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1.
Risk factors for cardiovascular disease and endothelin-1 levels in Takayasu arteritis patients 总被引:1,自引:0,他引:1
Alexandre Wagner Silva de Souza Henrique Ataíde Mariz Edgard Torres Reis Neto Anne Elizabeth Diniz Arraes Neusa Pereira da Silva Emília Inoue Sato 《Clinical rheumatology》2009,28(4):379-383
The objective of this study was to evaluate traditional risk factors for cardiovascular disease (CVD) and endothelin-1 (ET-1)
levels in Takayasu arteritis (TA) patients. Twenty-two TA patients and 37 controls were evaluated. TA patients had a higher
prevalence of hypertension (63.6% vs. 21.6%, p = 0.001) and higher levels of triglycerides (129.5 mg/dL ± 70.8 vs. 88.4 mg/dL ± 60.8, p = 0.017) than controls. Mean number of CVD risk factors was 1.64 ± 1.22 in TA patients and 1.03 ± 1.44 among controls, p = 0.030. More TA patients presented at least one CVD risk factor when compared to controls (77.2% vs. 51.3%, p = 0.048). ET-1 levels were higher in patients than in controls (1.49 pg/mL ± 0.45 vs. 1.27 pg/mL ± 0.32, p = 0.034), however no significant difference was found between patients with active and inactive disease. In this study, TA
patients presented a higher prevalence of hypertension, higher levels of triglycerides, and ET-1 than controls. 相似文献
2.
Hassen Zrour S Hassine Neffeti F Sakly N Jguirim M Korbaa W Younes M Bejia I Touzi M Fadel NM Bergaoui N 《Clinical rheumatology》2011,30(10):1325-1331
This study aims to assess the prevalence of dyslipidaemia in Tunisian patients with active RA and to investigate the clinical
and biological associated factors. A cross-sectional study was conducted on 92 unselected patients with active RA (77 females
and 15 males, aged 49.1 ± 12.5 years) and 82 healthy subjects (68 females and 14 males, aged 50.8 ± 13.3 years). We recorded
the patients' characteristics and the results of a lipid profile test (total cholesterol, TC; high-density lipoprotein cholesterol,
HDL-c; low-density lipoprotein cholesterol, LDL-c; triglyceride, TG; lipoprotein (a), Lp (a); apolipoprotein A-1, apo A-1
and apolipoprotein B, apo B). In comparison to the control group, RA patients showed a higher prevalence of associated dyslipidaemia
(95.7% versus 65.9% of cases, p < 0.001). Sera of patients showed higher TC (4.86 ± 1.07 versus 3.98 ± 0.73 mmol/L, p < 0.001), LDL-c (3.49 ± 0.98 versus 1.99 ± 0.62 mmol/L, p < 0.001), Lp (a) (288.04 ± 254.59 versus 187.94 ± 181.37 mmol/L, p = 0.004) and lower HDL-c (0.66 ± 0.24 versus 1.12 ± 0.3 mmol/L, p < 0.001). TC/HDL-c, LDL-c/HDL-c and non-HDL-c/HDL-c were also higher in RA patients; they were 8.24 ± 3.20 versus 3.76 ± 1.26
(p < 0.001), 5.91 ± 2.48 versus 1.92 ± 0.99 (p < 0.001) and 7.24 ± 3.20 versus 2.76 ± 1.26 (p < 0.001), respectively. Apo A-1 was correlated to Lp (a) (r = 0.291, p = 0.005). Corticoid dose was not associated to dyslipidaemia, but in multiple regression models, corticoid dose may be negatively
related to some atherogenic markers, in particular non-HDL-c. Tunisian patients with markedly active RA experience substantially
reduced serum HDL-c and increased TC, LDL-c and Lp (a) concentrations as well as increased TC/HDL-c, LDL-c/HDL-c and non-HDL-c/HDL-c
ratios. 相似文献
3.
Karadag O Calguneri M Yavuz B Atalar E Akdogan A Kalyoncu U Kiraz S Aksoyek S Ozmen F Ertenli AI 《Clinical rheumatology》2007,26(10):1701-1704
Cardiovascular disease is a major cause of death in patients with systemic lupus erythematosus (SLE) especially during the
late phase of the disease. This study was conducted to evaluate B-type natriuretic peptide (BNP) levels in female SLE patients
without cardiac symptoms and to investigate whether BNP levels correlated with echocardiographic findings. We studied 59 women
with SLE and 33 healthy women. SLE patients with history of cardiac disease, diabetes mellitus, hypertension, and other inflammatory
diseases were excluded from the study. All subjects had a complete history and physical examination. Overall disease activity
assessment in SLE patients at the time of the study were derived by calculation of SLE disease activity index (SLEDAI). BNP
levels were determined, and transthoracic echocardiography were performed in all subjects. There was no difference between
SLE patients and controls in terms of age, blood pressure, smoking status, plasma glucose, creatinine levels, and lipid profiles.
