Increased Risk of Arterial Stiffness in Rhumatoid Arthritis Patients in a Sub-Saharan African Setting

Background: Analysis of arterial stiffness (AS) is a good marker of early arterial disease and an important determinant of cardiovascular risk, independent of other traditional cardiovascular risk factors. Carotid-femoral pulse wave velocity (CfPWV) is the gold standard to evaluate arterial stiffness. There is evidence that patients with rheumatoid arthritis (RA) have a higher arterial stiffness than their age-matched healthy counterparts and thus have higher cardiovascular (CV) risk. However, data on arterial stiffness in African rheumatoid arthritis patients is scarce. Objectives: To determine the patterns of arterial stiffness in rheumatoid arthritis patients in a sub-Saharan African setting, using CfPWV and Augmentation index (AIx). Method: We conducted a case-control study, at the Douala general hospital over four months (February to May 2018) on 63 subjects among which 31 RA patients matched for age and sex with 32 healthy subjects. AIx and CfPWV were determined non-invasively by radial pulse wave analysis and carotid femoral wave analysis respectively, using a sphygmocor Atcor device (SphygmoCor, PWV Medical, Sydney, Australia). Results: The mean age of RA patients was 47 ± 14 years with most of them being females (n = 26, 83.9%). CfPWV was significantly higher in RA patients compared to the control group (mean: 8.85 ± 2.1 vs 7.45 ± 1.38;p ≤ 0.01) as well as was AIx (Median: 33 [26 - 43] vs 26 [20 - 31];p = 0.01). RA (OR: 6.105;95% CI: 1.52 - 24.54;p 1.34;95% CI: 1.14 - 5.17;p = 0.05), elevated CRP levels (OR: 4.01;95% CI: 1.16 - 13.68;p = 0.03) and Hypertension (OR: 5.75;95% CI: 1.24 -11.60;p Conclusion: Arterial stiffness, a well-recognized marker of cardiovascular risk is increased among patients suffering from rheumatoid arthritis when compared to a healthy control group.

Assessment of Arterial Stiffness Index in Hypertensive Patients in Relation to Their Treatment Status Attending a Tertiary Care Center in South India

Objectives: To assess the arterial stiffness index (ASI) and pulse wave velocity (PWV) in patients with hypertension and to compare with age matched healthy controls;to assess and compare the ASI and PWV in relation to the treatment status. Methods: The study was observational-cross sectional. Group one included chronic hypertensive patients on regular treatment for more than 2 months;group two included newly diagnosed hypertensive patients and group three had age matched healthy controls with normal blood pressure. The hypertensives subjects with other comormid conditions such as renal disease, diabetes were excluded from the study. The study was approved by the Institute Ethics Committee. The subjects were interviewed and explained the purpose of the study. All subjects gave written informed consent. The noninvasive periscope device was used to measure PWV, ASI and pulse pressure. Results: PWV, ASI and pulse pressure were statistically higher in hypertensive patients when compared to controls. Further, carotid-femoral PWV was correlated with mean arterial pressure in hypertensive subjects and was found to be statistically significant. Conclusion: PWV, ASI and pulse pressure are significantly higher in chronic and newly diagnosed non-diabetic hypertensives as compared to controls irrespective of their treatment status.

Association of arterial stiffness with coronary flow reserve in revascularized coronary artery disease patients

AIM: To investigate the association of arterial wave reflection with coronary flow reserve(CFR) in coronary artery disease(CAD) patients after successful revascularization.METHODS: We assessed 70 patients with angiographically documented CAD who had undergone recent successful revascularization. We measured(1) reactive hyperemia index(RHI) using fingertip peripheral arterial tonometry(RH-PAT Endo-PAT);(2) carotid to femoral pulse wave velocity(PWVc-Complior);(3) augmentation index(AIx), the diastolic area(DAI%) and diastolic reflection area(DRA) of the central aortic pulse wave(Arteriograph);(4) CFR using Doppler echocardiography; and(5) blood levels of lipoprotein-phospholipase A2(LpPLA2).RESULTS: After adjustment for age, sex, blood pressure parameter, lipidemic, diabetic and smoking status, we found that coronary flow reserve was independently related to AIx(b =-0.38, r = 0.009), DAI(b = 0.36, P = 0.014), DRA(b = 0.39, P = 0.005) and RT(b =-0.29,P = 0.026). Additionally, patients with CFR < 2.5 had higher PWVc(11.6 ± 2.3 vs 10.2 ± 1.4 m/s, P = 0.019), SBPc(139.1 ± 17.8 vs 125.2 ± 19.1 mm Hg, P = 0.026), AIx(38.2% ± 14.8% vs 29.4% ± 15.1%, P = 0.011) and lower RHI(1.26 ± 0.28 vs 1.50 ± 0.46, P = 0.012), DAI(44.3% ± 7.9% vs 53.9% ± 6.7%, P = 0.008), DRA(42.2 ± 9.6 vs 51.6 ± 11.4, P = 0.012) and Lp PLA2(268.1 ± 91.9 vs 199.5 ± 78.4 ng/m L, P = 0.002) compared with those with CFR ≥ 2.5. Elevated Lp PLA2 was related with reduced CFR(r =-0.33, P = 0.001), RHI(r =-0.37, P < 0.001) and DRA(r =-0.35, P = 0.001) as well as increased PWVc(r = 0.34, P = 0.012) and AIx(r = 0.34, P = 0.001). CONCLUSION: Abnormal arterial wave reflections are related with impaired coronary flow reserve despite successful revascularization in CAD patients. There is a common inflammatory link between impaired aortic wall properties, endothelial dysfunction and coronary flow impairment in CAD.

