双低剂量CTA评估颅内动脉粥样斑块稳定性的可行性研究

目的探讨双低剂量CT血管成像(CTA)评估颅内动脉粥样斑块稳定性的可行性。方法选取2015年1月—2016年3月期间于神经内科住院的表现有缺血性脑卒中(CIS)症状的病人42例,其中男29例,女13例,平均年龄(62.3±7.69)岁。将病人随机分为双低剂量组和常规剂量组,每组21例。两组管电压、碘对比剂剂量分别为80 k V、50 m L和120 k V、100 m L。对2组病人分别进行CTA检查,并进行相应后处理以显示颅内动脉斑块。采用t检验对比分析2组影像噪声、血管强化程度、影像质量评分及X线辐射剂量的差异,采用χ~2检验比较2组间斑块检出率的差异。结果双低剂量组的噪声显著高于常规剂量组(P0.05),两组间CNR及SNR差异均无统计学意义(均P0.05)。低管电压组大脑中动脉M1段及椎基底动脉监测点的CT值均高于常规管电压组(均P0.05)。双低剂量组和常规剂量组的影像质量评分均显示良好(均2分),两组间各种影像质量评分差异均无统计学意义(P0.05)。两组斑块检出率差异无统计学意义(P0.05)。双低剂量组的CT容积剂量指数、剂量长度乘积和有效辐射剂量均低于常规剂量组(均P0.05)。结论双低剂量组CTA检查能清楚显示颅内动脉粥样斑块形态及成分,可对其稳定性做出较精确的判断,并能有效降低X线对人体的电离辐射剂量及碘对比剂的肾毒性。双低剂量CTA评估颅内动脉粥样斑块稳定性可行,具有临床应用价值。     

Randomized Trial of Plaque-Identifying Toothpaste: Decreasing Plaque and Inflammation

Background

Randomized data are sparse about whether a plaque-identifying toothpaste reduces dental plaque and nonexistent for inflammation. Inflammation is intimately involved in the pathogenesis of atherosclerosis and is accurately measured by high-sensitivity C-reactive protein (hs-CRP), a sensitive marker for cardiovascular disease. The hypotheses that Plaque HD (TJA Health LLC, Joliet, Ill), a plaque-identifying toothpaste, produces statistically significant reductions in dental plaque and hs-CRP were tested in this randomized trial.

急性脑梗死患者同型半胱氨酸与颈动脉斑块的相关性研究

目的 探讨急性脑梗死患者血清同型半胱氨酸（homocysteine,HCY）与颈动脉斑块的关系。 方法 回顾性分析北京朝阳医院西区2013年6月～2014年6月神经内科住院的急性脑梗死患者196例, 通过彩色多普勒超声仪测定颈动脉粥样硬化斑块的有无,测定内中膜厚度及其最大斑块厚度。在发 病4 d内检测其血清HCY浓度。患者按照有无斑块分为斑块组（n =152）和无斑块组（n =44）。组间比 较采用秩和检验,HCY与颈动脉斑块最大厚度的关系采用Spearman秩相关检验。颈动脉斑块形成的危 险因素分析采用Logistic回归分析。 结果 无斑块组（n =44）的HCY中位数是11.6 μ mol/L,斑块组（n =152）的HCY的中位数是14.0 μ mol/L,秩和 检验P =0.011。Spearman相关检验发现HCY与颈动脉最大斑块厚度呈显著正相关,相关系数r =0.247, P <0.001。Logistic回归分析,发现年龄［比值比（odds ratio,OR）1.089,95%可信区间（confidence interval,CI）1.050～1.131,P =0.0001］、男性性别（OR 4.304,95%CI 1.738～10.660,P =0.002）、高血 压史（OR 3.864,95%CI 1.750～8.534,P =0.001）是影响斑块形成的独立危险因素,而HCY（OR 1.026, 95%CI 0.973～1.081,P =0.344）对斑块形成的影响无显著性。但是,对于非心源性脑梗死亚组 （n =183）分析发现HCY是斑块形成的独立危险因素（OR 1.267,95%CI 1.006～1.430,P =0.003）。 结论 对于急性脑梗死患者,斑块组血清HCY高于无斑块组,血清HCY与颈动脉最大斑块厚度呈正 相关。在非心源性脑梗死患者中HCY是颈动脉斑块形成的独立危险因素。     

