糖尿病患者心踝血管指数与颈动脉硬化的相关性及其危险因素分析

目的 探讨糖尿病患者心踝血管指数( CAVI)与颈动脉硬化的相关性及其危险因素.方法 入选60例2型糖尿病患者以及同期入院治疗的60例非糖尿病患者,对受试者进行病史采集,检测血糖、血脂等生化指标,行颈动脉彩色多普勒超声检查及CAVI测定,分析CAVI与颈动脉硬化的相关性;以CAVI为因变量,年龄、血压、体质量指数、血脂、空腹血糖、糖化血红蛋白(HbAlc)等指标为自变量进行多元线性回归分析.结果 糖尿病组患者体质量指数、甘油三酯、空腹血糖、HbAlc、颈动脉内膜中层厚度(IMT)、CAVI值及颈动脉斑块发生率均显著高于非糖尿病组[(27.6±3.6)、(25.3±3.3)kg/m2,(2.26±1.12)、(1.74±0.97) mmol/L,(8.86±2.64)、(5.26±0.92)mmol/L,(8.28±1.28)、(5.38±0.86),(1.16±0.16)、(0.86±0.14) mm,(9.55±1.13)、(8.54±0.94),46.7％ (28/60)与25.0％(15/60)],两组间差异均有统计学意义(t值分别为3.648、2.719、9.974、14.567、10.930、5.323,x2=6.125,P均＜0.05);CAVI与受试者颈动脉IMT呈正相关(r=0.435,P＜0.01);多元线性回归显示,CAVI与年龄(β=0.458,P＜0.01)、甘油三酯(β=0.058,P=0.012)、空腹血糖(β=0.168,P=0.002)、HbAlc(β =0.228,P=0.003)存在显著正相关.结论 CAVI与糖尿病患者颈动脉IMT呈正相关,糖尿病患者年龄、甘油三酯、空腹血糖及HbAlc是动脉僵硬的独立危险因素.     

GUIDE study: double-blind comparison of once-daily gliclazide MR and glimepiride in type 2 diabetic patients

BACKGROUND: Progressive beta-cell failure is a characteristic feature of type 2 diabetes; consequently, beta-cell secretagogues are useful for achieving sufficient glycaemic control. The European GUIDE study is the first large-scale head-to-head comparison of two sulphonylureas designed for once-daily administration used under conditions of everyday clinical practice. DESIGN: Eight hundred and forty-five type 2 diabetic patients were randomized to either gliclazide modified release (MR) 30-120 mg daily or glimepiride 1-6 mg daily as monotherapy or in combination with their current treatment (metformin or an alpha-glucosidase inhibitor) according to a double-blind, 27-week, parallel-group design. Efficacy was evaluated by HbA1c and safety by hypoglycaemic episodes using the European Agency definition. RESULTS: HbA1c decreased similarly in both groups from 8.4% to 7.2% on gliclazide MR and from 8.2% to 7.2% on glimepiride. Approximately 50% of the patients achieved HbA1c levels less than 7%, and 25% less than 6.5%. The mean difference between groups of the final HbA1c was -0.06% (noninferiority test P < 0.0001). No hypoglycaemia requiring external assistance occurred. Hypoglycaemia with blood glucose level < 3 mmol L(-1) occurred significantly less frequently (P = 0.003) with gliclazide MR (3.7% of patients) compared with glimepiride (8.9% of patients). The distribution of the sulphonylurea doses was similar in both groups. CONCLUSIONS: This study provides new insights into therapeutic strategies using sulphonylureas. It shows that gliclazide MR is at least as effective as glimepiride, either as monotherapy or in combination. The safety of gliclazide MR was significantly better, demonstrating approximately 50% fewer confirmed hypoglycaemic episodes in comparison with glimepiride.     