Nine patients had SLEDAI score greater than 5. All subjects had an EF greater than 55%. Diastolic dysfunction was more frequent
in lupus patients than in controls (15 [25.4%] vs. 2 [6%]; p = 0.022). BNP levels of SLE patients were significantly higher than controls (median 17.9 range [5–211] pg/ml vs. median
14.7 range [5–39.7] pg/ml; p = 0.033). Twenty-seven of the SLE patients (46%) and seven of the controls (21%) had BNP levels greater than or equal to
20 pg/ml (p = 0.019). There were no differences in BNP levels of SLE patients with and without diastolic dysfunction (median 17.8 range
[5–117] pg/ml vs. median 18.5 range [5–211] pg/mL; p = NS). BNP levels were positively correlated with left atrium diameter (r
2 = 0.39, p = 0.001). BNP levels did not correlate with erythrocyte sedimentation rate/C-reactive protein levels, SLEDAI scores, total
steroid dosage used, or other echocardigraphic parameters. BNP levels were increased in female SLE patients without cardiac
symptoms as compared to healthy controls. Although none of the SLE patients in our study had clinical signs of ischemic heart
disease, increased levels of BNP in SLE patients might be a reflection of a ischemic myocardial tissue. 相似文献
4.
Mycophenolate mofetil reduces disease activity and steroid dosage in Takayasu arteritis 总被引:1,自引:0,他引:1
Mycophenolate mofetil (MMF) has recently been reported as a useful alternative immunosuppressive drug in autoimmune diseases
including in Takayasu arteritis (TA). The aim of this study was to verify the efficacy and tolerability of MMF administration
in controlling TA disease activity and allowing glucocorticosteroid reduction. Ten consecutive active TA patients followed
at the Vasculitis Clinic were enrolled from January 2003 to 2006 and received oral MMF (2 g/day) for an average of 23.3 months.
Disease activity assessed using the National Institutes of Health criteria, clinical features, and inflammatory laboratory
findings were evaluated. Five patients had received at least one immunosuppressive drug before administration of MMF (four
methotrexate, two azathioprine, and one chlorambucil) but had not achieved clinical and laboratory remission. The other five
patients received MMF as their first immunosuppressive drug because of an important disease flare during steroid dose reduction.
Clinical activity disappeared in all patients with MMF therapy, except in one patient who abandoned the study because of an
important headache, attributed to the drug. Moreover, the MMF therapy allowed significant tapering of the prednisone dose
in the rest of the nine patients (24.5 ± 17.1 vs 5.8 ± 7.8 mg/day; p = 0.0019). Reinforcing this finding, a significant reduction in inflammatory laboratory parameters, erythrocyte sedimentation
rate (24.7 ± 15.5 vs 12.8 ± 10.8 mm/h; p = 0.036) and C-reactive protein (24.0 ± 14.9 vs 11.2 ± 10.7 mg/l; p = 0.0167), was observed. In summary, MMF therapy reduced clinical and laboratory parameters of TA disease activity, suggesting
that this drug is a promising immunosuppressive drug, particularly in refractory cases and as a steroid-sparing agent. 相似文献
5.
Levent Ozgonenel Esra Cetin Sule Tutun Pinar Tonbaklar Hale Aral Guvenc Guvenen 《Clinical rheumatology》2010,29(5):473-477
Vascular endothelial growth factor (VEGF) is known to be involved in the pathogenesis of rheumatoid arthritis (RA). In order
to elucidate the association between VEGF levels and RA disease activity, VEGF concentrations were measured in RA patients
at different phases and severity levels. Thirty-eight healthy subjects and 40 patients with RA were prospectively included
in the study. Subjects were further categorized into four subgroups (high, moderate, low, or remission) using the disease
activity score-28 (DAS28) scoring system. VEGF levels were significantly higher in patients than controls (p < 0.001). VEGF levels differed significantly in controls, early and late-phase RA patients (p = 0.002). A significant difference was found between controls and patients with high RA disease activity scores (p < 0.0001). VEGF levels were not correlated with age (r = −0.016; p = 0.921) or sex (r = 0.209; p = 0.921). VEGF values were correlated with erythrocyte sedimentation rate (r = 0.445; p = 0.004), but was not correlated with serum rheumatoid factor levels (r = −0.130; p = 0.424) in the patient group. In conclusion, higher VEGF levels are associated with late phase and high disease activity
in RA, independent of age and sex. 相似文献
6.
