老年高血压患者颈动脉内膜中层厚度与基质金属蛋白酶9及其组织型抑制剂1水平的关系

目的 探讨老年高血压患者颈动脉内膜中层厚度(IMT)与血清基质金属蛋白酶9(MMP-9)及基质金属蛋白酶组织型抑制剂1(TIMP-1)的相关性.方法 选择老年高血压患者135例作为高血压组,并按24 h动态脉压分为4个亚组,脉压≤40 mm Hg(1 mm Hg=0.133 kPa)为A组14例、41～60 mm Hg...     

Low testosterone levels are associated with carotid atherosclerosis in men

Objective. To study the relationship between endogenous sex hormone levels and intima‐media thickness (IMT) of the carotid artery measured by ultrasonography. Design. Population‐based cross‐sectional study. Methods. Sex hormone levels measured by immunoassay, anthropometric measurements and IMT was studied in 1482 men aged 25–84 years participating in the 1994–1995 Tromsø study. The data were analysed with partial correlation, multiple linear regression and logistic regression analysis. Results. Linear regression models showed that total testosterone and sex hormone‐binding globulin levels, but not calculated free testosterone, serum oestradiol or dehydroepiandrosterone sulphate levels were inversely associated with the age‐adjusted IMT (P = 0.008 and P < 0.001 respectively). These associations were independent of smoking, physical activity, blood pressure and lipid levels, but were not independent of body mass index (BMI). Excluding men with cardiovascular disease (CVD) did not materially change these results. In a logistic regression model adjusted for the confounding effect of CVD risk factors, men with testosterone levels in the lowest quintile (<9.0 nmol L^?1) had an independent OR = 1.51 (P = 0.015) of being in the highest IMT quintile. Conclusions. We found an inverse association between total testosterone levels and IMT of the carotid artery in men that was present also after excluding men with CVD, but was not independent of BMI. The clinical relevance of this, however, is uncertain and needs to be investigated in a clinical setting.     

新疆地区高血压患者血浆同型半胱氨酸水平与颈动脉粥样硬化的关系研究

目的探讨新疆维吾尔族和汉族高血压患者血浆同型半胱氨酸(Hcy)水平与颈动脉内膜中层厚度(IMT)及颈动脉粥样硬化之间的关系。方法入选2011年至2015年期间在新疆医科大学第一附属医院老年病科住院的原发性高血压患者420例,入选同期入院的健康体检人群405例作为对照。依据研究对象的民族及是否患有高血压分为4组:维吾尔族高血压组(n=206),维吾尔族对照组(n=202),汉族高血压组(n=214)和汉族对照组(n=203)。采用酶联免疫吸附实验测定血浆Hcy水平,彩色多普勒超声测定颈动脉IMT。结果民族内比较结果显示,相比对照组,高血压组体质量指数(BMI)、收缩压(SBP)、舒张压(DBP)、Hcy水平高,叶酸(FA)水平低,颈动脉IMT增厚,粥样硬化斑块发生率高,差异均具有统计学意义(P0.05)。民族间比较结果显示,维吾尔族和汉族高血压患者间年龄、性别、尿酸(UA)、甘油三酯(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)、FA、维生素B_(12)、Hcy水平、颈动脉IMT和粥样硬化斑块发生率差异无统计学意义(P0.05)。Hcy与年龄、TC、LDL-C、SBP呈正相关,与FA呈负相关。颈动脉IMT与年龄、TC、LDL-C、SBP、Hcy呈正相关,与FA呈负相关。结论高Hcy血症、年龄、TC、LDL-C是新疆维吾尔族和汉族高血压患者颈动脉粥样硬化的危险因素。     

Maximum home systolic blood pressure is a marker of carotid atherosclerosis

ABSTRACT

Background: Maximum home systolic blood pressure (maximum SBP) has been reported as a parameter of blood pressure (BP) variability. We tested the hypothesis that maximum SBP is one of the risk factors of hypertensive target organ damage (TOD).

Methods: We conducted a cross-sectional study of 4,310 subjects with>1 cardiovascular risk factor. The subjects measured their home BP for 14 consecutive days. Mean and maximum SBPs were used as independent variables. As dependent variables, we used left ventricular mass index (LVMI), brachial-ankle pulse wave velocity (baPWV), maximum carotid intima-media thickness (CIMT), and urine albumin creatinine ratio (UACR).