心踝血管指数在老年人大动脉硬化诊断中的意义

目的探讨一个新的判断大动脉硬化的指标——心踝血管指数(CAVI)在老年人中的临床意义。方法用VS-1000动脉硬化检测系统测定了115例老年人的CAVI,同时测定踝肱指数(ABI),颈动脉内膜中层厚度(IMT)和相应的生化指标。结果 115例老年人CAVI为10.70±4.32,以CAVI≥9定义为异常,异常率为88.1%,与以IMT≥0.9 mm定义的大动脉硬化检出率89.7%相似(P>0.05)。ABI≤0.9即存在外周血管病变(PAD),合并PAD组CAVI为12.0±19.44,无PAD组CAVI为10.38±1.19,两组间差异显著(P<0.01)。CAVI与ABI的相关系数为-0.247(P<0.05)。在这组以高龄老人为主的人群中,CAVI在高血压与非高血压组,糖尿病与非糖尿病组以及吸烟与非吸烟组之间,差异无统计学意义,CAVI与年龄无相关性(P>0.05)。结论 CAVI可以作为一个无创的大动脉硬化的早期筛查指标之一。但在老年人特别是高龄老人的实际运用中,需联合检测多个无创指标,以便在临床上进行综合分析和判断。     

Correlation between cardio-ankle vascular index and biomarkers of oxidative stress

Arterial stiffness is a pathological event related to arteriosclerosis that is also closely related to oxidative stress. The cardio-ankle vascular index (CAVI) is a novel arteriosclerotic index that has been used to detect arterial stiffness. However, the association between CAVI and oxidative stress has not yet been elucidated, especially in patients with risk of metabolic disorders. The aim of this study was to investigate the correlation between arterial stiffness by CAVI and biomarkers of oxidative stress. A total of 83 participants were enrolled in this study. Venous blood samples were collected for measurement of plasma oxidative biomarkers. All participants were examined for CAVI score. The univariate analysis showed that age (p?p?=?p?=?0.02), plasma glucose (p?=?0.003) are related to CAVI value. However, the multivariate analysis showed that age was the only significant independent factor related to the CAVI value. In addition, the CAVI and plasma malondialdehyde (MDA) levels showed a positive correlation (r?=?0.29, p?r?=??0.4, p?r?=??0.60, p?相似文献   

血管回声跟踪技术早期评价2型糖尿病患者下肢血管弹性功能

目的探讨血管回声跟踪技术对2型糖尿病患者下肢血管弹性的早期诊断价值。方法68例2型糖尿病患者和30例健康者（对照组）,按照病程将糖尿病患者分为A组（刚出现症状的首诊糖尿病患者）27例和B组（病程有一段时间的非首诊糖尿病患者）42例;采集受检者股动脉和腘动脉的二维声像图,应用血管回声跟踪技术检测其动脉弹性指标：僵硬度指数（B）、血管压力-应变弹性系数（Eρ）、顺应性（AC）、增大指数（Al）及脉搏波传导速度（PWVβ）,比较各组下肢血管弹性改变。结果糖尿病A组及B组股动脉、胴动脉的β、Eρ、PWVβ均较对照组增高（P〈0．05）,AC值降低（P〈0．05）;糖尿病A组与B组股动脉弹性指标间比较差异无统计学意义（P〉0．05）,B组腘动脉AC值较A组降低（P〈0．05）。结论糖尿病患者存在弹性大动脉硬化,腘动脉作为肌性动脉也存在动脉硬化,且在临床诊断糖尿病之前,这些血管动脉弹性已经发生异常。     

Brachio-ankle pulse wave velocity and cardio-ankle vascular index (CAVI)

In order to diagnose arteriosclerosis in any part of the body, pulse wave velocity (PWV) measurement is a useful approach. However, it is considered that the technique of PWV measurement should be simplified. A new method for measuring PWV has therefore been proposed in Japan. The PWV of the brachial artery (ba) and the ankle was measured by applying air pressure with the aid of a volume plethysmograph. Comparisons between the baPWV measurement method and the conventional method are currently being performed. Since satisfactory results have been obtained to date, baPWV has gained popularity throughout Japan. Since this method measures PWV in the arm and foot, it may be said that aortic PWV is not reflected though a large amount of past PWV measurements. BaPWV is influenced by blood pressure. With the baPWV technique, blood pressure compensation is not carried out. Furthermore, the pulse pressure is measured by air pressure; therefore any stimulus that exerts pressure on an artery may influence these results. Due to these reasons, a cardio-ankle vascular index (CAVI) has been proposed in which the pressure wave form indicating the closing of the aortic valve appears in the form of an arterial pressure wave after a fixed delay time. This delay is the time difference between the actual closing of the aortic valve and the measuring point. Prior to the introduction of baPWV, PWV was measured in the carotid artery and foot. As in traditional PWV, baPWV uses the delay time, but between the brachial artery and the ankle artery. However, the carotid artery differs from the brachial artery, and the measured value differs depending on whether the arteriosclerosis is present in the carotid artery or the brachial artery. CAVI is calculated from the ECG, PCG, brachial artery waveform and ankle artery waveform using a special algorithm. This new method represents a breakthrough in the diagnosis of atherosclerosis.     