Serum IL-6, TNFα, p55 srTNFα, p75 srTNFα, srIL-2α Levels and Disease Acitivity in Systemic Lupus Erythematosus 总被引:8,自引:0,他引:8
Davas EM Tsirogianni A Kappou I Karamitsos D Economidou I Dantis PC 《Clinical rheumatology》1999,18(1):17-22
The aim of this study was to determine whether the levels of serum cytokines IL-6 and TNFα and of the soluble receptors p55
srTNFα, p75 srTNFα and srIL-2α are valuable markers of disease activity in patients with systemic lupus erythematosus (SLE)
compared with the established parameters of anti-dsDNA, C3, C4 and CH50. Forty patients with SLE, 19 ambulatory and 21 hospitalised, were included in this study. On the day of blood sampling a
clinical examination was performed and SLEDAI and ECLAM disease activity scores were used to assess disease activity. Nineteen
patients had inactive disease and 21 patients had active disease. Thirteen patients from the second group developed nephritis.
In these patients the blood sampling and disease activity assessment were performed twice (at presentation and 6 months after
treatment). Serum levels of cytokines and soluble receptors were measured by ELISA. Serum levels of cytokines and soluble
receptors of patients with active disease were significantly higher than in patients with inactive disease (IL-6 p = 0.0004, TNFαp = 0.0015, srIL-2αp<0.0001, p55 srTNFαp<0.0001, p75 srTNFαp<0.0001). Serum soluble receptor levels of patients with inactive disease were higher than those of healthy controls (p55
srTNFαp<0.0001, p75 srTNFαp = 0.0002, srIL-2αp = 0.0012). No significant difference was found for TNFα and IL-6 (TNFαp = 0.015, IL-6 p = 0.019). Serum TNFα levels and especially srIL-2α, p55 srTNFα and p75 srTNFα levels correlated strongly with SLEDAI and
ECLAM disease activity scores, anti-dsDNA, C3, C4 and CH50 (p<0.0001). Serum soluble receptor (srIL-2α, p55 srTNFα, p75 srTNFα) levels were higher in patients with nephritis before treatment
and decreased significantly 6 months after treatment (p = 0.005). The same trend was noticed with SLEDAI and ECLAM disease activity scores (p = 0.005) and anti-dsDNA (p = 0.008). In contrast, no significant differences were observed for C3 and C4 levels before and after treatment, which suggests
that soluble receptors of cytokines are more sensitive markers of disease activity than C3 or C4 in predicting improvement.
Serum levels of srIL-2α, p55 srTNFα and p75 srTNFα could provide useful information about disease activity in SLE patients,
especially in cases where the other markers do not.
Received: 3 March 1998 / Accepted: 13 July 1998 相似文献
7.
Claudia Mendoza-Pinto Mario García-Carrasco Hilda Sandoval-Cruz Margarita Muñoz-Guarneros Ricardo O. Escárcega Mario Jiménez-Hernández Pamela Munguía-Realpozo Manuel Sandoval-Cruz Margarita Delezé-Hinojosa Aurelio López-Colombo Ricard Cervera 《Clinical rheumatology》2009,28(5):579-585
The aim of the current study was to analyze the role of traditional and systemic lupus erythematosus (SLE)-related risk factors
in the development of vertebral fractures. A cross-sectional study was performed in women with SLE attending a single center.
A vertebral fracture was defined as a reduction of at least 20% of vertebral body height. Two hundred ten patients were studied,
with median age of 43 years and median disease duration of 72 months. Osteopenia was present in 50.3% of patients and osteoporosis
in 17.4%. At least one vertebral fracture was detected in 26.1%. Patients with vertebral fractures had a higher mean age (50 ± 14
vs. 41 ± 13.2 years, p = 0.001), disease damage (57.1% vs. 34.4%, p = 0.001), lower bone mineral density (BMD) at the total hip (0.902 ± 0.160 vs. 982 ± 0.137 g/cm2, p = 0.002), and postmenopausal status (61.9% vs. 45.3%, p = 0.048). Stepwise logistic regression analysis revealed that only age (p = 0.001) and low BMD at the total hip (p = 0.007) remained as significant factors for the presence of vertebral fracture. The high prevalence of vertebral fractures
in the relatively young population implies that more attention must be paid to detect and treat vertebral fractures. 相似文献
8.
