Correlation Study of Aortic Velocity Propagation, Abdominal Aortic Intima-Media Thickness, and Epicardial Adipose Tissue Thickness in Subclinical Hypothyroidism Patients

Objective:To explore the correlation between epicardial fat thickness(EFT),aortic velocity propagation(AVP),and abdominal aortic intima-media thickness(AA-IMT)in patients with subclinical hypothyroidism(SH).Additionally,to compare these indicators between SH patients and healthy individuals,providing a new theoretical basis for the clinical prevention and treatment of cardiovascular diseases.Method:Clinical data from 50 SH patients(23 males and 27 females)and 50 healthy outpatient examinees(22 males and 28 females)were analyzed.The participants were selected from January 2022 to December 2023 at Loudi Central Hospital.EFT,AVP,and AA-IMT were measured,and their correlations were analyzed.Results:SH patients had significantly higher EFT and AA-IMT levels than the control group,while their AVP was significantly lower,with these differences being statistically significant(P<0.05).Correlation analysis revealed a significant negative correlation between EFT and AVP(P<0.001),a significant positive correlation between EFT and AAO-IMT(P<0.001),and a significant negative correlation between AVP and AAO-IMT(P<0.001).Multivariate binary logistic regression analysis identified increased EFT,decreased AVP,and increased AAO-IMT as independent risk factors for SH patients.Conclusion:In SH patients,EFT and AAO-IMT are elevated,whereas AVP is reduced.EFT and AVP are significantly correlated with AAO-IMT.EFT and AAO-IMT can serve as reliable indicators for evaluating subclinical atherosclerosis in SH patients,providing a diagnostic basis for clinical practice.

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.

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.

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.

Determining factors for carotid mean/max intima-media thickness and brachial flow-mediated dilation in healthy young women

Background: Many factors can contribute to atherosclerotic-type vascular changes in older individuals or men. Thus, confining the investigation to young women with no clinical evidence of the condition could enhance understanding of the early stages of cardiovascular disease. The aim of this study was to determine whether carotid mean/max intima-media thickness (IMT) and brachial flow-mediated dilation (FMD) values, which are well-known event-related indices, are associated with laboratory data and the other vascular indices of atherosclerosis in healthy young women. Methods: Carotid mean/max IMT and brachial FMD were measured in young women with no clinical evidence of atherosclerosis (n = 110;mean age, 39 years) who were instructed not to eat, drink or smoke after 9 PM the evening before testing. All participants also underwent laboratory assessment, including simultaneous measurements of arterial stiffness such as augmentation index (AI), cardioankle vascular index (CAVI) and brachial-ankle pulse wave velocity (baPWV). Results: Mean IMT was signifi-cantly and positively associated with age (p = 0.002), CAVI (p = 0.044), low-density lipoprotein-cholesterol (LDL-C, p = 0.047) and high-sensitive C-reactive protein (hs-CRP, p = 0.002) values but was not related to FMD, AI, baPWV or triglycerides (TG) in the multivariate regression analysis. Similarly, max IMT was positively associated with age (p p = 0.003) and hs-CRP (p = 0.005) values but was not related to FMD, AI, CAVI, baPWV, TG or blood pressure level in the multivariate regression analysis. The association between LDL-C and max IMT was much stronger than that between LDL-C and mean IMT. Brachial FMD was positively associated only with heart rate in the multivariate regression analysis. Conclusions: These results suggest that mean IMT more closely represents the sclerotic aspect of vascular change, whereas max IMT represents the atherotic aspect in healthy young women. Although the relationship between the autonomic nervous system and heart rate is well-known, there may be a complex interaction between the autonomic nervous system and endothelial function.

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.

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.

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.