心踝血管指数在老年慢性心衰患者运动康复效果中的评价与应用研究

目的探讨心踝血管指数在老年慢性心力衰竭患者运动康复效果评价中的应用价值。方法选取2014年5月-2015年10月我院住院治疗的老年慢性心力衰竭患者49例,行去除诱因、强心、利尿和扩血管等基础治疗,并根据病情调整药物剂量,在进行常规护理基础上,根据心功能分级实施运动康复护理,比较治疗前后的患者心踝血管指数、心率、射血分数和步行距离(6min),采用明尼苏达生活质量问卷进行生活质量评价。结果 49例患者治疗护理后的心踝血管指数、心率、射血分数、步行距离(6min)及生活质量评分平均值与治疗护理前比较差异有统计学意义(P0.05)。结论运动康复治疗后患者左室射血分数(LVEF)与步行距离(6min)、心踝血管指数与明尼苏达生活质量评分之间变化的一致性证明心踝血管指数可以通过抗心衰治疗及运动康复训练而得以下降,故可将其作为心力衰竭治疗及运动康复评价效果的参考指标之一。     

尿酸与2型糖尿病患者大血管病变的相关性

目的 探讨尿酸水平与2型糖尿病患者大血管病变的相关性.方法 随机选取2012年3月至2013年2月我院收治的2型糖尿病合并颈动脉或下肢动脉粥样硬化患者60例为研究组,2型糖尿病无颈动脉及下肢动脉粥样硬化患者60例为对照组,比较两组患者血压、血脂、血糖等生化指标,包括血尿酸、空腹胰岛素(FNS)、空腹血糖(FPG)、脂蛋白a[LP(a)]、载脂蛋白A1(APO-A1)、载脂蛋白B(APO-B)、糖化血红蛋白(HbA1c)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)和总胆固醇(TC).结果 研究组患者血压和血脂以及APO-A1、APO-B和HbA1c、FNS、FPG水平比较差异均无统计学意义(P均＞0.05).研究组LP(a)水平[(0.4±0.2)g/L]显著高于对照组[(0.2±0.1)g/L],差异有统计学意义(=3.842,P＜0.01);研究组血尿酸为(362.3±112.8)μmol/L,显著高于对照组[(284.8±68.6)μmol/L],差异有统计学意义(t=3.188,P＜0.01).结论 尿酸与LP(a)共同参与了动脉粥样硬化的发生和发展机制,与2型糖尿病大血管病变的发生密切相关,在防治2型糖尿病大血管病变时,除有效控制血糖、血压、血脂水平外,还应注意对患者尿酸和LP(a)代谢水平的观察.     

骨密度及下肢血管病变与2型糖尿病的相关性

目的:骨质疏松症、糖尿病、动脉粥样硬化均为代谢性疾病,在同一个体常常合并存在.通过分析2型糖尿病患者下肢血管病变不同程度的骨密度变化,可探讨其可能的影响因素.方法:选取2006-03/10河北医科大学第=三医院住院的2型糖尿病患者140例,男性71例,女性69例,年龄≥45岁(女性绝经1年以上).患者对检测指标知情同意.按照下肢血管病变严重性进行评分,将入选病例分为正常组、轻度组、中度组和重度组,每组35例.全部受试者均检测正位腰椎及双侧股骨骨密度,并行双下肢动脉彩超.结果:①年龄、体质量指数,糖尿病病程、绝经年限、血糖水平、胰岛素水平、脂代谢指标控制、尿白蛋白、继发甲状旁腺激素水平、雌激素水平变化越大,腰椎、双侧股骨各部位骨密度差异越明显(P＜0.05).②腰椎、股骨骨密度与糖尿病病程、年龄、空腹血糖、餐后2h血糖、糖化血红蛋白、尿白蛋白、胆固醇、低密度脂蛋白胆固醇、女性绝经年限呈负相关,与体质量指数、高密度脂蛋白和雌二醇呈正相关,与二酰甘油和极低密度脂蛋白水平无明显相关.腰椎骨密度与甲状旁腺激素水平正相关,股骨骨密度与空腹胰岛素正相关.③下肢动脉彩色超声动脉硬化程度积分与糖尿病病程、年龄、空腹血糖、餐后2 h血糖、糖化血红蛋白、尿白蛋白、胆固醇、低密度脂蛋白胆固醇、继发甲状旁腺激素水,平呈正相关,与雌二醇水平呈负相关,与体质量指数、空腹胰岛素水平、三酰甘油、高密度脂蛋白胆固醇、极低密度脂蛋白胆同醇和绝经年限无明显相关.2型糖尿病下肢血管病变患者较2型糖尿病非下肢血管病变患者骨密度低,且动脉硬化程度越重,骨密度越低,尤以股骨骨密度最为显著.结论:①糖尿病下肢血管病变与骨密度密切相关.②年龄、血糖、血脂、糖尿病病程、糖尿病肾病、女性雌激素、血继发甲状旁腺激素水平是影响糖尿病患者骨密度及下肢血管病变的共同因素.     

