2型糖尿病微量白蛋白尿与动脉硬化危险因素关系的研究

目的研究2型糖尿病(T2DM)微量白蛋白尿(MAU)与致动脉粥样硬化危险因素间的关系。方法回顾分析1995—2009年在卫生部北京医院住院的T2DM患者1004例,按尿白蛋白排泄率(UAER)分为MAU组及正常组,进行两组间患者临床和生化指标的比较,并进行MAU与致动脉硬化危险因素间的相关性分析。结果 (1)两组在性别、年龄、体重指数、收缩压、吸烟史、糖尿病病程、糖化血红蛋白、空腹血糖、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、血肌酐、尿酸、胰岛素抵抗指数等方面比较差异有统计学意义(P<0.05);(2)Logistic回归分析显示,体重指数(OR=1.137,95%CI:1.061～1.218)、收缩压(OR=1.033,95%CI:1.023～1.043)、糖尿病病程(OR=1.082,95%CI:1.056～1.108)、糖化血红蛋白(OR=1.172,95%CI:1.019～1.349)、低密度脂蛋白胆固醇(OR=1.346,,95%CI:1.090～1.661)是MAU发生的独立危险因素。结论 T2DM患者MAU的发生与体重指数、收缩压、糖尿病病程、糖化血红蛋白、低密度脂蛋白胆固醇密切相关。

急性肺栓塞患者规范抗凝中复发的特征及其相关因素

目的探讨无明确触发因素的肺栓塞(pulmonary embolism,PE)患者规范抗凝治疗中PE复发特征及其相关因素.方法连续收集2017年1月至2018年8月北京安贞医院急诊重症监护室(emergency intensive care unit,EICU)收治的无明确触发因素的急性PE患者,病情稳定按照研究拟定的随访方案进行院外随访;记录患者抗凝治疗情况、急性期及抗凝治疗1年时肺灌注/通气显像(ventilation/perfusion scan,V/Q scan)结果及每3个月检测的血压、糖化血红蛋白、同型半胱氨酸及血脂等动脉硬化相关指标的结果.结果连续纳入175例急性PE患者中符合入选标准的急性PE患者共70例,平均年龄64(64.22±10.94)岁;70例急性PE患者中59例(84.3%)患者具有一个或多个动脉硬化的危险因素;PE复发组20例(复发率28.57%),V/Q scan明确提示原有部位加重或新发部位的灌注缺损,均为无症状PE复发,治疗后灌注缺损面积较治疗前有所减小,但差异未见统计学意义(P>0.05).50例无PE复发患者治疗后灌注缺损面积显著减小(P<0.001);冠状动脉危险因素中,低密度脂蛋白(low density lipoprotein,LDL)累积暴露水平与PE复发相关:LDL每增加1 mmol/L,PE复发风险增加了47.6%(OR 1.476,95%CI1.108~1.964,P<0.05).结论①亟需建立急性PE患者的院外随访策略;②V/Q scan可以确定抗凝期间无症状PE复发的患者,有助于抗凝1年后疗程的确定;③LDL增加与PE复发风险增加有关.

Beneficial effect of sulphate-bicarbonate-calcium water on gallstone risk and weight control

AIM： To investigate the effect of drinking sulphate-bi- carbonate-calcium thermal water （TW） on risk factors for atherosclerosis and cholesterol gallstone disease.

