Arterial intima-media thickening and endothelial dysfunction in obese Chinese children

We studied ultrasonographic signs of early atherosclerosis in relation to established risk factors of cardiovascular disease in 43 obese school-age children compared to 28 non-obese controls. The groups did not show significant differences in age, gender ratio and body height. Mean carotid intima-media-thickness (IMT), carotid haemodynamic parameters, flow-mediated dilatation of the brachial artery (FMD), and biochemical markers of dyslipidaemia were measured and correlated. IMT was significantly increased (0.62 mm vs. 0.46 mm, P <0.001) and FMD was markedly reduced (10.9% vs. 18.8%, P <0.001) in the obesity group. Differences in IMT and FMD persisted after adjustment for Body Mass Index (BMI) and blood pressure on ANCOVA. BMI was highly associated with increased IMT ( r =0.58, P <0.01) and reduced FMD ( r =-0.42, P <0.01), as were blood levels of total cholesterol, LDL cholesterol and Apo B. Conclusion:Childhood obesity seems to contribute to the development and progression of early atherosclerosis, particularly in combination with hypertension and dyslipidaemia. In order to prevent coronary atherosclerosis and other cardiovascular complications, it is vital to control obesity starting from childhood. Ultrasonography of the arterial wall may be used in a clinical setting to identify high-risk patients among severely obese children.     

慢性阻塞性肺疾病患者颈动脉内膜受损的临床观察

目的探讨慢性阻塞性肺疾病对大血管病变的影响。方法选取稳定期COPD患者共92例纳入观察。记录受试者性别、年龄、血压(收缩压SBP、舒张压DBP)、体重指数(BMI),进行肺功能及慢阻肺患者自我评估测试(CAT评分)、动脉血气分析、颈动脉内膜中层厚度(IMT)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、超敏C反应蛋白(hs-CRP)测定。将病例分为颈动脉IMT正常组(A组,IMT0.9 mm)和颈动脉IMT增厚组(B组,IMT≥0.9 mm)。使用SPSS20.0等软件进行统计学处理。结果 (1)两组受试者性别、年龄、BMI、SBP、DBP无统计学差异(P0.05),两组CAT评分有统计学差异(P0.05)。(2)两组受试者TC、TG、HDL-C、LDL-C无统计学差异(P0.05),hs-CRP、PaO_2、PaCO_2、FEV1%有统计学差异(P0.05)。(3)线性相关分析显示,IMT与年龄、FEV1%、PaO_2、hs-CRP、SBP、DBP、TC、TG水平相关(P0.05)。偏相关分析显示IMT与FEV1%、PaO_2、hs-CRP相关(P0.05)。(4)以IMT为因变量,多元逐步回归分析结果显示PaO_2、hs-CRP、FEV1%依次进入方程。hs-CRP、PaO_2、FEV1%是COPD患者颈动脉IMT的独立影响因素。结论积极治疗COPD原发病,对COPD心血管合并症的防范与控制有积极意义。     

超声射频技术评价移植肾患者颈动脉形态学变化及其相关因素

目的 应用超声射频技术检测移植肾患者的颈动脉结构参数,初步探讨其形态学变化及相关影响因素.方法 选取2014年3月至2015年12月在我院就诊的移植肾患者31例(KTR组),与移植肾患者术前血液透析累积时间匹配的终末期肾病(ESRD)持续性血透患者31例(ESRD组),以及年龄、性别匹配的健康志愿者84例(对照组).超声射频技术测量各组受试者的右颈总动脉内-中膜厚度(CIMT)和右颈总动脉管径(CCAD),采用多元线性回归法分析CIMT和CCAD的独立影响因素.结果 ESRD组患者的CIMT较KTR组和对照组厚(P＜0.05),而KTR组和对照组相比差异无统计学意义(P＞0.05).ESRD组患者的CCAD较对照组增宽(P＜0.01),而KTR组与对照组和ESRD组相比差异均无统计学意义(P＞0.05).多元线性回归分析结果显示,年龄、体质量、收缩压及部分血流动力学参数与CIMT和CCAD呈正相关,是两者的独立影响因素.结论 持续性血透的ESRD患者肾移植后颈动脉形态学可部分恢复正常;年龄、体质量、收缩压和部分血流动力学参数是其变化的独立影响因素.     

