脑血管病及其病因病CBA检测的临床研究

应用CBA，CV-300型脑血管动力学检测仪对脑血管病及其病因病进行检查，发现阳性率均在92.5％，98.46％，其脑血管动力学参数（CVDI）的临床意义特点：脑出血和脑梗塞在急性期均出现明显异常，脑出血的CP增高、脑梗塞的动脉硬化发生率为其特点。同CT对比，CVDI异常与CT定位大多数相一致，且比CT出现得早，存在早期诊断价值，高血压糖尿病的CVDI特点为双侧对称性异常，出现明显不对称性异常，可视为卒中前改变。     

脑出血及高血压的脑血管动力学检测与临床意义

脑循环动力学参数(CVDI)改变的阳性率脑出血为94.3％,高血压为98.4％。其中高血压动态阻力(DR)升高明显.脑出血临界压力增高,而临界压与舒张压差(DP)降低更明显。脑出血CVDI异常与CT诊断一致占71.4％,不一致者血肿侧仍存在着CVDI的异常.脑出血较之高血压CVDI改变的特点为①外周阻力R(?)、颈动脉血流量(Qmean、CP、DP更易发生变化。②运动学四项指标下降更明显.③微循环障碍更明显.④CP增高DP降低。     

老年Ⅱ型糖尿病伴高血压患者的甲襞微循环观察

目的了解老年Ⅱ型糖尿病合并高血压与未合并高血压者的甲襞微循环改变。方法采用ＷＸ—６型多部位微循环显微仪及黑白显示系统;用第一军医大学研制的ＹＪＤ临床微循环图像分析仪进行图像分析。观察２５例合并高血压的Ⅱ型糖尿病（合并高血压组）及２５例未合并高血压（未合并高血压组）Ⅱ型糖尿病患者的甲襞微循环改变。结果两组患者的甲襞微循环均有明显异常,合并高血压者血管畸形更为明显,未合并高血压者血液流态方面异常却更为显著。结论老年人、单纯糖尿病患者、单纯高血压患者均有不同程度微循环障碍。当三者集于一身时,其血流速度却较不伴高血压者快．可能与高血压可使甲襞毛细血管内压力增高,而糖尿病可使微血管壁受损,两者共同作用所致。     

糖尿病患者微循环改变与胆石症

目的 探讨Ⅱ型糖尿病微循环障碍与胆石症的关系。方法 采用病例对照研究，观察４８例Ⅱ型糖尿病合并胆石症的４８例Ⅱ型糖尿病不合并胆石症患者的微循环分值，血清甘油三酯（ＴＧ），总胆固醇（ＴＣ），高密度脂蛋白－胆固醇（ＨＤＬ－Ｃ）。结果 糖尿病合并胆石症组与不合并胆石症组相比，微循环分值较高，ＴＧ，ＴＣ明显增高，而ＨＤＬ－Ｃ无显著变化。结论 微循环障碍，高脂血症是糖尿病患者中胆石症形成的危险因素。     

四肢血管病的甲襞和皮肤微循环临床分析

目的观察７种四肢血管病的甲襞和皮肤微循环的临床特点和特征,旨在拓宽微循环检测在临床的运用和提高临床诊疗率。方法采用ＸＴＷＹ多功能微循环彩色图像分析系统,放大１００倍,观测１１０例７种四肢血管病患者。结果７种四肢血管病的甲壁和皮肤微循环表现分为两大类：（）缺血性微循环障碍（糖尿病性坏疽＞动脉硬化性闭塞症＞血栓闭塞性脉管炎＞肢体动脉痉挛症）;（２）充血性微循环障碍（血栓性静脉炎,红斑性肢痛症,结节性血管炎）。同时,７种四肢血管病临床均有其独特的甲襞和皮肤微循环表现。结论本研究为微循环检测拓宽了思路,为四肢血管疾病的诊断和疗效观察提供了理论依据和客观指标。     

