脉搏波速度技术对原发性高血压患者颈动脉弹性功能的初步探讨

目的：评价脉搏波速度（ PWV）这一技术的稳定性和可重复性,研究颈动脉弹性和血压之间的相关性。方法收集高血压72例,男31例,女41例,年龄17～85（62．76±12．17）岁。依据血压水平将入组的高血压患者分为三个亚组（1、2、3级组）。同时纳入26例非高血压受检者作为对照组,男10例,女16例,年龄41～76（59．65±8．12）岁。两位医生分别测得颈动脉内中膜厚度（ IMT）、颈动脉PWV数值收缩期开始[ PWV（ BS）]、收缩期结束[ PWV（ ES）],评价IMT、BS、ES数值的可重复性,同时比较定量参数（ IMT、BS、ES）在组间（高血压组和对照组）及组内（高血压三个亚组）的差异性。结果①IMT、BS、ES数值的可重复性高。②对照组与高血压组之间比较,三个变量（ IMT、BS、ES）均存在组间统计学差异。高血压组组内（三个亚组间）比较：IMT,2级组与3级组无统计学意义;BS,1级组与2级组之间、2级组与3级组无统计学意义;ES,三个亚组间均有统计学意义（ P＜0．05）。结论 PWV技术可重复性高,相对IMT,PWV能更敏感显示血管弹性和血压之间的相关性。     

The role of low-grade inflammation in the polycystic ovary syndrome

PCOS is not only the most frequent cause of oligomenorrhea in young women, but also a metabolic disorder characterized by insulin resistance, glucose intolerance, dyslipidemia, and obesity, especially the visceral phenotype. PCOS represents a broad spectrum of endocrine and metabolic alterations which change with age and with increasing adiposity. In fact, during adolescence and youth the predominant clinical manifestations of PCOS are menstrual abnormalities, hirsutism and acne, whereas in peri-menopausal and post-menopausal periods metabolic disorders and an increased risk for cardiovascular diseases prevail. The pathogenetic links between PCOS and metabolic or cardiovascular complications are still debated. However, recent evidence has been focused on a condition of low-grade chronic inflammation as a potential cause of the long-term consequence of the syndrome.     

Associations of intra-renal arterial resistance index with chronic kidney disease and carotid intima-media thickness in type 2 diabetes mellitus

Renal dysfunction can be evaluated by increased intra-renal arterial resistance index (RI). We evaluated 113 Chinese men with type 2 diabetes on their RI. Results suggest that RI is associated with chronic kidney disease and subclinical arteriosclerosis. RI may help monitoring the deterioration of intra-renal hemodynamics.     

Ultrasonography in Heart Failure: A Story that Matters

Heart failure (HF) is a clinical syndrome caused by structural and/or functional cardiac abnormalities, resulting in a reduced cardiac output and/or elevated intracardiac pressures at rest or during stress. It is the leading cause of hospitalization in Internal Medicine departments. This article aims at reviewing evidence of the importance of ultrasound in HF both for hospitalized patients and in the follow-up. Ultrasound may be used as a recovery monitoring instrument at the bedside and also as a global cardiovascular assessment tool for these patients. HF represents an exciting opportunity to create an integrative ultrasound approach in Internal Medicine and/or Geriatric departments. The authors plan a five-step ultrasound examination to evaluate and monitor HF patients during hospitalization and follow-up. They call this examination: the “ABCDE” score. It includes the evaluations of A, the ankle-brachial index, B, the B-lines, C, the carotid intima media thickness, D, the diameter of the abdominal aorta and of the inferior cava vein and E, the echocardiographic assessment of the ejection fraction. This score may represent an integrative ultrasound approach in Internal Medicine and/or Geriatric departments.     

