颈动脉内膜中层厚度与亚临床甲状腺功能减退的Meta分析

背景：目前相关研究认为,亚临床甲状腺功能减退与颈动脉内膜中层厚度存在相关性,但此观点仍存在许多争议。 目的：评价分析亚临床甲状腺功能减退患者的颈动脉内膜中层厚度与甲状腺功能正常者的颈动脉内膜中层厚度是否存在差异。 方法：收集已公开发表的有关亚临床甲状腺功能减退患者颈动脉内膜中层厚度与甲状腺功能正常者比较的相关研究,按照Meta分析的要求对检索到的原始文献的研究方法及研究数据进行评价。 结果与结论：符合纳入标准的文献8篇,总样本量3 602例。合并结果提示,亚临床甲状腺功能减退组与甲状腺功能正常的对照组的颈动脉内膜中层厚度的差异有显著性意义[加权平均差WMD=0.056,95%CI(0.020,0.092)]。敏感性分析的合并结果采用7项质量更高的研究,进一步证明了亚临床甲状腺功能减退患者的颈动脉内膜中层厚度高于对照组[加权平均差WMD=0.064,95%CI(0.024,0.105)]。亚组分析中,在促甲状腺激素≥10 mU/L的患者,亚临床甲状腺功能减退与颈动脉内膜中层厚度更有显著性关联[加权平均差WMD=0.082,95%CI(0.049,0.116)]。同时,亚临床甲状腺功能减退也与收缩压增高、三酰甘油、总胆固醇、低密度脂蛋白及空腹血糖水平等存在相关性。结果提示,亚临床甲状腺功能减退与颈动脉内膜中层厚度存在相关性,这可能与促甲状腺激素水平的提高、血脂异常、高血压有关。尽管存在明显的个体差异,去进一步评估此观察的结论,大样本量的前瞻性研究是有必要的。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程全文链接：     

Effects of thyroxine replacement on endothelial function and carotid artery intima-media thickness in female patients with mild subclinical hypothyroidism

BACKGROUND:

Previous studies have suggested an association between subclinical hypothyroidism and coronary artery disease that could be related to changes in serum lipids or endothelial dysfunction.

METHODS:

Thirty-two female subclinical hypothyroidism patients were randomly assigned to 12 months of L-thyroxine replacement or no treatment. Endothelial function was measured by the flow-mediated vasodilatation of the brachial artery, as well as mean carotid artery intima-media thickness, and lipid profiles were studied at baseline and after 12 months of follow-up.

RESULTS:

The mean (±SD) serum thyroid-stimulating hormone levels in the L-thyroxine replacement and control groups were 6.09±1.32 and 6.27±1.39 µUI/ml, respectively. No relationship between carotid artery intima-media thickness or brachial flow-mediated vasodilatation and free T4 and serum thyroid-stimulating hormone was found. The median L-T4 dose was 44.23±18.13 µg/day. After 12 months, there was a significant decrease in the flow-mediated vasodilatation in the subclinical hypothyroidism control group (before: 17.33±7.88 to after: 13.1±4.75%, p = 0.03), but there were no significant differences in flow-mediated vasodilatation in the L-thyroxine treated group (before: 16.81±7.0 to after: 18.52±7.44%, p = 0.39). We did not find any significant change in mean carotid intima-media thickness after 12 months of L-thyroxine treatment.

CONCLUSION:

Replacement therapy prevents a decline in flow-mediated vasodilatation with continuation of the subclinical hypothyroidism state. Large prospective multicenter placebo-controlled trials are necessary to investigate endothelial physiology further in subclinical hypothyroidism patients and to define the role of L-thyroxine therapy in improving endothelial function in these patients.     

Carotid intima-media thickness is increased in patients with mucopolysaccharidoses

Background

The feasibility of carotid artery intima-media thickness (C-IMT), an established cardiovascular disease marker, as a cardiac risk marker in mucopolysaccharidosis (MPS) patients was explored.

Objectives

To determine if C-IMT is abnormal in MPS versus unaffected controls, and if C-IMT correlates with coronary artery diameter in MPS.

