颈动脉粥样硬化与血压及血脂的相关性分析

目的探讨颈动脉粥样硬化与血压及血脂的关系。方法随机抽取来西城区白纸坊中心进行体检的中老年患者共429例,并将其分成4组,其中单纯高血压患者108例,高血压合并高脂血症患者114例,高脂血症患者100例及健康人群107例。入选人群均进行颈动脉彩超检查,测量颈动脉内-中膜厚度(Intima Media Thickness,IMT)并探测斑块,同时抽取外周静脉血化验总胆固醇(Total Cholesterol,TC)、甘油三酯(Triglyceride,TG)、高密度脂蛋白(High Density Lipoprotein,HDL-C)、低密度脂蛋白(Low Density Lipoprotein,LDL-C)及空腹血糖(Glucose,GLU)。结果单纯高血压组IMT及斑块发生率高于健康人群组(P<0.05),高血压合并高脂血症组IMT及斑块发生率高于健康人群组,差异均有统计学意义(P<0.01)。结论颈动脉粥样硬化与血压及血脂水平有一定的相关性,在社区临床诊疗过程中,对高血压患者积极控制血压的同时,应早期对血脂水平进行干预。

动脉粥样硬化不同斑块类型的T淋巴细胞亚群的表达水平及临床意义

目的:探讨不同动脉粥样硬化斑块类型的T淋巴细胞亚群的表达水平及临床意义。方法:选择在我院收治的92例冠脉粥样硬化患者为研究对象,根据斑块类型分为稳定斑块组(46例)和不稳定斑块组(46例),比较两组血清T淋巴细胞亚群CD4^+、CD8^+、CD4^+/CD8^+及细胞上清液中细胞因子的含量,采用Logistic多元回归分析斑块类型的影响因素,采用ROC曲线分析上述因素对斑块类型的诊断价值。结果:与稳定斑块组比较,不稳定斑块组CD4^+[(45.84±6.23)比(82.56±4.37)]、CD8^+[(63.42±5.34)比(93.78±7.46)]、CD4^+/CD8^+[(0.62±0.23)比(1.88±0.19)]及干扰素γ(IFN-γ)[(4.25±0.22)μg/ml比(8.61±0.72)μg/ml]水平显著升高(P均=0.001)。多元Logistic回归分析显示:CD8^+、CD4^+/CD8^+及IFN-γ是不稳定斑块的独立危险因素(OR分别为4.836、4.225、4.894,P<0.05或<0.01),ROC曲线显示:CD8^+、CD4^+/CD8^+及IFN-γ对不稳定斑块的诊断价值较高(曲线下面积分别为0.931、0.935、0.943,P均=0.001)。结论:T淋巴细胞亚群及活化的T淋巴细胞分泌的IFN-γ对动脉粥样硬化斑块类型的诊断具有重要临床价值。

冠心合剂对氧化低密度脂蛋白诱导人脐静脉内皮细胞黏附分子表达的影响

目的：研究冠心合剂对氧化低密度脂蛋白（ox-LDL）诱导的人脐静脉内皮细胞（HUVEC）细胞间黏附分子-1（ICAM-1）及血管细胞黏附分子-1（VCAM-1）表达的影响。方法：进行HUVECs原代培养,取第4～6代进行实验,随机分为6组：对照组、模型组、氟伐他汀组、冠心合剂小剂量组、冠心合剂中剂量组、冠心合剂大剂量组。Ox-LDL刺激HUVEC 6h后,大鼠药物血清与HUVECs共培养48h,E lisa法检测细胞上清液ICAM-1、VCAM-1的表达。结果：冠心合剂可明显降低ox-LDL诱导的HUVECs ICAM-1和VCAM-1表达水平。结论：冠心合剂抗动脉粥样硬化（AS）的作用机制可能与其抗黏附作用进而保护血管内皮细胞功能密切相关。

Fatty liver,carotid disease and gallstones:A study of age-related associations

AIM: To evaluate carotid intima-media thickening (IMT) and plaques, gallstone disease (GD) and fatty liver (FL) as a function of age. METHODS: In 449 subjects, FL and carotid disease were assessed ultrasonographically. In a subgroup of 65/449 patients with non-alcoholic fatty liver disease (NAFLD), carotid disease, GD and associated factors were determined. RESULTS: FL of unspecified etiology was more common in younger and GD in older individuals. FL subjects had an increased prevalence of IMT and a decreased prevalence of plaques and manifested carotid disease earlier. Plaques were more common in subjects with GD. Age was an independent predictor of carotid disease outcome and FL was a protective factor for plaques. In NAFLD, there was an inverse correlation between body weight and age and the latter independently predicted carotid findings. CONCLUSION: Cardiovascular risk in patients with FL and NAFLD needs to be assessed as a function of age and body weight.