Chun-Hsiung Chen Hung-An Chen Hsien-Tzung Liao Chin-Hsiu Liu Chang-Youh Tsai Chung-Tei Chou 《Clinical rheumatology》2010,29(10):1155-1161
The objective of the study was to investigate the role of receptor activator of nuclear factor-κB ligand (RANKL) and osteoprotegerin
(OPG) in ankylosing spondylitis (AS). Serum levels of soluble RANKL (sRANKL) and OPG were measured in 42 AS patients and 26
healthy controls. We evaluated the AS patient's disease activity, functional ability, global assessment, and physical mobility
and tested markers of systemic inflammation, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels. Serum
levels of sRANKL [mean (SD), 4.75 (1.88) vs. 3.70 (1.14) pmol/l, p = 0.015] and OPG [mean (SD), 5.18 (1.19) vs. 4.52 (0.85) pmol/l, p = 0.026] were significantly higher in the 42 AS patients than the 26 healthy controls. Interestingly, serum OPG levels correlated
significantly with ESR (r = 0.417, p = 0.007), CRP (r = 0.524, p < 0.001), tragus-to-wall distance (r = 0.556, p < 0.001), fingertip-to-floor distance (r = 0.423, p = 0.007), and occiput-to-wall distance (r = 0.465, p = 0.002) and correlated inversely with modified Schober index (r = −0.525, p = 0.001), cervical rotation (r = −0.403, p = 0.022), lateral lumbar flexion (r = −0.587, p < 0.001), and chest expansion (r = −0.553, p < 0.001). Moreover, in the AS patients with higher (≥4.925 pmol/l, n = 21) serum OPG levels, there were significant increases in the tragus-to-wall distance (p = 0.007), fingertip-to-floor distance (p = 0.023), and CRP levels (p = 0.014) and decreased in the modified Schober index (p = 0.012), lateral lumbar flexion (p = 0.019), and chest expansion (p = 0.005). Serum levels of sRANKL and OPG are increased in the AS patients and may participate in the disease process of AS.
Production of OPG has association with poor physical mobility and may reflect systemic inflammation in AS. 相似文献
9.
Bruckert E Giral P Paillard F Ferrières J Schlienger JL Renucci JF Abdennbi K Durack I Chadarevian R;PEGASE group 《Cardiovascular drugs and therapy / sponsored by the International Society of Cardiovascular Pharmacotherapy》2008,22(6):495-505
Background Many studies have demonstrated a gap between guidelines for the prevention of cardiovascular disease (CVD) and their implementation
in clinical practice.
Aim The PEGASE education program has been devised with an aim to improve the management of patients at high risk of CVD.
Methods In a multicentre study carried out from 2001–2004 in France, 96 participating physicians were randomized into a “trained”
group, which included 398 “educated” patients, and a “non-trained” group, which included 242 “non-educated” patients. Educated
patients received six hospital-based educational sessions, four collective and two individual. Framingham score, smoking,
lipid levels, glycaemia, blood pressure, dietary intake and drug compliance, as well as quality of life, were evaluated at
baseline (M0) and 6 months (M6). The primary endpoint of the study was the efficacy of the PEGASE program in reducing global
CVD risk in high-risk patients.
Results The Framingham score was calculated for 473 patients. The Framingham score improved significantly at M6 vs M0 in the educated
group (13.0 ± 8.21 vs 13.6 ± 8.48, d = −0.658, p = 0.016), but not in the non-educated group (12.5 ± 8.19 vs 12.4 ± 7.81, d = +0.064, p = 0.836); the mean change between the two groups did not reach significance. Quality of life, LDL-c level and diet scores
improved in the “educated” group only.
Conclusions The PEGASE education program improved risk factors for CVD, although global assessment by Framingham score was not significantly
different between groups. This program, aimed at meeting needs and expectations of patients and physicians, was easily implemented
in all hospital centres.
The study and the PEGASE educational program were supported by AstraZeneca France.
E. Bruckert has received speaker’s fees from Astra Zeneca. 相似文献
10.
Straczkowski M Kowalska I Baranowski M Nikolajuk A Otziomek E Zabielski P Adamska A Blachnio A Gorski J Gorska M 《Diabetologia》2007,50(11):2366-2373
Aims/hypothesis Intramyocellular lipids, including ceramide, a second messenger in the sphingomyelin signalling pathway, might contribute
to the development of insulin resistance. The aim of our study was to assess parameters of the skeletal muscle sphingomyelin
signalling pathway in men at risk of developing type 2 diabetes.
Methods We studied 12 lean (BMI < 25 kg/m2) men without a family history of diabetes (control group), 12 lean male offspring of type 2 diabetic patients, and 21 men
with overweight or obesity comprising 12 with NGT (obese-NGT) and nine with IGT (obese-IGT). A euglycaemic-hyperinsulinaemic
clamp and a biopsy of vastus lateralis muscle were performed. Ceramide, sphingomyelin, sphinganine and sphingosine levels
and sphingomyelinase and ceramidase activities were measured in muscle. Muscle diacylglycerol and triacylglycerol levels were
estimated in a subgroup of 27 men (comprising men from all the above groups).
