2型糖尿病患者颈动脉内膜增厚的相关危险因素分析

目的分析2型糖尿病患者颈动脉内膜中层病变及相关危险因素。方法选取符合2型糖尿病诊断标准者2202例,并按照颈动脉内膜中层厚度（CIMT）值进行分组,其中,CIMT≥1mm为增厚组（1663例）,CIMT〈1mm为对照组（539例）。比较两组患者的年龄、性别、收缩压、舒张压、身体质量指数（BMI）、腰臀比、糖化血红蛋白（HbAlc）、空腹血糖（FPG）、餐后2h血糖（2hPG）、总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白（HDL—C）、低密度脂蛋白（LDL—C）、血尿酸（UA）、尿蛋白、尿蛋白,肌酐（UACR）,分析与CIMT相关的危险因素。结果增厚组患者的年龄、腰臀比、收缩压、FPG、2hPG、HbAlc、UACR、LDL—C、TC、UA均明显高于对照组,HDL—C明显低于对照组,差异均有统计学意义（P〈0．05）;年龄、收缩压、TC、HbAlc与CIMT呈正相关（P〈0．05）,性别、HDL—C与CIMT呈负相关（P〈0．05）．FPG、2hPG、BMI、腰臀比、LDL—C、TC、TG、UACR、UA与CIMT无相关性（P〉0．05）。结论年龄、收缩压、HbAlc、HDL—C是糖尿病患者颈动脉内膜增厚的独立危险因素。     

Carotid intima-media thickness in low-risk individuals with asymptomatic atherosclerosis: baseline data from the METEOR study*

ABSTRACT

Objective: Carotid intima-media thickness (CIMT) is an index for changes in atherosclerosis burden and changes in CIMT may relate to clinical events. We present baseline data from the METEOR study, a randomized, placebo-controlled trial evaluating the efficacy of rosuvastatin 40?mg on changes in CIMT. We set out to compare differ­ences in CIMT between several subgroups of individuals.

Design and methods: A total of 984 individuals aged 45–70 years (men) or 55–70 (women) were randomized. Participants were required to have: maximum CIMT ≥?1.2–<?3.5?mm; 2+ risk factors and 10-year coronary heart disease (CHD) risk <?10%, or <?2 CHD risk factors. Demo­graphic characteristics were compared in two groups: USA versus Europe, and individuals with maximum CIMT <?2?mm versus those with CIMT ≥?2?mm.

Baseline data: Overall, mean age was 57 years and mean low-density lipoprotein cholesterol was 152?mg/dL (3.9?mmol/L). Body mass index (BMI), triglyceride and high-sensitivity C-reactive protein levels were all higher in US individuals, whereas smoking, hypertension and high-density lipoprotein cholesterol levels were higher in Europeans. Mean CIMT levels were the same in both populations, and the percentage of individuals with ≥?2 CHD risk factors was similar. Increased baseline CIMT (>?2?mm) was related to increasing age, male gender, smoking, hypertension and lipid levels.

Conclusions: In this global trial, differences in baseline characteristics between participants from the USA and Europe are apparent. However, a strong association between CIMT and several cardiovascular risk factors was observed across the two continents.

Trial registration: ClinicalTrials.gov identifier: NCT00225589.     

天津市公安民警颈动脉内中膜厚度与代谢综合征的关系

目的 分析天津市警察人群颈动脉内中膜厚度与代谢综合征 （MS） 的关系, 探讨颈动脉内中膜增厚的危险因素。方法 在体检警察人群中筛选出 50 例 MS 患者为 MS 组及 50 例健康体检者为对照组, 对其进行问卷调查（家族史、 既往史、 现病史、 生活习惯、 职业紧张因素等）; 检测相关血液指标（空腹血糖、 三酰甘油、 总胆固醇、 高密度脂蛋白胆固醇、 低密度脂蛋白胆固醇、 同型半胱氨酸等）; 应用彩超测量其颈动脉内中膜厚度, 计算颈动脉内中膜增厚比率; 比较 2 组的相关指标, 用 Logistic 回归模型分析颈动脉内中膜增厚的影响因素。结果 MS 组的双侧颈总动脉、 颈内动脉、 颈外动脉内中膜厚度及内中膜增厚比率均高于对照组; 高血压家族史、 应激事件、 现吸烟、 糖尿病家族史、 高脂饮食、 高同型半胱氨酸血症是颈动脉内中膜增厚的危险因素, 饮用奶制品是其保护因素。结论 颈动脉内中膜增厚的原因具多样性, 健康的生活方式及采取临床干预措施减缓颈动脉内中膜增厚, 有利于控制动脉粥样硬化。     

