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.

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.

Reference values of carotid intima-media thickness and arterial stiffness in Chinese adults based on ultrasound radio frequency signal:A nationwide,multicenter study

Background:Carotid intima-media thickness(IMT)and diameter,stiffness,and wave reflections,are independent and important clinical biomarkers and risk predictors for cardiovascular diseases.The purpose of the present study was to establish nationwide reference values of carotid properties for healthy Chinese adults and to explore potential clinical determinants.Methods:A total of 3053 healthy Han Chinese adults(1922 women)aged 18-79 years were enrolled at 28 collaborating tertiary centers throughout China between April 2021 and July 2022.The real-time tracking of common carotid artery walls was achieved by the radio frequency(RF)ultrasound system.The IMT,diameter,compliance coefficient,βstiffness,local pulse wave velocity(PWV),local systolic blood pressure,augmented pressure(AP),and augmentation index(AIx)were then automatically measured and reported.Data were stratified by age groups and sex.The relationships between age and carotid property parameters were analyzed by Jonckheere-Terpstra test and simple linear regressions.The major clinical determinants of carotid properties were identified by Pearson’s correlation,multiple linear regression,and analyses of covariance.Results:All the parameters of carotid properties demonstrated significantly age-related trajectories.Women showed thinner IMT,smaller carotid diameter,larger AP,and AIx than men.Theβstiffness and PWV were significantly higher in men than women before forties,but the differences reversed after that.The increase rate of carotid IMT(5.5µm/year in women and 5.8µm/year in men)and diameter(0.03 mm/year in both men and women)were similar between men and women.For the stiffness and wave reflections,women showed significantly larger age-related variations than men as demonstrated by steeper regression slopes(all P for age by sex interaction<0.05).The blood pressures,body mass index(BMI),and triglyceride levels were identified as major clinical determinants of carotid properties with adjustment of age and sex.Conclusions:The age-and sex-specific reference values of carotid properties measured by RF ultrasound for healthy Chinese adults were established.The blood pressures,BMI,and triglyceride levels should be considered for clinical application of corresponding reference values.

Effect of intensive multifactorial treatment on the intima-media thickness of large arteries in patients with new-onset type 2 diabetes mellitus

Objective: To quantify the changes in blood glucose, blood lipids, blood pressure, and the intima-media thickness (IMT) of large arteries in patients with new-onset type 2 diabetes mellitus who received either intensive multifactorial treatment or conventional treatment. Methods: Two-hundred and ten patients with new-onset type 2 diabetes mellitus were randomly assigned to two groups: an intensive treatment group (n=110) and a conventional treatment group (n=100). Fasting blood glucose (FBG), glycosylated hemoglobin A1c (HbA1c), blood pressure, blood lipids [total cholesterol (TC), triglyceride (TG), low-density lipoprotein C (LDL-C), and high-density lipoprotein C (HDL-C)], and IMTs of large arteries (carotid, iliac, and femoral arteries) were determined before and at one and two years after starting treatment. The patients in the conventional treatment group received routine diabetes management in our outpatient department. Targets were established for patients in the intensive treatment group. Their blood glucose, blood lipids, and blood pressure levels were regularly monitored and therapeutic regimens were adjusted for those whose measurements did not meet the target values until all the parameters met the established targets. Within-group and between-group differences were evaluated. Results: A significantly greater percentage of patients in the intensive treatment group had LDL-C levels that reached the target value one year after starting treatment than those in the conventional treatment group (52.04% vs. 33.33%, P<0.05). No significant differences were found be- tween groups for FBG, HbA1c, blood pressure, TG, TC, or HDL-C. The percentages of patients with TG (51.02% vs. 34.48%), TC (52.04% vs. 33.33%), and LDL-C (61.22% vs. 43.67%) who met the respective target values in the in- tensive treatment group were all significantly higher than the corresponding percentages in the conventional treatment group two years after starting treatment (P<0.05). There were no significant differences in the percentages of patients with FBG, HbA1c, and blood pressure values meeting the respective targets between the groups at the two-year follow- up. One year after starting treatment, the LDL-C level, diastolic blood pressure (DBP), and the IMTs of the femoral and iliac arteries of the intensive treatment group were significantly lower compared to those of the conventional treatment group (P<0.05), although there was no significant difference in other metabolic parameters. Two years after starting treatment, the TC, LDL-C, blood pressure [systolic blood pressure (SBP) and DBP], and the IMTs of the carotid and femoral arteries of the intensive treatment group were significantly lower than those of the conventional treatment group (P<0.05). No significant differences in other metabolic parameters existed between the two groups two years after starting treatment. Conclusions: Early comprehensive and intensive treatment of type 2 diabetes mellitus can delay or even reverse the increase in IMT of large arteries. Lowering blood pressure and blood lipid regulation in patients with type 2 diabetes mellitus have great significance in decreasing the risk of diabetes-related macrovascular lesions.

