老年下肢动脉粥样硬化危险因素分析

目的探讨影响老年人下肢动脉粥样硬化疾病(LEAD)的相关危险因素。方法连续性收集2013年5月1日至2014年12月31日内蒙古自治区人民医院血管外科及北京协和医院血管外科老年LEAD患者共98例(病例组),同时选取2个中心进行体检的老年健康人群70名作为对照组。收集2组患者基线资料及临床相关指标并进行比较。采用SPSS 19.0软件进行统计分析。根据数据类型,组间比较采用独立样本t检验或χ~2检验。将单因素分析中P0.01的自变量纳入多因素logistic回归模型,分析影响老年LEAD的相关危险因素。结果病例组患者男性、高血压、吸烟比例及收缩压水平显著高于对照组,舒张压和体质量指数水平显著低于对照组,差异有统计学意义(P0.05)。临床指标中,病例组患者空腹血糖(FBG)、稳态模型胰岛素抵抗指数(HOMA-IR)、胰岛素、肌酐和高敏C-反应蛋白(hs-CRP)水平显著高于对照组,高密度脂蛋白胆固醇(HDL-C)及踝肱指数(ABI)水平显著低于对照组,差异均有统计学意义(P0.05)。多因素logistic回归分析显示,性别(OR=1.007,95%CI 0.201～1.232)、吸烟(OR=0.181,95%CI 0.044～1.119)、收缩压(OR=0.153,95%CI0.135～0.198)、FBG(OR=3.226,95%CI 1.589～5.103)、HOMA-IR(OR=2.971,95%CI 1.456～4.716)、胰岛素(OR=1.996,95%CI 1.309～3.311)、HDL-C(OR=0.311,95%CI-0.237～0.515)、hs-CRP(OR=1.058,95%CI 0.313～1.157)和ABI(OR=-3.011,95%CI-4.238～-2.010)是发生LEAD的独立危险因素(P0.05)。结论患有高血压或糖尿病的老年男性患者要注意LEAD的筛查,并积极戒烟,控制血压血糖,强化降脂。     

Risk factors relating to coronary artery disease in the elderly

A total of 224 patients with coronary artery disease (CAD) and 167 healthy control beings (C) were evaluated for coronary risk factors. Analysis of low age subset (age less than 55) disclosed hypertension and hypercholesterolemia were more common findings in CAD compared with C. Significantly elevated plasma triglyceride (TG) and low density lipoprotein cholesterol (LDL-C), and reduced high density lipoprotein cholesterol (HDL-C) concentrations were found in CAD, accompanied by significant increase of atherogenic index (AI). In CAD, a decreased number of males and smokers was noted in high age subset (age over 65). Significantly reduced plasma TG and elevated HDL-C were observed in the elderly compared with the young. AI was also significantly higher in this group. Therefore, in CAD, the level of coronary risk factors seemed to be attenuated in the hig age subset compared with the low age group, which was different from the findings in C in whom significantly increased AI was noted in the elderly. In 61 CAD cases, lipid profiles were monitored for 5 years in average. Significant changes recognized during this period were the reduction of TG, LDL-C and AI along with the elevation of HDL-C, suggesting their risk to be improved. To examine the metabolic effects of diuretics, 52 patients with essential hypertension on trichlormethiazide for long periods were subjected to the substitution of this drug by the inhibitor of angiotensin converting enzyme, enalapril, for more than 3 months. At the end of each treatment, measurements of blood sugar (BS) and insulin (IRI) were made together with lipid analysis.(ABSTRACT TRUNCATED AT 250 WORDS)     

颅内动脉粥样硬化的危险因素

颅内动脉粥样硬化是缺血性卒中的重要病因之一.由于颅内、外动脉在结构和血流动力学方面存在差异,传统血管危险因素,如性别、年龄、高血压、糖尿病等对颅内、外动脉粥样硬化的影响也有所不同.及早识别颅内动脉粥样硬化的危险因素,对于积极防治颅内动脉粥样硬化和降低缺血性卒中发病率具有重要意义.然而,针对危险因素和颅内动脉粥样硬化相关性的许多研究结论并不一致.文章对颅内动脉粥样硬化危险因素的研究现状做了综述.     