替米沙坦对高血压患者颈总动脉内膜中层厚度的影响

目的 观察替米沙坦对高血压患者颈总动脉内膜中层厚度的影响.方法 选择104例轻、中度高血压病患者,随机分为替米沙坦组35例（服用替米沙坦80 mg/d）、雷米普利组35例（服用雷米普利5 mg/d）和对照组34例（使用其它降压药物）.治疗过程中监测血压,入选患者开始时和治疗12个月后测定颈总动脉内膜中层厚度（CIMT）.结果 完成12个月治疗者共91例：替米沙坦组33例,雷米普利组28例,对照组30例.替米沙坦组和雷米普利组在有效降低血压同时,CIMT明显减低（均P〈0.05）,与对照组CIMT差异无统计学意义;雷米普利引起干咳需要停用药物者5例.结论 替米沙坦能够有效降低血压并减低CIMT,雷米普利具有相似作用,但替米沙坦不良反应较少.     

糖化血红蛋白与颈动脉内膜-中膜厚度的相关性研究

目的 研究普通体检人群糖化血红蛋白（HbA1c）水平与颈动脉内膜-中膜厚度（CIMT）的相关性。方法选取9 881例普通体检人群为研究对象,其中男7 091例,女2 790例,采用血管彩色多普勒超声测量CIMT。根据是否有CIMT增厚,分为增厚组（4 513例）和正常组（5 368例）。收集2组的一般资料和实验室资料并进行比较。采用Logistic回归分析总人群及不同性别中CIMT增厚的危险因素。采用受试者工作特征（ROC）曲线评价HbA1c水平对CIMT增厚的预测效果。结果 与正常组相比,增厚组的男性比例、年龄、体质量指数（BMI）、收缩压（SBP）、直接胆红素（DBIL）、球蛋白（GLB）、血尿素氮（BUN）、血肌酐（Scr）、血糖（GLU）、HbA1c、总胆固醇（TC）和低密度脂蛋白胆固醇（LDL-C）水平均升高,而估算肾小球滤过率（eGFR）、丙氨酸转氨酶（ALT）、白蛋白（ALB）、高密度脂蛋白胆固醇（HDL-C）降低（P<0.05）。多因素Logistic回归分析显示,在总人群中高龄,男性,ALB、GLU、LDL-C升高,HbA1c≥5.7%是CIMT增厚的危险因素,...     

健康人动脉结构及功能改变与室间隔厚度的相关性研究

目的 研究健康人中动脉结构和功能改变与心室间隔厚度的关系.方法 以颈动脉内膜中层厚度( IMT)和肱动脉血流介导的血管舒张反应(FMD)二指标反应动脉结构和功能改变.采用超声多普勒测定68例健康人(男16人,女52人)的IMT、FMD和室间隔厚度( IVST).结果 健康人中IVST与IMT呈正相关(r=0.394,P=-0.001),与FMD呈负相关(r=0.337,P＜ 0.01),IVST也与年龄和收缩压呈正相关.以IVST为因变量的多因素回归分析显示,IMT和FMD是其独立影响因素.结论 健康人中IMT、FMD和IVST相关,动脉结构和功能改变影响心室间隔厚度.     

