Relationship between Waist Circumference and Elevation of Carotid Intima-media Thickness in Newly-diagnosed Diabetic Patients

Objective Waist circumference, as a brief indicator of visceral obesity, is associated with multi-metabolic disorders and cardiovascular diseases. The present study was aimed to find out the relationship between waist circumference and carotid intima media thickness （C-IMT）, as well as the best waist circumference cutoff for identifying C-IMT elevation in Chinese male patients with newly-diagnosed diabetes. Methods Five hundred and seventy-eight patients from Department of Endocrinology and Metabolism in Shanghai Sixth People＇s Hospital affiliated to Shanghai Jiao Tong University were enrolled. Both physical examination （for measurement of waist circumference） and carotid ultrasonography （for measurement of C-IMT） were performed. Results After grouping according to the quartiles of C-IMT, the waist circumference increased across all its quartiles. The waist circumference in 3rd and 4th quartiles （90.7_＋9.8 cm and 90.8＋9.6 cm） was significant higher than in 1st and 2nd quartiles （P〈0.05）. When subjects were divided into 4 groups according to waist circumference, the C-IMT of subjects with waist circumference 90-95 cm was significant higher than that of subjects with waist circumference 85-90 cm and less than 85 cm respectively （P〈0.05）. Both spearman and partial correlation analysis showed that C-IMT was positively correlated with waist circumference （P〈0.01）. C-IMT was found significantly elevated with the increase of waist circumference. Multiple stepwise regression analysis showed that waist circumference was one of the independent risk factors of C-IMT. After an average of 2.23_＋0.85 years follow up, there was a significant elevation of C-IMT in the group with baseline waist circumference over 90 cm P〈0.05）, while no significant difference was detected in the group with baseline waist circumference less than 90 cm （P=0.27）. Logistic regression showed that baseline waist circumference over 90 cm was associated with a relative risk to C-IMT elevation of 1.132 （95% CI 1.043-1.431, P〈0.05）. Conclusion Among newly-diagnosed diabetic male patients, waist circumference over 90 cm not only reflects sub-clinical atherosclerosis in early stage, but also predicts the progression of atherosclerosis.

Correlation between Waist Circumference and Carotid Intima-Media Thickness in Women from Shanghai, China

Objective To evaluate whether waist circumference （WC） 〉85 cm is related to asymptomatic preclinical atherosclerosis in women from Shanghai, China. Methods A total of 2365 females aged 〉20 years recruited from 4 communities underwent physical examination and carotid artery scanning. Their carotid intima-media thickness （C-iMT） was measured. Results The C-IMT was significantly higher in overweight or obese women with their BMI 〉25.0 kg/m2 {P〈O.01） and in those with their WC _〉85 cm than in those with their WC 〈85 cm （P〈O.01）. Spearman and partial correlation analysis showed that the C-IMT was significantly correlated with WC which was independent of menopausal status. The C-IMT significantly increased with the increasing WC and reached to a platform in about 85 cm. An increment tendency was found in the subgroup with its WC 〈 85 cm （P〈O.01） while no significant tendency was found in the subgroup with its WC_〉85 cm （P=0.07）. Multiple stepwise regression analysis showed that the WC was an independent risk factor for C-IMT. In logistic regression model, the odd ratio of WC _〉80 cm, _〉80 cm and 〈85 cm and 〉85 cm for evaluating the risk of C-IMT elevation was 2.632, 2.501, and 1.878, respectively. Conclusion WC is significantly correlated with C-IMT in women from Shanghai, China, and WC_〉85 cm may be used in identifying the risk of subclinical carotid atherosclerosis.