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.

Clinical effect of long term aerobic exercise combined with Ginkgo Biloba Leaves Extract Tablets in the treatment of arteriosclerosis

Objective: To investigate the clinical effect of long-term aerobic exercise combined with Ginkgo biloba leaves on atherosclerosis. Methods: 104 patients with carotid atherosclerosis admitted to the Affiliated Hospital of Xi'an Medical College from January 2016 to January 2018 were randomly divided into exercise training group and control group, 52 cases in each group. The control group was treated with Ginkgo biloba leaves, and the exercise training group was treated with long-term aerobic exercise combined with Ginkgo biloba leaves. Both groups were treated for 6 months. The therapeutic effects of the two groups were compared. Results: After treatment, the levels of TC, TG and LDL-C in the two groups were lower than those before treatment, and the levels of HDL-C were higher than those before treatment (P<0.05);after treatment, the levels of TC, TG and LDL-C in the exercise training group were lower than those in the control group, and the levels of HDL-C were higher than those in the control group, with significant difference between the two groups (P<0.05). After treatment, the CIM T and plaque area of the two groups were smaller than those before treatment, and the blood velocity of cerebral artery was higher than that before treatment (P<0.05);after treatment, the CIM T and plaque area of the exercise training group were smaller than those of the control group, and the blood velocity of left middle cerebral artery, right middle cerebral artery and basilar artery were higher than those of the control group. The difference was statistically significant (P<0.05). Conclusion: Long-term aerobic exercise combined with Ginkgo biloba leaf therapy can effectively reduce the blood lipid concentration in patients with carotid atherosclerosis and improve cerebral blood supply.

正常人颈、股动脉内-中膜厚度的临床研究

目的:探讨正常人颈动脉(CA)、股动脉(FA)内中膜厚度(IMT)的超声诊断标准。方法:利用高频超声测量236例不同年龄组正常健康者CA、FA的IMT。结果:正常人CA的IMT均值为(0.59±0.12)mm,FA为(0.63±0.15)mm,CA、FA的IMT上限分别为0.83 mm、0.93 mm。年龄≤50岁正常人CA、FA的IMT上限分别为0.7 mm、0.77 mm。年龄>50岁正常人CA、FA的IMT上限分别为0.98 mm、1.07 mm。结论:正常人CA、FA的IMT变化规律表现为随年龄增长而增厚。

