Relationship Between Serum Gamma‐Glutamyltransferase Levels and Prehypertension in Chinese Adults: The Cardiometabolic Risk in Chinese Study

The authors aimed to investigate the relationship between serum gamma‐glutamyltransferase (GGT) and prehypertension, as well as the modification of other metabolic risk factors in a large cohort of Chinese individuals. The data were collected via a community‐based health examination survey in central China. Blood pressure, body mass index (BMI), and levels of GGT, fasting blood glucose, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lipid indicators were measured. In total, data from 18,302 patients with available biomarkers were included in the present study. Elevated blood pressure was associated with increased GGT concentration (P<.001). After adjusting for age, sex, BMI, fasting blood glucose, lipid indicators, AST, and family history of hypertension, the association between GGT levels and prehypertension remained significant (P=.021). The adjusted odds ratios (95% confidence interval) for prehypertension across quintiles of GGT level were 1.00, 1.057 (1.012–1.334), 1.068 (0.916–1.254), 1.024 (0.851–1.368), and 1.272 (1.027–1.593), respectively. In stratified analyses, the association between GGT levels and prehypertension was significant in women but was not significant in men. Moreover, additive effect of BMI and age on the effect of GGT levels on prehypertension (both P for interaction <.001) was observed. In summary, GGT levels were positively associated with prehypertension in women, independent of other metabolic factors. Furthermore, BMI and age may amplify the effects of GGT levels on prehypertension. These findings suggest that monitoring the levels of GGT could help in the diagnosis and monitoring of prehypertension.     

脉搏波速度与冠状动脉粥样硬化的关系

目的 为探讨脉搏波速度与冠状动脉粥样硬化程度的关系.方法 本文选择行冠状动脉造影或介入治疗的患者104例,进行脉搏速度测量、血液生化检查、病史采集及冠状动脉造影.结果 年龄、脉搏速度、脉压是显著性影响冠脉病变的危险因素(P＜0.05);年龄、脉搏速度、高血压病史、收缩压、脉压、吸烟、胆固醇在冠状动脉病变程度组间差异有显著性(P＜0.05);年龄、脉搏速度、脉压、总胆固醇、吸烟在多支病变组与正常组之间差异有显著性(P＜0.05).按照冠状动脉病变最大狭窄程度分组,冠状动脉病变程度间脉搏速度有显著性差异(P＜0.05);狭窄1级、2级、3级、4级与0级,狭窄1级与2级脉搏速度比较差异有显著性(P＜0.05).按脉搏速度值≤14 m/s和＞14 m/s分组,两组患者冠状动脉病变严重程度差异有显著性(P＜0.05);脉搏速度＞14 m/s组的患者既往多数有高血压病史,3支血管病变在脉搏速度＞14 m/s组中显著增高;冠状动脉无病变者在脉搏速度≤14 m/s组中显著性增多.冠心病合并高血压组与未合并高血压组患者的脉搏速度间差异有显著性意义(P＜0.05).在年龄与体重指数无明显差异的条件下,冠心病组、冠心病合并糖尿病组、冠心病合并高血压组、冠心病合并高血压及糖尿病组脉搏速度值逐渐升高(P＜0.05);冠心病组患者随着病变支数的增多,脉搏速度值显著性升高(P＜0.05).结论 提示脉搏速度与冠状动脉病变严重程度呈显著相关性,脉搏速度可综合反映高血压、高血糖等危险因素对血管的损伤,更能精确地对患者进行心血管危险分层,它可作为对冠心病患者危险分层的评估和冠状动脉严重程度识别的独立因素.     

