超重及肥胖2型糖尿病患者血浆脂蛋白相关磷脂酶A2水平与颈动脉内膜中层厚度的相关性研究

［摘要］　目的　探讨超重及肥胖2型糖尿病（T2DM）患者血浆脂蛋白相关磷脂酶A₂（Lp-PLA₂）水平及其与颈动脉内膜中层厚度（IMT）的相关性。方法　选择2018-01～2018-08桂林医学院附属医院收治的T2DM患者95例,根据体质量指数（BMI）将其分为单纯T2DM组（BMI<24 kg/m²）56例和超重及肥胖T2DM组（BMI≥24 kg/m²）39例。比较两组空腹血糖（FBG）、总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、空腹胰岛素（FINS）、胰岛素抵抗指数（IRI）、糖化血红蛋白（HbA1c）、颈动脉IMT和Lp-PLA₂。分析Lp-PLA₂与颈动脉IMT的相关性。结果　与单纯T2DM组相比,超重及肥胖T2DM组的FINS、IRI、TC、LDL-C、Lp-PLA₂及颈动脉IMT水平较高,HDL-C水平较低,差异有统计学意义（P<0.05）。两组FBG、HbA1c、TG比较差异无统计学意义（P>0.05）。T2DM患者血浆Lp-PLA₂水平与颈动脉IMT水平呈正相关（r=0.388,P=0.000）。单纯T2DM组和超重及肥胖T2DM组血浆Lp-PLA₂水平与颈动脉IMT水平均呈正相关（r=0.292,P=0.029;r=0.470,P=0.003）。多元线性回归分析结果显示,较高水平的BMI、LDL-C及Lp-PLA₂是影响颈动脉IMT增厚的主要危险因素（P<0.05）。结论　超重及肥胖T2DM患者的血浆Lp-PLA₂水平较高,且Lp-PLA₂水平与颈动脉IMT呈正相关,检测该指标可能有利于临床医师及早发现、干预糖尿病大血管病变的发生。     

OSAHS合并高血压患者血浆同型半胱氨酸与颈动脉厚度的相关性观察

目的观察阻塞型睡眠呼吸暂停低通气综合征(OSAHS)、原发性高血压(EH)及OSAHS合并EH患者血浆同型半胱氨酸(homocysteine,Hcy)与颈动脉内膜中层厚度(carotidartery intima media thickness,IMT)的相互关系。方法选择OSAHS合并EH患者组33例,OSAHS患者组35例及EH患者组43例,采用全自动生化仪测定其血浆Hcy水平,及超声检测颈动脉IMT。结果 OSAHS合并EH组的血浆Hcy水平和IMT厚度明显高于OSAHS组及EH组,差异有统IMT厚度之间有较好的相关性(r=0.66,P<0.01)。结论 OSAHS患者存在内皮功能损害,OSAHS合并EH者内皮功能     

纤维蛋白原、颈动脉内膜中层厚度和斑块与冠心病的关系

颈动脉内膜中层厚度(IMT)和斑块情况能间接反映冠状动脉粥样硬化(CAS)的严重程度.新近研究发现血浆纤维蛋白原(Fg)是动脉硬化性疾病的重要危险因素,其水平对冠状动脉粥样硬化性心脏病(CHD)具有独立的预后意义[1,2].本文通过测定CHD患者颈动脉IMT、动脉硬化斑块发生情况和血浆Fg水平,并与冠状动脉造影Gensini积分做相关性分析,从而深入探讨颈动脉IMT、斑块发生情况和血浆Fg水平与CAS之间的关系.     

