血清胱抑素C与冠心病合并糖尿病患者冠状动脉病变相关性研究

目的:对血清胱抑素C与冠心病合并糖尿病患者冠状动脉病变之间的相关性进行分析探讨。方法:随机抽取在2009年4月-2010年4月行冠状动脉介入治疗的住院患者病例298例,其中包括合并2型糖尿病者89例和未合并2型糖尿病者209例,对其展开血清胱抑素C水平检测,并对比分析检测结果。结果:单纯冠心病组血清胱抑素C检测水平低于冠心病合并糖尿病组,单支病变组与多支病变组血清胱抑素C低于冠心病合并糖尿病组,单支病变组血清胱抑素C低于多支病变组,差异有统计学意义(P0.05)。结论:血清胱抑素C水平与冠心病合并糖尿病患者冠状动脉病变之间显著相关,值得关注。     

冠心病患者血清胱抑素C、同型半胱氨酸和尿酸水平及其与冠状动脉狭窄程度的相关性

目的探讨冠心病患者血清胱抑素C、同型半胱氨酸、尿酸水平及其与冠状动脉狭窄程度的相关性。方法纳入212例进行冠状动脉造影的患者,将冠状动脉造影检查为阴性的47例患者作为对照组,冠状动脉造影确诊为冠心病的165例患者作为研究组。比较两组患者的血清胱抑素C、同型半胱氨酸、尿酸水平。根据Gensini积分,进一步将研究组患者分为低分组51例(Gensini积分≤30分)、中分组52例(Gensini积分为31～59分)、高分组62例(Gensini积分≥60分),比较3个亚组的血清胱抑素C、同型半胱氨酸、尿酸水平,并分析上述指标与冠脉狭窄程度的相关性。结果研究组的血清胱抑素C、同型半胱氨酸及尿酸水平高于对照组(均P<0.05)。低分组、中分组、高分组的血清胱抑素C、同型半胱氨酸、尿酸水平依次升高(均P<0.05)。冠心病患者的Gensini积分与血清胱抑素C、同型半胱氨酸及尿酸水平呈正相关(均P<0.05)。结论冠心病患者血清胱抑素C、同型半胱氨酸及血尿酸水平较非冠心病患者升高,三者或可用来评估冠状动脉狭窄的严重程度。     

冠状动脉CT血管造影、血清Hcy和胱抑素C水平对无症状冠心病的诊断价值

目的 探讨冠状动脉CT血管造影(CTA)、血清同型半胱氨酸(Hcy)和胱抑素C水平对无症状冠心病的诊断价值。方法 选取110例疑似无症状冠心病患者作为研究对象，以冠状动脉造影检查为诊断金标准，采用受试者工作特征(ROC)曲线分析血清Hcy、胱抑素C水平单独及联合冠状动脉CTA诊断无症状冠心病的价值。结果 110例疑似患者中，共有89例被诊断为无症状冠心病，21例为非冠心病患者。无症状冠心病患者血清Hcy水平高于非冠心病患者，而胱抑素C水平低于非冠心病患者(均P<0.05)。冠状动脉CTA诊断无症状冠心病的灵敏度、特异度、准确度、阳性预测值和阴性预测值分别为95.51%、90.48%、94.55%、97.70%和82.61%。血清Hcy、胱抑素C水平诊断无症状冠心病的ROC曲线下面积分别为0.798和0.873,最佳截断值分别为9.80μmol/L和1.30 mg/L,灵敏度分别为70.50%和96.80%,特异度分别为82.00%和75.50%;冠状动脉CTA联合血清Hcy、胱抑素C水平诊断无症状冠心病的ROC曲线下面积为0.960,灵敏度和特异度分别为84.00%和92.00%...     