Vascular protection by high-density lipoprotein-associated sphingosine-1- phosphate

Epidemiological studies and animal experiments have consistently demonstrated cardiovascular protection by high-density lipoprotein （HDL）. Findings from a growing number of studies further indicate that sphingosine-l-phosphate （S1P） mediates many of the beneficial effects of HDL on the cardiovascular system, including vasodilatation, angiogenesis, maintenance of endothelial barrier function, and protec- tion against atherosclerosis and ischemiaJreperfusion injury. In this review, we summarize the most recent literature investigating the effects of HDL-S 1 P on cardiovascular health and highlight potential opportunities for clinical translation of these findings.

Aortic stenosis： insights on pathogenesis and clinical implications

Aortic stenosis （AS） is a common valvular heart disease in the Western populations, with an estimated overall prevalence of 3% in adults over 75 years. To understand its patho-biological processes represents a priority. In elderly patients, AS usually involves trileaflet valves and is referred to as degenerative calcific processes. Scientific evidence suggests the involvement of an active ＂atherosclerosis-like＂ pathogenesis in the initiation phase of degenerative AS. To the contrary, the progression could be driven by different forces （such as mechanical stress, genetic factors and interaction between inflammation and calcification）. The improved understanding presents potentially new therapeutic targets for preventing and inhibiting the development and progression of the disease. Furthermore, in clinical practice the management of AS patients implies the evaluation of generalized atherosclerotic manifestations （i.e., in the coronary and carotid arteries） even for prognostic reasons. In counselling elderly patients, the risk stratification should address individual frailty beyond the generic risk scores. In these regard, the co-morbidities, and in particular those linked to the global atherosclerotic burden, should be carefully investigated in order to define the risk/benefit ratio for invasive treatment strategies. We present a detailed overview of insights in pathogenesis of AS with possible practical implications.

Is there any link between homocysteine and atherosclerosis？

I have read with interest the paper by Hart, et al. re- porting that homocysteine （Hey） is an independent risk fac- tor for non-culprit coronary lesions progression after 12 months of follow-up in elderly patients who has undergone percutaneous coronary stenting. Hcy-mediated increased lipid peroxidation and generation of free radicals results in in- flammation and endothelial dysfunction, which triggers atherosclerotic process. Coronary artery disease is also as- sociated with higher levels of Hcy.

Andropause and the development of cardiovascular disease presentationmore than an epi-phenomenon

Andropause refers to a generalized decline of male hormones, including testosterone and dehydroepiandrosterone in middle-aged and aging men. This decline in hormones has been associated with changes such as depression, loss of libido, sexual dysfunction, and changes in body composition. Aging has been associated with an abundance of concomitant diseases, in particular cardiovascular diseases, and although andropause is correlated to aging, a causal relationship between reduction of androgens and the development of chronic diseases such as atherosclerosis and heart failure has not been convincingly established yet. On the other hand, increasing data has emerged that revealed the effects of low levels of androgens on cardiovascular disease progression. As an example, low levels of testosterone have been linked to a higher incidence of coronary artery disease. Whether hormone replacement therapy that is used for andropausal men to alleviate symptoms of ＂male menopause＂ can halt progression of cardiovascular disease, remains controversially discussed, primarily due to the lack of well-designed, randomized controlled trials. At least for symptom improvement, the use of androgen replacement therapy in andropausal men may be clinically indicated, and with the appropriate supervision and follow up may prove to be beneficial with regard to preservation of the integrity of cardiovascular health at higher ages.

Enigma of primary aortoduodenal fistula

A diagnosis of primary aortoenteric fistula is difficult to make despite a high level of clinical suspicion. It should be considered in any elderly patient who presents with upper gastrointestinal bleeding in the context of a known abdominal aortic aneurysm. We present the case of young man with no history of abdominal aortic aneurysm who presented with massive upper gastrointestinal bleeding. Initial misdiagnosis led to a delay in treatment and the patient succumbing to the illness. This case is unique in that the fistula formed as a result of complex atherosclerotic disease of the abdominal aorta, and not from an aneurysm.

Factors Influencing the Disturbed Flow Patterns Downstream of Curved Atherosclerotic Arteries

Pulsatile blood flows in curved atherosclerotic arteries are studied by computer simulations. Computations are carried out with various values of physiological parameters to examine the effects of flow parameters on the disturbed flow patterns downstream of a curved artery with a stenosis at the inner wall. The numerical results indicate a strong dependence of flow pattern on the blood viscosity and inlet flow rate, while the influence of the inlet flow profile to the flow pattern in downstream is negligible.