Macular edema reflects generalized vascular hyperpermeability in type 2 diabetic patients with retinopathy

OBJECTIVE: Diabetic maculopathy (DMa) is the most prevalent sight-threatening type of retinopathy in type 2 diabetes and a leading cause of visual loss in the western world. The disease is characterized by hyperpermeability of retinal blood vessels and subsequent formation of hard exudates and macular edema, the degree of which can be estimated by measurement of retinal thickness. We examined associations between retinal thickness as evaluated by optical coherence tomography scanning (OCT), glomerular leakage as evaluated by urinary albumin excretion rate (UAE), and general vascular leakage as evaluated by the transcapillary escape rate of albumin (TER(alb)) in type 2 diabetic patients with and without DMa. RESEARCH DESIGN AND METHODS: In 20 type 2 diabetic patients with DMa and 20 type 2 diabetic patients without retinopathy matched for age, sex, and duration of diabetes, we performed OCT, fundus photography, fluorescein angiography, and 24-h ambulatory blood pressure measurement. UAE was determined by radioimmunoassay. TER(alb) was determined as the initial disappearance of intravenously injected (125)I-labeled human serum albumin. RESULTS: Patients with diabetic maculopathy had higher HbA(1c) (8.5 +/- 1.5 vs. 7.4 +/- 1.2%, P < 0.05) and higher total cholesterol (5.8 +/- 0.7 vs. 5.2 +/- 0.9 mmol/l, P < 0.05) than patients without retinopathy. UAE was higher in the DMa group than in the group with no retinopathy (9.3 x// 3.1 vs. 3.9 x// 1.9 micro g/min, P < 0.01). There was no difference in TER(alb) between the two groups (6.0 +/- 1.6 vs. 6.6 +/- 1.5%, NS). In the group with DMa, OCT, TER(alb), and UAE correlated significantly (OCT versus TER(alb): r = 0.55, P < 0.05; OCT versus UAE: r = 0.58, P < 0.01; UAE versus TER(alb): r = 0.81, P < 0.01). Conversely, there were no correlations between these three parameters in the group without retinopathy. CONCLUSIONS: Macular edema seems to reflect a generalized vascular leakage in type 2 diabetic patients.     

Forearm vascular reactivity is differentially influenced by gliclazide and glibenclamide in chronically treated type 2 diabetic patients

Sulphonylureas (SUs) act by inhibition of beta-cell K(ATP) channels after binding to the sulphonylurea receptor SUR1. K(ATP) channels are also expressed in cardiac and vascular myocytes coupled to SUR2A and SUR2B involved into adaptations of vascular tone and myocardial contractility. Different influence of SUs on vascular function is based on different binding to the SUR family. Few data on the effect of different SUs, used in patients in therapeutic doses, on vascular function are currently available. We investigated possible effects of acute and chronic treatment with glibenclamide and gliclazide on forearm postischaemic reactive hyperaemia (RH) in type 2 diabetic patients. To that purpose a double-blind, randomized, cross-over study with gliclazide (80 mg, b.i.d.) and glibenclamide (5 mg, b.i.d.) was performed in 15 type 2 diabetic patients. Forearm vascular reactivity was measured after 5 min of ischaemia by plethysmography before and after 4 weeks treatment. After acute administration of gliclazide (80 mg) or glibenclamide (5 mg) RH was not influenced. After 4 weeks of treatment, no influence of either drug was seen in the steady state before dosing. After dosing glibenclamide induced a significant (P = 0.004) reduction of RH from 26.4 +/- 6.9 to 21.9 +/- 7.6 ml min(-1)/100 ml after 4 h. Gliclazide, conversely, did not induce a reduction of RH (23.9 +/- 6.0 to 23.3 +/- 6.6 ml min(-1)/100 ml). No influence of HbA1c or actual glycaemia on RH was observed. Our results indicate that in chronically treated patients with type 2 diabetes ingestion of glibenclamide but not gliclazide results in sustained reduction of postischaemic RH. This difference is most probably based on different SUR binding.     

