Relationship of Retinal Nerve Fiber Layer Thickness and Retinal Vessel Calibers with Cognitive Impairment in the Asymptomatic Polyvascular Abnormalities Population

Objective Cognitive impairment(CI)in older individuals has a high morbidity rate worldwide,with poor diagnostic methods and susceptible population identification.This study aimed to investigate the relationship between different retinal metrics and CI in a particular population,emphasizing polyvascular status.Methods We collected information from the Asymptomatic Polyvascular Abnormalities Community Study on retinal vessel calibers,retinal nerve fiber layer(RNFL)thickness,and cognitive function of 3,785participants,aged 40 years or older.Logistic regression was used to analyze the relationship between retinal metrics and cognitive function.Subgroups stratified by different vascular statuses were also analyzed.Results RNFL thickness was significantly thinner in the CI group(odds ratio:0.973,95%confidence interval:0.953–0.994).In the subgroup analysis,the difference still existed in the non-intracranial arterial stenosis,non-extracranial carotid arterial stenosis,and peripheral arterial disease subgroups(P<0.05).Conclusion A thin RNFL is associated with CI,especially in people with non-large vessel stenosis.The underlying small vessel change in RNFL and CI should be investigated in the future.

Long-Term Prognosis and Predictive Risk Factors for Polyvascular Disease in Patients with Peripheral Arterial Disease

Background: The aim of the current study was to assess fifteen-year life expectancy, cardiovascular events, fate of the limb, and risk factors with or without polyvascular disease in patients with Peripheral Arterial Disease (PAD). Methods: We conducted a prospective cohort study in 1019 PAD patients. The endpoints were Cardiovascular or Cerebrovascular Death (CCVD), All-Cause Death (ACD), Major Adverse Cardiovascular Events (MACE), and Cardiovascular and/or Limb Events (CVLE). Results: The patients who died were 539 (52.9%) during follow-up periods. The rate of CCVD was 50.5% (n = 272). In multiple regression analysis, the number of affected arteries had correlations with estimated Glomerular Filtration Rate (eGFR), HDL-cholesterol, Ankle Brachial Pressure Index (ABI), and diabetes (p < 0.05). In multiple logistic analysis, PAD with Cerebrovascular Disease (CVD) was correlated with older age, ABI, eGFR, and atrial fibrillation (p < 0.05);PAD with Coronary Heart Disease (CHD) was correlated with younger age, eGFR, HDL-cholesterol, LDL- cholesterol, and diabetes (p < 0.05);and triple vascular disease (PAD with CVD and CHD) was correlated with ABI, eGFR, HDL-cholesterol, and diabetes (p < 0.05). The number of affected arteries had significant correlations with CCVD, ACD, MACE, and CVLE (p < 0.05). In Cox multivariate analyses, age, Critical Limb Ischemia (CLI), eGFR, albumin, C-Reactive Protein (CRP), Body Mass Index (BMI), CVD, and CHD were related to CCVD (p < 0.05);age, albumin, eGFR, CRP, BMI, CLI, and CVD were associated with ACD (p < 0.05);age, albumin, eGFR, CRP, CLI, CHD, and diabetes were associated with MACE (p < 0.05);age, ABI, albumin, eGFR, CRP, CLI, CHD, and diabetes were related to CVLE (p < 0.05). Statins improved all outcomes (p < 0.05). Conclusions: Polyvascular disease was independently associated with fifteen-year mortality, cardiovascular events, and the fate of the limb with diverse risk factors in PAD patients.

颈动脉内中膜厚度及尿微量白蛋白在多动脉粥样硬化患者心血管危险评估中的作用

目的探讨颈动脉内中膜厚度（carotid intima-media thickness,CIMT）及尿微量白蛋白（microalbuminuria,MA）与动脉粥样硬化患者的病情程度及心血管事件发生率之间的关系。方法选择发生在多个区域中,动脉狭窄≥50%,已施行血运重建操作的患者149例为试验组;同时选择40例动脉粥样硬化性狭窄〈50%的患者作为对照,分别测定IMT和MA。结果 CIMT≥1.38 mm时,对≥3个区域动脉狭窄的敏感性和特异性分别为90.0%和82.6%。MA≥6.85 mg/dl时,对≥2个区域动脉狭窄的敏感性和特异性分别为54.9%和83.3%。试验组发生心血管事件104例。CIMT第1、2、3、4四分位数Kaplan-Meier两年无心血管事件存活率分别为93.9%、95.7%、73.9%和59.6%;MA第1、2、3、4四分位数Kaplan-Meier两年无心血管事件存活率分别为95.7%、89.6%、72.3%和66.0%。独立的心血管不良事件预测因子在多变量Cox比例风险模型中为：CIMT≥1.38 mm,RR=1.83;CI=1.049~3.196（P〈0.001）,MA≥6.85 mg/dl,RR=0.99;CI=0.576~1.703（P〈0.001）。把CIMT引入模型分层显著提高了心血管事件危险的预测（_chi2=7.098,P〈0.01）,把MA引入模型分层对心血管事件危险预测影响不显著（_chi2=0.002,P〈0.01）。结论经过血运重建操作的患者,测量颈动脉内中膜厚度对未来心血管危险分层有重要且独立的贡献,CIMT≥1.38 mm与1.8倍有害心血管事件有关,而尿MA≥6.85 mg/dl与近1倍有害心血管事件有关。

