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.

Quality control of ultrasonic measurement of carotid artery intima-media thickness

Background To report quality control methods and baseline reproducibility data of the ultrasound measurements of carotid artery intima-media thickness in the project of Establishment of an Integrated System for Coronary Heart Disease Prevention and Treatment. Methods Standard ultrasound scanning and measuring protocols were established by the study group. All sonographers and readers were trained by the carotid ultrasound core lab and all digital ultrasound images were centrally read. Ten subjects were scanned twice （with 1 week interval） by 2 sonographers independently and images were read by a single reader to evaluate the sonographer variability. Twenty subjects＇ images were read twice （with 1 week interval） by a single reader to assess the reader variability and the reproducibility of IMT measured at different carotid segments. Results The intraclass correlation （ICC） of intra- and inter-sonographer and intra- reader for mean IMT measurements was 0.99, 0.98 and 0.97 respectively; while for max IMT, it was 0.97, 0.99 and 0.95 respectively. Among different carotid segments and sites, ICC for mean 1MT measurements of common carotid （CCA）, carotid artery bulb （Bulb）, internal carotid artery （ICA）, overall near wall and overall far wall was 0.97, 0.99, 0.89, 0.93 and 0.98 respectively. Conclusion The reproducibility of IMT measurements according to our protocol is acceptable, although better reproducibility is found when measuring the mean IMT than max IMT, CCA and Bulb IMT than ICA IMT, and far wall IMT than near wall IMT.

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.

Coronary atherosclerosis burden is not advanced in patients with β-thalassemia despite premature extracardiac atherosclerosis： a coronary artery calcium score and carotid intima-media thickness study

Background Thalassemic patients demonstrate an increased rate of extracardiae vascular complications and increased carotid wall intima-media thickness （cIMT）, but very low prevalence of coronary artery disease （CAD）. We investigated the atheroma burden by assessing the coronary artery calcium （CAC） and elMT in these patients. Methods We examined 37 patients with β-thalassemia and 150 healthy control volunteers with multi-detector computer tomography （CT） and ultrasonography to determine CAC score and cIMT, respectively. Results Propensity score matching （C-statistic： 0.88; 95% CI： 0.83-0.93） resulted in 27 pairs of patients; severe CAC was observed in 2 （7.4%） and 0 of β-thalassemia patients and healthy volunteers respectively （P = 0.5）. Median calcium score was 0 （0-0） in β-thalassemia patients and 0 （0-4） in healthy volunteers （P = 0.8）. Median intima-media thickness was higher in β-thalassemia patients compared to control group [0.45 （0.06-0.65） vs. 0.062 （0.054-0.086）; P = 0.04]. Conclusions Patients with β-thalassemia in comparison with healthy control subjects exhibit similar CAC score and increased cIMT. Our findings indicate a disparate rate of progression of atherosclerosis between coronary and extracardiac arteries in these patients lending support to the epidemiological evidence.

A REVIEW ON ARTERY WALL SEGMENTATION TECHNIQUES AND INTIMA-MEDIA THICKNESS MEASUREMENT FOR CAROTID ULTRASOUND IMAGES

Stroke and heart attack,which could be led by a kind of cerebrovascular and cardiovascular disease named as atherosclerosis,would seriously cause human morbidity and mortality.It is important for the early stage diagnosis and monitoring medical intervention of the atherosclerosis.Carotid stenosis is a classical atherosclerotic lesion with vessel wall narrowing down and accumulating plaques burden.The carotid artery of intima-media thickness(IMT)is a key indicator to the disease.With the development of computer assisted diagnosis technology,the imaging techniques,segmentation algorithms,measurement methods,and evaluation tools have made considerable progress.Ultrasound imaging,being real-time,economic,reliable,and safe,now seems to become a standard in vascular assessment methodology especially for the measurement of IMT.This review firstly attempts to discuss the clinical relevance of measurements in clinical practice at first,and then followed by the challenges that one has to face when approaching the segmentation of ultrasound images.Secondly,the commonly used methods for the IMT segmentation and measurement are presented.Thirdly,discussion and evaluation of different segmentation techniques are performed.An overview of summary and future perspectives is given finally.

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.