原发性高血压并发颈动脉粥样硬化患者血清HCY水平与氧化应激的相关性

目的通过观察原发性高血压(EH)患者颈动脉内膜中层厚度(CAIMT)和血清同型半胱氨酸(HCY)、丙二醛(MDA)水平及超氧化物歧化酶(SOD)活性,探讨EH并发颈动脉粥样硬化(CAS)患者血清HCY与氧化应激的相关性。方法选择2014-01~2016-12在该院就诊的266例EH患者为研究对象,以同期体检健康者50名作为对照组。检测CAIMT(彩色多普勒超声仪)和血清HCY(循环酶法)、MDA(TBA法)水平及SOD活性(比色法),并进行统计学对比分析。结果 (1)EH患者并发CAS发生率为62.8%(167/266),与其年龄、病情及病程有关,与性别差异无关。(2)EH并发CAS组与对照组比较,血清HCY和MDA水平显著升高(t=7.118、6.326,P0.05),SOD活性显著降低(t=12.809,P0.01)。(3)血清HCY水平与MDA水平呈显著正相关(r=0.493,P0.05),与血清SOD活性呈显著负相关(r=-0.562,P0.05)。结论EH并发CAS患者血清HCY水平显著升高,氧化应激反应增强,血清HCY水平与氧化应激显著相关。     

糖尿病伴颈动脉粥样硬化Hs-CRP水平及罗格列酮疗效探讨

目的:探讨超敏c反应蛋白(Hs-CRP)、颈动脉内膜中层厚度(IMT)、胰岛素抵抗指数(HOMA-IR)之间的关系及罗格列酮对Hs-CRP水平,颈动脉内膜中层厚度疗效。方法:将2型糖尿病患者分为2组:2型糖尿病伴颈动脉硬化组、单纯2型糖尿病组,并测定超敏反应蛋白、颈动脉内膜中层厚度,血糖、胰岛素等。结果:2型糖尿病伴颈动脉硬化组的Hs-CRP明显高于单纯2型糖尿病组,对2型糖尿病患者进行线性相关分析表明2型糖尿病患者hs-CRP与胰岛素抵抗指数、糖化血红蛋白、颈动脉IMT都有极显著的相关性(P<0.01)。与对照组相比,罗格列酮治疗组治疗后HOMA-IR、Hs-CRP、颈动脉颈IMT值明显下降(P<0.05)。结论:hs-CRP不仅与2型糖尿病相关,而且与胰岛素抵抗及颈动脉硬化有密切的关联。而罗格列酮可以降低hs-CRP的水平,改善2型糖尿病患者大血管并发症。     

老年高血压合并糖尿病患者颈动脉粥样硬化的观察

目的 观察老年高血压患者合并2型糖尿病时对颈动脉内膜中层厚度的影响及血脂水平的变化,探讨此类患者颈动脉粥样硬化的特点.方法 将120例患者分为高血压组（EH组,60例）、高血压合并糖尿病组（EH＋DM组,60例）,并按性别年龄匹配对照组.采用高分辨率超声采集患者颈动脉内膜中层厚度数据并收集患者其他一般情况数据.结果 EH＋DM组及EH组患者血浆甘油三酯水平均明显升高,EH＋DM组低密度脂蛋白胆固醇明显增高,颈动脉内膜中层厚度及斑块发生率均明显高于EH组.结论 高血压患者一旦合并糖尿病,相对于单纯高血压患者,其血脂异常及动脉粥样硬化的危险均增加,更易形成斑块.     

糖尿病伴径动脉粥祥硬化Hs-CRP水平及罗格列酮疗效探讨

目的:探讨超敏c反应蛋白(Hs-CRP)、颈动脉内膜中层厚度(IMT)、胰岛素抵抗指数(HOMA-IR)之间的关系及罗格列酮对H,CRP水平,颈动脉内膜中层厚度疗效.方法:将2型糖尿病患者分为2组:2型糖尿扁伴颈动脉硬化组、单纯2型糖尿病组,并测定超敏反应蛋白、颈动脉内膜中层厚度,血糖、胰岛素等.结果:2型糖尿病伴颈动脉硬化组的Hs-CRP明显高于单纯2型糖尿病组,对2型糖尿病患者进行线性相关分析表明2型糖尿病患者hg.CRP与胰岛素抵抗指数、糖化血红蛋白、颈动脉IMT都有极显著的相关性(P相似文献   

