Advanced glycation end products via skin autofluorescence as potential marker of carotid atherosclerosis in patients with type 2 diabetes

Background and aimsAdvanced glycation end products (AGEs) are reported to be correlated with diabetic vascular complications. This study aimed to investigate the association between AGEs and carotid atherosclerosis (CAS) as a surrogate marker of cardiovascular disease (CVD).Methods and resultsA total of 1006 patients with type 2 diabetes were included. CAS was defined as the presence of carotid arterial atherosclerotic plaque in any of bilateral carotid artery segments measured by ultrasonography. AGEs were measured by the noninvasive skin autofluorescence method. AGE_age index was calculated as AGEs × age/100. Patients with CAS showed a significantly higher AGE_age (P < 0.01), and the prevalence of CAS increased with ascending AGE_age levels (P for trend < 0.001). Logistic regression analysis revealed that AGE_age was significantly positively associated with odds of CAS, and the odds ratios of the presence of CAS across quartiles of AGE_age were 1.00, 3.00 [95% confidence interval (CI) 1.90–4.74], 4.04 (95%CI 2.50–6.53) and 4.99 (95%CI 2.97–8.40) for the multivariable-adjusted model (P for trend <0.001), respectively. In the fully adjusted model, each 5.0 increase in AGE_age was associated with a 0.019 mm increment in carotid intima-media thickness. Furthermore, AGE_age presented an acceptable predictive value for CAS, with an optimal cutoff point of 43.2, and the sensitivity, specificity and area under the curve (AUC) were 74.5% (95%CI 70.7–78.1%), 61.9% (95%CI 57.2–66.4%) and 0.735 (0.706–0.762), respectively.ConclusionAGE_age, the noninvasive measurement of AGEs combined with age is a promising approach for triaging patients at high risk of CVDs.     

PTA及支架在老年人下肢动脉硬化性闭塞中的临床应用

目的 探讨老年人下肢动脉硬化性闭塞（ASO）腔内治疗手术的疗效。方法 老年下肢ASO患者56例,分为腔内治疗组和药物治疗组。药物治疗组33例患者48条下肢,予阿加曲班静脉滴注2W,波立维、培达长期口服,3月后低分子肝素皮下注射10d。腔内治疗组23例患者33条下肢,予球囊扩张（PTA）及选择性股动脉支架置入治疗,术后给予药物治疗组相同药物治疗。治疗6月后比较两组踝肱指数（ABI）和间歇性跛行、下肢疼痛麻木感、坏疽溃烂改善程度。结果 治疗后ABI改善程度,A组有统计学意义,B组无统计学意义。间歇性跛行、下肢疼痛麻木感、坏疽溃烂改善程度方面A组均优于B组。下肢疼痛麻木感．坏疽溃烂改善有效率A组和B组有统计学意义。结论 PTA及支架置入手术治疗老年人下肢ASO是安全有效的腔内治疗方法。     

Behçet's disease: How to diagnose and treat vascular involvement

Behçet's disease is a multisystem disorder with unknown etiology and a unique geographic distribution. The disease is characterized by recurrent skin–mucosa lesions and sight-threatening panuveitis. Vascular involvement, which is more common and more severe among males, has also equally characteristic features such as affecting mostly veins, having a significant tendency for thrombosis, and running a relapsing course. Lower extremity vein thrombosis (LEVT) is the most frequent manifestation, followed by vena cava inferior thrombosis. Pulmonary artery involvement (PAI), the most common form of arterial involvement, manifests as aneurysms and “in situ” thrombosis. PAI and Budd–Chiari syndrome are the leading causes of increased mortality. In vascular cluster, typically, several types of venous or arterial vascular involvement may accumulate in the same individual. LEVT or cerebral venous sinus thrombosis is often present in these subgroups as the first event. Immunosuppressive treatment is essential in preventing the attacks and increasing survival.     

下肢血管MRA的临床应用和评价

目的 :探讨MRA对下肢血管性病变的临床应用价值。方法 :12 0例资料完整的下肢血管性病变行 2DTOTMRA检查 ,其中 45例同时行动态增强MRA(DCEMRA)。 12 0例中 2 1例与血管造影对照 ,35例与手术对照 ,6 6例与超声检查对照研究。结果 :MRA与血管造影符合率 92 .2 6 % (15 5 /16 8) ,与手术符合率 93.0 2 % (88/94) ,与超声符合率 93.10 % (189/2 0 3)。结论 :2DTOTMRA能清楚显示下肢动脉狭窄、闭塞、动脉瘤、血管瘤、动 -静脉畸形 ,以及下肢深静脉狭窄和血栓形成。DCEMRA能进一步显示病变范围、术后吻合口、移植血管和动静脉畸形的供血、引流血管。MRA和血管造影、手术、超声对照符合率高(>90 % ) ,当MRA与超声结果一致时 ,基本上可取代创伤性的血管造影。     