长期服用缬沙坦对高血压患者颈动脉内膜-中层厚度及血管内皮依赖性舒张功能的影响

目的探讨缬沙坦对高血压患者粥样硬化动脉形态及功能的影响。方法以彩色多普勒超声检测83例高血压病患者颈动脉内膜-中层厚度（IMT），并按照IMT大小将83例患者分为3组，连续服用缬沙坦36个月后检测颈动脉IMT和未受干预状态下、肱动脉反应性充血时以及含服硝酸甘油后颈动脉内径，与治疗前进行比较。结果使用缬沙坦8周后血压能控制在140／90mmHg以下且保持平稳。治疗前A、B、C三组的颈动脉IMT值分别为（1．04±0．07）mm、（1．23±0．05）mm、（1．33±0．03）mm，治疗36个月后，三组的颈动脉IMT分别为（0．95±0．04）mm、（1．08±0．11）mm、（1．19±0．21）mm，各组治疗前后比较，P均〈0．01，A组IMT恢复达正常，B组IMT值接近正常。A、B、C三组治疗前肱动脉反应性充血时颈动脉内径的变化率分别为（6．87±2．23）％、（6．13±2．11）％、（5.88±1．26）％，治疗后分别为（24．71±7．02）％、（20，57±4．72）％、（14．32±3．81）％，各组治疗前后比较，P均〈0．01，A组疗效优于B组（P〈0．05）、C组（P〈0．01），B组疗效优于C组（P〈0．01），含服硝酸甘油后颈动脉内径在治疗前后无显著变化。结论血管紧张素Ⅱ受体桔抗剂缬沙坦在平稳降压的同时，能保护血管内皮细胞，改善血管内皮依赖性舒张功能，延缓甚至逆转IMT的进展。     

彩色多普勒超声对高血压合并脑梗死颈动脉的临床分析

目的　探讨颈动脉粥样硬化与高血压合并脑梗死的关系。方法　使用百胜 AU4彩色多普勒超声仪 ,对 78例高血压患者 (排除合并脑梗死 )及 82例高血压合并脑梗死患者 ,观察其颈动脉内 -中膜厚度 (IMT)及斑块形成情况。结果　高血压合并脑梗死患者组的颈动脉 IMT、斑块积分、发生率及溃疡斑的检出率显著大于高血压患者 (排除合并脑梗死 ) (P<0 .0 1)。溃疡斑是高血压合并脑梗死患者组的主要栓子来源。结论　彩色多普勒超声可清晰显示颈动脉 IMT情况 ,在高血压合并脑梗死的预防及防治监测上有重要临床意义。     

糖尿病和高血压患者颈动脉内中膜厚度检测和内皮功能的判断

目的　检测 2型糖尿病 (DM )、高血压病 (EH)、DM合并EH患者颈动脉的内中膜厚度 (IMT)和内径 ,分析DM和EH对血管功能的影响。方法　 3 7例DM患者分为A组 ,3 2例DM合并EH患者为B组 ,41例EH患者为C组 ,3 7例健康志愿者为D组。利用彩色多普勒超声检测所有观察对象的颈动脉IMT ,休息时、肱动脉反应性充血时和含服硝酸甘油后的颈动脉内径。结果　各组患者的IMT明显厚于D组 ( 0 .68± 0 .2 4)mm ,P均 <0 .0 1,B组 ( 2 .3 1± 1.0 4)mm明显厚于A组 ( 1.2 7± 0 .5 1)mm和C组 ( 1.5 8± 0 .77)mm ,P均 <0 .0 1,C组明显厚于A组 (P <0 .0 5 ) ;各组患者的颈动脉内径明显小于D组 ,P均 <0 .0 5 ,各组患者之间颈动脉内径无明显差异 ;肱动脉反应性充血时 ,各组患者颈动脉舒张程度明显小于D组 ( 5 .3 3 %± 1.14 %) ,P均 <0 .0 1,B组 ( 2 .62 %± 0 .85 %)明显小于A组 ( 3 .43 %± 1.0 7%)和C组 ( 3 .2 7%±1.0 3 %) ,P均 <0 .0 1,A、C组之间无明显差异 ;含服硝酸甘油后 ,各组观察对象之间颈动脉的舒张程度无明显差异。结论　DM、EH患者血管IMT增厚 ,血管内皮依赖性舒张功能降低 ;DM合并EH时 ,IMT进一步增厚 ,血管内皮依赖性舒张功能损伤加重。     

