急性腔隙性脑梗死与颈部动脉狭窄的相关性及危险因素分析

探讨急性腔隙性脑梗死与颈部动脉狭窄的关系以及LI发病的危险因素。方法 选取2015年6月~2018年4月在宁波市第二医院神经内科确诊的急性LI患者162例,根据发现的梗死病灶数目分为A组（病灶数目≤3个）115例和B组（病灶数目＞3个）47例,记录病灶的位置、数目,同时选取75例阴性患者为对照组,记录颈部动脉狭窄情况,分析急性LI发病与颈部动脉狭窄的相关性,以及患者的年龄、性别、严重心律失常、高血压病、糖尿病、高脂血症、嗜烟、酗酒等因素与LI发病的关系。结果 A组与B组病灶的分布比较,差异无统计学意义（P＞0.05）,A组、B组与对照组之间的颈部动脉狭窄率比较,差异有统计学意义（P＜0.05）,但狭窄位置差异无统计学意义（P＞0.05）。急性LI病灶数量与动脉狭窄程度的Spearman相关系数为0.25（P＜0.05）。急性LI发病的独立危险因素是糖尿病（OR=2.391,P＜0.05）和嗜烟（OR=2.865,P＜0.05）。结论 急性LI病灶数目与颈部动脉狭窄程度存在弱正相关性,有效控制血糖水平、尽早戒烟可能对急性LI的二级预防有利。     

颈内动脉扭曲危险因素的研究

目的：探讨颈内动脉（ ICA ）扭曲与血管危险因素之间的关系。方法回顾性分析2013年6月-2014年1月接受DSA或头颈部CTA检查的87例患者的临床资料。按ICA有无扭曲分为扭曲组（40例）和对照组（47例）,对比两组患者的年龄、性别以及高血压病、糖尿病、高脂血症、缺血性心脑血管病、吸烟史等危险因素与ICA扭曲的相关性。结果两组患者在性别、吸烟史以及糖尿病、高脂血症以及缺血性心脑血管病患病率等方面比较,差异均无统计学意义（P值均〉0.05）;扭曲组患者年龄、高血压病患病率均大于对照组,差异均有统计学意义（P值均〈0.05）。多因素Logistic回归分析结果显示,年龄和高血压病与ICA扭曲的发生具有相关性。结论年龄和高血压病是ICA扭曲发生的危险因素,可能参与了ICA扭曲的发生发展过程。     

Prevalence of asymptomatic carotid stenosis in Korea based on health screening population

We attempted to investigate the prevalence and risk factors of carotid artery stenosis in Korea. Twenty thousand seven hundred twelve individuals who underwent carotid artery ultrasonography for health screening between March 2005 and March 2010 were retrospectively evaluated. The population was divided into four groups, according to the degree of stenosis, as Group A, below 29%; Group B, 30% to 49%; Group C, 50% to 74%; Group D, above 75%. The medical records of the individuals were investigated, and Fisher's exact test, chi-square tests, Kruskal-Wallis tests and a binary logistic regression model were used for statistical analysis. The prevalence of carotid stenosis was Group B, 5.5%; Group C, 0.9%; Group D, 0.1%. Old age, male gender, hypertension, diabetes mellitus and ischemic heart disease were significantly higher in Groups C and D (P = 0.001, 0.001, 0.001, 0.048, and 0.001, respectively). Among the males aged over 65 yr, the prevalence of carotid stenosis ≥ 50% and ≥ 30% were 4.0% and 18.2%, respectively. Asymptomatic carotid stenosis is not uncommon in Korea. Carotid ultrasonography is necessary for people with above-listed risk factors.     