Ultrasound Assessraent of Intima-media Thickness and Diameter of Carotid Arteries in Patients Undergoing Hemodialysis or Renal Transplantation

Renal transplant （RT） recipients have a high risk of developing cardiovascular diseases. However, the effects of renal transplantation on the development of arteriosclerosis have been controversial. The carotid intima-media thickness （CIMT） and diameter （CD） are important indicators of vascular remodeling and arteriosclerosis. In this study, 31 patients with hemodialysis （HD）, 31 RT recipients and 84 age- and gender-matched control subjects were enrolled. Their CIMT and CD were measured by ultrasonic radiofrequency tracking, and the linear regression models and Z test were used to identify the progression of arteriosclerosis and the risk factors. Compared with HD group, RT group had significantly lower CIMT and CD. CIMT was found to be associated with age, body weight, resistance index and diastolic velocity, while CD was associated significantly with age, body weight, pulsatility index, end diastolic velocity and diastolic blood pressure （DBP）, respectively. The correlation curves between CIMT and age showed the slopes of curves were decreased successively in control, RT and HD groups, and the curves between CD and age showed the slopes were decreased in order of RT 〉 control 〉 HD groups. It was concluded that CIMT and CD were significantly correlated with age in RT and moderately with age in HD patients. RT could reduce the progress of arteriosclerosis in patients with end-stage renal disease.

Relationship between Carotid Intima-Media Thickness and Diabetes Clinical Risk Factors among Normotensive Type 2 Diabetes Mellitus among Native Black African Population

Background: Type 2 diabetes mellitus is frequently associated with atherosclerosis with changes in the thickness of the intima-media of carotid arteries which causes increased risk of cardiovascular diseases. Cardiovascular disease is a major cause of morbidity and mortality in this group of patients. The carotid artery reflects the degree of atherosclerosis in the various vessels especially coronary arteries. Measurement of the carotid artery thickness with real time, relatively cheap and non-invasive ultrasonography method is used in monitoring atherosclerotic disease progression and response to treatment. This study is aimed at ultrasonographic evaluation of the carotid intima-media thickness (CIMT) in adult Type 2 Diabetic patients compared to non-diabetic healthy controls matched for age, gender and body mass index (BMI). And to also determine its association if any with selected clinical factors among a native Black African population. Methodology: This was a prospective case control study involving 54 adult type 2 diabetics and 54 adult non-diabetic controls. CIMT was measured at 3 segments of the extracranial carotid arteries by a 7.5 - 10 MHz linear transducer of a portable Mindray M5 ultrasound machine. Results: Among the native black African population studied, there was significant difference in CIMT of adult type 2 diabetics compared to healthy non-diabetics adults (p value = 0.012 and 0.001 on the right and left respectively). The mean carotid intima-media thickness in diabetics was 0.81 mm and 0.85 mm, while in non-diabetics it was 0.74 mm and 0.75 mm on the right and left respectively. The presence of diabetes showed independent positive correlation with CIMT (beta: 0.24, p value = 0.004). Age (beta: 0.30, p value = 0.001) and plasma cholesterol level (beta: 0.30, p value = 0.013) also had positive correlation with CIMT. Conclusion: There was statistically significant difference in carotid intima-media thickness between adult type 2 diabetics and age, sex matched non-diabetics. DM showed independent correlation with CIMT.

Determining factors for carotid mean/max intima-media thickness and brachial flow-mediated dilation in healthy young women

Background: Many factors can contribute to atherosclerotic-type vascular changes in older individuals or men. Thus, confining the investigation to young women with no clinical evidence of the condition could enhance understanding of the early stages of cardiovascular disease. The aim of this study was to determine whether carotid mean/max intima-media thickness (IMT) and brachial flow-mediated dilation (FMD) values, which are well-known event-related indices, are associated with laboratory data and the other vascular indices of atherosclerosis in healthy young women. Methods: Carotid mean/max IMT and brachial FMD were measured in young women with no clinical evidence of atherosclerosis (n = 110;mean age, 39 years) who were instructed not to eat, drink or smoke after 9 PM the evening before testing. All participants also underwent laboratory assessment, including simultaneous measurements of arterial stiffness such as augmentation index (AI), cardioankle vascular index (CAVI) and brachial-ankle pulse wave velocity (baPWV). Results: Mean IMT was signifi-cantly and positively associated with age (p = 0.002), CAVI (p = 0.044), low-density lipoprotein-cholesterol (LDL-C, p = 0.047) and high-sensitive C-reactive protein (hs-CRP, p = 0.002) values but was not related to FMD, AI, baPWV or triglycerides (TG) in the multivariate regression analysis. Similarly, max IMT was positively associated with age (p p = 0.003) and hs-CRP (p = 0.005) values but was not related to FMD, AI, CAVI, baPWV, TG or blood pressure level in the multivariate regression analysis. The association between LDL-C and max IMT was much stronger than that between LDL-C and mean IMT. Brachial FMD was positively associated only with heart rate in the multivariate regression analysis. Conclusions: These results suggest that mean IMT more closely represents the sclerotic aspect of vascular change, whereas max IMT represents the atherotic aspect in healthy young women. Although the relationship between the autonomic nervous system and heart rate is well-known, there may be a complex interaction between the autonomic nervous system and endothelial function.