原发性高血压伴慢性肾脏病与动脉硬化的关系

目的探讨动脉僵硬度无创性检测指标对原发性高血压伴慢性肾脏病风险的预测价值。方法以541例原发性高血压患者作为研究对象,其中单纯原发性高血压患者330例(高血压组),原发性高血压合并慢性肾脏病211例(高血压+肾病组)。采用动脉僵硬度无创性检测方法,对颈动脉-股动脉脉搏波传导速度(cf PWV)及大、小动脉弹性(C1、C2)进行测定,同时行脉搏波分析(PWA),并经颈动脉超声检查测定内膜中层厚度(IMT)。结果与高血压组比较,高血压+肾病组患者高龄、高血压病程长、尿白蛋白与肌酐比值较高(P<0.01),而估测的肾小球滤过率(e GFR)较低(P<0.05)。在调整年龄、心率、病程、吸烟和服用降压药物情况及肱动脉收缩压之后,高血压+肾病组动脉僵硬度指标中的c-f PWV显著高于高血压组(P<0.05)。随着e GFR的降低,两组cf PWV和IMT均逐渐增高(P<0.01),C2降低(P<0.01);调整心血管危险因素之后,cf PWV与e GFR呈负相关(r=-0.085 1,P=0.02)。将原发性高血压伴慢性肾脏病作为二分类变量,进一步的多元Logistic回归分析发现:cf PWV每增加1个SD(3 m/s),单纯原发性高血压患者发生慢性肾脏病的危险度增加1.50倍。结论原发性高血压伴慢性肾脏病时cf PWV明显增高。cf PWV可作为高血压发生慢性肾脏病风险的预测指标之一。

多普勒超声测定人股动脉的相关指标及其影响因素

目的 应用高频彩色多普勒超声探讨正常人股动脉内-中膜厚度、血流动力学变化与血管弹性的相互关系，并分析不同年龄段、性别、血压和心率等因素对这些指标的影响，旨在确定正常人下肢动脉相关指标的正常值范围及其影响因素，为下肢动脉硬化的研究提供参考。方法 对60例正常人的股动脉行二维及彩色多普勒超声检查，观察血管内．中膜厚度（IMT），用M型测量血管收缩期及舒张期的内径（Ds及Dd），脉冲多普勒测量收缩期峰值速度（Vs）、舒张早期峰值速度（Vd）、舒张早期血流频谱积分（VTId）、血流波传递时间（TR-Vs），M型超声记录股动脉前后壁收缩末期和舒张末期运动幅度内径、计算僵硬度B指数、扩张性和顺应性等参数。结果 正常人股动脉IMT随着年龄的增大而逐渐增厚，血流峰值最大速度（Vmax）及TR-Vs随着年龄的增大而递减，50—70岁年龄段更明娃，随着年龄的增大，Ds和Dd僵硬度指数增大，扩张性和顺应性降低（P〈0．05）。IMT与僵硬度指数、扩张性和顺应性无明显相关性。僵硬度指数、扩张性、顺应性与脉压相关（P〈0．01），而与收缩压、舒张压无明显相关性。结论 IMT、Vmax、TR-Vs等指标可反映股动脉功能变化的特征，且TR-Vs可作为评价老年人股动脉硬化程度的常规指标，操作简单，受相关因素影响较小。

益气活血通脉法治疗股动脉硬化症36例疗效观察

目的:观察益气活血通脉法对患者股动脉内一中膜厚度(IMT)和中医临床症状的影响。方法:将72例患者随机分为两组,对照组36例,予降脂药普伐他汀20mg;治疗组36例,在对照组治疗基础上加用中药活血通脉法,两组均12周为1疗程。结果:两组均可有效降低血清胆固醇(Tch)、低密度脂蛋白(LDL)浓度,活血通脉法可有效改善股动脉硬化患者的中医临床症状,且对降脂有一定作用;治疗组治疗后股动脉IMT均值较治疗前明显降低,P<0.05,对照组治疗后股动脉IMT均值较治疗前有降低趋势,P>0.05。结论:益气活血通脉法可能有降脂及减缓动脉粥样硬化作用。

益气化痰通络方对股动脉粥样硬化和超敏C反应蛋白水平的影响

目的观察益气化痰通络方对股动脉硬化患者股动脉内-中膜厚度(IMT)和超敏C反应蛋白(hs-CRP)的影响。方法将58例股动脉粥样硬化患者随机分为治疗组和对照组,对照组予降脂药辛伐他汀40mg/d,治疗组在对照组基础上加用益气化痰通络方(黄芪、当归、地龙、桑椹、丹参、茶树根、泽泻、石菖蒲等组成)。疗程均为12周。结果治疗组和对照组均可有效降低血清胆固醇、低密度脂蛋白浓度(P<0.05,P<0.01)。治疗组股动脉IMT均值较治疗前明显降低(P<0.01),而对照组无明显改变,两组间差异有显著性(P<0.01);治疗组和对照组血清hs-CRP均明显低于治疗前(P<0.01,P<0.05),且治疗组明显低于对照组(P<0.05)。结论益气活血化痰通络方可消减股动脉粥样硬化,对IMT和hs-CRP有明显调节作用。