Therapeutic modification of arterial stiffness:An update and comprehensive review

Arterial stiffness has been recognized as a marker of cardiovascular disease and associated with longterm worse clinical outcomes in several populations. Age, hypertension, smoking, and dyslipidemia, known as traditional vascular risk factors, as well as diabetes, obesity, and systemic inflammation lead to both atherosclerosis and arterial stiffness. Targeting multiple modifiable risk factors has become the main therapeutic strategy to improve arterial stiffness in patients at high cardiovascular risk. Additionally to life style modifications, long-term ω-3 fatty acids(fish oil) supplementation in diet may improve arterial stiffness in the population with hypertension or metabolic syndrome. Pharmacological treatment such as reninangiotensin-aldosterone system antagonists, metformin, and 3-hydroxy-3-methyl-glutaryl-Co A reductase inhibitors were useful in individuals with hypertension and diabetes. In obese population with obstructive sleep apnea, weight reduction, aerobic exercise, and continuous positive airway pressure treatment may also improve arterial stiffness. In the populations with chronic inflammatory disease such as rheumatoid arthritis, a use of antibodies against tumor necrosis factor-alpha could work effectively. Other therapeutic options such as renal sympathetic nerve denervation for patients with resistant hypertension are investigated in many ongoing clinical trials. Therefore our comprehensive review provides knowledge in detail regarding many aspects of pathogenesis, measurement, and management of arterial stiffness in several populations, which would be helpful for physicians to make clinical decision.

Association of glomerular filtration rate with arterial stiffness in Chinese women with normal to mildly impaired renal function

Objective Both decreased glomemlar filtration rate （GFR） and arterial stiffness were considered as risk factors for atherosclerosis. Previous studies have suggested the association between central arterial stiffness and the degree of GFR loss. Whether decreased GFR contributes to peripheral artery stiffness remains controversial. Moreover, data analyzed from a cohort of Chinese women are rare. Our aim was to explore the relationship between GFR and regional arterial stiffness in Chinese women. Methods In this cross-sectional study, we randomly recruited 1131 adult women residents with GFR 〉 60 mL/min per 1.73 m2 estimated by the Chinese Modification of Diet in Renal Disease equation from three large communities. Central and peripheral arterial stiffness were estimated simultaneously by measuring carotid-femoral pulse wave velocity （PWVcf） and carotid-radial PWV （PWVcr） using a validated automatic device. Augmentation Index at heart rate 75 beats/minutes （AIx-75） was measured by pulse wave analysis as a composite parameter reflecting both large and distal arterial properties. Results The mean estimated GFR （eGFR） of the study group was 100.05 ＋ 23.26 mL/minute per 1.73 m2. Subjects were grouped by tertiles of eGFR level. PWVef and AIx-75 increased ongoing from the top to the bottom eGFR tertile, while the values of PWVcr were comparable. Both univariate Pearson correlations and multiple stepwise regression analyses showed that eGFR significantly correlated to PWVcf, but not to PWVcr and AJx-75. Conclusions In Chinese women with normal to mildly impaired renal function, decreased eGFR affected carotid-to-femoral rather than carotid-to-radial stiffening. This provides rational to conduct future prospective studies to investigate predictors of atherosclerosis in this population.