Results Compared with the control group, the lean offspring of diabetic patients and the men with overweight or obesity showed lower
insulin sensitivity (all p < 0.005) and a greater muscle ceramide level (all p < 0.01). The obese-IGT group had lower insulin sensitivity (p = 0.0018) and higher muscle ceramide (p = 0.0022) than the obese-NGT group. There was lower muscle sphingosine level and alkaline ceramidase activity in offspring
of diabetic patients (p = 0.038 and p = 0.031, respectively) and higher sphinganine level in the obese-NGT (p = 0.049) and obese-IGT (p = 0.002) groups than in the control group. Muscle sphingomyelin was lower (p = 0.0028) and neutral sphingomyelinase activity was higher (p = 0.00079) in the obese-IGT than in the obese-NGT group. Muscle ceramide was related to insulin sensitivity independently
of other muscle lipid fractions.
Conclusions/interpretations Ceramide accumulates in muscle of men at risk of developing type 2 diabetes. 相似文献
11.
Background Low-density lipoprotein receptor-related protein associated protein (LRPAP1) insertion/deletion polymorphism influences cholesterol homeostasis and may confer risk for gallstone disease and gallbladder
carcinoma (GBC) incidence usually parallels with the prevalence of cholelithiosis.
Aim We aimed to examine the role of LRPAP1 polymorphism in susceptibility to GBC.
Methods Present case control study included 129 proven GBC patients, 183 gallstone patients, and 208 healthy controls. Genotyping
was done by polymerase chain reaction–restriction fragment length polymorphism method.
Results The D allele of LRPAP1 was significantly higher in GBC patients as compared to gallstone patients (p = 0.013; OR = 1.6, 95% CI = 1.1–2.4). However, II genotype and I allele was associated with reduced risk of GBC as compared to gallstone patients (p = 0.002; OR = 0.1, 95% CI = 0.1–0.6; p = 0.013; OR = 0.6, 95% CI = 0.4–0.8) The increased risk due to D allele was limited to female GBC patients (p = 0.021; OR = 1.8, 95% CI = 1.1–3.0). However, reduced risk due to II genotype and I allele was observed which was also confined to female GBC patients (p = 0.005; OR = 0.1, 95% CI = 0.1–0.6; p = 0.021; OR = 0.5, 95% CI = 0.3–0.8). On comparing GBC patients having gallstone with gallstone patients, high risk was observed
in the GBC patients having gallstone due to the presence of D allele (p = 0.032; OR = 1.7, 95% CI = 1.0–2.8). However, low risk was observed because of I allele in GBC patients with gallstone in comparison to gallstone patients (p = 0.032, OR = 0.6, 95% CI = 0.4–0.9).
Conclusion It appears that ‘D’ allele may modulate the susceptibility of GBC, and the risk is independent to genetic risk of gallstone. 相似文献
12.
Mariusz Ciołkiewicz Anna Kuryliszyn-Moskal Piotr Adrian Klimiuk 《Clinical rheumatology》2010,29(2):175-180
The aim of the study was to evaluate the correlation between selected serum endothelial cell activation markers such as vascular
endothelial growth factor (VEGF), endothelin-1 (ET-1), soluble thrombomodulin (sTM), soluble E-selectin (sE-selectin), disease
activity, and microvascular changes determined by nailfold capillaroscopy in patients with systemic lupus erythematosus (SLE).
Serum levels of VEGF, ET-1, sTM, and sE-selectin were determined by an enzyme-linked immunosorbent assay in 80 SLE patients.
The disease activity was measured with Systemic Lupus Erythematosus Disease Activity Index score. Nailfold capillaroscopy
was performed in all patients. Positive correlation was found between VEGF and both ET-1 (r = 0.294, p < 0.01) and sE-selectin (r = 0.274, p < 0.05) serum levels as well as between sTM and ET-1 (r = 0.273, p < 0.05) serum concentrations. We noticed also positive correlation between VEGF (r = 0.224, p < 0.05) and ET-1 (r = 0.471, p < 0.001) serum levels and disease activity, and also between VEGF serum concentration and grade of morphological changes
observed by nailfold capillaroscopy (r = 0.458, p < 0.001). There was also positive correlation between capillaroscopic score and disease activity (r = 0.339, p < 0.01). Our data suggest that correlation between VEGF and both ET-1 and E-selectin serum levels as well as between sTM
and ET-1 serum concentrations may reflect their participation in the pathogenesis of SLE. VEGF seems to reflect changes in
microcirculation in the course of SLE, visualised by nailfold capillaroscopy. The relationship between changes in nailfold
capillaroscopy, endothelial cell activation markers, and the clinical activity of SLE points to an important role of microvascular
abnormalities in the clinical manifestation of the disease. 相似文献
13.