Relationship Between Coronary Artery Calcium and Atherosclerosis Progression Among Patients With Suspected Coronary Artery Disease

BackgroundAmong symptomatic patients, it remains unclear whether a coronary artery calcium (CAC) score alone is sufficient or misses a sizeable burden and progressive risk associated with obstructive and nonobstructive atherosclerotic plaque.ObjectivesAmong patients with low to high CAC scores, our aims were to quantify co-occurring obstructive and nonobstructive noncalcified plaque and serial progression of atherosclerotic plaque volume.MethodsA total of 698 symptomatic patients with suspected coronary artery disease (CAD) underwent serial coronary computed tomographic angiography (CTA) performed 3.5 to 4.0 years apart. Atherosclerotic plaque was quantified, including by compositional subgroups. Obstructive CAD was defined as ≥50% stenosis. Multivariate linear regression models were used to measure atherosclerotic plaque progression by CAC scores. Cox proportional hazard models estimated CAD event risk (median of 10.7 years of follow-up).ResultsAcross baseline CAC scores from 0 to ≥400, total plaque volume ranged from 30.4 to 522.4 mm³ (P < 0.001) and the prevalence of obstructive CAD increased from 1.4% to 49.1% (P < 0.001). Of those with a 0 CAC score, 97.9% of total plaque was noncalcified. Among patients with baseline CAC <100, nonobstructive CAD was prevalent (40% and 89% in CAC scores of 0 and 1-99), with plaque largely being noncalcified. On the follow-up coronary CTA, volumetric plaque growth (P < 0.001) and the development of new or worsening stenosis (P < 0.001) occurred more among patients with baseline CAC ≥100. Progression varied compositionally by baseline CAC scores. Patients with no CAC had disproportionate growth in noncalcified plaque, and for every 1 mm³ increase in calcified plaque, there was a 5.5 mm³ increase in noncalcified plaque volume. By comparison, patients with CAC scores of ≥400 exhibited disproportionate growth in calcified plaque with a volumetric increase 15.7-fold that of noncalcified plaque. There was a graded increase in CAD event risk by the CAC with rates from 3.3% for no CAC to 21.9% for CAC ≥400 (P < 0.001).ConclusionsCAC imperfectly characterizes atherosclerotic disease burden, but its subgroups exhibit pathogenic patterns of early to advanced disease progression and stratify long-term prognostic risk.     

基质金属蛋白酶与冠状动脉斑块稳定性相关研究

目的 :探讨基质金属蛋白酶 1(MMP 1)、基质金属蛋白酶抑制剂 1(TIMP 1)、TIMP 1/MMP 1与冠状动脉 (冠脉 )粥样硬化斑块稳定性的相关性。方法 :以冠脉血管内超声检出冠脉粥样硬化斑块的软硬特性 ,将急性冠脉综合征患者分为不稳定斑块组 (n =2 2 )和稳定斑块组 (n =12 )。测定两组间血浆MMP 1、TIMP 1浓度 ,并与冠脉血管内超声测定的斑块大小、斑块纤维帽厚度、脂核或无回声带大小、脂核或无回声带与斑块比及面积狭窄率进行相关性分析。结果 :在冠状静脉窦血和外周血中 ,不稳定斑块组MMP 1浓度明显大于稳定斑块组 (P <0 0 1) ,TIMP 1/MMP 1明显小于稳定斑块组 (P <0 0 0 1) ,有非常显著性差异。血浆MMP 1浓度与纤维帽厚度呈负相关 ,与脂核或无回声带面积、脂核与斑块比和面积狭窄率呈正相关 ,与斑块大小无关。TIMP 1/MMP 1与纤维帽厚度、面积狭窄率呈正相关 ,与脂核或无回声带面积、脂核与斑块比呈负相关。结论 :MMP 1和TIMP 1/MMP 1与冠脉斑块不稳定性呈密切相关 ,可望作为冠脉斑块不稳定性的参考指标。     