Albuminuria as a marker of arterial stiffness in chronic kidney disease patients

AIM： To access the association between albuminuria levels and arterial stiffness in non-diabetic patients with hypertension and chronic kidney disease （CKD） stages 1-2, treated with renin angiotensin blockade agents plus other hypertensive drugs when needed.METHODS： One hundred fifteen patients [median age 52 years （68% males）] were consequently enrolled in the study. For each patient, we recorded gender, age, body mass index （BMI）, peripheral systolic blood pressure （pSBP）, peripheral diastolic blood pressure, peripheral pulse pressure, central systolic blood pressure （cSBP）, central diastolic blood pressure （cDBP）, central pulse pressure （cPP）, hematocrit, hemoglobin, hsCRP, total cholesterol triglycerides, high-density lipoprotein-C, low-density lipoprotein-C, calcium, phosphorus, parathormone, and albumin, as well as 24 h urine albumin excretion. According to 24-h urine albumin collection, patients were then classified as those with moderately increased albuminuria （formerly called macroalbuminuria） （≤ 300 mg/d） and those with severely increased albuminuria （formerly called macroaluminuria （〉 300 mg/d）. We considered aortic stiffness （AS） indices [carotid femoral pulse wave velocity （PWVc-f） and augmentation index （AIx）] as primary outcomes of the study. We explored potential correlations between severely increased albuminuria and AS indices using a multiple linear regression model. RESULTS： Fifty-eight patients were included in the moderately increased albuminuria group and 57 in the severely increased albuminuria. Blood pressure measurements of the study population were 138 ± 14/82 ± 1.3 mmHg （systolic/diastolic）. There were no significant differences in age, sex, and BP measurements between the two groups. Patients with severely increased albuminuria had higher PWV and AIx than patients with moderately increased albuminuria （P 〈 0.02, P 〈 0.004, respectively）. In addition these patients exhibited higher BMI （P 〈 0.03）, hsCRP （P 〈 0.001）, and fibrinogen levels （P 〈 0.02） compared to patients with moderately increased albuminuria. In multivariate linear regression analysis, severely increased albuminuria （β = 1.038, P 〈 0.010） pSBP （β = 0.028, P 〈 0.034） and Ht （β = 0.171, P = 0.001） remained independent determinants of the increased PWVc-f. Similarly, severely increased albuminuria （β = 4.385, P 〈 0.012）, cSBP （β = 0.242, P 〈 0.001）, cPP （β = 0.147, P 〈 0.01） and Ht levels （β = 0.591, P 〈 0.013） remained independent determinants of increased AIx.CONCLUSION： These fndings demonstrate an independent association between AS indices and severely increased albuminuria in non-diabetic, hypertensive patients with CKD stages 1-2 treated with renin angiotensin aldosterone system blockers.

The Effects of Magnesium-EDTA Chelation Therapy on Arterial Stiffness

Traditional risk factors for cardiovascular disease can only assess risks for groups of people. New parameters of arterial stiffness are more reliable for predicting cardiovascular outcomes for individuals with and without a cardiovascular history. The objective of this study was to assess the effects of Magnesium-EDTA chelation therapy using new methods and parameters such as pulse wave velocity (PWV), central blood pressure (SBPao) and endothelial function (Aix). We followed 43 patients with an abnormal PWV and SBPao, setting them up in two groups. The 21 patients in Group A had already been diagnosed with cardiovascular disease. The other 22 patients in Group B also showed abnormal PWV, SBPao and Aix, but showed no cardiovascular symptoms. Each patient in Groups A and B received one Mg-EDTA treatment per week. The total treatment plan consisted of 25 Mg-EDTA chelation treatments according to the standard protocol of IBCMT. After 25 Mg-EDTA chelation sessions, PWV and SBPao improved significantly in all patients of Groups A and B. In addition, Aix improved significantly in these patients, but remained abnormal. Group C included 18 asymptomatic patients with normal PWV or SBPao. Aix was abnormal in this group, but to a much lesser extent than Groups A and B. The 18 asymptomatic patients of Group C did not receive Mg-EDTA treatment. Observation showed no significant changes in all three parameters of arterial stiffness. The results of this study indicate that a course of treatment with Magnesium-EDTA chelation therapy significantly lowers cardiovascular risks. We conclude that Mg-EDTA chelation therapy improves PWV as an indicator of arterial stiffness, SBPao (central blood pressure) as an indicator of aortic elasticity and Aix (augmented aortic index) as an indicator of endothelial functioning. These improvements in PWV, SBPao and Aix demonstrate that atherosclerosis is a dynamic and (partially) reversible process.

Association of microalbuminuria with ambulatory arterial stiffness index in patients with type 2 diabets mellitus

Background Microalbuminuria （MAU） and ambulatory arterial stiffness index （AASI） may predict cardiovascular events and death. However, there is little information about the correlation between the two parameters in patients with type 2 diabetes mellitus （T2DM）. Therefore, we examined the association of MAU with 24-hour AASI in patients with T2DM. Methods A total of 189 patients with 24-hour ambulatory blood pressure monitoring （24h-ABPM） who were hospitalized from January 2011 to January 2017 were selected. 136 patients without hypertension were screened. The subjects were divided into two groups according to urinary albumin-to-creatinine ratio （uACR）. MAU group was defined as uACR of 30-299 mg/g （n=69）, NMAU group was defined as uACR 〈30 mg/g （n=67）. AASI was calculated as 1 minus the regression slope of diastolic blood pressure （DBP） value vs. systolic blood pressure （SBP） value according to ABPM. The differences of clinical and bio- chemical indicators between the two groups were determined. The correlation between AASI and MAU was analyzed by unconditional forward stepwise logistic regression. Results Patients with MAU had significantly higher level of diabetic duration, TC, LDL-C, Scr, AASI and lower eGFR than NMAU group （P〈0.05）. Using MAU as the dependent variable （ 1 with MAU and 0 without MAU）, LDL-C, decreased eGFR, AASI were independent risk factors of MAU in patients with T2DM. The ROC curve of AASI in predicting the risk of MAU showed when AASI was 0.48, the area under the curve was the largest 0.659（95 % CI 0.568-0.750, P=0.001）. The sensitivity was 71.0% and the specificity was 56.7%. Conclusions Patients with MAU have higher AASI than patients without MAU. As a new index of arterial stiffness, AASI is associated with MAU, and could inde- pendently predict MAU in patients with T2DM.

