超声测量的双肾下极脂肪囊面积与子痫前期关系研究

目的 探讨超声测量的双肾下极脂肪囊面积（US-IPAPF）与子痫前期（PE）的关系及其临床意义.方法 超声测量20例PE孕妇（PE组）和40例正常孕妇（对照组）双肾下极脂肪囊面积,将两组的测值进行比较.采用ROC曲线评价US-IPAPF预测PE的价值.结果 PE组US-IPAPF为（11.65±4.02）cm2,正常对照组为（7.29±2.46）cm2,PE组US-IPAPF值显著高于正常对照组（=4.44,P＜0.05）.ROC曲线下面积为0.86,以7.64 cm2为截断值US-IPAPF预测PE的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为80％、72％、75％、59％、88％.高US-IPAPF组中PE患病率明显高于低US-IPAPF组,差异有统计学意义（x2=12.80,P＜0.01）.结论 US-IPAPF作为一项实用、简便的指标可以对临床早期预测PE提供一定的参考价值.     

运脾化浊颗粒对代谢综合征患者内脏脂肪的影响

目的 观察运脾化浊颗粒对代谢综合征(MS)患者内脏脂肪的影响.方法 将符合临床研究要求的80例患者按照随机数字表分为对照组和观察组,各40例.两组均给予生活方式干预(包括健康教育、控制饮食、加强运动等),对照组给予口服二甲双胍,观察组给予运脾化浊颗粒.观察两组治疗前、后体重(W)、腰围(WC)、体重指数(BMI)、腰臀...     

脂肪因子与代谢综合征的关系探讨

目的探讨以血清瘦素、抵抗素和脂联素为代表的脂肪因子与代谢综合征的关系。方法选择代谢综合征患者50例,正常对照30例,观察一般情况,并测定血清瘦素、抵抗素、脂联素、空腹血糖、空腹血胰岛素和血脂等指标,计算胰岛素敏感指数。结果代谢综合征患者的血清瘦素和抵抗素水平均显著高于正常对照,血清脂联素水平显著低于正常对照。瘦素:代谢综合征14.9±2.1μg/L,正常对照7.5±1.4μg/L,P<0.05;抵抗素:代谢综合征24.1±7.2μg/L,正常对照14.3±5.6μg/L,P<0.05;脂联素:代谢综合征9.7±2.2 m g/L,正常对照12.1±3.6 m g/L,P<0.05。相关分析显示瘦素、抵抗素和脂联素水平与体重指数、胰岛素敏感指数等指标显著相关。结论脂肪因子与代谢综合征密切相关,代谢综合征常伴有高瘦素血症、低脂联素血症及抵抗素水平升高。     

代谢综合征与颈动脉的超声标识与临床意义

目的 测量颈动脉内-中膜厚度及粥样硬化斑块，评价代谢综合征患者颈动脉粥样硬化的诊断价值及临床意义。方法 采用高频超声探头测量代谢综合征患者59人的颈动脉内中膜厚度、粥样斑块发生率，粥样斑块面积积分，正常健康人59人作对照。结果 代谢综合征患者组颈动脉内中膜厚度明显大于对照组（P〈0．01），颈动脉粥样斑块发生率、粥样斑块面积积分均显著高于对照组（P〈0．01），具有显著统计学意义。结论 颈动脉粥样硬化严重程度与代谢综合征发生率呈显著正相关，具有重要临床意义。高频超声技术对代谢综合征患者的动脉粥样硬化病变程度有良好的监测作用，对指导治疗代谢综合征患者动脉粥样硬化有重要的价值。     

囊性肾肿瘤的超声表现

报告7例囊性肾肿瘤的超声表现,并探讨其病理基础改变.6例恶性囊性肾肿瘤中83.3%(5/6)超声表现为多房分隔,囊壁及房壁薄厚不均的囊性肿物,内充满陈旧性出血和/或坏死组织碎屑.     