Heavy snoring as a cause of carotid artery atherosclerosis

STUDY OBJECTIVES: Previous studies have suggested that snoring and obstructive sleep apnea hypopnea syndrome may be important risk factors for the development of carotid atherosclerosis and stroke. However, it is not clear if snoring per se is independently related to the risk of developing carotid atherosclerotic plaque. DESIGN: Observational cohort study. SETTING: Volunteer sample examined in a sleep laboratory. PARTICIPANTS: One hundred ten volunteers (snorers and nonsnorers with only mild, nonhypoxic obstructive sleep apnea hypopnea syndrome) underwent polysomnography with quantification of snoring, bilateral carotid and femoral artery ultrasound with quantification of atherosclerosis, and cardiovascular risk factor assessment. Subjects were categorized into 3 snoring groups: mild (0%-25% night snoring), moderate (> 25%-50% night snoring), and heavy (> 50% night snoring). INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: The prevalence of carotid atherosclerosis was 20% with mild snoring, 32% with moderate snoring, and 64% with heavy snoring (P < 0.04, X2). Logistic regression analysis was used to determine the independent effect of snoring on the prevalence of carotid and femoral atherosclerosis. After adjustment for age, sex, smoking history, and hypertension, heavy snoring was significantly associated with carotid atherosclerosis (odds ratio 10.5; 95% confidence interval 2.1-51.8; P = 0.004) but not with femoral atherosclerosis. CONCLUSIONS: Heavy snoring significantly increases the risk of carotid atherosclerosis, and the increase is independent of other risk factors, including measures of nocturnal hypoxia and obstructive sleep apnea severity. Considering the high prevalence of snoring in the community, these findings have substantial public health implications for the management of carotid atherosclerosis and the prevention of stroke.     

Leukocyte count and cardiovascular risk factors.

In view of the growing evidence for leukocyte count as an important cardiovascular risk factor, data from the first National Health and Nutrition Examination Survey (NHANES I) were examined to determine the association of leukocyte count with a number of other cardiovascular risk factors. Complete data were available for 5586 persons. Multiple linear regression analyses revealed hemoglobin concentration and height in white male nonsmokers and hemoglobin, cigarettes/day, and pulse rate in white male smokers were associated with leukocyte count. In white female nonsmokers, age, pulse rate, systolic blood pressure, height, and uric acid concentration were associated with leukocyte count. In white female smokers, hemoglobin, cigarettes/day, pulse rate, and height were associated with leukocyte count. However, associated variables explained only 8% of the variation in leukocyte count. Other measured risk factors were not associated with leukocyte count. Future analyses of leukocyte count and cardiovascular disease should control for hemoglobin concentration and pulse rate in addition to smoking, blood pressure, and cholesterol.     

Risk factors for cerebral hypoperfusion, mild cognitive impairment, and dementia

Putative risk factors accelerating mild cognitive decline and dementia were correlated with repeated measures of cerebral atrophy, CT, densitometry, perfusions, and cognitive testing among neurologically and cognitively normative aging volunteers. A total of 224 normative subjects at increased risk for cognitive decline were admitted to the study. Mean entry age was 59.5 +/- 15.8 years. Mean follow-up is 5.8 +/- 3.3 years. At follow-up, 22 developed mild cognitive impairment (41 CCSE >/= -3), 19 became demented-8 with Vascular type (VAD), 11 with Alzheimer's type (DAT)-and 183 remain cognitively unchanged. Cerebral atrophy, tissue densities, and perfusions were measured by Xe-CT. After age 60, cerebral atrophy, ventricular enlargement, and polio- and leuko-araiosis geometrically increased as perfusions declined. Risk factors accelerating perfusional decline, cerebral atrophy, polio-araiosis, and leuko-araiosis were: transient ischemic attacks (TIAs), hypertension, smoking, hyperlipidemia, and male gender. At age 71.5 +/- 11.9, mild cognitive impairment began accelerated by TIAs, hypertension and heart disease. Leuko-araiosis began before cognitive decline. TIAs, hypertension, and hyperlipidemia correlated with VAD. Excessive cortical perfusional decrease, gray and white matter hypodensities, and cerebral atrophy correlate with cognitive decline.     