Resistin might not be a risk factor for carotid artery atherosclerosis in elderly Chinese males

Objective To investigate the correlation between the serum resistin level and carotid artery atherosclerosis in elderly Chinese males. Methods The study enrolled 235 elderly Chinese males [median age 76 （range 60-97） years] scheduled for ultrasound examination of carotid artery plaque and determination of carotid artery intima-media thickness （CIMT）. They were divided into carotid atherosclerotic plaque （CAP） and carotid atherosclerotic plaque-free （CAP-free） groups according to the ultrasound results. Their clinical profiles were col-lected, and the serum resistin and other blood biochemistry levels were determined.Results The CAP group was older and had a thicker mean CIMT than the CAP-free group. However, there was no difference in the serum resistin level between the groups. CIMT was positively correlated with age （r = 0.299,P〈 0.001）. The serum resistin level was not correlated with CIMT, even after controlling for age. Multiple linear regression analysis revealed that age （β = 0.001,P〈 0.001） and body mass index （β = 0.002,P= 0.015） were significantly and posi-tively correlated with the mean CIMT. Only age [odds ratio （OR）： 1.159; 95% confidence interval （CI）： 1.078-1.183,P〈 0.001] was associ-ated with the presence of carotid artery atherosclerotic plaque. The serum resistin level was not correlated with the mean CIMT or associated with the presence of carotid artery atherosclerotic plaque.Conclusion The results suggest that resistin might not be a risk factor for atherosclerosis in elderly Chinese males.

CAROTID INTIMA- MEDIA THICKNESS AND THE ASSOCIATION WITH CARDIOVASCULAR RISK FACTORS IN THE ELDERLY

To investigate the association of carotid arterial intima- media thickness (IMT) with principal cardiovascular risk factors in the elderly. Methods. Carotid arterial IMT was measured by high resolution B mode ultrasound in 94 elderly subjects (old- aged group), and compared with subjects aged Results. In comparison with the middle- aged group, the prevalence of coronary heart disease, cerebral vascular disease, hypertension and diabetes mellitus was significantly higher, and serum cholesterol and systolic blood pressure were also significantly higher in old- aged group. Although there was no obvious difference in IMT between the two groups, carotid plaque and carotid wall thickening were more frequently found in old- aged group. Age, systolic blood pressure and serum cholesterol were shown as the independent determinants for carotid IMT in the total participants, whereas no such independent relation was found in old- aged group. Conclusion. Age is the major risk factor for carotid atherosclerosis in the elderly. In other words, the occurrence of carotid atherosclerosis is the result of advancing age combined with the effect of multiple cardiovascular risk factors.

院外规范化治疗对急性肺栓塞患者复发的影响

目的观察规范急性肺栓塞（pulmonary thromboembolism，PE）患者院外的管理对其抗凝治疗中及停药后复发的影响。方法分为规范治疗组（观察组）和未规范治疗组（对照组）两组。观察组：收集2015年1月至2016年12月期间收治的急性、首次发病的PE患者资料，院外管理策略：指导抗凝治疗；记录患者所有症状；完成治疗3个月的超声心动图、6个月及12个月的肺灌注等检查；现有指南指导下抗凝结束后未来1年内的血栓事件复发情况；定期检查期间，一旦出现可疑复发的症状即给予确诊检查明确。对照组：回顾2010年1月至2014年12月的PE资料及出院后在非抗栓门诊治疗的抗凝治疗状态及转归情况。结果①收治无明确触发因素的急性PE患者分别为观察组129例和对照组的246例；两组年龄（观察组64±12岁和对照组65．9±12．9岁）及性别（男／女：观察组1：1．22和对照组1：1．46）差异无统计学意义（P〉0．05）；②观察组复发率（11．63％）明显低于对照组（22．36％），（P〈0．01）；③观察组病死率（3．1％）低于对照组（9．3％），（P〈0．05）；观察组中PE患者的失访率及中断治疗率均低于对照组，分别为10．85％vs．21．54％（P〈0．01）和1．55％vs．8．5％（P〈0．01）；④具有动脉硬化危险因素分别在观察组和对照组中占82．17％和77．64%（P〉0．05），而动脉硬化危险因素控制达标分别为79．31％和54．97%（P〈0．05）.结论规范PE患者的抗凝治疗可以有效降低PE患者VTE的复发率，应加强PE患者的院外抗凝治疗管理；暴露于动脉硬化危险因素的PE患者，抗凝治疗期间或抗凝结束后血栓事件的复发值得关注。