Results: In a multiple regression analysis, the subjects' mean and maximum SBPs were significantly associated with the above TOD markers. Compared to mean SBP, maximum SBP demonstrated a significantly stronger association with CIMT (p<0.001).

Conclusion: Based on its clinical significance herein, measurement of maximum home SBP is warranted in addition to measurement of mean home SBP.     

上海城镇人群颈动脉内中膜厚度与血脂的相关性研究

动脉粥样硬化是心脑血管病的重要危险因素[1]。脂代谢紊乱在动脉粥样硬化的发生和发展中具有重要的作用[2]。通过超声测量颈动脉内中膜厚度(CIMT)是估计早期动脉粥样硬化程度的非侵袭性方法,可作为反映早期全     

血脂康胶囊对老年颈动脉粥样硬化患者CIMT、血脂、CD40/CD40L、MMP-9的影响

目的 观察老年颈动脉粥样硬化(CAS)患者行血脂康胶囊治疗前后的颈动脉内膜中层厚度(CIMT)、血脂、白细胞分化抗原40及其配体(CD40/CD40L)和基质金属蛋白酶9(MMP-9)变化,探讨血脂康胶囊对患者上述指标的影响.方法 选择CAS患者60例(GAS组),其中合并脑梗死(CI)34例;健康体检者20例(对照组).CAS组用血脂康胶囊治疗24周,治疗前后行颈CIMT检测,采用ELISA法检测血清CD40/CD40L和MMP-9,并行血脂检测.对照组在查体时检测上述指标.结果 与对照组比较,CAS组CIMT及血清CD40、CD40L、MMP-9明显升高(P＜0.05或＜0.01);CAS合并CI患者的CIMT及血清CD40、CD40L、MMP-9较无CI患者明显升高,CAS组治疗前后的CIMT及血清CD40、CD40L、MMP-9比较有统计学差异(P均＜0.05).结论 血脂康胶囊可通过调节血脂水平,降低CAS患者的CIMT及血清CD40、CD40L、MMP-9,从而延缓CAS进展,减少CI发生率.     

老年糖尿病患者颈动脉硬化的相关危险因素分析

目的 分析影响老年糖尿病患者颈动脉硬化的危险因素.方法 分析2015年7月-2020年6月安徽医科大学附属巢湖医院内分泌科门诊收治95例2型糖尿病患者的病例资料,根据是否存在颈动脉粥样硬化分为颈动脉粥样硬化组(n=56)和非颈动脉粥样硬化组(n=39).收集2组患者临床基本资料、体格检查结果、生化指标和颈动脉内-中膜厚...     

Carotid and femoral atherosclerosis, cardiovascular risk factors and C-reactive protein in relation to smokeless tobacco use or smoking in 58-year-old men

Objectives. To examine the associations between smokeless tobacco use, smoking, cardiovascular risk factors, inflammation and ultrasound-assessed measures of atherosclerosis in the carotid and femoral arteries. Subjects. The study was performed in a population-based sample of clinically healthy men (n = 391) all 58 years old. Exclusion criteria were cardiovascular or other clinically overt diseases or continuous medication with cardiovascular drugs. Methods. The habits of smoking and oral moist snuff use were assessed by questionnaires. C-reactive protein (CRP) was assessed by high sensitive enzyme-linked immunosorbent assay (ELISA). Intima-media thickness (IMT) in the carotid bulb, the common carotid artery and the common femoral artery and plaque occurrence were measured by ultrasound. Results. The use of oral moist snuff was associated with serum triglycerides and waist-hip ratio (WHR), but not with CRP or ultrasound-assessed measures of subclinical atherosclerosis. Smoking, on the other hand, was associated with CRP, the components in the metabolic syndrome and IMT as well as plaques in the carotid and femoral arteries. In comparison to never-smokers the current smokers had higher values of WHR, triglycerides, C-reactive protein and IMT in carotid bulb and femoral artery. Ex-smokers were in general more obese and had a femoral IMT that was in-between that of never-smokers and current smokers. Conclusions. Tobacco smoking, but not oral moist snuff use, was associated with carotid and femoral artery IMT, and increased levels of CRP. Current smoking was also associated with abdominal obesity. Ex-smokers though, are generally more obese. Smoking was also associated with hyperinsulinaemia, dyslipidaemia and high blood pressure, i.e. the metabolic syndrome. The inhaled smoke from the combustion of tobacco seems to be an important aetiological factor in the atherosclerotic process.     