甘油三酯-葡萄糖乘积指数与动脉硬化进展的回顾性队列研究

目的:胰岛素抵抗(insulin resistance,IR)与动脉硬化和不良心血管病事件均存在密切关联。甘油三酯-葡萄糖(triglyceride-glucose,TyG)指数可作为评估IR的有效指标。本研究旨在探讨Ty G指数与动脉硬化进展风险的关系。方法:本研究为回顾性队列研究。选取2012年1月至2022年12月在中南大学湘雅三医院健康管理医学中心参加健康体检次数≥2且完成动脉硬化检测的成年人作为研究对象,收集其临床资料。TyG指数采用公式ln(甘油三酯×空腹血糖/2)计算。基线TyG指数分别以连续变量和四分位数的分类变量为自变量评价。动脉硬化进展采用臂踝脉搏波传导速度(brachial-ankle pulse wave velocity,baPWV)的年变化速率和新发动脉僵硬度增加为因变量评价。通过线性回归模型和Cox比例风险回归模型,探索TyG指数是否为动脉硬化进展的独立风险因素。根据年龄、性别、体重指数,以及是否合并2型糖尿病、高血压和高脂血症进行亚组分析,以确定TyG指数和动脉硬化进展之间的关联特征。结果:共纳入4971名研究对象,随访时间为(3.01±1.98)年。随访期间,baPWV的年变化速率为(24.94±81.15)cm/s,共计278例为新发动脉僵硬度增加。在全面校正混杂因素后,自变量为连续变量时,基线Ty G指数与baPWV的年变化速率(β=17.5,95%CI 9.00~25.94,P<0.001)和新发动脉僵硬度增加[风险比(hazard ratio,HR)=1.43,95%CI 1.18~1.74,P<0.001]呈独立正相关。自变量为分类变量时,与第1四分位数组相比,第2、3、4四分位数组的baPWV年变化速率依次增加,新发动脉僵硬度增加的风险也依次增高(均P<0.05)。年龄≥45岁、男性、BMI<28 kg/m2、高血压病、无高血压病、无2型糖尿病和无高脂血症亚组中,基线TyG指数(连续和分类变量)与新发动脉僵硬度增加具有明显关联(均P<0.05),各亚组均不存在显著的交互作用(均P>0.05)。结论:TyG指数与动脉硬化进展风险增加独立相关,可用作体检人群动脉硬化进展风险的评估指标。

动态动脉硬化指数联合血清肿瘤坏死因子受体相关因子6、前蛋白转化酶枯草溶菌素9对急性分水岭脑梗死病人的预后价值

目的探究动态动脉硬化指数(AASI)联合血清肿瘤坏死因子受体相关因子6(TRAF6)、前蛋白转化酶枯草溶菌素9(PCSK9)对急性分水岭脑梗死(CWI)病人的预后价值。方法选取2019年8月至2021年8月保定市第二中心医院收治的96例急性CWI病人为研究组,另取同期体检健康者80例为对照组。收集病人一般临床资料,并对研究组和对照组的血清TRAF6、PCSK9水平及AASI进行检测;根据研究组病人预后情况将其分为预后良好组(67例)和预后不良组(29例),多因素logistic回归分析急性CWI病人预后的影响因素;绘制AASI与血清TRAF6、PCSK9对急性CWI病人预后评估的受试者操作特征曲线(ROC曲线)。结果研究组血清TRAF6(1.48±0.34)µg/L、PCSK9(97.25±14.25)µg/L水平及AASI(0.56±0.15)高于对照组(0.87±0.19)µg/L、(82.78±9.17)µg/L、(0.36±0.11)(P<0.05)。预后良好组与预后不良组年龄、美国国立卫生研究院卒中量表(NIHSS)评分、空腹血糖、狭窄程度及血管斑块性质差异有统计学意义(P<0.05)。预后不良组血清TRAF6(1.77±0.37)µg/L、PCSK9(104.82±17.93)µg/L水平及AASI(0.62±0.12)高于预后良好组(1.35±0.21)µg/L、(93.97±12.65)µg/L、0.53±0.09(P<0.05)。多因素logistic回归分析结果显示NIHSS评分、狭窄程度、血管斑块性质、AASI、血清TRAF6、PCSK9水平是急性CWI病人预后的影响因素(P<0.05)。AASI联合血清TRAF6、PCSK9预测急性CWI病人预后的AUC是0.92,灵敏度为93.10%,特异度为76.12%,Youden指数为0.69,优于AASI、TRAF6、PCSK9各自单独预测(P<0.05)。结论急性CWI病人血清TRAF6、PCSK9水平显著升高,联合AA-SI对病人的预后状况具有较高的预测效能,可为临床的合理干预和改善病人预后提供依据。