Correlation of the carotid intima-media unevenness and stiffness with serum illness indexes in patients with type 2 diabetes mellitus

Objective: To investigate the correlation of the carotid intima-media unevenness and stiffness with serum illness indexes in patients with type 2 diabetes mellitus. Methods: A total of 118 patients with type 2 diabetes mellitus who were treated in this hospital between February 2016 and August 2017 were selected as the diabetes group, and 100 healthy volunteers who received physical examination in this hospital during the same period were selected as normal control group. The differences in carotid intima-media unevenness and stiffness levels as well as serum levels of insulin resistance indexes and inflammatory adipocytokines were compared between the two groups of subjects. Pearson test was used to assess the correlation between carotid intima-media parameter levels and above serum illness index levels in patients with type 2 diabetes mellitus. Results: IMIsqrt and PWV levels in diabetes group were higher than those in normal control group;serum FINS and IRI levels were higher than those in normal control group whereas ISI level was lower than that in normal control group;serum APN content was lower than that in normal control group whereas LEP and SAA contents were higher than those in normal control group. Pearson test showed that the IMIsqrt and PWV levels in patients with type 2 diabetes mellitus were directly correlated with serum insulin resistance index levels and inflammatory adipocytokine contents. Conclusion: Carotid intima-media unevenness and stiffness both increase in patients with type 2 diabetes mellitus, and could objectively reflect the insulin resistance and systemic micro-inflammatory state.

Metformin effect on internal carotid artery blood flow assessed by area under the curve of carotid artery Doppler in women with polycystic ovarian syndrome

BACKGROUND Insulin resistance(IR)was reported in most polycystic ovarian syndrome(PCOS)cases.Metformin,a biguanide drug,successfully reduced IR.Homeostatic Model Assessment for IR(HOMA-IR)and Doppler parameters assessed metformin's effectiveness.AIM To verify whether the area under the curve of the internal carotid artery(AUC-ICA)Doppler wave can be a useful marker for assessing IR among PCOS cases who presented with menstrual irregularity and were treated with metformin over 6 mo.METHODS An observational,cross-sectional study recruited 54 eligible PCOS women;the anthropometrics were as follows:age,body mass index(BMI),menstrual cycle days,biochemical serum cholesterol,low and high-density lipoprotein,sex hormone-binding globulin,fasting blood glucose,and HOMA-IR,hormonal testosterone,luteinizing hormone over follicle-stimulating hormone ratio,and ultrasonic pulsatility index(PI)and resistance index(RI),carotid artery intima-media thickness(CIMT)and(AUC-ICA)parameters were initially recorded and repeated 3 mo and 6 mo later with metformin tab 500 mg;three times/day for 6 mo.In addition,AUC-ICA was assessed by taking repeated systolic and diastolic wave height measurements.RESULTS Metformin caused a progressive reduction in BMI,menstrual cycle days,biochemical hormonal,and Doppler parameters(CIMT,PI,RI,and AUC-ICA).AUC-ICA correlated strongly to all PCOS parameters.AUC-ICA correlated inversely with treatment time(r=-0.98,P<0.001)and positively with HOMA-IR(r=0.98,P<0.0001).Via the best subset regression model,the AUC-ICA had the highest predictive value for HOMA-IR.CONCLUSION AUC-ICA preceded PI,RI,and CIMT with a strong,meaningful correlation to all PCOS parameters,making it a reliable marker for the assessment of IR,especially during metformin therapy.Further studies are recommended to promote the application in practice.

Relationship of plasma homocysteine, soluble intercellular adhesion molecule-1, high mobility group box 1 protein with carotid intima-media thickness in elderly patients with type 2 diabetes mellitus