Effects of amlodipine and candesartan on arterial stiffness estimated by cardio-ankle vascular index in patients with essential hypertension: A 24-week study

Background: Aortic stiffness assessed by brachio-ankle pulse wave velocity (baPWV) can be used to predict cardiovascular events. However, baPWV is dependent on blood pressure. Antihypertensive drugs have been reported to reduce baPWV; but it is difficult to determine if this effect is associated with lowered blood pressure or reduced arterial stiffness.Objectives: The primary end point of this study was to assess whether antihypertensive drugs reduce arterial stiffness as estimated by cardio-ankle vascular index (CAVI). The secondary end point was to compare the effects of 2 widely used drugs, the calcium-channel blocker amlodipine and the angiotensin II receptor blocker candesartan, on arterial stiffness.Methods: Between October 2005 and September 2006, consecutive Japanese outpatients with essential hypertension (EHT) (defined as using antihypertensive drugs at screening, systolic blood pressure [SBP] > 140 mm Hg, or diastolic BP [DBP] >90 mm Hg) were assigned to treatment for 24 weeks with either amlodipine (5-10 mg/d) or candesartan (8-12 mg/d). Arterial stiffness was evaluated with CAVI before and after 24 weeks of treatment. Relative change in arterial stiffness from baseline was also compared. The evaluator was blinded to treatment.Results: Twenty patients (11 men, 9 women; mean [SD] age, 62 [10] years) were included in the study. There were no significant differences in clinical characteristics between the 2 groups. At baseline, mean (SD) CAVI was not significantly different in the amlodipine group compared with the candesartan group (8.93 [0.93] vs 8.46 [1.34], respectively). During the 24-week treatment period, mean SBP and DBP decreased significantly in both the amlodipine (14/10 mm Hg; P = 0.006 and P = 0.005) and the candesartan groups (13/11 mm Hg; P = 0.033 and P = 0.005). Amlodipine was associated with a significant change in CAVI from baseline (8.93 [0.93] vs 8.60 [1.50]; P = 0.017), whereas candesartan was not (8.46 [1.34] vs 8.81 [1.20]). The percentage change in CAVI was significantly different in the amlodipine group compared with the candesartan group (−7.14 [8.83] vs 5.85 [16.0], respectively; P = 0.038). After 24 weeks of treatment, the CAVI of the amlodipine group was still numerically larger than baseline CAVI of the candesartan group, although the difference was not statistically significant. Furthermore, there was no significant difference in absolute CAVI between the 2 groups after 24 weeks, but the relative change from baseline was significant in favor of amlodipine. Logistic regression analysis revealed that amlodipine improved CAVI independent of its antihypertensive effect.Conclusion: These data suggest that amlodipine and candesartan had different effects on aortic stiffness estimated by CAVI, despite similar effects on brachial blood pressure after 24 weeks of treatment in these Japanese patients with EHT.     

