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.     

高血压病患者心房颤动与动脉粥样硬化的相关性

目的分析高血压病患者心房颤动与动脉粥样硬化的相关性。方法本研究共纳入高血压病患者145例,根据心电图表现分为两组:其中窦性心律组75例、心房颤动组70例。分析145例高血压病患者的一般临床资料,同时使用颈动脉彩超测定颈动脉内膜中膜厚度及粥样斑块个数,从而判断高血压患者的动脉硬化程度。结果高血压病合并心房颤动患者组颈动脉内膜中膜厚度明显高于窦性心律组(P<0.05),其斑块检出率(53.5%)明显高于窦性心律组(19.0%;P<0.01)。颈动脉内膜中膜厚度及粥样斑块检出率与年龄、高血压病程、高敏C反应蛋白等成正相关(P<0.05)。多元Logistic回归分析显示,校正主要的危险因素后,心房颤动是颈动脉粥样斑块的相关危险因素(OR值为1.752,P<0.01)。结论在排除了年龄、高血压病程、收缩压、高敏C反应蛋白等可导致颈动脉内膜中膜厚度增厚及粥样斑块形成等干扰因素后,心房颤动可能是导致颈动脉内膜中膜厚度增厚及粥样斑块形成的一个相关危险因素。     

颈动脉超声检查各指标与年龄和性别关系的分析

目的探讨颈动脉超声检查各项指标与年龄和性别的相互关系。方法选择后循环缺血和急性脑梗死患者234例,其中<50岁22例,50～59岁55例,60～69岁76例,70～79岁58例,≥80岁23例;男性136例,女性98例。均行颈动脉彩色超声检查,记录颈动脉内膜中层厚度(CIMT)、颈动脉粥样斑块数量(CPNS)、颈动脉斑块最大厚度(CPMT)、颈动脉狭窄数量(CSN)和颈动脉狭窄程度评分(CSES)。同时检测颈动脉斑块超声回声强度,并依据回声强度分为无斑块组、软斑块组、混合斑块组和硬斑块组。分析各项指标与年龄和性别间的关系。结果不同年龄段患者CIMT、CPNS、CPMT、CSN和CSES比较,差异均有统计学意义(P<0.05,P<0.01);且随年龄增长各项指标均呈线性增长趋势(P<0.01)。CIMT(r=0.247,P=0.001)、CPNS(r=0.464,P=0.000)、CPMT(r=0.438,P=0.000)、CSN(r=0.168,P=0.010)和CSES(r=0.163,P=0.012)均与年龄呈正相关,但与70～79岁比较,≥80岁所有指标变化均不明显(P>0.05)。无斑块组、软斑块组、混合斑块组和硬斑块组患者的平均年龄分别为(56.34±9.27)岁、(63.41±10.25)岁、(68.18±10.02)岁和(71.41±9.49)岁,各组患者的年龄比较,差异有统计学意义(f=25.602,P<0.01),线性检验显示,差异也有统计学意义(f=74.703,P<0.01)。55～75岁不稳定斑块脱落风险较高,<55岁和>75岁则较低。男性患者CIMT、CPNS、CPMT和CSES均较女性明显升高(P<0.05,P<0.01)。女性患者无斑块和稳定斑块比例显著高于男性,不稳定斑块比例显著低于男性(P<0.01)。结论动脉粥样硬化程度随年龄增长而增加,但动脉斑块脱落风险在<55岁和>75岁相对较低,在55～75岁相对较高。男性动脉粥样硬化程度高于女性,且男性动脉斑块脱落风险也高于女性。     