Material and methods

Measurements of C-IMT via neck ultrasound and echocardiographic parameters, including coronary artery diameters, were obtained from MPS and control patients, and compared.

Results

Sixteen MPS subjects (6 MPS I, 6 MPS II, 2 MPS III, 1 MPS VI, 1 MPS VII) and sixteen age, ethnicity, and gender-matched controls were enrolled. Median MPS and control subject ages were 8.3 ± 4.5 and 8.6 ± 4.3 years, respectively (p = 0.73). Mean MPS and control C-IMTs were 0.54 ± 0.070 and 0.48 ± 0.034 mm (p = 0.0029). No differences in left main, left anterior descending, or right coronary artery diameters were seen between MPS and controls. A significant proportion of MPS subjects had mitral insufficiency (14/16; p = 0.0002), aortic insufficiency (10/16; p = 0.0021), and left ventricular dilatation (7/16, p = 0.037) versus controls. C-IMT did not correlate significantly with age, height, weight, coronary measurements, or duration of treatment.

Conclusion

C-IMT in MPS patients is increased compared to matched controls, likely reflective of arterial intima-medial glycosaminoglycan accumulation. MPS subjects demonstrated a high percentage of left-sided valvular insufficiency and ventricular dilatation. Additional studies should be performed in MPS patients to determine if C-IMT correlates with arterial elasticity, biomarkers of vascular dysfunction, and higher risk of cardiovascular events.     

Endothelial dysfunction and increased carotid intima-media thickness in the patients with slow coronary flow

Flow mediated brachial dilatation (FMD) and carotid intima-media thickness (IMT) have been a surrogate for early atherosclerosis. Slow coronary flow in a normal coronary angiogram is not a rare condition, but its pathogenesis remains unclear. A total of 85 patients with angina were evaluated of their brachial artery FMD, carotid IMT and conventional coronary angiography. Coronary flow was quantified using the corrected thrombosis in myocardial infarction (TIMI) frame count method. Group I was a control with normal coronary angiography (n = 41, 56.1 ± 8.0 yr) and group II was no significant coronary stenosis with slow flow (n = 44, 56.3 ± 10.0 yr). Diabetes was rare but dyslipidemia and family history were frequent in group II. Heart rate was higher in group II than in group I. White blood cells, especially monocytes and homocysteine were higher in group II. The FMD was significantly lower in group II than in group I. Elevated heart rate, dyslipidemia and low FMD were independently related with slow coronary flow in regression analysis. Therefore, endothelial dysfunction may be an earlier vascular phenomenon than increased carotid IMT in the patients with slow coronary flow.     

Thyroid antoantibodies and the response to thyrotropin releasing hormone in patients with subclinical hypothyroidism.

AIM--To evaluate the clinical usefulness of the thyrotropin releasing hormone (TRH) test and estimation of thyroid autoantibody concentrations in patients with borderline raised thyroid stimulating hormone (TSH). METHODS--The records of 34 consecutive patients with persistent borderline increased TSH (4.4-9.9 mU/l) referred to the Medical Investigation Unit were reviewed. The response of patients with thyroid autoantibodies to the TRH test was compared with that of patients with a negative antibody screen. RESULTS--Eleven (44%) of 25 patients with positive anti-thyroid microsomal and/or thyroglobulin antibody tests and three (33%) of nine patients with a negative antibody screen had hypothyroid responses to TRH. Neither age nor sex affected the response to TRH. Basal TSH alone was poorly correlated with these indices. Twelve (35%) patients who had elevated basal TSH had a normal response to the TRH test. CONCLUSION--Patients with positive or negative thyroid autoantibodies and an exaggerated response to the TRH test should be regarded as hypothyroid and treated with thyroxine. Patients with positive thyroid autoantibodies and normal TSH response may subsequently develop hypothyroidism and should be given long term follow up.     

Carotid intima-media thickness and arterial stiffness in type 1 diabetic patients with and without microangiopathy

Introduction

The aim of the study was to assess carotid intima-media thickness (CIMT) as a subclinical marker of atherosclerosis and arterial stiffness in type 1 diabetic patients in relation to microangiopathy.

