高血压合并高脂血症对血管早期病变的影响

目的探讨高血压合并高脂血症患者肱踝脉搏波传导速度和踝臂指数的变化及相关影响因素。方法随机入选高血压合并高脂血症患者和单纯高血压患者各400例。检测肱踝脉搏波传导速度、踝臂指数、血糖、甘油三酯、低密度脂蛋白、高密度脂蛋白、总胆固醇等指标,比较两组肱踝脉搏波传导速度和踝臂指数值的差异,对血脂异常进行临床分型,比较各血脂异常亚型之间肱踝脉搏波传导速度值的差异,并对肱踝脉搏波传导速度相关影响因素进行相关分析。结果高血压合并高脂血症组肱踝脉搏波传导速度值(1674.0±13.0 cm/s)较单纯高血压组(1594.0±11.2 cm/s)显著升高(P<0.001);两组间踝臂指数值差异无统计学意义(P=0.897)。高血压病患者中,高甘油三酯血症、高胆固醇血症、混合型血脂异常组肱踝脉搏波传导速度值均显著高于单纯高血压组(P<0.001)。单因素相关分析表明,总胆固醇、低密度脂蛋白、总胆固醇/高密度脂蛋白均与动脉硬度指标肱踝脉搏波传导速度显著相关(P<0.05)。多元线性逐步回归分析结果表明,高血压患者中收缩压、年龄、总胆固醇/高密度脂蛋白、体质指数和空腹血糖与反映动脉僵硬度的肱踝脉搏波传导速度关系密切(P<0.05),总胆固醇/高密度脂蛋白(β=0.104,P<0.001),是仅次于收缩压和年龄的影响因素。结论血脂与肱踝脉搏波传导速度相关,高脂血症加速了高血压病患者的动脉硬化,高甘油三酯血症对动脉硬度的影响与高胆固醇血症相当,应引起足够的重视。     

高血压合并2型糖尿病患者动脉弹性与氧化应激和血管内皮功能的相关性

目的 研究高血压合并糖尿病患者肱-踝脉搏波传导速度与血清中丙二醛、超氧化物歧化酶和一氧化氮的相关性,探讨氧化应激、血管内皮功能变化在动脉硬化过程中的作用.方法 研究对象168例分为正常对照组(n=40)、原发性高血压组(n=70)和高血压合并2型糖尿病组(n=58),各组分别用比色法检测血清丙二醛、超氧化物歧化酶和一氧化氮含量,应用动脉硬化自动检测仪测定肱-踝脉搏波传导速度.结果 与对照组比较,原发性高血压组和高血压合并2型糖尿病组中丙二醛水平和肱.踝脉搏波传导速度明显增高(P<0.01),超氧化物歧化酶和一氧化氮水平明显降低(P<0.01);与原发性高血压组比较,高血压合并2型糖尿病组丙二醛水平和肱-踝脉搏波传导速度明显增高(P<0.05),超氧化物歧化酶和一氧化氮水平降低(P<0.05).相关分析显示肱-踝脉搏波传导速度与年龄、收缩压、舒张压、胆固醇、空腹血糖、高敏C反应蛋白和丙二醛呈正相关(相关系数r分别为0.418、0.672、0.469、0.179、0.392、0.277和0.571,均P<0.05),与超氧化物歧化酶和一氧化氮呈负相关(r分别为-0.438和-0.571,均P<0.05).多元逐步回归分析显示收缩压、丙二醛、空腹血糖和年龄是肱-踝脉搏波传导速度的独立危险因素.结论 高血压合并糖尿病患者动脉弹性明显减弱,且与体内氧化应激增强和血管内皮功能损伤有关,提示氧化应激和血管内皮功能在动脉硬化过程中起重要作用.     