Relationship between peripheral arterial disease, carotid intima-media thickness and C-reactive protein in elderly diabetic patients

Purpose: To study the association between carotid intima media thickness (CIMT) and high sensitivity CRP (hs-CRP) level as markers for PAD in elderly patients with DM. Subjects: A case-control study on 90 participants aged 60 years and older divided into 60 cases (30 patients with DM alone and 30 patients with DM and comorbidities) and 30 healthy controls. All were assessed by measuring CIMT, ankle brachial index (AB), and markers for cardiovascular disease such as high-sensitivity CRP (hs-CRP), total cholesterol (TC), triglycerides (TG), high density lipoprotein (HDL), and low density lipoprotein (LDL). Results: hs-CRP levels showed statistically significant difference being highest among patients with DM and comorbidities and lowest among controls (P < 0.001). Also, symptoms of PAD were significantly higher among cases than controls. ABI was able to detect PAD in many asymptomatic patients. Color changes were present in only 43.30% (n = 26) of positive PAD cases while delayed wound healing, claudication pain, rest pain, cold extremities, and trophic changes were present in 23.30% (n = 14), 16.71% (n = 10), 16.71% (n = 10), 45.00% (n = 27), and 21.7% (n = 13). Using logistic regression analysis revealed that DM, CIMT, and hs-CRP were independent predictors for PAD (OR = 4.194, 7.236, 1.003;P value = 0.044, 0.25, 0.031) after adjustment of other coronary risk factors such as sex, smoking, hypertension, TC, and TG. Conclusion: Diabetic elderly have higher prevalence of asymptomatic PAD thannon-diabetics using solely ABI. DM, CIMT, and hs-CRP are independent predictors for the occurrence of PAD. Hs-CRP levels are highest among diabetics with comorbidities.

Study on Folds of Equal Thickness Multi-layerSandwiched in Different Thickness Media

The theoretical model and non-homogeneous differential equation of equal thickness multi-layer folds sandwiched in different thickness and same character media are established by elastic and plastic mechanics. The special answer of the non-homogeneous differential equation and the common answer of the homogeneous differential equation are deduced by applying logistic equation and special function, and the dominant wavelength theory of equal thickness multi-layer folds sandwiched in different thickness and same character media. In addition, the experimental folding in both elastic and sticky materials proves the dominant wavelength theory.

Clinical and dietary predictors of common carotid artery intima media thickness in a population with type 1 and type 2 diabetes: A cross-sectional study

AIM To determine the clinical and dietary predictors of common carotid artery intima media thickness(CCA IMT) in a cohort of subjects with type 1 and type 2 diabetes. METHODS Participants with type 1(n = 23) and type 2 diabetes(n = 127) had mean and mean maximum CCA IMT measured using B mode ultrasound. Dietary intake was measured using a food frequency questionnaire. Clinical and dietary predictors of mean and mean maximum CCA IMT were determined using linear regression analysis adjusted for potential confounders. RESULTS The main predictors of mean and mean maximum CCA IMT were age and weight. After multivariate adjustment there were no dietary predictors of CCA IMT. However,in subjects that were not prescribed a lipid lowering medication alcohol consumption was positively associated with CCA IMT after multivariate adjustment. No difference existed in CCA IMT between subjects with type 1 or type 2 diabetes once age was adjusted for. CONCLUSION CCA IMT was predominantly predicted by age and weight in these subjects with diabetes. The finding that CCA IMT was not different between people with type 1 and type 2 diabetes warrants further investigation in a larger cohort.