The prevalence and associated risk factors of renal artery stenosis in patients undergoing cardiac catheterization

Renal artery stenosis may be a cause of hypertension and a potential contributor to progressive renal insufficiency. However, the prevalence of renal artery disease in a general population is poorly defined. The purposes of this study were to evaluate the prevalence of angiographically-determined renal artery narrowing in a patient population undergoing routine cardiac catheterization, and to identify the risk factors for renal artery stenosis. After left ventriculography, abdominal aortography was performed to screen for the presence of renal artery stenosis. A total of 427 patients (274 males, 153 females) were studied and the mean age was 59 years. Renal artery narrowing was identified in 10.5% of patients. Significant (> or = 50% diameter narrowing) renal artery stenosis was found in 24 patients (5.6%) and insignificant stenosis was found in 21 patients (4.9%). Significant unilateral stenosis was present in 4.2% of patients and bilateral stenosis was present in 1.4%. The stem of the renal artery was a more common site of stenosis in 62.2% of patients than in the ostium (37.8%), but the severity of stenosis was not significantly different according to the site of stenosis. By univariate and multivariate logistic regression analysis, the association of clinical variables with renal artery stenosis was assessed. Multivariable predictors included age, hypertension and peripheral vascular disease (p < 0.05). The variables such as sex, smoking history, hyperlipidemia, renal insufficiency, as well as the presence of obesity, severity of coronary heart disease and D.M., were not associated. In conclusion, the prevalence of angiographically-determined renal artery narrowing in a patient population undergoing cardiac catheterization is 10.5%. Old age, hypertension and evidence of peripheral vascular disease represent the predictors of renal artery stenosis.     

中青年冠脉严重狭窄分布特点与风险因子的相关性

 目的：对中青年人群冠脉严重狭窄的风险因子进行评价,并进一步探讨各风险因子与病变分布特点的相关性。方法：选择行冠状动脉造影年龄≤60岁患者350例,根据造影结果,分为冠脉严重狭窄组（大于管腔70%）和非严重狭窄组（包括正常者）,进一步将冠脉严重狭窄组按照病变分布划分为累及左主干（LMA）或左前降支（LAD）近或中段组和病变在其它部位组。询问患者病史,化验临床指标,并进行统计学分析。结果：比较冠脉严重狭窄组和非严重狭窄组可见：男性比例大（P<001）,吸烟人数多（P<001）,甘油三酯（TG）、载脂蛋白B(Apo-B)和同型半胱氨酸（Hcy）升高（P<005或P<001）,而载脂蛋白A1(Apo-A1)降低（P<001）。进一步将上述2组从性别角度分析,发现男性和女性组的严重冠脉狭窄者均出现Apo-B和Hcy显著升高;在男性中,冠脉严重狭窄组的糖尿病患病率较高（P<005）,空腹血糖偏高（P<005）;而在女性中,冠脉严重狭窄组的TG明显升高（P<005）。Logistic逐步回归分析表明,男性（OR=2798,95%CI：1520~5152, P<001）、吸烟（OR=3570,95%CI：2125~5996, P<001）、Hcy（OR=1079,95% CI：1028~1133, P<001）和Apo-B（OR=2883,95%CI：1427~5825, P<001）升高是冠脉严重狭窄的独立危险因素。冠脉严重狭窄位置最常见在LMA或LAD近中段,Hcy升高是发生在该常见部位病变的独立预测因子（OR=0911,95% CI：0831~0998, P<005）。结论：男性、吸烟、 Hcy水平升高和Apo-B增加是早发冠脉严重狭窄的4个独立危险因子。Hcy水平升高还进一步预示冠脉病变的分布特征。     

30岁以下急性ST段抬高型心肌梗死患者临床特点分析

目的 探讨30岁以下急性ST段抬高型心肌梗死患者的临床特点。方法 选择首次发病的STEMI患者51例,按年龄分青年组17例（年龄18～30岁）,对照组34例（年龄≥31岁）,对两组人群常见的危险因素、临床特点、冠状动脉病变特点以及发病30 d内主要不良心血管事件发生率进行对比分析。结果 ①青年组中男性、吸烟、合并高血压、合并高脂血症患者比例明显高于对照组,差异有统计学意义（P＜0.05）;青年组体质量指数、左心室射血分数以及血清总胆固醇、甘油三酯、低密度脂蛋白胆固醇水平明显高于对照组,总胆红素水平低于对照组,差异有统计学意义（P＜0.05）;②青年组“罪犯血管”病变类型以单支病变、A型病变为主,对照组多为三支病变、分叉病变、C型病变,差异有统计学意义（P＜0.05）;③青年组发病30 d内梗死后心绞痛、心力衰竭、恶性心律失常的发生率明显低于对照组,差异有统计学意义（P＜0.05）。结论 男性、吸烟、合并高血压、合并高脂血症是30岁以下STEMI患者突出的危险因素,其冠脉病变多为单支、A型病变,发病30 d内临床预后良好。     