冠心病患者颈动脉内-中膜厚度与血管内皮舒张功能临床研究

目的　研究冠心病患者颈动脉内 -中膜厚度 (IMT)及血管内皮舒张功能 (EDD% )的临床意义。方法　用高频超声测量 86例冠心病患者和 4 0例正常对照组颈动脉 IMT及 EDD% ,并进行对比分析。结果　 IMT心肌梗死组 (1.0 9± 0 .17) mm和心肌缺血组 (0 .92± 0 .12 ) mm较正常对照组 (0 .6 4± 0 .15 ) mm明显增厚 ;EDD%心肌梗死组 (3.78± 4 .12 ) %和心肌缺血组 (5 .11± 3.78) %较正常对照组 (15 .4 1± 6 .87) %明显减低。结论　超声检测颈动脉 IMT及 EDD%可作为监测冠心病患者的客观指标。     

超声检测颈动脉内中膜厚度及斑块的临床应用进展

颈动脉内中膜厚度及斑块与多种疾病密切相关且越来越受到重视,超声对其检测可对多种疾病作出评价及预后,临床应用广泛。该文对超声检测颈动脉内中膜厚度及斑块的临床应用进展作一综述。     

血压正常高值人群动脉血管功能和结构变化的研究

目的利用无创方法探讨血压正常高值人群动脉血管功能和结构的变化。方法应用博时全自动动脉硬化检测系统及超声诊断仪对349例血压正常高值人群进行踝臂指数(ABI)、臂-踝脉搏波传导速度(baPWV)、颈动脉内膜中层厚度(IMT)的检测,并与同期受检的201例血压正常人群、303例原发性高血压1级患者及77例原发性高血压2级患者的检测结果进行对比研究。结果正常高值血压组受检人群脉搏波传导速度、颈动脉内膜中层厚度的异常检出率较正常血压组明显增高,而低于原发性高血压1、2级组,且正常高值血压组、原发性高血压1、2级组分别与正常血压组相比,差异均有统计学意义(P<0.008 3);而踝臂指数异常的检出率均较低,正常血压组、正常高值血压组、原发性高血压1级组之间无统计学差异(P>0.008 3),但以上三组分别与原发性高血压2级组比较差异均有统计学意义(P<0.008 3)。结论血压正常高值人群尚未发展至高血压阶段时已经开始出现动脉血管功能和结构的损害,表现为血管顺应性下降,僵硬度增加,动脉内膜增厚,斑块形成,甚至出现管腔狭窄及堵塞等一系列病理改变。     

正常血压高值与肾功能及颈动脉内中膜厚度的关系

目的 观察正常血压高值患者尿微量白蛋白(mAlb)、肾功能和颈动脉内中膜厚度(IMT)的变化,探讨正常血压高值患者是否存在与血压升高相关的靶器官损害.方法 2009年8月至2010年5月,根据<中国高血压防治指南>2005年修订版诊断标准筛选180例研究对象并分为3组:正常血压组(NT组)、正常血压高值组(PH组)和高血压组(EH组)各60例,所有研究对象测定尿mAlb、血清肌酐(Cr)和颈动脉IMT,比较3组上述指标是否存在差别,分析尿mAlb、血清Cr和颈动脉IMT与正常血压高值的关系.结果 在NT组、PH组和EH组,尿mAlb分别为(15.3±7.5)、(24.6±10.7)、(37.3±20.4)mg/L;血清Cr分别为(68.0±16.5)、(81.9±14.9)、(95.8±22.5)μmol/L;颈动脉IMT分别为(1. 46±0.67)、(1.79±0.74)、(2.34±0.78)mm.尿mAlb、血清Cr和颈动脉IMT在NT组、PH组和EH组间差异有统计学意义,PH组和EH组高于NT组(P＜0.05或P＜0.01),EH组高于PH组(P＜0.01).多元线性回归分析显示:调整年龄、体重指数(BMI)、血压、血脂、血糖等因素后,在PH组,尿mAlb与收缩压(SBP)、舒张压(DBP)和血糖相关的标准偏回归系数分别为0.279、0.259和0.360(P值分别为0.012、0.043和＜0.001),血清Cr与SBP、DBP和血糖相关的标准偏回归系数分别为0.317、0.257和0.377(P值分别为0.006、0.049和＜0.001).颈动脉IMT与年龄、SBP、DBP、总胆固醇、血糖相关的标准偏回归系数分别为0.381、0.375、0.263、0.265和0.372(P值分别为＜0.001、＜0.001、0.033、0.021和＜0.001).在EH组,尿mAlb与SBP、DBP和血糖相关的标准偏回归系数分别为0.378、0.258和0.283(P值分别为＜0.001、0.046和0.009),血清Cr与SBP、DBP和血糖相关的标准偏回归系数分别为0.294、0.261和0.464(P值分别为0.008、0.042和＜0.001).颈动脉IMT与年龄、SBP、高密度脂蛋白胆固醇、血糖相关的标准偏回归系数分别为0.262、0.264、-0.374和0.306(P值分别为0.035、0.023、＜0.001和0.007).尿mAlb水平、血清Cr均与血压、血糖关联,颈动脉IMT与年龄、血压、血脂、血糖关联.结论 PH组患者尿mAlb、血清Cr和领动脉IMT出现了改变,尿mAlb、血清Cr和颈动脉IMT与血压水平关联.提示正常血压高值患者存在与血压升高相关的靶器官损害,血压水平是导致尿mAlb、血清Cr和颈动脉IMT增加的危险因素.

