Prevalence and Correlates of Macrovascular Complications at Type 2 Diabetes Diagnosis in a Tertiary Hospital in Yaoundé, Cameroon

Introduction: The presence of vascular complications at type 2 diabetes (T2D) diagnosis is a heavy burden for developing countries. We aimed to determine the prevalence and correlates of macrovascular complications at T2D diagnosis in Yaoundé, Cameroon. Materials and Methods: We conducted a cross-sectional study at the Essos Hospital Center in Yaoundé from January 2017 to June 2021. We recruited patients newly diagnosed with T2D who, simultaneously, with assessed macrovascular complications including stroke, myocardial infarction (MI) and arterial foot ulcer (AFU). Correlates were investigated using Chi square test and logistic regressions. The significance level was set at 5%. Results: In all, 286 newly diagnosed diabetic patients (51.7% being men) were included. The mean age was 52.6 ± 12.3 years. Prevalent cardiovascular risk factors at diabetes diagnosis were a dyslipidemia (63.6%), sedentary lifestyle (57.7%) and family history of type 2 diabetes (51.6%). The prevalence of macrovascular complications was 17.5% with 8.4% stroke, 5.6% myocardial infarction and 3.4% arterial foot ulcer. Hypertension was associated with all macrovascular complications (p Conclusion: Macrovascular complications are frequent at type 2 diabetes diagnosis and are represented by stroke and myocardial infarction in our study, highlighting the importance of cardiovascular risk evaluation and reduction in people with diabetes right from diagnosis.

Prevention of macrovascular complications in patients with type 2 diabetes mellitus: Review of cardiovascular safety and efficacy of newer diabetes medications

Lack of conclusive beneficial effects of strict glycemic control on macrovascular complications has been very frustrating for clinicians involved in care of patients with diabetes mellitus (DM). Highly publicized controversy surrounding cardiovascular (CV) safety of rosiglitazone resulted in major changes in United States Food and Drug Administration policy in 2008 regarding approval process of new antidiabetic medications, which has resulted in revolutionary data from several large CV outcome trials over the last few years. All drugs in glucagon-like peptide-1 receptor agonist (GLP-1 RA) and sodium-glucose cotransporter-2 (SGLT-2) inhibitor classes have shown to be CV safe with heterogeneous results on CV efficacy. Given twofold higher CV disease mortality in patients with DM than without DM, GLP-1 RAs and SGLT-2-inhibitors are important additions to clinician’s armamentarium and should be second line-therapy particularly in patients with T2DM and established atherosclerotic CV disease or high risks for CV disease. Abundance of data and heterogeneity in CV outcome trials results can make it difficult for clinicians, particularly primary care physicians, to stay updated with all the recent evidence. The scope of this comprehensive review will focus on all major CV outcome studies evaluating CV safety and efficacy of GLP-1 RAs and SGLT-2 inhibitors.

Bridging therapy and direct mechanical thrombectomy in the treatment of cardiogenic cerebral infarction with anterior circulation macrovascular occlusion