TyG和TyG-BMI与冠心病患者颈动脉粥样硬化的相关性

目的分析冠心病患者颈动脉粥样硬化与TyG及TyG-BMI的关系。方法选取2021年1月~2022年12月天津市人民医院心内科收治并进行冠脉造影和颈动脉超声检查患者592例为研究对象。依据冠脉造影结果分为正常对照组(n=103)及CAD组(n=489)。收集患者临床资料,计算TyG指数和TyG-BMI水平。分析TyG和TyG-BMI与冠心病患者颈动脉病变程度的相关性。结果与正常对照组比较,CAD组TyG指数和TyGBMI水平明显升高(均P<0.01)。按照Gensini评分三分位数将患者分为三组,中分组(均P<0.05)和高分组(均P<0.01)TyG指数和TyG-BMI水平显著高于低分组。高分组TyG指数和TyG-BMI水平显著高于中分组(均P<0.01)。Spearman相关性分析显示TyG与TyG-BMI和Gensini评分呈现正相关,且TyG指数关联性更强(均P<0.01)。与颈动脉正常组相比,颈动脉粥样硬化组TyG指数更高(P<0.01),TyG-BMI更高(P<0.05)。二元Logistic回归分析发现年龄(OR=1.114,95%CI:1.05~1.18,P<0.01)与高血压(OR=2.913,95%CI:1.27~6.70,P<0.05)是颈动脉粥样硬化的独立危险因素),HDL-C(OR=0.108,95%CI:0.03~0.43,P<0.01)是保护因素。多元Logistic回归分析结果提示高水平TyG和TyG-BMI是颈动脉斑块形成的危险因素。以颈动脉正常为参照,排除混杂因素(如性别、年龄、BMI、收缩压、吸烟史、高血压病史、糖尿病史、药物服用情况)后,高TyG指数组CAD患者发生颈动脉斑块形成的风险是低TyG组的2.56倍,高TyG-BMI组发生颈动脉斑块的风险是低水平TyG-BMI组的4.35倍。Spearman相关性分析发现,TyG指数和颈动脉斑块厚度呈显著正相关(P<0.05),而TyGBMI和斑块厚度无相关。ROC曲线分析结果显示,TyG指数对冠心病患者合并颈动脉斑块形成具有较好的预测价值。结论TyG指数和TyG-BMI是冠心病患者颈动脉斑块形成的危险因素,且TyG指数对颈动脉斑块的预测价值优于TyG-BMI。

常规体检指标对颈动脉硬化发生的预测价值

目的探讨常规体检指标如性别、年龄、血压、血脂、同型半胱氨酸等在颈动脉硬化发生的预测价值。方法采用回顾性研究方法。选取2016年1月至2021年12月连续6年在我院接受健康体检人群985例作为研究对象。收集受试者一般资料、体格检查指标、实验室检查指标、颈动脉超声结果等信息。受试者在随访中经颈动脉超声诊断为颈动脉内中膜厚度(cIMT)>1mm或有颈动脉斑块形成则被认为出现颈动脉粥样硬化进展并结束随访。受试者若未出现颈动脉粥样硬化进展,则直至2021年12月随访结束。将研究对象按随访过程中cIMT是否增加分为硬化组、进展组和对照组。分析颈动脉硬化发生的影响因素,并采用受试者操作特征曲线分析体检指标对颈动脉硬化的诊断效能。结果进展组在颈动脉硬化发病后TC、LDL-C、FBG、UA、Hcy和SBP均高于发生前,HDL-C低于发病前,差异有统计学意义(P<0.05);硬化组除HDL-C和Hcy指标差异没有统计学意义外,其他指标如男性比例、年龄、TC、TG、LDL-C、FBG、UA、SBP、DBP、BMI指标均高于对照组,差异有统计学意义(P<0.05);其中FBG、LDL-C和SBP为颈动脉硬化发生的独立风险因素(OR=5.505、4.222、1.071,P<0.05),以上指标联合诊断颈动脉硬化的曲线下面积高于各项单独检测,差异有统计学意义(P<0.01)。结论FBG、LDL-C和BMP与颈动脉硬化的发生密切相关,联合检测对颈动脉硬化有较好的诊断效能。