高血压合并阻塞性睡眠呼吸暂停低通气综合征患者发生动脉硬化风险预测模型的建立与验证

目的探讨高血压合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者发生动脉硬化的危险因素,复制风险预测模型并验证其有效性。方法选取2019年12月—2021年12月新疆医科大学第一附属医院高血压科收治的1014例高血压合并OSAHS患者的临床资料。根据行动态血压监测计算动态动脉硬化指数(AASI),严格按照纳排标准筛选,最终纳入380例患者作为研究对象。将患者以7∶3随机分为建模组和验证组,分别有266和114例;根据建模组患者是否存在动脉硬化分为研究组(AASI>0.55)和对照组(AASI≤0.55)。运用单因素分析和多因素逐步Logistic回归分析筛选发生动脉硬化的独立影响因素,依此构建列线图。分别通过受试者工作特征(ROC)曲线下面积(AUC)、校准曲线、Hosmer-Lemeshow检验、决策曲线分析和临床影响曲线评价模型的预测能力、校准度及临床适用性。结果建模组与验证组患者性别构成、年龄、高血压病史、饮酒史、家族史、体质量指数(BMI)、尿素氮(BUN)、肌酐(Cr)、估算肾小球滤过率(eGFR)、尿酸(UA)、空腹血糖(FBG)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、颈动脉内膜中膜厚度(IMT)、24 h平均收缩压(SBP)、24 h平均舒张压(DBP)、白天平均SBP、白天平均DBP、夜间平均SBP、夜间平均DBP、平均血氧饱和度(MSaO2)、最低血氧饱和度(LSaO2)、呼吸暂停低通气指数(AHI)、AASI比较,差异均无统计学意义(P>0.05)。研究组与对照组患者性别构成、年龄、饮酒史、家族史、BMI、BUN、Cr、eGFR、UA、TG、TC、HDL-C、LDL-C、AST、ALT、24 h平均DBP、dSBP、dDBP、nSBP、MSaO2比较,差异均无统计学意义(P>0.05)。两组患者FBG、24 h平均SBP、nDBP、LSaO2、AHI、IMT、高血压病史比较,差异均有统计学意义(P<0.05)。多因素逐步Logistic回归分析显示:FBG[OR=1.375(95%CI:1.058,1.786)]、24 h平均SBP[OR=1.019(95%CI:1.001,1.038)]、高血压病程[OR=2.721(95%CI:1.302,5.687)]、IMT[OR=2.197(95%CI:1.104,4.372)]、AHI[OR=2.657(95%CI:1.441,4.899)]是高血压合并OSAHS发生动脉硬化的危险因素(P<0.05)。ROC曲线分析结果显示,建模组AUC为0.741(95%CI:0.675,0.807),敏感性68.1%(95%CI:0.573,0.788),特异性71.6%(95%CI:0.653,0.780);验证组AUC为0.771(95%CI:0.681,0.861),敏感性78.1%(95%CI:0.638,0.924),特异性63.4%(95%CI:0.530,0.738)。校准曲线和Hosmer-Lemeshow检验显示该模型预测结果与实际结果的一致性较好(P>0.05);决策曲线及临床影响曲线验证列线图具有临床适用性。结论高血压合并OSAHS患者发生动脉硬化的危险因素包括FBG、24 h平均SBP、高血压病程、IMT、AHI,以此为基础复制风险预测模型,甄别高血压合并OSAHS患者发生动脉硬化的高危人群,为其早期防治提供临床依据。

曹宝国主任医师治疗顽固性失眠经验总结

通过文献阐述曹宝国主任医师以阴虚不能纳阳和阳盛不能入阴作为失眠基本病机,结合多年临证经验,强调失眠应当从心论治,并将失眠分为实火扰心、肝郁化火、痰瘀互结、脾胃不和、气血两虚、阴虚不寐、阳虚不寐7种证型,分别从病因病机、辨证论治、立方选药三个方面进行总结,附验案详细说明和佐证。