老年原发性高血压患者颈动脉病变与动态脉压指数

目的探讨老年原发性高血压(EH)患者颈动脉病变与动态脉压指数(PPI)的相关性。方法对103例老年 EH 患者行颈动脉超声和动态血压测定,PPI=24 h 脉压(PP)均值/24 h 收缩压(SBP)均值,按 PPI 值分为 A组(PPI<0.40,n=15)、B 组(PPI:0.40～0.49,n=48)、C 组(PPI≥0.50,n=40)3组,观察各组颈动脉内膜中膜厚度(IMT)的水平。结果 B 组IMT[(0.15±0.07)mm]水平高于 A 组[(0.12±0.04)mm,P<0.05],C 组 IMT[(0.16±0.05)mm]水平高于 B 组(P<0.05),并显著高于 A 组(P%0.01),随着 PPI 逐渐增大,IMT 明显增加(P<0.05);老年 EH 患者颈动脉内膜增厚的发生与 PP 及 PPI 相关(P<0.05);Logistic 回归分析显示,在矫正总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、血尿酸、SBP、DBP 与 PP 后,PPI 仍然是颈动脉内膜中膜厚度增厚主要决定因素(P=0.009)。结论老年 EH 患者 PPI 和 PP 与颈动脉病变呈正相关,...     

老年H型高血压患者血浆致动脉硬化指数与颈动脉内膜中层厚度的相关性研究

目的:探讨H型高血压患者血同型半胱氨酸(HCY)水平及血浆致动脉硬化指数(AIP)与颈动脉硬化的相关性。方法:所有入选的高血压患者(排除继发性高血压),均测量血压、身高、体重、HCY、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)。计算出AIP及体质指数(BMI)。超声检测颈动脉内膜-中层厚度(IMT),并计算斑块积分。根据血浆HCY水平将患者分为H型高血压组(HCY≥10μmol/L)和非H型高血压组(HCY10μmol/L),比较两组AIP、血脂、IMT及斑块积分差异。采用Pearson和Logistic检验进行相关性分析。结果:H型高血压组血HCY水平、AIP、LDL-C、颈动脉IMT及斑块积分均高于对照组(均P0.05)。Logistic多因素回归分析显示,HCY、AIP、LDL-C是颈动脉内膜增厚的危险因素。结论:老年H型高血压血HCY及AIP与IMT密切相关,且为正相关。HCY、AIP、LDL-C是颈动脉内膜增厚的危险因素,HCY及AIP可作为动脉硬化早期预测因子。     

代谢综合征对原发性高血压患者颈动脉结构和功能的影响

目的观察代谢综合征(MS)对原发性高血压(EH)患者颈动脉结构和功能的影响。方法将156例EH患者根据是否合并MS,分为EH+MS组(61例)和EH+非MS组(95例),同期选择31例健康体检者为对照组(NC组),超声测定颈动脉内径、颈动脉内膜中层厚度(IMT)、舒张末期血流速度及僵硬度等。结果EH+MS组颈动脉内径及IMT明显高于EH+非MS组和NC组(P<0.05),舒张末期血流速度明显低于后2组(P<0.05)。颈动脉僵硬度高低排序为EH+MS组>EH+非MS组>NC组。IMT、平均流速-时间积分与年龄、收缩压、体重指数的相关性较强。结论MS促进EH患者动脉硬化的发展。     

Safety of carotid artery stenting for symptomatic carotid artery disease: a meta-analysis.