伴代谢综合征的高血压病患者动脉功能的变化

目的 探讨伴有代谢综合征的高血压病患者动脉功能的变化.方法 64例门诊高血压病患者分为高血压病合并代谢综合征组(简称为伴代谢综合征组,32例)和单纯高血压病组(32例),31例健康受试者作为对照组,检测受检者的肱-踝脉搏波传导速度、大动脉弹性和小动脉弹性.比较三组受试者肱-踝脉搏波传导速度、大动脉弹性和小动脉弹性变化,分析动脉功能与各危险因素的相关性.结果 与对照组(1 517.9±315.0 cm/s)相比,伴代谢综合征组(1 916.5±318.0 cm/s)和单纯高血压病组(1 757.6±313.9 cm/s)肱-踝脉搏波传导速度均显著增加(P<0.01和0.05),且伴代谢综合征组显著高于单纯高血压病组(P<0.05).对照组、单纯高血压病组和伴代谢综合征组受试者大动脉弹性(113.2±46.2、91.1±35.0和66.6±31.1 mL/mmHg,P<0.01)和小动脉弹性(505±244、355±195和253±116 mL/mmHg,P<0.05)依次降低.Peason相关分析表明肱-踝脉搏波传导速度与年龄、收缩压、脉压差、甘油三酯呈显著正相关(P<0.01),与高密度脂蛋白胆固醇呈显著负相关(P<0.01);大动脉弹性、小动脉弹性与高密度脂蛋白胆固醇呈正相关(P<0.05和0.01),而与年龄、收缩压、脉压差和甘油三酯呈负相关(P均<0.01).结论 代谢综合征加重高血压病患者动脉功能的减退.     

国内动态

原发性高血压患者循环内皮微颗粒水平与动脉弹性功能的关系中国循环杂志,2008,23(3):167-170.该文研究原发性高血压患者循环内皮微颗粒水平和动脉弹性功能的关系。方法:采用流式细胞仪技术测定原发性高血压患者(n=60,高血压组)和健康志愿者(n=32,对照组)血浆中 CD_(31)~+/CD_(42)~-内皮微颗粒的水平,袖带震荡技术尤创检测肱动脉与胫后动脉之     

原发性高血压患者血压分级及危险因素分层与脉搏波速度关系的研究

目的探讨原发性高血压患者血压分级以及危险因素分层与动脉脉搏波速度(PWV)的关系。方法应用动脉脉搏波速度(PWV)自动测量系统测定入选的560例原发性高血压患者的肱动脉-踝动脉baPWV值,并对患者进行危险因素分层,比较不同血压水平及危险程度患者的脉搏波速度。结果1级与2级高血压患者的baPWV差异无统计学意义[(1540±150)cm/s比(1630±160)cm/s,P=0.298];伴有一种以上心血管危险因素者的baPWV显著高于单纯高血压患者[(1645±138)cm/s比(1584±160)cm/s,P=0.001)]。结论存在一种或一种以上心血管危险因素的高血压患者,PWV值明显高于无危险因素的高血压患者,心血管危险因素对脉搏波速度的影响可能较大。     

300例高血压前期者脉搏波传导速度与颈动脉硬化改变及相关性

目的 探讨高血压前期人群大动脉顺应性和颈动脉硬化的情况及相关性.方法 分层随机抽取高血压前期、高血压、正常血压各300例作为研究对象.采用动脉硬化诊断装置VP-1000测定肱踝脉搏波传导速度和踝臂指数,多普勒彩色超声观察颈总动脉内膜-中膜厚度以及斑块形成情况,比较三组间差异.比较各血压组合并颈动脉斑块时脉搏波传导速度的变化情况,分析颈动脉内膜-中膜厚度与脉搏波传导速度的相关性.结果 (1)随着血压从正常向高血压转变,肱踝脉搏波传导速度呈上升趋势,高血压前期组(1 390±171 cm/s)较正常血压组(1 293±151 cm/s)升高但低于高血压组(1 652±291 cm/s,P<0.01);踝臂指数高血压前期组(1.115±0.060)与正常血压组(1.114±0.061)相比差异无统计学意义(P>0.05),但在高血压组明显升高(1.132±0.067,P<0.01).(2)颈动脉内膜-中膜厚度增厚率及斑块发生率在高血压前期组与正常血压组相比差异均无统计学意义,但在高血压组显著升高(P<0.01);颈总动脉内膜-中膜厚度在高血压前期组(0.73±0.10mm)与正常血压组(0.72±0.12 mm)相比差异无统计学意义(P>0.05),但在高血压组显著增厚(0.78±0.16 mm,P<0.01).(3)有或无合并颈动脉斑块时,高血压前期组脉搏波传导速度均较正常血压组升高(P<0.01),但低于高血压组(P<0.01);各血压组合并颈动脉斑块时脉搏波传导速度较无颈动脉斑块时均升高(P<0.01).肱踝脉搏波传导速度与颈总动脉内膜-中膜厚度呈正相关(r=0.271,P<0.01),校正血压因素后相关性仍存在(r=0.156,P<0.01).结论 高血压前期肱踝脉搏波传导速度显著升高.提示存在早期动脉硬度改变.肱踝脉搏波传导速度与颈动脉内膜-中膜厚度呈正相关,肱踝脉搏波传导速度可作为评估高血压前期动脉硬度有效且简便易行的指标.     