64例Ⅱ例糖尿病患者的甲襞微循环改变和加权积分值分析

本文对64例Ⅱ型糖尿病患者和60例正常人进行了甲襞微循环观察。结果提示:Ⅱ型糖尿病患者甲襞微循环在形态、流态,袢周均较正常人有明显异常。并试述应用SWC—ⅡB型微循环参数测量仪和田牛氏甲襞微循环加权积分表的初步体会。     

苦碟子对Ⅱ型糖尿病血流变及甲襞微循环的影响

目的 探讨苦碟子对Ⅱ型糖尿病血流变和甲襞微循环的影响。方法 33例Ⅱ型糖尿病患者静脉点滴苦碟子注射液600ug/d，疗程13-15d,于治疗前后分别测定上述指标。结果 治疗后血流变异常及微循环障碍显著改善，治疗中未发现严重不良反应，结论 苦碟子能明显改善血流变异常及微循环障碍，在防治糖尿病及其并发症中有重要价值。     

微循环障碍与糖尿病慢性并发症

大多数糖尿病慢性并发症的发病基础是微循环障碍,糖尿病肾病和视网膜病变为其典型代表。微循环障碍包括三个方面:血流动力学异常、微血管病变和血液流变学改变。血流动力学异常一般为微循环障碍的早期表现,此时并发症一般为临床前期。随病程进展出现微血管结构损伤,并有血液流变学改变,多数并发症出现典型病理变化和临床表现。晚期微血管严重破坏,器官功能衰竭。１血流动力学异常糖尿病早期血流动力学改变以微血管血流量增加、压力增高为特征。血流动力学改变在糖尿病肾病的发病中起关键作用,甚至是始动因素。早期糖尿病肾病突出表现为肾小…     

一种脑动静脉畸形的血流动力学集中参数模型及其应用

脑动静脉畸形（脑AVM）是脑血管系统中结构异常的动静脉短路血管组织,其所导致的异常脑循环血流动力学状态是造成脑AVM血管破裂出血和产生某些神经功能障碍以及严重的手术并发症的重要原因之～由于对脑血管内血流动力学参数的临床或实验测量十分困难,利用理论模型来研究脑AVM的血流动力学特征特有助于加深对其病理机理的认识,从而为脑AVM的临床治疗和诊断提供理论依据。本文提出一种改进的脑循环集中参数模型,对脑AvM的几种典型结构所引起的脑血流动力学变化作了分析,模型分析的结果表明,当AVM流量相对较小（300ml／min以下）…     

脑外伤后脑微循环的改变

脑外伤后脑微循环的改变王凡＊综述陈长才＊审校创伤性脑损伤（ＴＢＩ）后都伴随着脑微循环动力学和流变性改变，影响着脑功能障碍的发生、发展和恢复过程。本文就其改变特点作一简要综述。１脑血流的变化脑损伤后的脑血流量（ＣＢＦ）变化是脑外伤后脑微循环改变最主要的...     

176例高血压、冠心病甲襞与球结膜微循环对比研究

本文报告176例心脑血管疾病的甲襞、球结膜微循环改变.其中高血压45例、冠心病86例、高血脂24例、脑动脉梗化21例.结果显示心脑血管疾病眼球结膜微循环的改变比甲襞微循环改变明显.眼球结膜微循环改变为动静脉血管迂曲、血细胞聚集,高血压病人动静脉比例大于1:2,高血脂症脂质沉着.而甲襞微循环改变为畸形管襻大于30%,血细胞聚集,部分病人改变不明显.     