Objective:To explore the relationship of plasma homocysteine(Hcy),soluble intercellular adhesion molecule-1(sICAM-1)and high mobility group box 1 protein(HMGB1)with carotid intima-media thickness(c-IMT)in elderly patients with type 2 diabetes mellitus.Methods:A total of 100 elderly patients who were diagnosed as type 2 diabetes mellitus in Baogang Hospital of Inner Mongolia from June 2017 to May 2020 were chosen as research objects.According to c-IMT,they were divided into the normal group(n=35),the mild to moderate group(n=41)and the severe group(n=24).The expression levels of plasma Hcy,sICAM-1 and HMGB1 were compared between groups respectively.Pearson’s correlation coefficient was used to analyze the relationship of plasma Hcy,sICAM-1,HMGB1 with c-IMT.Results:The comparison in plasma Hcy,sICAM-1,HMGB1 and c-IMT among the three groups of patients was of statistical significance(p<.05).The results of correlation analysis showed that the expression levels of plasma Hcy,sICAM-1 and HMGB1 were positively correlated with c-IMT in elderly patients with type 2 diabetes mellitus(r=.627,.598,.614;p<.05).Conclusions:The expression levels of plasma Hcy,sICAM-1 and HMGB1 are abnormally increased in elderly patients with type 2 diabetes mellitus,and related to c-IMT,which can provide a strong evidence for clinical diagnosis and treatment by detecting their levels in clinical practice.

健康体检人群颈动脉粥样硬化流行趋势

目的:回顾性分析2008—2017年健康体检人群颈动脉粥样硬化检出率变化趋势。方法:收集北京市体检中心2008—2017年184416例健康体检人群的相关数据,按年度分组,每年为一组;按年龄和性别分层,计算颈动脉粥样硬化检出率,并进行标化后分析10年间健康体检人群颈动脉粥样硬化检出率变化趋势。按年龄分为18~29岁组、30~39岁组、40~49岁组、50~59岁组、60~69岁组和70岁以上组,按性别分为男性组和女性组。结果:健康体检人群颈动脉粥样硬化检出率10年来呈总体上升趋势,男性各年龄组颈动脉粥样硬化检出率均高于女性(P<0.05),与2008年比较,2017年男性颈动脉粥样硬化检出率升高了16.45个百分点,女性升高了17.56个百分点。男女颈动脉斑块、颈动脉内中膜增厚检出率均呈上升趋势(P<0.05),各年度男性颈动脉内中膜增厚检出率均高于女性(P<0.05),与2008年比较,2017年男性颈动脉斑块检出率升高了21.60个百分点,女性升高了10.67个百分点。30岁以上男女各年龄组颈动脉粥样硬化检出率呈上升趋势(P<0.05)。40~59岁两个年龄组颈动脉粥样硬化上升趋势明显高于其他年龄组。结论:体检人群颈动脉粥样硬化水平近10年总体均呈上升趋势,40~59岁人群是颈动脉粥样硬化预防的重点人群。

Relationship between Carotid Atherosclerosis and Cerebral Infarction

Objective To study the relationship between carotid atherosclerosis and cerebral infarction (CI). Methods Between November 2008 and March 2009,147 CI patients (CI group) and 48 patients with non-cerebrovascular diseases (control group) were enrolled from inpatients of Neurology Department of our hospital. The diagnostic criterion of thickened carotid intima was set as 1.0 mm≤intima-media thickness (IMT) <1.5 mm and that of carotid plaque was as IMT≥1.5 mm. Carotid atherosclerosis was divided into three levels: normal intima,thickened intima,and plaque formation. The color Doppler ultrasonography data of carotid arteries in all patients were analyzed and the severity of carotid atherosclerosis was compared between the two groups. Results In the CI group,36 (24.5%) patients had normal carotid intima,22 (15.0%) had thickened carotid intima,and 89 (60.5%) had carotid plaque. In the control group,22 (45.8%) patients had normal carotid intima,4 (8.3%) had thickened carotid intima,and 22 (45.8%) had carotid plaque. The severity of carotid atherosclerosis in the CI group was higher than that in the control group (P=0.022). There was significant difference in the constitution of carotid plaque between the two groups (P=0.001); the CI group mainly had the soft plaque (55/89,61.8%),whereas the control group mainly had the hard plaque (17/22,77.3%). The first three common locations of carotid plaque in both groups were carotid bifurcation (CI group: 73.7%; control group: 64.1%),common carotid artery (CI group: 20.4%; control group: 25.6%),and internal carotid artery (CI group: 5.9%; control group: 10.3%). The location of carotid plaque between the two groups was not significantly different (P=0.438). There was no difference in the carotid inner diameter or resistance index between the two groups (P>0.05). Conclusions Carotid atherosclerosis is to some extent able to reveal the atherosclerotic condition of cerebral arteries and act as an important predictor for the risk of CI. The color Doppler ultrasonography of carotid arteries can provide a convenient way for the prevention and treatment of CI.