超声测量肾周及肾旁脂肪厚度在评估非酒精性脂肪肝患者肝脂肪浸润程度中的意义

目的 探讨腹部超声测量肾周及肾旁脂肪厚度（UFT）在定量评估非酒精性脂肪肝（NAFLD）患者肝脂肪浸润程度中的意义。方法 应用彩色多普勒超声测量90例NAFLD患者肾周及肾旁脂肪厚度（UFT）、腰围及体质量指数（BMI）。根据肝脂肪浸润程度将NAFLD患者分为轻度、中度和重度脂肪肝组。结果 轻度、中度和重度NAFLD患者肾周及肾旁UFT比较,差异有统计学意义（P〈0．05）。NAFLD患者。肾周及肾旁UFT和肝脂肪浸润程度比较,呈显著正相关（r=0．89,P〈0．01）。NAFLD患者肾周及肾旁UFT和腰围比较,呈显著正相关（r=0．81,P〈0．01）。NAFLD患者肾周及肾旁UFT和BMI比较,呈显著正相关（r=0．79,P〈0．01）。结论 超声测量肾周及肾旁UFT在预测NAFLD患者脂肪肝的发病和发展中有重要的临床应用价值,可准确地评估NAFLD患者肝脂肪浸润程度。     

肾脏超声对肾综合征出血热患者预后的提示意义

我们对1997～2000年间125例出血热患者少尿　期的肾脏超声表现做了回顾性分析,肾脏超声表现与　临床表现有一定的相关性并且对预后发展有一定的提　示意义。现将分析结果报道如下。     

老年冠心病合并代谢综合征患者可逆性危险因子的研究

目的分析老年代谢综合征患者冠心病的可逆性危险因子，为护理干预提供依据。方法回顾性调查132例年龄60-86岁的老年冠心病患者病历资料，对其中合并代谢综合征的92例做冠心病可逆性危险因子分析。结果有统计学意义的相关因子为：血脂异常、高血压、高血糖、肥胖、遵医不良、高脂饮食、高胆固醇饮食、吸烟、A型性格、运动少，共10项。多因子非条件逐步Logistic回归分析显示血脂异常是冠心痛最危险的因子（RR=7．80），其余依次是高血压、高血糖、肥胖、运动少、遵医不良、高胆固醇饮食、高脂饮食、A型性格、吸烟。结论老年人冠心病可逆性危险因子的存在与患者的健康认知有关，并且有可逆性和可干预性，通过护理干预可以降低各危险因子的危险性。     

代谢综合征患者超声心动图分析

目的:观察代谢综合征患者心脏结构及心功能改变.方法:332例代谢综合征惠者依据体质量指数分为非肥胖组37例,肥胖组295例;肥胖组再依据合并症情况分为4组,A组108例为同时惠高血压、高血脂、糖尿病者,B组106例为同时患高血压、高血脂者,C组47例为同时患高血脂、糖尿病者;D组34例为同时患糖尿痛、高血压者.患者均行超声心动图检查,比较各组心脏结构改变情况、左室功能.结果:各组心脏结构改变、左室舒张功能受损比较差异无统计学意义(P>0.05);A,B,C,D组左室收缩功能受损与非肥胖组比较差异均有统计学意义(P<0.05).结论:治疗高血压、糖尿痛、高血脂同时应重视肥胖干预.     

超声测量内脏脂肪厚度和胰岛素抵抗相关性研究

目的应用超声测量内脏脂肪厚度（VFT）,并评价其临床意义。方法收集了2005年3月至2005年12月在我院体检中心符合入选标准的可用资料210份,均进行人体指标测量、空腹血生化检查和经超声测量内脏脂肪厚度、腹壁脂肪厚度（SFT）。采用稳态模式胰岛素抵抗指数（HOMA-IR）评价胰岛素抵抗。用SPSS13.0软件进行统计分析。结果简单相关分析显示内脏脂肪厚度和腰围、血压、血尿酸、空腹血糖、甘油三酯、空腹胰岛素（FINS）和胰岛素抵抗指数（HOMA-IR）呈正相关,和胰岛素敏感指数（Si）呈负相关,P〈0.05。经年龄、性别、腰围和体质量指数（BMI）调整后的偏相关分析显示,内脏脂肪厚度和收缩压、甘油三酯、FINS、HOMA-IR呈正相关,相关系数分别为0.184、0.213、0.179、0.196,P〈0.05;和Si呈负相关,相关系数-0.196,P〈0.05。逐步法多元线性回归分析显示,内脏脂肪厚度和甘油三酯、收缩压、血尿酸、HOMA-IR呈正相关,相关系数分别为0.224、0.239、0.272、0.231,P〈0.01。结论由超声测量的内脏脂肪厚度是一种简单、实用的评价内脏型肥胖的方法,和胰岛素抵抗相关,可能是一个新的心血管危险标志。     