系统性红斑狼疮患者心外膜脂肪厚度与心血管疾病风险的相关性

目的:研究系统性红斑狼疮(SLE)患者心外膜脂肪组织厚度(EFT)的改变,并探讨其与心脏彩超参数及心血管疾病(CVD)传统危险因素的相关性。方法:纳入2019年10月至2021年10月于我院住院的SLE患者作为病例组,同期健康人群作为对照组,测量2组的EFT,根据EFT是否增厚将SLE患者分为增厚组及不增厚组,比较2组炎症指标、心脏彩超参数及CVD传统危险因素之间的差异,并应用Logistic回归分析寻找EFT的危险因素。结果:SLE组患者的EFT[4.40(2.60)mm]较对照组[3.10(1.60)mm]显著增厚(P<0.001)。病例组患者中EFT增厚者占42.0%(76/131),对照组EFT增厚者仅占9.5%(9/95)。病例组中EFT增厚组与不增厚组比较结果显示,EFT增厚组的年龄、体质量指数(BMI)、左心房直径(LAD)、右心室内径(RVD)、室间隔厚度(IVST)、左心室后壁厚度(LVPWT)及颈动脉内膜中层厚度(CIMT)均显著高于不增厚组。EFT与年龄、病程、BMI、甘油三酯、低密度脂蛋白、LAD、RVD、IVST、LVPWT及CIMT等呈正相关。Logistic回归分析显示LVPWT增加是EFT增厚的危险因素。结论:SLE患者的EFT增厚与心脏结构或功能参数的改变相关,提示应对EFT增厚及心脏结构或功能参数异常的SLE患者进一步筛查心血管病变的危险因素。

早发型2型糖尿病患者子女颈动脉全息血管硬度及影响因素分析

目的评估早发型2型糖尿病患者子女颈动脉弹性功能,并分析影响其弹性的因素。资料与方法前瞻性分析2020年10月—2021年8月河南省人民医院2型糖尿病患者子女63例,根据其父母糖尿病发病年龄(<40岁为早发型,≥40岁为晚发型)分为父母早发糖尿病子女组(早发组,32例)和父母晚发糖尿病子女组(晚发组,31例)。同期选择32例年龄、性别及体重指数相匹配的健康志愿者作为对照组。应用全息血管内-中膜厚度测量和全息血管硬度分析技术测量受试者颈总动脉内-中膜厚度、血管壁位移、血管收缩期管径、硬度指数和脉搏波传导速度,比较上述参数的组间差异。结果早发组颈动脉内-中膜厚度、脉搏波传导速度、硬度指数高于晚发组及对照组(t=0.054~1.228,P均<0.05),血管壁位移低于晚发组及对照组(t=0.048、0.109,P<0.05)。结论2型糖尿病患者子女颈动脉僵硬度明显高于正常对照组,且早发组的颈动脉弹性下降较晚发组更明显。

非酒精性脂肪性肝病严重程度与颈动脉斑块、内-中膜厚度相关性研究及危险因素分析

目的:探讨非酒精性脂肪性肝病(NAFLD)严重程度与颈动脉斑块、内-中膜厚度(cIMT)之间的关系,并分析其危险因素。方法:收集2021年1至11月行肝脏、颈动脉超声检查并诊断为NAFLD的患者154例,评估患者NAFLD严重程度、颈动脉斑块及血管狭窄程度测量患者cIMT值,计算肝纤维化评分,并进行统计学分析。结果:NAFLD轻度组患者cIMT值、血管狭窄发生率低于中-重度组患者(W=6905.500,P<0.001);有颈动脉斑块组患者cIMT值明显高于无颈动脉斑块组患者(W=3361.500,P<0.001);BMI是NAFLD严重程度的独立危险因素,年龄和NAFLD严重程度是cIMT的独立危险因素,年龄、高血压、肝纤维化评分是颈动脉斑块出现的独立危险因素,差异均有统计学意义(P<0.05)。结论:NAFLD患者cIMT的增加、颈动脉狭窄与NAFLD严重程度有关,其颈动脉斑块发生率与cIMT呈正相关。另外,其肝纤维化评分增加,对颈动脉斑块出现也有提示意义。