Vascular Calcifications Seen on Mammography: An Independent Factor Indicating Coronary Artery Disease

PURPOSE

Establish a relationship between vascular calcifications seen via mammography and coronary artery disease, estimate the risk ratios, and investigate the interrelationships between vascular calcification and other risk factors for coronary artery disease.

MATERIALS AND METHODS

This was a case-control study consisting of 40 women with coronary artery disease in the case group and 40 women without any history of coronary artery disease in the control group who were matched according to age. The study was approved by the Institution’s Research Ethics Committee (consent statement was obtained). Odds ratios and confidence intervals were calculated using univariate analysis. Interrelationships among other risk factors, such as arterial hypertension, dyslipidemia, smoking and diabetes mellitus, were calculated using multivariate analysis. A p <0.05 was considered to be significant for statistical analysis.

RESULTS

The mean ages for the case and control groups were 64.65 years and 63.88 years, respectively. In multivariate analysis, the only variables related to coronary artery disease were Vascular calcification [OR 4.71 (CI 1.36–16.33) p=0.014], family history [OR 5.76 (CI 1.58–21.03) p=0.008] and arterial hypertension [OR 15.92 (CI 3.12–81.14) p=0.001]. Although smoking and diabetes are important variables in the pathogenesis of coronary artery disease, these factors did not show statistically significant associations in this sample.

CONCLUSION

The presence of vascular calcifications seen via mammography was an independent risk factor for coronary artery disease, as were hypertension and a family history of coronary artery disease.     

Relationship between of carotid ultrasonography in Japanese hypertensive subjects for intima-media thickness and plaque, and candidate gene polymorphism--possibility of early detection of arteriosclerotic disease

The purpose of this study was to determine the relationship between organic changes in carotid artery walls and candidate gene polymorphism in Japanese sufferers of essential hypertension. Carotid Ultrasonography was used to measure intima-media thickness (IMT) and presence of plaque formation. Patients were divided into two groups; a hypertension (HT) group and a healthy control (C). Group HT consisted of 273 subjects (56.5 +/- 11.3y) and group C consisted of 500 subjects (55.6 +/- 11.4y). 5HTR2A (T102C, A-1438G) and beta3-AR (Trp64Arg) genetic polymorphism for genetic analysis were performed on 43 subjects (63.5 +/- 8.5y) in group HT and 24 subjects (60.3 +/- 6.8y) in group C. IMT showed 0.81 +/- 0.28mm in Group C and 1.05 +/- 0.22mm in Group HT in patients aged 50 or above, respectively. The thickening was significantly greater in Group HT than in Group C (p < 0.01). Plaque was present in 45.1% in Group C and 70.2% in Group HT in patients aged 50 or above, respectively. It was significantly present greater in Group HT than in Group C (p < 0.01). Results of genetic analysis showed no difference between Group HT and Group C for either genotype of allele frequency of T102C and A-1438G, or of beta3-AR. It is suggested that increase of IMT and formation of plaque are risk factors in patients aged 50 or above with hypertension, and that careful observation of the carotid artery will be effective for early detection of arteriosclerosis, and to predict the symptoms thereof.     

Minimal nocturnal oxygen saturation predicts future subclinical carotid atherosclerosis: the Wisconsin sleep cohort

