双联抗血小板治疗伴易损斑块的轻度症状性颈动脉狭窄的疗效和安全性

目的：探讨阿司匹林联合氯吡格雷治疗伴易损斑块的症状性颈动脉狭窄患者的疗效和安全性。方法利用颈动脉超声检查筛选205例存在颈动脉易损斑块,且颈动脉狭窄＜50％的缺血性卒中患者,随机分为阿司匹林治疗组（单抗组）102例和阿司匹林联合氯吡格雷治疗组（双抗组）103例,比较两组治疗90 d内外周血基质金属蛋白酶－9（MMP －9）的变化,以及卒中和血管性意外事件的发生率。结果治疗21 d后,双抗组血液中M M P －9浓度下降值高于单抗组[（77．26±13．71）ng／ml比（96．86±16．52）ng／ml ,P＜0．01]。双抗组90 d内脑梗死总复发率和同侧复发率均低于单抗组（3．88％比11．76％,P ＝0．035;1．94％比8．82％,P ＝0．029）,两组对侧脑梗死复发率差异无统计学意义（1.94％比2．94％,P＝0．643）。双抗组同单抗组相比,出血事件（0．97％比0,P＞0．05）和急性冠脉综合征的发生率（1．94％比5．88％, P ＝0．145）差异均无统计学意义。结论对于伴易损斑块的症状性颈动脉狭窄患者,阿司匹林联合氯吡格雷双联抗血小板治疗相对阿司匹林单抗治疗更具优势。     

血清高迁移率族蛋白B1与颈动脉易损斑块患者合并短暂性脑缺血发作的相关性研究

目的探讨血清高迁移率族蛋白B(HMGB1)与颈动脉易损斑块合并短暂性脑缺血发作(TIA)的相关性。方法本研究共纳入144例颈动脉易损斑块患者,根据是否合并TIA分为合并TIA组(A组,n=48)及未合并TIA(B组,n=96),另设颈动脉稳定斑块患者(C组,n=60)及正常健康人群组(D组,n=45)为对照组,采用酶联免疫吸附(ELISA)法测量各组血清高迁移率族蛋白B1水平。结果 A组血清HMGB1水平显著高于B组[(8.75±1.46)ng/mL vs(5.12±30.64)ng/mL],B组血清HMGB1水平显著高于C组[(5.12±30.64)ng/mL vs(2.35±0.42)ng/mL],上述3组血清HMGB1水平显著高于D组的(1.38±0.21)ng/mL,差异均有统计学意义(P0.05)。多元Logistic回归分析显示,高血清HMGB1水平与颈动脉易损斑块合并TIA呈独立相关(优势比2.374,95%可信区间1.264~3.982;P0.01)。结论血清高迁移率族蛋白B1水平的升高有助于评估颈动脉易损斑块患者发生TIA的风险。     

缺血性脑卒中患者血同型半胱氨酸水平与颈动脉斑块及性质的相关分析

目的研究缺血性脑卒中患者血浆同型半胱氨酸水平与颈动脉斑块及性质的关系。方法选择我院神经内科住院的急性缺血性脑卒中者112例为研究对象,通过颈动脉彩超检查按有无颈动脉斑块分为颈动脉斑块形组和无颈动脉斑块组,所有研究者采用荧光偏振免疫法测定血浆同型半胱氨酸(Hcy)水平。结果 (1)颈动脉斑块组和颈动脉无斑块组同型半胱氨酸[(16.56±7.5)vs(11.25±6.3)]、高密度脂蛋白(HDL-C)[(1.01±0.23)vs(1.25±0.43)]、低密度脂蛋白(LDL-c)[(2.87±0.75)vs(2.5±0.76)]比较差异有统计学意义(P0.05)。(2)颈动脉斑块组中按斑块性质分为稳定斑块组和不稳定斑块组,两者同型半胱氨酸水平[(13.86±4.24)vs(15.78±6.46)]比较差异有统计学意义(P0.05)。结论除高密度脂蛋白降低、低密度脂蛋白升高外,同型半胱氨酸水平升高亦是颈动脉斑块形成的危险因素,同时高同型半胱氨酸血症亦是不稳定性斑块形成的重要原因。     

Dual-Energy Computed Tomography as an Adjunct in the Evaluation of Peripheral Chronic Total Occlusions: A Feasibility Study

This study investigated the role of dual-energy computed tomography (CT) for lesion characterization in patients with peripheral arterial disease manifesting with chronic total occlusions (CTOs). Forty-one symptomatic patients with CTOs underwent dual-energy CT angiography before endovascular treatment. The lesions were subsequently analyzed in a dedicated workstation, and 2 indexes—dual-energy index (DEI) and effective Z (Z_eff)—were calculated, ranging from 0.0027 to 0.321 and from 6.89 to 13.02, respectively. Statistical analysis showed a significant correlation between the DEI and Z_eff values (P < .001). The interobserver intraclass correlation coefficient was 0.91 for the mean Z_eff values and 0.86 for the mean DEI values. This technique could potentially provide useful information regarding the composition of a CTO.     

