Increased subclinical atherosclerosis in patients with chronic plaque psoriasis

Background: Psoriasis is an immune-mediated inflammatory skin condition of unknown aetiology which usually requires life-long treatment. It is regarded a systemic inflammatory disease with a possible increased risk of cardiovascular disease. The aim of this study was to assess carotid intima-media thickness (IMT), plaque prevalence and carotid stenosis as surrogate measures for cardiovascular disease in psoriasis patients and healthy controls. Methods: Sixty-two patients with psoriasis and thirty-one healthy controls were included in the study. All were examined by Colour duplex ultrasound of the carotid arteries to compare carotid IMT values, carotid plaques and carotid stenosis in the two groups. Adjustments were made for traditional cardiovascular risk factors. Results: Patients with psoriasis had increased carotid IMT values compared to the controls: mean ± SD 0.71 ± 0.17 mm vs. 0.59 ± 0.08 mm; p = 0.001. When adjusted for known atherosclerotic risk factors this difference remained significant (p = 0.04). Carotid plaques were also more common (p = 0.03) in patients with psoriasis 13 (21%) compared to controls 1 (3%). There was no difference with regard to the number of carotid stenoses in patients and controls. Conclusion: The results of this study support previous evidence which suggests that psoriasis is associated with an increased risk for atherosclerosis and subsequent cardiovascular disease.     

Assessment of subclinical carotid atherosclerosis in patients with primary osteoarthritis: Correlation with disease severity and insulin resistance

Aim of the workTo assess the carotid artery intima–media thickness (IMT) as an index of subclinical atherosclerosis in patients with primary osteoarthritis (OA) and its correlation to severity and insulin resistance (IR).Patients and methodsThis study included 40 primary OA patients (28 with predominant knee OA and 12 with hip OA) and 15 age and sex matched controls. They were subjected to full medical history, thorough clinical examination and radiological assessment by plain X-rays of knee and hip joints scored according to the Kellgren–Lawrence grading. In patients and control, the IR was calculated by the homeostasis model assessment (HOMA) and carotid IMT measured by ultrasonography.ResultsThere was significant increased carotid IMT in OA patients (0.82 ± 0.12 mm) compared to controls (0.61 ± 0.02 mm) (p < 0.001) with cut-off value of 0.65 mm. There was significant higher HOMA in OA patients (2.55 ± 0.8) compared to controls (1.79 ± 0.44) (p < 0.001). OA patients with IMT > 0.65 mm (n = 34) had longer duration (9 ± 2.56y), higher Kellgren–Lawrence score (2.89 ± 0.45) and higher HOMA (3.8 ± 0.53) compared to those patients with IMT < 0.65 mm (n = 6) (3.41 ± 2.09 y, 2.01 ± 0.26 and 2.23 ± 0.32 respectively). Multi-regression analysis showed that disease duration, Kellgren–Lawrence Grading and HOMA are the best sensitive discriminators for patients having carotid intima >0.65 mm. (F ratio 36.54, p < 0.001).ConclusionOsteoarthritis patients have higher risk of subclinical atherosclerosis independent of traditional risk factors. The severity of OA may contribute to the progression of atherosclerotic disease. Measurement of insulin resistance in OA patients can identify those with higher risk of subclinical atherosclerosis and may help in their follow up and early intervention.     

三七丹参胶囊联合叶黄素和阿托伐他汀治疗颈部血管斑块的疗效及安全性观察

目的 研究三七丹参胶囊联合叶黄素和阿托伐他汀治疗颈部血管斑块的效果及安全性。方法 选取2017年1月—2018年1月安康市中医医院的98例颈部血管斑块患者作为研究对象。用抽签法随机分为对照组和观察组,每组各49例。对照组患者口服阿托伐他汀钙片,20 mg/次,1次/d;且口服叶黄素软胶囊,2粒/次,2次/d。观察组在对照组的基础上口服三七丹参胶囊,3粒/次,3次/d。两组患者均治疗3个月。观察两组患者的临床疗效,同时比较两组患者的中医症候评分、Crouse斑块积分、血管内中膜厚度（IMT）和不良心血管事件情况。结果 治疗后,观察组的总有效率为81.63%,显著高于对照组为59.18%（P<0.05）。两组治疗后的心悸不安、头痛、胸闷不舒、舌质紫暗、唇甲紫绀、结代或脉涩积分明显降低（P<0.05）,观察组上述中医证候评分明显低于对照组（P<0.05）。两组治疗后的Crouse斑块积分和IMT明显降低（P<0.05）,观察组Crouse斑块积分和IMT明显低于对照组（P<0.05）。治疗期间,观察组的急性心肌梗死、不稳定型心绞痛、脑出血和急性脑梗死发生率显著低于对照组（P<0.05）。结论 三七丹参胶囊联合叶黄素软胶囊能明显减轻颈部血管斑块患者的症状,促进斑块面积的缩小,安全性高,且能降低不良心血管事件的发生风险。     

中青年心血管疾病风险评估与IMT监测的相关性分析

目的：对中青年进行心血管疾病危险因素、颈动脉内膜中层厚度（IMT ）的监测,探讨Framingham心血管疾病风险评分（Framingham risk score）与IM T的相关性。方法选取2012年至2013年在济宁医学院附属济宁市第一人民医院体检的中青年个体1045例,采用Framingham risk score计算10年风险值;依据颈动脉超声结果,将IM T分为正常、增厚和斑块形成3种,分析两者相关性。结果1045例中青年中Framingham心血管疾病10年风险≤10％占475例（45．5％）;＞10％的占570例（54．5％）。颈动脉超声无异常占593例（56．7％）;超声显示IM T 增厚或有斑块者占452例（43．4％）,其中211例出现动脉粥样硬化的典型改变。颈动脉IMT与Framingham心血管疾病10年风险之间有相关性,有统计学意义（P＜0．001）。结论在中青年中颈动脉内膜中层厚度的监测可有助于预计心血管发生危险性,为心血管疾病的早期发现提供了证据。     

