血浆致动脉硬化指数与足背动脉硬化的关系

目的 探讨血浆致动脉硬化指数(AIP)与2型糖尿病足背动脉粥样硬化病变程度的关系.方法 选取我院2型糖尿病患者127例,其中足背动脉粥样硬化66例,非动脉粥样硬化61例,选择我院同期体检健康者33名为健康对照组,应用彩色多普勒超声测定其足背动脉内膜中膜厚度(IMT),并测定其血甘油三酯、高密度脂蛋白胆固醇等代谢指标,计算AIP.用单因素方差分析比较3组各指标差异,并对各指标进行Pearson相关性分析.应用ROC曲线确定AIP对2型糖尿病足背动脉粥样硬化的最佳诊断工作点(OOP).结果 动脉粥样硬化组、非动脉粥样硬化组和健康对照组AIP分别为0.229±0.132、0.112±0.074、-0.045±0.033,IMT分别为(0.71±0.24)、(0.49±0.09)、(0.34±0.15)mm,组间差异均有统计学意义(F值分别为88.015、54.892,P值均为0.001).经校正可能的影响因素,AIP仍与IMT呈正相关(r=0.315,P=0.001).AIP的最佳诊断工作点为0.1671,曲线下面积为0.783.结论 AIP与2型糖尿病足背动脉粥样硬化相关性良好,其OOP具有较好的诊断参考价值.

Abstract：

Objective To investigate the relationship between Atherogenic Index of Plasma(AIP) and the dorsalis pedis artery atherosclerosis in type 2 diabetes. Methods One hundred and twenty-seven patients with type 2 diabetes and 33 healthy individuals were included in the study. The diabetic patients were devided into 2 groups, with( n = 66) or without ( n = 61 ) atherosclerosis. The intima media thickness (IMT) of dorsalis pedis artery were measured by B-mode Doppler ultrasonography. The triglyceride(TG) ,high density lipoproteincholesterol(HDL-C) and other glucolipid metabolic indices were measured in all patients. The AIP was defined as the log value of TG/HDL-C ratio. The one-way ANOVA test was performed to determine the differences among three groups. The relationships between IMT and the other indicators were assessed using Pearson bivariate correlations analysis. The optimal operating point of AIP to diagnose the dorsalis pedis artery atherosclerosis in type 2 diabetes was obtained by drawing ROC curve. Results The AIP value in atherosclerosis diabetic patients,no-atherosclerosis diabetic patients and healthy subjects were 0. 229 ± 0. 132,0. 112 ± 0. 074 and -0. 045 ± 0. 033 respectively. The IMT value were (0. 71 ± 0. 24 ) mm, (0. 49 ± 0. 09 ) mm and (0. 34 ± 0. 15 ) mm respectively. Both indices shown statistical differences among the three groups (Ps = 0. 001 respectively). After adjusting for potential influence factors, AIP showed positive correlation with IMT( r = 0. 315, P = 0. 001 ). The OOP of AIP was 0. 1671 ,the area under the curve was 0. 783. Conclusion AIP was well related to the dorsalis pedis artery atherosclerosis in type 2 diabetes,and the OOP of AIP had good diagnostic reference value in these patients.     

Validation of an Open-Source Tool for Measuring Carotid Lumen Diameter and Intima–Media Thickness

In low- and middle-income regions, a relatively large number of deaths occur from cardiovascular disease or stroke. Carotid intima–media thickness (cIMT) and carotid lumen diameter (cLD) are strong indicators of cardiovascular event risk and stenosis severity, respectively. The interactive open-source software described here, Cimtool, is based on active contours for measuring these indicators in clinical practice and thus helping in preventive diagnosis and treatment. Cimtool was validated using carotid phantoms and real images obtained using ultrasound. Expert users measured cIMT and cLD in regular practice and also with Cimtool. The results obtained with Cimtool were then compared with the results for the manual approach in terms of measurement agreement, time spent on the measurements and usability. Intra-observer variability when using Cimtool was also analyzed. Statistical analysis revealed strong agreement between the manual method and Cimtool (p?>?0.01 for cIMT and cLD). The correlation coefficient for both cIMT and cLD measurements was r?>?0.9. Moreover, this software allowed the users to spend considerably less time on each measurement (3.5?min per study versus 50?s with Cimtool on average). An open-source, interactive, validated tool for measuring cIMT and cLD clinically was thus developed. Compared with the manual approach, Cimtool's straightforward measurement flow allows the user to spend less time per measurement and has less standard deviation. The coefficients of variation for measurements and intra-observer variability were lower than those reported for recent automated approaches, even with low-quality images.     