低血糖指数营养教育对2型糖尿病患者治疗效果的影响

目的:观察低血糖指数营养教育对2型糖尿病患者治疗效果的影响。方法:将156例2型糖尿病患者随机分为实验组和对照组各78例。实验组采用低血糖指数食物对患者进行营养教育,对照组给予常规饮食教育。两组均随访观察3个月,分别于就诊时与3个月后对两组患者进行相关生化指标测定,以观察治疗效果。结果:采用干预措施后,两组空腹血糖、餐后2h血糖、糖化血红蛋白、血清胆固醇、甘油三酯等生化指标均降低,但实验组与对照组相比效果更为明显(P<0.05)。结论:低血糖指数营养教育有助于增强2型糖尿病患者对糖尿病的认识,对控制和稳定血糖有积极意义。     

Associations of renal vascular resistance with albuminuria and other macroangiopathy in type 2 diabetic patients

OBJECTIVE—Albuminuria can be caused by endothelial dysfunction as a result of ischemic nephropathy rather than classic diabetic nephropathy. We studied whether renal vascular resistance (resistive index [RI]) of the main renal arteries could be associated with albuminuria and further assessed the relationship between RI and aorta stiffness measured by brachial-ankle pulse-wave velocity (baPWV).RESEARCH DESIGN AND METHODS—We consecutively studied 150 patients with type 2 diabetes and the absence of clinically overt renal artery stenosis. Renal function expressed as the estimated glomerular filtration rate (eGFR) was calculated using the modified formula of modification of diet in renal disease (MDRD). The RI [(peak systolic velocity –end-diastolic velocity)/peak systolic velocity] was measured with duplex Doppler ultrasonography.RESULTS—When the presence of albuminuria (uAlb) was defined as urinary albumin-to-creatinine ratio (μg/mg · creatinine) >30, mean RI [(left RI + right RI)/2] was significantly higher in uAlb, compared with that in patients without uAlb. RI had significant associations with age (r = 0.398, P < 0.0001), diastolic blood pressure (r = −0.398, P < 0.0001), eGFR (r = −0.373, P < 0.0001), and baPWV (r = 0.223, P < 0.05), respectively. Multivariate logistic regression analysis showed that increased RI when defined as RI >0.72 (median) was significantly associated with age (P < 0.01, 95%CI 1.02–1.19), diastolic blood pressure (P < 0.01, 0.86–0.97), and uAlb (P < 0.01, 1.53–15.46), respectively. Moreover, RI was an independent risk factor for uAlb after adjustment of both diastolic blood pressure and eGFR.CONCLUSIONS—Renal vascular resistance was associated with albuminuria and aorta stiffness. Increased RI may imply the presence of any type of underlying renal damage, including ischemic nephropathy.Duplex Doppler ultrasonography was used to assess intrarenal hemodynamics. The resistive index (RI) calculated from blood flow velocities in vessels reflects renovascular resistance and is known to increase in various disorders (1–5). Moreover, vasoactive agents, such as angiotensin II or ACE inhibitors (6), are known to affect RI. Regarding mechanisms by which RI of intrarenal arterioles increase, we previously reported that arterio-arteriolosclerosis rather than interstitial fibrosis could play an important role (7). In addition, we reported that there was a direct relationship between RI and arteriolosclerosis in damaged kidneys, and RI at renal biopsy may be useful as one of the prognostic markers for renal outcome (7).According to the annual report of the Japan Dialysis Treatment Society in 2006, the most frequent cause of end-stage renal disease is diabetes (8). Although diabetic nephropathy has been considered to be a microvascular complication, histopathological examination of renal biopsies showed not only typical diffuse or nodular lesions, but also arteriosclerotic glomerulosclerosis (9). It has been reported that RI in patients with renal dysfunction (chronic renal failure) secondary to type 2 diabetes were significantly increased compared to the patients with nondiabetic chronic renal failure (10). Furthermore, regardless of the status of microalbuminuria, which has been considered to be a risk factor for diabetic nephropathy and progression of renal insufficiency, glomerular filtration rate (GFR) was also reported to be correlated with RI (11). Indeed, there are several reports showing a correlation between RI and renal function (7,11,12). It is therefore conceivable that nonalbuminuric renal insufficiency (13) could be related to other pathogenetic disorders, such as ischemic nephropathy, rather than classic diabetic nephropathy. In this regard, it should be borne in mind that macroangiopathy, not microangiopathy, is likely to affect GFR because systemic atherosclerotic vascular disease adversely affects renal blood perfusion, resulting in a decrease of GFR, even if clinically overt renal artery stenosis is not evident. Ishimura et al. (12) have already reported that RI values are significantly correlated with both femoral and carotid arterial intima-media thickness (IMT) in type 2 diabetic patients with nephropathy and that intrarenal hemodynamics are affected by decreased GFR, probably through advanced arteriosclerosis. Recently, Ohta et al. (14) reported that increased RI of the main renal arteries is significantly correlated with the severity of systemic atherosclerosis. Furthermore, the intrarenal vascular resistance differs depending on the underlying renal disease and appears to increase to a greater extent in diabetic nephropathy (14). However, the relationship between RI and albuminuria remains unknown, despite albuminuria being a strong predictor of cardiovascular events caused by endothelial dysfunction (15).Therefore, we assessed the relationship between RI of the main renal arteries and albuminuria. Moreover, we studied the severity of other macroangiopathy evidenced by an increase in aorta stiffness measured by brachial-ankle pulse-wave velocity (baPWV), carotid IMT, and ankle-brachial pressure index (ABI) in association with RI.     