维持性腹膜透析患者颈动脉粥样硬化程度及相关危险因素分析

目的研究终末期肾功能衰竭（ESRD）行维持性腹膜透析患者颈动脉粥样硬化程度及相关危险因素分析。方法选择75例终末期肾功能衰竭行维持性腹膜透析患者为PD组及46例健康对照者为对照组。检测血红蛋白（Hb）、血尿素氮（BUN）、血肌酐（SCr）、白蛋白（ALB）、总胆固醇（TC）、甘油三脂（TG）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、C反应蛋白（CRP）、血钙（Ca）、血磷（P）、甲状旁腺激素（PTH）、血压;用彩色多普勒超声测量双侧颈动脉内中膜厚度（CIMT）及斑块情况。结果PD组患者和对照组CIMT分别是（0．84±0．12）mm和（0．53±0．04）mm,PD组的CIMT较对照组明显增厚（P〈0．05）,PD组和对照组颈动脉粥样斑块发生率分别是36％和13％,PD患者组斑块的发生率明显高于对照组（P〈0．05）。CIMT和斑块发生率与下列因素相关：分别是年龄（r=0．46,P〈0．001）,CRP（r=0．51,P〈0．05）,ALB（r=-0．29,P〈0．05）。结论维持性腹膜透患者颈动脉粥样硬化发生率明显高于正常对照组;除传统的人危险因素外,我们认为尿毒症内环境紊乱、微炎症状态、营养不良等也是加速粥样硬化过程的重要因素。     

中老年女性颈动脉斑块发生及稳定性相关危险因素分析

目的　探讨中老年女性发生颈动脉斑块的危险因素,并对影响斑块发生及斑块稳定性的相关因素进行分析。方法　选择2016年3月—2018年3月于天津医科大学总医院门诊就诊的45~80岁中老年女性,均行颈动脉超声检查,观察内-中膜厚度及斑块特征,并根据有无斑块分成斑块组和无斑块组;根据斑块的特征,将有斑块者分成稳定斑块组和不稳定斑块组。收集患者的临床资料、实验室检查结果以及颈动脉超声检查结果,分析颈动脉斑块形成的影响因素。结果　本研究共纳入中老年女性954例,平均（62.24±13.24）岁。与无斑块组相比,斑块组的年龄、低密度脂蛋白胆固醇（LDL-C）、收缩压均较高（P＜0.05）。Logistic回归分析发现,较高水平的LDL-C、高龄以及绝经是中老年女性颈动脉斑块形成的独立危险因素;稳定斑块组的LDL-C明显低于不稳定斑块组（P＜0.05）;Logistic回归分析显示,较高水平的LDL-C是影响斑块稳定性的独立危险因素。结论　中老年女性颈动脉斑块的发生与年龄、LDL-C及绝经有关,并且LDL-C水平影响颈动脉斑块的稳定性。     

Association of the −262C/T polymorphism in the catalase gene promoter with carotid atherosclerosis in Slovenian patients with type 2 diabetes

Genetic variations of the antioxidant enzymes may influence the susceptibility to oxidative stress and consequently the development and progression of diabetic complications. The aim of the current study was to test the association between the −262C/T polymorphism in the catalase gene promoter and carotid atherosclerosis in Slovenian patients with type 2 diabetes. Two-hundred and eighty six diabetics and 150 healthy controls were enrolled in the study. Carotid atherosclerosis was quantified ultrasonographiocally by carotid intima-media thickness (CITM), plaque score and plaque type. Genotypes were determined using the real-time PCR. Fibrinogen concentration showed a borderline statistically significant difference due to catalase genotypes (p=0,05). No difference in clinical characteristics, CIMT, plaque stability or plaque score was observed. Logistic regression model adjusted for age, gender, smoking, BMI, lipid parameters and duration of hypertension and diabetes showed significant association of T allele and lower risk for higher plaque score (OR=0,25; p=0,025). No association with CIMT>1mm and unstable plaques was observed. T allele of −262C/T is associated with lower risk for higher plaque score but it did not affect clinical parameters, CIMT and plaque stability. Whether this polymorphism can be used as a genetic marker for advanced carotid atherosclerosis in diabetic patients needs to be evaluated in the future.     

Age, adiposity, blood pressure and blood lipids in a rural New Zealand population.

Multiple regression analysis of data on age, blood pressure, adiposity and blood lipids from a rural New Zealand population of over 1200 adults has been undertaken. The results show that rises in blood lipids over time in the population are independent of age and correlate significantly with adiposity. Thus plasma cholesterol and triglycerides correlate with adiposity (expressed as Quetelet's index or skinfold thickness) in men whereas significant correlation in women was only between adiposity and plasma triglycerides. Systolic and diastolic blood pressure in men was strongly correlated with their plasma triglycerides, but not cholesterol, when the effect of age and adiposity was removed. In women however only a weak correlation was observed between plasma triglycerides and systolic blood pressure. The significance of the findings is discussed.     