Glycemic and blood pressure control in older patients with hypertension and diabetes: association with carotid atherosclerosis

Backgroud Numerous studies have confirmed the effectiveness of slowing the progression of atherosclerosis by blood pressure (Bp) control in patients with hypertension and several studies also showed the efficacy of intensive glycemic control in decreasing progression of carotid intima-media thickness (CIMT) in patients with type 1 and type 2 diabetes. However, few studies have compared the relative importance of glycemic vs. Bp control in patients with diabetes and hypertension. We aimed to investigate the association between Bp and glycemic control and subclinical carotid atherosclerosis in older patients with hypertension and type 2 diabetes. Methods In a cross-sectional study, B-mode high-resolution ultrasonography of the carotid artery was performed in 670 subjects (508 males and 162 females) aged 60 years or over who had self-reported hypertension and diabetes but no history of coronary heart disease or stroke. Subjects were categorized by their systolic blood pressure: tight control, < 130 mmHg; usual control, 130–139 mmHg; or uncontrolled, ≥ 140 mmHg, and by their hemoglobin A1c (HbA1c) level: tight control, < 6.5%; usual control, 6.5%–7.5%; or uncontrolled, ≥ 7.5%, respectively. Results The mean CIMT was 8.20 ± 0.11 mm, and carotid plaque was found in 52.5% (352/670) subjects. Overall, 62.1% of the subjects had subclinical carotid atherosclerosis, defined as having either carotid plaque or elevated CIMT (≥ 1.1 mm). The mean CIMT was significantly different between Bp control categories (7.60 ± 0.09 mm, 7.90 ± 0.08 mm, and 8.60 ± 0.12 mm, respectively, P = 0.03) but not between glycemic control categories (8.20 ± 0.10 mm, 8.1 ± 0.08 mm, and 8.40 ± 0.14 mm, respectively, P = 0.13) using ANCOVA analysis. Multivariable logistic regression adjusting for potential confounding factors showed that usual or uncontrolled Bp control were associated with having carotid plaque (OR = 1.08 and OR = 1.42, respectively), or elevated CIMT [Odd ratio (OR) = 1.17, 95% confidence interval (CI) 1.04–2.24, and OR = 1.54, 95% CI 1.36–2.96, respectively compared to tight Bp control; but did not show glycemic control as independent predictor of either having carotid plaque or elevated CIMT. Conclusions In older patients with hypertension and diabetes, blood pressure control, but not glycemic control is associated with subclinical carotid atherosclerosis.     

Determinants of femoral and carotid artery atherosclerosis

Abstract. Objectives . The aim of the study was to find the most important determinants of early atherosclerosis in the carotid and femoral arteries. Design . Carotid and femoral maximal intima media thickness (IMT) was measured 19 months after the first of 4 risk factor measurements. Setting . Department of Community Health and General Practice, University of Kuopio, and Occupational Health Care in Pyhäsalmi Mine, Finland. Subjects . The subjects comprised 60 male volunteers aged from 32 to 65 years from amongst 277 workers at the Pyhäsalmi Mine, Finland. Subjects were invited for an ultrasound examination, in order of serum total cholesterol content, until the required figure of 60 cases was achieved. Main outcome measures . Carotid and femoral maximal intima media thickness. Results . Systolic blood pressure (P < 0.01), serum total cholesterol (P < 0.01), age (P = 0.01) and pack-years smoked (P = 0.02) were independent determinants of maximal carotid artery IMT, and total cholesterol (P = 0.01), age (P = 0.03) and pack-years smoked (P = 0.01) for maximal femoral artery IMT. For the latter, plasma fibrinogen concentration (P = 0.10) was the next factor to enter the multiple regression model. Body mass index, heart rate, serum HDL cholesterol, triglycerides, urate, apolipoprotein A,*** antithrombin III, lipid peroxides, vitamin E and plasma vitamin C had no significant association with either maximal carotid or femoral IMT or the mean of the carotid and femoral IMT. Conclusions . Systolic blood pressure, serum total cholesterol, age and pack-years smoked are the most important determinants of early atherosclerosis in the carotid artery and total cholesterol, age and pack-years smoked in the femoral artery. Prevention should take into consideration these findings. The role of plasma fibrinogen and oxidized low density lipoprotein would require re-evaluation in larger populations studied longitudinally.     

