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.     

Correlation between glycosylated hemoglobin and carotid intima-media thickness in non-diabetic peritoneal dialysis patients

Objective To investigate the correlation between glycosylated hemoglobin (HbA1c) and carotid intima?media thickness (CIMT) in non?diabetic peritoneal dialysis patients. Methods Forty?two non?diabetic peritoneal dialysis adult patients were enrolled in this study [mean age was (48.2±12.3) years, 50% was male]. CIMT was determined by carotid ultrasound. Patients were divided into two groups according to CIMT: CIMT normal group (CIMT＜0.9 mm) and CIMT thickening group (CIMT≥0.9 mm). HbA1c, 2?hour postprandial blood glucose (2hPBG) and other factors of the patients were analyzed with Spearman rank correlation and multiple linear regression. Results CIMT was correlated with age, 2hPBG, LDL?C, TG, TC, HbA1c in non?diabetic peritoneal dialysis patients (r＝0.355, 0.373, 0.416, 0.345, 0.351, 0.456, all P＜0.05). Multiple linear regression showed that HbA1c was the most powerful influence factor of CIMT（β＝0.459）. Conclusion HbA1c level is positively correlated with CIMT and may be a predictor of carotid atherosclerosis in non?diabetic peritoneal dialysis patients.     

Correlation between cathepsin D serum concentration and carotid intima-media thickness in hemodialysis patients

Aim  

Cardiovascular (CV) disease is the leading cause of death in hemodialysis (HD) patients, and approximately half of mortalities in HD patients are attributed to CV disease. Atherosclerosis is the most frequent cause of CV complications in patients with end-stage renal disease (ESRD). Based on recent studies, cathepsin D has been suggested as a potential marker of atherosclerosis, and we hypothesized that there is an association between serum concentration of cathepsin D and carotid intima-media thickness (CIMT) in hemodialysis patients.     

Relationship between carotid artery intima-media thickness and brachial artery flow-mediated dilation in peritoneal dialysis patients

Background and aim   Carotid artery intima-media thickness (CIMT) and brachial artery flow-mediated dilation percentage (FMD%) are two commonly used parameters for detecting subclinical atherosclerosis. However, studies investigating the relationship between CIMT and brachial artery FMD% in different populations have produced conflicting results. The aim of this study was to determine the relationship between CIMT and brachial artery FMD% in patients on peritoneal dialysis (PD) Methods   Fifty-two PD patients without known cardiovascular disease and 30 age-gender matched controls were included in the study. Endothelial function was determined using ultrasonography (US) to measure the FMD of the brachial artery, and this parameter was expressed as the percentage change from the baseline diameter of the brachial artery (FMD%). We also measured CIMT by US and analysed the relationship between CIMT and brachial FMD%. Results   The CIMT was significantly higher in patients than in the control group (0.84 ± 0.08 vs. 0.75 ± 0.06 mm, P < 0.01), whereas brachial artery FMD% was lower in patients than in the controls (8.2 ± 5.0 vs. 11.7 ± 5.5%, P < 0.01). There was no significant correlation between CIMT and FMD% (r = −0.004, P = 0.94). Conclusion  Although PD patients are known to be characterized by an impaired flow-mediated vasodilatation of brachial artery and increased in CIMT, we did not find a significant correlation between FMD% and CIMT in our PD patient cohort. One possible explanation for our results is that each method measures a different aspect and stage of atherosclerosis.     

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.     

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。     

Relationship between periodontal status and disease activity in patients with ankylosing spondylitis

ObjectivesAnkylosing spondylitis (AS) is a chronic inflammatory disease mainly affecting the spine and sacroiliac joints, characterized by enthesitis. Recent studies have investigated the relationship between AS and periodontitis. The aim of this study was to evaluate the periodontal status of patients with AS and to determine the factors affecting this.Material and methodsThe study included 200 AS patients, of which 129 were taking anti-tumour necrosis factor (TNF) drugs and 71 were taking non-steroid anti-inflammatory drugs (NSAID). Patients did not change their medication during the study. Disease activity was evaluated with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), mobility with the Bath Ankylosing Spondylitis Metrology Index (BASMI), functional status with the Bath Ankylosing Spondylitis Functional Index (BASFI), enthesitis with the integrated Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), and quality of life with the Ankylosing Spondylitis Quality of Life (ASQoL) scale. Data related to erythrocyte sedimentation rate, and C-reactive protein were recorded from the hospital information system. The plaque index (PI), gingival index (GI), pocket depth (PD), attachment level (CAL) measurements, and bleeding index (BOP) were measured.ResultsThe results showed that 35.5% of the AS patients had periodontitis, at a lower rate in the anti-TNF group than in the NSAID group, but the difference was not statistically significant. Periodontitis-related factors were found to be age, BASFI and BASMI. A significant relationship was found between MASES and BOP and GI.ConclusionsThis suggests that periodontitis may be an enthesis in AS. Nevertheless, further studies are needed to explain the mechanism of periodontitis in AS patients.     