Brachial-ankle pulse wave velocity is an independent predictor of carotid artery atherosclerosis in the elderly

Objective Brachial-ankle pulse wave velocity （baPWV） is widely used as a simple noninvasive measure of arterial softness. The aim of this study was to evaluate the usefulness of baPWV as a predictor of the carotid artery atherosclerosis in the elderly. Methods A total of 721 elderly participants （mean ~ SD age, 70.3 -4- 5.6years） were enrolled in the current study. All participant underwent both baPWV measurement and B-mode ultrasound for the intima-media thickness. Carotid atherosclerosis （CAS） was defined as the present of carotid plaque or and/or intima media thickness for at least 1.1 mm. Results A multivariate logistic regression analysis reveals that age, sex, brachial-ankle pulse wave velocity, smoking and LDL-C level showed a significant correlation with the presence of CAS. The odds ratios of CAS associated with a 500cm/s increase of brachial-ankle pulse wave velocity were 2.378 [95% confidence interval, 1.36 to 4.00, P〈0.05], 3.733 [95% confidence interval, 1.729 to 8.058, P〈0.01], 4.438 [95% confidence interval, 1.659 to 11.803, P〈0.01]. The baPWV significantly correlated with IMT by bivariate correlation analysis （r=-0.39; p=0.001）. After adjusting for factors influencing, baPWV all the same correlated with IMT （r=-0.35; p=0.001）.Conclusion These results indicate that brachial-ankle PWV is an independent predictor of CAS in the elderly.It also means that the direct measurement of arterial stiffness by this simple method may be of great help for the evaluation of carotid artherosclerosis, at least in the elderly

COMBINED INTRAOPERATIVE ILIAC ARTERY STENTS AND FEMORO- POPLITEAL BYPASS FOR MULTILEVEL ATHEROSCLEROTIC OCCLUSIVE DISEASE

Objective. To review our preliminary experience and evaluate our early results of a combined intraoperative iliac angioplasty and stenting with infrainguinal revascularization in multilevel atherosclerotic occlusive disease. Methods. From July 1999 to April 2000, intraoperative iliac angioplasty and stenting combined with simultaneous femoro- popliteal bypass were performed on 12 lower extremities of 10 patients suffering from multilevel atherosclerotic occlusive disease. There were 8 men and 2 women, average 72 years. The indications for procedures included disabling claudication in 3 and rest pain in 7 patients. Results. Eleven iliac angioplasty and stent procedures combined with simultaneous 9 femoro- popliteal bypass and 3 femoro- femoral- popliteal bypass were performed in 12 limbs of 10 patients. Angioplasty and stent placement was technically successful in all patients. One contralateral femoral- popliteal bypass was failure after femorofemoral- popliteal bypass. There were no additional instances of procedural or postoperative morbidity or mortali- ty. Mean follow- up was 5 months (range 1～ 10 months). During the follow- up period, one femoro- infrapopliteal graft became occluded after 7 months and above- knee amputation was required. The cumulative primary patency rate of stented iliac arteries, femoro- femoral bypass grafts and femoro- popliteal bypass grafts were 100％ (11/11), 100％ (3/3) and 90.9％ (10/11) in the follow- up period, respectively. The amputation rate was 8.3％ (1/12). Conclusions. Intraoperative iliac artery PTA and stent placement can be safely and effectively performed simultaneously with infrainguinal revascularization for multilevel atherosclerotic occlusive disease by skilled vascular surgeon, using a portable C arm fluoroscopy in the operating room. Furthermore, iliac artery PTA and stenting was valuable adjunct to distal bypass either to improve inflow and outflow, or to reduce the extent of traditional surgical intervention, and also, any angioplasty and stenting- related complications can be immediately corrected as well.

Lower Extremity Arterial Occlusive Disease As a Rare Complication of Crohn’s Disease

Objective To investigate the clinical characteristics and treatment strategy of lower extremity arterial occlusive disease in patients with Crohn's disease (CD). Methods Clinical information of 9 cases suffering from lower extremity arterial occlusion and CD was investigated retrospectively. Results All the cases were less than 50 years old and the most were females (8/9). Arterial occlusions occurred in either active (5/9) or inactive (4/9) stage of CD. Besides the arteries of lower extremities, other arteries could also be involved such as aorta, iliac artery, renal artery or mesentery artery. Seven cases had atherosclerotic imaging findings (4 had aortic plaques and 6 had iliac artery stenoses). Embolectomy or thromboendarterectomy were mostly performed. Four (44.4%) cases had recurrent lower limb ischemia. Conclusions Arterial occlusive disease is a rare extraintestinal manifestation of CD. A thorough inspection of aorta is necessary. Embolectomy is mostly preferred. Anticoagulation treatment is highly recommended after the operation.