Material and methods

We included 87 type 1 diabetic patients (44 women, 43 men), median age 34 years (interquartile range [IQR] 29-43), median disease duration 10 years (IQR: 9-14), mean ± standard deviation (SD) glycated haemoglobin (HbA_1c) 8.4 ±1.4%. Fifty patients had at least one microangiopathic complication. Intima-media thickness (IMT) of the common carotid artery was measured using high resolution ultrasonography. Arterial stiffness was assessed using digital volume pulse analysis and tonometric measurement of wave reflection and central haemodynamics.

Results

Subjects with microangiopathy compared with those without had higher values of CIMT (median [IQR]: 0.53 mm [0.45-0.60 mm] vs 0.47 mm [0.34-0.52 mm], p = 0.002), higher central augmentation index (CAI_x) (mean ± SD: 120.2 ±19.4% vs. 110.5 ±17.1%, p = 0.016) and higher peripheral augmentation index (PAI_x) (65.7 ±18.1% vs. 57.2 ±14.9%, p = 0.023). In the logistic regression analysis, the duration of diabetes, systolic and diastolic blood pressure, postprandial glycaemia, HbA_1c and triglycerides predicted the presence of diabetic microangiopathy independently of age and sex. The CIMT, CAI_x and PAI_x were associated with the presence of diabetic microangiopathy only in the univariate model.

Conclusions

In type 1 diabetic patients with microangiopathic complications, increased carotid IMT and arterial stiffness were observed. The study confirms the role of traditional risk factors for late diabetic complications, such as the duration of the disease and metabolic control in the development of microangiopathy.     

Brief report: carotid intima-media thickness in heavily pretreated HIV-infected patients

The authors used ultrasonography to measure carotid artery intima-media thickness (IMT) in 36 HIV-infected patients taking highly active antiretroviral therapy (cases) and in two control groups without (control group 1) or with (control group 2) blood lipid and glucose disturbances similar to those of the patients. Case IMT values were 8% higher than control group 1 IMT values (p <.05) but not different from control group 2 IMT values. Positive independent associations of IMT with the total-to-HDL cholesterol ratio and waist circumference existed for cases (p <.05) but not for controls. Case IMT did not correlate with parameters of HIV infection and antiretroviral treatment. This case-control study suggests that lipid disturbances, mainly hypoHDLemia, may be involved in the early atherosclerotic process in HIV-infected patients.     

The relationship of carotid intima-media thickness with anthropometric and metabolic parameters in patients with classic congenital adrenal hyperplasia

Background/aimWe aimed to determine the presence of subclinical atherosclerosis using carotid intima-media thickness (CIMT) and biochemical parameters in children and adolescents with congenital adrenal hyperplasia (CAH).Materials and methods Thirty-four patients with classic congenital adrenal hyperplasia due to 21-hydroxylase deficiency on regular glucocorticoid treatment for ≥3 years and 31 healthy subjects were included in the study. The patients were divided into two groups according to the degree of control of the clinic, laboratory, and radiological parameters as a) “uncontrolled” [n= 22; with increased height velocity (HV) standard deviation score (SDS) (≥2 SDS), advanced bone age, serum 17-OH progesterone <2.0 and ≥10.0 ng/mL or androstenedione <0.3 and ≥ 3.0 ng/mL] or b) “controlled” [n= 12; with HV SDS < 2, bone age (BA)/ chronologic age (CA) ratio < 1.2, serum 17-OH progesterone between 2 and 10 ng/mL and androstenedione between 0.3 and 3.0 ng/mL]. Ultrasonographic examination of carotid artery was performed by the same radiologist using a B-mode ultrasound system.Results There was no significant difference between the CAH and control groups in terms of median (IQR) CIMT values [0.47 (0.05) mm and 0.47 (0.07) mm, respectively; p > 0.05]. When subgroup comparisons were done in terms of median (IQR) CIMT values, there was no significant difference among the controlled, uncontrolled, and healthy control groups [0.45 (0.03) mm, 0.47 (0.04) mm, 0.47 (0.07) mm, respectively; p> 0.05]. In addition, CIMT levels were similar according to sex and disease control status.Conclusion In this study, the CIMT values of CAH cases were similar to those of healthy subjects.     