Buchs NC Gervaz P Secic M Bucher P Mugnier-Konrad B Morel P 《International journal of colorectal disease》2008,23(3):265-270
Background Anastomotic dehiscence is the most severe surgical complication after large bowel resection. This study was designed to assess
the incidence, to observe the consequences, and to identify the risk factors associated with anastomotic leakage after colorectal
surgery.
Materials and methods All procedures involving anastomoses of the colon or the rectum, which were performed between November 2002 and February 2006
in a single institution, were prospectively entered into a computerized database.
Results One thousand eighteen colorectal resections and 811 anastomoses were performed over this 40-month period. The most frequent
procedures were sigmoid (276) and right colectomies (217). The overall anastomotic leak rate was 3.8%. The mortality rate
associated with anastomotic leak was 12.9%. In univariate analysis, the following parameters were associated with an increased
risk for anastomotic dehiscence: (1) ASA score ≥ 3 (p = 0.004), (2) prolonged (>3 h) operative time (p = 0.02), (3) rectal location of the disease (p < 0.001), (4) and a body mass index > 25 (p = 0.04). In multivariate analysis, ASA score ≥ 3 (OR = 2.5; 95% CI 1.5–4.3, p < 0.001), operative time > 3 h [OR = 3.0; 95% CI 1.1–8.0, p = 0.02), and rectal location of the disease (OR = 3.75; 95% CI 1.5–9.0 (vs left colon), p = 0.003; OR = 7.69; 95% CI 2.2–27.3 (vs right colon), p = 0.001] were factors significantly associated with a higher risk of anastomotic dehiscence.
Conclusions Three risk factors for anastomotic leak have been identified, one is patient-related (ASA score), one is disease-related (rectal
location), the third being surgery-related (prolonged operative time). These factors should be considered in perioperative
decision-making regarding defunctioning stoma formation. 相似文献
14.
Brevetti G Oliva G Giugliano G Schiano V De Maio JI Chiariello M 《Journal of general internal medicine》2007,22(5):639-644
BACKGROUND Peripheral arterial disease (PAD) is undertreated by general practitioners (GPs). However, the impact of the suboptimal clinical
management is unknown.
OBJECTIVE To assess the mortality rate of PAD patients in relation to the type of physician who provides their care (GP or vascular
specialist).
DESIGN Prospective study.
SETTING Primary care practice and academic vascular laboratory.
PARTICIPANTS GP patients (n = 60) were those of the Peripheral Arteriopathy and Cardiovascular Events study (PACE). Patients managed by specialists (n = 82) were consecutive subjects with established PAD who were referred to our vascular laboratory during the enrolment period
of the PACE study.
MEASUREMENTS All-cause and cardiovascular mortality.
RESULTS After 32 months of follow-up, specialist management was associated with a lower rate of all-cause mortality (RR = 0.04; 95%
CI 0.01–0.34; p = .003) and cardiovascular mortality (RR = 0.07; 95% CI 0.01–0.65; p = .020), after adjustment for patients’ characteristics. Specialists were more likely to use antiplatelet agents (93% vs
73%, p < .001), statins (62% vs 25%, p < .001) and beta blockers (28% vs 3%, p < .001). Survival differences between specialists and GPs disappeared once the use of pharmacotherapies was added to the
proportional hazard model. The fully adjusted model showed that the use of statins was significantly associated with a reduced
risk of all-cause mortality (RR = 0.02; 95% CI 0.01–0.73, p = .034) and cardiovascular mortality (RR = 0.02; 95% CI 0.01–0.71, p = .033).
CONCLUSIONS Specialist management of patients with symptomatic PAD resulted in better survival than generalist management. This effect
appears to be mainly caused by the more frequent use of effective medicines by specialists. 相似文献
15.
Bakhtadze E Cervin C Lindholm E Borg H Nilsson P Arnqvist HJ Bolinder J Eriksson JW Gudbjörnsdottir S Nyström L Agardh CD Landin-Olsson M Sundkvist G Groop LC 《Diabetologia》2008,51(12):2224-2232
Aims/hypothesis Type 1 diabetes in children is characterised by autoimmune destruction of pancreatic beta cells and the presence of certain
risk genotypes. In adults the same situation is often referred to as latent autoimmune diabetes in adults (LADA). We tested
whether genetic markers associated with type 1 or type 2 diabetes could help to discriminate between autoimmune and non-autoimmune
diabetes in young (15–34 years) and middle-aged (40–59 years) diabetic patients.