BACKGROUND Intravenous thrombolysis is an important treatment for cerebral infarction.However,it is difficult to achieve good results if the patient is complicated with anterior circulation macrovascular occlusion.In addition,the vascular recanalization rate is low,so mechanical thrombectomy,that is,bridging therapy,is needed AIM To investigate the efficacy and safety of bridging therapy and direct mechanical thrombectomy in the treatment of cardiogenic cerebral infarction with anterior circulation macrovascular occlusion.METHODS Ninety-six patients in our hospital with cardiogenic cerebral infarction with anterior circulation macrovascular occlusion from January 2017 to July 2020 were divided into a direct thrombectomy group(n=48)and a bridging group(n=48).Direct mechanical thrombectomy was performed in the direct thrombectomy group,and bridging therapy was used in the bridging treatment group.Comparisons were performed for the treatment data of the two groups(from admission to imaging examination,from admission to arterial puncture,from arterial puncture to vascular recanalization,and from admission to vascular recanalization),vascular recanalization rate,National Institutes of Health Stroke Scale(NIHSS)and Glasgow Coma Scale(GCS)scores before and after treatment,prognosis and incidence of adverse events.RESULTS In the direct thrombectomy group,the time from admission to imaging examination was 24.32±8.61 min,from admission to arterial puncture was 95.56±37.55 min,from arterial puncture to vascular recanalization was 54.29±21.38 min,and from admission to revascularization was 156.88±45.51 min,and the corresponding times in the bridging treatment group were 25.38±9.33 min,100.45±39.30 min,58.14±25.56 min,and 161.23±51.15 min;there were no significant differences between groups(P=0.564,0.535,0.426,and 0.661,respectively).There was no significant difference in the recanalization rate between the direct thrombectomy group(79.17%)and the bridging group(75.00%)(P=0.627).There were no significant differences between the direct thrombectomy group(16.69±4.91 and 12.12±2.07)and the bridging group(7.13±1.23) and(14.40±0.59)in preoperative NIHSS score and GCS score(P=0.200 and 0.203,respectively).After the operation,the NIHSS scores in both groups were lower than those before the operation,and the GCS scores were higher than those before the operation.There was no significant difference in NIHSS and GCS scores between the direct thrombectomy group(6.91±1.10 and 14.19±0.65)and the bridging group(7.13±1.23 and 14.40±0.59)(P=0.358 and 0.101,respectively).There was no significant difference in the proportion of patients who achieved a good prognosis between the direct thrombectomy group(52.08%)and the bridging group(50.008%)(P=0.838).There was no significant difference in the incidence of adverse events between the direct thrombectomy group(6.25%)and the bridging group(8.33%)(P=0.913).CONCLUSION Bridging therapy and direct mechanical thrombectomy can safely treat cardiogenic cerebral infarction with anterior circulation macrovascular occlusion,achieve good vascular recanalization effects and prognoses,and improve the neurological function of patients.

Genetics of macrovascular complications in type 2 diabetes

Type 2 diabetes mellitus(T2DM)is a metabolic disorder that currently affects more than 400 million worldwide and is projected to cause 552 million cases by the year 2030.Long-term vascular complications,such as coronary artery disease,myocardial infarction,stroke,are the leading causes of morbidity and mortality among diabetic patients.The recent advances in genome-wide technologies have given a powerful impetus to the study of risk markers for multifactorial diseases.To date,the role of genetic and epigenetic factors in modulating susceptibility to T2DM and its vascular complications is being successfully studied that provides the accumulation of genomic knowledge.In the future,this will provide an opportunity to reveal the pathogenetic pathways in the development of the disease and allow to predict the macrovascular complications in T2DM patients.This review is focused on the evidence of the role of genetic variants and epigenetic changes in the development of macrovascular pathology in diabetic patients.

Effects of long-term monotherapy with glimepiride vs glibenclamide on glycemic control and macrovascular events in Japanese Type 2 diabetic patients

We investigated whether long-term glimepiride (GP) monotherapy improves insulin resistance and exerts a beneficial effect on beta cell function, as compared with glibenclamide (GC). One hundred Japanese Type 2 diabetic patients were randomly assigned to the GP (n = 50) or the GC (n = 50) group. During a 5-year monitoring period, patients received the indicated SU monotherapy, while changes in SU doses were allowed as needed to maintain HbA1C below 7.0%. The GC group, in parallel with fasting insulin, showed a rapid homeostatic model assessment (HOMA)-R increase and maintained a high HOMA-R level. In contrast, HOMA-R in the GP group decreased continuously, from 2.9 at baseline to 1.8 at study completion. In the GC group, HOMA-b was markedly increased in the first 6 months, then gradually decreased through 18 months. While the HOMA-β elevation in the GP group was more moderate than that in the GC group, HOMA-β levels were maintained with a slight decrease. The cumulative macrovascular disease outcome was 1 for the GP and 7 for the GC group, showing a significant difference. These results suggest that glimepiride monotherapy markedly improved HOMA-R with moderate insulin stimulation, which may account for the difference in macrovascular disease development as compared with the group receiving glibenclamide.

