原发性高血压患者颈动脉内膜中层厚度与hsCRP Hcy及血压变异性相关性研究

目的 研究原发性高血压患者血浆中同型半胱氨酸(Hcy)及超敏C反应蛋白(hsCRP)的含量,探讨其与原发性高血压患者颈动脉内膜中层厚度(IMT)和动态血压变异性(BPV)之间的关系。方法 对180例原发性高血压患者行颈动脉彩超测定IMT,按IMT厚度分为,IMT正常组、IMT增厚组、IMT斑块组;并检测24 h动态血压、血Hcy、血清hsCRP。结果 原发性高血压患者颈动脉IMT增厚组、颈动脉IMT斑块组血清hsCRP、Hcy及BPV明显高于颈动脉IMT正常组,差异有统计学意义(均P<0.05)。结论 原发性高血压患者血清Hcy、hsCRP、以及血压变异性与颈动脉粥样硬化之间密切相关     

冠心病患者CAVI与IMT应用价值及相关分析

目的:探究CAVI与IMT检测对冠心病的临床应用价值及相关性分析方法:选取在我院进行治疗的62例冠心病患者列为观察组,同时选取55例在我院进行体检的健康人群作为对照组.比较两组研究对象CAVI与IMT的检测值差异及相关性;分析CAVI与IMT的检测值对冠心病的诊断价值.结果:观察组CAVI与IMT检测值显著高于对照组;用Pearson检验得出观察组CAVI与IMT呈正相关,对照组CAVI与IMT无相关性;ROC曲线分析显示,当CAVI值取9.01时对冠心病诊断的灵敏度为90.81%,特异度为79.22%,诊断价值高于IMT,但当CAVI与IMT联合对冠心病诊断的灵敏度93.55%,特异度87.27%,诊断效度更高.结论:CAVI是一种有效评估诊断冠心病的检测方法,操作简便且无创性,与IMT呈正相关,同时二者联合诊断冠心病的价值更高,对冠心病早期预防治疗及病理进程研究提供重要临床指导价值.     

颈动脉超声联合血清同型半胱氨酸在冠状动脉粥样硬化性心脏病诊断中的应用价值

目的:探讨颈动脉超声联合血清同型半胱氨酸(Hcy)在冠状动脉粥样硬化性心脏病(CAD)诊断中的应用价值。方法:选取161例经冠脉造影证实为CAD的患者为研究对象,作为观察组,另选取同期161例健康体检者为对照组,比较两组患者颈动脉超声结果、血清同型半胱氨酸(Hcy)水平的差异,分析与冠状动脉狭窄相关的危险因素。结果:观察组与对照组比较,颈动脉内-中膜厚度(IMT)分别为(1.25±0.19)mm∶(0.84±0.20)mm,Crouse斑块积分分别为(8.87±2.89)分、(3.86±1.44)分,血清Hcy水平分别为(17.59±2.82)μmol/L、(6.29±2.99)μmol/L),差异均具有统计学意义(P<0.05);观察组中冠状动脉中度狭窄、重狭窄、闭塞三个亚组比较,颈动脉内-中膜厚度(IMT)、Crouse斑块积分呈明显的递增趋势(P<0.05);而血清Hcy水平与CAD患者冠脉狭窄程度无相关性(P>0.05)。结论:颈动脉超声联合Hcy检测可以作为CAD的临床诊断筛查手段,同时颈动脉超声还能预判CAD冠脉的狭窄程度。     