老年代谢综合征患者颈动脉内膜中层厚度的研究

目的通过测定老年代谢综合征患者颈动脉内膜中层厚度(IMT),并分析它与血脂、血糖、体重指数(BMI)、尿酸、胰岛素抵抗指数(HOMA-IR)之间关系。方法根据NCEPATPⅢ标准,对其中国内腰围增大切点加以修改,诊断MS患者158例(MS组),非MS患者100例(对照组),两组均测定颈动脉内膜中层厚度(IMT)、血脂、血糖、BMI、尿酸、HOMA-IR,并进行统计分析。结果MS组IMT较对照组明显增高,差异有统计学意义(P<0.01)。IMT与尿酸(r=0.537,P=0.001)、TG(r=0.152,P=0.023)相关。结论MS易导致动脉粥样硬化,IMT与尿酸相关,血尿酸水平可协助诊断动脉粥样硬化。     

Automatic Measurements of Diameter,Distension and Intima Media Thickness of the Aorta in Premature Rabbit Pups Using B-Mode Images

To improve cardiovascular research, there is a growing need for arterial characterization in small animals. We developed a method, ARTIC (arterial characterization) for measuring lumen diameter, distension and intima media thickness (IMT). In this study ARTIC was used to automatically characterize the aorta of premature rabbit pups. Automatic measurements were compared with manual measurements, both performed by three observers. Diameter was 769 ± 140 μm (manual) and 766 ± 142 μm (automatic), distension was 35 ± 15 μm (manual) and 40 ± 12 μm (automatic) and IMT was 84 ± 11 μm (manual) and 88 ± 8 μm (automatic) (mean ± standard deviation). The variation in the measured diameter, distension and IMT ranged from 1.1% to 26.0% (manual) and from 1.0% to 9.0% (automatic). The intra-class correlation coefficient ranged from 33.0% to 99.3% (manual) and from 76.9% to 99.6% (automatic). The evaluation revealed that it is feasible to use ARTIC on B-mode images of arteries with small dimensions, which makes it a useful tool for arterial characterization in small animals.     

川崎病患儿颈动脉内膜-中层厚度、踝肱指数分析及其与冠状动脉病变程度的相关性

目的 观察川崎病患儿颈动脉内膜-中层厚度(IMT)和踝肱指数(ABI),探究其与冠状动脉病变程度的相关性.方法 选取2018年2月至2019年10月于衢州市人民医院确诊为川崎病的患儿52例,根据心脏彩色多普勒超声检查结果将所有患儿分为未发生冠状动脉病变的对照组(29例)和发生冠状动脉病变的观察组(23例).同时选取健康...     