AIMS: Clinical trials comparing carotid artery stenting (CAS) with carotid endarterectomy (CEA) for patients with symptomatic carotid artery disease have produced conflicting results. We performed a meta-analysis to systematically evaluate currently available data by comparing CAS with CEA in patients with symptomatic carotid artery disease. METHODS AND RESULTS: We searched MEDLINE, Embase, ISI Web of Knowledge, Current Contents, International Pharmaceutical Abstracts databases, the Cochrane Central Register of Controlled Trials, and scientific meeting abstracts up to 31 October 2006 and then calculated summary risk ratios (RRs) for mortality, stroke, disabling stroke, and death using random- and fixed-effect models. Data from five trials with 2122 patients were pooled. There was no difference in risk of 30-day mortality (summary RR 0.57, 95% CI 0.22-1.47, P = 0.25), stroke (summary RR 1.64, 95% CI 0.67-4.00, P = 0.34), disabling stroke (summary RR 1.67, 95% CI 0.50-5.62, P = 0.50), death and stroke (summary RR 1.54, 95% CI 0.81-2.92, P = 0.19), or death and disabling stroke (summary RR 1.19, 95% CI 0.57-2.51, P = 0.64) among patients randomized to CAS, compared with CEA. CONCLUSIONS: No significant differences could be identified between CAS and CEA in the treatment of patients with symptomatic carotid artery disease. Larger randomized controlled trials are warranted to compare the two strategies.     

Type 2 diabetes is not associated with an altered plaque phenotype among patients undergoing carotid revascularization. A histological analysis of 1455 carotid plaques

Aims

Diabetes accelerates progression of atherosclerotic disease, but data on associations between diabetes and advanced atherosclerotic plaque composition are scarce.

Methods and results

We used one of the largest biobanks, the Athero-Express study (n = 1455) at carotid endarterectomy (CEA). All plaques were subjected to histological analysis to assess lipid core size, collagen, macrophages, smooth muscle cells, micro-vessel density and calcifications. In addition, within a subset of patients cytokines and chemokines were assessed.The 295 patients (20%) with type-2 diabetes showed a higher proportion of previous cardiovascular interventions and more stringent treatment for hypertension and hypercholesterolaemia compared with patients without type-2 diabetes. Surprisingly, no associations between diabetes and histological plaque characteristics were observed. In addition, no differences were observed in the expression of inflammatory chemokines, cytokines or advanced glycation end products in plaques of diabetic and non-diabetic patients.

Conclusion

In patients suffering from significant carotid artery disease, diabetes does not appear to be associated with specific atherosclerotic plaque characteristics.     

江苏省常熟市肠道线虫感染情况及防治效果评价

常熟市属典型的江南水乡 ,是苏南经济比较发达的地区之一。 5 0、6 0年代蛔虫感染率高达 80 % ,钩虫感染率 2 0 .86 % ,对人民的身体健康危害极大。随着预防工作的深入和人们生活水平提高 ,肠道线虫感染率有了一定的下降。进入80年代后 ,为降低肠道线虫的总感染率 ,1987年进行了一次全市肠道线虫抽样调查 ,总感染率 16 .6 8%。之后 ,全市从1993年开始逐步在较大范围内开展重点人群肠道线虫集体化疗 ,并做了防治效果观察 ,取得了明显的成效。材料与方法1　方法　采用改良加藤法、饱和盐水漂浮法检查肠道线虫虫卵 ,并作虫卵计数。2　化疗对象…     

常熟地区抗结核药致肝损害的发生及影响因素研究

目的了解常熟地区抗结核药致肝损害(ATLI)的发生、转归及其影响因素,为科学防治抗结核药致肝损害提供依据。方法基于常熟地区2013-2014年全市新诊断结核病患者的抗结核治疗病历进行回顾性分析,采用国际共识会议标准进行ATLI的判断,对其发生和转归进行分析,同时采用1:4匹配病例对照研究探讨其影响因素。结果常熟地区2年内新诊断851例结核病人,其中832人完成了抗结核治疗(19人失访)。排除了治疗期间无肝功能检测或只有基线肝功能检测的患者后,在剩余724人中,55人发生了药物性肝损害(ATLI发生率为7.6%),中位发生时间为17天(四分位间距为14-24天),且均发生在抗结核治疗的前2个月内。55人中有41例在加强保肝治疗的基础上仍沿用原治疗方案,11例患者改变了原治疗方案;24人治愈,30人完成疗程,1例患者停止治疗;多因素条件Logistic回归分析显示合并有其他疾病的结核病患者易发生ATLI(OR=3.367,95%CI:1.506-7.530)。结论 2013-2014年常熟地区ATLI的发生率为7.6%,应重点针对罹患有其他疾病的患者加强肝功能检测,以便早期发现肝损害。     