隐匿性脑梗死和多血管床病变相关性研究

目的研究隐匿性脑梗死（SCI）和多血管床病变（PolyVD）的相关性,为识别脑梗死高危人群提供依据。方法纳入2015年2月~2016年6月入住台州市中心医院神经内科的患者,95例被确诊为首次隐匿性脑梗死的患者作为脑梗死组,95例同期头晕、头痛而经头颅MRI证实无梗死灶者作为对照组。检测外周动脉区（颈动脉、锁骨下动脉、下肢动脉）及冠状动脉、颅内动脉,比较各个区域血管床病变情况。结果两组患者在性别、年龄、烟酒史及高血压病史、糖尿病史、冠心病史、血脂基线水平等方面差异无统计学意义（P〉0.05）。检测外周血管区（颈动脉、锁骨下动脉、下肢动脉）及冠状动脉、颅内动脉,相应动脉病变检出率,脑梗死组分别为65.3%、24.2%、33.7%,21.1%、32.6%,对照组分别为49.5%、17.9%、25.3%、15.8%、24.2%,其中脑梗死组颈动脉斑块检出率高于对照组,差异有统计学意义（χ~2=4.842,P=0.028）。两组病变血管检出条数率分别为35.4%、27.4%,脑梗死组高于对照组,差异有统计学差异（χ~2=8.689,P=0.003）。外周动脉、冠状动脉、颅内动脉的三个区域,两组1个区域发生动脉粥样硬化病变分别是37.9%、72.6%,存在2个区域血管病变分别为47.4%、22.1%,存在3个区域血管病变分别为14.7%、5.3%,两组病变区域比较,差异有统计学意义（Z=4.761,P=0.000〈0.01）。两组Poly VD发生率分别为62.1%、27.4%,差异有统计学意义（χ~2=23.183,P=0.000〈0.01）。结论 Poly VD和SCI存在相关性,是脑卒中的危险因素,病变血管越多,导致卒中的风险大。

血脂异常与动脉粥样硬化性泛血管疾病相关研究进展

动脉粥样硬化性泛血管疾病是指两个或两个以上动脉血管床发生动脉粥样硬化。近年来,从泛血管的角度系统认识血管性疾病并制订诊治策略逐渐受到重视。血脂异常作为动脉粥样硬化的危险因素,对动脉粥样硬化性泛血管疾病的发生、进展、严重程度及预后有不同程度的影响。更积极的降脂疗法对于泛血管疾病患者效果更佳、意义更深远。本文就动脉粥样硬化性泛血管疾病的发生风险与血脂异常的关系及泛血管疾病血脂管理现状和策略,对近年研究进展作一综述。

多血管床病变对急性脑梗死患者神经功能恢复的影响及评估

目的探究急性脑梗死(acute cerebral infarct,ACI)患者合并多血管床疾病(polyvascular disease,PolyVD)的神经功能恢复及颅内血管病变情况。方法回顾性分析2019年1月-2019年8月在锦州医科大学附属第三医院神经内科住院的ACI合并单血管床病变组患者83例及ACI合并PolyVD患者68例,统计单血管床病变与多血管床病变组颅内动脉病变及神经功能恢复的情况,并分析影响神经功能恢复的多种因素。结果(1)与单血管床病变组相比,多血管床病变组的神经功能恢复不良的比例较高、神经功能恢复率低、颅内病变血管数目较多,差异具有统计学意义(P<0.05);(2)颅内病变血管数目与病变血管床数目呈正相关(P<0.05),而神经功能恢复率与病变血管床数目呈负相关(P<0.05);(3)年龄、糖尿病史、卒中病史、血管床数目均为神经功能恢复不良的独立危险因子。结论多血管床动脉粥样硬化是急性脑梗死患者神经功能恢复不良的独立危险因素,合并动脉粥样硬化的血管床数目越多,其神经功能恢复不良的几率越大,同时其颅内动脉病变也越重。

Phactr1与多血管疾病的研究进展:从基础到临床

最近的全基因组关联研究发现并确认Phactr1是一个与多种血管疾病相关的风险基因。但是,Phactr1如何调控血管疾病的发生发展尚不明确。近年来的研究表明:Phactr1编码了一种能与肌动蛋白和蛋白磷酸酶1结合的蛋白,可以调节内皮细胞的增殖、凋亡、迁移和管形成,影响巨噬细胞的极化,以及血管平滑肌细胞的钙化。本文围绕Phactr1与多血管疾病的相关性及Phactr1调控动脉粥样硬化的分子机制,阐述Phactr1在多血管疾病进程中的作用和治疗潜力。