应用血管内超声显像技术评价冠状动脉病变与颈动脉病变相关性

目的 通过研究血管内超声、冠状动脉造影检查结果与体表颈动脉超声检测的颈动脉病变的相关性,分析颈动脉粥样硬化与冠心病的关系,进一步探讨颈动脉粥样硬化对冠心病发病的预测价值.方法 38例拟诊为冠心病的患者行冠状动脉造影、血管内超声和体表颈动脉超声检查,其中8例患者经冠状动脉造影和血管内超声检查未发现冠状动脉有明显狭窄病变为对照组;30例经冠状动脉造影和血管内超声检查发现冠状动脉有明显狭窄病变为冠心病组,其中不稳定型心绞痛18例,稳定型心绞痛12例.将血管内超声及冠状动脉造影检查结果与颈动脉超声指标进行分析比较.结果 30例冠心痛患者冠状动脉造影平均直径狭窄率71.21%±9.81%,血管内超声示有不同类型的动脉粥样硬化斑块,平均面积狭窄率80.88%±7.77%;8例对照组无动脉粥样硬化斑块.冠状动脉造影平均直径狭窄率与血管内超声平均面积狭窄率之间差异有显著性(P<0.01);冠状动脉造影平均直径狭窄率与血管内超声平均面积狭窄率之间有显著相关性(r=0.663,P<0.01).根据冠状动脉造影平均直径狭窄率计算的Gensini积分分别与颈动脉粥样硬化的等级积分、Crouse积分和斑块数三项指标间均有相关性(P<0.01).颈动脉斑块对冠心痛的阳性预测值为70%(21/30),阴性预测值为75%(6/8).结论 应用血管内超声显像技术能准确诊断冠状动脉斑块的性质并测量冠状动脉狭窄率;与冠状动脉造影相比,血管内超声对评价冠状动脉病变更准确.颈动脉粥样硬化严重程度与冠状动脉血管内超声检查结果有很好的相关性;颈动脉超声检测对冠心病的诊断有一定的预测价值.     

平均血小板体积与冠状动脉SYNTAX评分相关性分析

目的探讨平均血小板体积与冠状动脉粥样硬化严重程度的关系。方法纳入1 924例行冠状动脉造影术的汉族患者,应用全自动血液分析仪检测平均血小板体积,采用Syntax评分评估冠状动脉病变严重程度,分析平均血小板体积与冠状动脉粥样硬化严重程度的关系。结果平均血小板体积在不同组间分布有统计学意义(P0.01);Spearman相关性分析发现,SYNTAX评分与MPV之间存在正相关性(r=0.687,P0.001);多元线性回归分析结果显示,MPV是CHD的独立危险因素。结论平均血小板体积与冠状动脉病变严重程度可能呈正相关,对冠状动脉病变严重程度可能具有预测意义。     

冠心病患者微量白蛋白尿与可溶性糖基化终产物受体的关系研究

目的:研究冠心病患者微量白蛋白尿(MAU)与可溶性糖基化终产物受体(sRAGE)的关系。方法:纳入符合标准的149例患者,根据冠状动脉造影结果分为冠心病组(n=99)和非冠心病组(n=50);并将99例冠心病患者按照有无MAU分为冠心病MAU亚组(n=26)和冠心病非MAU亚组(n=73);比较各组间sRAGE的水平,并使用logstic回归进行分析,观察冠心病患者MAU与sRAGE的关系。结果:sRAGE各组间比较:冠心病组(732.6±133.2)明显低于非冠心病组(1055.5±279.5),冠心病MAU亚组(655.3±121.4)明显低于冠心病非MAU亚组(760.1±127.0),差异均有统计学意义(P均<0.001)。logistic回归分析显示:MAU与sRAGE明显负相关(P=0.018,95%可信区间0.992～0.999)。结论:冠心病患者MAU水平与sRAGE明显负相关,sRAGE可能是预测冠心病患者风险的新型生物标志物。     

稳定型心绞痛患者与急性冠状动脉综合征患者动脉粥样硬化斑块血管内超声对比

目的 应用血管内超声,对比稳定型心绞痛和急性冠状动脉综合征患者动脉粥样硬化斑块的特点.方法 对明确诊断为稳定型心绞痛患者(51例,冠状动脉造影显示病变位于63条血管)以及急性冠状动脉综合征患者(32例,冠状动脉造影显示病变位于46条血管)的动脉粥样硬化斑块形态学特点进行比较.结果 两组患者血管内超声发现,软斑块比例、血管重构指数、最小面积处血管外弹力膜面积、最小面积处斑块负荷和斑块破裂急性冠状动脉综合征组高于稳定型心绞痛组(P<0.05);但血栓检出率两组患者差异没有显著性(P>0.05).结论 目前临床工作中,人们只能半定性诊断易损斑块.如检出软斑块且位于重要血管的近端,不论病变的狭窄程度或检查发现任何斑块加正性血管重构和最小管腔面积≤4 mm+,为急性冠状动脉综合征患者易损斑块.需要尽早介入干预.     

