小而密低密度脂蛋白与急性冠脉综合征及其危险因素的关系

目的　观察急性冠脉综合征 (ACS)患者血浆小而密低密度脂蛋白 (sLDL)水平 ,探讨sLDL与ACS及其危险因素的关系。方法　按病例 对照方法收集ACS患者 2 10例 ,其中急性心肌梗死患者 114例为AMI组 ,不稳定性心绞痛患者 96例为UAP组。选取 2 10名年龄、性别相匹配的健康人作为对照 ,用 2 %～ 16%的非变性聚丙烯酰胺梯度胶电泳法检测sLDL血浆水平 ,观察各组间的sLDL的变化 ;并对sLDL的影响因素采用多元逐步回归进行分析 ,了解ACS的危险因素对sLDL的影响。结果　 ( 1)sLDL在AMI组和UAP组含量明显增高。 ( 2 )多元逐步回归分析结果显示sLDL与TG、性别、腰臀比、高血压史有关 ,校正了这些因素的影响后 ,sLDL与ACS仍有相关性 (r =0 .2 15 ,P<0 .0 0 1)。 ( 3 )与对照组比较 ,sLDL异常者 ,发生ACS的危险性是 3 .85倍 (OR =3 .85 ,95 %的可信区间 2 .40 4～ 6.164 ;χ2 =3 3 .64 ,P <0 .0 0 1)。结论　sLDL水平升高是ACS的重要危险因素 ,使发生ACS的危险性增加。     

Soy isoflavones improve cardiovascular disease risk markers in women during the early menopause

Background

Hormone replacement therapy may be beneficial for cardiovascular disease risk (CVR) in post-menopausal women. Soy isoflavones may act as selective estrogen receptor modulators. The aim of this study was to evaluate whether soy isoflavones had an effect on CVR markers.

老年2型糖尿病患者颅内动脉粥样硬化与亚临床甲状腺功能减退的关系

目的探讨老年2型糖尿病(T2DM)患者颅内动脉粥样硬化与亚临床甲状腺功能减退(SCH)的相关性。方法选择老年T2DM患者404例,其中甲状腺功能正常组(甲功正常组)291例,SCH组113例,比较2组一般情况及各生化指标的差异。分析促甲状腺激素(TSH)与各临床指标的相关性。结果 SCH组女性、颅内动脉粥样硬化、TC、TG、LDL-C、脂蛋白(a)、纤维蛋白原、C反应蛋白、血尿酸、同型半胱氨酸较甲功正常组明显升高,空腹血糖[(6.03±1.32)mmol/L vs(7.61±0.93)mmol/L]、HDL-C[(1.25±0.46)mmol/L vs(1.41±0.49)mmol/L]、D-二聚体[(0.23±0.11)mg/L vs(0.55±0.27)mg/L]显著降低(P<0.05)。TSH、年龄、收缩压、LDL-C、纤维蛋白原、血尿酸、同型半胱氨酸是颅内动脉粥样硬化独立的危险因素,且TSH与纤维蛋白原、TC、TG、LDL-C、脂蛋白(a)、C反应蛋白、血尿酸、同型半胱氨酸呈正相关,与空腹血糖、D-二聚体、HDL-C呈负相关(P<0.05)。结论老年T2DM合并SCH发生颅内动脉粥样硬化风险增加,高TSH是T2DM患者颅内动脉粥样硬化的独立危险因素。     

β_3肾上腺素受体对前蛋白转化酶枯草溶菌素9和低密度脂蛋白受体表达的影响

目的观察激动β3肾上腺素受体(β3-AR)对载脂蛋白E基因敲除(apoE-/-)老年高脂小鼠血脂、肝脏前蛋白转化酶枯草溶菌素9(PCSK9)和LDL受体(LDLR)表达水平的影响。方法选择10周龄雄性C57BL/6小鼠10只(A组)。apoE-/-小鼠40只给予高脂饲料饲养至36周龄,随机分为4组,分别为高脂模型组(B组)、阿托伐他汀阳性药物对照组(C组)、β3-AR激动剂小剂量组(D组)、β3-AR激动剂大剂量组(E组),每组10只,共干预12周。采用Beckman CX7全自动生化分析仪,检测血清TC、TG、VLDL/LDL-C、HDL-C水平,采用Western blot测定肝脏PCSK9和LDLR表达水平。结果与B组比较,C组、D组和E组TC、VLDL/LDL-C明显下降,C组、B组、D组LDLR水平明显上调,C组PCSK9水平明显上调(P<0.05,P<0.01);与C组比较,D组和E组TG、PCSK9水平明显下降,D组LDLR水平明显下降,HDL-C水平明显升高,差异有统计学意义(P<0.05,P<0.01)。结论β3-AR调脂、升高LDLR、降低PCSK9表达水平是其抗动脉粥样硬化的多重作用机制之一。     

Association of Epicardial Adipose Tissue With Progression of Coronary Artery Calcification Is More Pronounced in the Early Phase of Atherosclerosis: Results From the Heinz Nixdorf Recall Study