颅内动脉粥样硬化的危险因素

颅内动脉粥样硬化是缺血性卒中的重要病因之一.由于颅内、外动脉在结构和血流动力学方面存在差异,传统血管危险因素,如性别、年龄、高血压、糖尿病等对颅内、外动脉粥样硬化的影响也有所不同.及早识别颅内动脉粥样硬化的危险因素,对于积极防治颅内动脉粥样硬化和降低缺血性卒中发病率具有重要意义.然而,针对危险因素和颅内动脉粥样硬化相关性的许多研究结论并不一致.文章对颅内动脉粥样硬化危险因素的研究现状做了综述.

Abstract：

Intracranial atherosclerosis is one of the important causes of ischemic stroke. Because extra- and intracranial arteries have differences in the structure and hemodynamics, the effects of traditional vascular risk factors, including sex, age, hypertension, and diabetes mellitus, on extra-and intracranial atherosclerosis are also different. The early identification of the risk factors for intracranial atherosclerosis has important significance for aggressively preventing and treating intracranial atherosclerosis and reducing the incidence of ischemic stroke. However, many research conclusions aiming at the risk factors and intracranial ng andatherosclerotic correlation are not consistent. This article reviews the research status quo of the risk factors for intracranial atherosclerosis.     

Development of coronary atherosclerosis in the elderly

The role of aging, hypertension and plasma cholesterol in the development of coronary atherosclerosis was examined in 3569 consecutive autopsy cases, aged 60 to 99 years, at the Tokyo Metropolitan Geriatric Hospital. The prevalence of coronary atherosclerosis increased with aging. Both systolic and diastolic hypertension were related to the prevalence of coronary atherosclerosis. High plasma cholesterol (230 mg/dl) was related to increased prevalence of coronary atherosclerosis. This effect was observed in a hypertensive group, but not in a normotensive group. To define the effect of hypertension on vascular diseases, endothelial cells from spontaneously hypertensive rats (SHR) were obtained and characterized in terms of cellular response. Cellular Ca2+ level in response to A23187 was significantly enhanced in SHR compared to normotensive Wistar-Kyoto rats (WKY). Thus, aging, hypertension and high plasma cholesterol are risk factors for coronary artery atherosclerosis in the elderly.     

甲状腺功能减退症患者动脉粥样硬化的相关影响因素分析

目的探讨甲状腺功能减退症(甲减)患者发生动脉粥样硬化(AS)的影响因素。方法:选取甲减患者152例,根据颈动脉内膜中层厚度(IMT)分为颈动脉正常组(A组)32例和AS组120例,AS组包括IMT增厚组(B组)27例和斑块形成组(C组)93例。收集受试者一般资料,检测促甲状腺素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、TC、TG、LDL-C、HDL-C,采用颈部血管超声检测颈部血管斑块,采用logistic回归分析甲减患者发生AS及AS严重程度的影响因素。结果 AS组年龄[(70.65±5.34)岁vs (64.44±4.89)岁]、TSH[(13.83±9.01)mmol/L vs (6.00±4.01)mmol/L]、LDL-C[(3.84±1.02)mmol/L vs (2.52±1.39)mmol/L]明显高于A组,而HDL-C明显低于A组,差异有统计学意义(P0.01);C组年龄和LDL-C最高,B组次之,A组最低(P0.05);C组TSH、TC明显高于A组和B组,HDL-C明显低于A组和B组,差异有统计学意义(P0.05)。logistic回归分析显示,TSH、年龄和LDL-C为甲减患者发生AS的危险因素(P0.05,P0.01),其中LDL-C对其影响较大(β=0.521);年龄、TSH和LDL-C为AS严重程度的危险因素(P0.01),且LDL-C的影响程度较大(β=1.056)。结论TSH、年龄和LDL-C为甲减患者发生AS的独立危险因素,同时三者也是AS严重程度的影响因素,且LDL-C对AS的发生及严重程度的影响均较大。     

Risk factors for atherosclerosis in proper perspective

There is widespread misconception about risk factors for atherosclerosis in general and for myocardial infarction in particular. Based on fifty-two years of practice of pathology and forty-six years of study of atherosclerosis, misunderstandings are being corrected by placing risks into proper perspective. Risk factors are being scrutinized, the etiologic roles of hypertension and of diabetes are being re-evaluated and transvalued.     