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。     

Premature ejaculation in patients with ankylosing spondylitis

We aimed to evaluate the premature ejaculation (PE) among ankylosing spondylitis (AS) patients. Fifty male patients with AS who were diagnosed according to the modified New York criteria and fifty normal healthy controls (NHC) were included in this study. The details of patient age, disease duration, morning stiffness, laboratory activity, disease severity and medication use were obtained by reviewing the medical record. The Bath AS Functional Index (BASFI) was used to measure the functional status of the patients with AS. By taking a careful medical and sexual history, patients were classified as lifelong, natural variable, acquired PE or premature ejaculatory dysfunction. In addition to medical and sexual history, self-estimated intravaginal ejaculatory latency times (IELT) of patients were used in the classification of patients. To our knowledge, this is the first study of frequency of PE in men with AS. The prevalence rates of PE in patient and healthy controls were 32 and 30%, respectively (p = 0.331). The prevalence of PE was not significantly different between AS patients and NHC groups as regards the four PE syndromes. Average estimated IELT was 10,009 ± 51.9 sec in the PE group and 145.26 ± 43.01 sec in the non-PE group (p = 0.000). Patients with lifelong PE had a significantly lower mean estimated IELT than the other group (p = 0.000). Patients with premature-like ejaculatory dysfunction had the highest estimated IELT (p = 0.000). There was a significant association between self-estimated IELT and distribution of the patients according to the four PE syndromes (p = 0.01). Both AS patients and NHC groups have the same results. The present study demonstrates that PE in men with AS is as prevalent as it is in the general population. Although this study is restricted in terms of the number of patients, it is the first study ever conducted. For more meaningful results, multi centred studies with more patients are required.     

早期强直性脊柱炎病人的骨质疏松

目的：研究强直性脊柱炎（AS）病人的骨质疏松症（OP）,探讨AS病人的OP与病人的血沉以及强的松治疗之间的关系。方法：28例早期AS病人按照血沉高低分组,用双能X线吸收法（DEXA）测定了腰椎正位和股骨颈的骨密度。结果：AS病人常伴有OP,腰椎正位骨密度比股骨颈骨密度下降更为明显。使用强的松15mg/d会促进骨密度下降,钙剂治疗有助于改善病人的临床指标。结论：AS病人应同时注意对OP的防治。     

Spinal fractures in patients with ankylosing spondylitis

Thirty-one consecutive patients with ankylosing spondylitis and spinal fractures were reviewed. There were 6 women and 25 men with a mean age of 60±11 years; 19 had cervical and 12 had thoracolumbar injuries. Of the patients with cervical fracture, two had an additional cervical fracture and one had an additional thoracic fracture. Three trauma mechanisms were identified: high-energy trauma in 13 patients, low-energy trauma in 13 and insufficiency fracture in 5. One-third of the patients suffered immediate neurological impairment, a further one-third developed neurological impairment before coming for treatment and only one-third remained intact. Two patients with thoracolumbar fractures had deteriorated neurologically due to displacements during surgery at other hospitals. All patients were treated operatively except the two patients with two-level cervical fractures, who were managed in halo vests. In the cervical spine both anterior and posterior approaches were employed. In the thoracolumbar spine the majority of the patients were initially treated using a posterior approach only. Complications were common. Of the 27 patients with neurological compromise, 10 had remained unchanged; 12 had improved one Frankel grade; 4 had improved by two Frankel grades; 1 had improved by four Frankel grades. We conclude that even minor trauma can cause fracture in an ankylosed spine. A high proportion of patients with spinal fractures and ankylosing spondylitis have neurological damage. The risk of late neurological deterioration is substantial. As the condition is very rare and the treatment is demanding and associated with a very high risk of complications, the treatment of these patients should be centralised in special spinal trauma units. A combined approach that stabilises the spine from both sides is probably beneficial.     

青年官兵强直性脊柱炎(Anklosing spondyltis AS)的门诊关注及其处理措施

目的探讨提高青年官兵强直性脊柱炎的门诊诊断率,及时针对性的检查,诊断性的治疗,减少延诊漏诊。方法教育青年官兵坚持保存有连续的门诊记录,对19例血清阴性脊柱关节病严密跟踪检查治疗,得出满意的诊断和治疗。结果随访2年~6年,平均36个月,19例AS中,无一例病情恶化,临床症状都得到控制,血沉CRP,连续检查5次以上均在正常范围。结论强直性脊柱炎症在青年官兵中并不少见,由于其起病隐匿,早期又多无影像学阳性表现,加之患者多无保存门诊病历的习惯,以致极易延诊和漏诊。提至对不明原因的胸背间歇痛,血清类风湿子阴性的患者,要警惕AS的存在,拟诊为AS的血清阴性脊柱关节病病人,检查HLA-B27及关注症状性骶髂关节炎的存在,及时给予柳氮磺等标志性药物的综合治疗,19例病人得到了满意控制。     

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.     