CT-based radiomics to predict development of macrovascular invasion in hepatocellular carcinoma:A multicenter study

Background:Macrovascular invasion(MaVI)occurs in nearly half of hepatocellular carcinoma(HCC)patients at diagnosis or during follow-up,which causes severe disease deterioration,and limits the possibility of surgical approaches.This study aimed to investigate whether computed tomography(CT)-based radiomics analysis could help predict development of MaVI in HCC.Methods:A cohort of 226 patients diagnosed with HCC was enrolled from 5 hospitals with complete MaVI and prognosis follow-ups.CT-based radiomics signature was built via multi-strategy machine learning methods.Afterwards,MaVI-related clinical factors and radiomics signature were integrated to construct the final prediction model(CRIM,clinical-radiomics integrated model)via random forest modeling.Cox-regression analysis was used to select independent risk factors to predict the time of MaVI development.Kaplan-Meier analysis was conducted to stratify patients according to the time of MaVI development,progression-free survival(PFS),and overall survival(OS)based on the selected risk factors.Results:The radiomics signature showed significant improvement for MaVI prediction compared with conventional clinical/radiological predictors(P<0.001).CRIM could predict MaVI with satisfactory areas under the curve(AUC)of 0.986 and 0.979 in the training(n=154)and external validation(n=72)datasets,respectively.CRIM presented with excellent generalization with AUC of 0.956,1.000,and 1.000 in each external cohort that accepted disparate CT scanning protocol/manufactory.Peel9_fos_InterquartileRange[hazard ratio(HR)=1.98;P<0.001]was selected as the independent risk factor.The cox-regression model successfully stratified patients into the high-risk and low-risk groups regarding the time of MaVI development(P<0.001),PFS(P<0.001)and OS(P=0.002).Conclusions:The CT-based quantitative radiomics analysis could enable high accuracy prediction of subsequent MaVI development in HCC with prognostic implications.

Clinical significance of serum miR-129-5p in patients with diabetes mellitus presenting macrovascular complications

BACKGROUND Diabetic macrovascular complications(DMCs)are the most common complications encountered during the course of diabetes mellitus(DM)with extremely high mortality rates.Therefore,there is an urgent need to identify specific and sensitive biomarkers for the early diagnosis of DMCs.AIM To investigate the expression and significance of serum miR-129-5p in patients with DM and macrovascular complications.METHODS Serum samples were collected from 36 healthy controls,58 patients with DM presenting no macrovascular complications,and 62 patients with DMCs.The expression of miR-129-5p was detected using quantitative real-time polymerase chain reaction.Pearson’s correlation assay was performed to analyze the correlation between serum miR-129-5p levels and clinical indicators.Receiver operator characteristic(ROC)analysis was conducted to analyze the diagnostic value of serum miR-129-5p in patients with DM or DMCs.RESULTS There was a 4.378-fold and 7.369-fold increase in serum miR-129-5p expression in the DM(5.346±0.405)and DMCs(8.998±0.631)groups,respectively(P<0.001),compared with the control group(1.221±0.090).In addition,the expression of serum miR-129-5p in patients with DMCs was higher than that in patients with DM,revealing a 1.683-fold increase(P<0.001).Additionally,serum miR-129-5p expression significantly correlated with smoking history,disease duration,and glycated hemoglobin(HbA1c)in patients with DMCs(P<0.001).The area under the ROC curve(AUC)of miR-129-5p as a serum marker was 0.964(95%confidence interval[CI]:0.930-0.997,P<0.001)in distinguishing between patients with DM and healthy controls,whereas the AUC of miR-129-5p as a serum marker was 0.979(95%CI:0.959-0.999,P<0.001)in distinguishing between patients with DMCs and healthy controls.CONCLUSION Elevated serum miR-129-5p expression levels correlate with the development of DMCs and can be utilized as a novel early diagnostic biomarker for DM combined with macrovascular complications.

Association between the Neutrophil-to-lymphocyte Ratio and New-onset Subclinical Macrovascular and Microvascular Diseases in the Chinese Population

Objective The association between neutrophil-to-lymphocyte ratio(NLR)with subclinical macrovascular and microvascular diseases has been less investigated.We sought to examine the association between NLR and new-onset subclinical macrovascular and microvascular abnormalities in the Chinese population.Methods From a community cohort,we included 6,430 adults aged≥40 years without subclinical macrovascular and microvascular diseases at baseline.We measured subclinical macrovascular and microvascular abnormalities separately using the ankle-brachial index(ABI),brachial-ankle pulse wave velocity(baPWV),and albuminuria.Results During a mean follow-up of 4.3 years,110 participants developed incident abnormal ABI,746 participants developed incident elevated baPWV,and 503 participants developed incident albuminuria.Poisson regression analysis indicated that NLR was significantly associated with an increased risk of newonset abnormal ABI,elevated baPWV,and albuminuria.Compared to overweight/obese participants,we found a much stronger association between NLR and subclinical vascular abnormalities in participants with normal weight.Furthermore,we found an interaction between the NLR and body mass index(BMI)on the risk of new-onset abnormal ABI(P for interaction:0.01).Conclusion NLR was associated with subclinical macrovascular and microvascular diseases in the Chinese population.Furthermore,in participants with normal weight,the association between NLR and subclinical vascular abnormalities was much stronger.