原发性高血压患者血浆致动脉粥样硬化指数与动脉硬化进展的相关性研究

目的:探索原发性高血压患者血浆致动脉粥样硬化指数(plasma atherogenic index AIP)的影响因素,并研究此类患者中AIP与动脉硬化进展的相关性。方法:本研究为回顾性研究,连续选取2018年3月至2021年3月,柳州市柳铁中心医院收治的原发性高血压患者104例,男性78例,女性26例。根据患者基线AIP指数(中位数=2.8)分为高AIP组和低AIP组,比较两组基线资料及臂踝脉搏波流速(brachial ankle pulse wave velocity,ba-PWV)差异,并利用多因素Logistic回归模型分析动脉硬化(ba-PWV>1800cm/s)的影响因素。同时进行了随访,比较两组患者动脉硬化的进展差异,探索AIP与动脉硬化进展的关系。结果:两组基线资料比较发现:高AIP组[4.2(2.8,7.8)]较低AIP组[1.7(-0.3,2.8)]男性比例更大(84.6%vs.65.4%,P=0.024),BMI更大[(30.2±4.1)vs.(28.4±3.5)kg/m^(2),P=0.016],TG[2.1(1.3,3.9)vs.1.6(1.2,3.2)]mmol/L,P<0.001和ba-PWV[(1765.1±240.9)vs.(1457.2±218.4)cm/s,P<0.001]水平和ba-PWV变化率[25.0(-13.5,55.2)vs.9.3(-24.9,25.2)cm·s^(-1)·year^(-1),P<0.001]更高,动脉硬化比例更大(36.5%vs.17.3%,P=0.027)。余变量组间均差异无统计学意义(P均>0.05)。多因素Logistic回归分析显示:在调整了混杂因素后,高AIP组动脉硬化风险更大(OR=1.34,95%CI:1.07~2.03,P=0.013)。广义相加模型显示AIP与ba-PWV变化率存有剂量效应关系,在AIP指<3时,AIP每增加1个单位,ba-PWV变化率增加18.92 cm·s^(-1)·year^(-1);在AIP指数≥3时,AIP每增加1个单位,ba-PWV变化率增加1.72cm·s^(-1)·year^(-1)。结论:高AIP的原发性高血压患者年龄及ba-PWV更大,AIP增大与动脉硬化风险增加相关。高AIP患者其动脉硬化进展更快,ba-PWV变化率更大,且存在剂量效应关系:当AIP≥3时,其ba-PWV变化率的增长显著低于AIP<3时。综上,在原发性高血压患者中,AIP对于评估动脉硬化水平及其进展存在一定临床价值。

原发性胆汁性胆管炎的肝脏硬度值与脾静动脉血流学参数的相关性分析

目的分析原发性胆汁性胆管炎(PBC)患者肝脏硬度值(LSM)与脾静动脉血流学参数的相关性。方法选择PBC患者83例(PBC组),其中男性10例,女性73例;年龄45~75岁,平均年龄51.2岁;病程2.8~12.4年,平均病程7.2年。正常体检者50例(对照组),其中男性11例,女性39例;年龄34~62岁,平均年龄50.3岁。分别做超声脾静动脉检查和LSM检测,统计分析LSM与脾静动脉血流学参数[脾脏厚径、脾脏长径、脾静脉内径、脾静脉最大流速、脾静脉平均流速、脾动脉最大流速、脾动脉最小流速、脾动脉阻力指数(SRI)]的相关性。结果根据Scheuer分期评分系统对标本进行病理分期:Ⅰ期18例,Ⅱ期20例,Ⅲ期9例,Ⅳ期36例。PBC组LSM明显高于对照组[12.4(7.3~20.5)kPa vs 5.1(3.8~6.3)kPa。P<0.01]。脾脏厚径、长径和内径PBC组均大于对照组[(45.4±13.4)mm vs(31.3±5.6)mm、(127.7±36.3)mm vs(90.7±5.6)mm、(8.5±2.8)mm vs(6.5±0.7)mm。P<0.01]。脾动脉最大流速和SRI PBC组高于对照组[(79.7±28.7)cm/s vs(61.9±21.6)cm/s、0.62±0.08 vs 0.59±0.07。P>0.01];在PBC的各肝纤维化分期中,LSM、脾脏厚径、脾脏长径、脾静脉内径、脾动脉最大流速、SRI差异均有统计学意义(F=14.555、44.831、32.813、24.693、3.407、11.080,P<0.05)。PBC患者中,Ⅳ期的LSM、脾脏厚径、脾脏长径、脾脏内径、SRI均高于Ⅰ期和Ⅱ期[(25.8±17.3)kPa vs(6.1±2.3)kPa&(9.5±3.5)kPa、(56.3±8.2)mm vs(31.5±3.8)mm&(37.0±10.3)mm、(151.3±27.6)mm vs(89.5±10.5)mm&(108.0±21.9)mm、(10.6±2.6)mm vs(6.0±1.0)mm&(6.8±1.4)mm、0.68±0.08 vs 0.58±0.05&0.59±0.07。P<0.05]。Ⅲ期的LSM、脾脏长径、脾静脉内径均高于Ⅰ期和Ⅱ期[(19.7±6.6)kPa vs(6.1±2.3)kPa&(9.5±3.5)kPa、(153.0±36.3)mm vs(89.5±10.5)mm&(108.0±21.9)mm、(8.6±1.7)mm vs(6.0±1.0)mm&(6.8±1.4)mm。P<0.05];PBC患者的LSM与病理分期、脾脏厚径、脾脏长径、脾静脉内径、脾动脉最大流速、SRI分别呈正相关性(r=0.754、0.695、0.686、0.660、0.243、0.373,P=0.000、0.000、0.000、0.000、0.027、0.001)。结论PBC患者的LSM与病理分期、脾脏厚径、脾脏长径、脾静脉内径、脾动脉最大流速、SRI呈正相关,可为临床评估PBC疾病进展提供参考性依据。