激光多普勒流量计观察单侧输尿管梗阻大鼠双侧肾皮质微循环血流变化

目的:用激光多普勒流量计观察单侧输尿管梗阻大鼠双侧肾皮质微循环血流的变化,探讨梗阻侧肾间质纤维化的发病机制及健侧肾的代偿机制。方法:成年雌性SD大鼠,随机分为假手术组和模型组。假手术组仅将输尿管游离但不结扎离断,模型组行单侧输尿管结扎术。术后第7、14和21天随机选取并处死各组中的6只大鼠,观察双肾病理学改变,并检测双侧肾皮质微循环血流。结果:H-E染色显示假手术组双侧肾各时间点肾单位结构正常,间质无增宽;模型组大鼠梗阻侧肾术后7 d出现早期间质纤维化的病理改变,并随梗阻时间延长逐渐加重;健侧肾小球系膜细胞增生并随代偿时间延长逐渐增多。肾皮质微循环血流,与假手术组比较,模型组大鼠健侧肾皮质微循环血流显著增加,梗阻侧肾皮质微循环灌注量先增加后进行性降低。结论:血液流变学改变、梗阻侧肾皮质微循环血流灌注量进行性减少是肾间质纤维化的发病机制之一;而健侧肾皮质微循环血流灌注量增高,在一定程度上有利于健侧肾的功能代偿。     

Comparison of glycemic response and insulin requirements after mixed meals of equal carbohydrate content in healthy,type-1, and type-2 diabetic man

Summary The postprandial insulin requirements after three mixed meals of equal carbohydrate and energy content were assessed in 10 type-1 and 12 type-2 diabetics by a glucose-controlled insulin infusion system. These were compared with the glycemic response to the same meals of 10 healthy individuals (glycemic index). In type-1 diabetics, we found the highest insulin requirements after consumption of a continental breakfast (low fibre, low protein, high fat). Ten percent less insulin was infused after milk (low fat, high protein) and 30% less after an English breakfast (high fibre, high protein). Type-2 diabetics showed no significant differences in insulin requirements between the three test meals. The glycemic response in healthy individuals had no relation to these insulin requirements. Continental and English breakfast had a similar glycemic effect, whereas milk produced only 30% of the blood glucose response observed after the continental breakfast. These results indicate that neither the carbohydrate content (exchange lists) nor the glycemic index enable prediction of postprandial insulin requirements in insulin-deficient diabetes. For this purpose, we propose the insulin-need index, elaborated by testing whole meals in closed-loop experiments with type-1 diabetics.     

Subjective quality of life of outpatients with diabetes: comparison with family caregivers' impressions and control group

BACKGROUND: There is a paucity of studies on comparison of quality of life (QOL) of type-1 and type-2 diabetes patients, and the impact of family caregivers' impressions on the QOL of patients. OBJECTIVES: To assess the subjective QOL of Sudanese diabetics using the WHOQOL-Bref, compared with a general population sample; examine caregiver-patient concordance; and assess the variables that impact on QOL. METHOD: The responses of 105 outpatients with type-1 diabetes and 136 with type-2 diabetes were compared with their family caregivers' impressions and 139 general population subjects. RESULTS: Patients were predominantly dissatisfied with their life circumstances. Type-1 diabetics had significantly lowest QOL scores, while the control group had highest scores. Having additional medical problems; having diminished sexual desire; and being young, unemployed and single were associated with poor QOL, but illness duration was not. Type-2 diabetics had lesser concordance with caregivers. The only predictor of patients' QOL was the caregivers' impression of patients' QOL. CONCLUSIONS: Caregivers' impression of patients' QOL impacted on outcome. Caregiver education is, therefore, important. The factors associated with QOL indicate a group that needs focused attention. The good QOL for type-2 and nonsignificance of illness duration encourage therapeutic optimism.     