Evaluation of serological indicators of intravenous thrombolysis bridge stent combined with aspiration embolectomy for intracranial macrovascular infarction

Objective: To explore the effect of intravenous thrombolysis bridge stent combined with aspiration embolectomy on serological indicators in patients with intracranial macrovascular infarction. Methods: 92 patients with intracranial macrovascular infarction who received treatment in our hospital between February 2016 and January 2018 were selected as the research subjects and divided into the control group (n=46) and the study group (n=46) by random number table method. Control group received stent embolectomy alone, and study group received intravenous thrombolysis bridge stent combined with aspiration embolectomy. The differences in serum levels of inflammatory mediators, chemokines and nerve function-related indexes were compared between the two groups before treatment and 24h after embolectomy. Results: Before treatment, the differences in serum levels of inflammatory mediators, chemokines and nerve function-related indexes were not significant between the two groups. 24h after embolectomy, serum inflammatory mediators sICAM-1, hs-CRP and TNF-α levels of study group were lower than those of control group;serum chemokines CXCL16, Fractalkine and MCP-1 contents were lower than those of control group;serum nerve function-related indexes IGF-1, BDNF and CNTF levels were higher than those of control group whereas NSE level was lower than that of control group. Conclusion:Intravenous thrombolysis bridge stent combined with aspiration embolectomy can effectively reduce the systemic inflammatory response and optimize the nerve function in patients with intracranial macrovascular infarction.

Serum metrix metalloproteinase-9 combined with homocysteine, IL-6, TNF-α, CRP, HbA11c and lipid profile in the incipient diabetic nephropathy with or without macrovascular diseases

Objective: To evaluate the changes of serum matrix metalloproteinase-9 (mmp-9) in patients of incipient diabetic nephropathy with or without macrovascular disease and to analyze the factors associated with homocysteine(hcy), interleukin-6(IL-6), tumor necrosis factor-alpha (TNF-α), highly sensitive C-reactive protein (hsCRP), HbA1c and lipid profile in those patients in order to know whether this marker or other factors are more important to induce diabetic macrovascular disease. Methods: Type 2 diabetes mellitus(T2DM) subjects with incipient diabetic nephropathy with or without macrovascular disease were selected for participation and divided into 2 groups. The patients in group 1(n= 38) used insulin, and patients in group 2 (n = 34) were treated with an oral antidiabetic drug. Then serum mmp-9, hcy, IL-6 and TNF-αin these patients were measured, and compared to the healthy subjects as control (n= 16). The results were analyzed by SPSS13. Results: Serum mmp-9 and hcy of the patients having incipient diabetic nephropathy with macrovascular disease were higher than that of patients without macrovascular disease (P<0. 01). For insulin-injected patients, whether they accompanied with macrovascular diseases or not, the serum levels of mmp-9, hcy, IL-6 and TNF-αwere all lower, but no significant statistics compared with non-insulin used patients or the healthy subjects. The serum level of mmp-9 was more correlated with the serum hcy in antidiabetic drug used patients. (P<0. 000) Conclusion: The serum level of mmp-9 plays an important role of pathogenesis in the macrovascular disease in the incipient diabetic patients, and the serum level of hcy also can reflect the severely degree of macrovascular disease in these patients, insulin can reduce these markers.

Effect of Shenqi Compound Formula on PPARγ in White Adipose Tissue of Rats with Macrovascular Lesion in Early Stage of Diabetes

Objective:To investigate the effect of Shenqi Compound Formula (SCF) on peroxisome proliferators-activated receptor γ (PPARγ) in white adipose tissue of rats with macrovascular lesion in early stage of diabetes. Methods: Corresponding treatment was given to rats in model group, Ramipril group, normal control group, low dosage SCF group and high dosage SCF group respectively for 32 days. The expressions of PPARγ and adiponectin Messenger RNA (mRNA) were detected by real-time reverse transcriptase poly-merase chain reaction. Results: The expressions of PPARγ and adiponectin mRNA increased significantly in both low and high dosage SCF groups as compared with the model group, and a positive linear correlation was found between the expressions of PPARγ and adiponectin mRNA. Conclusions: SCF can prevent macrovascular lesion in early stage of diabetes, which is possibly related with up-regulating expressions of PPARγ and activating PPARγ.