血浆脂蛋白(a)浓度与青年人群冠心病关系的横断面研究

目的:探讨血浆脂蛋白(a)[Lp(a)]浓度与青年人群冠心病的相关性。方法:选取2018年3月至2019年2月期间在中国医学科学院阜外医院行冠状动脉造影术的1 093例青年患者作为研究对象(<45岁),按照冠状动脉造影结果分为冠心病组(n=906)和非冠心病组(n=187)。采用Gensini评分法评估冠心病组患者的冠状动脉病变严重程度,并将其分为三个亚组:高Gensini评分亚组(n=302)、中Gensini评分亚组(n=302)、低Gensini评分亚组(n=302)。收集所有研究对象的病史及相关临床与实验室检测指标,血浆Lp(a)检测采用免疫比浊法;分析基线血浆Lp(a)浓度与冠心病诊断及严重程度之间的关系。结果:冠心病组患者血浆Lp(a)浓度显著高于非冠心病组[13.46(6.58~28.91)mg/dl vs 8.39(5.06~19.31)mg/dl,P<0.001]。进一步分析显示,冠心病组男性、女性、高血压、无高血压、无糖尿病患者的血浆Lp(a)浓度均显著高于非冠心病组(P均<0.05)。多因素Logistic回归分析表明,logLp(a)水平升高为青年冠心病的独立危险因素(OR=2.898,95%CI:1.949~4.311,P<0.001)。在冠心病组患者中,高Gensini评分亚组的Lp(a)浓度明显高于中Gensini评分亚组及低Gensini评分亚组[18.07(9.22~40.29)mg/dl vs13.89(6.57~32.77)mg/dl、9.63(4.83~18.96)mg/dl,P均<0.001]。多元线性回归分析表明,较高logLp(a)水平与高Gensini评分显著相关(B=0.353,P<0.001)。结论:横断面观察提示,血浆Lp(a)浓度与青年人群冠心病的发生及病变严重程度相关,其结果有待更大样本前瞻性研究证实。     

The Effect of Drinking Intensity and Frequency on Serum Carbohydrate-Deficient Transferrin and γ- Glutamyl Transferase Levels in Outpatient Alcoholics

Whereas heavy alcohol consumption is known to elevate serum carbohydrate-deficient transferrin (CDT) and γ-glutamyl transferase (GGT) levels, the contribution of drinking pattern to these effects is not completely understood. We present data on 423 men and 146 women evaluated 1 year after treatment in a large-scale alcoholism treatment study (Project MATCH). Relationships between drinking frequency (number of days drinking), intensity (drinks per drinking day), and blood levels of CDT and GGT were analyzed by using response surface regression models and thin-plate spline-smoothing techniques. Both models indicated differences between CDT- and GGT-drinking pattern relationships in men and, also, a difference between men and women in CDT drinking-pattern relationships. For men, CDT levels appeared to respond primarily to frequency of drinking, whereas GGT was influenced primarily by drinking intensity. For women, both CDT and GGT were influenced more by drinks per drinking day (intensity) than by number of days drinking (frequency). The data confirm both the independent nature of these biological markers of alcohol consumption and gender differences in alcohol-induced CDT response reported previously.     