急性脑梗死患者血清CTRP3及CTRP9水平与颈总动脉内膜中层厚度的相关性分析

目的 探讨急性脑梗死患者血清C1q/肿瘤坏死因子相关蛋白(CTRP)3和CTRP9水平与颈总动脉内膜中层厚度(IMT)的相关性。方法 前瞻性纳入2020年12月至2023年5月河北北方学院附属第一医院收治的急性脑梗死患者87例作为观察组,另选取同期在该院体检的健康者85名作为对照组。采用酶联免疫吸附试验法检测两组研究对象血清中CTRP3、CTRP9水平,并通过彩色多普勒超声系统测量颈总动脉IMT。比较两组研究对象的血清CTRP3、CTRP9水平及颈总动脉IMT,比较两组研究对象的颈总动脉硬化程度,不同动脉硬化程度急性脑梗死患者血清CTRP3、CTRP9水平,分析血清CTRP3,CTRP9水平与急性脑梗死患者颈总动脉IMT的相关性。结果 观察组患者的血清CTRP3、CTRP9水平分别为(238.34±65.23)、(138.34±52.65)ng/mL,均明显低于对照组[(372.14±83.47)、(249.25±78.32)ng/mL],颈总动脉IMT为(1.34±0.41) mm,显著高于对照组[(0.74±0.12)mm],差异均有统计学意义(P<0.05)。观察组患者的颈总动脉硬化程度正常占比为9.20%,明显低于对照组(72.94%),内膜增厚和斑块形成占比分别为31.03%、57.47%,均明显高于对照组(17.64%、9.41%),差异均有统计学意义(P<0.05)。随着颈总动脉IMT的增加,血清CTRP3和CTRP9的水平显著降低,差异均有统计学意义(P<0.05)。血清CTRP3和CTRP9水平与颈总动脉IMT均呈负相关(r=-0.461、-0.592,P<0.05),而CTRP3和CTRP9之间呈正相关(r=0.498,P<0.05)。结论 急性脑梗死患者血清CTRP3和CTRP9水平与颈总动脉IMT有明显负相关性。CTRP3和CTRP9可能作为动脉粥样硬化和急性脑梗死的潜在生物标志物,为临床预测和干预缺血性脑卒中提供重要信息。

老年高血压患者血清同型半胱氨酸与颈动脉内膜中层厚度的关系及对颈动脉斑块形成的影响

目的探讨老年高血压患者的同型半胱氨酸(Hcy)水平与颈动脉内膜中层厚度的关系,以及Hcy对颈动脉斑块形成的影响。方法选取自2020年3月至2022年1月于衡水市人民医院就诊的老年高血压患者259例。根据血清Hcy水平四分位数将患者分为H1组(<17.81 umol/L)64例,H2组(17.81~20.93 umol/L)65例,H3组(20.93~24.06 umol/L)65例,H4组(>24.06 umol/L)65例;统计研究对象颈动脉斑块形成的情况并检测患者颈动脉内膜中层厚度(CIMT),按照斑块形成情况分为斑块组(n=149)和无斑块组(n=110)。比较4组不同血清Hcy水平患者的CIMT、颈动脉斑块形成情况,比较斑块组和无斑块组血清Hcy水平,采用Pearson相关分析血清Hcy与CIMT的相关性,采用多元线性回归分析CIMT的危险因素,采用多因素logistic回归分析CIMT增加和颈动脉斑块形成的影响因素。结果四组研究对象的吸烟史、饮酒史、总胆固醇、低密度脂蛋白、血清Hcy、CIMT、颈动脉斑块形成率比较差异有统计学意义(P<0.05);H4组的总胆固醇、CIMT、颈动脉斑块形成率(78.46%)均明显高于其他三组(P<0.05),低密度脂蛋白、血清Hcy均明显高于H1、H2组(P<0.05);斑块组的总胆固醇、低密度脂蛋白、血清Hcy、CIMT均明显高于无斑块组(P<0.05);Pearson相关分析显示,CIMT与年龄、吸烟史、总胆固醇、低密度脂蛋白、血清Hcy呈正相关(r=0.298、0.178、0.214、0.293、0.305,P<0.05),与高密度脂蛋白呈负相关(r=-0.205,P<0.05);多元线性逐步回归分析结果显示,年龄、高密度脂蛋白、低密度脂蛋白、血清Hcy是CIMT的影响因素(β=0.157、-0.211、0.204、0.269,P<0.05);多因素logistic回归分析结果显示,年龄、吸烟史、总胆固醇、低密度脂蛋白、血清Hcy均是颈动脉斑块形成的独立危险因素(β=0.864、0.243、1.546、0.026、0.549,P<0.05),高密度脂蛋白是颈动脉斑块形成的独立保护因素(β=-1.207,P<0.05)。结论老年高血压患者血清Hcy水平是颈动脉斑块形成的独立危险因素,并且与CIMT呈正相关,可作为临床上辅助诊断动脉粥样硬化的检测方式。