大黄糖络丸通过调控PI3K-Akt/NF-κB信号通路减轻糖尿病大鼠大血管炎症反应

目的:基于磷脂酰肌醇3-激酶(PI3K)-蛋白激酶B(PKB/Akt)/核因子κB(NF-κB)信号通路,探讨大黄糖络丸(RSP)防治Zucker糖尿病肥胖(ZDF)大鼠大血管炎症反应的作用机制。方法:15只雄性ZDF(fa/+)大鼠作为对照组;高脂饲料诱导成模的75只雄性ZDF(fa/fa)大鼠随机分为模型组,高、中、低剂量RSP组,以及二甲双胍组,每组15只。药物干预12周后,处死大鼠,分离血清,检测高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)和总胆固醇(TC)水平;ELISA法检测大鼠血清CD4、白细胞介素6(IL-6)和肿瘤坏死因子α(TNF-α)含量;HE染色观察大鼠腹主动脉组织病理改变;免疫组化染色检测腹主动脉中单核细胞趋化蛋白1(MCP-1)蛋白表达;RT-qPCR检测大鼠腹主动脉中PI3K、Akt和NF-κB p65的mRNA表达;Western blot观察腹主动脉组织中PI3K、Akt、p-Akt、p-IκB和NF-κB p65蛋白水平。结果:与模型组相比,RSP显著降低糖尿病大鼠空腹血糖及LDL-C、TG和TC水平(P<0.05),升高HDL-C水平(P<0.05或P<0.01),显著降低血清炎症介质表达,IL-6、TNF-α和CD4水平显著下降(P<0.05或P<0.01),腹主动脉组织病理学损伤程度显著减轻,腹主动脉中PI3K、Akt和NF-κB p65的mRNA及蛋白水平,以及MCP-1、p-Akt和p-IκB蛋白水平均显著降低(P<0.05或P<0.01)。结论:RSP可降糖调脂并减轻糖尿病大鼠大血管炎症损伤,其机制可能与抑制PI3K-Akt/NF-κB信号通路活化、减轻炎症反应有关。

Changes of macrovascular endothelial ultrastructure and gene expression of endothelial nitric oxide synthase in diabetic rats

Background The most intimidatory pathological changes in patients with DM are cardiovascular illnesses, which are the major causes of death in diabetic patients and are far more prevalent than in nondiabetics because of accelerated atherosclerosis In this study, we tried to clarify the changes in macrovascular endothelial ultrastructure and in the gene expression of endothelial nitric oxide synthase (eNOS)mRNA in diabetic rats KH*2/5DMethods The study was conducted on 52 of 10-week old Sprague Dawley (SD) rats with body weight of (320±42) g SD rats were divided into: experimental group treated with a single intraperitoneal injection of streptozotocin (STZ, 60 mg/kg), (male, n=20, diabetes mellitus (DMM)); female, n=12, diabetes mellitus female (DMF)) and control group (male, n=10, diabetes mellitus male control (DMMC); female, n=10, diabetes mellitus female control (DMFC)) Four weeks after treatment, half of the rats were sacrificed; the remainders were sacrificed ten weeks after treatment One part of the abdominal aortic sample was stored under glutaraldehyde (volume fraction ψ B = 2 5 %) After the process of chemical fixation, chemical dehydration, drying and conductivity enhancement, all samples were observed and photographed using scanning electron microscopy (Leica-Stereoscan 260, England) The other part of the abdominal aortic sample was treated with liquid nitrogen and the expression of eNOSmRNA was assessed by semi-quantitative RT-PCR Results The aortic lumen of both experimental groups adsorbed much more debris than that of either control group The endothelial surfaces of diabetic rats were coarse, wrinkled and protuberant like fingers or villi The vascular endothelial lesions of diabetic male rats were very distinct after 4 weeks, and as obvious as those at 10 weeks The vascular endothelial lesions of diabetic female rats were not severe at 4 weeks and only became marked after 10 weeks In both males and females, the abdominal aortic eNOSmRNA content of 4 weeks and 10 weeks diabetic rats was very significantly lower ( P <0 01) than that of controls Conclusions Aortic endothelial ultrastructure in DM rats is injured compared with controls Abnormal changes of aortic endothelia in male DM rats are more obvious than those in females Expression of abdominal aortic eNOSmRNA content of DM rats is significantly lower than that of controls

