代谢综合征与冠心病及踝臂指数的相关性分析

目的探讨代谢综合征（MS）与冠心病及踝臂指数（ABI）的相关性。方法行冠状动脉造影术的患者300例，分为MS组和非MS组，比较2组的冠状动脉病变血管支数、Gensini评分及ABI，同时对MS代谢组分亚组进行上述指标比较。结果MS组三支血管病变发生率、Gensini评分及ABI〈0．9者所占比例均明显高于非MS组（P〈0．05），且随代谢组分的汇聚而增高。结论MS与冠状动脉病变的严重程度及下肢动脉硬化密切相关。     

冠心病伴代谢综合征患者冠状动脉病变特点及与相关危险因子相关性的分析

目的探讨冠心病（CHD）伴代谢综合征（Ms）患者冠状动脉病变特点及与相关危险因子[肿瘤坏死因子α（TNF—q）和高敏C反应蛋白（hs—CRP）]的相关性。方法检测211例CHD患者空腹血糖（FBG）、餐后2h血糖（2hPBG）、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）、TNF-α、hs-CRP,并常规检查体重指数、腹围、血压。其中135例CHD患者行冠状动脉造影检查,根据病变损害程度评分。结果211例CHD患者中有76例（36％）伴MS,其冠状动脉病变分数高于不伴MS者。FBG、2hPBG、TC、TG、LDL—C、HDL—C、血压、TNF—α、hs—CRP水平增高与冠状动脉造影病变分数相关。伴MS者TNF-α、hs—CRP水平增高者多于不伴MS者。结论CHD伴MS患者的冠状动脉病变严重程度高于不伴MS患者,且多数伴MS患者的TNF—α、hs—CRP水平增高。MS可作为预测冠状动脉狭窄严重程度的指标之一。     

Lasers in the treatment of ischaemic heart disease

Mounting evidence showing that transmyocardial laser revascularization (TMR) is a safe and effective treatment for angina pectoris arrives just as an increasing number of patients who have undergone angioplasty and coronary artery bypass grafting experience failure with time. TMR, nevertheless, remains controversial. It appears to relieve the symptoms without treating the underlying atherosclerotic disease, and its method of action is unproven. Like angioplasty and coronary bypass, TMR in fact offers palliation rather than a cure for atherosclerotic heart disease. The most sensible current formulations of the therapeutic mechanism of TMR posit a reconfiguration of the microcirculation, with blood shunted from epicardial to endocardial areas. These unresolved issues notwithstanding, TMR benefits patients with end-stage coronary disease and represents a pioneering effort to remodel the microcirculation of patients with arteriosclerotic occlusive disease.     

冠心病伴代谢综合征患者冠状动脉病变特点及与相关危险因子相关性的分析

目的探讨冠心病(CHD)伴代谢综合征(MS)患者冠状动脉病变特点及与相关危险因子[肿瘤坏死因子α(TNF-α)和高敏C反应蛋白(hs-CRP)]的相关性。方法检测211例CHD患者空腹血糖(FBG)、餐后2 h血糖(2hPBG)、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)、TNF-α、hs-CRP,并常规检查体重指数、腹围、血压。其中135例CHD患者行冠状动脉造影检查,根据病变损害程度评分。结果211例CHD患者中有76例(36%)伴MS,其冠状动脉病变分数高于不伴MS者。FBG、2hPBG、TC、TG、LDL-C、HDL-C、血压、TNF-α、hs-CRP水平增高与冠状动脉造影病变分数相关。伴MS者TNFα-、hs-CRP水平增高者多于不伴MS者。结论CHD伴MS患者的冠状动脉病变严重程度高于不伴MS患者,且多数伴MS患者的TNF-α、hs-CRP水平增高。MS可作为预测冠状动脉狭窄严重程度的指标之一。     

Adenosine infusion to patients with ischaemic heart disease may provoke left ventricular dysfunction detected by echocardiography