血清胱抑素C与冠状动脉病变相关性研究

目的研究血清胱抑素C(CysC)与冠状动脉病变及其严重程度的关系。方法对104例行冠状动脉造影检查患者按造影结果分为冠心病组(47例)和对照组(非冠心病组,57例),对所有入组患者进行血清胱抑素C检测。比较冠心病组和对照组患者的血清胱抑素C水平,同时,在冠心病组中将不同亚组患者的血清胱抑素C水平进一步加以比较,明确血清胱抑素C水平与冠心病及冠脉血管病变严重程度的关系。结果冠心病组血清胱抑素C水平明显高于对照组(P<0.05)。在冠心病亚组中有多支血管病变者血清胱抑素C水平明显高于单支血管病变组,差异有统计学意义(P<0.01)。结论血清胱抑素C水平是冠心病的预测因子,且随血管病变程度加重其水平增高。     

高龄高血压患者血清胱抑素水平与冠心病的相关性研究

目的研究血清胱抑素C（CysC）与老年高血压患者冠状动脉病变的关系。方法对98例平均年龄82.4岁的患者行冠状动脉造影检查,按造影结果分为冠心病组（62例）和非冠心病组（36例）,比较两组患者的血清胱抑素C水平;同时将冠心病患者分为单支病变组和非单支病变组,分析血清胱抑素C与冠脉病变的相关性。结果冠心病组血清胱抑素C水平明显高于对照组（P〈0.01）,但多支血管病变组与单支血管病变组之间血清胱抑素C水平无统计学意义（P〉0.05）。在纠正了肌酐水平后,冠心病组血清胱抑素C仍高于对照组（P〈0.05）。结论血清胱抑素C水平与高龄高血压患者的冠心病相关,且独立于血清肌酐水平,但与血管病变的严重程度无关。     

不同剂量普伐他汀对冠心病患者血脂与血清胱抑素C的影响及意义

目的:研究不同剂量普伐他汀对早冠心病患者的血脂水平及血清胱抑素C的影响.方法:选取26例正常人群作为健康对照组,另选取104例冠心病患者作为观察治疗组,并将其随机分为:常规治疗组及普伐他汀10、20、40 mg/d治疗组(各26例).常规治疗组采用予以低分子肝素、波立维、阿斯匹林、硝酸酯类药物、β-受体阻滞剂、血管紧张素转换酶抑制剂等治疗,普伐他汀治疗组在常规治疗基础上加用普伐他汀,持续治疗8周.治疗前后分别测取患者的总胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白和血清胱抑素C水平.结果:与正常组相比,冠心病患者的血清胱抑素C升高(P=0.008);与治疗前相比,20、40 mg/d普伐他汀能够显著改善患者的胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白和血清胱抑素C水平(P＜0.05).结论:普伐他汀可以通过降低血脂水平,以及抑制炎症反应两种途径来改善冠状动脉疾病,且中高剂量的普伐他汀均能够起到良好降脂抗炎效果,值得临床上推广运用于冠心病的治疗.     

剪切力促侧支动脉重塑研究进展

冠心病治疗措施包括冠状动脉介入治疗（PCI）、冠状动脉旁路移植术（CABG）和药物治疗等。对于稳定型冠心病患者, PCI 可减轻缺血症状但未能延长生存;CABG 可改善多支血管病变伴左室功能降低冠心病患者心肌灌注、延长患者生存,但有较大手术风险;以他汀类药物为基础的药物治疗仅适度减轻斑块负荷、防止冠脉内形成血栓,尚不能逆转居高不下的冠心病病死率和病残率。鉴于 PCI 、CABG 的潜在风险和现有药物的局限性,探索心肌内侧支动脉新生的方法成为新的研究方向。     

冠心病患者血清胱抑素C和胆红素测定及其临床意义

目的:探讨血清胱抑素C和胆红素在冠心病患者中的含量以及对评估冠心病病情的临床意义。方法:将320例经冠状动脉造影证实为冠心病的患者根据病变冠脉支数的不同分为单支病变组128例,双支病变组110例和多支病变组82例,对照组80例为冠脉正常者,测定各组血清胱抑素C、胆红素以及血脂水平。结果:从对照组到多支病变组,随着病变冠脉支数的增多,血清胱抑素C含量,血脂TC、TG、LDL-C出现不同程度的升高(P<0.05);血清胆红素、HDL-C则出现明显的下降(P<0.05)。结论:血清胱抑素C和胆红素可以作为评估冠状动脉粥样硬化严重程度的敏感指标,指导临床诊断和治疗。     