不同分级高血压患者IMT与Hcy水平的相关性分析

目的探讨不同分级高血压患者颈动脉IMT与Hcy水平的变化以及与二者之间的关系。方法选取住院治疗的原发性高血压180例,其中1级、2级、3级高血压患者各60例。采用免疫荧光法来测定Hcy的值,使用彩色多普勒超声测定颈动脉IMT,比较二者在不同组之间的差异以及二者的关系。结果 (1)各组之间的IMT厚度差异显著[F(3,237)=28.12,P<0.01],Hcy值也差异显著[F(3,237)=8.78,P<0.05)],随着血压的升高,IMT厚度逐渐增厚,Hcy水平也呈现出升高的趋势;(2)无斑块组、单发斑块组和多发斑块组之间的Hcy水平差异显著,F(2,178)=19.36,P<0.05,斑块程度越大Hcy值越大;(3)各组的颈动脉IMT与Hcy水平之间的呈显著正相关(P<0.05)。结论随着血压升高,颈动脉IMT越厚,Hcy水平则越高,提升了罹患血管疾病的风险。

2型糖尿病颈动脉IMT与胰岛素抵抗的相关性研究

目的研究不同程度颈动脉内膜中层厚度(IMT)的2型糖尿病(T2DM)患者稳态模型评估(HOMA)胰岛素抵抗指数的变化,探讨T2DM患者颈动脉粥样硬化与胰岛素抵抗相关性。方法选择T2DM患者60例(男33例,女27例),平均年龄(53.12±15.35)岁,经彩色多普勒超声检测颈动脉IMT将其分为3组:IMT正常组(IMT<1.0mm)、IMT增厚组(1.0mm≤IMT≤1.2mm)、颈动脉粥样硬化斑块形成组(IMT>1.2mm)。同时选取20例性别、年龄匹配健康的志愿者作为正常对照组。受试者均晨起空腹,口服75g葡萄糖行葡萄糖耐量试验(OGTT),测定空腹血糖(FBG)、胰岛素(FINS)、糖化血红蛋白(HbA1 c)、血脂等。计算稳态模型胰岛素抵抗评估指数(HOMA-IR),分析T2DM患者胰岛素抵抗与颈动脉IMT之间的关系。结果T2DM患者的颈动脉IMT及HOMA-IR均值明显高于正常对照组(P<0.01),即使IMT正常的T2DM患者的IMT及HOMA-IR值亦高于正常对照组(P<0.05)。相关分析显示,T2DM患者颈动脉IMT与HOMA-IR呈正相关(r=0.593,P<0.01)。结论T2DM患者的血糖控制和胰岛素抵抗程度与颈动脉IMT值密切相关。

中老年女性血压与颈动脉IMT及baPWV的关系

目的 探讨中老年女性血压与颈动脉内膜中层厚度及臂-踝脉搏波传导速度的关系.方法 选择中老年女性患者185例,平均年龄为62.55±9.81岁.其中高血压组96例（51.9%）,血压正常组89例（48.1%）.测量颈动脉内膜中层厚度及臂-踝脉搏波传导速度.结果 在高血压组及血压正常组中,颈动脉内膜中层厚度与收缩压、脉压均显著相关（在高血压组r分别为0.225和0.181,在血压正常组r分别为0.049和0.047;均P〈0.05）,臂-踝脉搏波传导速度与年龄、收缩压、平均压、脉压均显著相关（在高血压组r分别为0.599、0.551、0.429和0.560,在血压正常组r分别为0.624、0.451、0.290和0.518,均P〈0.05）;高血压组臂-踝脉搏波传导速度、颈动脉内膜中层厚度均明显高于血压正常组,经比较差异有统计学意义（t分别为7.678和0.713,均P〈0.05）;高血压组臂-踝脉搏波传导速度与颈动脉内膜中层厚度显著相关（r=0.206,P〈0.05）;经多因素分析提示年龄及平均压是与臂-踝脉搏波传导速度关系最为密切的参数.结论 联合检测臂-踝脉搏波传导速度及颈动脉内膜中层厚度对发现早期动脉硬化有一定的价值.