瑞舒伐他汀对原发性高血压患者尿微量白蛋白和动脉粥样硬化的影响

目的观察瑞舒伐他汀对无脂代谢紊乱的原发性高血压患者尿白蛋白/肌酐及动脉粥样硬化的影响。方法原发性高血压患者76例随机分为单用常规降压药物组（常规组,n=37）和常规降压药物＋瑞舒伐他汀（阿斯利康制药有限公司10 mg,睡前）组（联合组,n=39）。所有人选患者均在入选及随机治疗后8个月各测一次血压、尿白蛋白/肌酐、颈动脉内膜中层厚度（IMT）及冠状动脉钙化积分（CS）,对比分析组内治疗前后上述指标变化和两组间的差异。结果1）常规组和联合组治疗前后收缩压和舒张压均有显著下降,分别为（166.3±11.2,92.4±8.2）vs（133.6±9.8,85.5±6.1）mmHg和（165.6±10.5,91.5±6.7）vs（128.1±9.2,81.1±5.9）mmHg;联合组治疗后血压下降幅度较常规组大[（36.6±3.5,10.5±1.6）vs（33.1±2.2,6.5±1.3）mmHg,P〈0.05]。2）联合组治疗8个月后,尿白蛋白/肌酐、颈动脉内膜中层厚度及冠状动脉钙化积分均有显著下降,分别为[（31.6±21.8）vs（23.2±19.8）mg/g、（0.95±0.32）vs（0.84±0.28）mm和2.35±2.13vs1.71±1.68,P〈0.01];而常规组治疗8个月后,尿白蛋白/肌酐、颈动脉内膜中层厚度及冠状动脉钙化积分CS与治疗前相比差异无统计学意义（P〉0.05）。结论在应用常规降压药物基础上加用瑞舒伐他汀可使原发性高血压患者尿白蛋白/肌酐、颈动脉内膜中层厚度及冠状动脉钙化积分明显下降并进一步降低血压。     

Qualitative score of systemic arteriosclerosis by vascular ultrasonography as a predictor of coronary artery disease in type 2 diabetes

Objective

Patients with type 2 diabetes mellitus (T2DM) are at risk of polyvascular comorbidities and poor prognosis. Non-invasive techniques for early prediction of coronary artery disease (CAD) are desirable to prevent cardiovascular events in these patients. The aim of the present study was to investigate the association between CAD and systemic arteriosclerosis by qualitative vascular ultrasonography.

Methods

The study subjects were 102 consecutive outpatients with T2DM [males/females = 60/42, age: mean ± SD 67 ± 9 (range, 40–85) years] evaluated by vascular ultrasonography for arteriosclerosis in the abdominal aorta, carotid, renal, and common iliac arteries. The total number of detected arteriosclerotic vascular lesions in the four arteries was determined. CAD was diagnosed by two cardiologists using either stress electrocardiography, myocardial scintigraphy, multi-detector row computed tomography or coronary angiography.

Results

Multiple arteriosclerotic vascular lesions (>1) were detected in 64 (63%) patients. The total systemic vascular score was significantly higher in patients with CAD than those without (average score 2.7 versus 1.0, p < 0.0001). None of the CAD patients had a total score of 0. Age- and sex-adjusted multiple logistic regression analysis identified total score of ≥2 as the only predictor of CAD (p < 0.001). The sensitivity, specificity, positive and negative predictive values for total systemic vascular score in the prediction of CAD were 98%, 77%, 83%, and 97%, respectively, which were better than those for carotid mean and maximum intima-media thickness.

Conclusion

Non-invasive qualitative evaluation of systemic arteriosclerosis by the total systemic vascular score is potentially useful for the early prediction of CAD in T2DM patients.     