Variant rs2237892 of KCNQ1 Is Potentially Associated with Hypertension and Macrovascular Complications in Type 2 Diabetes Mellitus in A Chinese Han Population

KCNQ1 has been identified as a susceptibility gene of type 2 diabetes mellitus （T2DM） in Asian populations through genome-wide association studies. However, studies on the association between gene polymorphism of KCNQ1 and T2DM complications remain unclear. To further ana- lyze the association between different alleles at the single nncleotide polymorphism （SNP） rs2237892 within KCNQ1 and TD2M and its complications, we conducted a case-control study in a Chinese Han population. The C allele of rs2237892 variant contributed to susceptibility to T2DM （odds ratio [OR], 1.45; 95% confidence interval [CI], 1.20 1.75）. Genotypes CT （OR, 1.97; 95% CI, 1.24-3.15） and CC （OR, 2.49; 95% CI, 1.57-3.95） were associated with an increased risk of T2DM. Multivariate regression analysis was performed with adjustment of age, gender, and body mass index. We found that systolic blood pressure （P = 0.015）, prevalence of hypertension （P = 0.037）, and risk of maerovascnlar disease （OR, 2.10; CI, 1.00-4.45） were significantly higher in subjects with the CC genotype than in the combined population with genotype either CT or TT. Therefore, our data support that KCNQ1 might contribute to the higher incidence of patients with T2DM carrying the risk allele C population. is associated with an increased risk for T2DM and hypertension and macrovascular complications in though it needs further to be confirmed in a larger

Characteristics and outcomes of hepatocellular carcinoma patients with macrovascular invasion following surgical resection: a meta-analysis of 40 studies and 8,218 patients

Background:Guidelines recommend that hepatocellular carcinoma(HCC)patients with portal vein tumor thrombosis(PVTT)and/or hepatic vein tumor thrombosis(HVTT)should undergo systemic therapy.However,recent data suggest that surgical resection may be beneficial in selected cases,but outcomes are heterogenous.We aimed to estimate pooled overall survival(OS),recurrence free survival(RFS)and complication rates in HCC patients with macrovascular invasion(MVI)following surgical resection.Methods:In this systematic review and meta-analysis,two investigators independently searched PubMed,Embase,and Cochrane databases from inception to Nov 10,2020,without language restrictions,for studies reporting outcomes of adult HCC patients with MVI who underwent liver resection with curative intent.Results:We screened 8,598 articles and included 40 studies involving 8,218 patients.Among all patients with MVI,the pooled median OS was 14.39 months[95%confidence interval(CI):10.99-18.84],1-year OS was 54.47%(95%CI:46.12-62.58%)and 3-year OS was 23.20%(95%CI:16.61-31.42%).Overall,1-and 3-year RFS were 27.70%(95%CI:21.00-35.57%)and 10.06%(95%CI:6.62-15.01%),respectively.Among patients with PVTT,median OS was 20.41 months in those with segmental/2nd order involvement compared to 12.91 months if 1st order branch was involved and 6.41 months if the main trunk was involved.The pooled rate of major complications was 6.17%(95%CI:3.53-10.56%).Conclusions:Overall median survival was 14.39 months for HCC patients with MVI following resection.Median survival was higher in PVTT with segmental/2nd order involvement at 20.41 versus 6.41 months if the main trunk was involved.

心脏康复护理在心脏大血管外科术后的应用效果分析

目的:分析心脏康复护理在心脏大血管外科术后的应用效果。方法:选取2021年1月—2023年1月滨州医学院附属医院心脏大血管外科收治的心脏大血管外科术后患者82例作为研究对象,按照随机数字表法分为对照组和观察组,各41例。对照组采用常规护理,观察组在对照组基础上采用心脏康复护理。比较两组心肺功能、运动能力以及心脏不良事件发生情况。结果:护理前,两组峰值摄氧量、无氧阈、左心室射血分数(LVEF)比较,差异无统计学意义(P>0.05);护理后,两组峰值摄氧量、无氧阈、LVEF升高,观察组高于对照组,差异有统计学意义(P<0.05)。护理前,两组6 min步行距离(6MWD)、功能独立性评定量表(FIM)评分比较,差异无统计学意义(P>0.05);护理后,两组6MWD、FIM评分升高,观察组高于对照组,差异有统计学意义(P<0.05)。观察组心脏不良事件总发生率低于对照组,差异有统计学意义(P=0.048)。结论:心脏康复护理在心脏大血管外科术后的应用效果显著,能够改善患者心肺功能,增强运动能力,减少心脏不良事件发生风险。