Obstructive sleep apnea and carotid-artery intima-media thickness

STUDY OBJECTIVES: We investigated whether the carotid-artery intimamedia thickness (IMT) measured by ultrasonography, which is regarded as an indicator of atherosclerosis, was associated with the severity of obstructive sleep apnea (OSA). DESIGN: Cross-sectional study. SETTING: A sleep laboratory in a general hospital in Japan. PATIENTS: A total of 167 patients referred to the sleep laboratory of our hospital for screening or treatment of OSA were investigated. They had no history of chronic obstructive pulmonary disease, cerebrovascular disease, or cardiovascular disease. INTERVENTIONS: NA. MEASUREMENTS AND RESULTS: Obstructive sleep apnea was diagnosed by polysomnography. Carotid-artery IMT was measured by ultrasonography, and known risk factors for atherosclerosis (age, obesity, hyperlipidemia, hypertension, diabetes mellitus, and insulin resistance) were also investigated. Multiple regression analysis was performed to assess the association between IMT and the severity of OSA, after adjusting for confounding factors. This analysis revealed that the apnea-hypopnea index, the duration of an oxygen saturation below 90%, and the mean nadir oxygen saturation were significantly associated with the IMT after adjustment for confounding factors that could promote atherosclerosis. Moreover, OSA-related hypoxemia was associated with the IMT independently of the apnea-hypopnea index. CONCLUSIONS: Our results demonstrated that the severity of OSA is independently related to atherosclerosis and that the severity of OSA-related hypoxemia is more important than the frequency of obstructive events.     

Association of self-reported snoring with carotid artery intima-media thickness and plaque

Previous studies have suggested that self‐reported snoring is associated with atherosclerotic vascular diseases. However, the role of self‐reported snoring as an independent risk factor for subclinical atherosclerosis has not been well established. This study aimed to evaluate whether and to what extent self‐reported snoring is associated with subclinical carotid atherosclerosis after adjusting for traditional cardiovascular risk factors. Carotid intima‐media thickness and plaque were investigated with ultrasonography in 1245 urban Chinese aged 50–79 years between September 2007 and November 2007. Information on self‐reported snoring and measurements of traditional cardiovascular risk factors was also collected. A total of 1050 participants were involved in the final analysis. The prevalence of self‐reported snoring habitually (snoring frequency ≥5 days per week) was 31.5, and 64.3% of the participants in this population had a history of snoring. The mean values of the maximum intima‐media thickness of bifurcation and common carotid arteries in snorers were significantly higher than in non‐snorers (1.08 ± 0.14 mm versus 1.04 ± 0.14 mm, P < 0.001, in carotid bifurcation; 1.03 ± 0.15 mm versus 1.00 ± 0.15 mm, P = 0.002, in common carotid artery). After adjustment for traditional cardiovascular risk factors, logistic regression analysis showed that the odds ratio of self‐reported snoring habitually for increased intima‐media thickness and carotid bifurcation plaque was 1.71 [95% confidence interval (CI): 1.22–2.39; P = 0.002] and 3.63 (95% CI: 2.57–5.12; P < 0.001), respectively. In conclusion, the current study suggested that self‐reported snoring is associated significantly with carotid bifurcation intima‐media thickness and the presence of plaque, independent of traditional cardiovascular risk factors.     

优甲乐对妊娠期亚临床甲状腺功能减退症患者甲状腺功能及母婴结局的影响

目的:研讨优甲乐对妊娠期亚临床甲状腺功能减退症(甲减)患者母婴结局的影响.方法:选取2018年1月至2021年3月收入我院的妊娠期亚临床甲减患者76例,按随机数字表法分为两组,每组38例.对照组予以甲状腺素片治疗,观察组施加优甲乐治疗,比较两组的甲状腺激素水平以及母婴结局.结果:观察组患者的治疗总有效率显著优于对照组(...     

Ultrasound measurements of carotid intima-media thickness and plaque in HIV-infected patients on the Mediterranean diet

Aim

To evaluate the influence of food habits, specifically adherence to the Mediterranean diet, on carotid intima-media thickness (CIMT) and the presence of plaques in HIV-infected patients taking antiretroviral therapy (ART) and non-HIV-infected participants and to determine if HIV infection contributes independently to subclinical atherosclerosis.