高血压合并肥胖患者脉搏波传导速度的变化及其相关影响因素分析

目的 探讨高血压合并肥胖患者脉搏波传导速度的变化及其相关影响因素.方法 随机入选高血压合并肥胖患者和单纯高血压患者各300例.应用日本科林VP-1000动脉硬化测定仪测定臂踝脉搏波传导速度,同时检测血糖、甘油三酯、肌酐、尿酸、高密度脂蛋白胆固醇、总胆固醇及腰围等指标,并以臂踝脉搏波传导速度为因变量,以年龄、收缩压、舒张压、脉压、体质指数、腰围、血糖、甘油三酯、总胆固醇、高密度脂蛋白胆固醇、肌酐、尿酸等为自变量,行臂踝脉搏波传导速度的多因素分析.结果 高血压合并肥胖患者臂踝脉搏波传导速度(1635±239cm/s)较单纯高血压患者(1583±288 cm/s)显著升高(P<0.05).Pearson相关分析表明,两组臂踝脉搏波传导速度均与收缩压、脉压显著正相关(P<0.05),与舒张压无相关性(P>0.05).多元逐步回归分析表明,600例高血压患者中年龄、收缩压和腰围与反映动脉僵硬度的臂踝脉搏波传导速度关系密切(P<0.05).结论 高血压合并肥胖患者与单纯高血压患者之间臂踝脉搏波传导速度存在显著性差异,年龄、收缩压及腰围与臂踝脉搏波传导速度相关.     

高血压病患者压力感受器敏感性

目的探讨高血压病患者压力感受器敏感性(BRS)情况及其可能影响因素。方法用全自动生化仪测定血脂、血糖,用倾斜方法同时记录血压和心率,BRS=(最低血压时RR间期-基础RR间期)/(最低血压-基础血压),用袖带对肱动脉加压后放气,测定肱动脉内径变化率的方法代表血流介导的内皮舒张功能。结果(1)高血压病患者的BRS明显小于正常对照组[(6.9±7.3vs13.9±3.6)ms/mmHg,P<0.01],亦明显小于肾性高血压组[(6.9±7.3vs12.2±6.2)ms/mmHg,P<0.01];高血压病BRS有随着高血压分级增高而下降趋势,1级患者BRS大于3级患者[(10.2±4.0vs5.4±4.8)ms/mmHg,P<0.01],2级患者BRS大于3级患者[(7.6±2.4vs5.4±4.8)ms/mmHg,P<0.01];(2)高血压病伴高脂血症患者BRS小于高血压病不伴高脂血症组[(2.2±4.7vs7.2±6.4)ms/mmHg,P<0.01];(3)高血压病患者血管内皮舒张功能与BRS相关(r=0.565,P<0.01),肾性高血压组内皮舒张功能与BRS相关(r=0.573,P<0.05),正常对照组内皮舒张功能与BRS相关(r=0.610,P<0.05)。结论(1)BRS功能降低可能是高血压病发病原因之一;(2)降脂治疗可通过升高BRS,改善高血压病患者的预后;(3)血管内皮舒张功能与BRS有关,可通过改善血管内皮舒张功能改善BRS。     