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.

Glycemic and blood pressure control in older patients with hypertension and diabetes： association with carotid atherosclerosis

Backgroud Numerous studies have confirmed the effectiveness of slowing the progression of atherosclerosis by blood pressure （Bp） control in patients with hypertension and several studies also showed the efficacy of intensive glycemic control in decreasing progression of carotid intima-media thickness （CIMT） in patients with type 1 and type 2 diabetes. However, few studies have compared the relative importance of glycemic w＇. Bp control in patients with diabetes and hypertension. We aimed to investigate the association between Bp and glycemic control and subclinical carotid atherosclerosis in older patients with hypertension and type 2 diabetes. Methods In a cross-sectional study, B-mode high-resolution ultrasonography of the carotid artery was performed in 670 subjects （508 males and 162 females） aged 60 years or over who had self-reported hypertension and diabetes but no history of coronary heart disease or stroke. Subjects were categorized by their systolic blood pressure： tight control, 〈 130 mmHg; usual control, 130-139 mmHg; or uncontrolled, 〉 140 mmHg, and by their hemoglobin Alc （HbAlc） level： tight control, 〈 6.5%; usual control, 6.5%-7.5%; or uncontrolled, 〉 7.5%, respectively. Results The mean CIMT was 8.20 ±0.11 mm, and carotid plaque was found in 52.5% （352/670） subjects. Overall, 62.1% of the subjects had subclinical carotid atherosclerosis, defined as having either carotid plaque or elevated CIMT （≥ 1.1 ram）. The mean CIMT was significantly different between Bp control categories （7.60 ± 0.09 mm, 7.90 ±0.08 mm, and 8.60 ± 0.12 mm, respectively, P = 0.03） but not between glycemic control categories （8.20± 0.10 mm, 8.1 ±0.08 mm, and 8.40 ± 0.14 ram, respectively, P = 0.13） using ANCOVA analysis. Multivariable logistic regression adjusting for potential confounding factors showed that usual or uncontrolled Bp control were associated with having carotid plaque （OR = 1.08 and OR=1.42, respectively）, or elevated CIMT [Odd ratio （OR） = 1.17, 95% confidence interval （CI） 1.04-2.24, and OR = 1.54, 95% CI 1.36-2.96, respectively compared to tight Bp control; but did not show glycemic control as independent predictor of either having carotid plaque or elevated CIMT. Conclusions In older patients with hypertension and diabetes, blood pressure control, but not glycemic control is associated with subclinical carotid atherosclerosis.

Association between Metabolic Syndrome and Carotid Atherosclerosis: A Cross-sectional Study in Northern China

Objective Increased carotid artery intima-media thickness(CIMT)and carotid plaque as manifestations of carotid atherosclerosis have been used as markers of cardiovascular disease(CVD).The components of metabolic syndrome(Met S)are linked to CVD,but the association between Met S and CVD is controversial.Methods A total of 8,933 Chinese adults aged 40 years or older from 2010 to 2014 were selected from the Jidong and Kailuan communities.Met S was defined by the International Diabetes Federation criteria.CIMT and carotid plaque were measured using color Doppler ultrasound.Logistic regression models were used to assess the association of Met S with carotid plaque and CIMT.Results Met S was found among 3,461(3,461/8,933)participants.The odds ratio and 95%confidence internal(CI)for carotid plaques in participants with Met S was 1.16(1.03-1.30).The risk of carotid plaques increased with the number of Met S components.The average CIMT was higher in participants with Met S(β=0.020,95%CI,0.014-0.027)and in participants with more Met S components.Conclusion Individuals with Met S are at an increased risk for carotid atherosclerosis compared to those without MetS.