急性脑梗死患者动脉僵硬度相关参数变化与神经功能改善的关系

目的探讨急性脑梗死患者动脉僵硬度参数变化与神经功能改善的关系。方法根据转归情况将107例急性脑梗死患者分为出院组(90例)和住院死亡组(17例),再按神经功能改善情况将出院组进一步分为功能改善组(51例)和无功能改善组(39例)。在入院第1日和第7日监测24 h血压并测量动脉僵硬度参数——动脉僵硬度指数(ASI)和脉搏波速度(PWV)。采用美国国立卫生研究院卒中量表(NIHSS)评估脑梗死严重程度,采用改良Rankin量表(mRS)评估神经功能恢复情况。采用逻辑回归分析确定住院死亡和神经功能改善的独立预测因子。结果住院死亡组患者入院时的NIHSS评分、PWV和ASI较出院组患者差(P均<0.05)。在Logistic回归分析中,入院时NIHSS评分以及ASI是住院死亡的独立预测因子。功能改善组患者入院第7日的PWV低于第1日(P<0.05)。功能改善组与无功能改善组患者入院第1日和第7日的PWV比较差异均有统计学意义(P均<0.05)。PWV和中心舒张压降低能独立预测神经功能改善(P均<0.05)。结论急性脑梗死患者ASI增高与较高住院病死率有关。急性脑梗死患者住院期间PWV降低与神经功能改善有关。

血浆致动脉硬化指数及动态动脉硬化指数与冠心病SYNTAX评分的相关性分析

目的探讨血浆致动脉硬化指数(AIP)及动态动脉硬化指数(AASI)与冠心病心脏外科与介入治疗狭窄冠状动脉研究(SYNTAX)评分的相关性。方法100例冠心病患者,根据冠状动脉造影结果进行SYNTAX评分,根据评分结果将患者分为低分组(≤22分,39例)、中分组(23~32分,41例)及高分组(≥33分,20例)。比较三组AIP、AASI、脂质代谢指标[甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]、空腹血糖(FBG)、肝肾功能[血肌酐(Scr)、天门冬氨酸氨基转移酶(AST)]。采用Pearson检验分析AIP、AASI与SYNTAX评分的相关性,采用Logistic回归模型分析冠心病患者SYNTAX评分的影响因素。结果高分组患者的AIP、AASI、LDL-C均高于中分组和低分组,HDL-C低于中分组和低分组,差异有统计学意义(P<0.05)。三组患者的TG、TC、FBG、Scr及AST水平比较差异无统计学意义(P>0.05)。Pearson相关分析显示,AIP、AASI与SYNTAX评分均呈正相关(r=0.620、0.557,P<0.05)。Logistic回归分析结果显示,高血压、高血脂、未服用抗血小板药物、AIP、AASI、HDL-C是SYNTAX评分的影响因素(OR>1,P<0.05)。结论AIP、AASI与冠心病患者SYNTAX评分密切相关,可作为评估患者冠状动脉病变程度的有效指标。

动脉僵硬度新指标AVI与API的临床价值

目的探讨动脉僵硬度新指标动脉波速指数(AVI)和动脉压力容积指数(API)的临床价值及其影响因素。方法2020年9月—2021年2月上海交通大学附属第一人民医院嘉定分院健康体检的自然人2677例,依据年龄三分位数分为≥64.2岁(Q1组)929例、≥47.8岁(Q2组)890例和<47.8岁(Q3组)858例。采用袖带振荡波分析法监测受试者的AVI和API。随机选取124例受试者,获取其左心室射血分数(EF)。采用单因素方差分析比较3组间受试者AV和API的差异。采用Pearson相关和多元线性回归分析获取AVI和API的独立影响因素。结果3组间AVI和API比较,差异均有统计学意义(均P<0.05),且AVI和API值随年龄增加而增加(P<0.05)。升高的AVI与年龄、体质量指数(BMI)、收缩压和舒张压呈正相关(r=0.536、0.055、0.486和0.189,均P<0.01),与身高、体质量、射血分数和短轴缩短率呈负相关(r=-0.123、-0.049、-0.268和-0.259,均P<0.05)。多元线性回归分析显示,年龄和收缩压是AVI独立影响因素(P<0.05)。升高的API与年龄、体质量、BMI和收缩压呈正相关(r=0.475、0.108、0.230和0.690,均P<0.01),与身高呈负相关(r=-0.107,P<0.01)。多元线性回归分析提示,舒张压和收缩压是API独立影响因素(P<0.01)。结论AVI和API可用于评估不同段动脉僵硬度,为动脉僵硬度筛查提供一个新的替代指标,能对临床心脑血管病早期筛查和治疗提供帮助。