Left ventricular diastolic function in normotensive type-2 diabetic subjects

BACKGROUND: Most previous studies on diastolic function in diabetics are confounded by coexisting ischemic heart disease, obesity and hypertension. Therefore, there may be advantages in studying patients with diabetes mellitus in developing nations where confounding variables are less prevalent. The aim of this study was to assess the effect of type-2 diabetes mellitus on left ventricular diastolic function in normotensive subjects in Nigeria. METHODS: One-hundred-twenty-two patients with type-2 diabetes mellitus aged 35-74 years with a mean age of 55.30 +/- 8.53 years were studied. Patients with blood pressure > or =140/90 mmHg or on treatment for hypertension were excluded from the study. Ninety-one healthy volunteers aged 40-75 years with a mean age of 55.30 +/- 8.56 years were recruited as normal controls. Transthoracic echocardiography was performed in all subjects to assess their left ventricular diastolic filling pattern by analyzing mitral and pulmonary flow velocities. RESULTS: Seventy-one (58%) of the type-2 diabetic subjects had evidence of impaired relaxation, 9 (7%) had pseudonormal filling and 7 (6%) had a restrictive filling pattern. Only 29% of the diabetics had a normal filling profile compared to 58% of the normal controls (X2 = 19.4, p = 0.0002). CONCLUSIONS: The result of the study shows that Nigerian type-2 diabetics have impaired left ventricular filling compared with normal subjects independent of confounding factors such as obesity and blood pressure. Therefore, not only Caucasians, African Americans and Asians but also African diabetic subjects suffered from diastolic dysfunction.     

Cerebrovascular disease in sickle cell anemia patients

The cerebrovascular disease is a common complication in Sickle Cell Anemia (SCA). The objective of the present work was to determine the incidence of cerebrovascular disease in patients with SCA, through physical and radiological examination. Twenty one patients between 5 and 18 years were studied, homozygous SS, with or without history of neurologic manifestations, at the "Instituto Hematológico de Occidente, Maracaibo-Venezuela". A clinical history, neurological clinical examination and Cerebral Magnetic Resonance (CMR) were carried out on each patient. CMR showed findings of cerebrovascular disease (CVD) of the ischemic type, in 5 of 21 (23.8%) patients, 3 of them presented neurological alterations (2 with spastic hemiparesis and one with spastic tetraparesis); the other 2 presented silent CVD). The most affected artery was the cerebral media. We suggest to carry out a neurological evaluation (clinic and images) in patients with SCA, once a year, in order to detect early abnormalities of the central nervous system and to offer timely and adequate therapies, avoiding important sequels for the patient normal life development.     

Vascular abnormalities: the insidious pathogenesis of Alzheimer's disease

Alzheimer's disease (AD) and cerebrovascular dementia (CVD) are two major causes of senile dementia in elderly individuals. Mounting evidence from epidemiological, clinical, and neuropathological studies suggests that there is considerable overlap between AD and CVD with respect to risk factors, prevalence, and pathological changes. Although our lack of understanding on the important contribution of vascular disturbance to pathogenesis of AD has further hindered our understanding of AD, data on the roles of cerebrovascular diseases and systemic vascular diseases in AD need to be carefully analyzed to avoid misinterpretation. Here, we review studies on the cerebral vasculature, cardiac vasculature, and apoE that lead us to contend that vascular abnormalities are likely an important mechanism underlying dementia. Because early and aggressive intervention is available to prevent and treat a number of vascular diseases, therapies that attenuate vascular risk factors could be valuable in preventing and treating AD.     

糖尿病的血液流变性改变与其微循环障碍的关系

目的：探讨糖尿病血液流变性与微循环的关系。方法：检测35例糖尿病患者甲壁微循环、血液流变指标，与35例正常人对照。结果：（1）非胰岛素依赖型糖尿病（NIDDM）组全血高、低切粘度和高、低切还原粘度及血浆粘度均显著高于对照组（P＜0．01～0．001），而胰岛素依赖性糖尿病（IDDM）组上述各粘度指标仅轻度增高（P＞0．05）；（2）糖尿病各组及不同并发症组均有微循环血流减慢，红细胞刚性增高、电泳率降低、聚集性增强，白色微血栓等指标显著异常（P＜0.05～0.001）；（3）NIDDM组及并发症组微血管畸形数增多，管袢长度增加，微血管周围有明显渗出及出血等形态和管周指标的改变（P＜0.05～0.001）。结论：（1）各型糖尿病患者均有不同程度微循环障碍及血液流变性异常。（2）甲襞微循环障碍与血液流变性异常有一定的相关性。