冠心病血运重建术后患者药物治疗现状

目的 了解我院冠心病血运重建患者二级预防的现状.方法 入选药物洗脱支架对血运重建的影响研究(DESIRE)数据库中2003年7月至2004年6月接受血运重建的冠心病且资料完整的患者2048例,平均年龄(60.1±10.4)岁,男1580例.记录经皮冠状动脉成形术(PCI)或冠状动脉搭桥术(CABG)患者住院和随访期间服用阿司匹林(ASA)、B受体阻滞剂(BB)、他汀类药物、血管紧张素转换酶抑制剂(ACEI)等药物的情况.随访中记录主要心血管不良事件(死亡、AMI、再次血运重建、脑卒中)发生情况.平均随访(587±127)d.结果 住院期间ASA、BB、他汀类药物和ACEI的使用率分别为1923例(93.9%)、1821例(88.9%)、1387例(67.7%)和1288例(62.9%).ASA、BB、他汀类药物3种药物合用者1206例(58.9%),4种药物合用者813例(39.7%).PCI组二级预防常用药物的使用率显著高于CABG组(P＜0.001).随访期间药物的使用率均显著低于住院期间(P＜0.001),ASA、BB、他汀类药物及ACEI的使用率分别为1860例(90.8%)、1175例(57.4%)、881例(43.0%)和501例(24.5%),其中CABG组使用率显著低于PCI组(P＜0.001).随访药物使用率有区域差异,北京地区患者药物使用率显著高于其他地区患者(P＜0.001).结论 冠心病患者接受血运重建后,住院期间二级预防药物治疗使用率均较高.随访期间药物使用率显著降低,特别是接受CABG治疗和北京以外地区患者,应加强冠心病患者二级预防药物的治疗.     

应用ROC曲线评估胱抑素C在冠心病中的应用价值

目的:探讨胱抑素C升高与冠心病的关系,应用受试者工作特征(ROC)曲线为胱抑素C的临床应用提供更有力的理论支持。方法:将102例有心绞痛症状的患者分为冠心病组(CHD)及稳定型心绞痛组(SAP),比较胱抑素C在两组间的差异,应用ROC进一步评估胱抑素C的应用价值,再比较其与脂蛋白(a)及纤维蛋白原(FG)的临床价值。结果:冠心病组胱抑素C含量最高,为1.58±0.53mg/L,胱抑素C诊断冠心病的曲线下面积为0.786。结论:胱抑素C的水平与冠心病的发生有一定关系,胱抑素C在常用血清标志物中较脂蛋白(a)及FG的诊断价值更高。     

血浆胱抑素c对冠心病的预后价值评估

目的探讨血浆胱抑素C（CysC）对冠心病预后的评估价值。方法选择2009年4月～2011年3月在莆田．学院附属医院经冠脉造影检查确诊为冠心病的患者200例,颗粒增强透射免疫比浊法测定血浆Cys-C浓度,对’所有患者随访1年,记录终点事件（定义为死亡或心肌梗死）发生情况。结果随访1年,有9例患者（4．5％）出现终点事件,多变量Logistic回归分析在调整了传统危险因素以后,CysC是冠心病不良预后的显著预测因子（10gCysC每增加一个标准差,调整后OR1．70,95％CI1．51～1．94）;相对于CysC最低第四分位数水平（〈1．8m班）患者,CysC最高四分位数水平（〉5．4mg／L）患者1年内发生冠心病不良预后的风险增加7．93倍（调整后OR值7．93,P〈0．001）。结论CysC能作为早期预测冠心病患者死亡率、心脏事件的一个独立的评价指标。     

Preoperative beta-blocker use and mortality and morbidity following CABG surgery in North America