大连地区血压、生化指标正常人群颈动脉内膜中膜厚度的影响因素

目的探讨大连地区血压、生化指标正常人群颈动脉内膜中膜厚度的危险因素。方法选取大连地区血压、生化指标正常人群736例。所有研究人群均已测量身高、体重、血压、腰围、臀围,检测空腹血糖、糖化血红蛋白、75 g OGTT 2 h血糖、空腹胰岛素、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、总胆固醇、甘油三酯、血尿酸及血肌酐等指标,计算腰臀比、体质指数、尿白蛋白/肌酐、肌酐清除率、胰岛素抵抗指数及脉压差,应用血管彩色多普勒超声检测患者颈动脉内膜中膜厚度。将入选人群根据颈动脉内膜中膜厚度值分为C1组(颈动脉内膜中膜厚度0.9 mm)、C2组(0.9 mm≤颈动脉内膜中膜厚度1.2 mm)及C3组(颈动脉内膜中膜厚度≥1.2 mm),研究上述各指标与颈动脉内膜中膜厚度的相关关系。结果 (1)三组间在年龄、体质指数、腰围、腰臀比、血尿酸、收缩压及脉压差存在组间差异,差异有统计学意义(P0.05)。随着年龄、腰围、血尿酸、收缩压及脉压差的升高,颈动脉内膜中膜厚度有增厚的趋势;而体质指数和腰臀比仅在C3组高于C2和C1组,差异有统计学意义(P0.05)。(2)男性和女性人群颈动脉内膜中膜厚度均随年龄增加有逐渐增加的趋势,差异有统计学意义(P0.05);在40~50岁组,男性颈动脉内膜中膜厚度高于女性,差异有统计学意义(P0.05),在50~60岁组,女性颈动脉内膜中膜厚度高于男性,差异有统计学意义(P0.05)。(3)偏相关分析显示,在控制年龄因素的影响后,无论男性、女性,脉压差、体质指数、腰围、收缩压及血尿酸均与颈动脉内膜中膜厚度呈正相关;单因素Logistic回归分析显示,无论男性、女性,年龄、脉压差均是颈动脉内膜中膜厚度的独立危险因素(P0.05)。结论 (1)在血压、生化指标正常人群中,无论男性、女性,颈动脉内膜中膜厚度均随年龄增加有逐渐增加的趋势,男性颈动脉内膜中膜厚度在40~50岁组明显高于女性,女性颈动脉内膜中膜厚度在50~60岁组明显高于女性。(2)增龄和脉压差是颈动脉内膜中膜厚度增厚的独立危险因素。     

2型糖尿病患者颈动脉硬化斑块形成的相关因素分析

目的 探讨2型糖尿病患者颈动脉硬化斑块形成的相关因素.方法 123例2型糖尿病患者,根据颈动脉彩色超声结果分为颈动脉无硬化斑块组、颈动脉硬化斑块组,分别检测各组血清C反应蛋白、空腹血糖、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、血浆致动脉硬化指数、血尿酸、血肌酐,并记录年龄、糖尿病病程、体重指数、收缩压、舒张压、脉压差、吸烟史、高血压史、微血管并发症、颈动脉内膜厚度等指标,进行统计学处理.结果 颈动脉硬化斑块组中年龄(P<0.01)、C反应蛋白(P<0.05)、颈动脉内膜厚度(P<0.01)以及微血管并发症发生率(P<0.05)均比颈动脉无硬化斑块组显著增高,差别均有统计学意义.Logistic回归分析显示,颈动脉内膜厚度与颈动脉硬化斑块形成独立相关(P<0.05).结论 2型糖尿病患者颈动脉硬化斑块形成与颈动脉内膜厚度、年龄、C反应蛋白等多因素有关,颈动脉内膜厚度增加是颈动脉硬化斑块形成的危险因素,颈动脉硬化斑块形成的同时微血管并发症的发生率增加.     