Methods In 1,642 young and 1,619 middle-aged patients we determined: (1) HLA-DQB1 genotypes; (2) PTPN22 and INS variable-number tandem repeat (VNTR) polymorphisms; (3) two single nucleotide polymorphisms (rs7903146 and rs10885406) in
the TCF7L2 gene; (4) glutamic acid decarboxylase (GAD) and IA-2-protein tyrosine phosphatase-like protein (IA-2) antibodies; and (5)
fasting plasma C-peptide.
Results Frequency of risk genotypes HLA-DQB1 (60% vs 25%, p
= 9.4×10−34; 45% vs 18%, p
= 1.4 × 10−16), PTPN22 CT/TT (34% vs 26%, p
= 0.0023; 31% vs 23%, p
= 0.034), INS VNTR class I/I (69% vs 53%, p
= 1.3 × 10−8; 69% vs 51%, p
= 8.5 × 10−5) and INS VNTR class IIIA/IIIA (75% vs 63%, p
= 4.3 × 10−6; 73% vs 60%, p
= 0.008) was increased in young and middle-aged GAD antibodies (GADA)-positive compared with GADA-negative patients. The type
2 diabetes-associated genotypes of TCF7L2 CT/TT of rs7903146 were significantly more common in young GADA-negative than in GADA-positive patients (53% vs 43%; p
= 0.0004). No such difference was seen in middle-aged patients, in whom the frequency of the CT/TT genotypes of TCF7L2 was similarly increased in GADA-negative and GADA-positive groups (55% vs 56%).
Conclusions/interpretation Common variants in the TCF7L2 gene help to differentiate young but not middle-aged GADA-positive and GADA-negative diabetic patients, suggesting that young
GADA-negative patients have type 2 diabetes and that middle-aged GADA-positive patients are different from their young GADA-positive
counterparts and share genetic features with type 2 diabetes.
Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorised users.
G. Sundkvist died in September 2006. 相似文献
16.
Although its exact mechanism is unclear, anaemia is well recognised as a feature of hypopituitarism; and anaemia is associated
with Sheehan’s syndrome (SS). We aimed to evaluate the frequency and severity of anaemia and other haematological changes
among patients with Sheehan’s syndrome, in comparison with healthy controls. Sixty-five SS patients and 55 age-matched female
healthy controls were included. Biochemical and hormonal assessments and haematological evaluations were carried out, and
groups were compared. The mean number of red blood cells, as well as mean haemoglobin, iron and erythropoietin levels, total
iron-binding capacity and transferrin saturation were all significantly lower in SS patients compared to controls. SS patients
had significantly higher rates of anaemia (80.0% vs. 25.5%, p = 0.0001), iron deficiency (44.6% vs. 5.4%, p = 0.001), leukopenia (20.0% vs. 5.4%, p = 0.015), thrombocytopenia (9.2% vs. 0.0%, p = 0.028) and bicytopenia (21.5% vs. 1.8%, p = 0.001) compared to controls. Anaemic SS patients had normochromic-normocytic anaemia (55%) or hypochromic-microcytic anaemia
(45%). Anaemia is frequently associated with Sheehan’s syndrome and responds to appropriate replacement therapy. Hypopituitarism
should be considered as a possible cause of anaemia, and a hormone examination should be undertaken promptly, particularly
in patients with anaemia resistant to therapy and/or with a history suggestive of Sheehan’s syndrome. 相似文献
17.
R.?R.?Holman S.?Paul A.?Farmer L.?Tucker I.?M.?Stratton H.?A.?W.?Neil 《Diabetologia》2009,52(1):50-59
Aims/hypothesis The aim of the study was to examine the impact of statin or omega-3-acid ethyl esters 90 (omega-3 EE90; omega-3-acid ethyl
esters 90 refers to a mixture of ethyl esters of n-3 fatty acids) on estimated cardiovascular disease (CVD) risk in community-based people with type 2 diabetes but without
known CVD and not taking lipid-lowering therapy.
Methods A central computer randomised 800 patients in 59 UK general practices to atorvastatin (n = 401, 20 mg/day) or placebo (n = 399) and omega-3 EE90 (n = 397, 2 g/day) or placebo (n = 403) in a concealed factorial manner. Participants with LDL-cholesterol <2.6 mmol/l, triacylglycerol <1.5 mmol/l and estimated
10-year CVD risk <20% were compared at 4 months.