他汀类药物对冠脉综合征患者血清hs-CRP与颈动脉IMT的影响

目的：探讨他汀类药物对冠脉综合征患者血清超敏C反应蛋白(hs-CRP)和颈动脉内膜中层厚度（IMT）的影响。方法选取2012年6月至2015年1月期间我院心血管内科确诊治疗的冠脉综合征患者150例,依据随机分配原则分为常规组和他汀组,每组75例,常规组患者给予抗血小板、抗凝、溶栓、抗缺血、抗心力衰竭及心律失常等常规治疗和10 mg阿托伐他汀口服治疗,他汀组患者在基础治疗上给予20 mg阿托伐他汀口服治疗,两组均持续治疗1个月,采用酶联免疫吸附法(ELISA)检测血清hs-CRP水平,随访1年,统计分析所有患者治疗前后颈动脉IMT、斑块大小、厚度、数量和治疗前、治疗后3个月、6个月、12个月的血清hs-CRP水平及左心射血分数(LVEF)、不良心脏事件发生情况。结果治疗前,常规组和他汀组患者颈动脉IMT [(1.74±0.46) mm vs (1.71±0.44 mm]、斑块大小[(23.58±5.84) mm2 vs (24.02±5.91) mm2]、厚度[(2.82±0.82) mm vs (2.76±0.79) mm]、数量[(5.48±0.64)个vs (5.39±0.61)个]和血清hs-CRP [(27.46±7.31) mg/L vs (28.06±7.41) mg/L]水平基本相同,差异均无统计学意义(P>0.05);治疗后,他汀组患者颈动脉IMT [(1.21±0.34) mm vs (1.52±0.38) mm]、斑块大小[(14.57±4.72) mm2 vs (19.51±5.41) mm2]、厚度[(1.53±0.52) mm vs (1.89±0.61) mm]、数量[(2.94±0.33)个vs (3.52±0.38)个]和3个月[(18.32±7.02) mg/L vs (24.23±7.11) mg/L]、6个月[(12.36±6.13) mg/L vs (18.43±7.05) mg/L]、12个月[(7.63±3.21) mg/L vs (11.36±5.03) mg/L]的血清hs-CRP水平明显低于常规组,差异均有统计学意义(P<0.05);他汀组患者治疗后LVEF水平为(57.96±8.11%)%,明显高于常规组的(52.13±7.84)%,不良心脏事件发生率为4.00%,明显低于常规组的13.33%,差异有统计学意义(P<0.05)。结论较大剂量他汀类药物可有效缓解冠脉综合征患者的颈部血管斑块及机体炎症状态,改善患者左心室功能,且可有效减少不良心脏事件的发生,值得临床推广应用。     

Effects of an aqueous extract of Crataegus pinnatifida Bge. var. major N.E.Br. fruit on experimental atherosclerosis in rats

Ethnopharmacological relevance

Atherosclerosis (AS) can result in severe cardiovascular diseases. Early indications of AS include disorders in lipid metabolism, inflammatory responses, and endothelial dysfunction. Statins are the preferred drugs for stabilizing atherosclerotic plaques because of their lipid-lowering, anti-inflammation and endothelial-protection activities. However, they can exhibit side effects and are effective in only one-third of patients. Many natural products (especially traditional Chinese medicines (TCMs)) possessing similar lipid-lowering, anti-inflammation and antioxidant activities are of interest in many studies exploring new AS drug therapy.The widely distributed hawthorn is used to prevent and cure heart disease not only in China but also in the United States and several European countries. For example, the fruit of Crataegus pinnatifida Bge. and Crataegus pinnatifida Bge. var. major N.E.Br. (a commonly used hawthorn fruit in China) is used in combination with other TCMs to treat AS. Studies have also shown that the water extracts of these two hawthorn fruits are effective against hyperlipidemia by lowering lipid levels, reducing endothelial dysfunction, and inhibiting inflammation. The aim of the study is to investigate the effect and possible mechanisms of the aqueous extract of Crataegus pinnatifida var. major on AS rats.

Materials and methods

The fruit of Crataegus pinnatifida var. major was extracted with 70% ethanol; the ethanol extract was chromatographed on a D101 macroporous resin to obtain a sugar-free aqueous extract (AECP). Atherosclerotic rats were fed a high-fat diet and injected with vitamin D₃ and ovalbumin. Rats were divided into five groups: normal, model, model plus simvastatin, model plus low-dose AECP, and model plus high-dose AECP. AECP and simvastatin were administered (via the intragastric route) to AECP groups and the simvastatin group. For normal and model groups, water was given for 4 weeks. After 12 weeks, levels of total cholesterol (TC), triglyceride (TG), low-density lipoprotein-cholesterol (LDL-C) and high-density lipoprotein-cholesterol (HDL-C) in blood were measured by an automatic biochemistry analyzer. Serum concentrations of interleukin (IL)-1β, IL-8, nitric oxide (NO), endothelin (ET), 6-keto-prostaglandin F_1α (6-keto-PGF_1α) and thromboxane B₂ (TXB₂) were determined by radioimmunoassay (RIA). Serum concentrations of C-reactive protein (CRP) and IL-18 were measured by enzyme-linked immunosorbent assay (ELISA). Pathological changes in arteries were observed using an optical microscope and the intima-media thickness (IMT) calculated. Cholesterol deposition was evaluated by filipin staining. Chemical ingredients in AECP were analyzed by qualitative and quantitative means by high-performance liquid chromatography (HPLC).