中老年人群颈动脉粥样硬化分布特点及影响因素分析

目的 探讨我国中老年人群颈动脉粥样硬化性病变的分布特点以及与心血管病危险因素的关系.方法 对中美协作研究队列中的石景山人群和多省市队列中的北京大学社区人群2007年9至10月期间的心血管病危险因素以及颈动脉超声的横断面复查结果进行分析.参加调查人数共计2681名,年龄43～81岁.结果 (1)颈动脉内中膜36点厚度平均值为0.68 mm,最大值为1.07 mm.(2)颈动脉斑块检出率为60.3%.男女两性颈动脉膨大部斑块检出率分别为61.2%和51.6%(x~2=23.44,P<0.01).颈内动脉斑块检出率分别为24.7%和12.2%(x~2=69.57,P<0.01).颈总动脉斑块检出率分别为20.9%和13.8%(x~2=23.18,P<0.01).(3)多因素分析:男女两性颈动脉内中膜厚度平均值和最大值随着收缩压、血糖及低密度脂蛋白胆固醇水平的增加而增加.与无危险因素者比较,高血压、糖尿病、吸烟和高低密度脂蛋白胆固醇血症者颈动脉斑块检出率较高(P<0.05).结论 我国中老年人群颈动脉粥样硬化普遍存在,且与多个心血管病危险因素有关联.     

老年男性骨质疏松与动脉粥样硬化相关性的研究

目的 探讨老年男性人群中骨质疏松与动脉粥样硬化之间的相关性. 方法 以93例老年医学科住院男性患者为研究对象,采用双能X线吸收法(dual-energy X-ray absorptiometry,DXA)测定腰椎骨和股骨区的骨密度(BMD);同时采用超声探查颈动脉内中膜厚度(intima-media thickness,IMT)及粥样斑块的情况. 结果 在骨质疏松组(46例)中,存在内膜增厚者38例(82.61%),粥样斑块34例(73.91%),与非骨质疏松组比较,骨质疏松组在动脉内中膜增厚(IMT≥0.9 mm)及粥样斑块的发生率上均明显升高(P<0.05);而内中膜增厚组(67例)及斑块组(57例)的BMD分别较其对照组低,并在NECK、WARDs三角、TORCH等部位具有统计学差异(P<0.05). 结论 老年男性骨质疏松人群较非骨质疏松人群更易发生动脉粥样硬化病变,同时存在动脉粥样硬化病变的人群也易致骨量的丢失.提示骨质疏松与动脉粥样硬化之间可能存在着共同危险因素.     

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。     

北京市顺义区2445名年龄≥50岁居民颈动脉超声筛查结果分析

目的调查北京市顺义区年龄≥50岁的户籍居民颈动脉内膜增厚、颈动脉粥样硬化斑块、颈动脉狭窄流行现况及其相关因素。方法采取多阶段整群随机抽样的方法,纳入2015年12月至2016年6月,顺义区11个镇、街道年龄≥50岁的户籍居民2 500名,剔除问卷调查、体格检查或颈动脉彩色多普勒血流显像(CDFI)筛查信息不完整者55名,最终2 445名资料完整者纳入分析,应答率为97.8%。开展问卷调查、体格检查和颈动脉CDFI筛查,筛查记录双侧颈动脉内膜增厚[内-中膜厚度(IMT)≥1.0 mm]、斑块(IMT≥1.5 mm)及颈动脉狭窄[单侧和(或)双侧的颈内动脉狭窄(流速50%)或颈总动脉狭窄(流速≥70%)、椎动脉狭窄(流速50%)]。根据颈动脉CDFI筛查结果,将2 445名研究对象分为内膜增厚与无增厚、有动脉粥样硬化斑块与无斑块、狭窄与无狭窄进行人口学资料及脑血管病相关因素的分析。同一研究对象的颈动脉病变(增厚、斑块、狭窄)并存两种或以上时,则分别计数后分析。结果 2 445名居民中,有颈动脉狭窄、内膜增厚及粥样硬化斑块者分别为301名(12.3%)、1 419名(58.0%)及1 287名(52.6%)。不同年龄段(50~60、60~70、≥70岁)户籍居民的颈动脉狭窄、内膜增厚和斑块检出率的差异有统计学意义(χ2值分别为65.642、118.648和185.275,均P0.01);男性户籍居民颈动脉狭窄、内膜增厚和斑块的检出率均高于女性,差异均有统计学意义[17.7%(162/916)比9.1%(139/1 529),67.1%(615/916)比52.6%(804/1 529),64.2%(588/916)比45.7%(699/1 529);均P0.01]。存在颈动脉狭窄、内膜增厚和斑块的辖区内户籍居民中,性别比、高血压病、卒中、吸烟和饮酒的暴露比例均高于无狭窄、无增厚和无斑块的人群(均P0.05)。存在颈动脉狭窄和斑块的辖区内户籍居民中,糖尿病和血脂异常的检出比例高于无狭窄和无斑块的人群(均P0.05)。结论辖区内年龄≥50岁的颈动脉粥样硬化性病变人群中,部分慢性疾病和不良生活方式的检出率显著偏高,在开展卒中防治时,需采取有效措施,降低人群的吸烟、饮酒比例,及时治疗高血压病、糖尿病和血脂异常。     