CONTEXT: beta-Blockade therapy has recently been shown to convey a survival benefit in preoperative noncardiac vascular surgical settings. The effect of preoperative beta-blocker therapy on coronary artery bypass graft surgery (CABG) outcomes has not been assessed. OBJECTIVES: To examine patterns of use of preoperative beta-blockers in patients undergoing isolated CABG and to determine whether use of beta-blockers is associated with lower operative mortality and morbidity. DESIGN, SETTING, AND PATIENTS: Observational study using the Society of Thoracic Surgeons National Adult Cardiac Surgery Database (NCD) to assess beta-blocker use and outcomes among 629 877 patients undergoing isolated CABG between 1996 and 1999 at 497 US and Canadian sites. MAIN OUTCOME MEASURE: Influence of beta-blockers on operative mortality, examined using both direct risk adjustment and a matched-pairs analysis based on propensity for preoperative beta-blocker therapy. RESULTS: From 1996 to 1999, overall use of preoperative beta-blockers increased from 50% to 60% in the NCD (P<.001 for time trend). Major predictors of use included recent myocardial infarction; hypertension; worse angina; younger age; better left ventricular systolic function; and absence of congestive heart failure, chronic lung disease, and diabetes. Patients who received beta-blockers had lower mortality than those who did not (unadjusted 30-day mortality, 2.8% vs 3.4%; odds ratio [OR], 0.80; 95% confidence interval [CI], 0.78-0.82). Preoperative beta-blocker use remained associated with slightly lower mortality after adjusting for patient risk and center effects using both risk adjustment (OR, 0.94; 95% CI, 0.91-0.97) and treatment propensity matching (OR, 0.97; 95% CI, 0.93-1.00). Procedural complications also tended to be lower among treated patients. This treatment advantage was seen among the majority of patient subgroups, including women; elderly persons; and those with chronic lung disease, diabetes, or moderately depressed ventricular function. Among patients with a left ventricular ejection fraction of less than 30%, however, preoperative beta-blocker therapy was associated with a trend toward a higher mortality rate (OR, 1.13; 95% CI, 0.96-1.33; P =.23). CONCLUSIONS: In this large North American observational analysis, preoperative beta-blocker therapy was associated with a small but consistent survival benefit for patients undergoing CABG, except among patients with a left ventricular ejection fraction of less than 30%. This analysis further suggests that preoperative beta-blocker therapy may be a useful process measure for CABG quality improvement assessment.     

Serum Uric Acid is Associated with the Predicted Risk of Prevalent Cardiovascular Disease in a Community-dwelling Population without Diabetes

Objective To examine the association between serum uric acid levels and cardiovascular disease risk among individuals without diabetes. Methods We investigated the association between serum uric acid levels and the risk of prevalent cardiometabolic diseases, 10-year Framingham risk for coronary heart disease, and 10-year risk for atherosclerotic cardiovascular diseases(ASCVD) among 8,252 participants aged ≥ 40 years without diabetes from Jiading district, Shanghai, China. Results Body mass index, waist circumference, blood glucose, glycated hemoglobin, blood pressure, and serum lipids increased progressively across the sex-specific quartiles of uric acid(all P trend 0.05). Compared with individuals in the lowest quartile, those in the higher quartiles had a significantly higher prevalence of obesity, hypertension, and dyslipidemia(all P trend 0.05). A fully adjusted logistic regression analysis revealed that individuals in the highest quartile had an increased risk of predicted cardiovascular disease compared with those in the lowest quartile of uric acid. The multivariate adjusted odds ratios(ORs) [95% confidence intervals(CIs)] for the highest quartiles for high Framingham risk were 3.00(2.00-4.50) in men and 2.95(1.08-8.43) in women. The multivariate adjusted ORs(95% CIs) for the highest quartile for high ASCVD risk were 1.93(1.17-3.17) in men and 4.53(2.57-7.98) in women. Conclusion Serum uric acid level is associated with an increased risk of prevalent obesity, hypertension, dyslipidemia, 10-year Framingham risk for coronary heart disease, and 10-year risk for ASCVD among Chinese adults without diabetes.     