Summary. Infusion of the endogenous vasodilator adenosine to patients with ischaemic heart disease (IHD) frequently provokes myocardial ischaemia, possibly caused by a coronary steal. The aim of this study was to detect the occurrence and incidence of disturbances in left ventricular (LV) wall motion and Doppler indices of altered LV function during infusion of adenosine. Thirty-seven patients (six female) aged 37–74 years with IHD, verified by coronary angiography, were given up to 200 μg kg^-1 min^-1 (mean 155 ± 5) adenosine i.v. for 18 ± 1 min. LV wall motion was monitored by two-dimensional echocardiography (2D-echo). Doppler spectral signal was obtained from the mitral blood flow. All but six of the patients experienced angina pectoris of habitual character in connection with the adenosine infusion. Heart rate increased by 22 ± 1 beats min^-1, systolic blood pressure was unchanged, but diastolic blood pressure decreased slightly. 2D-echo revealed severe regional LV wall motion disturbances already in the basal state in 17 patients. During infusion of adenosine, these abnormalities were aggravated and disturbances also occurred in another 15 patients. Thus, adenosine increased the sensitivity for IHD in this selected material from 49 to 89%. In all, the mean index of wall motion abnormalities increased from 5·1 ± 1·1 to 10·1 ± 1·4 (P< 0·001). The diastolic LV filling characteristics, as evaluated by the Doppler A/E ratios, were of limited value for determination of IHD grade. It is concluded that infusion of adenosine to patients with IHD frequently elicits myocardial ischaemia with disturbances in LV function, and offers an alternative to exercise for stress echocardiography.     

Visceral fat thickness determined using ultrasonography is associated with anthropometric and clinical parameters of metabolic syndrome

The aim of this study is to find out the relation between the ultrasonographic (USG) measurements of the abdominal fat thickness and cardiovascular risk factors in metabolic syndrome. The thickness of subcutaneous fat (SF), visceral fat (VF) and preperitoneal fat (PF) was measured using USG in 75 subjects (35 women and 40 men) with metabolic syndrome. The body mass index (BMI), waist circumference (WC), systolic (SBP) and diastolic (DBP) blood pressures, fasting plasma glucose, fasting insulin and lipid parameters of all participants were recorded. Insulin resistance was estimated using HOMA-IR formula. BMI (p < 0.05), WC (p < 0.01), SBP (p < 0.001), DBP (p < 0.05), fasting insulin (p < 0.05), total cholesterol (p < 0.001) and triglyceride (p < 0.001) levels were found in correlation with VF thickness in the female group. There was a positive association between WC and SF thickness (p < 0.05) in the same group. In the male patients, BMI (p < 0.001), WC (p < 0.01), SBP (p < 0.05), DBP (p < 0.05) and triglyceride level (p = 0.01) were significantly correlated with VF thickness. SF thickness was associated with BMI (p < 0.001) and WC (p < 0.01) in this group. There was no relation between PF thickness and clinical variables in both groups (p > 0.05). It can be concluded that VF thickness may have a significant pathophysiological role in the development of the metabolic syndrome.     

Association of C34T AMPD1 gene polymorphism with features of metabolic syndrome in patients with coronary artery disease or heart failure

Objective. The common C34T polymorphism in the AMP deaminase‐1 (AMPD1) gene results in an inactive enzyme in homozygotes for the mutated T allele. Some studies have shown an association of T allele with longer survival in heart failure (HF) and/or coronary artery disease (CAD). The aim of this study was to assess genotype–phenotype correlations in such patients, with emphasis on components of the metabolic syndrome. Methods. Ninety‐seven patients with CAD without HF (CAD+ HF–) and 104 with HF (HF+) were genotyped by PCR‐RFLP. The genetic control group comprised 200 newborns. Results. No significant differences were found in the frequency of AMPD1 genotypes between the groups. In the CAD+ HF– group, the carriers of T allele compared to CC homozygotes had significantly lower values of waist circumference (89.5±8.5 versus 97.7±11.2?cm; p = 0.00029), waist/hip ratio (p = 0.0059) and BMI (p = 0.045). There was no diabetes or fasting glycaemia ?126?mg/dL in T carriers, while these features were present in 25?% of CC homozygotes (p = 0.0024). In the HF+ group, a tendency towards a lower prevalence of diabetes (20?% versus 41?%; p = 0.068) and significantly lower systolic blood pressure (p = 0.048) were observed in T allele carriers. Conclusions. C34T AMPD1 polymorphism may be associated with reduced frequency of obesity in CAD patients and of hyperglycaemia and diabetes in both CAD and HF patients. Morphometric parameters associated with adipose tissue distribution and parameters of glucose metabolism should be analysed as potential confounders in further studies on the role of polymorphisms of AMPD1 and other genes associated with AMP and adenosine metabolism in cardiovascular disease.     