Previous data on the associations between nocturnal oxygen saturation parameters and carotid atherosclerosis are conflicting. We examined the prospective associations of nocturnal oxygen saturation (SaO₂) and cardiovascular disease (CVD) risk factors with carotid intima‐media thickness (IMT) and plaques. We used data on 689 Wisconsin sleep cohort participants who had baseline overnight polysomnography followed by carotid ultrasonography a mean (SD) of 7.8 (2.5) years later. Far wall common carotid IMT was measured using B‐mode ultrasound. Bilateral common, bifurcation and internal carotid artery segments were evaluated for plaque score. Participants (8) were aged 56 years (55% male); 32% had hypertension and mean body mass index (BMI) was 31 (7) kg m². Mean and minimum nocturnal SaO₂ were 95% (2) and 86% (7), respectively. Mean percentage sleep time with SaO₂ < 90% was 2% (8). Both mean (odds ratio [OR]: 0.60 lower plaque count per 5% higher mean SaO₂, 95% confidence interval [CI]: 0.38–0.96, P = 0.033) and minimum SaO₂ (OR: 0.88 lower plaque count per 5% higher minimum SaO₂, 95% CI: 0.80–0.97, P = 0.013) predicted carotid plaque score after adjusting for age, sex and BMI. Minimum SaO₂ predicted future plaque score after adding adjustment for traditional CVD risk factors (OR: 0.90 lower plaque count per 5% higher minimum SaO₂, 95% CI: 0.81–0.99, P = 0.038). Mean SaO₂ was not associated with carotid IMT after CVD risk factor adjustment. We conclude that minimum nocturnal SaO₂ is an independent predictor of future carotid plaque burden. Other nocturnal SaO₂ parameters are not associated with future carotid IMT or plaques after adjusting for traditional CVD risk factors.     

Atherosclerosis of the carotid arteries documented by Duplex scan as a predictor of coronary artery disease in familial hyperlipidemias

Summary The degree of atherosclerotic plaques in the carotid arteries was evaluated in 85 patients with familial hypercholesterolemia and in 43 patients with familial combined hyperlipidemia by means of Duplex scan which recognizes early atherosclerosis. In patients older than 40 years carotid atherosclerosis of moderate degree was associated with coronary heart disease in 90% of cases. The extent of elevated cholesterol, age, cigarette smoking, and hypertension determined the degree of carotid atherosclerosis.Abbreviations CHD Coronary heart disease - FCH Familial combined hyperlipidemia - FHC Familial hypercholesterolemia - HDL High density lipoprotein - LDL Low density lipoprotein     

Insulin Resistance Is an Important Risk Factor for Cognitive Impairment in Elderly Patients with Primary Hypertension

Purpose

Insulin resistance plays a role in the development of dementia and hypertension. We investigated a possible relationship between cognitive impairment and insulin resistance in elderly Chinese patients with primary hypertension.

Materials and Methods

One hundred and thirty-two hypertensive elderly patients (>60 years) were enrolled in this study, and assigned into either the cognitive impairment group (n=61) or the normal cognitive group (n=71). Gender, age, education, body mass index (BMI), waist hip ratio (WHR), total cholesterol (TC), triglyceride (TG), C-reactive protein (CRP), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), creatinine (Cr), fasting plasma glucose (FPG), fasting insulin (FINS), homeostasis model of assessment for insulin resistance index (HOMA-IR), systolic blood pressure, diastolic blood pressure, smoking history, atherosclerosis and the proportion of uncontrolled hypertension were compared between the two groups. Multi-factorial logistic regression analysis was performed.

Results

No significant differences were found in gender, age, TC, CRP, HDL-C, LDL-C, Cr, BP, smoking history, atherosclerosis and the proportion of uncontrolled hypertension between the two groups. The cognitive impairment group had lower education levels, and higher BMI, WHR, TG, FPG, FINS, and HOMA-IR levels than the control group. Logistic regression analysis revealed the levels of education, BMI, WHR, and HOMA-IR as independent factors that predict cognitive impairment in patients.

Conclusion

Our study demonstrates that poor education and increased BMI, WHR, and HOMA-IR are independent risk factors for cognitive impairment in elderly patients with hypertension. Insulin resistance plays an important role in the development of cognitive impairment in primary elderly hypertensive patients.     