冠心病患者肱—踝脉搏波速与血管内皮舒张功能相关

目的探讨冠心病患者肱—踝脉搏波速与内皮依赖性舒张功能的关系。方法选择98例冠心病患者和33例非冠心病对照者,采用高分辨率超声检测肱动脉血流介导的内皮依赖性血管舒张功能;自动脉搏波速度测定仪测定肱—踝脉搏波速。结果冠心病组肱动脉血流介导的内皮依赖性血管舒张功能明显低于对照组(5.4%±2.5%比11.1%±4.4%,P<0.01),冠心病组肱—踝脉搏波速明显高于对照组(1745.3±215.2cm/s比1495.3±202.3cm/s,P<0.01),两组硝酸甘油介导的内皮非依赖性血管舒张功能无明显差异;肱动脉血流介导的内皮依赖性血管舒张功能与肱—踝脉搏波速呈负相关(r=-0.70,P<0.001)。结论冠心病患者血管内皮功能受损和肱—踝脉搏波速增快,提示血管内皮舒张功能的受损伴随冠心病动脉硬化。     

沿海正常人群糖化血红蛋白与肱-踝脉搏波传导速度的关系

目的 评估正常人动脉顺应性与糖化血红蛋白之间的关联.方法 横断面调查福建沿海地区30岁以上健康人1175例,行肱-踝脉搏波传导速度和糖化血红蛋白等检测,采用单因素分析和Logistic多元回归分析评价糖化血红蛋白与肱-踝脉搏波传导速度相关情况.结果 (1)肱-踝脉搏波传导速度与糖化血红蛋白具有相关性(r=0.147,P＜0.05);(2)糖化血红蛋白四分法组间显示,肱-踝脉搏波传导速度在四组间差异有统计学意义(P＜0.001);随着糖化血红蛋白水平升高,脉搏波传导速度增快,异常肱-踝脉搏波传导速度的比例升高;异常肱-踝脉搏波传导速度组糖化血红蛋白大于正常肱-踝脉搏波传导速度组(P＜0.05);(3) Logistic回归分析显示,年龄、收缩压、舒张压、糖化血红蛋白、尿酸为正常人群肱-踝脉搏波传导速度独立危险因素(均P ＜0.05),其中糖化血红蛋白比值比最大(OR=2.692,P＜0.05).结论 糖化血红蛋白与肱-踝脉搏波传导速度独立相关,提示非糖尿病健康人群中中间高血糖水平参与了大动脉血管壁早期功能或结构性损伤.     

高血压患者循环内皮细胞微颗粒水平的变化

目的研究高血压患者内皮细胞微颗粒水平的变化及其与血压的关系。方法采用流式细胞术检测26例高血压患者(高血压组)和30例健康志愿者(健康对照组)血浆中CD31+/CD42-内皮细胞微颗粒的水平,并比较其与血压的关系。结果与健康对照组比较,高血压组患者血浆中内皮细胞微颗粒水平明显增高[(1 900.7±226.4)个/μlvs(944.9±124.5)个/μl,P<0.001]。内皮细胞微颗粒水平与收缩压和脉压呈正相关(r=0.38,P=0.004;r=0.42,P=0.001)。结论高血压患者内皮细胞微颗粒水平增高,内皮细胞微颗粒水平与血压呈正相关。     

老年高血压伴下肢动脉硬化症患者血小板微粒膜蛋白的变化

目的探讨老年原发性高血压(EH)伴下肢动脉硬化症(LEASD)患者血小板微粒膜蛋白的变化。方法选择老年EH伴LEASD患者组(32例),老年EH患者组(30例)、健康老年组(30例),用流式细胞术检测上述3组的血小板微粒膜蛋白CD62p、活化的糖蛋白(GP)Ⅱb/Ⅲa的表达百分率。结果老年EH伴LEASD患者组血小板微粒膜蛋白CD62p、活化的GPⅡb/Ⅲa表达的百分率明显高于老年EH患者组及健康老年组(P<0.01),而老年EH患者组明显高于健康老年组(P<0.01)。结论老年EH伴LEASD患者血小板微粒膜蛋白CD62p、活化的GPⅡb/Ⅲa指标显著升高,提示老年EH伴LEASD患者存在高凝状态,即血栓前状态。     