身体活动水平对2型糖尿病患者颈动脉内膜中层厚度增厚的影响研究

背景心血管疾病是2型糖尿病(T2DM)患者的主要死亡原因,颈动脉内膜中层厚度(CIMT)增厚可预测心血管疾病的发生。中高水平的身体活动(PA)可改善患者的血糖水平并降低心血管疾病的发生率和死亡风险。探讨这一可改变的生活方式与CIMT的关系可能是预防心血管疾病的有效策略。目的分析不同PA水平与T2DM患者CIMT增厚的关系,为患者推荐个性化活动方案提供科学依据。方法本研究为横断面研究,选取2019年1月—2022年2月于江苏省两家三级甲等医院内分泌门诊就诊的3099例T2DM患者为研究对象,采用国际身体活动量表(IPAQ)短问卷评估患者的PA水平,将患者分为轻度及以下PA组、中度PA组和高强度PA组。通过二元Logistic回归分析探讨PA与CIMT增厚的关系,并按照不同肥胖程度和血压、血脂及糖化达标状况进行分层分析。将PA水平作为连续变量绘制限制性立方样条评价PA与CIMT增厚的剂量反应关系。结果与轻度及以下PA患者(n=981)相比,中度(n=1389)和高强度(n=729)PA患者的年龄较小,糖化血红蛋白(HbA_(1c))和低密度脂蛋白胆固醇(LDL-C)水平较高(P<0.05)。二元Logistic回归分析结果显示,中度PA与发生CIMT增厚的风险呈负关联(OR=0.775,95%CI=0.629~0.956,P<0.05),这种关联独立于社会人口学、生活方式及血脂等生化指标。进一步绘制限制性立方样条结果显示,PA与CIMT增厚的风险之间存在非线性关系(P_(非线性)=0.014)。分层分析结果显示,在体质量正常(n=996)和超重(n=1395)的患者中未发现PA与CIMT的关系(P>0.05);而在肥胖患者(n=708)中仅中度PA与CIMT增厚相关(OR=0.614,95%CI=0.382~0.987,P<0.05);血压、血脂及糖化3项指标均不达标(n=324)和仅1项指标达标(n=1416)的患者,中度PA与发生CIMT增厚呈负相关(P<0.05)。结论PA水平与CIMT增厚存在剂量反应关系,中度PA与CIMT增厚呈负相关,尤其是在肥胖、血压、血脂及糖化控制较差的人群中,而高强度PA对CIMT的影响不显著。

甲状腺功能正常的老年2型糖尿病患者TSH水平与颈动脉内膜中膜厚度的相关性研究

目的探讨甲状腺功能正常的老年2型糖尿病(T2DM)患者促甲状腺激素(TSH)水平与颈动脉内膜中膜厚度(CIMT)的关系。方法选取2020年5月—2024年3月上海市同仁医院内分泌科门诊及住院诊疗的617例甲状腺功能正常的老年T2DM患者,以CIMT 1.0 mm为切点分为CIMT正常组(CIMT<1.0 mm)和CIMT增厚组(CIMT≥1.0 mm),收集患者资料进行横断面分析。结果CIMT增厚组年龄、收缩压、空腹C肽、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、尿酸(UA)、TSH、饮酒比例高于CIMT正常组(P<0.05)。年龄(OR=1.074,95%CI:1.0221.128,P=0.005)、空腹C肽(OR=2.048,95%CI:1.0324.061,P=0.040)、LDL-C(OR=1.959,95%CI:1.1793.257,P=0.009)、TSH(OR=1.456,95%CI:1.1601.826,P=0.001)、饮酒(OR=0.504,95%CI:0.2830.897,P=0.020)为CIMT增厚的独立危险因素。结论正常范围内较高水平的血清TSH是甲状腺功能正常的老年T2DM患者CIMT增厚的独立危险因素。