Evaluation of selected lipid parameters and blood pressure in ethnically-homogenous population of middle-aged persons,depending on gender,age and body mass

The study is a retrospective analysis of data obtained from a cardiovascular disease prevention program financed by the National Health Fund (Poland). The aim of the study was to evaluate the population to demonstrate the prevalence of favourable and unfavourable lipid parameters and blood pressure values depending on age and BMI. A total of 2,616 subjects were included in the study (811 men and 1805 women aged between 35 and 55 years of age) who perceived themselves as completely healthy individuals and in whom no cardiovascular disease or diabetes mellitus had been diagnosed. We evaluated blood pressure values, body weight, height, BMI, fasting glucose, total cholesterol, triglycerides, HDL and LDL in the serum of venous blood. The above-mentioned parameters were compared in women and men depending on BMI and age. It was demonstrated that the epidemiological situation of women in the analysed age group, regardless of the studied parameter and method of its evaluation, is much more favourable than that of men. We have demonstrated that evaluation of the analysed lipid parameters and blood pressure should be performed with consideration to gender and age. Otherwise conclusions may be obtained which are not satisfied by 75-95% of the population in a given age group. Obesity was highlighted as a factor triggering further lipid disturbances and blood pressure increase.     

颈动脉粥样斑块与冠心病相关因素分析

目的 分析颈动脉粥样斑块与冠心痛及其危险因素的关系,进一步探讨颈动脉斑块对冠心病的诊断价值.方法 选取拟诊为冠心病在我院行40层螺旋CT冠状动脉造影的患者173例,行颈动脉超声检查,观察颈动脉最大内膜中层厚度及斑块发生情况,同时检测患者血超敏C反应蛋白(超敏CRP)、血糖(BS)、甘油三酯(TG)、总胆固醇(TC)、高...     

Rosuvastatin reduces intima-media thickness in hypercholesterolemic subjects with asymptomatic carotid artery disease: the Asymptomatic Carotid Atherosclerotic Disease in Manfredonia (ACADIM) Study

Background: An increase in carotid intima-media thickness (CIMT) represents an early phase of the atherosclerotic process. The aim of this study was to evaluate whether a reduction in CIMT could be seen with only 16 weeks of treatment with rosuvastatin (10 mg/day). Methods/results: Sixty-six participants of the ACADIM Study with hypercholesterolemia and carotid atherosclerosis at baseline carotid ultrasound investigation (CUI) were examined, with repeat CUI after 16 weeks of treatment. Demographic and lifestyle data were collected, as well as physical examination and fasting venous blood samples. Total cholesterol, low density lipoprotein cholesterol (LDL-C) and triglycerides decreased significantly (p < 0.0001), while high density lipoprotein cholesterol (HDL-C) increased significantly (p < 0.0001) during the intervention. The mean decrease in IMT of the right and left common carotid arteries (CCAs) was 0.35 and 0.38 mm, respectively (p < 0.05 for each). Age and lipid profile parameters were significant predictors of change in CIMT in linear regression analyses after adjustment for established atherosclerosis risk factors. Conclusions: Treatment with rosuvastatin in adults with evidence of subclinical atherosclerosis significantly reduced the CIMT of both CCAs, as well as improving lipid and lipoprotein levels.     