常熟市晚期血吸虫病现状调查

组织有经验的医务人员通过询检、体检、特殊检查及实验室检查,对原登记在册的晚期血吸虫病(晚血)病人和新的疑似病人,建立个案调查卡。2008年常熟市共有晚血病人1 516例,患病率为0.14%,较2005年下降了2.80%;新发现晚血病人101例,占现有晚血病人的6.67%,新增晚血病人都为过去流行区曾有血吸虫病治疗史的60～80岁农民。全市晚血病人中男性709例,占46.77%,女性807例,占53.23%。腹水型119例,占7.85%;巨脾型1 395例,占92.02%;结肠增殖型2例,占0.13%。临床治愈1 076例,占70.97%;病情稳定237例,占15.63%;尚需治疗203例,占13.40%。常熟市晚血病人总数多,尚需治疗病人也多,且有新的晚血病人出现,要加强晚血的防治工作。     

Association of an allelic variant of interleukin-6 with subclinical carotid atherosclerosis in an Australian community population.

AIMS: Atherosclerosis can be viewed as a low grade inflammatory process, and genetic polymorphisms within cytokines are candidate risk factors for the development of atherosclerosis. We examined the association of a common functional variant in the IL-6 gene with carotid intimal-medial wall thickness (IMT) and the presence of plaques in a randomly selected, cross-sectional Australian population. METHODS: B-mode carotid ultrasound was performed on 1109 subjects aged 27-77 years, who were genotyped for the IL-6 polymorphism (-174G>C) and assessed for conventional cardiovascular risk factors. RESULTS: The frequency of the IL-6 -174C allele was 0.41. Initial univariate analysis showed no association of the IL-6 -174G>C polymorphism with carotid IMT. Multivariate analysis however showed an association of the IL-6 -174C allele with increased IMT in subjects older than the median age of 53 years (P=0.005). Initial univariate analysis of the IL-6 -174G>C polymorphism and carotid plaque showed no association in the whole sample. In multivariate analysis the -174C allele was independently associated with an increased risk of carotid plaque in the whole sample (CC vs GG, OR=2.22, 95% CI=1.32 to 3.73, P=0.003). CONCLUSIONS: This study shows that the IL-6 -174G>C variant is independently associated with carotid plaque formation in the whole population and an increased carotid IMT in older subjects within a randomly selected, cross-sectional Australian population.     

颈动脉粥样硬化斑块及内-中膜厚度与冠心病的关系

目的：探讨冠心病患者颈动脉粥样硬化斑块及内-中膜厚度与冠心病的关系。方法：对58例冠心病患者的颈动脉内一中膜厚度及斑块进行超声检测，与35例具有动脉粥样硬化危险因素的患者作对照。结果：冠心病患者的颈动脉内-中膜厚度、斑块指数及斑块检出率明显高于对照组(P均＜0．01)，颈动脉内-中膜厚度与年龄，血总胆固醇、收缩压水平，高血压病呈正相关(r＝0．267-0．532，P＜0.05-0．01)。结论：年龄、甘油三酯、收缩压、高血压病程及斑块指数与颈动脉内-中膜厚度密切相关。     