累积高敏C反应蛋白暴露与颈动脉内膜中层厚度的相关性

目的 探讨累积高敏C反应蛋白(cumulative high sensitivity C-reactive protein,cum CRP)与颈动脉内膜中层厚度(carotid intima media thickness,CIMT)的相关性。方法 本研究回顾性对连续参加了2006—2007年、2008—2009年、2010—2011年、2012—2013年4次健康体检并完成颈动脉超声的开滦职工4 701例进行横断面分析。观察对象年龄(50.9±10.9)岁,其中男性2 510例(53.39%)。根据暴露剂量与暴露时间乘积之和计算出4次健康体检的cum CRP并根据其三分位数将观察对象分为Q1、Q2、Q3三组,分析cum CRP对CIMT的影响。结果 随着cum CRP增加,CIMT逐渐增厚(P<0.000 1)。多因素Logistic回归分析校正其他混杂因素后,以Q1组作对照,Q2、Q3组的OR值分别为1.36 (95%CI:1.01~1.82)、1.49 (95%CI:1.07~2.07)。结论 cum CRP是CIMT增厚的独立危险因素;不同性别及年龄均要重视cum CRP。

载脂蛋白B联合颈动脉内膜中层厚度对冠心病的预测价值

目的探讨血清载脂蛋白B(apoB)联合颈动脉内膜中层厚度(CIMT)在冠心病中的预测价值。方法回顾性分析2020年1—6月在右江民族医学院附属医院就诊的胸痛疑似冠心病并行冠脉造影的患者210例,根据冠脉造影结果,分为冠心病组和非冠心病组。所有患者检测血清apoB、行颈动脉彩超检查。分析两组患者血清apoB、CIMT、斑块差异,采用受试者工作特征曲线(ROC)分析apoB、CIMT以及二者联合对冠心病的预测价值。结果冠心病组血清apoB、CIMT、颈动脉斑块比例明显高于非冠心病组,差异有统计学意义(P<0.05);冠心病多支病变患者血清apoB、CIMT明显高于单支病变患者,差异有统计学意义(P<0.05);血清apoB和CIMT预测冠心病的价值差异无统计学意义(P>0.05)。两者联合预测冠心病的ROC曲线下面积为0.865,诊断的敏感度和特异度分别为93.20%和63.30%,两者联合预测冠心病的价值优于单独使用血清apoB、CIMT,差异有统计学意义(P<0.05)。结论血清apoB联合CIMT能提高对冠心病的预测价值。

普罗布考联合他汀类药物治疗颈动脉斑块的meta分析

目的探究普罗布考联合他汀类药物治疗颈动脉斑块的疗效。方法以“普罗布考”“他汀”“颈动脉”为中文关键词,检索中文数据库中国知网、维普网、万方数据库,以“carotid artery”“probucol”“statins”为英文关键词,检索英文数据库PubMed、Cochrane Library、Embase,筛选普罗布考联合他汀类药物治疗颈动脉斑块的随机对照试验。检索时间为数据库建立至2023年12月17日。以单用他汀类药物治疗为对照组,他汀类药物联合普罗布考治疗为联合治疗组。参照Cochrane偏倚风险评估对纳入的研究进行质量评价。主要结局指标包括颈动脉内-中膜厚度(intima-media thickness,IMT),次要结局指标包括TC水平、hs-CRP水平、卒中事件发生等。采用RevMan 5.1软件进行meta分析。结果最终纳入11项随机对照试验,共纳入3251例患者。meta分析显示,在降低I MT方面,联合治疗组优于对照组[标准化均数差(standardized mean difference,SMD)-0.93,95%CI-1.66~-0.20,P<0.001];在降低TC水平方面,联合治疗组优于对照组(SMD-1.08,95%CI-1.60~-0.55,P<0.001);在降低hs-CRP水平方面,两组差异无统计学意义(SMD-1.22,95%CI-2.48~0.04,P=0.060);在减少卒中事件发生方面,联合治疗组优于对照组(RR 0.34,95%CI 0.17~0.65,P=0.001)。结论普罗布考联合他汀类药物治疗颈动脉斑块疗效更优,可降低患者的TC水平,并减少卒中事件发生。