超声定量技术及Sono CT在2型糖尿病颈动脉病变中的应用

目的:探讨超声内-中膜自动测量技术(QLAB)和实时复合成像(Sono CT)对2型糖尿病颈动脉病变检测的价值。方法:对124例2型糖尿病患者及82例对照组的颈动脉分别进行检测,观察颈动脉后壁内-中膜厚度(IMT)、有无斑块形成,并根据是否伴有高血压及病程长短分组,将结果进行比较分析。结果:糖尿病各组IMT增厚共101例(81.5%),检出斑块96例(78.2%),对照组IMT增厚33例(40.2%),检出斑块26例(31.7%)。两组比较有显著性差异(P<0.05)。糖尿病合并高血压组斑块检出率高于无高血压组,经QLAB测量的IMTmean>无高血压组,结果有显著性差异(P<0.05)。糖尿病病程>5年者斑块检出率高于病程≤5年者,IMT厚度大于病程≤5年者厚度,结果有显著性差异(P<0.05)。结论:2型糖尿病患者颈动脉病变以IMT增厚为主,其次是斑块形成。SonoCT技术可使颈部血管细微结构的分辨率提高,增加血管病变边界的可见度,QLAB测定颈动脉内膜平均厚度较最厚值更具优越性,对糖尿病血管病变的早期诊断及指导治疗具有重要价值。     

组织蛋白酶S与脑梗死患者颈动脉内膜中膜厚度的关系及临床意义

目的 探讨组织蛋白酶S( Cat S)与脑梗死患者颈动脉内膜中膜厚度的关系及临床意义.方法 132例首发脑梗死患者,按颈动脉内膜中膜厚度(IMT)分为3组,IMT≤0.8 mm为第一组,38例;IMT 0.8 mm～1.0 mm为第二组,45例;IMT≥1.0mm,或有一个以上动脉粥样硬化斑块为第三组,49例;正常对照...     

不同剂量瑞舒伐他汀对颈动脉粥样硬化合并高血脂患者疗效及安全性的对照分析

目的观察不同剂量瑞舒伐他汀治疗颈动脉粥样硬化合并高血脂患者的疗效及安全性,并进行对照分析。方法本研究选取2008年5月-2011年5月颈动脉粥样硬化合并高血脂患者110例,随机分为瑞舒伐他汀5mg组（A组）、10mg组（B组）、20mg组（C组）,均为晚餐后顿服。比较3组患者治疗前后TC、TG、HDL-C、LDL-C、颈动脉斑块面积、颈内膜-中膜厚度的变化,并统计不良反应发生情况。结果3组患者治疗后颈动脉斑块面积、颈内膜-中膜厚度均明显减小（P〈0．01）;TC、TG、LDL-C指标均明显降低（P〈0．01）,HDL-C明显增高（P〈0．01）。但总体疗效C组优于B组;B组优于A组（P〈0．05或0．01）。3组患者治疗前后均未发现明显不良反应。结论瑞舒伐他汀在治疗颈动脉粥样硬化合并高血脂患者方面疗效显著．具有良好的调脂,抗感染以及抗动脉硬化作用,其疗效具有一定的剂量依赖性,本研究3种剂量治疗均未发现严重不良反应,安全性值得认可。     

Moderating effect of indoleamine 2,3-dioxygenase (IDO) activation in the association between depressive symptoms and carotid atherosclerosis: evidence from the Young Finns study

Background

Depression and inflammation have been suggested to be involved in the atherosclerotic processes, but empirical evidence is mixed. We tested the hypothesis that depressive symptoms are associated with atherosclerosis only when combined with other risk factors, such as inflammation indicated by indoleamine 2,3-dioxygenase (IDO) activation.

Methods

Participants were 544 women and 442 men (aged 24-39 years) who participated in the Young Finns Study medical examinations in 2001 and 2007. At baseline (in 2001), IDO activity (tryptophan and kynurenine ratio) and other biological and behavioral risk factors were assessed and depressive symptoms were determined using a modified 21-item Beck Depression Inventory. Carotid atherosclerosis was measured on the basis of carotid intimamedia thickness (IMT) at baseline and again in 2007.

Results

In women, IDO activity moderated the association between depressive symptoms and IMT (p = 0.02), so that a longitudinal association between depressive symptoms and IMT was found only in combination with high IDO activity (B = 0.21, p = 0.009). This association was robust to adjustment for other risk factors except body mass index and lipids which largely removed the association.

Limitations

The results of this study need to be confirmed using larger data sets and studies using clinical cut-off point for depression.

Conclusions

These data suggest that depressive symptoms are associated with preclinical y carotid atherosclerosis only if they are linked to inflammation, and that this association is present only in women. Underlying mechanisms are unknown but probably relate to adiposity.