Results Mean (SD) age was 63.5 (11.7) years, HbA1c 6.9 (1.1) % and known diabetes duration (median [interquartile range]) was 4 (2–8) years. Fifty-seven per cent were men,
90% white and 74% had an estimated 10-year CVD risk ≥20%. Of 732 patients with 4-month data, more allocated atorvastatin (n = 371) compared with placebo (n = 361) achieved LDL-cholesterol <2.6 mmol/l (91% vs 24%, p < 0.001) and had estimated 10-year CVD risks <20% (38% vs 26%, p < 0.001). No differences were seen between those allocated omega-3 EE90 (n = 371) compared with placebo (n = 361) for participants achieving triacylglycerol <1.5 mmol/l (65% vs 60%, p = 0.18) or estimated 10-year CVD risks <20% (34% vs 30%, p = 0.18). There were no side effects of note.
Conclusions/interpretation Many community-based diabetic patients without known CVD remain at high CVD risk despite statin treatment and require additional
risk-reduction strategies. The impact of omega-3 EE90 on CVD risk will remain uncertain until clinical endpoint trial results
are available.
Trial registration: ISRCT no. 76737502
Funding: The study was funded by Pfizer.
Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorised users. 相似文献
18.
The aim of this study was to evaluate serum and synovial levels of IL-17A by ELISA in rheumatoid arthritis (RA) and find out
the correlations between IL-17A levels and various clinical, laboratory parameters and RA disease activity and severity indices.
Group I consists of 30 adult active RA patients fulfilling the ARA 1987 revised criteria, with knee effusion and receiving
basic therapy, and with a mean age of 41.47 ± 11.49 years and mean disease duration of 9.5 ± 4.16 years. Group II consisted
of 13 healthy volunteers, age- and sex-matched, with a mean age of 39.08 ± 14.19 years. RA patients showed significantly higher
mean serum IL-17A levels than controls (11.25 ± 9.67 vs. 0.6 ± 1.4 pg/mL, respectively, p = 0.0002). Synovial IL-17A levels showed a significant positive correlation with serum IL-17A levels (r = 0.5 and p = 0.005). RA patients with negative rheumatoid factor (RF) had non-significantly higher mean serum IL-17A levels (12 ± 9.86 pg/mL)
compared to those with positive RF (10.82 ± 9.81 pg/mL); however, the mean synovial IL-17A levels were nearly the same. Significant
positive correlations were found between both serum and synovial IL-17A levels and DAS-28 scores (r = 0.556, 0.392 and p = 0.001, 0.032, respectively). RA patients with class III functional status showed significantly higher mean serum IL-17A
levels (17.53 ± 13.43 pg/mL) than classes I and II (8.97 ± 6.97 pg/mL, p = 0.009). These led us to conclude that the elevated serum and synovial IL-17A levels in RA patients parallel the degree
of disease activity and severity. This may highlight the usefulness of IL-17 (especially serum level) as a possible marker
for more aggressive joint involvement and damage. 相似文献
19.
Allogeneic hematopoetic stem cell transplantation (HSCT) is still the only curative therapeutic option for chronic myelogenous
leukemia (CML). To examine the development of allogeneic HSCT at our center over the past two decades (decade 1: 1984–1994;
decade 2: 1995–2005), all CML patients transplanted in first chronic phase (n = 234) were analyzed with respect to patient characteristics, overall survival, transplant-related mortality (TRM), and relapse
incidence. The median follow up time was 54 months (range 1–218). The incidence of acute graft vs host disease (GvHD) °II–IV
and extensive chronic GvHD were not different between the two decades (p = 0.894 and p = 0.422, respectively). There was also no difference in the relapse incidence (23 vs 26%, p = 0.869). One-year TRM and overall survival were improved in the later decade (33 vs 18%, p = 0.011 and 62 vs 73% at 5 years, p = 0.063, respectively). The major reason for improved outcome in decade 2 was the improved management of acute GvHD and infections
in the early phase after transplantation (p = 0.026). In conclusion, the past decade has seen significant improvement in the performance of allogeneic HSCT for CML. 相似文献
20.
IgG subclass levels of sera from 105 patients with systemic lupus erythematosus (SLE) were determined by immunonephelometric
assay. Patients were divided into two groups according to clinical activity of the disease: active disease and remission.
Forty-five normal controls were also measured. We found a significant increase of IgG1 (p = 0.000), IgG2 (p = 0.000), and IgG3 (p = 0.000) in SLE sera, while IgG4 (p = 0.494) values did not differ significantly from those of controls. When patients were divided according to clinical activity,
decrease of IgG3 concentration was observed in the patients in remission. In contrast, the concentrations of IgG1, IgG2, and
IgG4 subclass were similar between the two groups (p > 0.05). Our data suggest that differential increase of IgG subclasses during the course of SLE may be of relevance to the
pathogenesis of the disease. 相似文献