Platelets oxidative stress in Indian patients with ischemic heart disease

Background: Oxidative stress has been implicated in the development of atherosclerosis and vascular tissue injury. Both platelet activation and lipid peroxidation are known to play major role in ischemic heart disease. The purpose of this study was to investigate the status of platelets oxidative stress in Indian patients with ischemic heart disease. Methods: We measured platelets aggregation, malonyldialdehyde (MDA), plasma‐ionized Ca²⁺, and antioxidant enzymes, i.e., glutathione peroxidase and superoxide dismutase in healthy volunteers and patients with myocardial infarction, unstable and stable angina 40 subjects each. Results: Platelets aggregation, MDA, and plasma‐ionized Ca²⁺ have increased significantly across the patients groups compared with controls, this increase was accompanied by an overall decrease in the antioxidant enzymes activity; except for the slight increases in the glutathione peroxidase levels among the myocardial infarction patients. Conclusions: The current results suggest that platelet lipid peroxidation as marked by increased MDA level is augmented in ischemic heart diseases. The increased oxidative stress seen in these patients was accompanied by platelet activation and impaired antioxidant enzymes activity. J. Clin. Lab. Anal. 24:49–54, 2010. © 2010 Wiley‐Liss, Inc.     

代谢综合征患者护理干预模式的探讨

目的 通过对代谢综合征患者护理模式的探讨,以各项指标达标来评价治疗和控制状况.方法 在2006年对深圳地区人群进行身高、体重、空腹血糖(FPG)、葡萄糖耐量餐后2 h血糖(OGTr 2 h PG)、血压(HP)、血脂测定的体检,计算体质指数(BMI),并据此计算出代谢综合征(MS)的患病率以及成分组合特点,随机对代谢综合征病人进行健康教育及护理模式的探讨,以各项指标达标来评价治疗和控制状况,通过我们的护理模式干预,提出各项指标达标的方案,即:通过运动和适宜的体力劳动,使体质指数控制在＜24 kg/m2;通过系统内科治疗配以健康教育,使空腹血糖＜7.0 mmol/L;血压的控制在指导病人科学自测不同时段血压、评估1 d内血压峰值的基础上,及时让病人调整降压药的使用等护理干预下,使血压控制在收缩压130 mmHg、舒张压≤85 mmHg.结果 体质指数3个月达标率72.4%,1年达标率为49%.血糖3个月达标率75.5%,1年达标率为58.2%.血压3个月达标率为85.6%,1年达标率为61.9%.血脂3个月达标率82.1%,1年达标率为41.2%.结论 通过我们的护理模式干预,使各项指标达标.代谢综合征得到有效控制和治疗,目标是减少心脑血管事件的发生.     

The success of an integrated care programme for patients with ischaemic heart disease: the practice nurses' perspective of SHIP

Follow-up care of patients with angina and myocardial infarction after hospital discharge is known to be suboptimal across the UK. The employment of cardiac liaison nurses ensured timely notification of hospital discharge and good communication of each patient's current and planned care. The direct ongoing support of the liaison nurse was valued by more practice nurses than educational support meetings and the initial counselling skills course. The most important factor which enabled practice nurses to expand their role to provide post-hospital follow-up care was the support of the doctors in the practice. After the conclusion of the Southampton Heart Integrated Care Project (SHIP) and the withdrawal of cardiac liaison nurses, the lack of hospital discharge notification was the most important reason for practice nurses discontinuing follow-up care.     