Predictors of atrial fibrillation after coronary artery bypass graft surgery

Objective To identify the clinical predictors of atrial fibrillation (AF) after coronary artery bypass grafting (CABG).Methods 322 consecutive patients who had undergone isolated CABG were reviewed. Preoperative, intraoperative and postoperative data were collected. Patients were grouped according to whether AF appeared postoperatively.Results AF occurred in 75 patients (23.3%). Most cases of AF (85.6%) appeared on or before the third postoperative day. The mean age for patients with AF was 62.5 years compared with 56.7 years for patients without AF ( P &lt;0.05). The mean aortic crossclamp time for patients with AF was 67 min compared with 60.3 min for patients without AF ( P &lt;0.05). The mean duration of cardiopulmonary bypass for patients with AF was 109.6 min compared with 97.3 min for patients without AF ( P &lt;0.05). The mean duration of mechanical ventilation for patients with AF was 19.1 h compared with 15.7h for patients without AF ( P &lt;0.05). Multivariate logistic regression analysis was used to identify the following independent predictors of postoperative AF ( P &lt;0.05): age≥65 years (OR 2.7; 95% CI 1.5 to 5.1), lesions in the right coronary artery (OR 2.5; 95% CI 1.4 to 4.5), and early postoperative withdrawal of β blocker (OR 3.9; 95% CI 2.1 to 7.7).Conclusions AF remains the most common complication after CABG. Age and lesions in the right coronary artery can influence the incidence of AF, and β blocker and magnesium may be the most economical and effective prevention for AF early after CABG.     

Combination of high-sensitivity C-reactive protein and homocysteine may predict an increased risk of coronary artery disease in Korean population

Background  The association of emerging biomarkers such as high-sensitivity C-reactive protein (hs-CRP), homocysteine and fibrinogen with the risk of coronary artery disease (CAD) is still uncertain in Asian population including Koreans and little is known about the combined effect of biomarkers on the risk of CAD.

Methods  A total of 10 650 subjects (6538 men and 4112 women) were enrolled in this study. A 10-year CAD risk was calculated using Framingham risk score modified by the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) and levels of circulating hs-CRP, homocysteine and fibrinogen were measured using validated assays.

Results  The 10-year CAD risk gradually augmented with increase in the circulating levels of hs-CRP, homocysteine and fibrinogen. For the highest quartile of hs-CRP, odds ratio (OR) of high-risk for CAD (10-year risk ≥20%) compared with the lowest quartile was 3.97 (95% CI: 2.51–6.29). For homocysteine and fibrinogen, ORs in the highest quartile compared to the lowest quartile were 5.10 (95% CI: 3.05–8.53, P <0.001) and 1.46 (95% CI: 0.69–3.11, P=0.325), respectively. OR of high-risk for CAD in both the highest quartile of hs-CRP and homocysteine was 9.05 (95% CI: 5.30–15.45) compared with the below median of hs-CRP and homocysteine.

Conclusions  The present study demonstrated that hs-CRP and homocysteine are well associated with the 10-year CAD risk estimated using NCEP ATP III in Koreans and combination of hs-CRP and homocysteine can have strong synergy in predicting the development of CAD.

     

Asymmetric Dimethylarginine Predicts One-year Recurrent Cardiovascular Events: Potential Biomarker of "Toxin Syndrome" in Coronary Heart Disease