上海郊区人群血尿酸与颈动脉内中膜厚度相关性分析

近年来,动脉粥样硬化的发生率升高,其是心脑血管病变的重要危险因素。通过超声测量颈动脉内中膜厚度(CIMT)是评估早期动脉粥样硬化程度的非侵袭性方法,可作为反映早期全身动脉粥样硬化的指标。近期研究显示,血尿酸增高为心脑血管病变的独立危险因素。本研究旨在分析上海市郊区40岁以上社区人群血尿酸与颈动脉内中膜厚度的相关性。     

老年人颈动脉粥样硬化与外周血白细胞及分类计数的关系

目的探讨老年人颈动脉粥样硬化(CAS)与外周血白细胞(WBC)及分类计数、C-反应蛋白(CRP)的关系。方法收集192名健康体检老年人的颈动脉、实验室检测、人体学指标及骨密度检测数据,根据有无CAS进行分组,进行统计对比分析。结果老年人CAS的总体患病率为61.98%。CAS组与无CAS组比较,年龄、脉压(PP)、WBC计数、中性粒细胞(N)计数、CRP、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FBG)、骨质疏松等因素差异有统计学意义(P0.05)。Logistic回归分析显示年龄、LDL-C、FBG、N计数等因素为CAS的独立危险因素。结论 WBC计数、N计数及CRP等炎症标志物对CAS有一定预测作用,具有一定的临床意义。     

Asymmetric dimethylarginine is associated with carotid atherosclerosis in patients with essential hypertension

Abstract

This study was to assess the relationship between asymmetric dimethylarginine (ADMA) and carotid atherosclerosis in patients with essential hypertension. A total of 182 individuals with never-treated essential hypertension and 182 age-matched healthy controls were studied. Plasma ADMA levels, mean intima-media thickness (IMT) and plaque score were significantly greater in hypertensive patients than normotensive controls. ADMA was positively correlated with mean IMT. On multiple logistic regression analysis, ADMA was a crucial independent predictor of carotid plaque formation (plaque score ≥1.1). Our results suggest that increased levels of ADMA are associated with the development of carotid atherosclerosis in hypertensive patients.     

冠心病患者颈动脉粥样硬化与冠状动脉造影的关系

目的评价颈动脉粥样硬化与冠状动脉性心脏病(冠心病)的关系。方法对冠状动脉造影证实的冠心病患者153例(冠心病组)和非冠心病者(正常组)42例进行双侧颈动脉超声检查,测定血管后壁内膜-中膜厚度(inteima-media thickness,IMT),记录斑块数目,并计算斑块积分,同时冠心病组按血管狭窄累及主要病变血管支数分为单支病变亚组(63例)、双支病变亚组(49例)、3支病变亚组(41例)。结果冠心病组斑块发生率[68%(104/153) vs.11.9%(5/42),P<0.05]、颈动脉IMT[(1.11±0.19)mm vs.(0.82±0.06)mm,P<0.05]、斑块积分[(5.03±3.33)分vs.(1.11±0.75)分,P<0.05]和Gensini评分[(21.7±10.3)分vs.(0.0±0.0)分,P<0.05]比正常组高,差异有统计学意义。冠心病3支病变亚组和双支病变亚组斑块发生率、颈动脉IMT、斑块积分和Gensini评分均比单支病变亚组高,差异有统计学意义(P<0.05)。冠心病、原发性高血压、糖尿病、低密度脂蛋白、吸烟、肥胖与颈动脉IMT呈显著正相关(P<0.05)。结...     

Pravastatin intervention trial on carotid artery atherosclerosis in patients with mild hypercholesterolemia: the CAIUS study

The Carotid Atherosclerosis Italian Ultrasound Study (CAIUS) is a multicenter double-blind, placebo-controlled randomized investigation of the effects of Pravastatin on progression of asymptomatic carotid atherosclerosis in outpatients with moderate hypercholesterolemia and without symptoms or signs of coronary heart disease. Intima-Media Thickness changes of the carotid arteries will be evaluated by B-mode ultrasound imaging. This method allows the detection and monitoring of early lesions and their evolution over time. The study involves approximately 305 patients with moderate hypercholesterolemia, and at least one asymptomatic and uncomplicated early carotid artery lesion. Randomized subjects are in the age range between 45 and 65 yrs. For women a natural or artificial menopause was mandatory. The subjects were randomized to receive either a placebo or an HMG CoA reductase inhibitor (Pravastin 40 mg OD), known to act selectively and primarily on liver cholesterol biosynthesis. The patient follow-up of CAIUS will have a duration of at least 36 months. Every 6 months participating subjects are being monitored by B-mode ultrasound as described in the protocol requiring training and certification of sonographers/readers and centralized reading. The study offers a unique opportunity to monitor the natural history of asymptomatic carotid lesions in hypercholesterolemic patients, as well as to evaluate the effect of a potent cholesterol-lowering medication on progression or regression of carotid atherosclerosis.     