颈动脉转流管在颈动脉内膜切除术中的临床应用

目的探讨颈动脉转流管在颈动脉内膜切除术（CEA）中的应用价值。 方法收集胜利油田中心医院神经外科&头颈血管外科2013年1月至2019年8月935例行CEA患者的临床资料,纳入统计标本的有304例症状性颈动脉重度狭窄合并颅内血流代偿较差的患者。术中行转流管转流的患者为转流管组（98例）,术中未行转流管转流的患者为对照组（206例）,通过比较2组患者术后症状改善率、术后并发症发生率及血管再狭窄发生率,对术中转流管的应用进行全面系统的研究。 结果转流管组和对照组的术中颈动脉阻断时间分别为（2.3±0.6）min和（13.6±8.2）min,术后出现颅脑过度灌注发生率分别为1.02%（1/98）和7.28%（15/206）,2组对比差异均有统计学意义（P<0.05）;2组患者术后症状改善率、术后其他并发症发生率及血管再狭窄发生率比较差异无统计学意义（P>0.05）。 结论对于症状性颈动脉重度狭窄合并颅内血管代偿较差的患者,CEA中转流管的熟练应用是安全可靠的。     

颈动脉粥样硬化与LDL—RmRNA、VCAM-1mRNA表达及氧化反应的相关性及脂脉宁的干预作用

目的：探讨颈动脉粥样硬化（CAS）与相关基因表达及过氧化反应的相关性,以及脂脉宁胶囊的干预作用。方法：人选CAS患者72例,随机分为脂脉宁组（36例,给予脂脉宁胶囊）,血脂康组（36例,给予血脂康）,检测治疗前后颈动脉内膜-中膜厚度（IMT）、氧化指标、血脂、淋巴细胞低密度脂蛋白受体（LDL—R）mRNA及血管细胞黏附分子-1（VCAM-1）mRNA表达;另选同龄正常人20例作为正常对照组。结果：与正常对照组比较,两组治疗前LDL—RmRNA表达明显降低,VCAM-1mRNA表达明显升高（P〈0．05或〈0．01）。两组治疗后血脂（除HDL明显升高外）及脂质过氧化物（LPO）水平皆明显降低,SOD活性明显升高（P〈0．05或〈0．01）;与血脂康组比较,脂脉宁组LDL—RmRNA的表达明显上调[（108．2±17．9）比（135．7±21．8）],VCAM—1mRNA表达明显下调[（91．6±21．3）比（64．9±16．2）],P均〈0．01。结论：颈动脉粥样硬化与脂质过氧化、低密度脂蛋白受体及血管细胞黏附分子-1基因表达失调有关,脂脉宁胶囊有明显的干预作用。     

Carotid artery stenting in octogenarians: results from the ALKK Carotid Artery Stent (CAS) Registry.

AIMS: We tried to determine the influence of age on complication rates of carotid artery stenting (CAS). METHODS AND RESULTS: Two thousand seven hundred eighty CAS procedures were included in the registry. Median age of the patients was 70.8 years, with a proportion of octogenarians of 11.2% and a significant increase between 1996 (5.9%) and 2005 (13.7%; P for trend = 0.002). In octogenarians, a symptomatic stenosis was a more frequent indication for CAS (60.7% vs. 48%, P < 0.001), the CAS procedure was aborted more frequently (6.9% vs. 2.2%; P < 0.001) and the duration of intervention was longer (Median 45 vs. 40 min; P = 0.008). Increasing age was associated with a significant increase in the in-hospital death or stroke rate (P for trend: 0.001). In-hospital death or stroke rate was also higher in octogenarians compared with younger patients (5.5 vs. 3.2%; P = 0.032, OR = 1.79; 95%CI: 1.04-3.06). Logistic regression analysis showed that age analysed as a continuous variable was a strong predictor of in-hospital death or stroke (P < 0.001), whereas octogenarians had only a trend towards a higher event rate (P = 0.062). CONCLUSION: CAS in octogenarians is performed in an increasing proportion of patients. In-hospital stroke or death rates increase significantly with older age; however, there was no excess complication rate in octogenarians.