Quantitative assessment of atherosclerotic plaque,recent progress and current limitations

An important advantage of computed tomography coronary angiography (CCTA) is its ability to visualize the presence and severity of atherosclerotic plaque, rather than just assessing coronary artery stenoses. Until recently, assessment of plaque subtypes on CCTA relied on visual assessment of the extent of calcified/non-calcified plaque, or visually identifying high-risk plaque characteristics. Recent software developments facilitate the quantitative assessment of plaque volume or burden on CCTA, and the identification of subtypes of plaque based on their attenuation density. These techniques have shown promise in single and multicenter studies, demonstrating that the amount and type of plaque are associated with subsequent cardiac events. However, there are a number of limitations to the application of these techniques, including the limitations imposed by the spatial resolution of current CT scanners, challenges from variations between reconstruction algorithms, and the additional time to perform these assessments. At present, these are a valuable research technique, but not yet part of routine clinical practice. Future advances that improve CT resolution, standardize acquisition techniques and reconstruction algorithms and automate image analysis will improve the clinical utility of these techniques. This review will discuss the technical aspects of quantitative plaque analysis and present pro and con arguments for the routine use of quantitative plaque analysis on CCTA.     

Are risk factors necessary for pretest probability assessment of coronary artery disease? A patient similarity network analysis of the PROMISE trial

BackgroundPretest probability (PTP) calculators utilize epidemiological-level findings to provide patient-level risk assessment of obstructive coronary artery disease (CAD). However, their limited accuracies question whether dissimilarities in risk factors necessarily result in differences in CAD. Using patient similarity network (PSN) analyses, we wished to assess the accuracy of risk factors and imaging markers to identify ≥50% luminal narrowing on coronary CT angiography (CCTA) in stable chest-pain patients.MethodsWe created four PSNs representing: patient characteristics, risk factors, non-coronary imaging markers and calcium score. We used spectral clustering to group individuals with similar risk profiles. We compared PSNs to a contemporary PTP score incorporating calcium score and risk factors to identify ≥50% luminal narrowing on CCTA in the CT-arm of the PROMISE trial. We also conducted subanalyses in different age and sex groups.ResultsIn 3556 individuals, the calcium score PSN significantly outperformed patient characteristic, risk factor, and non-coronary imaging marker PSNs (AUC: 0.81 vs. 0.57, 0.55, 0.54; respectively, p ?< ?0.001 for all). The calcium score PSN significantly outperformed the contemporary PTP score (AUC: 0.81 vs. 0.78, p ?< ?0.001), and using 0, 1–100 and ?> ?100 cut-offs provided comparable results (AUC: 0.81 vs. 0.81, p ?= ?0.06). Similar results were found in all subanalyses.ConclusionCalcium score on its own provides better individualized obstructive CAD prediction than contemporary PTP scores incorporating calcium score and risk factors. Risk factors may not be able to improve the diagnostic accuracy of calcium score to predict ≥50% luminal narrowing on CCTA.     

256层螺旋CT血管造影术评价颈动脉溃疡斑块

目的探讨256层螺旋CTA评价颈动脉溃疡斑块的价值。方法回顾性分析136例颈动脉粥样硬化患者的256层螺旋CTA资料,观察斑块的分布情况及颈动脉管腔狭窄程度,并分析斑块的构成成分,重点分析其中溃疡斑块的相关情况,并分析溃疡斑块与临床症状的相关性。结果 136例患者中共发现颈动脉斑块452个,其中溃疡斑块78个,溃疡发生率为17.26%（78/452）,位于颈总动脉14个,分叉部32个,颈内动脉13个,颈外动脉19个;纤维斑块7个,脂肪斑块49个,钙化斑块3个,混合性斑块19个;溃疡斑块导致管腔轻、中、重度狭窄及闭塞分别为7、29、34和8个。溃疡斑块与脑缺血症状存在统计学关联（OR=3.433,P〈0.01）。结论 256层螺旋CTA可无创地评价颈动脉溃疡斑块的特征,具有较高应用价值。     