Risk factors for atherosclerosis in young individuals

Atherosclerosis starts in childhood, and is accelerated in some individuals. A cluster of clinical and biochemical factors constitute the risk profile for many of them, perhaps most important being metabolic insulin resistance syndrome. Insulin resistance and its components for children and adolescents, especially obesity and dyslipidemia, are generators of hypertension, glucose intolerance and complications of atherosclerosis in adulthood. Some individuals are genetically predisposed, particularly those with the family history of such disorders. For many subjects, there is 'tracking' of metabolic and lifestyle factors from early age to adulthood. Several new risk factors of atherosclerosis (e.g. level of lipoprotein (a), procoagulant state, hyperhomocysteinemia, low birth weight and adverse in-utero environment, and possibly inflammatory markers) are current and potentially future areas of research concerning children and young individuals. Definition of and research on new and hitherto not investigated factors and formulation of strategies to neutralize the known factors are of paramount importance for primary prevention of atherosclerosis. Simple and effective measures for prevention include increasing awareness of the diseases, maintenance of ideal body weight, regular physical exercise, avoidance of smoking and chewing of tobacco, eating a balanced diet, and early periodic monitoring of blood pressure and metabolic status. These measures, starting from childhood, should be applied to all and in particular to the susceptible offspring, predisposed individuals, and populations.     

早发性颈动脉粥样硬化危险因素分析

目的 探讨颈动脉粥样硬化早期发生（≤50岁）的危险因素.方法 回顾性分析277例心内科＜50岁住院患者的临床资料,将其按颈动脉超声结果分为斑块组和无斑块组,比较两组患者的基线资料,分别采用Logistic回归及多元线性回归模型分析斑块形成及内膜-中膜增厚的危险因素.结果 与无斑块组相比,斑块组患者的年龄、低密度脂蛋白胆固醇（LDL-C）水平明显升高（P＜0.05）,Logistic回归显示男性（OR=1.85,P＜0.05）、年龄（OR =1.08,P＜0.01）、LDL-C（OR =1.60,P＜0.05）与斑块形成密切相关,多元线性回归显示男性（P＜0.05）、年龄（P＜0.05）、收缩压（P＜0.01）、醛固酮水平（P＜0.01）与颈动脉内膜-中膜增厚密切相关.结论 多个因素参与了颈动脉粥样硬化的早期发生,早发性颈动脉粥样硬化斑块形成和内膜-中膜增厚各自的主要危险因素可能存在差异.     

冠心病危险因素在老年人群中的分布及其集聚

目的 分析老年人冠心病主要危险因素及多种危险因素的集聚，评估近期内发生冠心病事件的危险水平。方法 以北京市60岁以上男性老年退休干部5197例为研究对象，以30～44岁男性中青年干部3993例为对照组，分析两组中8项冠心病危险因素流行率的差异，统计的危险因素包括年龄、吸烟、高血压、高胆固醇(TC)、高密度脂蛋白胆固醇(HDL—C)降低、高空腹血糖(FBG)、高甘油三酯(TG)及超重高体质指数(BMI)。结果 老年组高血压、高TC及高FBG流行率明显高于对照组，但两组间低HDL—C和高BMI相似，TG也无明显差异。对照组现吸烟率高于老年组。冠心病及冠心病等同危险状态的流行率老年组与对照组分别为27．5％及4．5％；冠心病危险因素集聚率老年组高于对照组，后者处于“0”危险因素者有31．3％；老年组处于冠心病高危者约45％、中危39％、低危16％，对照组分别为7％、21％和72％。结论 本组老年人属于冠心病高危人群，控制多种危险因素在冠心病预防中十分重要。     

Risk factors for progression of atherosclerosis six months after balloon angioplasty of coronary stenosis