Analysis and clinical applications of metabolic syndrome risk factors for cardiovascular

Metabolic syndrome had many different names, including syndrome X, insulin resistance syndrome. At present the cause of metabolic syndrome is unclear, it may come from two aspects： First, acquired, including being overweight or obese, reduced physical activity and excessive carbohydrate diet; Second, genetic factors, involving multiple genes, not yet fully elucidated. The syndrome is generally believed to be the collection of a variety of cardiovascular risk factors caused by poor lifestyle under the genetic background, including hypertension, dyslipidemia, abdominal obesity, hyperinsulinemia, microalbuminuria, hypercoagulable state, hyperhomocysteinemia and so on. Hyperinsulinemia and insulin resistance is the central link, which is closely related to dyslipidemia, impaired glucose tolerance, and abdominal obesity. Metabolic syndrome may eventually lead to atherosclerosis： coronary artery disease, myocardial infarction, stroke, peripheral vascular disease and endothelial dysfunction. In 1999, the working definition of World Health Organization （WHO） to the metabolic syndrome is： glucose regulation impairment or diabetes, and / or insulin resistance, accompanied by the other two items or more ingredients, such as hypertension, high triglycerides esters hyperlipidemia and / or low HDL cholesterol, central obesity or microalbuminuria.

Percutaneous transluminal stenting in patients with carotid artery stenosis

Objective To assess the efficacy and safety of percutaneous transluminal stenting for patients with carotid artery stenosis.Methods Selective percutaneous transluminal stenting was performed for patients with symptomatic carotid artery stenosis(luminal narrowing ≥ 70%).Success rates and complications associated with the procedures were observed.During six months of follow-up,both recurrent symptom and restenosis rates were recorded.Results There were 17 bifurcating lesions among 27 stenoses in 26 patients,of whom 18 had concomitant coronary artery diseases.The acute procedural success rate was 96.3%(26/27),and the degree of stenosis was reduced from 88.6% ± 8.9%(range 70 - 100)to 0.4% ± 2.0%(range 0 - 10).Six patients developed severe bradycardia and hypotension,and 3 experienced transient loss of consciousness during balloon dilatation.During hospitalization,2 patients experienced loss of consciousness and convulsion,respectively,due to hyperperfusion,and both recovered 12 hours later.There were 2 minor stroke cases (7.4%)but no cases of major stroke or death.At the 6-month follow-up,there were no cases of TIA or new onset of stroke.There was no restenosis detected in 16 cases using angiography and in 10 cases using MRI in 6 to 16 months of follow-up.Conclusions Percutaneous transluminal stenting for patients with carotid artery stenosis has a high procedural success rate with few and acceptable complications.Few patients suffered from recurrent symptoms or showed restenosis in long-term follow-up.

Application of transesophageal echocardiography to aortic embolic stroke

OBJECTIVES: To determine the relative value of transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) in exploring the potential embolic source (PES) in heart and aortic arch and to study the clinical significance of aortic arch atherosclerosis (AAA). METHODS: Forty-nine patients with cerebral embolism were included in this study. TEE and TTE were used to evaluate the potential source of emboli in aortic arch, heart and duplex in the carotid artery. An atherosclerotic lesion of the aortic arch was defined as normal, mild plaque, moderate plaque, and protruding plaque or mobile plaque. RESULTS: Of the 49 patients, 31 (63%) patients showed evidence of AAA: 7 (14.1%) patients were mild, 9 (18.4%) were moderate and 15 (30.6%) were severe. In those 15 patients, 11 had neither severe ICAA nor heart disease. Thirty-three patients had internal carotid arterial atherosclerosis (ICAA). The potential sources of embolization of heart and aortic arch is 48.98% by TEE, but only 18.4% by TTE; 9 patients had heart disease. Age and ICAA were significantly correlated with AAA. CONCLUSION: At present, TEE is a better method for exploring atherosclerotic lesions in the thoracic aorta. AAA is an important potential source of cerebral embolic stroke.