Increased oxidative stress and inflammatory markers contrasting with the activation of the cholinergic anti-inflammatory pathway in patients with metabolic syndrome

IntroductionMetabolic syndrome (MetS) is a disorder that is closely associated with risk factors that increase the chance of atherosclerosis and cardiovascular diseases. We demonstrate the presence of inflammation and oxidative stress in patients with MetS through levels of antioxidants and oxidative and inflammatory markers, in order to determine influential variables in therapy. Methods: In this study, lipid peroxidation, carbonylated protein content and enzymatic and non-enzymatic antioxidants were evaluated in samples obtained from 30 patients with MetS and 30 control patients. In addition, acetylcholinesterase (AChE) activity, C-reactive protein (CRP) and uric acid (UA) levels were determined to investigate the inflammatory process in patients with MetS. Results: Our results demonstrated an increase in the levels of oxidative markers, such as substances reactive to thiobarbituric acid (TBARS) and carbonyl protein. In addition, a decrease in the defense of non-enzymatic antioxidants, such as levels of vitamin C and glutathione (GSH) in patients with MetS. As for inflammatory markers, CRP and UA were increased in patients with MetS. Finally, activation of the cholinergic anti-inflammatory pathway was observed due to decreased AchE activity in patients with MetS.ConclusionThe analyzes indicated oxidative stress, together with a reduction in the levels of antioxidant enzymes, corroborating the high consumption of these proteins. In addition, inflammation and activation of the cholinergic anti-inflammatory pathway was observed by the AChE analysis. Thus, the activation of this pathway can be studied as a possible route to a potential therapy. In addition, the markers AChE, CRP and UA may be used as a focus for the treatment of MetS.     

评价冠心病合并代谢综合征患者心房内和心房间的同步性

目的 应用脉冲组织多普勒技术(PW-TDI)和同步ECG观察冠心病合并代谢综合征患者心房内和心房间的电-机械收缩同步性的变化.方法 将139例冠心病患者分为冠心病合并代谢综合征组(CAD-MS组,n=66)和冠心病不合并代谢综合征组(CAD-NMS组,n=73).对ECG P波起始点到PW-TDI心房收缩A峰起始点的时间间期进行统计分析,比较两组间心房壁收缩速度和心房各壁的电-机械收缩时间的变化.结果 与CAD-NMS组相比,CAD-MS组中左右心房各壁心电图P波起始点到PW-TDI心房收缩A峰起始点的时间间期明显延长(P＜0.05),左心房前壁运动速度降低[(6.1 2士2.27)cm/s vs(7.00±2.11)cm/s,P＜0.05],左心房前壁心电图P波起始点到PW-TDI心房收缩A峰起始点时间间期较其他房壁明显延长(P＜0.05),左心房前壁与下壁心电图P波起始点到PW-TDI心房收缩A峰起始点电-机械收缩时间差值明显增大(P＜0.05).结论 冠心病合并代谢综合征患者心房内和心房间的电-机械收缩时间出现延迟,左心房部分房壁存在电-机械传导不同步.     

慢性压力对冠心病患者心率变异性的影响

冠心病是一种公认的心身疾病,严重威胁人类健康,慢性压力在冠心病发生和发展的整个过程中起到了重要作用,心脏神经功能紊乱可能是慢性压力导致冠心痛的机制之一.心率变异性分析（HRV）是一种快捷无创的检查,可用于评价心脏自主神经系统的功能,并且HRV也被认为是急性冠脉综合征（ACS）患者重要的危险分层因子.本文就近年来关于慢性压力对冠心病患者HRV影响的研究成果进行简述.     

Defining metabolic syndrome and factors associated with metabolic syndrome in a poly-pharmaceutical population

Objectives: Metabolic Syndrome (METs) definitions vary and diagnosis takes into account consumption of medications commonly prescribed for conditions defining METs. This paper evaluates the potential differences in population characteristics using two different methods of defining METs, with and without the adjustment of the effects of pharmacotherapy on biochemical and blood pressure (BP) measurements

Methods: This was a cross-sectional study utilizing the Malaysian Elders Longitudinal Research (MELoR) cohort comprising urban community-dwellers aged ≥55 years. Participants were interviewed using a structured questionnaire during home visits where medications were reviewed. Health impacts assessed included heart disease, stroke, body mass index (BMI), peptic ulcers, arthritis, and number of medications and comorbidities. Risk factors and health impacts associated with METs were determined by Poisson multivariate regression models using a binary and count dependent variables.