非酒精性脂肪肝与颈动脉粥样硬化的相关性研究

目的探讨非酒精性脂肪肝（NAFL）与颈动脉粥样硬化的相关性。方法选择135例NAFL患者,按严重程度分为轻度组、中度组及重度组,选择60名健康人为对照组,进行颈动脉彩色多普勒超声检查,比较各组患者颈动脉内中膜厚度差异及粥样斑块及动脉狭窄发生率差异,并分析非酒精性脂肪肝患者脂肪肝严重程度与颈动脉狭窄的相关性。结果轻、中、重度组颈动脉内膜中层厚度、颈动脉斑块及颈动脉狭窄发生率均高于正常肝脏组。脂肪肝的严重程度与颈动脉狭窄程度呈正相关关系（r=0．442,P=0．002）。结论非酒精脂肪肝与颈动脉粥样硬化密切相关,对于非酒精性脂肪肝患者应注意颈动脉粥样硬化及狭,苫的可能。     

高血压致颈动脉粥样硬化的作用研究

目的：观察高血压在颈动脉粥样硬化（carotid atherosclerosis,CAS）发生中的重要意义。方法：从2008-10～2009-10内蒙古自治区医院健康体检者和心内科住院病人中筛选正常人群、高血压病人各30例作为研究对象,应用彩色多普勒超声检测所有研究对象的颈动脉内-中膜厚度（intima-media thickness,IMT）和颈动脉粥样斑块的发生率,并进行相关的统计学分析。结果：正常对照组IMT为0.97mm±0.12mm,高血压组IMT为1.08mm±0.16mm,P=0.004,两组间比较有显著统计学差异;正常对照组人中有4人发生颈动脉斑块,高血压组有17人发生颈动脉斑块P=0.001,两组间比较有显著统计学差异。结论：高血压与颈动脉斑块形成及斑块厚度明显正相关,积极控制血压对于减少和减轻颈动脉粥样硬化进程有重要临床意义。     

2型糖尿病颈动脉内膜-中层厚度与微血管病变的关系

目的:探讨2型糖尿病病人颈动脉内膜-中层厚度(IMT)与微血管病变的关系.方法:高分辨B超测定44例2型糖尿病病人及21名健康对照者双侧颈总动脉IMT,并检测临床指标,计算胰岛素抵抗指数(HOMA-IR指数)和B细胞功能指数(HOMA-IS指数).结果:有、无微血管并发症,两组间IMT、病程、糖化血红蛋白(HbA1c)差异有统计学意义. 糖尿病微血管并发症组HOMA-IS小于无微血管并发症组,而HOMA-IR在两组之间无统计学差异,有微血管并发症组较正常对照组IMT值高.结论:大血管病变与微血管病变相关联,其中病程、HbA1c及胰岛素分泌水平在大血管及微血管病变的形成中起作用.     

消痰化瘀方对高脂血症患者颈动脉内膜中层厚度及血清炎症因子的影响

目的：研究消痰化瘀方对高脂血症合并颈动脉粥样硬化患者颈动脉内膜中层厚度（IMT）及血清炎症因子的影响,探讨其抗动脉粥样硬化（AS）的作用机制。方法：将110例高脂血症患者随机分为2组,治疗组服用消痰化瘀中药,对照组给予阿托伐他汀钙片,观察两组服药24周后血清白细胞介素-6（IL-6）、超敏-C反应蛋白（hs-CRP）、细胞间黏附分子-1（ICAM-1）的水平及颈动脉IMT的变化情况。结果：两组患者治疗后血清IL-6、hs-CRP和ICAM-1水平较治疗前降低,颈动脉IMT明显改善,差异具有显著性（P〈0.05或P〈0.01）;治疗后两组比较,治疗组血清ICAM-1水平较对照组降低,差异具有显著性（P〈0.05）。结论：消痰化瘀方具有显著的抗AS作用,这些作用可能与降低血清炎症因子有关。     

代谢综合征颈动脉粥样硬化血管外膜重构的超声评价

目的 应用高频超声定量测定代谢综合征(MS)患者颈动脉血管外膜厚度(AT)变化,分析AT与颈动脉内-中膜厚度(IMT)的相关关系.方法 回顾分析2010年10月-2011年7月川北医学院附属医院代谢综合征患者161例和年龄性别匹配的健康对照组94例,将代谢综合征患者分为斑块组(MS-P,n=70)和无斑块组(MS-NP,n=91),采用高频超声获取颈动脉平均IMT、管壁厚度和AT进行分析比较和相关性评价.结果 MS-P组和MS-NP组患者的平均IMT和管壁厚度均显著高于健康对照组(P＜0.05),MS-P组平均AT[(0.77 ±0.13)mm]高于健康对照组[(0.66±0.11) mm,P＜0.01)]和MS-NP组[(0.69±0.13)mm,P＜0.01)],颈动脉平均AT与IMT在MS-P组、MS-NP组和健康对照组有一定的相关关系(分别为r=0.603,P＜0.01;r=0.325,P=0.005和r=0.344,P=0.004).结论 代谢综合征患者中AT出现增厚改变,AT与IMT在健康对照组和代谢综合征患者伴或不伴有斑块的患者中均有着较一致的变化,高频超声技术进行动脉外膜无创定量分析可提供评价血管外膜重构的信息.