To assess the possible progression of coronary artery disease after percutaneous transluminal coronary angioplasty (PTCA) and its relation to risk factors and restenosis, 124 patients who underwent a first successful PTCA were studied. All had routine follow-up angiography 5 to 8 months after PTCA. Restenosis was defined as a 30% decrease in diameter stenosis or a return to greater than 50% stenosis, and progression (in any nondilated site) as a 20% decrease in diameter stenosis, assessed by a video-densitometric computer-assisted technique. Univariate and multivariate analysis with respect to progression was carried out for age, sex, initial unstable angina, previous myocardial infarction, diabetes mellitus, hypertension, hypercholesterolemia (greater than or equal to 6.2 mmol), smoking habits, Jenkins' score, dilated artery and restenosis. Forty-one patients (33%) had restenosis, and 23 (19%) had evidence of progression; 20 (87%) of these latter patients had restenosis and 3 (13%) did not. Univariate correlates of progression were: previous myocardial infarction (p less than 0.05), higher Jenkins' score (p less than 0.0003) and restenosis (p less than 0.0001). Restenosis was the only multivariate correlate (p less than 0.00003). Progression at routine angiography after PTCA is not rare, and appears to be related to both the initial extent of coronary artery disease and restenosis.     

老年人静脉血栓栓塞症的危险因素

静脉血栓栓塞症(VTE)包括深静脉血栓形成(DVT)和肺栓塞(PE),其发生率随着年龄的增高而显著上升,老年人是VTE的高危人群。随着人口老龄化加剧,老年VTE患者势必不断增多。明确老年人VTE危险因素,及时采取有效预防措施,具有重要的现实意义。本文综述了与老年人VTE发生较为密切的一些因素,包括制动相关危险因素、癌症、老年人常见慢性病、慢性静脉功能不全、衰弱综合征等,以期发现其特点,为老年人VTE预防提供可靠的临床参考。     

Risk factors for nosocomial pneumonia in the elderly

PURPOSE: Pneumonia is now the second most frequent hospital-acquired infection in acute-care facilities, and recent studies indicate that the incidence rate for nosocomial pneumonia in long-term-care facilities is of similar magnitude. The mortality rate is high, especially in the elderly. With prevention of this complication as an overall priority, this study was designed to determine the risk factors associated with nosocomial pneumonia in the elderly in both acute-care and long-term-care settings. PATIENTS AND METHODS: An epidemiologic case-control study was undertaken to compare patients or residents who developed radiographically confirmed pneumonia with control subjects who did not have and did not develop respiratory infection. Thirty-three cases were identified in the acute-care setting during the 18-week period, and 27 cases were identified in the long-term-care setting. Two matched controls were chosen for each case. Data collection involved review of the medical record and verification by medical personnel while the cases or controls were still institutionalized. Risk factor variables were analyzed using an odds ratio and 95% confidence interval calculation for matched triplets, and chi-square analysis. Selected risk factors were entered into a backward stepwise logistic regression to determine the best combination of risk factors for each setting. RESULTS: In the acute-care setting, current neurologic disease, current renal disease, deteriorating health, altered level of consciousness, disorientation, dependent bathing, dependent bowel function, dependent feeding, aspiration, difficulty with oropharyngeal secretions, and presence of a nasogastric tube were significant risk factors. In the long-term-care setting, deteriorating health, malnourishment, recent weight change, altered level of consciousness, disorientation, aspiration, difficulty with oropharyngeal secretions, suctioning, presence of a nasogastric or gastric tube, upper respiratory infection, inhalation therapy, increased confusion, and increased agitation were determined to be significant. Current pulmonary disease, previous infection, and antibiotic therapy were found not to be associated with the onset of nosocomial pneumonia. Through logistic regression, the best models for prediction of nosocomial pneumonia in the elderly were identified. In the acute-care setting, difficulty with oropharyngeal secretions and presence of a nasogastric tube were the best predictors. In the long-term-care setting, difficulty with oropharyngeal secretions, deteriorating health, and occurrence of an unusual event were the best combination of predictors. CONCLUSION: These data confirm prior findi     

颈动脉粥样硬化与冠状动脉粥样硬化的关系

目的　探讨颈动脉粥样硬化与冠状动脉粥样硬化的关系。方法　对 94例老年患者进行了冠状动脉造影和颈动脉超声检查。颈动脉粥样硬化斑块积分采用Sutton法。结果　单支组及多支组内膜中膜厚度、斑块积分显著高于正常组 ,多支组显著高于单支组 (P<0 .0 5 )。斑块指数与年龄、吸烟、低密度脂蛋白胆固醇与高密度脂蛋白胆固醇的比值、收缩压以及高血压病程的程度呈正相关。结论　颈动脉粥样硬化与冠状动脉粥样硬化的病变是平行的     