中青年心血管疾病风险评估与IMT监测的相关性分析

目的对中青年进行心血管疾病危险因素、颈动脉内膜中层厚度(IMT)的监测,探讨Framingham心血管疾病风险评分(Framingham risk score)与IMT的相关性。方法选取2012年至2013年在济宁医学院附属济宁市第一人民医院体检的中青年个体1045例,采用Framingham risk score计算10年风险值;依据颈动脉超声结果,将IMT分为正常、增厚和斑块形成3种,分析两者相关性。结果 1045例中青年中Framingham心血管疾病10年风险≤10%占475例(45.5%);>10%的占570例(54.5%)。颈动脉超声无异常占593例(56.7%);超声显示IMT增厚或有斑块者占452例(43.4%),其中211例出现动脉粥样硬化的典型改变。颈动脉IMT与Framingham心血管疾病10年风险之间有相关性,有统计学意义(P<0.001)。结论在中青年中颈动脉内膜中层厚度的监测可有助于预计心血管发生危险性,为心血管疾病的早期发现提供了证据。

阿托伐他汀钙对高血压冠心病患者IMT厚度及血脂和心功能的影响

目的探究阿托伐他汀钙对高血压冠心病患者颈动脉内膜、中膜厚传(IMT)厚度及血脂和心功能的影响分析,为高血压合并冠心病的治疗提供理论依据。方法 100例高血压合并冠心病患者,通过回顾性分析的探究方式进行疗效比较。将使用缬沙坦联合氨氯地平治疗的50例患者设为对照组,将阿托伐他汀钙联合氨氯地平治疗的50例患者设为观察组。连续治疗2个月后比较2组患者治疗前后收缩压(SBP)、舒张压(DBP)以及高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、三酰甘油(TG)、总胆固醇(TC)等血脂指标水平变化,并检测两组患者治疗前后颈动脉内膜-中膜(IMT)厚度,通过超声心动图检查治疗前后心脏左室舒张末内径(LVDD)以及左心室射血分数(LVEF)。结果 2组治疗后SBP、DBP均较治疗前显著降低,且观察组显著低于对照组,差异有统计学意义(P<0.01);2组治疗前后HDL-C差异无统计学意义(P>0.05),2组治疗后LDL-C、TG、TC均显著降低,且观察组显著低于对照组,差异有统计学意义(P<0.01);2组治疗后IMT厚度、LVDD显著降低,LVEF显著升高,且2组治疗后比较,差异有统计学意义(P<0.01)。结论在常规降压治疗基础上采用阿托伐他汀钙能显著降低高血压合并冠心病患者血压,改善血脂水平,提高心脏功能,降低IMT厚度以延缓动脉粥样硬化。

他汀类药物对冠脉综合征患者血清hs-CRP与颈动脉IMT的影响

目的探讨他汀类药物对冠脉综合征患者血清超敏C反应蛋白(hs-CRP)和颈动脉内膜中层厚度(IMT)的影响。方法选取2012年6月至2015年1月期间我院心血管内科确诊治疗的冠脉综合征患者150例,依据随机分配原则分为常规组和他汀组,每组75例,常规组患者给予抗血小板、抗凝、溶栓、抗缺血、抗心力衰竭及心律失常等常规治疗和10 mg阿托伐他汀口服治疗,他汀组患者在基础治疗上给予20 mg阿托伐他汀口服治疗,两组均持续治疗1个月,采用酶联免疫吸附法(ELISA)检测血清hs-CRP水平,随访1年,统计分析所有患者治疗前后颈动脉IMT、斑块大小、厚度、数量和治疗前、治疗后3个月、6个月、12个月的血清hs-CRP水平及左心射血分数(LVEF)、不良心脏事件发生情况。结果治疗前,常规组和他汀组患者颈动脉IMT[(1.74±0.46)mm vs(1.71±0.44 mm]、斑块大小[(23.58±5.84)mm2vs(24.02±5.91)mm2]、厚度[(2.82±0.82)mm vs(2.76±0.79)mm]、数量[(5.48±0.64)个vs(5.39±0.61)个]和血清hs-CRP[(27.46±7.31)mg/L vs(28.06±7.41)mg/L]水平基本相同,差异均无统计学意义(P>0.05);治疗后,他汀组患者颈动脉IMT[(1.21±0.34)mm vs(1.52±0.38)mm]、斑块大小[(14.57±4.72)mm2vs(19.51±5.41)mm2]、厚度[(1.53±0.52)mm vs(1.89±0.61)mm]、数量[(2.94±0.33)个vs(3.52±0.38)个]和3个月[(18.32±7.02)mg/L vs(24.23±7.11)mg/L]、6个月[(12.36±6.13)mg/L vs(18.43±7.05)mg/L]、12个月[(7.63±3.21)mg/L vs(11.36±5.03)mg/L]的血清hs-CRP水平明显低于常规组,差异均有统计学意义(P<0.05);他汀组患者治疗后LVEF水平为(57.96±8.11%)%,明显高于常规组的(52.13±7.84)%,不良心脏事件发生率为4.00%,明显低于常规组的13.33%,差异有统计学意义(P<0.05)。结论较大剂量他汀类药物可有效缓解冠脉综合征患者的颈部血管斑块及机体炎症状态,改善患者左心室功能,且可有效减少不良心脏事件的发生,值得临床推广应用。