Methods

We conducted a cross-sectional study of 110 HIV-infected patients on ART and 131 non-HIV-infected participants at the University Hospital for Infectious Diseases in Zagreb, Croatia, from 2009-2011. CIMT measurement and determination of carotid plaque presence was detected by ultrasound. Adherence to the Mediterranean diet was assessed by a 14-point food-item questionnaire. Subclinical atherosclerosis was defined by CIMT≥0.9 mm or ≥1 carotid plaque.

Results

In HIV-infected patients, subclinical atherosclerosis was associated with older age (P < 0.001; Mann-Whitney test), higher body mass index (P = 0.051; Mann-Whitney test), hypertension (P < 0.001; χ² test), and a lower Mediterranean diet score (P = 0.035; Mann-Whitney test), and in non-HIV-infected participants with older age (P < 0.001; Mann-Whitney test) and hypertension (P = 0.006; χ² test). Multivariate analysis showed that decreased adherence to the Mediterranean diet was associated with higher odds of subclinical atherosclerosis (odds ratio [OR] 2.28, 95% confidence interval [CI] 1.10-4.72, P = 0.027) as was current smoking (OR 2.86, 95% CI 1.28-6.40), hypertension (OR 3.04, 95% CI 1.41-6.57), and male sex (OR 2.35, 95% CI 0.97-5.70). There was a significant interaction of age and HIV status, suggesting that older HIV-infected patients had higher odds of subclinical atherosclerosis than controls (OR 3.28, 95% CI 1.24-8.71, P = 0.017 at the age of 60 years).

Conclusion

We confirmed the association between lower adherence to the Mediterranean diet and increased risk of subclinical atherosclerosis and found that treated HIV infection was a risk factor for subclinical atherosclerosis in older individuals.The advent of antiretroviral therapy (ART) for treatment of human immunodeficiency virus (HIV) infection has improved the quality of life and life expectancy of HIV-infected patients (1,2). However, a number of comorbidities have emerged, including atherosclerosis (3,4).The impact of HIV infection and exposure to ART on development of subclinical atherosclerosis is incompletely understood (1,5). Several factors may contribute to an increased risk of coronary and cerebrovascular artery disease in HIV-infected patients: chronic endothelial or myocardial inflammation due to HIV infection per se, dyslipidemia associated with ART, and the interaction of treatment with traditional risk factors for cardiovascular disease (smoking, hypertension, age, etc) (1). Also, several antiretroviral drugs are believed to be partially related to an increase in cholesterol levels (6). The risk and problems associated with ART have led to the study of treatment-sparing strategies, which might provide the benefits of ART while minimizing the risk of adverse advents and other risks (7). The Strategies for Management of Antiretroviral Therapy (SMART) trial was conducted to compare the episodic use of ART according to the CD4+ count with the current practice of continuous ART (7).An early marker of atherosclerosis is an increase in carotid intima-media thickness (CIMT), which enables the risk assessment of coronary and cerebral-artery disease (8). Carotid plaque area is another marker, which is more strongly associated with traditional risk factors and is more predictive of myocardial infarction than of stroke (9,10). There are many studies on the association of HIV infection, HIV disease parameters, and ART use with subclinical carotid artery atherosclerosis, yet there is still controversy over whether chronic HIV infection and ART (mainly protease inhibitors, PI) contributes to subclinical atherosclerosis. Although there are cross-sectional studies reporting an association between HIV infection, ART, and subclinical atherosclerosis (11-16), a number of studies did not find such an association (1,17-19).The Mediterranean diet (20) has been shown to protect against cardiovascular disease and other chronic conditions (21-23). However, only a few studies have investigated the relationship of dietary intake with body fat changes and metabolic abnormalities in HIV-infected patients (24-26). To the best of our knowledge, the association between the adherence to Mediterranean diet and CIMT and the presence of plaques in HIV-infected patients taking ART has never been explored.The aims of the present study are to evaluate the influence of food habits, specifically adherence to the Mediterranean diet, on CIMT and the presence of plaques in HIV-infected patients taking ART and non-HIV-infected participants and to assess if HIV-infection contributes independently to subclinical atherosclerosis.     