Objective: To examine the prognostic value of serum levels of asymmetric dimethylarginine (ADMA) in patients with stable coronary heart disease (CHD) thus explore a potential biomarker of "toxin syndrome" in CHD. Methods: In this prospective nested case-control study, 36 of 1,503 Chinese patients with stable CHD experienced at least 1 recurrent cardiovascular event (RCE) during 1-year follow-up. Serum levels of ADMA at the start of follow-up were compared between these 36 cases and 36 controls which matched to cases in terms of gender, age, history of hypertension, and myocardial infarction. Results: Based on the crude model, subjects in the 2 highest ADMA quartiles showed significantly higher risk of developing RCE than those in the lowest ADMA quartile [odds ratio (OR) 4.09, 95% confidence interval (CI) 1.01 to 16.58; OR 6.76, 95% CI 1.57 to 29.07]. This association was also observed in the case-mix model (OR 5.51, 95% CI 1.23 to 24.61; OR 7.83, 95% CI 1.68 to 36.41) and multivariable model (OR 6.64, 95% CI 1.40 to 31.49; OR 13.14, 95% CI 2.28 to 75.71) after adjusting for confounders. The multivariable model which combined ADMA and high-sensitivity C-reactive protein (hsCRP) showed better predictive power with areas under the receiver operator characteristic curves (0.779) than the model of either ADMA (0.694) or hsCRP (0.636). Conclusion: Serum ADMA level may be a potential biomarker of "toxin syndrome" in CHD which shows favorable prognostic value in predicting 1-year RCE in patients with stable CHD. [The registration number is ChiCTR-PRNRC-07000012]     

中青年体质指数、腰围及腰臀比与脑卒中发生的相关性研究

目的探讨中青年人肥胖的不同指标,如体质指数(BMI)、腰围(WC)及腰臀比(WHR)与脑卒中发生的关系。方法采用以医院为基础的病例对照研究。病例组由280例脑卒中(缺血性脑卒中和出血性脑卒中)患者组成,对照组为患其他与脑卒中无关的疾病同期入住和病例组相同医院的280例患者。采用标准调查表对研究对象进行调查,收集研究对象的人口学特征、生活方式、个体疾病史、脑卒中家族遗传史以及实验室检查等资料,同时对身高、体质量、WC、臀围进行测量,并计算BMI及WHR。采用多元Logistic回归分析对研究对象的BMI、WC及WHR与脑卒中的比值比(OR)及其95%可信区间(CI)进行估计。结果 280例脑卒中患者中出血性76例,缺血性204例。与正常BMI者相比较,调整年龄、性别后的分析结果显示,超重或肥胖的病例发生缺血性脑卒中的危险性明显高于对照组〔超重者:OR=2.03,95%CI(1.26,2.91),P<0.05;肥胖者:OR=1.88,95%CI(1.32,2.39),P<0.05〕。与BMI最低四分位数相比,BMI最高四分位数的病例发生缺血性脑卒中的危险性增加了18%〔OR=1.18,95%CI(1.06,3.54),P<0.01〕。WC最高四分位数的病例发生出血性和缺血性脑卒中的危险性分别是WC最低四分位数的1.80和1.96倍〔OR=1.80,95%CI(1.03,3.16)和OR=1.96,95%CI(1.37,3.78),P<0.01〕。与WHR最低四分位数比较,WHR最高四分位数的病例发生出血性及缺血性脑卒中的危险性分别增加了98%和126%〔OR=1.98,95%CI(1.41,3.59),P<0.01和OR=2.26,95%CI(1.34,2.79),P<0.01〕。结论 BMI增高是发生脑卒中的一个重要危险因素,WC增加可使发生缺血性脑卒中的危险性显著升高,而WHR与发生出血性及缺血性脑卒中的危险性呈正相关。维持正常体质量可能是脑卒中发病的保护因素。     

