股总动脉内膜中层厚度联合hs-CRP、Hcy在高血压合并阻塞性睡眠呼吸暂停低通气综合征患者的应用价值

目的 探讨股总动脉内膜中层厚度、超敏C反应蛋白(hs-CRP)、同型半胱氨酸(Hcy)水平与高血压合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者严重程度的相关性。方法 收取2021年12月~2022年12月住院连续治疗的高血压患者85例。所有患者均行多导睡眠监测,依据呼吸紊乱(AHI)指数将患者分为高血压合并中重度OSAHS组(A组,n=34)、高血压合并轻度OSAHS组(B组,n=23)和单纯高血压组(C组,n=28)。比较三组间的股总动脉内膜中层厚度,hs-CRP、Hcy水平并分析这三者与高血压合并OSHAS严重程度的相关性。结果 三组间Hcy、hs-CRP水平比较,差异均有统计学意义(P <0.05)。与C组相比较,A、B组Hcy、hsCRP水平显著升高,差异均有统计学意义(P <0.05)。与C组相比较,A、B组股总动脉内膜中层厚度均有升高,A组更为显著,差异均有统计学意义(P <0.05)。相关性分析显示血清Hcy、hs-CRP水平及股动脉内膜中层厚度与AHI、氧减指数(ODI)呈正相关(P <0.05),与最低血氧饱和度水平呈负相关(P <0.05)。结论 高血压合并OSAHS患者股总动脉内膜中层厚度及hs-CRP、Hcy水平均高于单纯高血压患者,且与严重程度呈正相关。股总动脉内膜中层厚度及hs-CRP、Hcy对高血压合并OSAHS患者严重程度有预测评估价值。

2型糖尿病动脉内中膜厚度的变化

目的以动脉内中膜厚度(IMT)作为早期动脉硬化指标,观察2型糖尿病患者的IMT变化及其与代谢指标的相关性。方法收集2型糖尿病患者160例作为糖尿病组,其中糖化血红蛋白(HbA_1c)<7.0%作为控制良好亚组(37例),HbA_1c>7.0%作为控制不良亚组(123例)。另选择糖耐量正常的健康者作为正常对照组(38名)。采用高分辨彩色多普勒超声仪测定颈总动脉(CCA)、颈内动脉(ICA)和股动脉(FA)的IMT。结果糖尿病组的CCA-IMT、ICA-IMT、FA-IMT均显著厚于正常对照组(P值分别<0.05、0.01);且控制不良亚组均显著厚于控制良好亚组(P值均<0.05),经年龄校正后差异仍有统计学意义(P值均<0.05)。糖尿病组中,CCA-IMT、ICA-IMT及FA-IMT与年龄、总胆固醇、低密度脂蛋白胆固醇、HbA_1c均呈正相关(P值均<0.05)。结论2型糖尿病患者较糖耐量正常人群CCA、ICA、FA的IMT明显增厚,动脉硬化较严重,调控血糖、血脂有助于减轻IMT增厚,减少心脑血管并发症。

糖尿病下肢动脉硬化闭塞症中医证型与股总动脉内膜中层厚度的关系

目的分析糖尿病下肢动脉硬化闭塞症(DLASO)患者中医证型与股总动脉内膜中层厚度(CFA-IMT)的关系。方法收集2020年1月至2021年8月山东中医药大学附属医院收治的80例DLASO患者的临床资料,根据不同的中医证型将其分为湿热证组及血瘀证组,各40例。记录两组患者的性别、年龄、糖化血红蛋白(HbA1c)、总胆固醇(TC)、低密度脂蛋白(LDL)、中性粒细胞-淋巴细胞比(NLR)及CFA-IMT,并分析两组患者与上述指标之间的关系。结果湿热证组患者CFA-IMT增厚程度高于血瘀证组患者,湿热证组患者年龄小于血瘀证组患者,差异均有统计学意义(P<0.05)。两组患者性别、NLR、HbA1c、TC、LDL比较,差异均无统计意义(P>0.05)。结论CFA-IMT值及年龄可预测DLASO的中医证型,且简便易行,可以考虑将其作为DLASO中医证型的客观化理论依据。

Relationship between plasma adipokines, inflammation, insulin resistance and subclinical atherosclerosis in newly diagnosed type 2 diabetes

Background: The aim of this study was to investigate the occurrence of subclinical atherosclerosis, evaluated by carotid artery intima-media thickness (CIMT) in subjects with newly diagnosed type 2 diabetes. Methods: A total of 167 subjects, 50 newly diagnosed type 2 diabetic subjects and 117 non-diabetic subjects were included in the study. Obese and overweight newly diagnosed type 2 diabetic patients were matched for age and BMI with obese and overweight non-diabetic subjects. Only postmenopausal women were selected. The following biomarkers were analyzed: fasting glucose, HbA1c, fasting insulin, fasting proinsulin, total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, adiponectin, leptin, hs-CRP, urine albumin/creatinine ratio. 75 g oral glucose tolerance test was performed in all subjects. Ultrasound imaging was used to evaluate IMT of the common carotid artery. Results: CIMT was greater in newly diagnosed type 2 patients compared to non-diabetic subjects. When analyzed by BMI, the difference regarding CIMT between diabetic and non-diabetic subjects was significant only in overweight subjects, in both sexes. In univariate analysis in men with newly diagnosed type 2 diabetes, CIMT was positively correlated with age, SBP, triglycerides, leptin and negatively correlated with HDL-cholesterol and in women CIMT was positively correlated with SBP and leptin. Independent determinants of CIMT in patients with newly diagnosed type 2 diabetes were in men age (β = 0.556, p = 0.0028) and log leptin (β = 0.393, p = 0.049) and in women systolic blood pressure (β = 0.48, p = 0.026). Conclusions: Subclinical atherosclerosis is present in newly diagnosed type 2 diabetic subjects. Body fat accumulation in men and hypertension in postmenopausal women have a primary role in increase carotid intima-media thickness.

超声检测颈股总动脉内中膜厚度及粥样硬化斑块

本研究以120例普通健康人群为研究对象,通过血管超声检查内颈总动脉（CCA）与股总动脉（CFA）内中膜厚度（IMT）及粥样硬化斑块,试图探讨普通健康人群血管内中膜厚度（IMT）及粥样硬化斑块的特征与差异。检测结果显示,平均颈总动脉的IMT与股总动脉的IMT之间存在显著性差异（0.68 mm vs 0.75 mm,p〈0.01）;股总动脉中斑块形成的几率显著高于颈总动脉（46.7%vs 29.2%）;48.2%的研究对象同时存在股总动脉与颈总动脉的动脉粥样硬化斑块,仅在股总动脉与颈总动脉中的几率分别为40.2%与19.6%;若仅考虑纤维脂质分离的斑块时,股总动脉与颈总动脉之间的差异更加明显（47.2%vs 25.6%）。本研究结果初步证实,健康一般人群中超过40%的人群粥样硬化斑块存在于股总动脉而非颈总动脉中。因此,我们认为有必要做进一步研究确认在心血管疾患风险评估筛查中引入股总动脉超声检查的必要性。