肱动脉残余应力新指标临床应用影响因素的初步探讨

目的 应用袖带振荡波获得反映肱动脉环向残余应力的新指标,初步探讨其影响因素。方法 招募2020年8月至2020年12月上海市第一人民医院嘉定分院无心脑血管疾病的志愿者2 581名,依据年龄由高至低五分位数分为Q1组、Q2组、Q3组、Q4组和Q5组。采用袖带振荡波获取受试者肱动脉环向残余应力参数压力容积指数(arterial pressure volume index,API)。选取其中124名受试者,采用超声心动图获取其左心室射血分数(left ventricular ejection fraction,LVEF)和短轴缩短率(fractional shortening rate,FS)。比较5组受试者API和一般资料数据的差异。采用Pearson相关和多元性线性回归分析分别分析API和年龄、身高、体质量、体质量指数、收缩压、舒张压、脉搏及LVEF的关系。结果 API随年龄增加而增加,在5组受试者组间差异有统计学意义(P<0.05)。在总体样本中,API与年龄、体质量、体质量指数和收缩压呈正相关(r=0.471、0.141、0.260和0.671,均P<0.01),与身高和脉搏呈显著负相关(r=-0.082和-0.143,P<0.01)。多元线性回归分析提示,收缩压、舒张压和脉搏是API的独立影响因素(P<0.01)。结论 API是反映动脉僵硬度的新指标,与收缩压、舒张压及脉搏相关,有望为研究动脉环向残余应力提供一个新的指标。

血清8-OHdG联合动态动脉僵硬指数对高血压伴慢性心力衰竭患者主要不良心血管事件的预测价值

目的分析血清8-羟基脱氧鸟苷(8-OHdG)联合动态动脉僵硬指数(AASI)对高血压伴慢性心力衰竭患者主要不良心血管事件(MACE)的预测价值。方法选取2019年1月-2022年1月于皖南医学院第二附属医院心血管内科诊治高血压伴慢性心力衰竭患者132例,根据出院后1年内是否发生MACE分为MACE组(n=42)和非MACE组(NMACE组,n=90)。比较2组患者临床资料、血清8-OHdG和AASI的差异;多因素Logistic回归分析高血压伴慢性心力衰竭患者发生MACE的危险因素;受试者工作特征曲线(ROC)分析血清8-OHdG、AASI对高血压伴慢性心力衰竭患者并发MACE的诊断价值。结果随访1年,高血压伴慢性心力衰竭患者MACE的发生率为31.82%(42/132)。MACE组患者8-OHdG、AASI、NYHA心功能分级级别、肿瘤坏死因子-α(TNF-α)、臂踝动脉脉搏传导速度(ba-PWV)均显著高于NMACE组[t(χ^(2))/P=16.881/<0.001、12.437/<0.001、8.921/0.030、7.234/<0.001、9.492/<0.001],而左心室射血分数(LVEF)明显低于NMACE组(t/P=6.095/<0.001);Logistic多因素回归分析显示,血清8-OHdG高、AASI高均是高血压伴慢性心力衰竭患者发生MACE的危险因素[OR(95%CI)=2.447(1.809~3.309)、1.853(1.471~2.336)];ROC曲线分析显示,血清8-OHdG、AASI及二者联合预测高血压伴慢性心力衰竭患者并发MACE的ROC曲线下面积(AUC)分别为0.756、0.712、0.867,二者联合预测AUC高于单项指标(Z/P=2.969/0.031、3.558/0.015)。结论高血压伴慢性心力衰竭并发MACE的患者血清8-OHdG、AASI明显升高,是高血压伴慢性心力衰竭并发MACE的独立危险因素,二者联合检测可提高对患者并发MACE的诊断效能。

天麻钩藤饮加减联合耳尖放血疗法治疗肝阳上亢型高血压临床观察

目的探讨天麻钩藤饮加减联合耳尖放血疗法治疗肝阳上亢型高血压的临床疗效。方法选取医院2020年1月至2022年1月收治的肝阳上亢型高血压患者300例,按随机抽签法分为对照组(100例)和观察组(200例)。两组患者均予耳尖放血疗法治疗,对照组患者加服硝苯地平控释片,观察组患者加服天麻钩藤饮(随证加减),两组均连续治疗4周。结果观察组总有效率为93.50%,显著高于对照组的77.00%(P<0.05)。观察组患者治疗后的中医证候(头痛眩晕、恶心欲呕、胸闷乏力、失眠烦躁)积分均显著低于对照组(P<0.05),24 h平均收缩压、24 h平均舒张压、24 h动态血压标准差、动态动脉硬化指数均显著低于对照组(P<0.05),尿微量白蛋白、尿肌酐清除率及两者的比值均显著低于对照组(P<0.05)。观察组与对照组不良反应发生率相当(13.00%比8.00%,P>0.05)。结论天麻钩藤饮加减联合耳尖放血疗法治疗肝阳上亢型高血压,能改善患者的中医证候,减小血压波动,改善动脉硬化和肾功能损伤程度。