凌晨血压增高与亚临床动脉粥样硬化密切相关

目的探讨高血压患者凌晨血压增高(MBPS)及动态血压监测参数与颈动脉粥样硬化的关系。方法高血压患者226例,分为MBPS组(51例)与非MBPS组(175例),并根据颈动脉内膜中膜厚度(IMT)分为IMT增厚组94例和非IMT增厚组132例,分别检查血脂、动态血压监测、颈动脉超声等,比较两组之间年龄、动态血压参数以及颈动脉IMT以及斑块Crouse积分的差别。结果1)MBPS组MBPS值、凌晨平均动脉压、凌晨脉压、颈动脉IMT、斑块积分显著高于非MBPS组(P<0.05);2)颈动脉IMT增厚组MBPS值、凌晨平均动脉压、凌晨脉压、24h平均收缩压、24h平均舒张压、白昼平均收缩压、白昼平均舒张压、夜间平均收缩压、夜间平均舒张压显著高于颈动脉非IMT增厚组(P<0.05)。结论MBPS者颈动脉粥样硬化程度较高,MBPS可能促进颈动脉粥样硬化进程。     

Serum salusin-alpha levels are decreased and correlated negatively with carotid atherosclerosis in essential hypertensive patients.

Salusin-alpha is a new bioactive peptide with mild hypotensive and bradycardic effects. Our recent study showed that salusin-alpha suppresses foam cell formation in human monocyte-derived macrophages by down-regulating acyl-CoA:cholesterol acyltransferase-1, contributing to its anti-atherosclerotic effect. To clarify the clinical implications of salusin-alpha in hypertension and its complications, we examined the relationship between serum salusin-alpha levels and carotid atherosclerosis in hypertensive patients. The intima-media thickness (IMT) and plaque score in the carotid artery, blood pressure, serum levels of salusin-alpha, and atherosclerotic parameters were determined in 70 patients with essential hypertension and in 20 normotensive controls. There were no significant differences in age, gender, body mass index, fasting plasma glucose level, or serum levels of high-sensitive C-reactive protein, high- or low-density lipoprotein (LDL) cholesterol, small dense LDL, triglycerides, lipoprotein(a), or insulin between the two groups. Serum salusin-alpha levels were significantly lower in hypertensive patients than in normotensive controls. The plasma urotensin-II level, maximal IMT, plaque score, systolic and diastolic blood pressure, and homeostasis model assessment for insulin resistance (HOMA-IR) were significantly greater in hypertensive patients than in normotensive controls. In all subjects, maximal IMT was significantly correlated with age, systolic blood pressure, LDL cholesterol, urotensin-II, salusin-alpha, and HOMA-IR. Forward stepwise multiple linear regression analysis revealed that salusin-alpha levels had a significantly independent and negative association with maximal IMT. Serum salusin-alpha levels were significantly lower in accordance with the severity of plaque score. Our results suggest that the decrease in serum salusin-alpha, an anti-atherogenic peptide, may be associated with carotid atherosclerosis in hypertensive patients.     