替罗非班用于急性前循环大血管闭塞机械取栓术效果及预后影响因素分析

目的探讨替罗非班用于急性前循环大血管闭塞患者机械取栓术的临床效果,并分析患者预后的独立影响因素。方法选取医院2019年2月至2023年2月行机械取栓术的急性前循环大血管闭塞患者160例,按治疗方案的不同分为观察组(90例)和对照组(70例)。两组患者均行机械取栓术,术后均予双联抗血小板聚集(口服阿司匹林肠溶片及硫酸氢氯吡格雷片)治疗,观察组患者术中加用盐酸替罗非班注射用浓溶液静脉泵入并维持24 h。两组疗程均为3个月。采用单因素分析筛选影响观察组患者预后的指标,建立多因素Logistic线性回归模型,采用受试者工作特征(ROC)曲线评估模型的预测价值,并采用Hosmer-Lemeshow检验判断模型的拟合优度。结果两组患者治疗1,3个月后的美国国立卫生研究院卒中量表(NIHSS)评分、改良Rankin量表(mRS)评分均显著降低,白细胞介素6(IL-6)、超敏C反应蛋白(hs-CRP)水平均显著降低,中枢神经特异性蛋白(S100β)、髓鞘碱性蛋白(MBP)水平均显著降低,凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)均显著延长,且两组治疗3个月后上述指标的改善程度均显著优于治疗1个月后,观察组上述指标的改善程度均显著优于对照组(P<0.05)。两组患者术后出血发生率及不良反应发生率均无显著差异(P>0.05)。术前NIHSS评分、PT、APTT、hs-CRP、S100β均为预后的独立影响因素(P<0.05)。ROC曲线下面积(AUC)为0.894,敏感度为83.3%,特异度为73.3%,Hosmer-Lemeshow拟合优度检验结果表明模型预测效果良好(χ²=8.616,P=0.376)。结论替罗非班联合机械取栓术治疗急性前循环大血管闭塞,能减轻患者的炎性反应,改善神经功能。PT、APTT、术前NIHSS评分、hs-CRP、S100β为术后预后的独立影响因素。

非高密度脂蛋白胆固醇与2型糖尿病大血管病变相关性的研究进展

糖尿病不仅需要关注,同时其导致的大血管病变更是全球健康威胁的主要原因之一。随着糖尿病大血管并发症发生率的增加,急需新的指标及策略来预防疾病进展。血脂异常增加了大血管并发症的可能性,包括冠心病、中风或外周血管疾病。本篇综述旨在全面分析非高密度脂蛋白胆固醇(non-HDL-C)与大血管病变的相关性,进一步论证non-HDL-C是否可替代低密度脂蛋白胆固醇(LDL-C)作为未来潜在的治疗靶点。