循环EPCs CD34^＋水平与高血压病患者心血管危险因素的关系

目的探讨能否将循环内皮祖细胞(EPCs)CD34 水平作为评价高血压病患者心血管危险度的标志。方法高血压病患者组62例,对照组20例。高血压病患者采用Framingham心血管危险因素积分分层心血管危险因素,分为低危组18例,中危组14例,高危组17例,极高危组13例。作外周血循环EPCs CD34 水平与Framingham心血管危险因素积分的相关性分析。结果各研究组高血压病患者外周循环EPCs CD34 水平随着其心血管危险程度的增加,逐步下降,各组间比较有统计学意义(P<0.05)。EPCs CD34 水平与Framingham心血管危险因素积分呈负相关关系(r=-0.875,P<0.01)。结论高血压病患者循环EPCs CD34 水平下降与心血管危险因素有显著的相关性。循环EPCs CD34 水平可以作为高血压病患者心血管危险度的标志。     

Circulating endothelial microparticles in patients with acute myocardial infarction

BACKGROUND: Circulating endothelial microparticles (EMPs), the small vesicles released from altered endothelial cells, have been established as markers of endothelial injury. The elevated count of EMPs has been described in different conditions involving endothelial injury, including acute myocardial infarction (AMI). AIM: To assess the presence of EMP in patients with acute MI in relation to early clinical outcome and coronary angiography results. MATERIALS AND METHODS: EMPs counts were determined in 66 patients pts (23 women, 43 men) with documented ST elevation AMI and in 10 control patients with no evidence of coronary artery disease. All pts with AMI underwent coronary angiography with attempted primary angioplasty. EMPs were assayed by flow cytometry in platelet-poor plasma with combinations of fluorescent antibodies (anti CD31, -51, -42) allowing distinction of EMPs from platelet microparticles. Clinical and angiography results were compared with EMP levels. RESULTS: Three kinds of EMPs were measured: CD31+, CD51+ and CD31+/51+. The percentage of EMPs CD31+/CD51 was significantly (p=0,042) higher in patients with AMI in comparison with control subjects. However, a marker, which distinguished both groups the most, was the level of EMPs CD51+. It was significantly (p=0,024) higher in pts with AMI than in control pts. The levels of CD31+ were similar in both groups. There was no correlation between EMP levels, clinical and angiography results. CONCLUSION: The presence of circulating EMPs provides direct evidence of endothelial injury in AMI. The clinical and practical value of these results, however, needs further exploration.     

老年原发性高血压患者伴下肢动脉硬化闭塞症与血小板功能的相关性研究

目的　探讨老年原发性高血压 (EH)患者伴下肢动脉硬化闭塞症 (LEAO)与血小板功能的关系及其临床意义。方法　采用病例对照设计 ,老年EH患者伴LEAO组 (32例 )及老年EH患者组 (30例 )、健康老年组 (30例 ) ,用流式细胞术观察 3组的血小板膜糖蛋白 (GP)Ⅱb Ⅲa的活化水平、血小板聚集率 (PAgT)、纤维蛋白原 (Fg)等指标的变化。结果　GPⅡb Ⅲa的活化水平及PAgT在老年EH患者伴LEAO组明显高于老年EH患者组及健康老年组(P <0 .0 1) ,老年EH患者组与健康老年组的GPⅡb Ⅲa的活化水平及PAgT比较有明显增高 (P <0 .0 1) ,老年EH患者伴LEAO组的Fg与健康老年组比较有显著差异 (P <0 .0 1) ,老年EH患者伴LEAO组GPⅡb Ⅲa的活化水平与PAgT呈正相关 (r=0 .870 1、P <0 .0 1)。结论　GPⅡb Ⅲa及PAgT与老年EH患者伴LEAO密切相关 ,并对判断其血小板活化以及血管病变有重要的临床价值。     

Circulating endothelial microparticles in children with Henoch�CSch?nlein purpura; preliminary results