老年高血压合并不同程度下肢动脉粥样硬化危险因素的分析

目的 探讨老年高血压合并不同程度下肢动脉粥样硬化（LEAD）的危险因素.方法 纳入2010年1月至2012年1月在本院就诊的老年原发性高血压合并LEAD患者129例,依照肱踝血压比（ABI）的检测结果分为轻度组（n=60,0.7＜ABI＜0.9）、中度组（n=33,0.4＜ABI＜0.7）、重度组（n=36,ABI＜0.4）,观察高血压患者发生LEAD的可能危险因素（血压、血糖、血脂）.结果 三组在高血压病程、脉压、糖尿病病程、甘油三酯（TG）、血浆纤维蛋白原（FIB）存在统计学差异（P均＜0.05）.在逐步logistic回归中发现高血压病程（OR=3.455,95%CI：1.024~19.231）、TG（OR=2.489,95%CI：0.845~13.481）及糖尿病病程（OR=2.330,95%CI：0.667~9.340）是导致ABI显著减低的主要危险因素.结论 随着老年高血压患者高血压病程延长、糖尿病时间的延长、高TG血症的严重程度增加及脉压增大,老年高血压患者发生LEAD的危险性显著增加,并且与LEAD病情严重程度密切相关.     

老年冠心病患者合并非酒精性脂肪性肝病的危险因素分析

目的探讨老年冠心病患者合并非酒精性脂肪性肝病(NAFLD)的患病率和危险因素。方法入选冠状动脉造影诊断为冠心病的老年患者359例,NAFLD组172例,非NAFLD组187例,住院期间经腹部超声检查和采集病史,观察2组患病率、肝脏酶学异常比例及其与冠状动脉病变程度的关系。结果 NAFLD组糖尿病、丙氨酸转氨酶、天冬氨酸转氨酶水平明显高于非NAFLD组,差异有统计学意义(P<0.05,P<0.01)。NAFLD与冠状动脉病变严重程度呈正相关(χ2=16.182,P<0.01)。NAFLD组患者斑块检出率、斑块数目明显高于非NAFLD组,差异有统计学意义[89.7%vs 78.3%,(2.27±1.20)个vs(1.81±1.32)个,P<0.05]。多因素logistic回归分析显示,糖尿病和冠状动脉多支病变(或左主干病变)与NAFLD的发生相关。结论老年冠心病患者NAFLD的患病率随着冠状动脉病变程度加重而增加。     

Risk factors for accelerated atherosclerosis in renal transplant recipients

The factors responsible for atherosclerosis in renal transplant recipients are not known. In the present study, cardiovascular disease was investigated in 403 patients who received 464 kidney transplants during a 10-year period. Among those who had no clinical evidence of vascular disease at the time of transplantation, atherosclerotic complications developed in 15.8 percent during the post-transplant follow-up period (46.1 +/- 36.2 months). Pre- and post-transplant vascular diseases were closely linked. However, after taking pre-transplant vascular disease into account, multivariate analysis showed that a number of known risk factors (age, sex, diabetes, cigarette smoking, hypertension, and serum cholesterol) were independently associated with post-transplant vascular disease. In addition, the number of acute rejection episodes (all treated with high doses of corticosteroids) was also independently linked to vascular disease. These results suggest that an increased prevalence of known risk factors, and events linked to allograft rejection, explain the high incidence of cardiovascular disease in renal transplant recipients.     

Risk factors for atherosclerosis in healthy employees-a multidisciplinary approach

BACKGROUND: The aim of the study was to investigate the prevalence of early atherosclerosis in healthy workers and the relationship between classical, psychological, and immunological risk factors and atherosclerosis, as well as their predictive value. METHODS: One hundred healthy managers and 50 office workers aged 35-65 were studied. In all subjects, individual, family, and occupational stress/coping risk factors were evaluated, including plasma levels of biochemical (total cholesterol, LDL, HDL, TG, glucose) and inflammatory-immunological (aCL, anti-beta(2) GPI, oxLDL, HSP, HSCRP) parameters. Carotid artery intima-media thickness (IMT) and atherosclerotic plaques in carotid arteries were assessed with computer analysis of B-mode ultrasound images. RESULTS: In 107 persons (71%) no changes were found in ultrasound images and in 43 individuals (29%) the presence of plaque was shown. The mean IMT value was 0.0618+/-0.013 mm. Cross-domain analysis showed that core predictors for IMT were age, LDL level, smoking, and occupation (being a manager) (beta=0.33, 0.30, 0.23, and 0.20, respectively); the core predictors for plaque were age, total cholesterol level, and an occupational stressor home-work balance (Wald=7, 6.7, and 5.6, respectively). Immunological factors were not independent predictors. CONCLUSIONS: In atherosclerosis, not only traditional risk factors (age, lipid disorders, and lifestyle) but also occupational stress factors may play a role. Immunological factors do not seem to play a role in the development of atherosclerosis in a population of healthy workers. The interplay between occupational stress and atherosclerotic changes requires further investigation.     