Cardiovascular Risk Factors and the Prediabetic Syndrome

Cardiovascular disease is increased 2- to 4-fold in non-insulin-dependent diabetes mellitus (NIDDM); yet in most studies, there is a relatively weak relationship between the frequency of coronary heart disease (CHD) and the duration of diabetes and severity of hyperglycaemia. A number of authors have suggested that the prediabetic stage may contribute to the risk of CHD in NIDDM. Hyperinsulinaemia and insulin resistance have been strongly associated with the development of NIDDM. Data are less conclusive about the relationship of hyperinsulinaemia to the development of CHD in nondiabetic subjects. Relatively little data are available on hyperinsulinaemia and/or insulin resistance to CHD in NIDDM subjects. Tight control of glycaemia with exogenous insulin improves cardiovascular risk factors in NIDDM subjects and therefore is unlikely to increase the risk of CHD. Although the relation of insulin to CHD in the general population is somewhat controversial, insulin is clearly related to multiple cardiovascular risk factors (especially elevated triglyceride, decreased high-density lipoprotein, small dense low-density lipoprotein, impaired glucose tolerance and increased plasminogen activator inhibitor 1 (PAI-1)). However, the relation of insulin resistance to hypertension remains controversial.     

Comparison of the Effect of the Metabolic Syndrome and Multiple Traditional Cardiovascular Risk Factors on Vascular Function

ObjectiveTo assess the effect of the metabolic syndrome (MetS) on endothelial function and compare these findings to those in individuals with a similar burden of traditional cardiovascular (CV) risk factors (≥3) without MetS.Patients and MethodsBoth MetS and multiple CV risk factors were identified from 1103 individuals who underwent the evaluation of endothelial function at the Mayo Clinic, in Rochester, Minnesota, from July 1, 2000, through July 31, 2011. Endothelial function was measured using digital arterial tonometry by assessing reactive hyperemia–induced vasodilation in one arm and adjusting for changes in the contralateral arm (reactive hyperemia index [RHI]).ResultsA total of 316 individuals with MetS and 210 with multiple risk factors were assessed. Endothelial dysfunction was more pronounced in the MetS group compared with the multiple risk factor group (mean ± SD natural logarithmic RHI, 0.61±0.25 and 0.68±0.28, respectively; P=.006). Leukocyte count (7.00±1.89 × 10⁹/L vs 6.41±1.76 × 10⁹/L, respectively; P=.001) and high-sensitivity C-reactive protein level (1.78±1.53 mg/L vs 1.48±1.42 mg/L, respectively; P=.01) were higher in the MetS group compared with the multiple risk factor group. After adjustment for covariates and 6 traditional CV risk factors in a multivariate regression model, MetS had a significant and independent influence on natural logarithmic RHI (β=?.11; P=.01).ConclusionThe current study found that individuals with MetS have a higher degree of endothelial dysfunction and inflammation compared with individuals with multiple CV risk factors and may therefore have an increased CV risk beyond the contributions of multiple traditional risk factors.     

Prothrombotic State, Cardiovascular, and Metabolic Syndrome Risk Factors in Prepubertal Children Born Large for Gestational Age

OBJECTIVE

To evaluate metabolic syndrome and cardiovascular disease risk factors in prepubertal children born large for gestational age (LGA) to nondiabetic, nonobese mothers.

RESEARCH DESIGN AND METHODS

At 6–7 years of age, the comparison of various factors was made between 31 LGA and 34 appropriate-for-gestational-age (AGA) children: fibrinogen, antithrombin III, protein C and S, fasting insulin, glucose, homeostasis assessment model of insulin resistance (HOMA-IR) index, adiponectin, leptin, visfatin, IGF-1, IGF-binding protein (IGFBP)-1, IGFBP-3, lipids, and the genetic factors V Leiden G1691A mutation, prothrombin 20210A/G polymorphism, and mutation in the enzyme 5,10-methylenetetrahydrofolate-reductase gene (MTHFR-C677T).

RESULTS

LGA children had higher levels of leptin (P < 0.01), fasting insulin (P < 0.01), and HOMA-IR (P < 0.01), but lower IGFBP-3 (P = 0.0001), fibrinogen (P = 0.0001), and lipoprotein(a) (P < 0.001) than AGA children. Significantly more LGA children were homozygous for the MTHFR-C677T mutation (P = 0.0016).