Results

AECP significantly reduced the levels of TC, TG and LDL-C but increased HDL-C levels. It also decreased the concentrations of CRP, IL-1β, IL-8 and IL-18. AECP increased levels of ET and TXB₂ but increased 6-keto-PGF_1α levels. Histopathological examination showed that AECP inhibited pathological changes in the arteries of AS rats and reduced IMT. Chemical analysis suggested that the main components of AECP were chlorogenic acid, procyanidin B₂, (−)-epicatechin, rutin and isoquercitrin.

Conclusions

These data suggest that AECP can inhibit AS progression in high-fat-diet-fed rats. Possible mechanisms of action include improvement of lipid metabolism, decrease in inflammatory cytokine responses, and protection of the endothelium.     

炎性肌纤维母细胞瘤影像诊断的研究进展

随着现代医学的高速发展,医疗设备不断更新完善,对某些疾病认识越来越深入,如炎性肌纤维母细胞瘤(inflammatory myofibroblastic tumor,IMT)。IMT的病因、发病机制、临床表现均不典型,其影像学表现亦缺乏特异性,与恶性肿瘤有许多相似之处,极易发生误诊。但影像学可提示肿块范围、与周围组织关系、良恶倾向等信息,对IMT的术前诊断具有一定的价值并能够指导临床选择合理的治疗方案。本文对近年来IMT在影像学诊断上取得的进展做一综述,以期提高对IMT的认识。     

Hyperhomocysteinemia and the presence of cardiovascular disease are associated with kynurenic acid levels and carotid atherosclerosis in patients undergoing continuous ambulatory peritoneal dialysis

Introduction

Hyperhomocysteinemia and the activation of kynurenine (KYN) pathway have been reported as the factors participated in atherosclerosis in uraemic patients. The objective of this study was to verify whether hyperhomocysteinemia may be involved in atherosclerotic cardiovascular disease (CVD) in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).

Materials and methods

We determined the plasma concentrations of KYN, KYNA, KYNA/KYN ratio, homocysteine (Hcy) and intima-media thickness (IMT) - an early reflection of the systemic atherosclerosis in CAPD patients both with and without CVD and healthy controls.

Results

KYNA concentrations and KYNA/KYN ratio were about 3 times higher in the patients with hyperhomocysteinemia (Hcy > 15 μM) compared to those with normal Hcy levels (< 15 μM), and they were significantly lower in CVD[+] than in CVD[−] patients in these studied groups. The presence of CVD was associated with higher Hcy levels only in the patients with Hcy > 15 μM. The positive association was between Hcy and KYNA, KYNA/KYN ratio in all CAPD patients and in CVD[+] patients with hyperhomocysteinemia. IMT was positively associated with Hcy levels in patients with hyperhomocysteinemia, whereas there was no relationship between IMT and KYNA concentrations in the studied groups.

Conclusions

These results showed the association between hyperhomocysteinemia and carotid atherosclerosis as well as the possible role of hyperhomocysteinemia in the activation of KYNA production in CAPD patients. The elevated KYNA levels observed in patients with hyperhomocysteinemia seem to be protective against Hcy-mediated atherosclerosis in these patients.     

急性脑梗死患者颈动脉内膜中层厚度与血清VE—cadherin和脂联素水平变化

目的探讨急性脑梗死患者颈总动脉平均内膜中层厚度（IMT）与血清血管内皮细胞钙黏蛋白（VE—cadherin）、脂联素（APN）的含量变化,及其在急性脑梗死发生过程中的作用和意义。方法采用高分辨率彩色超声诊断仪测量颈动脉IMT,并采用酶联免疫法测定血清VE-cadherin和APN水平,并与60例年龄和性别相当的健康体检者（对照组）进行比较。结果①急性脑梗死患者颈动脉IMT和血清VE-cadherin含量较两对照组显著升高,脂联素含量较对照组显著降低;②急性脑梗死患者颈动脉IMT和血清VE-cadherin、脂联素含量之间存在相关性。结论监测患者颈动脉IMT和血清VE-cadherin、脂联素含量变化有助于预测脑梗死的发生。