无创性动脉硬化检测技术在高血压肾病中的评估价值

目的探讨无创性动脉硬化检测指标[颈动脉内中膜厚度(carotid intima-media thickhess,IMT),踝臂指数(ankle brachial index,ABI)及心脏-脚踝血管指数(cardio-ankle vascular index,CAVD]在高血压肾病中的评估价值。方法选择2010年1月至2014年1月在我院经病理检查确诊为高血压肾病的46例患者作为高血压肾病组,另按数字表法随机选取高血压患者50例及健康人群50名分别为高血压组和健康对照组,比较IMT、ABI和CAVI。尿微量白蛋白/尿肌酐比值(urinary albumin-creatinine ratio,ACR)、尿β微球蛋白(urinary beta 2 microglobulin,β2-MG)、估算肾小球滤过率(estimated glomerular filtration rate,eGFR)的差异。结果高血压肾病组ACR、尿β2-MG、IMT、CAVI均较高血压组、健康对照组增高,差异有统计学意义(P0.01)。高血压组ACR、尿β2-MG、IMT、CAVI均较健康对照组增高,差异有统计学意义(P0.05)。高血压肾病组eGFR及ABI较高血压组及健康对照组下降,差异有统计学意义(P0.01)。高血压组ABI较健康对照组下降,差异有统计学意义(P0.05)。高血压组和健康对照组eGFR差异无统计学意义(P0.05)。随着高血压病情进展及动脉硬化程度加重,IMT、CAVI与肾功能下降呈负相关,ABI与肾功能下降呈正相关,可见动脉硬化程度与肾功能水平密切相关。结论及早应用无创动脉硬化检测技术于高血压患者,并使用此检测手段监测血管硬化情况,并予相关药物干预,或许可延缓高血压病情的进展。     

颈动脉支架术后视网膜动脉栓塞1例

<正>患者男,74岁,因间歇头晕,下肢乏力1月余入院。既往高血压病史10年,慢性胃炎,右手震颤10年。入院体检:体温36.6℃,脉搏规则、85次/分,呼吸规则、19次/分,血压138mmHg/74mmHg,神志清,查体合作,双侧视力粗测正常,左侧颈部检查未闻及血管杂音,右侧颈部可闻及血管杂音。经颈动脉彩色多普勒超声和CTA提示颈动脉狭窄,欲接受颈动脉支架治疗。入院2天后接受主动脉弓+全脑血管造影示左     

Sclerosing Paraganglioma of the Carotid Body: A Potential Pitfall of Malignancy

Paragangliomas (PGs) of the head and neck region are typically benign, slow-growing neuroendocrine tumours. At times, they may exhibit unusual histological features, such as prominent stromal sclerosis (sclerosing PG), which may raise concerns of malignancy. We describe a case of sclerosing PG of the carotid body, emphasizing the value of immunohistochemical stains for differential diagnosis. A 43-year-old woman presented with a painless lump on the neck. A magnetic resonance imaging scan demonstrated a hypervascular lesion of the carotid body, which was surgically excised. Grossly, the lesion measured 1.8 cm at maximum diameter. On microscopic examination, irregular nests and tiny bundles of neoplastic cells were found between thick bands of fibrous tissue. Focal nuclear cytomegaly and marked pleomorphism were noted. Neoplastic cells proved to be immunoreactive for chromogranin, synaptophysin and neuron specific enolase, but negative for cytokeratins, smooth muscle actin and CD34. Ultrastructurally, numerous mitochondria, rough endoplasmic reticulum structures and endocrine granules were seen in the cytoplasm of the tumour cells. On consideration of the above-mentioned clinico-pathological and ultrastructural findings a diagnosis of sclerosing PG was established. Sclerosing PG is a rare entity which may mimic a malignant neoplasm. The recognition of this unusual morphological variant of PG, together with appropriate immunostains, leads to the correct diagnosis.     

Pseudo subclavian steal syndrome: Case report

IntroductionVertebrobasilar insufficiency (VBI) is a condition that results from restricted blood flow to the posterior portions of the brain, which are primarily served by the vertebral and basilar arteries. It is the most common cause of vertigo in the elderly and is usually accompanied by impaired vision and sensation. Congenital abnormalities, atherosclerosis, stroke and/or trauma may all lead to decreased vertebrobasilar circulation. A syndrome called Subclavian Steal Syndrome (SSS), which manifests with similar neurological symptoms but with a different pathophysiology, may also cause VBI.Case presentationA middle-aged female presented with gradual onset fainting and vertigo attacks. Cardiac, auditory and autonomic etiologies were investigated and excluded. Clinical findings and presentation were highly suggestive of subclavian steal. However, subsequent CT angiography showed normal subclavian arteries. Instead, findings included a persistent right trigeminal artery (PTA), stenosis of the right proximal internal carotid artery, atresis of the left vertebral artery and distal segment of right vertebral artery, congenitally compromised changes in vertebral circulation (bilateral absence of the posterior communicating arteries (PCOMs)) and an absent anterograde vertebrobasilar circulation. Symptoms resolved after carotid endarterectomy.DiscussionDue to the absence of a normally developed posterior circulation, the PTA was the main source of blood supply for the patient. Development of recent artheromatous changes in the right internal carotid artery, however, resulted in decreased blood through PTA, further compromising posterior circulation. This resulted in vertebrobasilar insufficiency, and manifested in symptomology similar to SSS.ConclusionsThis clinical encounter illustrates the relative contribution of anatomical and vasoocclusive factors in closely mimicking symptoms of subclavian steal syndrome.     

老年2型糖尿病患者颈动脉粥样硬化与骨密度的相关性研究

目的 探讨老年2型糖尿病患者颈动脉粥样硬化与骨质疏松症的关系.方法 昆明医科大学第二附属医院住院2型糖尿病患者200例行颈部血管彩超,IMT＜1.0 mm为对照组,IMT≥1.0 mm为实验组.均用双能X线骨密度测量技术检测骨密度,分为骨量正常组与骨量变化组,分析各组生化指标及颈动脉粥样硬化斑块与骨密度的相关性.结果 实验组发生骨量变化的机率高于对照组,差异有统计学意义(P＜0.01);年龄、HOMA、TC、TG、LDL-C、UA、MAU、硬化斑块是骨量减低的独立危险因素,BMI是保护因素(P＜0.01).结论 老年2型糖尿病患者颈部血管病变与骨密度密切相关.     

家族性高胆固醇血症并发主动脉瓣上及颈动脉狭窄报告并文献复习

目的探讨家族性高胆固醇血症(familial hypercholesterolemia,FH)的临床特点及诊治要点。方法对我院收治的1例FH临床资料进行回顾性分析。结果本例17岁女性,因活动后胸闷、气促5年,加重1个月入院。4岁时皮肤出现黄色瘤,手术治疗后复发。病程中于外院就诊,考虑先天性心脏病及高脂血症,并予降血脂治疗未见明显效果入我院。经查血脂升高,心脏及颈动脉超声检查示主动脉瓣上狭窄及颈动脉狭窄,并结合有黄色瘤病史,确诊为纯合子型FH,给予降血脂、强心、利尿、抗血小板聚集等治疗,病情好转,因拒绝血浆置换治疗,继续上述治疗,随访1年血脂控制不佳,症状反复发作。结论 FH易出现心血管并发症,预后差,早期容易漏诊,早期诊断与治疗是延缓疾病进展的关键。