脑梗死患者同型半胱氨酸与颈动脉内膜中层厚度的关系

【摘要】目的探讨脑梗死患者血浆总同型半胱氨酸（tHcy）与颈动脉内膜中层厚度（CIMT）的关系。方法从急性脑梗死住院患者中选取tHcy 水平≤10μmol/L（非Hhcy组）、tHcy 水平>10μmol/L且≤15μmol/L（H1组）、tHcy 水平>15μmol/L（H2组）的患者各60例,测量3组患者CIMT,并检测三酰甘油（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、空腹血糖（FBS）、叶酸（FA）、维生素B12 （VitB12）、糖化血红蛋白（HbA1c）等临床生化指标。结果3组患者CIMT差异有统计学意义（P<0.01）,其中H2组[0.98（0.90,1.05）mm ]与非 Hhcy组[0.85（0.80,0.95）mm]、H2组与H1组[0.85（0.85,0.95）mm]比较均增加（均P<0.05）。3组患者tHcy、FA、VitB12 水平差异有统计学意义。以CIMT的常用对数为因变量进行多重线性逐步回归分析,结果显示年龄增长、吸烟史、糖尿病史、LDL-C升高、tHcy升高与CIMT增加有关。结论伴有tHcy水平升高的脑梗死患者常有FA、VitB12水平降低,CIMT增加,且当tHcy 水平>15μmol/L时CIMT明显增加,脑梗死患者CIMT增加与部分脑血管病危险因素有关。     

社会牙周治疗需要指数与血脂的相关性研究

目的 了解社会牙周治疗需要指数与血脂水平的关系.方法 1 879名来大庆油田总医院进行健康体检者被纳入本项研究.所有实验对象均取静脉血检测胆固醇、甘油三酯、高密度脂蛋白胆固醇,低密度脂蛋白胆固醇.牙周状况采用牙周治疗需要指数评价.校正了性别、吸烟情况、血糖、年龄、体重指数、舒张压等影响因素后,对牙周治疗需要指数与血脂水平进行相关性分析.结果 牙周治疗需要指数与血清总胆固醇、低密度脂蛋白存在正相关,且具有统计学意义.牙周治疗需要指数与血清高密度脂蛋白、甘油三脂不存在统计学意义的相关关系.结论 牙周病的严重程度与血清总胆固醇、低密度脂蛋白的水平有关,牙周病对血脂水平的影响可能是其促成动脉粥样硬化的病变基础.     

EFFECTS OF OESTROGEN AND PROGESTERONE ON AGE-RELATED CHANGES IN ARTERIES OF POSTMENOPAUSAL WOMEN

1. Hormone replacement therapy (HRT) with oestrogen or oestrogen plus progestin may have different effects on arterial structure and function. To examine this question, carotid artery intima-medial thickness (IMT) and indices of systemic and carotid arterial compliance were measured in groups of older men, postmenopausal women not on HRT (non-HRT) and those women on long-term HRT with oestrogen alone (HRT-E) or oestrogen plus progestin (HRT-EP). 2. Sixty men, 90 postmenopausal women taking HRT and 91 not taking HRT participated in the study. The groups were similar for age, body mass index, numbers of smokers, physical activity, alcohol intake and blood pressure. 3. Plasma total cholesterol was reduced and high-density lipo-protein-cholesterol was increased in the HRT group compared with the non-HRT group; low-density lipoprotein-cholesterol, triglyceride and lipoprotein (a) values were similar in these two groups. Results for HRT-E and HRT-EP subgroups were similar. 4. Carotid IMT was significantly reduced in the HRT group compared with men and non-HRT groups. Results for HRT-E and HRT-EP subgroups were similar. 5. Mean systemic arterial compliance (SAC) was significantly greater in men than in women and was related to age; SAC was higher in both HRT-E and HRT-EP groups compared with the non-HRT group. Indices of carotid stiffness were similar in men and in non-HRT groups. The HRT-EP group showed increased carotid stiffness compared with the HRT-E group. 6. There is an apparent protective effect of long-term oestrogen therapy on carotid IMT and age-related changes in arterial stiffness. Progestin does not alter the IMT effects but may adversely influence arterial stiffness.     