Descriptive study of the relationship between the subclinical carotid disease and biomarkers,carotid femoral pulse wave velocity in patients with hypertension

Background: Carotid intima-media thickness (cIMT) is a significant early prediction signal for preclinical atherosclerosis. Plasma homocysteine (Hcy) level is an independent risk factor for cardiovascular diseases. Pulse wave velocity (PWV), an index of arterial stiffness (AS), has showed its value in the evaluation of AS in vascular-related diseases. The data regarding the relationships between cIMT and other indices of vascular damage are limited and partly controversial. We aim to investigate the relationships between cIMT and other indices of vascular damage such as Hcy and carotid femoral PWV (CF-PWV). Methods: In total,1188 (male/female 514/674) subjects with hypertension from Vascular Medicine of Peking University Shougang Hospital were enrolled into our study. The patients with hypertension were measured bilateral cIMT by B-mode ultrasound and measured plasma levels of Hcy, total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), C-reactive protein (CRP), glucose, and other biomarkers. Plaques were detected in 78% of the study patients. Plasma Hcy (p < 0.001), CRP (p <  0.001), LDL (p < 0.001), HDL (p = 0.008), TC levels (p < 0.001), and CF-PWP (p < 0.001) were significantly greater in hypertensive patients with carotid plaques than patients without. The carotid plaque detection rate (p < 0.001) and bilvertebral artery max velocity (p < 0.05) were significantly different in quartiles of plasma Hcy levels. R-IMT correlated significantly with HCY, high sensitive CRP (hs-CRP), CF-PWV, and R-vertebral artery intimal diameter. Age (p < 0.001) and CF-PWV (p < 0.05) predicted the presence of carotid plaques independently in the logistic regression. However, Hcy did not independently predict the presence of carotid plaques in the logistic regression. Conclusion: Increased carotid femoral PWV and elevated plasma Hcy levels are associated with subclinical carotid disease in hypertensive patients. CF-PWV independently predicted subclinical carotid plaque in the patients with hypertensive. While, there is insufficient evidence for Hcy in predicting plaque incidence.     

颈动脉粥样硬化与血管性痴呆的相关性分析

目的探讨颈动脉粥样硬化对血管性痴呆发生、发展的影响。方法对61例血管性痴呆（VaD）患者（VaD组）及70例健康体检者（对照组）行高频超声检查,测定其颈总动脉、颈内动脉内-中膜厚度（IMT）及内径,颈动脉粥样硬化斑块的发生情况及斑块性质,采用全自动生化分析仪测定血TC、TG、HDL—C及LDL-C水平。结果VaD组颈总动脉IMT及颈内动脉IMT均明显大于对照组,颈总动脉及颈内动脉内径均明显小于对照组（P均〈0．05）;VaD组斑块发生率明显高于对照组（P〈0．05）;TC、TG、LDL-C水平均明显高于对照组、HDL-C明显低于对照组（P均〈0．05）。结论颈动脉粥样硬化形成与VaD的发生密切相关。     

超声检测股动脉、腹主动脉及颈动脉粥样硬化与冠状动脉粥样硬化的相关性

目的:探讨股动脉、腹主动脉及颈动脉粥样硬化与冠状动脉粥样硬化的相关性。方法: 采用高频超声测量109例行冠状动脉造影术后1周的患者股动脉、腹主动脉及颈动脉的内-中膜厚度（IMT）、斑块积分及斑块数目。结果: 股动脉、腹主动脉及颈动脉粥样硬化与冠状动脉粥样硬化呈正相关（P<0.01、P<0.05）;股动脉斑块预测冠状动脉粥样硬化的灵敏度为89%,特异度为77%,准确度84%;腹主动脉斑块预测冠状动脉粥样硬化的灵敏度为73%,特异度为72%,准确度72%;颈动脉斑块预测冠状动脉粥样硬化的灵敏度为83%,特异度为79%,准确度82%。结论: 超声检查股动脉、腹主动脉及颈动脉IMT及斑块可间接预测不同程度的冠状动脉粥样硬化;股动脉的灵敏度与准确度较腹主动脉更好。