Carotid lesions in outpatients with nonalcoholic fatty liver disease

AIM:To ascertain whether carotid lesions are more prevalent in outpatients with incidental findings of nonalcoholic fatty liver disease (NAFLD) at abdominal ultrasound (US).METHODS: One hundred and fifty-four consecutive outpatients (age range 24-90 years, both sexes) referred by general practitioners for abdominal US, and drinking less than 20 g alcohol/day, underwent carotid US for an assessment of carotid intima-media thickness (c-IMT) and carotid plaque prevalence. Hepatic steatosis, visceral fat thickness and subcutaneous fat thickness were also assessed at ultrasonography.RESULTS: Higher c-IMT values were found in the presence of NAFLD (90 patients), even after adjustment for indices of general and abdominal obesity and for the principal cardiovascular risk factors (0.84±0.10 mm vs 0.71±0.10 mm, P<0.001). The prevalence of carotid plaques was 57.8% in the patients with NAFLD vs 37.5% in the patients without this condition (P=0.02). The adjusted relative risk of having carotid plaques for patients with NAFLD was 1.85 (95% CI:1.33-2.57, P<0.001).CONCLUSION: An incidental finding of hepatic steatosis may suggest the presence of silent carotid atherosclerotic lesions.

Naïve hepatitis B e antigen-negative chronic hepatitis B patients are at risk of carotid atherosclerosis:A prospective study

BACKGROUND There is an increased risk of atherosclerosis in patients with chronic hepatitis C or human immunodeficiency virus,but there is scarce data on hepatitis B virus infection.The hypothesis of this study is that hepatitis B virus infection increases the risk of carotid plaques and subclinical atherosclerosis in naïve hepatitis B e antigen(HBeAg)negative subjects.AIM To assess the rate of carotid plaques and subclinical atherosclerosis in naïve HBeAg negative subjects in comparison with a cohort of healthy controls.METHODS Prospective case-control collaborative study conducted in two tertiary hospitals.Four hundred and two subjects prospectively recruited at the outpatient clinic were included from May 2016 to April 2017:201 naïve HBeAg-negative hepatitis B virus-infected[49 chronic hepatitis B(CHB)and 152 inactive carriers(ICs)]and 201 healthy controls.Anthropomorphic and metabolic measures,liver stiffness and carotid Doppler ultrasound were performed.Subclinical atherosclerosis was established on an intima-media thickness increase of≥1.2 mm and/or the presence of carotid plaques.Normally distributed quantitative variables were compared with the Student t test and those with a non-normal distribution with the Mann-Whitney U test.Categorical variables were compared between groups using theχ2 or Fisher exact test.RESULTS Carotid plaques were found more often in CHB(32.7%)than ICs(17.1%)or controls(18.4%)(P=0.048).Subclinical atherosclerosis was also increased in CHB(40.8%)vsICs(19.1%)or controls(19.4%)(P=0.003).No differences in the risk of atherosclerosis were observed between controls and ICs.The factors independently associated with the presence of carotid plaques were age[odds ratio(OR)1.43,P<0.001]and CHB(OR 1.18,P=0.004)and for subclinical atherosclerosis,age(OR 1.45,P<0.001),CHB(OR 1.23,P<0.001)and diabetes(OR 1.13,P=0.028).In the subset of young subjects(<50 years),carotid plaques(12.5%vs 1.1%,P=0.027)and subclinical atherosclerosis(12.5%vs 2.2%,P=0.058)were more frequent among CHB than ICs.CONCLUSION Untreated HBeAg-negative CHB is an independent risk factor for carotid plaques and subclinical atherosclerosis,while ICs present a similar risk to controls.

Relationship between platelet-lymphocyte ratio and carotid atherosclerosis in middle-aged and elderly patients with type 2 diabetes mellitus