Abstract：

Objective To observe the changes of urine microalbumin (mAlb), renal function and intima-media thickness(IMT) of the carotid artery in prehypertensive patients and investigate whether there are related target organ damage. Methods From August 2009 to May 2010,one hundred and eighty patients were recruited into the study and divided into 3 groups according to the 2005 revised edition of guideline for prevention and treatment of hypertension in China: Sixty normotensive subjects ( NT group,41 males, 19 females,mean age [54. 6 ± 12. 3] years old) ;Sixty prehypertensive patients( PH group,32 males,28 females,mean age [57.0 ± 12.7] years old) and 60 hypertensive patients ( EH group, 28 males, 32 females, mean age [65.0 ±12. 1] years old). Urine mAlb, serum creatinine(Cr) and IMT of the carotid artery were measured and compared among the three groups. The relationships between prehypertension and urine mAlb,serum Cr, IMT of the carotid artery were analyzed. Results In the NT group, PH group and EH group, the urine mAlb concentrations were ( 15.3 ± 7.5 ) mg/L, ( 24. 6 ± 10. 7 ) mg/L and ( 37.3 ± 20. 4) mg/L respectively ;serum Cr were ( 68.0 ± 16. 5 )μmol/L, (81.9 ± 14.9)μmol/L and (95.8 ± 22.5)μmol/L respectively; IMT of the carotid artery were ( 1.46 ± 0. 67 ) mm, ( 1.79 ± 0. 74 ) mm and( 2. 34 ± 0. 78 ) mm respectively. Urine mAlb, serum Cr and IMT of the carotid artery were significantly higher in the PH group and EH group when compared to NT group ( P ＜0. 05 or 0. 01 ); and in the EH group these indices were also significantly higher than those in the PH group( P ＜0. 01 ). Multiple linear regression analysis showed that after adjusted age, body mass index (BMI), blood pressure( BP), serum lipid and serum glucose, in the PH group,the standard partial regression coefficients of correlation between urine mAlb and systolic blood pressure (SBP), diastolic blood pressure(DBP) and serum glucose were 0. 279,0. 259 and 0. 360 respectively ( P = 0. 012, 0. 043 and ＜ 0. 001 ); the standard partial regression coefficients of correlation between serum Cr and SBP, DBP and serum glucose were 0. 317,0. 257 and 0. 377 respectively ( P = 0. 006,0. 049 and ＜ 0. 001 ). The standard partial regression coefficients of correlation between IMT of the carotid artery and age, SBP, DBP, total cholesterol and serum glucose were 0. 381,0. 375,0. 263,0. 265 and 0. 372 respectively( P ＜ 0. 001, ＜ 0. 001, = 0. 033,0. 021 and ＜ 0. 001 ). In the EH group, the standard partial regression coefficients of correlation between urine mAlb and SBP, DBP and serum glucose were 0. 378,0. 258 and 0. 283 respectively( P ＜ 0. 001, = 0. 046, and 0. 009); the standard partial regression coefficients of correlation between serum Cr and SBP, DBP and serum glucose were 0. 294,0. 261 and 0. 464respectively (P =0. 008,0. 042 and ＜0. 001 ) ;the standard partial regression coefficients of correlation between IMT of the carotid artery and age, SBP, high density lipoprotein cholesterol and serum glucose were 0. 262,0. 264, -0. 374 and 0. 306 respectively ( P = 0. 035,0. 023, ＜ 0. 001 and 0. 007 ). We found that both urine mAlb and serum Cr were significantly associated with BP and serum glucose; IMT of the carotid artery was significantly associated with age, BP, serum lipid and serum glucose. Conclusion Urine mAlb, serum Cr andIMT of the carotid artery increased in prehypertensive patients, and these indices were significantly associatedwith the level of the BP. These data indicated there were related target organ damage occurred in prehypertensive patients,the BP level was the risk factor that increased urine mAlb,serum Cr and IMT of the carotid artery.