Results: A total of 891 participants with a mean (SD) age of 68.6 (7.3) years were included. The prevalence of METs vary from 52.7% to 35.1% depending upon the definition used. The risk factors associated with METs were increasing age, ethnicity, lower education levels, BMI, stroke and medication use. Male gender was considered a risk factor following modification for medication usage using a count model. The drug-modified model removed marginal candidates prescribed medications used for specific conditions which defined METs who did not meet the criteria once their BP or biochemical parameters were modified for the effects of medication-use.

Conclusion: The IDF definition for METs that makes allowance for treatment for each specific condition can lead to an overestimation in the prevalence of METs in population studies. Not including those medicated with normal results conversely underestimates the prevalence of METs. We have therefore proposed adjustments to BP and lipid measurements based on pooled mean effects from published systematic reviews to mitigate bias in future research on prevalence of METs.     

Gender differences in the metabolic syndrome and their role for cardiovascular disease

Summary Women live longer than men and develop cardiovascular disease (CVD) at an older age. The metabolic syndrome represents a major risk factor for the development of CVD, and gender¹ differences in this syndrome may contribute to gender differences in CVD. In recent years, the metabolic syndrome has been more prevalent in men than in women. Prevalence is increasing and this increase has been steeper in women, particularly in young women, during the last decade. The contributions of the different components of the metabolic syndrome differ between genders and in different countries. In a recent survey in Germany, 40% of the adult population had been diagnosed with disturbed glucose tolerance or type 2 diabetes. Undiagnosed diabetes was more frequent in men than in women, and risk factors for undiagnosed diabetes differed between the sexes. Worldwide, in individuals with impaired glucose tolerance, impaired fasting glucose was observed more frequently in men, whereas impaired glucose tolerance occurred relatively more often in women. Lipid accumulation patterns differ between women and men. Premenopausal women more frequently develop peripheral obesity with subcutaneous fat accumulation, whereas men and postmenopausal women are more prone to central or android obesity. In particular, android obesity is associated with increased cardiovascular mortality and the development of type 2 diabetes. Visceral adipocytes differ from peripheral adipocytes in their lipolytic activity and their response to insulin, adrenergic and angiotensin stimulation and sex hormones. Visceral fat is a major source of circulating free fatty acids and cytokines, which are directly delivered via the portal vein to the liver inducing insulin resistance and an atherogenic lipid profile. Inflammation increases cardiovascular risk particularly in women. A relatively greater increase in cardiovascular risk by the appearance of diabetes in women has been reported in many studies. Thus, the presently available data suggest that the pathophysiology of the metabolic syndrome and its contribution to the relative risk of cardiovascular events and heart failure show gender differences, which might be of potential relevance for prevention, diagnostics, and therapy of the syndrome. ¹ "Gender" is used to include biological sex as well as gender in its strict sense Supported by the DFG (grants to V. Regitz–Zagrosek) and the BMBF (Competence Network Heart Failure) An erratum to this article can be found at     