膳食宏量营养素摄入量与年龄相关白内障危险性分析

目的探讨中老年人膳食宏量摄入量与年龄相关白内障(ARC)危险性之间的关系。方法选取2009年9月—2011年3月45～85岁的白内障患者360例为病例组,对照组为同期入院的360例非白内障患者。采用标准调查表对研究对象进行调查,内容包括人口学特征、生活方式以及既往疾病史等,同时采用一份有效的半定量化食物频率调查表(FFQ),获取研究对象膳食营养素的摄入情况。应用多因素Logistic回归分析估计各种宏量营养素摄入量与3种类型白内障关联的比值比(OR)及其相应的95%可信区间(CI)。结果调整多种潜在性混杂因素后,总碳水化合物摄入量与皮质性白内障呈正相关,与摄入量为最低四分位数的患者相比,摄入量为最高四分位数的患者发生皮质性白内障的OR=2.471〔95%CI(1.348,6.043),P=0.027〕。蛋白质摄入量增加对后囊膜下白内障(PSC)具有预防作用〔OR=0.528,95%CI(0.148,0.869),P=0.023〕。总脂肪摄入量与任一类型白内障均无相关性,但多不饱和脂肪酸摄入量为最高四分位数者发生核性白内障的危险性是最低四分位数者的2.7倍〔OR=2.742,95%CI(1.790,4.200),P=0.033〕。结论大量摄入碳水化合物和多不饱和脂肪酸可分别使发生皮质性和核性白内障的危险性升高,而蛋白质,尤其是动物蛋白摄入量增加能够预防PSC,调整中老年人群膳食习惯可能有助于预防ARC。     

非糖尿病人群腰臀比和慢性肾脏病的相关性

目的分析非糖尿病人群中腰臀比与慢性肾脏病的相关性,比较其在男性和女性中的差异。方法选择2012年6月~10月 我国南方社区居民进行横断面筛查（n=2142）,排除糖尿病人群。将参与者分为男性组和女性组,并以腰臀比四分位数将男女各 分为4组。采用Logistic 回归模型分析在非糖尿病人群中腰臀比与慢性肾脏病的相关性,并比较其在男性和女性中的差异。结 果在女性非校正模型中,腰臀比与慢性肾脏病显著相关（OR 7.29,95% CI 3.56 to 16.32,P<0.001）。在校正潜在混杂因素如年 龄、高血压史、冠心病史、吸烟饮酒史、收缩压、舒张压、甘油三酯、高密度脂蛋白后,二者仍相关（OR 6.13,95% CI 2.56 to 15.20, P=0.003）。在男性非校正模型中,腰臀比四分位数最高与最低组慢性肾脏病与腰臀比的OR值为2.44（95% CI,0.98 to 4.97,P= 0.103）。结论在非糖尿病人群中,女性腰臀比是慢性肾脏病独立危险因素,在男性中无相关性。     

Effects of SalB on the antioxidases

Background Dual anti-platelet treatment with aspirin and clopidogrel is established foundation for patients undergoing percutaneous coronary intervention （PCI） to prevent thrombotic events. The present study was conducted to examine whether the CYP2C19 681G〉A polymorphism and cigarette smoking had independent or interactive effect on response to clopidogrel. Methods Among 722 Chinese Han patients undergoing elective coronary stent placement due to stable angina pectoris, a loading dose of 300 mg clopidogrel was given to all patients and a daily maintenance dose of 75 mg for a minimum of 12 months. CYP2C19 681G〉A polymorphism was genotyped. The platelet reactivity was measured by light transmittance aggregometry （LTA） with 5 lumol/L adenosine diphosphate （ADP） induced. The poor response was defined as 10% or less absolute difference between aggregation at baseline and 24 hours after loading dose of clopidogrel. Results The results showed that the poor-response to clopidogrel was presented in 105 patients （14.5%）. Overall, the genotype GA/AA carriers were likely to be poor-responsive cases （19.6% vs. 11.0%, P=-0.001） with odds ratio （OF/） of 1.971 （95% CI： 1.296-2.998, P=0.002）, compared with the GG homozygotes. Meanwhile, compared with nonsmokers, the smokers showed lower rate of poor-response （10.9% vs. 17.3%, P=0.015） with OR of 0.582 （95% C/： 0.374-0.904, P=-0.016）. The smokers with GG genotype had the lowest risk with OR of 0.487 （95% CI： 0.246-0.961, P=-0.038） while nonsmokers with GA/AA genotype had the highest risk of poor-response with OR of 1.823 （95% C/： 1.083-3.068, P=0.024）, compared with nonsmokers with GG genotype. However, there was no significant interaction between genotype and smoking. Conclusion Our study indicated that both CYP2C19 polymorphism and smoking independently affected response to clopidogrel.