彩色多普勒超声检测颈动脉硬化斑块在脑梗死中的应用价值

目的探讨彩色多普勒超声检测颈动脉硬化斑块在脑梗死中的应用价值。方法选取2016年1月~2017年1月在我院就诊的50例脑梗死患者为观察组,并选择同期非脑梗死体检者50例为对照组,两组患者均采用彩色多普勒超声检查颈动脉检测颈动脉中层内膜厚度(IMT)、斑块类型,并检测收缩期峰值流速(PSV)、舒张末期流速(EDV)、阻力指数(RI)。结果观察组IMT、颈动脉斑块数量、面积[(1.49±0.42)mm、(5.86±1.35)个、(1.48±0.32)cm2]均明显大于对照组[(0.93±0.29)mm、(1.16±0.32)个、(0.59±0.12)cm2](P0.05或P0.01);观察组颈动脉斑块不稳定型数量(144个)明显多于对照组(10个)(P0.01);观察组颈动脉PSV、EDV[(65.35±14.26)cm/s、(16.69±4.36)cm/s]低于对照组[(72.51±14.58)cm/s、(19.11±4.82)cm/s](P0.05),RI(0.75±0.16)高于对照组(0.65±0.15)(P0.05)。结论彩色多普勒超声提示颈动脉硬化与脑梗死密切相关,早期检查颈动脉能为临床预防脑梗死发生提供客观依据。     

血浆同型半胱氨酸与缺血性脑血管病患者颈动脉粥样硬化斑块的关系研究

目的探讨血浆同型半胱氨酸(Hcy)浓度与缺血性脑血管病患者颈动脉粥样硬化斑块的关系。方法选择2017年1月～2018年6月治疗的缺血性脑血管病患者307例作为研究对象,所有患者均行颈动脉彩色多普勒超声检查,根据超声检查结果分为三组:A组(稳定斑块)、B组(不稳定斑块)、C组(无斑块);对其血浆Hcy浓度进行检测,采用SPSS Pearson相关性分析软件对血浆Hcy浓度与颈动脉粥样硬化斑块的关系进行分析。结果 307例患者中,C组68例(占比22.15%),有颈动脉斑块239例(占比77.85%),其中,B组81例(占比33.89%),A组158例(占比66.11%)。此外,D组112例(占比46.86%),E组127例(占比53.14%);A组与B组的血浆Hcy浓度显著高于C组(P0.05);B组的血浆Hcy浓度显著高于A组(P0.05);D组的血浆Hcy浓度显著高于E组(P0.05);SPSS Pearson相关性分析结果表明:血浆Hcy浓度与颈动脉粥样硬化斑块呈正相关(P0.05)。结论血浆Hcy浓度与缺血性脑血管病患者颈动脉粥样硬化斑块的形成以及稳定性均存在密切关联,加强血浆Hcy浓度测定可评估患者预后,指导临床治疗。     

他扎罗汀倍他米松乳膏治疗慢性斑块型银屑病的临床疗效和安全性评价

目的 探讨他扎罗汀倍他米松乳膏（含0.05%他扎罗汀和0.05%二丙酸倍他米松）治疗慢性斑块型银屑病的临床疗效和安全性。方法 将90例慢性斑块型银屑病患者随机分为治疗组（45例）和对照组（45例）,治疗组外用他扎罗汀倍他米松乳膏,每日1次,睡前应用;对照组外用卡泊三醇软膏,早晚各1次;疗程均为4周。疗程结束后,随访8周。结果 治疗4周后,治疗组的银屑病皮损面积和严重程度指数（psoriasis area severity index, PASI）、医生对病情的总体评估（physician’s global assessment, PGA）和皮肤病生活质量指数（dermatology life quality index, DLQI）均较对照组显著下降,差异有统计学意义（P＜0.05）。治疗组的有效率（65.00%）显著高于对照组（41.46%）,差异有统计学意义（P＜0.05）。治疗过程中,两组间不良反应发生率差异无统计学意义（P＞0.05）。随访8周后,治疗组的复发率为23.07%,对照组为29.41%,差异无统计学意义（P＞0.05）。结论 他扎罗汀倍他米松乳膏治疗慢性斑块型银屑病的疗效优于卡泊三醇软膏,不良反应和复发率与卡泊三醇软膏没有差异。