Predictors of Coronary and Carotid Atherosclerosis in Patients with Severe Degenerative Aortic Stenosis

Background. Patients with degenerative aortic stenosis (AS) exhibit elevated prevalence of coronary artery disease (CAD) and internal carotid artery stenosis (ICAS). Our aim was to investigate prevalence of significant CAD and ICAS in relation to demographic and cardiovascular risk profile among patients with severe degenerative AS.Methods. We studied 145 consecutive patients (77 men and 68 women) aged 49-91 years (median, 76) with severe degenerative AS who underwent coronary angiography and carotid ultrasonography in our tertiary care center. The patients were divided into two groups according to the presence of either significant CAD (n=86) or ICAS (n=22).Results. The prevalence of significant CAD or ICAS was higher with increasing number of traditional risk factors (hypertension, hypercholesterolemia, diabetes, smoking habit) and decreasing renal function. We found interactions between age and gender in terms of CAD (p=0.01) and ICAS (p=0.06), which was confirmed by multivariate approach. With the reference to men with a below-median age, the prevalence of CAD or ICAS increased in men aged >76 years (89% vs. 55% and 28% vs. 14%, respectively), whereas the respective percentages were lower in older vs. younger women (48% vs. 54% and 7% vs. 17%).Conclusions. In severe degenerative AS gender modulates the association of age with coronary and carotid atherosclerosis with its lower prevalence in women aged >76 years compared to their younger counterparts. This may result from a hypothetical “survival bias”, i.e., an excessive risk of death in very elderly women with severe AS and coexisting relevant coronary or carotid atherosclerosis.     

老年患者颅内动脉粥样硬化性狭窄的分布和危险因素研究

目的 探讨老年患者颅内动脉粥样硬化性狭窄的分布特征和相关危险因素。方法 收集2013年1月~2016年10月我院颅内动脉粥样硬化性狭窄的老年患者178例设为狭窄组,选取同期非动脉粥样硬化151例患者作为对照组,收集患者一般人口学资料明确颅内动脉狭窄诊断前后3 d内行空腹血糖（FPG）、糖化血红蛋白（HBA1c）、血脂、血尿酸（UA）、血同型半胱氨酸（Hcy）、纤维蛋白原（FIB）等检查。结果 前循环颅内动脉狭窄、后循环颅内动脉狭窄和前后循环兼有的颅内动脉狭窄患者例数分别为80例（44.90%）、55例（30.90%）和43例（24.20%）。脑血管病家族史（OR=6.762,P=0.048）、高血压（OR=4.173,P=0.021）、糖尿病（OR=5.005,P=0.038）、高低密度脂蛋白胆固醇（LDL-C）（OR=3.454,P=0.036）是老年患者前循环颅内动脉硬化性狭窄的危险因素;吸烟（OR=3.799,P=0.036）、高总胆固醇（TC）（OR=1.479,P=0.022）、高甘油三酯（TG）（OR=1.110,P=0.041）、高LDL-C（OR=4.172,P=0.010）是后循环狭窄的危险因素;而前、后循环狭窄的危险因素包括高血压（OR=5.8585,P=0.043）、高LDL-C（OR=2.924,P=0.038）、高载脂蛋白B（ApoB）（OR=3.589,P=0.025）、高Hcy（OR=5.529,P=0.007）和高FIB（OR=1.460,P=0.029）。结论 在老年颅内动脉粥样硬化性狭窄患者中,以前循环狭窄最为多见。高LDL-C是三种类型老年颅内动脉狭窄共有的危险因素,高血压是前循环和前后循环狭窄类型的危险因素,FIB是后循环、前后循环狭窄共有的危险因素。     

Association of angiotensin-converting enzyme insertion/deletion polymorphism with obesity,cardiovascular risk factors and exercise-mediated changes in Korean women

This study examined whether the angiotensin-converting enzyme (ACE) insertion (I)/deletion (D) polymorphism is associated with obesity, cardiovascular risk factors and 12-week exercise-mediated changes in Korean women. A total of 105 subjects were divided into three groups as II, ID and DD genotype groups based upon ACE I/D genotypes. Body composition and cardiovascular risk factors were compared among the three groups, and the association of ACE I/D genotypes with obesity and hypertension was evaluated. Total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) levels were higher (P < 0.05) in the DD genotype than in II or ID genotypes. D allele frequency in ACE I/D gene had a higher (P = 0.063) trend in the hypertensive group than the normotensive group. The DD genotype had a trend to develop (odds ratio 4.032, P = 0.086) more hypertension than the II genotype. The II and ID genotypes showed a significant (P < 0.05) decrease in intima media thickness of the carotid artery after an exercise intervention, whereas the DD genotype showed an increase. In conclusion, there is a trend towards association of ACE I/D polymorphism with hypertension but not with obesity. Exercise-mediated changes did not differ significantly among genotypes except IMTCA.     