Impact of increased plasma serotonin levels and carotid atherosclerosis on vascular dementia

Serotonin (5-HT), a potent vasoconstrictor in the large cerebral arteries, is considered to play a key role in atherothrombosis and to be implicated in ischemic cerebrovascular events followed by delayed neuronal death. The present study aims at evaluating the relationship between plasma levels of 5-HT and vascular dementia (VaD) caused by stroke or atherosclerotic small vessel disease. Carotid artery intima-media thickness (IMT), plaques, plasma 5-HT levels and atherosclerotic parameters were determined in 20 patients with VaD and 40 age-matched controls. Age, gender, body mass index, systolic and diastolic blood pressure, fasting plasma glucose levels and serum levels of insulin, triglycerides, high-density lipoprotein cholesterol, leptin, adiponectin and interleukin-6 and plasma levels of plasminogen activator inhibitor-1 were not significantly different between the two groups. Serum levels of insulin-like growth factor-1 (IGF-1) were significantly lower in VaD patients than in controls. Plasma 5-HT levels, serum levels of hepatocyte growth factor (HGF), low-density lipoprotein (LDL) cholesterol and high-sensitive C-reactive protein (hs-CRP), max IMT and plaque frequency were significantly greater in VaD patients than in controls. There was a significant positive correlation of max IMT with 5-HT or HGF levels. Multiple logistic regression analysis revealed that increased plasma levels of 5-HT and carotid plaque prevalence had significantly independent association with VaD as compared with serum levels of IGF-1, HGF, LDL cholesterol and hs-CRP. These results suggest that increased plasma levels of 5-HT and carotid atherosclerotic plaques may be involved in the pathogenesis and progression of VaD.     

Intact insulin, insulin propeptides, and intima-media thickness in the femoral artery in 58-year-old clinical healthy men--the Atherosclerosis and Insulin Resistance Study

The aim of this study was to examine the association between intact insulin, insulin propeptides, and femoral artery intima-media thickness. The design was a cross-sectional study and the study group (n = 391) consisted of randomly recruited clinically healthy 58-year-old Swedish men. The intima-media thickness of the common femoral artery was measured with ultrasound. Fasting plasma insulin; intact insulin; proinsulin; 32,33 split-proinsulin; and C-peptide concentrations were assessed. The results showed that the common femoral artery intima-media thickness correlated significantly and univariately with waist-hip ratio, systolic blood pressure, serum total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, ApoB, low-density lipoprotein peak particle size, and cigarette years. Furthermore, of intact insulin and insulin propeptides, only intact insulin and C-peptide were univariately associated with common femoral artery intima-media thickness (r= 0.14, p < 0.01; r= 0.18, p < 0.01; respectively). In a multiple regression analysis, common femoral artery intima-media thickness was independently associated with systolic blood pressure (beta-coefficient = 0.004, p = 0.002), ApoB (beta-coefficient = 0.338, p < 0.001 ) and cigarette years (beta-coefficient = 0.0004, p < 0.001), (R2= 25%, p相似文献   

老年人颈动脉粥样硬化与冠状动脉粥样硬化的关系

为探讨老年人颈动脉粥样硬化与冠状动脉粥样硬化的关系,对94例进行冠状动脉造影的老年患者进行颈动脉超声检查。颈动脉粥样硬化斑块积分采用Sutton法,结果发现,冠状动脉病变单支组和多支组内膜一中膜厚度,斑块积分显著高于正常组,冠状动脉病变多支组显著高于单支组（P均＜0．05）,斑块指数与年龄,吸烟,低密度脂蛋白胆固醇／高密度脂蛋白胆固醇比值,收缩压以及高血压病程及程度密切相关,结果提示,颈动脉粥样硬化与冠状动脉粥样硬化的病变是平行的。     

Atherosclerosis of the aorta and coronary arteries and cardiovascular risk factors in persons aged 6 to 30 years and studied at necropsy (The Bogalusa Heart Study).