雌激素及其受体调节剂对去势APOE基因敲除小鼠胸主动脉中NF-κB和MMP-9的影响

目的：观察雌激素及其受体调节剂对去势APOE基因敲除（APOE-/-）小鼠胸主动脉血管组织中NF-κB和MMP-9的影响。方法：44只APOE-/-小鼠喂养4 周, 确定动脉粥样硬化斑块形成后, 将其随机分成模型组和5组不同给药组：生理盐水0.2 mL/d（模型组）;戊酸雌二醇0.13 mL/d + 地屈孕酮0.13 mL/d（HT组）;ICI 皮下注射0.13 mL/周+戊酸雌二醇0.13 mL/d（ICI+E2组）;ICI 皮下注射0.13 mL/周+戊酸雌二醇0.13 mL/d+地屈孕酮0.13 mL/d（ICI+HT组）;戊酸雌二醇0.13 mL/d+PHTTP 0.13 mL/d（PHTTP+E2组）;戊酸雌二醇0.13 mL/d+地屈孕酮0.13 mL/d+PHTTP 0.13 mL/d（PHTTP+HT组）。8周后,获取动脉粥样硬化斑块的胸主动脉组织后行总RNA提取、逆转录,利用real-time PCR 检测小鼠胸主动脉NF-κB和MMP-9的mRNA含量。结果：各组NF-κB mRNA 的表达差异有统计学意义（P＜0.05）,而MMP-9 mRNA 的表达差异无统计学意义（P＞0.05）。与模型组相比,PHTTP+E2和PHTTP+HT组NF-κB表达显著升高（P=0.047和P=0.035）,ICI+HT组NF-κB的表达明显低于PHTTP+HT组（P=0.028）;模型组、HT组、ICI+E2组及ICI+HT组间NF-κB的表达差异不明显（与模型组相比,P分别为0.072,0.068和0.054）。结论：ERα介导的激素替代治疗（PHTTP+E2和PHTTP+HT）使NF-κB的表达升高,提示ERα可能对动脉粥样硬化斑块稳定性不利。     

ANTIPLAQUE AND ANTIGINGIVITIS EFFECT OF LIPPIA SIDOIDES. A DOUBLE-BLIND CLINICAL STUDY IN HUMANS

Objectives:

The antiplaque and antigingivitis effect of Lippia Sidoides (LS) was evaluated in this in vivo investigation.

Material and Methods:

Twenty-three subjects participated in a cross-over, double-blind clinical study, using 21-day partial-mouth experimental model of gingivitis. A toothshield was constructed for each volunteer, avoiding the brushing of the 4 experimental posterior teeth in the lower left quadrant. The subjects were randomly assigned initially to use either the placebo gel (control group) or the test gel, containing 10% LS (test group).

Results:

The clinical results showed statistically significant differences for plaque index (PLI) (p<0.01) between days 0 and 21 in both groups, however only the control group showed statistically significant difference (p<0.01) for the bleeding (IB) and gingival (GI) index within the experimental period of 21 days. On day 21, the test group presented significantly better results than the control group with regard to the GI (p<0.05).

Conclusions:

The test gel containing 10% LS was effective in the control of gingivitis.     

应用64排螺旋CT评价阿托伐他汀对冠状动脉斑块的影响

目的：评价阿托伐他汀对冠状动脉粥样斑块的影响。方法：对43例经64排螺旋CT冠脉CTA检测出的粥样斑块患者,给予阿托伐他汀20 mg/d口服,6个月后复查粥样斑块情况。结果：43例患者有119支冠状动脉存在132个粥样斑块,治疗后各种斑块大小有不同程度的下降,其中脂质斑块下降幅度16.4%,纤维斑块下降幅度8.1%,混合斑块下降幅度10.7%,而钙化斑块下降幅度不明显。结论：阿托伐他汀可逆转或稳定冠脉粥样斑块,从而降低急性冠状动脉事件的发生;64排螺旋CT可定量评价粥样斑块的变化,为临床治疗提供客观依据。     

Inhibition of inositol monophosphatase by lithium chloride induces selective macrophage apoptosis in atherosclerotic plaques

BACKGROUND AND PURPOSE

Lithium chloride (LiCl) inhibits inositol monophosphatase (IMPase) at therapeutic concentrations. Given that LiCl induces death in cultured macrophages and that macrophages play an active role in atherosclerotic plaque destabilization, we investigated whether LiCl would induce selective macrophage death to stabilize the structure of the plaque.

EXPERIMENTAL APPROACH

The effect of LiCl was assessed on macrophages and smooth muscle cells (SMCs) in culture, in isolated atherosclerotic carotid arteries from rabbits and after local in vivo treatment via osmotic minipumps to rabbits with collared atherosclerotic carotid arteries. In addition, in vitro experiments were performed to elucidate the mechanism of LiCl-induced macrophage death.

KEY RESULTS

In vitro, whereas SMCs were highly resistant, LiCl induced macrophage death characterized by externalization of phosphatidylserine, caspase-3 cleavage and DNA fragmentation, all indicative of apoptosis. LiCl reduced inositol-1,4,5-trisphosphate levels in macrophages. Moreover, the IMPase inhibitor L-690 330 as well as IMPase gene silencing induced macrophage apoptosis. Both in vitro treatment of rabbit atherosclerotic carotid arteries with LiCl and local in vivo administration of LiCl to the plaques decreased plaque macrophages through apoptosis, as shown by terminal deoxynucleotidyl transferase deoxyuridine triphosphate (dUTP) nick-end labelling (TUNEL), without affecting SMCs. Vasomotor studies in vitro showed that LiCl did not affect the functionality of SMCs and endothelial cells.