高龄冠心病患者PCI后院内死亡危险因素分析

目的:探讨高龄冠心病患者接受经皮冠状动脉介入治疗(PCI)后发生院内死亡事件的危险因素。方法:连续入选我院2005年1月至2010年12月确诊为冠心病并接受PCI的高龄患者(年龄≥75岁)共1 007例,回顾性分析病历资料,通过单因素及多因素Logistic回归分析确定患者院内死亡的独立危险因素,并通过该多因素Logistic回归模型的受试者工作特征(ROC)曲线下面积和Hosmer-Lemeshow拟合优度检验,判断其对PCI后发生院内死亡事件的预测能力。结果:所有高龄冠心病患者中共33例发生院内死亡,死亡率为3.3%。PCI后患者院内死亡的独立危险因素包括急诊PCI(OR=8.59)、肾功能不全(OR=4.53)、急性心肌梗死(OR=6.83)、左室射血分数50%(OR=3.53),左主干病变(OR=6.12)、C型病变(OR=5.90)、置入支架数≥3(OR=4.64),ROC曲线下面积为0.96,Hosmer-Lemeshow拟合优度检验P=0.48。结论:急诊PCI治疗、肾功能不全、急性心肌梗死、左室射血分数50%、左主干病变、C型病变、置入支架数≥3是高龄冠心病患者PCI后发生院内死亡的独立危险因素,该回归模型对PCI后院内死亡事件的发生有较高的预测能力。     

Risk factors for nosocomial pneumonia in the elderly.

PURPOSE: Elderly patients have a disproportionate incidence of nosocomial pneumonia (NP) and a higher mortality rate, yet few studies have focused on this high-risk population. We undertook a study to examine risk factors for NP in elderly inpatients and to describe how these patients differ from younger patients with NP. METHODS: In a public teaching hospital, all cases of NP in patients aged 65+ were ascertained by prospective surveillance during a 2-year period (n = 59). These elderly cases were compared with 59 cases of NP in patients aged 25 to 50 to describe differences in risk factors and outcomes. Elderly cases were then matched to elderly control subjects who were admitted to the same hospital service but did not develop NP. Data were collected on known risk factors and on the potential risk factors of poor nutrition, neuromuscular disease, and dementia. Significant differences in risk factors were analyzed using univariate and multivariate comparisons of cases and controls. RESULTS: Elderly patients had twice the incidence of NP (RR = 2.1) as younger patients. Onset of infection was earlier for young than for older cases (6 versus 11 days, p less than or equal to 0.02), but mortality following NP was equal for the two age groups (42% versus 44%). No significant differences in risk factors were found for old and young cases, although older cases tended to have higher rates of poor nutrition, neuromuscular disease, and aspiration preceding their pneumonias. Comparison of elderly cases and elderly controls revealed significantly increased frequencies of poor nutrition, neuromuscular disease, pharyngeal colonization, aspiration, depressed level of alertness, intubation, intensive care unit admission, nasogastric tube use, and antacid use among cases. Cases were more severely ill on admission and had more pre-existing risk factors (2.8 versus 1.3, p less than or equal to 0.001) and more in-hospital risk factors (4.7 versus 1.6, p less than or equal to 0.001). Logistic regression analysis revealed low albumin, diagnosis of neuromuscular disease, and tracheal intubation to be strong independent predictors of risk for NP among elderly inpatients. CONCLUSIONS: We conclude that the specific risk factors of poor nutrition, neuromuscular disease, and tracheal intubation may prove useful to target future clinical interventions to prevent NP in the elderly.