ObjectivesThis study sought to determine whether epicardial adipose tissue (EAT) volume predicts the progression of coronary artery calcification (CAC) score in the general population.BackgroundEAT predicts coronary events and is suggested to influence the development of atherosclerosis.MethodsWe included 3,367 subjects (mean age 59 ± 8 years; 47% male) from the population-based Heinz Nixdorf Recall study without known coronary artery disease at baseline. CAC was quantified from noncontrast cardiac electron beam computed tomography at baseline and after 5 years. EAT was defined as fat volume inside the pericardial sac and was quantified from axial computed tomography images. Association of EAT volume with CAC progression (log[CAC(follow-up) + 1] − log[CAC(baseline) + 1]) was depicted as percent progression of CAC + 1 per SD of EAT.ResultsSubjects with progression of CAC above the median had higher EAT volume than subjects with less CAC change (101.1 ± 47.1 ml vs. 84.4 ± 43.4 ml; p < 0.0001). In regression analysis, 6.3% (95% confidence interval [CI]: 2.3% to 10.4%; p = 0.0019) of progression of CAC + 1 was attributable to 1 SD of EAT, which persisted after adjustment for risk factors (6.1% [95% CI: 1.2% to 11.2%]; p = 0.014). For subjects with a CAC score of >0 to ≤100, progression of CAC + 1 by 20% (95% CI: 11% to 31%; p < 0.0001) was attributable to 1 SD of EAT. Effect sizes decreased with CAC at baseline, with no relevant link for subjects with a CAC score ≥400 (0.2% [95% CI: −3.5% to 4.2%]; p = 0.9). Likewise, subjects age <55 years at baseline showed the strongest association of EAT with CAC progression (20.6% [95% CI: 9.7% to 32.5%]; p < 0.0001). Interestingly, the effect of EAT on CAC progression was more pronounced in subjects with low body mass index (BMI), and decreased with degree of adiposity (BMI ≤25 kg/m²: 19.8% [95% CI: 9.2% to 31.4%]; p = 0.0001, BMI >40 kg/m²: 0.8% [95% CI: −26.7% to 38.9%]; p = 0.96).ConclusionsEAT is associated with the progression of CAC, especially in young subjects and subjects with low CAC score, suggesting that EAT may promote early atherosclerosis development.     

D-dimer relates positively with increased blood pressure in black South Africans: The SABPA study

Introduction

Hypertension is highly prevalent in black South Africans in which morbidity and mortality from stroke are on the increase. Elevated blood pressure and haemostatic markers can induce changes in blood rheology and endothelial function which could result in a procoagulant state that increases the risk for cerebrovascular disease. Information about the coagulation and fibrinolytic systems of people from African descent are limited. We therefore, investigated the haemostatic profile and its relationships with blood pressure in black South Africans.

Materials and methods

We measured ambulatory blood pressure and haemostatic markers of 201 black and 208 white school teachers. The haemostatic markers included measurements representing coagulation and fibrinolysis (von Willebrand factor, fibrinogen, plasminogen activator inhibitor-1, fibrin D-dimer and clot lysis time).

Results

Black participants displayed significantly higher blood pressure, von Willebrand factor, fibrinogen, plasminogen activator inhibitor-1 and D-dimer levels and longer clot lysis times (p ≤ 0.001). Single, partial and multiple regression analyses showed that systolic (p ≤ 0.011) and diastolic blood pressure (p = 0.010) correlated positively with D-dimer in black participants, while systolic (p ≤ 0.001) and daytime diastolic blood pressure (p = 0.011) correlated negatively with clot lysis time in white participants.

Conclusion

The black population had a more prothrombotic profile, with higher levels of coagulation markers and inhibited fibrinolysis, than the white study participants. The positive association between blood pressure and elevated D-dimer in the blacks may contribute to the high prevalence of hypertension and related increased cardiovascular and cerebrovascular risk in this group.     

达肝素对载脂蛋白E基因缺陷小鼠肾动脉粥样硬化病变的影响

目的在动脉粥样硬化模型鼠中,观察达肝素对肾动脉粥样硬化病变进展及对植物血凝素样氧化型低密度脂蛋白受体1(LOX-1)和血管内皮生长因子(VEGF)的表达影响,探讨达肝素可能的抗动脉粥样硬化机制。方法以6周龄雄性C57BL/6J小鼠24只为对照,随机分为普通饲料组及高脂饲料组。雄性6周龄载脂蛋白E基因缺陷(Apo E-/-)小鼠36只,均予高脂饲料喂养至12周龄,随机分为模型组、低剂量肝素组[达肝素钠100 IU/(kg.d)]、高剂量肝素组[达肝素钠200 IU/(kg.d)],皮下注射连续4周(16周龄)后各组随机取6只处死。分离肾动脉,制成石蜡切片行HE及免疫组织化学染色,观察斑块情况及LOX-1蛋白的表达。用RT-PCR方法,检测肾动脉LOX-1 mRNA及VEGF mRNA的表达。用Western Blot分析法,检测肾动脉中LOX-1蛋白的表达。剩余小鼠继续原方案喂养4周(20周龄)后处死,肾动脉石蜡切片行HE染色,观察斑块情况。结果 Apo E-/-模型组在16周龄时出现轻度肾动脉粥样硬化。低剂量及高剂量达肝素均抑制肾动脉粥样硬化的形成(P<0.05)。Apo E-/-模型组LOX-1 mRNA、VEGF mRNA及LOX-1蛋白的表达水平较C57BL/6J普通饲料组的表达水平明显升高(P<0.05)。低剂量及高剂量达肝素治疗后,LOX-1 mRNA、VEGF mRNA及LOX-1蛋白的表达水平表达较模型组明显下降(P<0.05)。结论达肝素钠可能通过抑制LOX-1蛋白及VEGF表达的途径,抑制肾动脉粥样硬化的进展。