The aim of this study was to investigate the levels of circulating endothelial microparticles (EMPs) in children with HSP and to determine whether there was a difference between patients with nephritis and those without nephritis. Twenty patients with HSP aged between 2.5 and 15 and 10 age-and sex-matched healthy controls were enrolled in the study. The HSP group was divided into two groups, including patients with nephritis (n = 9) and those without nephritis (n = 11). In all groups, circulating EMPs were enumerated by flow cytometry, after staining platelet-free plasma with PE-conjugated anti-CD144. At the same time, human umbilical vein endothelial cells (HUVEC) were incubated with the platelet-free plasma of patients with HSP and that of the control group. Then, circulating EMPs were counted in HUVEC supernatant incubated with the platelet-free plasma of patients and control groups, after staining the supernatant with PE-conjugated anti-CD146. Circulating EMPs were significantly higher in both the active and the remission period of the patient groups compared with the control subjects. In the patient group, there were no statistically significant differences in the level of circulating EMPs between patients with nephritis and those without nephritis. Both CD144 and 146+EMP in patients with HSP nephritis in the active period were substantially higher than in those remissions. CD144+EMP in the active period were substantially higher than in the remission period in patients without nephritis. We detected that circulating EMPs increased in patients with HSP in both active and remission periods. Although clinical and laboratory findings return to normal in the remission period, the increased circulating EMPs may show that the subclinical inflammatory process is continuous. We think that circulating EMPs could be used as a surrogate marker for subclinical inflammation in HSP.     

通心络对高血压患者血内皮微粒的影响

目的:探讨通心络对高血压患者循环血内皮微粒(EMPs)和血管内皮功能的影响。方法:94例高血压病患者被随机分为通心络组(48例)和常规治疗组(46例),另以20例健康者作为健康对照组。于治疗前、治疗后6个月采集静脉血,采用流式细胞术(FCM)测定患者血浆EMPs水平,同时测定血流介导的内皮依赖性血管舒张功能(FMD)的变化。结果:治疗前,与健康对照组比较,通心络组和常规治疗组EMPs水平明显升高,FMD明显降低(P均<0.01);在治疗后6个月,通心络组和常规治疗组EMPs和血压较治疗前明显降低,FMD明显升高,且与常规治疗组比较,通心络组EMPs水平[(785.4±119.4)个/μl比(727.2±128.2)个/μl]和血压[(140.9±9.6/80.8±6.5)mmHg比(136.1±10.8/76.1±7.4)mmHg]降低、FMD[(8.6±2.5)%比(9.7±2.1)%]升高得更为显著(P均<0.05)。直线相关分析显示,EMPs与收缩压水平呈显著正相关(r=0.463,P=0.002),与FMD呈显著负相关(r=-0.523,P=0.001)。结论:通心络治疗可明显降低高血压患者内皮微粒水平和改善其内皮功能;内皮微粒对评价高血压患者内皮功能障碍程度具有一定的临床意义。     

高血压患者治疗前后肱一踝脉搏波传导速度和内皮微颗粒的变化

目的观察1级原发性高血压（高血压）患者治疗前后肱踝脉搏波传导速度（brachial—ankle pulse wavevelocities,baPWV）和血浆内皮微颗粒（endothelial micro—particles,EMPs）变化的规律及意义。方法人选高血压1级患者63例,给予降压药物治疗后,观察患者治疗前,治疗后30、60、120d的血压、baPWV和EMPs水平及血清内皮素-1、高敏C反应蛋白、白细胞介素-6、一氧化氮浓度。结果63例高血压1级患者治疗前后在体质量指数、总胆固醇等指标上比较,差异无统计学意义（P〉0．05）。经过高血压药物治疗后,患者收缩压、舒张压、循环EMPs水平、baPWV水平及血清内皮素-1、高敏C反应蛋白、白细胞介素-6、一氧化氮浓度均较治疗前明显下降,差异有统计学意义（P〈0．01）;治疗后患者血清一氧化氮浓度升高,差异有统计学意义（P〈0．01）。患者baPWV及lg—EMPs与收缩压（r=0．846,0．597：P〈0．001）、舒张压（r=0．619,0．428;P〈0．001）及血清内皮素-1（r=0．803,0．454;P〈0．001）、高敏c反应蛋白（r=0．801,0．569;P〈0．001）、白细胞介素-6（r=0．844,0．567;P〈0．001）浓度呈正相关,与一氧化氮浓度呈负相关（r=-0．482,-0．127;P〈0．001）。患者baPWV与lg．EMPs呈正相关（r=0．583,P〈0．001）。结论在1级高血压患者中开展baPWV监测对于评估及预防动脉粥样硬化进程具有重要的临床意义及价值。     