Fat overload aggravates oxidative stress in patients with the metabolic syndrome

Background   Patients with the metabolic syndrome have greater levels of oxidative stress. However, as the response of markers of this stress to a fat overload is unknown, we evaluated certain markers of oxidative stress in these patients.
Material and methods   The study population comprised 93 subjects (70 men and 23 women): 13 healthy people (controls) with a mean age of 48·81 ± 9·01 years and 80 patients with the metabolic syndrome (mean age, 43·25 ± 11·55 years), according to the Adult Treatment Panel III criteria. All the participants were given a 60 g fat overload (Supracal). Three hours later the following biomarkers of oxidative stress were measured: lipid peroxidation products, protein carbonyl groups, reduced glutathione, glutathione peroxidase (GSH-Px), catalase, superoxide dismutase, glutathione reductase (GSH-Road) and glutathione S-transferase. The levels of oxidized glutathione (GSSG) were calculated.
Results   Compared with the controls, the patients showed greater baseline oxidative stress, higher levels of lipid peroxidation products and oxidized glutathione, and lower levels of reduced glutathione, glutathione peroxidase activity, glutathione reductase and glutathione transferase. This stress was more intense after the subjects received a fat overload, more so in the patients who experienced a greater reduction in GSHpx and GSHrd antioxidant activity and a greater increase in the levels of carbonylated proteins and lipoperoxides than the controls.
Conclusions   Patients with the metabolic syndrome have greater oxidative stress than healthy people. The variation in markers of this stress after a fat overload was even more pronounced in the patients.     

Intra-thoracic fat volume is associated with myocardial infarction in patients with metabolic syndrome

Background

Visceral adiposity is increased in those with Metabolic Syndrome (MetS) and atherosclerotic disease burden. In this study we evaluate for associations between intra-thoracic fat volume (ITFV) and myocardial infarction (MI) in patients with MetS.

Methods

Ninety-four patients with MetS, MI or both were identified from a cardiovascular CMR clinical registry. MetS was defined in accordance to published guidelines; where-as MI was defined as the presence of subendocardial-based injury on late gadolinium enhancement imaging in a coronary vascular distribution. A healthy control group was also obtained from the same registry. Patients were selected into the following groups: MetS+/MI- (N = 32), MetS-/MI + (N = 30), MetS+/MI + (N = 32), MetS-/MI- (N = 16). ITFV quantification was performed using signal threshold analysis of sequential sagittal CMR datasets (HASTE) and indexed to body mass index.

Results

The mean age of the population was 59.8 ± 12.5 years. MetS+ patients (N=64) demonstrated a significantly higher indexed ITFV compared to MetS- patients (p = 0.05). Patients in respective MetS-/MI-, MetS+/MI-, MetS-/MI+, and MetS+/MI + study groups demonstrated a progressive elevation in the indexed ITFV (22.3 ± 10.6, 28.6 ± 12.6, 30.6 ± 12.3, and 35.2 ± 11.4 ml/kg/m2, (p = 0.002)). Among MetS+ patients those with MI showed a significantly higher indexed ITFV compared to those without MI (p = 0.02).

Conclusions

ITFV is elevated in patients with MetS and incrementally elevated among those with evidence of prior ischemic myocardial injury. Accordingly, the quantification of ITFV may be a valuable marker of myocardial infarction risk among patients with MetS and warrants further investigation.     

代谢综合征患者动态血压有关指标与冠状动脉病变的相关性分析

目的探讨动态收缩压（SBP）、舒张压（DBP）、平均动脉压（MBP）、脉压（PP）、脉压指数（PPJ）与代谢综合征（MS）患者冠状动脉病变严重程度相关性，评价各指标对冠状动脉病变的预测价值。方法对204例患者行冠状动脉造影（CAG），分析冠状动脉狭窄程度，并计算冠状动脉病变血管数和冠状动脉病变评分；同时行动态血压监测（ABPM）。分为非CHD和CHD组，按PPI≤0．40、0．41-0．50、0．51—0．60、〉0．60分为4组，按PP≤40mmHg、41-60mmHg、61—80mmHg、〉80mmHg分为4组，比较各组间冠状动脉病变程度。结果非CHD和CHD组在年龄、血脂、体重指数、SBP、PP、PPI上差异有统计学意义（P〈0．05）；PP和PPI组在冠心病发生率、冠状动脉病变的血管数、评分和冠脉狭窄程度上均差异有统计学意义（P〈0．05 or P〈0．01）；MS患者的CHD发生率及病变程度与SBP、PP、PPI显著相关（P〈0．01），与PPI相关性最为最著。结论在动态血压各指标中，PP、PPI、SBP与冠状动脉病变密切相关，可作为代谢综合征患者二级预防靶点。