老年女性2型糖尿病患者颈动脉内膜中层厚度的相关因素分析

目的研究老年女性2型糖尿病患者颈动脉内膜中层厚度（IMT）的相关因素。方法将205例2型糖尿病患者分为老年女性组,非老年女性组、老年男性组和非老年男性组,比较各组颈动脉IMT差异;将老年女性组分为内膜正常组、内膜增厚组、斑块形成组、管腔狭窄组,比较各组间尿白蛋白排泄率（UAER）、血糖、血脂等。对颈动脉IMT异常的老年女性患者,采用多元逐步回归分析颈总动脉IMT和UAER、血糖、血脂等之间的关系。结果（1）老年女性组和非老年女性组比较IMT显著增厚;（2）非老年男性组和非老年女性组比较IMT显著增厚;老年女性组和老年男性组比较无显著性差异;（3）老年女性患者中斑块形成组和管腔狭窄组与内膜正常组比较,UAER显著增加。（4）相关分析发现老年女性2型糖尿病患者平均IMT值与UAER、收缩压呈正相关,与高密度脂蛋白胆固醇呈负相关。结论2型糖尿病患者颈动脉硬化程度存在性别、年龄差异,老年女性2型糖尿病患者平均IMT值与收缩压、UAER呈正相关。     

老年人动态脉压及脉压指数与颈动脉内膜中层厚度的相关性分析

目的探讨老年人动态脉压及脉压指数与颈动脉内膜中层厚度的关系。方法随机抽样调查65岁以上人群200人进行24h动态血压监测,监测患者的动态脉压（APP）水平,按APP≤40mmHg（46例）、41～60mmHg（66例）、61—80mmHg（61例）和〉80mmHg（27例）分为4组;按动态脉压指数（APPI）≤0．40（49例）、0．41—0．50（70例）、0．51～0．60（57例）和〉0．60（24例）分为4组。分别以彩色多普勒超声测定其颈动脉内膜中层厚度（IMT）,并采集其静脉血测定血脂及高敏C-反应蛋白（hs—CRP）。结果随着APP及APPI的增加,颈动脉IMT明显增加,差异有统计学意义（P〈0．05）;Spearman相关分析,结果APP、APPI与颈动脉IMT呈正相关,其中以APPI相关系数（r）值大。结论动态脉压及脉压指数与颈动脉内膜中层厚度密切相关,且脉压指数在一定程度上较脉压在动脉硬化发展上有更大相关性。     

二氧化碳气腹时间对老年腹腔镜胆囊切除术患者凝血-纤溶和血管内皮细胞活性的影响

目的 观察二氧化碳(CO2)气腹时间对老年人腹腔镜胆囊切除术(LC)患者凝血-纤溶和血管内皮细胞活性的影响.方法 胆石症择期行LC患者45例,年龄＞60岁,术后根据气腹持续时间分组:气腹时间≤60 min组21例;气腹时间＞60 min组24例.于入院检查时(术前)、术毕、术后第1、2、3天抽取静脉血检测凝血酶原时间(PT)、激活部分凝血活酶时间(APTT)、凝血酶原片段1+2(F1+2)浓度、抗凝血酶-Ⅲ(AT-Ⅲ)活性、纤维蛋白原(Fib)浓度、组织纤溶酶原激活物(t-PA)浓度、纤溶酶原激活物抑制物-1(PAI-1)浓度、D-二聚体(D-D)浓度、血管性血友病因子(vWF)活性.结果 (1)凝血指标:术后第3天,＞60 min组的,F1+2为 (1.60±0.26) μg/L,高于≤60 min组的(1.32±0.24) μg/L(P＜0.05);AT-Ⅲ为(84.82±20.21)%,低于≤60 min组的(97.49±16.87)%(P＜0.05);术后第2、3天的Fib分别为(3.87±0.62)、(3.98±0.77)g/L,高于≤60 min组的 (3.42±0.72)、(3.42±0.63)g/L(P＜0.05).(2)纤溶-抗纤溶指标:＞60 min组术后第2 、3天的PAI-1为(33.93±10.42)、(32.90±11.25) μg/L高于≤60 min组的(26.69±9.49)、(26.31±7.06)μg/L(P＜0.05).(3)血管内皮细胞活性指标:＞60 min组术后第2 、3天的vWF为(174.53±44.03)%、(176.31±47.6)%,高于≤60 min组的(134.37±37.74)%、(131.21±36.34)% (P＜0.05).结论 老年LC患者,术后有明显的凝血-纤溶激活和血管内膜损伤;随气腹时间延长,凝血激活和纤溶抑制程度高,凝血-纤溶相对不平衡,血管内膜损伤更明显,可能增加血栓形成风险.