Effects of pioglitazone versus metformin on circulating endothelial microparticles and progenitor cells in patients with newly diagnosed type 2 diabetes--a randomized controlled trial

Aim: Endothelial microparticles (EMPs) and endothelial progenitor cells (EPCs) are markers of endothelial injury and repair. We compared the effects of pioglitazone versus metformin on the circulating numbers of EMPs and EPCs in patients with newly diagnosed type 2 diabetes. Methods: This was a randomized, double‐blind, comparator‐controlled, 24‐week single‐centre trial conducted in a Teaching Hospital in Naples, Italy. One hundred and ten people with newly diagnosed type 2 diabetes who were never treated with antihyperglycaemic drugs and had haemoglobin A1c (HbA1c) levels between 7 and 10% were given pioglitazone hydrochloride (15–45 mg/day) (n = 55) or metformin (1000–2000 mg/day) (n = 55) as an active comparator. Absolute change from baseline to final visit in circulating EMPs and EPCs and their ratio were the main outcomes. Results: Baseline characteristics did not differ between the study groups. The decrease in circulating EMPs CD31+ [intergroup difference, ?32 counts/µl (95% CI ?51 to ?9)] and the increase in EPCs CD34+/KDR+ [intergroup difference, 33 cells/10⁶ events (95% CI 13 to 55)] were greater with pioglitazone versus metformin. EMPs/EPCs ratio was reduced with pioglitazone and unchanged with metformin [difference, ?1.5 (95% CI ?2.6 to ?0.5), p < 0.001]. Participants assigned to pioglitazone gained more weight and experienced greater improvements in some coronary risk measures [high‐density lipoprotein (HDL)‐cholesterol, triglycerides, adiponectin and C‐reactive protein (CRP)] than did those assigned to metformin. Conclusion: Compared with metformin, pioglitazone treatment improved the imbalance between endothelial damage and repair capacity and led to more favourable changes in coronary risk factors in patients with newly diagnosed type 2 diabetes.     

Effect of 40 mg versus 10 mg of atorvastatin on oxidized low-density lipoprotein, high-sensitivity C-reactive protein, circulating endothelial-derived microparticles, and endothelial progenitor cells in patients with ischemic cardiomyopathy

Background:

There are few recent data to delineate the beyond lipids‐decreased effect of statins and the effect of different doses of statins on endothelial‐derived microparticles (EMPs) and circulating endothelial progenitor cells (EPCs) in patients with ischemic cardiomyopathy (ICM).

Hypothesis:

Statins might have the beyond lipids‐decreased effect and there were different effects between different doses of statins on EMPs and circulating EPCs in patients with ICM.

Methods:

One hundred patients with ICM and 100 healthy examined people, who served as the normal control group, were recruited to this study. Patients were randomly divided into 2 groups: 10‐mg atorvastatin group (n = 50) and 40‐mg atorvastatin group (n = 50). All subjects were followed for 1 year. The levels of serum lipids, oxidized low‐density lipoprotein (oxLDL), high‐sensitivity C‐reactive protein (hsCRP), circulating EPCs, and EMPs were examined in all subjects. The incidences of adverse reactions in the 2 study groups were determined.

Results:

At the beginning of this study, there were no significant differences in baseline characteristics between the 2 study groups. At the end of this study, the levels of total cholesterol, low‐density lipoprotein, serum hsCRP, oxLDL, and circulating EMPs were significantly decreased; circulating EPCs were significantly increased in the 40‐mg atorvastatin group compared to the 10‐mg atorvastatin group, P < 0.05. The multivariate linear regression analysis indicated that receiving only 40 mg of atorvastatin had a significant effect on the levels of circulating EPCs (β = 0.252,P = 0.014). There were no significant differences in the adverse reactions between the 2 groups.

Conclusions:

Use of 40 mg of atorvastatin might decrease the levels of circulating EMPs and increase the number of circulating EPCs in patients with ICM in comparison with 10 mg of atorvastatin, and the effect might be independent of the decrease of lipids, oxLDL, and hsCRP. © 2012 Wiley Periodicals, Inc. This study was supported by the Bureau of Health of Guangzhou city (2009‐YB‐186). The authors have no other funding, financial relationships, or conflicts of interest to disclose.