血清PCSK9、vWF和apoM水平在2型糖尿病并发大血管病变中的诊断价值

目的观察血清转化酶枯草溶菌素9(PCSK9)、血管性假血友病因子(vWF)和载脂蛋白M(apoM)水平在2型糖尿病并发大血管病变中的诊断价值。方法选择2018年1月至2021年6月在该院就诊的210例2型糖尿病患者纳入2型糖尿病组。选择同期在该院行健康体检的75例健康者纳入健康对照组。根据大血管病变的诊断标准将2型糖尿病患者分为单纯糖尿病组(118例)和大血管病变组(92例)。观察各组血清PCSK9、vWF和apoM水平变化,对2型糖尿病并发大血管病变进行单因素和多因素分析,比较2型糖尿病患者治疗前后血清PCSK9、vWF和apoM水平变化,并分析3项指标在2型糖尿病并发大血管病变中的诊断效能。结果2型糖尿病组血清PCSK9和vWF水平明显高于健康对照组,而血清apoM水平明显低于健康对照组,差异有统计学意义(P<0.05)。治疗前大血管病变组血清PCSK9和vWF水平明显高于单纯糖尿病组,差异有统计学意义(P<0.05);治疗后两组血清PCSK9和vWF水平均较治疗前明显降低,但大血管病变组仍高于单纯糖尿病组,差异有统计学意义(P<0.05)。治疗前大血管病变组血清apoM水平明显低于单纯糖尿病组,差异有统计学意义(P<0.05);治疗后两组血清apoM水平均较治疗前明显升高,但大血管病变组仍低于单纯糖尿病组,差异有统计学意义(P<0.05)。单因素分析显示,大血管病变组年龄≥60岁及糖尿病病程≥10年比例、甘油三酯和低密度脂蛋白胆固醇水平明显高于单纯糖尿病组,差异有统计学意义(P<0.05)。多因素分析显示PCSK9、vWF水平升高是2型糖尿病并发大血管病变的独立危险因素(P<0.05),血清apoM水平升高是2型糖尿病并发大血管病变的保护因素(P<0.05)。血清PCSK9、vWF和apoM联合检测诊断2型糖尿病并发大血管病变的灵敏度为89.1%,特异度为90.7%,曲线下面积(AUC)为0.956,AUC明显高于PCSK9(Z=4.167,P<0.01)、vWF(Z=4.056,P<0.01)和apoM(Z=5.183,P<0.01)单项指标检测,而3项指标之间的AUC差异无统计学意义(P>0.05)。结论PCSK9、vWF和apoM参与了2型糖尿病并发大血管病变的过程,3项指标联合检测对诊断2型糖尿病并发大血管病变具有较高的效能。

缺血性脑卒中大血管病变不同治疗方法脑微出血的比较

目的 比较两种方法治疗缺血性脑卒中大血管病变发生脑微出血有无差异。方法 入组78例缺血性脑卒中合并大血管病变患者,分为双联抗血小板药物保守治疗组和支架植入+双联抗血小板药物治疗组,进行临床队列研究。收集患者的一般资料,年龄、性别、吸烟饮酒史,相关高血压病、糖尿病病史;测身高体重计算体重指数;动态监测患者血压;分别于入组时以及治疗3月后记录血常规、血生化指标:血小板计数、空腹血糖、血尿酸、同型半胱氨酸、低密度脂蛋白;同样于入组时以及治疗3月后完善头颅CT、头颅核磁平扫+磁敏感加权成像(MRI+SWI),明确是否发生脑出血,记录脑微出血数目。应用SPSS 25.0软件进行统计学分析,比较入组时以及治疗3月后上述指标有无统计学差异。结果 双联抗血小板药物治疗组入组38人,平均年龄:64.87±6.29岁,女性患者15人,男性患23人。支架植入+双联抗血小板药物治疗组入组40人,平均年龄:64.28±6.82岁,两组间年龄无统计学差异。治疗前两组间年龄、体重指数(BMI)、收缩压(SBP)、舒张压(DBP)、空腹血糖(FPG)、血尿酸(UA)、同型半胱氨酸(Hcy)、血小板计数(Plt)以及脑微出血(CBMs)数量比较,差异均无统计学意义(P≥0.05)。两组间低密度脂蛋白比较,差异有统计学意义(P<0.05)。双联抗血小板药物治疗组治疗3月后血压、空腹血糖、同型半胱氨酸、血小板计数、低密度脂蛋白水平下降,脑微出血数量增加(P<0.05)。血尿酸水平与治疗前比较,差异无统计学意义(P≥0.05)。支架植入+双联抗血小板治疗3月后血压、空腹血糖、同型半胱氨酸、血小板计数、低密度脂蛋白水平下降,脑微出血数量增加(P<0.05)。血尿酸水平与治疗前比较,差异无统计学意义(P≥0.05)。治疗后两组间收缩压(SBP)、舒张压(DBP)、空腹血糖(FPG)、血尿酸(UA)、同型半胱氨酸(Hcy)、血小板计数(Plt)以及脑微出血(CBMs)数量比较,差异均无统计学意义(P≥0.05)。两组间低密度脂蛋白比较,差异有统计学意义(P<0.05)。结论 缺血性脑卒中大血管病变两种治疗方法脑微出血比较差异无统计学意义。两种治疗方法治疗3月后脑微出血数量均有所增加。