Association of dialysate calcium concentration with fetuin a level and carotid intima-media thickness in peritoneal dialysis patients

Serum fetuin A has been shown to be associated with the risk of vascular calcification and atherosclerosis, and it can predict the onset of cardiovascular mortality in dialysis patients. The carotid intima-media thickness (cIMT) is an accessible and reliable method to identify the subclinical atherosclerosis. The aim of this study was to investigate the relationships between dialysate calcium concentrations and fetuin A or cIMT in patients undergoing peritoneal dialysis (PD). Forty patients, newly diagnosed end-stage renal disease (ESRD) and undergoing peritoneal dialysis, were enrolled in the study, with a calcium content of the peritoneal dialysis (PD) solution of 1.25?mmol/L in 20 patients (low-Ca group) and 1.75?mmol/L in 20 patients (standard-Ca group). The patients were followed up for 12 months after the PD conducted. Serum fetuin A was determined using a human fetuin A enzyme-linked immunosorbent assay kit and cIMT was detected using ultrasonic wave. We observed no difference between two groups with regard to the baseline data of fetuin A, cIMT, calcium, phosphorus, calcium-phosphorus product, high sensitivity CRP (hsCRP), parathyroid hormone (PTH), or lipid parameters. After 12 months follow-up, fetuin A (263.92?±?16.1 vs. 282.76?±?21.0, p?=?0.017) and calcium-phosphorus product (39.85?±?7.76 vs. 47.50?±?6.65, p?=?0.009) were obviously lower in the low-Ca group than standard-Ca group, the other serum parameters were not different between these two groups. Compared with baseline data, serum fetuin A concentration significantly reduced in low-Ca group (?p?p?相似文献   

强直性脊柱炎累及髋关节的全髋人工关节置换术

目的 探讨对强直性脊柱炎累及髋关节患者实施全髋人工关节置换术的临床特点、手术技术难点及中长期疗效.方法 对1986年5月～2004年6月34例(41髋)强直性脊柱炎累及髋关节患者施行全髋人工关节置换术并进行随访,所有患者均得到完整的临床及X 线片资料,平均随访时间为7.1年(2.2～19.3 年).结果 所有患者术后的临床症状及髋关节活动度均得到明显改善, Harris评分术前平均为33.9分(13.0～59.2分),术后改善为86.2分(72～96分).髋关节术前总活动度为45°(0～150°),术后改善为130°(70°～210°).随访时3例(4髋)出现假体的松动(均为骨水泥假体),其中1例患者术后10年行股骨柄及髋臼杯假体翻修术,其余患者无假体松动和下沉.2例(2髋)术后发生髋关节脱位, 2例(3 髋)髋关节周围出现轻度异位骨化.结论 强直性脊柱炎累及髋关节患者行全髋人工关节置换术后在髋关节活动度改善方面略差.术中应注意到此类患者因骨盆旋转对安放髋臼杯假体方向所产生的影响,减少术后关节脱位等并发症的发生,中、长期疗效令人满意.     

全髋表面置换术治疗强直性脊柱炎

目的：研究金属对金属全髋表面置换术治疗强直脊柱炎性髋关节病的近期疗效,探讨该病行全髋表面置换术的适应证和技术要点。方法：对2006年2月至2008年4月11例（15髋）行全髋表面置换术的强直性脊柱炎性髋关节病患者进行随访,男9例,女2例;年龄16～53岁,平均32．5岁。对手术前后关节疼痛、活动度、畸形矫正、松动及功能的改善进行对比研究,根据Harris评分系统进行比较,分析强直性脊柱炎患者行全髋表面置换术的可行性和技术难点。结果：失访1例,实际得访10例（14髋）,10例疼痛缓解：随访时间平均16．2个月（8-34个月）。术前Harris评分平均（30．9±3．4）分（2-47分）,术后16个月平均（85．1±3．1）分（46-94分）;术前屈髋度0°-75°,术后16个月35°～105°;术前外展度0°-30°,术后16个月15°～55°。评价：优10髋,良3髋,差1髋。9例术后生活自理,其中6例可奔跑。1例疼痛部分缓解,关节功能恢。复差。无术后股骨颈骨折发生,无异位骨化。结论：经过适当患。者选择,全髋表面置换术治疗强直性脊柱炎性髋关节病可以获得满意的疗效,术中的精细操作和个体化手术设计至关重要。     

Homocysteine-lowering therapy and carotid intima-media thickness in renal transplant recipients

The aim of this study was to document, in hyperhomocysteinemic renal transplant recipients, the effect of vitamin supplementation on carotid intima-media thickness (cIMT). Fifty-six hyperhomocysteinemic stable renal transplant recipients were randomly assigned to either vitamin supplementation (group A) or placebo treatment (group B). All patients underwent high-resolution B mode ultrasound to measure IMT of common carotid arteries before and after 6 months of vitamin supplementation. In group A, cIMT significantly decreased after treatment, whereas no significant changes were observed in group B. In conclusion, our results demonstrate a beneficial effect of the treatment of hyperhomocysteinemia by vitamin supplementation on an early sign of atherosclerosis in a group of renal transplant recipients.