CONCLUSIONS

Being born LGA to nondiabetic, nonobese mothers is associated with diverse effects on cardiometabolic risk factors at prepuberty.Large-for-gestational-age (LGA) infants may be at risk for the development of obesity and insulin resistance (1–4). A relationship between excess birth weight and metabolic syndrome (MetS) and cardiovascular disease (CVD) risk factors (1–4) has not yet been clearly demonstrated.The aim of this study was to evaluate markers of the prothrombotic state and other MetS and CVD risk factors in prepubertal children born LGA to nondiabetic, nonobese mothers.     

高频彩超在研究慢性肾衰竭患者颈动脉斑块及相关危险因素的应用价值

目的 研究慢性肾功能衰竭(chronic renal failure,CRF)患者颈动脉斑块情况与相关危险因素的关系.方法 对43例CRF患者采用高分辨率高频彩超观察双侧颈动脉内-中膜厚度(IMT)及斑块情况,同时抽血检测血钙、磷,胆固醇、甘油三酯、二氧化碳结合力、血肌酐,并计算钙磷乘积.结果 43例CRF患者,24例(55.8％)存在颈动脉斑块.斑块组IMT值、血磷及钙磷乘积较无斑块组显著增高(分别P＜0.01、P＜0.05、P＜0.05).结论 CRF患者颈动脉斑块的超声特征表现为高回声的钙化斑块,且多位于动脉中膜,CRF患者颈动脉钙化斑块的形成与钙磷代谢紊乱密切相关,因此可将颈动脉有无斑块作为一个筛选因素来预测CRF患者的心血管疾病病变程度.     

阻塞性睡眠呼吸暂停低通气综合征对心血管危险因素的影响

目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)在心血管疾病发病中的作用。方法将2007年1月~2008年12月在呼吸睡眠监测中心就诊的成年患者,进行多导睡眠图(PSG)检测,根据睡眠呼吸暂停低通气指数(AHI)将所有对象分为轻度组(AHI为5~20次/h)、中度组(AHI为21~40次/h)、重度组(AHI大于40次/h)和健康对照组(AHI小于5次/h);全自动生化仪检测血清胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、载脂蛋白A-I、载脂蛋白B、脂蛋白a;ELISA法检测患者外周血清C反应蛋白。结果所有入选对象M型超声心动图检测结果均在正常范围内。血脂检测显示:①HDL-C、载脂蛋白A-I在OSAHS组和对照组间比较无统计学意义;②脂蛋白a、载脂蛋白B水平在OSASH各组间比较无统计学意义,但均高于对照组(P均小于0.05);③与对照组相比,OSAHS患者的甘油三酯和LDL-C水平明显升高(P<0.05),重度组明显高于轻中度组(P<0.05),轻中度组间差异无统计学意义(P>0.05);④与健康对照组相比,OSAHS患者的外周血总胆固醇水平显著升高,并随着OSAHS病情加重呈升高趋势,差异均有统计学意义(P<0.05)。OSAHS患者外周血清C反应蛋白水平明显高于健康对照组,并且随着病情加重逐渐上升,差异均有统计学意义(P<0.05)。结论OSAHS可引起患者血清C反应蛋白和血脂升高,导致OSAHS患者心血管疾病的发病率和死亡率上升,这将为临床上心血管疾病的早期诊断和OSAHS的治疗提供新思路。     

胆囊切除与代谢综合征及其危险因素的相关性分析

【目的】分析胆囊切除与代谢综合征（MS ）的关系,为更好的认识MS并减轻其危害提供依据。【方法】回顾性分析2012年于本院参加健康体检的4537例体检资料,分析胆囊切除与M S及其各组分患病率的关系。【结果】调查人群胆囊结石、胆囊切除、MS的患病率（胆囊切除率）分别为5．9％、3．4％和32．7％;胆囊切除人群的M S患病率（63．5％）显著高于胆囊结石人群（45．5％）和无胆囊疾病人群（30．7％）;进一步多因素Logistic回归分析发现,胆囊切除与MS的患病风险有关（OR ：2．181,95％ CI：1．295-3．674）。【结论】胆囊切除人群MS患病率显著升高,且胆囊切除与MS患病危险因素有关。     

Role of Intravascular Ultrasound in the Detection of Cardiovascular Disease in Diabetes and Metabolic Syndrome in Latin America

Purpose of Review

Intravascular ultrasound (IVUS) is an essential tool in the cardiac cath lab, providing tomographic slices series of intra-luminal and vascular wall images with high quality and spatial resolution, that complement angiographic luminal information. It has been successfully used in research for the understanding of atherosclerotic process, and it was the first clinical method that delineated diverse patterns of atherosclerosis. IVUS also contributed to the advancement in the knowledge of restenosis after percutaneous coronary interventions (PCI).