Race and sex differences in aorta and coronary atherosclerotic lesions were studied in 150 persons aged 6 to 30 years. The intimal surface involvement with aorta fatty streaks was extensive, 0 to 71%, and greater in blacks than in whites (32 vs 20%, p less than 0.001). Coronary artery fatty streaks were more extensive in male than in female subjects (range 0 to 22%). Fibrous plaque lesions were present but not extensive in either the aorta (0 to 12%) or the coronary artery (0 to 24%) specimens. Lesions were more prevalent in male than in female persons, particularly white male subjects. The relation of fatty streaks to fibrous plaques was greater in the coronary vessels than in the aorta. In male subjects, aorta fatty streaks were strongly related to antemortem levels of total cholesterol, low-density lipoprotein cholesterol and ponderal index in white male subjects. Coronary artery fatty streaks in white male persons were significantly associated with serum triglycerides, very low density lipoprotein cholesterol, systolic and diastolic blood pressure and ponderal index. These results link antemortem risk factors to the development of atherosclerotic lesions and emphasize the need for preventive cardiology in early life.     

非糖尿病代谢综合征与颈动脉粥样硬化的研究

目的研究非糖尿病的代谢综合征(MS)对颈动脉粥样硬化的影响,为临床动脉粥样硬化性心血管疾病的防治提供依据。方法依据国际糖尿病联盟MS诊断标准将446例非糖尿病患者分为非MS组(298例)及MS组(148例),应用彩色多普勒超声检测颈动脉血管结构及功能,分析两组间颈动脉损害情况的差异。结果MS组腰围、甘油三酯、高密度脂蛋白胆固醇、稳态模型评估法的胰岛素抵抗指数、糖化血红蛋白(HbA1c)显著高于非MS组(P<0.01,P<0.05);非MS组动脉斑块发生率仍较高,其颈动脉内膜中层厚度(IMT)和斑块指数与MS组相似,而MS组虽不伴糖尿病,但其HbA1c较非MS组高。直线相关分析显示,IMT与总胆固醇(TC)、年龄、HbA1c、收缩压呈正相关(P<0.01,P<0.05);逐步回归分析显示IMT与TC、年龄、HbA1c相关。结论MS在不合并糖尿病时,其颈动脉损害仍较明显,HbA1c明显升高,可能预示MS易发展为糖尿病和较严重的动脉粥样硬化性心血管疾病。     

Increased human urotensin II levels are correlated with carotid atherosclerosis in essential hypertension

BACKGROUND: Circulating blood levels of human urotensin II (U-II), the most potent vasoconstrictor peptide identified to date, are increased in patients with essential hypertension. Our previous studies showed that U-II accelerates human macrophage foam cell formation and vascular smooth muscle cell proliferation, suggesting development of atherosclerotic plaque. In this study, we demonstrated a correlation between plasma U-II level and progression of atherosclerosis in hypertensive patients. METHODS: The intima-media thickness (IMT) and plaque score in the carotid artery, blood pressure (BP), plasma levels of U-II, and atherosclerotic parameters were determined in 50 hypertensive patients and 31 normotensive controls. RESULTS: Plasma U-II level, maximum IMT, plaque score, systolic BP, and homeostasis model assessment for insulin resistance (HOMA-IR) were significantly greater in hypertensive patients than normotensive controls. Age, gender, body mass index, and serum levels of high-sensitive C-reactive protein (CRP), HDL and LDL cholesterols, small dense LDL, triglycerides, lipoprotein(a), insulin, and fasting plasma glucose level were not significantly different between the two groups. In all subjects, plasma U-II level showed significant positive correlations with systolic BP, maximum IMT, plaque score, and HOMA-IR. Multiple logistic regression analysis indicated that the contribution of plasma U-II levels to carotid plaque formation (plaque score >/=1.1) was significantly still greater with a 60% increase than those of established risk factors, such as age, systolic BP, high-sensitive CRP, small dense LDL, and HOMA-IR. CONCLUSIONS: Our results suggest that increased levels of U-II may play a crucial role in the development of carotid atherosclerosis in hypertensive patients.     