Abstract：

Objective To observe the effect of duration of carbon dioxide pneumoperitoneum on coagulation, fibrinolysis and endothelial activation in elderly patients undergoing laparoscopic cholecystectomy (LC). Methods The 45 elderly patients with cholelithiasis scheduled for LC, aged over 60 yeas, were placed in different groups respectively after surgery according to the duration of pneumoperitoneum. The duration of pneumoperitoneum was ≤60 minutes in group A (n=21),and more than 60 minutes in group B (n=24). Venous blood samples were taken on admission (baseline), at the end of surgery, the 1st, 2nd and 3rd day after surgery for determination of prothrombin time (PT), activated partial thromboplastin time (APTT), prothrombin fragment F1+2 (F1+2), antithrombin 3 (AT-Ⅲ activity), fibrinogen (Fib), tissue plasminogen activator (t-PA), plasminogen activator inhibitor type-1 (PAI-1), D-dimer (D-D), von Willebrand factor (vWF activity). Results Concerning the coagulation activation, at the 3rd postoperative day, the level of F1+2 was significantly higher in group B than in group A [(1.60±0.26) μg/L vs. (1.32±0.24) μg/L, P＜0.05]; AT-III was significantly higher in group B than in group A [(84.82%±20.21%) vs. (97.49%±16.87%), P＜0.05]. At the 2nd and 3rd postoperative day, the levels of Fib were significantly higher in group B than in group A [(3.87±0.62) g/L vs. (3.42±0.72) g/L, (3.98±0.77) g/L vs. (3.42±0.63) g/L, respectively, P＜0.05]. Concerning fibrinolysis, But at the 2nd and 3rd postoperative day, the level of PAI-1 was significantly higher in group B than in group A [(33.93±10.42) μg/L vs. (26.69±9.49) μg/L, (32.90±11.25) μg/L vs. (26.31±7.06) μg/L respectively, P＜0.05]. Concerning endothelial activation, at the 2nd and 3rd postoperative day, vWF was significantly higher in group B than in group A [(174.53%±44.03%) vs. (134.37%±37.74%), (176.31%±47.6%) vs. (131.21%±36.34%), respectively, P＜0.05]. Conclusions Marked activations of coagulation-fibrinolysis and endothelial activation are observed postoperatively in elderly patients undergoing laparoscopic cholecystectomy. Along with prolonged duration of pneumoperitoneum, more pronounced alterations of increased coagulation, reduced fibrinolysis and endothelial activation are observed, which could constitute an imbalanced situation of coagulation-fibrinolysis and increases the risk of venous thrombosis.     

早发心肌梗死患者健康子代血管结构和功能的无创检测

目的　探讨早发心肌梗死家族史对健康子代血管内皮依赖性舒张功能和颈动脉内中膜厚度的影响。方法　采用高分辨血管外超声技术 ,检测了 30例有早发心肌梗死家族史的健康子代和31例无心血管病家族史对照者的肱动脉在静息状态下、反应性充血及含服硝酸甘油后的内径变化以及颈动脉内中膜厚度。结果　发现有心肌梗死家族史组肱动脉血流介导性舒张功能 (FMD)较对照组明显减弱 (7 8%± 5 3%比 15 1%± 3 5 %,P <0 0 0 1) ,同时颈动脉内中膜厚度 (IMTc)较对照组明显增厚 [(0 5 3± 0 0 6 )mm比 (0 4 9± 0 0 5 )mm ,P <0 0 1) ],二组合并后直线相关分析发现FMD和IMTc呈负相关 (r= 0 5 45 ,P <0 0 1) ;多因素线性回归分析发现早发心肌梗死家族史是影响FMD和IMTc独立的危险因素 (β= 6 0 76 ,P <0 0 0 1;β =0 0 81,P <0 0 1)。 结论　早发心肌梗死患者健康子代存在血管早期的结构和功能的异常。