Recent Findings

Routine clinical of IVUS is hindered in most Latin American countries due to lack of reimbursement. In comparison with the rate of IVUS utilization around 5 % in the USA and of 5 % in Europe, the rate is less than 1 % in Latin America. These low rates occur despite the fact that the European, American, and Brazilian guidelines agreed regarding IVUS utilization in specific clinical settings: assessment of non-left main intermediate lesions as evaluated by angiography, assessment of angiographically uncertain severity of left main coronary artery disease, and as a guidance to optimization of coronary stent implantation.

Summary

In this review, we emphasize the importance of IVUS as a research tool in selected patients with coronary heart disease, especially those treated with PCI, particularly in diabetic patients, and also discuss some data that support its routine clinical use.

     

Paternal Metabolic and Cardiovascular Risk Factors for Fetal Growth Restriction: A case-control study

OBJECTIVE

Fathers of low–birth weight offspring are more likely to have type 2 diabetes and cardiovascular disease in later life. We investigated whether paternal insulin resistance and cardiovascular risk factors were evident at the time that fetal growth–restricted offspring were born.

RESEARCH DESIGN AND METHODS

We carried out a case-control study of men who fathered pregnancies affected by fetal growth restriction, in the absence of recognized fetal disease (n = 42), compared with men who fathered normal–birth weight offspring (n = 77). All mothers were healthy, nonsmoking, and similar in age, BMI, ethnicity, and parity. Within 4 weeks of offspring birth, all fathers had measures of insulin resistance (HOMA index), blood pressure, waist circumference, endothelial function (flow-mediated dilatation), lipid profile, weight, and smoking habit. Comparison was made using multivariable logistical regression analysis.

RESULTS

Fathers of fetal growth–restricted offspring [mean (SD) 1.8th (2.2) customized birth centile] were more likely to have insulin resistance, hypertension, central adiposity, and endothelial dysfunction and to smoke cigarettes compared with fathers of normal grown offspring. After multivariable analysis, paternal insulin resistance and smoking remained different between the groups. Compared with fathers of normal grown offspring, men who fathered pregnancies affected by fetal growth restriction had an OR 7.68 (95% CI 2.63–22.40; P < 0.0001) of having a 1-unit higher log HOMA-IR value and 3.39 (1.26–9.16; P = 0.016) of being a smoker.

CONCLUSIONS

Men who recently fathered growth-restricted offspring have preclinical evidence of the insulin resistance syndrome and are more likely to smoke than fathers of normal grown offspring. Paternal lifestyle may influence heritable factors important for fetal growth.Fetal growth is influenced by maternal in utero environment and genetic factors inherited from both parents. The combined influence of environment and genes can be seen through the dual effects of insulin on glucose metabolism and fetal growth. Whereas maternal diabetes and hyperglycemia lead to excess fetal insulin secretion and increased fetal growth (1), a fetus that inherits risk alleles for type 2 diabetes may have reduced insulin secretion or insulin resistance that lead to fetal growth restriction: the fetal insulin hypothesis (2,3).The role of maternally inherited risk alleles for type 2 diabetes on fetal growth is difficult to assess owing to the confounding effect of maternal hyperglycemia on in utero environment (4). Support for the fetal insulin hypothesis has come from epidemiological studies that showed men who develop diabetes in later life were more likely to have fathered low–birth weight offspring (5–8). These fathers are also at increased risk of cardiovascular disease (9). Whether this latter observation is secondary to paternal diabetes or other risks shared by parents of low–birth weight offspring, such as smoking, is uncertain.A study of nondiabetic families that specifically tested the fetal insulin hypothesis was unable to correlate paternal insulin resistance with offspring birth weight (10). Another study showed that men who fathered small-for-gestational-age infants were more likely to be obese and have larger waist circumferences but did not measure insulin resistance (11). We carried out a case-control study to investigate whether elements of the insulin resistance syndrome, including hyperinsulinemia, hyperglycemia, endothelial dysfunction, dyslipidemia, hypertension, and upper–body fat redistribution, could be observed in men at the time that they fathered growth-restricted offspring.