Increased carotid intima-media thickness in patients with inflammatory bowel disease

BACKGROUND: Patients with inflammatory bowel disease have an increased risk of thrombotic complications; moreover, mesenteric microvascular thrombosis has been hypothesized as a contributing factor in the pathogenesis of inflammatory bowel disease. AIM: To assess the extent of subclinical atherosclerosis in inflammatory bowel disease by measuring the intima-media thickness of the common carotid artery. METHODS: Fifty-two patients were enrolled in the study. Patients aged >45 years, with a history of cardiovascular disease and known risk factors for atherosclerosis were excluded from the study. Twenty healthy subjects were studied as controls. Carotid ultrasonography was performed in all patients and controls. intima-media thickness was measured proximal to the carotid bifurcation over both right and left common carotid arteries. The clinical characteristics and the laboratory parameters relevant to disease activity were recorded for all inflammatory bowel disease patients. In particular, plasma homocysteine, a well-known risk factor for thrombosis, was assessed. RESULTS: Common carotid artery intima-media thickness was significantly higher in inflammatory bowel disease patients (0.63 +/- 0.15 mm) compared with controls (0.53 +/- 0.08 mm). Multiple regression analysis revealed a significant association of carotid intima-media thickness with homocysteine levels and age. CONCLUSIONS: Inflammatory bowel disease patients have an increased risk of early atherosclerosis than healthy controls as showed by greater values of carotid intima-media thickness. Homocysteine levels and age resulted independently associated with the increased arterial wall thickness.     

Working women are better responders to beta-blocker monotherapy of mild hypertension than men

The aim of this single-blind study was to compare the efficacy of betaxolol treatment (20 mg/day) on 24-h blood pressure profiles in working men and women with mild hypertension (grade 1 acc. ESH/ESC/JNC 2003), A group of 11 men and 11 women with a mean age 47+/-5 years underwent 24-h blood pressure monitoring after 8 days of placebo and after 20 days of treatment. A significant reduction (p < 0.05) in blood pressure was found for 11 h in men and 15 h in women (systolic) and 9 h in men and 13 h in women (diastolic). There was a tendency for a greater mean reduction in women (9.6/8.0 mmHg in men versus 12.9/7.4 mmHg in women). Diastolic blood pressure variability was significantly reduced in women (9.9 versus 13.1, respectively, p < 0.002) with a tendency for systolic blood pressure variability reduction (13.0 versus 15.1). The smoothness index for systolic blood pressure was higher in women (1.0/0.74 versus 0.64/0.61). A better response for betaxolol treatment 20 mg/day was observed in women in terms of target organ damage: a longer period of significant blood pressure reduction, lower variability and a tendency toward a greater reduction.     

急性脑梗塞和动脉粥样硬化患者的颈动脉B超对照研究

目的探讨颈动脉粥样硬化(CAA)与急性脑梗塞(ACI)和动脉粥样硬化(AS)患者年龄、血压、血糖、血脂、尿酸、C反应蛋白(CRP)等的动脉粥样硬化危险因子之间的关系。方法采用B型血管彩色多谱勒检查的方法,研究86例ACI患者和88例非脑梗塞(NS)患者进行检查,并分析两组患者入院时各项临床观察指标与颈动脉B超结果之间相关关系。为了进一步分析颈动脉斑块的可能机制,所有病例根据颈动脉斑块的有无重新分组为斑块组和无斑块组,并比较重组后的各项观察指标的差异。结果年龄和CRP可能是CAA形成的最主要危险因子(P<0.001;P=0.04),而血压、血糖、血脂、尿酸水平与CAA的关系并不密切。作为CAA重要指标的内-中膜厚度(IMT)也是随着年龄的增长而增厚。结论CAA的发生机制可能有别于全身其他部位的AS。     

应用AHP技术自动测量颈动脉内-中膜厚度的临床研究

目的探讨超声动脉健康评估软件包（AHP）测量颈动脉内-中膜厚度（CIMT）的临床应用价值。方法应用超声动脉健康评估软件自动测量238名健康人的颈总动脉、窦部和颈内动脉的内-中膜厚度和血管年龄,同时进行手动测量,对不同年龄组的测量值进行比较分析。结果不同部位的CIMT不同（窦部〉颈总动脉〉颈内动脉,P〈0.05）。年龄大于60岁组的CIMT明显高于年龄小于60岁的CIMT（P〈0.05）。随着CIMT的增厚,血管年龄亦增大（P〈0.05）。血管年龄随着年龄增大而增大（P〈0.05）,但小于实际年龄（P〈0.05）。自动测量值要明显小于手动测量值（P〈0.05）。结论 AHP能方便准确地测量CIMT,具有应用于临床评估动脉粥样硬化的潜力。