2型糖尿病患者颈动脉IMT与血清25(OH)D水平的相关性研究

目的探讨葡萄糖耐量减低和2型糖尿病患者颈动脉内膜中层厚度(IMT)与血清25OH总维生素D[25(OH)D]浓度的关系,为糖尿病及其大血管并发症的防治提供新的思路。方法选取2014年9月至2015年9月在我院就诊的葡萄糖耐量减低和2型糖尿病患者各28例,分别设为糖耐量减低组和2型糖尿病组,另选取同期在我院进行健康体检者28例,设为正常对照组。检测各组受检者的IMT和25(OH)D水平,应用Spearman统计分析IMT和25(OH)D水平的相关性。结果正常对照组、糖耐量减低组、2型糖尿病组患者IMT依次升高[(0.87±0.15)mm vs(0.96±0.18)mm vs(1.13±0.30)mm]、25(OH)D水平依次降低[(18.03±7.35)μg/L vs(15.34±6.84)μg/L vs(12.53±5.38)μg/L],组间比较差异均具有统计学意义(P<0.05);Spearman相关分析显示,IMT和25(OH)D水平呈负相关(r=-0.40,P<0.05)。结论葡萄糖耐量减低和2型糖尿病患者存在不同程度的颈动脉IMT增厚、血清25(OH)D水平降低,血清25(OH)D水平降低与颈动脉IMT增厚密切相关。

超声评价糖尿病肾病合并非酒精性脂肪肝及其与心脏瓣膜钙化的关系研究

目的:探讨超声诊断糖尿病肾病(DN)合并非酒精性脂肪肝(NAFLD)及其与心脏瓣膜钙化(HVC)的相关性。方法:选取医院收治的120例DN患者,根据有无NAFLD将其分为合并NAFLD组(56例)和未合并NAFLD组(64例)。两组患者均行肝脏超声及经胸超声心动图检查,并行血常规及血脂检测,比较两组血常规指标、血脂指标以及超声心动图指标,对DN合并NAFLD的影响因素进行Logistic回归分析。根据超声二维图像特征对NAFLD进行严重程度分级,统计HVC发生率,并对其钙化程度进行评分,分析NAFLD严重程度与HVC程度的相关性。结果:在两组120例DN患者中有56例(占46.67%)合并NAFLD。两组患者的血红蛋白、血小板计数、总胆固醇(TC)、舒张期末室间隔厚度(IVST)、左心室舒张末期内径(LVDD)、左心室后壁厚度(LVPWT)、左室射血分数(LVEF)以及左心室短轴缩短率(LVFS)指标比较差异无统计学意义;合并NAFLD组患者的甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、左心房内径(LAD)及颈动脉内中膜厚度(IMT)均高于未合并NAFLD组,低密度脂蛋白胆固醇(LDL-C)低于未合并NAFLD组,差异有统计学意义(t=17.591,t=10.125,t=4.050,t=7.174,t=13.253;P<0.05);多因素Logistic回归分析显示,TG、LDL-C、HDL-C、LAD及IMT是DN合并NAFLD的独立影响因素;二维超声诊断结果显示,56例合并NAFLD组患者中,26例为轻度NAFLD,17例为中度NAFLD,13例为重度NAFLD;41例(占34.17%)出现HVC,其中19例为轻度HVC,13例为中度HVC,9例为重度HVC;DN合并NAFLD严重程度与HVC钙化程度呈正相关(r=0.724,P<0.05)。结论:DN合并NAFLD与血脂异常、LAD及IMT密切相关,且NAFLD严重程度与HVC钙化程度正相关,通过超声诊断能够预测HVC风险,故应给予高度重视。

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.