慢性阻塞性肺疾病频繁急性加重患者的临床特征分析

目的 观察慢性阻塞性肺疾病（COPD）频繁急性加重患者与非频繁急性加重患者临床特征的差异。方法 回顾性纳入2016年1月~2018年12月合肥市第一人民医院呼吸内科住院的274例COPD急性加重患者,根据患者上一年急性加重次数分为频繁组（住院次数≥2次/年）143例和非频繁组（住院次数＜2次/年）131例,比较两组性别、年龄、病程、吸烟量、mMRC评分、共患疾病（高血压、冠心病、糖尿病）、白细胞计数、中性粒细胞百分比、淋巴细胞百分比、嗜酸粒细胞百分比、降钙素原（PCT）、血气指标（pH、PaO2、PaCO2）及血氧饱和度（SpO2）,多因素Logistic回归分析COPD频繁急性加重的危险因素。结果 两组性别、年龄、白细胞计数、淋巴细胞百分比、嗜酸粒细胞百分比、PCT、pH、PaCO2、共患疾病（高血压、冠心病、糖尿病）比较,差异无统计学意义（P＞0.05）;频繁组病程、吸烟量、mMRC评分、中性粒细胞百分比、SpO2、PaO2均高于非频繁组,差异均有统计学意义（P＜0.05）;多因素Logistic回归分析显示,病程、吸烟量、mMRC评分、中性粒细胞百分比是COPD频繁急性加重的独立危险因素。结论 COPD频繁急性加重多病程较长,患者多长期吸烟,临床中应重视病程长、吸烟量大、mMRC评分高、中性粒细胞百分比高的COPD患者,加强对其的监护管理,防止发生COPD频繁急性加重。     

Age-related change in kidney function,its influencing factors,and association with asymptomatic carotid atherosclerosis in healthy individuals—A 5-year follow-up study

Objectives

To better define the longitudinal changes in renal function, to examine the associated risk factors, and to investigate whether there is an independent association of decline in renal function with presence of carotid plaque in a middle-aged and elderly healthy population.

Methods

245 healthy individuals (98 males, 147 females) evaluated at baseline and 5 years later.

Results

Over five years, estimated glomerular filtration rate (eGFR) decreased from 98.1 ± 15.6 to 90.4 ± 17.3 mL/min/1.73 m². There are three kinds of change in eGFR (elevated, stable and decreased) during follow-up, accounting for 14%, 29% and 57%, respectively. Multivariate analysis of cross-sectional data showed that gender, age, and serum uric acid (UA) were major factors which consistently affected eGFR at both baseline and follow-up, and that higher systolic blood pressure (SBP) and presence of plaque were involved in lower eGFR at the follow-up point. In longitudinal analysis, five baseline factors – age, SBP, low-density lipoprotein cholesterol (LDL-C), serum transferrin (TRF) and eGFR − independently predicted a greater variability in renal function. In addition, presence of plaque was an independent risk factor for a faster decline of eGFR.

Conclusions

Cross-sectional analysis demonstrates that renal function declines with increasing age. However, 43% of participants did not experience a decline in eGFR during follow-up. Besides older age and higher initial eGFR, presence of atherosclerotic carotid plaque, higher SBP, higher LDL-C and lower TRF are independent risk factors to predict a rapid decline of renal function in the healthy Chinese population.     

辛伐他汀对糖尿病高脂血症患者体内炎症水平和颈动脉斑块的影响

目的:探讨辛伐他汀对糖尿病高脂血症患者体内炎症水平和动脉斑块的影响.方法:120例2型糖尿病(DM2)合并高脂血症患者,给予控制血糖,每晚给予辛伐他汀片20mg口服,持续12周.观察患者血脂、hs-CRP、TNF-α及颈动脉斑块的变化.结果:患者经辛伐他丁治疗后血清TC、TG和LDL-C水平均较治疗前有明显降低(P<0...