益气活血化痰方早期干预老年无症状期下肢动脉粥样硬化的临床观察

目的观察益气活血化痰方治疗老年无症状期下肢动脉粥样硬化的临床疗效。方法将70例老年无症状期下肢动脉粥样硬化患者随机分为治疗组和对照组,每组35例。对照组予辛伐他汀,治疗组在对照组治疗措施基础上加用益气活血化痰方。两组疗程均为12周,观察中医证候积分、ABI及IMT水平的变化情况。结果 1治疗前后组内比较,两组中医证候积分差异有统计学意义(P<0.05);组间治疗前后中医证候积分差值比较,差异有统计学意义(P<0.05)。2治疗前后组内比较,治疗组ABI水平、IMT厚度差异有统计学意义(P<0.05);组间治疗前后ABI水平、IMT厚度的差值比较,差异有统计学意义(P<0.05)。结论益气活血化痰方治疗老年无症状期下肢动脉粥样硬化,可显著改善患者血管弹性及下肢功能不全,延缓下肢动脉粥样硬化进程。

2型糖尿病纤维蛋白原与颈动脉及股动脉内膜关系的研究

目的探讨2型糖尿病(T2DM)高纤维蛋白原(FIB)血症与颈动脉内膜厚度(CAIM T)、股总动脉内膜厚度(FAIM T)及斑块累及的相关性。方法用高分辨率彩色多普勒超声测定164例2型糖尿病病人及60例健康者(对照组)的CAIM T、FAIM T,同时测定凝血象、血脂等9项指标,并进行统计学分析。结果2型糖尿病患者CAIM T≥0.09cm组与CAIM T<0.09cm组比较内膜厚度(IM T)与FIB、CH O、TG、LDL、年龄、DM病程(P<0.01)、高血压病程(P<0.05)呈正相关,与H DL、凝血酶时间(PT)呈负相关(P<0.01);FAIM T≥0.10cm组与FAIM T<0.10cm组结果与颈动脉组相似;两组DM组较正常对照组IM T均明显增厚(P<0.01),DM高FIB组较DM正常FIB组CAIM T、FAIM T均增厚(P<0.01),且上下肢均累及的比例增加(P<0.05)。结论2型糖尿病合并高FIB水平大动脉内膜增厚更明显,FIB升高是2型糖尿病动脉硬化、斑块形成的危险因素。

糖尿病下肢动脉病变中医证型与临床指标的关系

目的:探讨糖尿病下肢动脉病变中医辨证分型与客观指标的关系,为该病辨证分型提供客观依据。方法:选择2型糖尿病下肢动脉病变患者174例,进行辨证分型,收集客观指标建立数据库,观察客观指标在各中医证型中的分布规律。结果:气滞痰阻证的糖尿病病程最短。慢性并发症发生率在阳虚痰凝证中最高。阳虚痰凝证和血瘀热蕴证的ABI显著低于气滞痰阻证;且两者血浆黏度、TC、LDL-C、FIB和股动脉IMT均显著高于气滞痰阻证。结论:血浆粘度、TC、LDL-C、FIB、ABI、股动脉IMT 6项指标与本病辨证分型相关,推测其有望成为评价本病辨证分型的客观参考指标。