他汀类药物对老年颈动脉粥样硬化斑块的影响和对急性心脑血管事件的干预作用简

目的 探讨他汀类药物对老年颈动脉粥样硬化斑块的影响和对急性心脑血管事件的干预作用及机制.方法 将符合入选标准的180例患者按照抽签方法均分为对照组与观察组,各为90例.对照组采用饮食控制或服用非他汀类降脂药物,观察组在此基础上给予20 mg的辛伐他汀口服,每晚1次,服用12个月.对比两种治疗方法对老年颈动脉粥样硬化斑块的影响,比较两组血脂指标以及急性心脑血管事件的发生率.结果 （1）观察组服药后斑块大小、斑块厚度、斑块数量及内膜中层厚度均比服药前改善,差异有统计学意义（P＜0.05）,且比对照组服药后改善的效果更好,差异有统计学意义（P＜0.05）.（2）观察组服药后血脂指标（总胆固醇、甘油三酯、高密度脂蛋白胆固醇及低密度脂蛋白胆固醇）与血浆超敏C反应蛋白浓度均比服药前改善,差异有统计学意义（P＜0.01）,且比对照组服药后改善的效果更好,差异有统计学意义（P＜0.01）.（3）观察组急性心脑血管事件的发生率要明显低于对照组,差异有统计学意义[1.11％（1/90）vs.8.89％（8/90）,P＜0.01].（4）经Logistic多元回归分析,他汀类药物的预处理（OR=0.36,95％CI：0.21～1.18）、射血分数＜50％ （OR=1.58,95％CI：1.12～2.22）、冠状动脉粥样硬化性心脏病（冠心病）家族史（OR=1.87,95％CI：0.87～2.13）为患者住院期间出现死亡的独立预测因素.结论 持续性服用他汀类药物能够对老年颈动脉粥样硬化斑块起到稳定与消退的作用,且会通过降低血脂使得急性心脑血管事件减少.     

Is cardiovascular reactivity associated with atherosclerosis among hypertensives?

Exaggerated cardiovascular reactivity to behavioral challenges among otherwise healthy individuals has been associated with carotid atherosclerosis. We evaluated whether a similar relationship exists among hypertensives, who are at a heightened atherosclerotic risk. Untreated, hypertensive men (n=251; age range, 40 to 70 years; 197 white, 54 black) completed a standardized battery of behavioral challenges while their blood pressure responses to the battery were measured. Mean and maximum carotid intima-media thickness and the occurrence of carotid plaques were subsequently determined using B-mode ultrasonography. Although greater systolic and diastolic responses to the battery were associated with greater mean and maximum intima-media thickness in univariate analyses (P<0.01), only diastolic reactivity showed a unique association with mean and maximum carotid intima-media thickness after multivariate adjustment for age, race, socioeconomic status, smoking and alcohol use, body mass index, lipid profile, glucose and insulin concentrations, and resting blood pressure (P<0.05). Carotid plaque occurrence was associated with greater systolic reactivity (P=0.05) and was marginally associated with greater diastolic reactivity (P=0.07) in univariate analyses, but neither systolic nor diastolic reactivity was uniquely associated with the presence of carotid plaques after multivariate risk-factor adjustment. Among hypertensives, exaggerated behaviorally evoked cardiovascular reactivity appears to be uniquely associated with greater carotid intima-media thickness but not with carotid plaque occurrence.