有氧运动联合左旋甲状腺素与维生素D3改善亚临床甲减大鼠骨质疏松的作用

文题释义：亚临床甲减：是指轻度甲状腺功能衰竭的表现,其临床表现为促甲状腺激素(TSH)升高而游离的甲状腺激素T3、T4基本正常,是一种内分泌代谢性疾病,是甲状腺功能障碍的早期阶段。亚临床甲减是一种系统性疾病,可以引起机体各器官功能状态变化,包括引起骨密度降低、骨质疏松等。抗酒石酸酸性磷酸酶(tartrate resistant acid phosphatase,TRACP)：为最近发现的骨吸收和破骨细胞活性的良好标志物,测定血清中抗酒石酸酸性磷酸酶尤其是抗酒石酸酸性磷酸酶5 b的浓度,有助于了解生理条件和各种病理条件下的骨代谢状况。抗酒石酸酸性磷酸酶缺乏和过度表达的大鼠模型分别表现为骨硬化和骨质疏松。背景：左旋甲状腺素可以显著改善亚临床甲减的症状,也有研究指出左旋甲状腺素可部分改善实验大鼠的骨代谢异常,但其对于亚临床甲减性骨质疏松的治疗作用却鲜有研究。目的：在亚临床甲减大鼠模型上观察有氧运动联合左旋甲状腺素与维生素D3对骨质疏松症状的改善作用。方法：将Wistar大鼠分为空白对照组、假手术组、模型组进行造模,并检测大鼠甲功指标,此为造模阶段;造模成功后将模型组分为无处理组、运动组、左旋甲状腺素组、维生素D3组、运动+左旋甲状腺素组、运动+维生素D3组、左旋甲状腺素+维生素D3组、运动+左旋甲状腺素+维生素D3组,另设置一组正常对照组,其中正常对照组不作任何处理,其余各组分别接受相应的单一因素或者联合因素处理,共52 d,此为处理阶段。随后,检测大鼠血清中骨吸收标志物(β-Ⅰ型胶原羧基端肽和血清抗酒石酸酸性磷酸酶5b)、骨形成标志物(骨型碱性磷酸酶、Ⅰ型前胶原氨基端前肽和血清骨钙素)等骨代谢指标,并对大鼠头骨、脊柱、上肢和下肢进行骨密度扫描,测量各组大鼠血清中钙和磷及右股骨组织中Cathepsin K的蛋白水平,对各组大鼠股骨头行苏木精-伊红染色。结果与结论：①在造模阶段,相对于空白对照组与假手术组,模型组大鼠血清中促甲状腺素水平显著增加(P < 0.05),而血清FT3、FT4无明显变化,说明亚临床甲减大鼠造模成功。②进行干预后,与其他无甲状腺素处理的各组大鼠相比,4个补充左旋甲状腺素组大鼠的血清促甲状腺素水平明显降低(P < 0.05),而T3、T4无明显变化,但其骨代谢指标和骨密度则显著升高(P < 0.05),且以运动+左旋甲状腺素+维生素D3组改善最为显著(P < 0.05)。左旋甲状腺素+维生素D3组及运动+左旋甲状腺素+维生素D3组大鼠中的血清钙和磷水平显著高于其他无维生素D3处理组(P < 0.05);4个补充左旋甲状腺素组大鼠的股骨组织中Cathepsin K蛋白表达水平低于其他各组(P < 0.05),且其骨小梁组织形态比其他各组大鼠得到明显改善。③提示：亚临床甲减可诱发骨质疏松,而补充左旋甲状腺素是至关重要的一环;补充维生素D3通过增加血清钙和磷的水平起到改善骨质疏松的作用;有氧运动能显著增加左旋甲状腺素及维生素D3对亚临床甲减性骨质疏松的改善作用;亚临床甲减性骨质疏松的治疗中,应重视甲状腺素、维生素D3及有氧运动的综合性治疗手段。ORCID: 0000-0002-9466-9885(武青梅)中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程