CONCLUSIONS AND IMPLICATIONS

LiCl selectively decreased the macrophage load in rabbit atherosclerotic plaques via IMPase inhibition without affecting the viability or functionality of SMCs and endothelial cells. These data provide evidence for local administration of an IMPase inhibitor to stabilize atherosclerotic plaques.     

清热中药对ApoE基因缺陷小鼠动脉粥样硬化斑块的影响

目的观察穿心莲、黄芩、知母、牡丹皮和青蒿对ApoE基因缺陷小鼠动脉粥样硬化斑块的影响。方法以ApoE基因缺陷小鼠制作动脉粥样硬化模型,随机分为对照组、穿心莲组、黄芩组、知母组、牡丹皮组、青蒿组及辛伐他汀组,治疗13周后测定血脂、超敏C反应蛋白（hs-CRP）,并取主动脉进行病理学观察,测量斑块面积、血管横截面积、脂质中心面积、最小纤维帽厚度,计算校正斑块面积（斑块面积/血管横截面积）及脂质中心面积占斑块面积百分比。结果与对照组比较,各清热中药组血脂无明显差异,但hs-CRP明显下降。黄芩组、知母组、青蒿组的校正斑块面积明显低于对照组,各中药组脂质中心面积明显低于对照组,穿心莲组、黄芩组、青蒿组的脂质中心面积在斑块中的百分比明显低于对照组;各中药组的最小纤维帽厚度明显高于对照组。结论上述清热中药可能干预ApoE缺陷小鼠动脉粥样硬化斑块的形态结构,稳定斑块,其作用可能与抗炎有关。     

老年人血脂与颈动脉斑块形成的临床相关性研究

目的研究老年人颈动脉粥样硬化斑块形成的多种危险因素,同时探讨血脂与颈动脉斑块形成之间的相关性。方法收集2009年5月成都地区60岁以上干部人群139例体检资料,根据颈动脉彩超结果分为无斑块组（59例）与有斑块组（80例）,将两组的多种危险因素（如年龄、血脂、血压）进行统计学和二项分类Logistic回归分析,并对血脂四项指标绘制ROC曲线评价其对颈动脉斑块的预测价值。结果老年人颈动脉有斑块组与无斑块组年龄、收缩压比较差异有统计学意义（P〈0.05）,而两组血脂四项、血糖、血肌肝、血尿酸、BMI、吸烟比较差异无统计学意义（P〉0.05）。两组资料中年龄、血脂、血压之间的二项分类Logistic回归筛选影响颈动脉斑块的因素,结果年龄及SBP进入回归方程,血脂四项均被排除。血脂四项指标的ROC曲线下面积小于0.6（P〉0.05）,对有无斑块形成没有预测价值。结论老年人颈动脉粥样硬化及斑块形成主要受年龄及收缩压影响,而血脂四项指标对颈动脉斑块形成的影响不确切,血脂对颈动脉有无斑块形成没有预测价值。     

Serum cytokine levels in periodontitis patients in relation to the bacterial load

Background: Periodontitis is a local inflammatory disease that also has some systemic effects. We investigated the levels of interferon (IFN)‐γ, tumor necrosis factor (TNF)‐α, and interleukin (IL)‐2, ‐4, ‐5, and ‐10 in the serum of patients with periodontitis in relation to the bacterial load in the dental plaques. Methods: Serum cytokine levels in patients with generalized periodontitis and healthy control groups were determined using the cytometric bead array kit. Bacterial load in the dental plaque was determined semiquantitatively by real‐time polymerase chain reaction. The proportions of different lymphocyte subsets were determined in the peripheral blood of patients with periodontitis by flow cytometry. Finally, relationships between the bacterial load in the subgingival plaques of patients with periodontitis and levels of cytokines and counts of lymphocyte subsets were established. Results: Serum levels of IFN‐γ, TNF‐α, and IL‐10 were significantly increased, whereas those of IL‐2 were significantly decreased in patients with periodontitis compared to healthy controls. Increased serum levels of IFN‐γ and TNF‐α in patients with periodontitis were associated with the enhanced dental plaque load with Aggregatibacter actinomycetemcomitans (previously Actinobacillus actinomycetemcomitans) and Porphyromonas gingivalis, respectively. Finally, as revealed by analysis of lymphocyte populations, the presence of A. actinomycetemcomitans and Trepomena denticola was associated with an increased population of CD3^?/CD16⁺ and CD3⁺/CD8⁺ cells, respectively. Conclusion: Certain periodontal pathogens could be associated with an increased level of proinflammatory cytokines in the peripheral blood and thus increased risk of systemic diseases.