Association between diabetic microangiopathy and vascular endothelial function evaluated by flow-mediated vasodilatation in patients with type 2 diabetes

The main purpose of the study was to investigate the association between vascular endothelial function and diabetic microangiopathy (nephropathy, retinopathy and neuropathy) in patients with type 2 diabetes. In addition, the association between endothelial function and macroangiopathy evaluated by intimal-medial complex thickness (IMT) was also investigated. Endothelial function was evaluated non-invasively by the measurement of flow-mediated vasodilatation (FMD) of the brachial artery. Diabetic nephropathy and neuropathy were assessed by urinary albumin excretion (UAE) and motor or sensory nerve conduction velocity (MCV, SCV), respectively, and retinopathy was evaluated by an ophthalmologist using the Davis classification. FMD was measured in 102 patients with type 2 diabetes and in 20 control subjects, and showed a tendency to be lower in the diabetic patients. There was a significant decrease in FMD in patients with proliferative diabetic retinopathy, compared with those in patients with no diabetic retinopathy. FMD showed significant positive correlations with MCV and SCV, and significant negative correlations with log UAE, systolic blood pressure and diabetic duration, but no correlation was obtained between FMD and IMT. In stepwise regression analysis, MCV alone showed a significant association with FMD. In conclusion, our results show that in patients with type 2 diabetes FMD is closely associated with all types of microangiopathy, with neuropathy being most strongly associated with FMD; however, FMD is not associated with macroangiopathy evaluated by IMT.     

The diagnostic value and clinical significance of a method for estimating the arterial stiffness by cardio-ankle vascular index

The review presents the data of clinical studies of a new method for estimating the arterial stiffness by cardio-ankle vascular index (CAVI). The most significant factors influencing the vascular wall are analyzed and a CAVI measuring procedure and a calculation algorithm are described in detail. An association of the estimation of CAVI with other procedures determining the rigidity of the arterial wall is analyzed. A possibility for the practical application of this index to the study of the elastic properties of the vascular wall and for its use as a surrogate criterion to evaluate the vasoprotective effect of antihypertensive agents is considered.     

重庆市体检人群心踝血管指数与脂肪肝的相关性研究

目的研究重庆市体检人群心踝血管指数(CAVI)与脂肪肝之间的相关性。方法选取2015年1~12月重庆医科大学附属第一医院健康体检部健康体检者3 218例作为研究对象,按照是否有脂肪肝分为健康对照组(n=2 298)和脂肪肝组(n=920),比较两组CAVI值的大小及动脉硬化检出率,并且采用回归分析评估脂肪肝的危险因素。CAVI采用动脉硬化检测仪测量,脂肪肝采用彩色多普勒超声检测。结果脂肪肝组和健康对照组性别构成比男性比例高于女性,差异有统计学意义(P0.05)。脂肪肝组CAVI(8.00±1.14)m/s比健康对照组CAVI(7.80±1.07)m/s显著升高,差异有统计学意义(P0.05),脂肪肝组动脉硬化检出率显著高于健康对照组,差异有统计学意义(P0.05)。将性别、体质量指数(BMI)、收缩压(SBP)、舒张压(DBP)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、三酰甘油(TG)、空腹血糖(FPG)、CAVI作为自变量,是否有脂肪肝作为应变量,进行多变量Logistic回归分析,校正性别、SBP、DBP、HDL-C、LDL-C后发现,BMI、TG、FPG、CAVI升高是脂肪肝的易患危险因素,CAVI与脂肪肝密切相关。结论 CAVI与脂肪肝密切相关,体检人群尽早进行CAVI及腹部超声筛查有助于动脉硬化及脂肪肝的早期防治。