血浆内脏脂肪素水平与冠状动脉粥样硬化程度的相关性

目的 研究血浆内脏脂肪素水平是否与冠状动脉粥样硬化严重程度存在相关性.方法 62名患者接受冠状动脉造影检查,按造影结果 分为对照组13例和冠状动脉硬化组49例,并采用Gensini积分系统评估冠状动脉粥样硬化严重程度,将冠状动脉粥样硬化组患者分为轻度和重度冠状动脉粥样硬化组二个亚组.ELISA法检测各组血浆内脏脂肪素水平,比色法检测血脂水平.结果 与对照组比较,冠状动脉粥样硬化组血浆内脏脂肪素水平显著升高;重度冠状动脉粥样硬化组血浆内脏脂肪素水平显著高于轻度冠状动脉粥样硬化组;血浆内脏脂肪素水平与冠状动脉Gensini积分呈正相关(r=0.359;P<0.01).结论 血浆内脏脂肪素水平与冠状动脉粥样硬化严重程度相关,提示内脏脂肪素可能参与了冠状动脉粥样硬化的发生发展.     

The Relationship Between High‐Sensitivity C‐Reactive Protein Levels and Left Ventricular Hypertrophy in Patients With Newly Diagnosed Hypertension

The authors aimed to evaluate the relationship between high‐sensitivity C‐reactive protein (hs‐CRP) and presence of left ventricular hypertrophy and diastolic dysfunction in patients with hypertension. A total of 95 newly diagnosed hypertensive patients (mean age, 54±10 years) and 20 controls were included in this study. Patients were divided into four groups according to relative wall thickness as normal, concentric remodeling, concentric, and eccentric hypertrophy. hs‐CRP was measured in all patients and serum hs‐CRP level was shown to be increased in patients with hypertension compared with controls (0.57 mg/dL vs 0.25 mg/dL, respectively; P<.001). The hs‐CRP level was highest in patients with concentric hypertrophy. When compared with controls, serum hs‐CRP level was significantly higher in patients with concentric remodeling (0.61±0.3 mg/dL vs 0.43±0.5 mg/dL, P<.030) and concentric hypertrophy (0.69±0.3 mg/dL vs 0.43±0.5 mg/dL, P<.032). The present study shows that serum hs‐CRP is significantly associated with left ventricular diastolic function and concentric hypertrophy in patients with hypertension.     

The Association Between Endocan Levels and Subclinical Atherosclerosis in Patients With Type 2 Diabetes Mellitus

Background

Proinflammatory conditions induced by circulating factors in diabetes play a pivotal role in endothelial dysfunction and related vascular complications. Endothelial cell-specific molecule-1 or endocan is a dermatan sulfate proteoglycan secreted primarily by the vascular endothelium. Although endocan has been shown to be a potential biomarker in coronary heart disease, its role in the pathogenesis of atherosclerosis (AS) in diabetes remains unclear. In this study, we investigated the correlation between serum endocan levels and subclinical AS in patients with type 2 diabetes mellitus (T2DM).

老年人血清胆红素水平与冠状动脉病变程度的关系

目的观察老年人血清胆红素与冠状动脉病变的关系。方法经冠状动脉造影确诊的冠心病患者80例,其中冠状动脉轻度狭窄组15例,中度狭窄组32例,重度狭窄组33例;另外选取冠状动脉造影正常者40例做对照。采用重氮苯磺酸法测定血清胆红素水平,并对胆红素与各因素进行直线相关分析。结果冠心病组血清胆红素水平明显低于正常对照组,血清胆红素水平与冠状动脉病变程度成显著负相关关系(r=-0.26,P<0.05)。结论冠心病患者血清胆红素水平较正常人明显降低。低血清胆红素可能是冠心病的一种危险因素。血清胆红素水平与冠状动脉狭窄程度有明显相关性。     

男性性激素水平与糖尿病合并冠心病的关系

目的探讨2型糖尿病男性患者性激素水平与冠心病发病之间的关系。方法2型糖尿病男性患者102例,分为冠心病合并组(n=58)和无冠心病合并组(n=44),测定两组血清睾酮、性激素结合球蛋白、血压、血脂及血糖,计算体质指数。结果冠心病合并组血清睾酮和性激素结合球蛋白水平与无冠心病合并组相比明显降低,两组血压、血脂和体质指数差异有显著性(P<0.05),但血糖差异无显著性。结论合并冠心病的2型糖尿病患者男性激素水平比无冠心病合并患者明显降低,认为男性糖尿病患者男性激素水平降低是发生冠心病的重要危险因素。