超声评价糖尿病患者颈、股动脉内-中膜厚度及斑块与冠心病相关性的研究

目的探讨2型糖尿病病人颈动脉(CA)、股动脉(FA)的结构变化及其间相关性的研究。寻找2型糖尿病病人并发冠状动脉硬化的早期证据,为临床提供有效的观察方法和指标。方法分别测定了30例2型糖尿病合并冠心病(1型)、30例2型糖尿病无合并症者(2型)及30例正常对照组的外周动脉内中膜厚度(IMT)及动脉硬化斑块。结果糖尿病人的颈动脉、股动脉出现不同程度的内膜增厚及斑块形成;糖尿病合并冠心病(CAD)组与无合并症组颈动脉、股动脉的内-中膜增厚及斑块发生率均明显高于对照组(P<0.01),合并冠心病组颈动脉、股动脉的内-中膜增厚高于无合并症组(P<0.01);合并冠心病组股动脉的斑块发生率与无合并症组比较有显著差异(P<0.05)。颈动脉、股动脉粥样硬化与冠状动脉粥样硬化之间有着密切联系且股动脉粥样硬化斑块对冠心病的诊断的敏感性更高。结论外周动脉粥样硬化是糖尿病靶器官损害的标志之一,彩色多普勒超声能评价外周动脉病变的程度,临床上具有重要的实用价值。

不同糖耐量人群股动脉僵硬度、内中膜厚度及相关性

目的探讨糖代谢异常与股动脉僵硬度、内中膜厚度之间的关系。方法选取30例初诊2型糖尿病患者,糖耐量受损患者12例,正常糖耐量受试者20例,分别测定生化指标、股动脉内中膜厚度及股动脉僵硬度,比较分析各指标之间的相关性。结果与正常糖耐量组比较,糖耐量受损患者HOMA-IR(P<0.05)、股动脉内中膜厚度(P<0.05)及股动脉僵硬度(P<0.05或P<0.01)明显升高;2型糖尿病患者HOMA-IR、HbA1c、TG、股动脉内中膜厚度及股动脉僵硬度明显升高。与糖耐量受损组比较,2型糖尿病患者HbA1c、TG及股动脉僵硬度明显升高(P<0.05);两组股动脉内中膜厚度未见明显差异。不同糖耐量人群股动脉僵硬度与年龄、吸烟、SBP、HbA1c之间呈明显正相关(P<0.05);股动脉内中膜厚度与年龄、SBP、HbA1c、TC之间呈正相关(P<0.05);多元回归分析显示BMI、HbA1c为股动脉僵硬度的独立危险因素(P<0.05),SBP、HbA1c为股动脉内中膜厚度的独立危险因素(P<0.05)。结论股动脉僵硬度及股动脉内中膜厚度在糖尿病前期已有不同程度增加,可作为筛查糖尿病外周血管早期病变的可靠指标,而前者尤为灵敏。糖尿病外周血管病变需予以控制血糖为基础的全方位综合干预。

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。

冠状动脉多支病变与外周动脉粥样硬化的相关性及其意义

目的应用高频超声检测冠心病(CHD)冠状动脉多支病变者双侧颈动脉、双侧股动脉粥样硬化病变情况,探讨冠状动脉多支病变与外周动脉粥样硬化的相关性。方法选择经冠状动脉造影确诊为冠状动脉多支病变者65例作为CHD组,选择不明原因有心悸、胸闷、气短、胸痛等不适感觉的患者65例作对照组,应用高频超声观察、测量其左、右颈动脉、股主动脉内中膜厚度(IMT)及粥样硬化斑块形成情况。应用全自动生化分析仪测定血总胆固醇(TC)、甘油三脂(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、血糖(GLU)。结果CHD组TC、TG、LDL-C、GLU均高于对照组(P<0.01),HDL-C低于对照组(P<0.01);CHD组颈、股动脉IMT明显大于对照组(P<0.01),CHD组颈、股动脉粥样硬化斑块检出率均明显高于对照组(P<0.01),颈、股动脉分叉处斑块检出明显多于其他部位(P<0.01)。结论冠状动脉多支病变者颈动脉、股动脉粥样硬化性病变较显著,冠状动脉病变与外周动脉粥样硬化病变密切相关,及早行外周动脉超声检查具有重要临床意义。