Objective:To investigate the relationship between platelet-lymphocyte ratio(PLR)and carotid atherosclerosis(CAS)in middle-aged and elderly patients with T2DM.Methods:A total of 420 middle-aged and elderly patients with T2DM who were hospitalized in the Endocrinology Department of our hospital from September 2018 to September 2020 and were examined by ultrasound were selected as the subjects.The carotid artery intima-media thickness(CIMT)was examined by color Doppler ultrasonography,including normal CIMT group(n=111),CIMT thickening group(n=103)and CAS plaque group(n=206).The differences of serum PLR levels among the three groups were compared.Multivariate Logistic regression was used to analyze the relationship between PLR and CAS plaque formation.The receiver operating curve(ROC)was used to evaluate the value of multivariate Logistic regression model(Logit P)in the diagnosis of CAS lesions.Results:The mean value of PLR in CAS plaque group(127.86±48.54)was significantly higher than that in CIMT normal group(109.15±48.35).Multivariate Logistic regression analysis showed that after adjusting for other confounding factors,the increase of PLR was an independent risk factor for the occurrence of CAS plaque.ROC showed that the efficacy of multivariate Logit P model in the diagnosis of CAS plaque was(AUC=0.807,95%CI=0.759-0.858).Conclusions:PLR is one of the important risk factors for the occurrence of CAS lesions.At the same time,the multivariate Logistic regression model established in this study has clinical reference value in predicting CAS lesions in middle-aged and elderly patients with T2DM.

高频彩色多普勒超声在脑梗死患者颈动脉斑块性质评价中的应用价值分析

目的探讨与分析高频彩色多普勒超声在脑梗死患者颈动脉斑块性质评价中的应用价值。方法2019年2月到2022年1月选择在本院诊治的脑梗死患者78例作为脑梗死组,同期选择在本院诊治的非脑血管疾病患者78例作为对照组。所有患者都给予高频彩色多普勒超声检查,记录颈动脉的超声特征并判断斑块性质。结果脑梗死组的颈动脉内中膜厚度与增厚发生率分别为1.38±0.21mm,增厚发生率为84.6%,都明显高于对照组的1.03±0.13mm和7.7%(P<0.05)。脑梗死组中无斑块、硬化斑块、软化斑块、混合型斑块的占比分别为2.6%、64.1%、25.6%、7.7%,与对照组的89.8%、7.7%、2.6%、0.0%相比有明显差异(P<0.05)。脑梗死组中无狭窄、轻度狭窄、中度狭窄、重度狭窄、完全闭塞占比分别为1.3%、56.4%、33.3%、7.7%、1.3%,与对照组的91.0%、6.4%、2.6%、0.0%、0.0%相比有显著差异(P<0.05)。回归分析显示颈动脉软化斑块、重度狭窄、内中膜增厚为导致脑梗死发生的重要因素(P<0.05)。结论高频彩色多普勒超声在脑梗死患者的应用能有效判断颈动脉斑块性质与狭窄情况,也可有效判断颈动脉内膜增厚情况,超声特征可有效反映脑梗死的发生。

Detection of carotid artery fluid dynamics and serum inflammatory factors in patients with type 2 diabetes mellitus

Objective:To explore the value of fluid dynamic parameters and inflammatory factors in the prediction of early atherosclerosis in type 2 diabetes mellitus.Methods:A total of 126 patients with type 2 diabetes mellitus who were admitted to our hospital from March 2015 to July 2016 were selected as study subjects and divided into non atherosclerotic group (61 cases) and atherosclerosis group (65 cases)according to carotid artery IMT. At the same time, 60 healthy persons were selected as the control group. The fluid dynamics indexes (PSV, EDV and MV) and serum inflammatory factors (MCP-1, TNF-α and hs-CRP) were detected in the three groups.Results: There were no significant differences in PSV, EDV and MV between left and right carotid arteries in non-atherosclerotic group and control group. PSV, EDV and MV of left and right carotid artery were significantly lower in atherosclerosis group than those in control group. The carotid artery PSV, EDV and MV of left and right in atherosclerosis group were also significantly lower than those of non-atherosclerosis group. The MCP-1, TNF-α and hs-CRP levels in the non-atherosclerosis group were respectively (417.10±78.54), (85.72±9.97) and (3.73±0.61), significantly higher than those in the control group. The MCP-1, TNF-αand hs-CRP levels in atherosclerosis group were respectively (532.95±97.48), (123.56±12.85) and (5.39±0.74) , significantly higher than those in the control group and non-atherosclerosis group.Conclusion:Hydrodynamic parameters and serum inflammatory factors can be used as diagnostic criteria for carotid atherosclerosis in type 2 diabetic patients, and provide guidance for the early diagnosis of carotid atherosclerosis in patients with type 2 diabetes mellitus.