.01), and IL-18 (P < 0.01). Moreover, obese women had a higher myocardial performance index (P < 0.02) and lower transmitral Doppler flow (P < 0.05), pulmonary venous flow analysis (P < 0.02), and ejection fraction (P < 0.05), indicating ventricular dyssynchrony. Concentrations of CRP, TNF-alpha, and IL-6 were related to anthropometric indexes of obesity and to echocardiographic parameters of ventricular dyssynchrony. After 1 year of a multidisciplinary program of weight reduction, obese women lost at least 10% of their original weight. This was associated with reduction of cytokine (P < 0.01) and CRP (P < 0.02) concentrations and with improvement of echocardiographic parameters of ventricular dyssynchrony, which correlated with changes in adiposity, particularly visceral adiposity. CONCLUSIONS: In obese women, ventricular dyssynchrony correlates with body fat, possibly through inappropriate secretion of cytokines. Weight loss represents a safe method for downregulating the inflammatory state and ameliorating cardiac function in obese women.     

Lifestyle modification and endothelial function in obese subjects

The metabolic syndrome is a cluster of metabolic and vascular abnormalities that include central obesity, insulin resistance, hyperinsulinemia, glucose intolerance, hypertension, dyslipidemia, hypercoagulability and an increased risk of coronary and cerebral vascular disease. These metabolic and vascular abnormalities are the main cause of cardiovascular mortality in western societies. Endothelial dysfunction, an early step in the development of atherosclerosis, has been reported in obese nondiabetic individuals and in patients with Type 2 diabetes. It has also been observed in individuals at high risk for Type 2 diabetes, including those with impaired glucose tolerance and the normoglycemic first-degree relatives of Type 2 diabetic patients. Recent evidence points to adipocytes as a complex and active endocrine tissue whose secretory products, including free fatty acids and several cytokines (i.e., leptin, adiponectin, tissue necrosis factor-α, interleukin-6, and resistin) play a major role in the regulation of human metabolic and vascular biology. These adipocytokines have been claimed to be the missing link between insulin resistance and cardiovascular disease. Interventions designed to improve endothelial and/or adipose-tissue functions may reduce cardiovascular events in obese individuals with either the metabolic syndrome or Type 2 diabetes. Lifestyle modification in the form of caloric restriction and increased physical activity are the most common modalities used for treating those individuals at risk and is unanimously agreed to be the initial step in managing Type 2 diabetes. Several recent studies have demonstrated favorable impacts of lifestyle modifications in improving endothelial function and insulin sensitivity, in addition to altering serum levels of adipocytokines and possibly reducing cardiovascular events. This review discusses current knowledge of the role of lifestyle modifications in ameliorating cardiovascular risk in obese subjects with either the metabolic syndrome or Type 2 diabetes.     

Lifestyle modification and endothelial function in obese subjects

The metabolic syndrome is a cluster of metabolic and vascular abnormalities that include central obesity, insulin resistance, hyperinsulinemia, glucose intolerance, hypertension, dyslipidemia, hypercoagulability and an increased risk of coronary and cerebral vascular disease. These metabolic and vascular abnormalities are the main cause of cardiovascular mortality in western societies. Endothelial dysfunction, an early step in the development of atherosclerosis, has been reported in obese nondiabetic individuals and in patients with Type 2 diabetes. It has also been observed in individuals at high risk for Type 2 diabetes, including those with impaired glucose tolerance and the normoglycemic first-degree relatives of Type 2 diabetic patients. Recent evidence points to adipocytes as a complex and active endocrine tissue whose secretory products, including free fatty acids and several cytokines (i.e., leptin, adiponectin, tissue necrosis factor-alpha, interleukin-6, and resistin) play a major role in the regulation of human metabolic and vascular biology. These adipocytokines have been claimed to be the missing link between insulin resistance and cardiovascular disease. Interventions designed to improve endothelial and/or adipose-tissue functions may reduce cardiovascular events in obese individuals with either the metabolic syndrome or Type 2 diabetes. Lifestyle modification in the form of caloric restriction and increased physical activity are the most common modalities used for treating those individuals at risk and is unanimously agreed to be the initial step in managing Type 2 diabetes. Several recent studies have demonstrated favorable impacts of lifestyle modifications in improving endothelial function and insulin sensitivity, in addition to altering serum levels of adipocytokines and possibly reducing cardiovascular events. This review discusses current knowledge of the role of lifestyle modifications in ameliorating cardiovascular risk in obese subjects with either the metabolic syndrome or Type 2 diabetes.     

Lifestyle modification improves endothelial function in obese subjects with the insulin resistance syndrome

OBJECTIVE: Endothelial dysfunction has been reported in type 2 diabetic patients and in obese subjects with insulin resistance syndrome (IRS). This study evaluates the effects of weight reduction and exercise on vascular reactivity of the macro- and the microcirculation in obese subjects with IRS. RESEARCH DESIGN AND METHODS; We studied 24 obese subjects (9 men and 15 women, age 49.3 +/- 1.9 years, BMI 36.7 +/- 0.94 kg/m(2), mean +/- SEM) with IRS at baseline and after 6 months of weight reduction and exercise. Brachial artery flow-mediated dilation (FMD) and response to sublingual glyceryltrinitrate (GTN) were assessed by high-resolution ultrasound. Microvascular reactivity was evaluated by the laser-Doppler perfusion imaging after iontophoresis of acetylcholine and sodium nitroprusside. We also measured plasma levels of soluble intercellular adhesion molecule (sICAM), vascular adhesion molecule, von Willebrand factor, plasminogen activator inhibitor-1 (PAI-1) antigen, and tissue plasminogen activator antigen. RESULTS: This intervention resulted in 6.6 +/- 1% reduction in body weight (P < 0.001) and significant improvement of insulin sensitivity index (2.9 +/- 0.36 vs. 1.9 +/- 0.33 [10(-4) x min(-1) x ( microU ml(-1))], P < 0.001). FMD significantly improved (12.9 +/- 1.2% vs. 7.9 +/- 1.0%, P < 0.001), whereas response to GTN and microvascular reactivity did not change. Similar observations were seen when the subjects were subclassified according to their glucose tolerance to normal glucose tolerance, impaired glucose tolerance, and type 2 diabetes. sICAM and PAI-1 significantly decreased (251.3 +/- 7.7 vs. 265.6 +/- 9.3 ng/ml, P = 0.018 and 36.2 +/- 3.6 vs. 48.6 +/- 3.9 ng/ml, P = 0.001, respectively). The relationship between percentage weight reduction and improved FMD was linear (R(2) = 0.47, P = 0.001). CONCLUSIONS: We conclude that 6 months of weight reduction and exercise improve macrovascular endothelial function and reduces selective markers of endothelial activation and coagulation in obese subjects with IRS regardless of the degree of glucose tolerance.