彩色多普勒血流显像诊断下肢静脉病变的价值

目的　评价彩色多普勒血流显像 (CDFI)检测临床下肢静脉病变的应用价值。方法　对临床下肢静脉病变 90例 10 7条下肢静脉进行CDFI检查。结果　CDFI可迅速清晰地显示下肢静脉的解剖图像 ,其中检出 61例 64条下肢静脉有血栓形成 (急性血栓 3 1例 ,慢性血栓 3 0例 ) ,8例 9条深静脉瓣功能不全 ,3 1例 3 4条为下肢静脉曲张。结论　下肢深静脉血栓形成有一定的声像特征 ,CDFI检出敏感性高 ,可对血栓作出位置、范围和管腔阻塞程度的判断 ,是帮助临床选择治疗方案和客观评价药物疗效的重要方法。判断有无深静脉瓣功能不全 ,可为临床手术和治疗提供可靠依据     

糖尿病性和非糖尿病性下肢动脉硬化闭塞症患者的腔内治疗对比分析

目的探讨糖尿病性和非糖尿病性下肢动脉硬化闭塞症(ASO)行经皮血管内成形术(PTA)的疗效。方法回顾性分析行PTA治疗下肢ASO患者97例。观察糖尿病性ASO(糖尿病组)32例和非糖尿病性ASO(非糖尿病组)65例临床表现、合并症、病变位置、手术成功率、静息痛缓解率、渍疡愈合率、截肢率和踝肱指数变化等。结果所有患者中,围手术期死亡1例,总随访率87.6%。糖尿病组PTA成功率87.7%,置入支架16枚,随访中再次行PTA 4例,截肢5例。非糖尿病组PTA成功率96.1%,置入支架48枚,随访中再次行PTA 9例,截肢7例。54例静息痛患者,术后疼痛消失45例(83.3%),25例溃疡,术后愈合16例(64.0%)。结论 PTA治疗糖尿病性ASO和非糖尿病性效果满意,是一个理想的选择,尤其是对那些远端流出道不良的病例。     

下肢深静脉血栓形成62例综合治疗分析

目的探讨综合治疗下肢深静脉血栓形成的临床效果。方法对62例下肢深静脉血栓形成患者采取下腔静脉滤器置人、手术取栓、溶栓、抗凝、祛聚、穿减压袜等综合治疗。结果治愈43例(69.35%),好转15例(24.19%),无效4例(6.45%),无死亡病例。总有效率为93.5%。结论综合治疗下肢深静脉血栓形成效果好,可缩短病程,值得推广应用。     

脑卒中偏瘫患者早期康复对下肢运动功能的影响

目的探讨早期康复对脑卒中偏瘫患者下肢运动功能的影响。方法将78例急性脑卒中偏瘫患者随机分为康复组(40例)、对照组(38例)进行临床对照性研究,两组均进行常规神经内科治疗,康复组同时加入以运动疗法为主的综合康复治疗,平均疗程38d。治疗前后分别以Brunnstrom法评价运动功能,以三级平衡评价评定平衡功能,以Barthel指数法评定ADL能力。结果康复组在下肢运动功能、平衡功能方面治疗后显著改善,与对照组相比有显著差异(P<0.05)。Barthel指数治疗后康复组为68.5±17.2,对照组为45.8±18.3,两组相比,P<0.05,有显著差异。结论早期介入康复治疗可明显改善患者的下肢运动功能和ADL能力。     

儿童上肢晚期神经损伤的治疗

报告并评价儿童上肢晚期神经损伤的治疗效果。方法：报道１３岁以下儿童平均７岁上肢晚期神经损伤１５例２１条（正中神经８条，尺神经７条，桡神经５条，肌皮神经１条）。完全断裂９条，粘连、压迫１２条。损伤神经的处理时间为伤后１年至１４年（平均４年４个月）。采用神经外膜对端缝合术７条，神经松解术１２条，自体神经移植术１条，神经瘤对端缝合术１条。结果：１３例１８条神经随访１年至２３年６个月（平均４年９个月），优良率为６６．７％，尚有２７．８％病人恢复了保护性感觉。结论：本研究证实晚期神经损伤有修复价值，儿童病人能取得更满意疗效。     

高锰酸钾溶液浸泡联合紫外线照射治疗四肢外伤感染的疗效观察

目的探讨高锰酸钾溶液浸泡联合紫外线照射治疗四肢外伤感染的有效性。方法采用随机对照的研究方法，将64例四肢外伤感染患者分为两组，各32例，治疗组采用高锰酸钾溶液浸泡联合紫外线照射治疗，对照组采用常规换药的方法。分别在治疗后1周、2周对伤口分泌物、细菌培养阳性率、肉芽组织生长情况进行观察比较，并对最终创面愈合情况进行统计分析。结果治疗组的创面脓性分泌物减少的速度、细菌培养阳性率下降的速度、肉芽组织生长速度明显快于对照组，治疗组治愈率明显高于对照组。结论采用高锰酸钾溶液浸泡联合紫外线照射治疗四肢外伤感染效果确切，方法简便，疗程缩短。