Clinical implications of increased expression of CD40L in patients with acute coronary syndromes

To investigate clinical implications of expression of CD40L in monocytes and changes in serum soluble CD40L in patients with acute coronary syndromes (ACS) Methods Sixteen control and 56 patients, including 24 with stable angina (SA), 20 with unstable angina (UA) and 12 with acute myocardial infarction (AMI) enrolled in this study Expression of CD40L in monocytes was analyzed by flow cytometry and sCD40L levels were measured by ELISA Results Expression of CD40L in monocytes and serum levels of sCD40L in UA and AMI patients were higher than in SA patients and controls In patients with AMI, sCD40L levels showed no significant increase when compared to patients with UA, while AMI patients had a peak level of sCD40L at 24 hours after AMI PTCA induced a marked rise in sCD40L levels in all patients, while CD40L expression in monocytes showed no difference between patients with PTCA, before and after Conclusion Enhanced level of serum sCD40L may be a reliable prognostic indicator for ACS and may represent a marker of coronary disease activity

Application of transesophageal echocardiography to aortic embolic stroke

s To determine the relative value of transesophageal echocardiography (TEE) and tr ansthoracic echocardiography (TTE) in exploring the potential embolic source (PE S) in heart and aortic arch and to study the clinical significance of aortic arc h athersclerosis (AAA) Methods Forty nine patients with cerebral embolism were included in this study TEE an d TTE were used to evaluate the potential source of emboli in aortic arch, heart and duplex in the carotid artery An atherosclerotic lesion of the aortic arch was defined as normal, mild plaque, moderate plaque, and protruding plaque or m obile plaque Results Of the 49 patients, 31(63%) patients showed evidence of AAA: 7 (14 1%) patients were mild, 9 (18 4%) were moderate and 15 (30 6%) were severe In those 15 p atients, 11 had neither severe ICAA nor heart disease Thirty three patients h ad internal carotid arterial atherosclerosis (ICAA) The potential sources of e mbolization of heart and aortic arch is 48 98% by TEE, but only 18 4% by TTE; 9 patients had heart disease Age and ICAA were significantly correlated with A AA Conclusion At present, TEE is a better method for exploring atherosclerotic lesions in the thoracic aorta AAA is an important potential source of cerebral embolic stroke

Screening for significant atherosclerotic renal artery stenosis with a regression model in patients undergoing transradial coronary angiography/intervention

Objective:Early detection of atherosclerotic renal artery stenosis (ARAS) is clinically important with respect to blood pressure control, prevention of renal insufficiency, and even improving survival. We investigated whether the presence of significant ARAS (luminal diameter narrowing ≥70%) could be predicted using a logistic regression model before coronary angiography/intervention. Methods:Initially, we developed a logistic regression model for detecting significant ARAS based upon clinical and angiographic features and biochemical measurements in a cohort of 1 813 patients undergoing transfemoral coronary and renal angiography. This model was then prospectively applied to an additional 495 patients who received transradial renal angiography to ascertain its predictive accuracy for the presence of significant ARAS. Results:Multivariate regression analysis revealed that older age (≥65 years), resistant hypertension, type 2 diabetes, creatinine clearance (Ccr) ≤60 ml/min, and multivessel coronary disease were independent predictors for significant ARAS. A logistic regression model for detecting ARAS by incorporating conventional risk factors and multivessel coronary disease was generated as:P/(1 P)=exp( 2.618+1.112[age≥65 years]+1.891[resistant hypertension]+0.453[type 2 diabetes]+0.587[Ccr≤60 ml/min]+2.254[multivessel coronary disease]). When this regression model was prospectively applied to the additional 495 patients undergoing transradial coronary and renal angiography, significant ARAS could be detected with a sensitivity of 81.2%, specificity of 88.9%, and positive and negative predictive accuracies of 53.8% and 96.7%, respectively. Conclusions:The logistic regression model generated in this study may be useful for screening for significant ARAS in patients undergoing transradial coronary angiography/intervention.

Two-stent strategy for renal artery stenosis with bifurcation lesion

Renal artery stenosis(RAS) with a bifurcation lesion is a challenge for interventional therapy.The aim of this study is to summarize our experience in RAS with a bifurcation lesion.Five patients with RAS involving bifurcation lesion are described.In cases 1 to 3,a single-stent strategy was first adopted.However,these three patients were converted to a two-stent strategy for bailout stent implantation in the side branches.In cases 4 and 5,a simultaneous kissing stent technique was performed.Angiography showed that the reference vascular diameter of the main branch was much larger than those of the side branches.Although obvious residual stenosis existed in cases 1 to 3 after stent implantation,no obvious residual stenosis was seen in cases 4 and 5.Renal artery duplex sonography was performed in cases 1 through 5 at 6,7,7,8,and 6 months,respectively,after the procedures.No evidence of restenosis or occlusion was seen.In conclusion,stent implantation with the simultaneous kissing stent technique may result in more simple and more satisfactory immediate angiographic results.