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.

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.

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.

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.

腹主动脉瘤及外周血管病患者的颈动脉超声特征分析研究

目的:分析比较腹主动脉瘤及外周血管病患者的颈动脉超声特征,探讨动脉粥样硬化在腹主动脉瘤及外周血管病发病机制中的作用。方法:选取经计算机断层摄影血管造影术(CTA)检查确诊的腹主动脉瘤患者67例(腹主动脉瘤组),经数字减影血管造影术(DSA)及外周血管超声检查确诊的外周血管病患者86例(外周血管病组),同期正常体检人群46例(正常对照组),应用彩色多普勒超声检测入选者的颈动脉内—中膜厚度(IMT),观察颈动脉斑块数量及性质等,并将三组检测结果进行对比分析。结果:在腹主动脉瘤组和外周血管病组中,男性的颈动脉斑块发生率、颈动脉斑块总积分及平均颈动脉IMT值均显著高于女性(P<0.05);同性别内,外周血管病组的平均颈动脉IMT值、颈动脉斑块发生率、颈动脉斑块总积分均显著高于腹主动脉瘤组和正常对照组(P<0.001);经性别校正后,外周血管病组的平均颈动脉IMT值、颈动脉斑块发生率及颈动脉斑块总积分均高于腹主动脉瘤组及正常对照组,差异有统计学意义(P<0.001);而腹主动脉瘤组与正常对照组两者之间差异无统计学意义(P>0.05),外周血管病组合并冠心病例数及脑卒中的例数明显高于腹主动脉瘤组和正常对照组,差异有统计学意义(P<0.001)。结论:颈动脉超声可以反映全身动脉粥样硬化,本文通过颈动脉超声研究证明动脉粥样硬化是外周血管病的重要致病因素,动脉粥样硬化在腹主动脉瘤的形成中所起的作用极小。

ABI评估T2DM并发下肢动脉病变及预测心脑血管病变风险

目的探讨和分析踝臂指数(ankle-brachial index,ABI)评估2型糖尿病(type 2 diabetes mellitus,T2DM)并发下肢动脉病变及预测心脑血管疾病的发生风险。方法 157例T2DM患者根据ABI分为下肢动脉病变组(PAD组)和非PAD组,比较两组之间颈动脉内中膜厚度(intima-media thickness,IMT)、脉搏波传导速度(pulsewave velocity,PWV)及各种危险因素的差异。结果 T2DM患者PAD的患病率为13.4%,PAD组冠心病、脑梗死发病风险分别增高6.40、3.67倍,且IMT值、PWV值、HbAlc和TC水平明显升高,HDL-C水平明显下降。相关分析显示ABI与HbAlc、TC、PWV和IMT呈显著负相关。多因素Logistic回归分析提示年龄、LDL-C、HDL-C是ABI的独立危险因素。结论 ABI可评估外周血管病变的严重程度并可有效的预测心脑血管疾病的发病风险。

ABI联合CIMT对外周动脉疾病患者无症状性冠心病的预测价值

目的评价踝臂指数（ankle branchial index，ABI）ABI联合颈动脉内中膜厚度（carotid intima—media thickness，CIMT）IMT对外周动脉疾病（peripheralal arterial disease，PAD）患者无症状性冠心病的预测价值。方法随机选择2013年7月-2017年3月中山大学附属第八医院院确诊PAD且无相关临床症状的患者152例，依ABI及CIMT水平分为观察组A组（ABI≤0．9且CIMT〈1．5ram）、B组（ABI≤0．9且CIMT≥1．5mm）、C组（ABI≤0．9且CIMT≥1．5mm），以及对照组D组50例（ABI〉0．9且CIMT〈1．5mm），行冠状动脉造影评估冠脉病变程度，并对所有入选者进行6个月以上主要心血管事件（major adverse cardiovascular events，MACE）的随访，比较各组无症状冠心病与MACE事件的发生率的及其相关性。结果观察组各组中的冠心病及MACE事件发生率明显高于对照组（P〈0．01），以C组最高。校正血糖、血脂及一般临床资料等因素影响后，ABI串行联合CIMT预测PAD患者无症状性冠心病的灵敏度为94．74％，特异性为61．25％，比值比28．26；ABI与冠脉病变程度呈显著负相关（r=0．282，P〈0．01），CIMT与冠脉病变程度呈显著正相关（r=0．405，P〈0．01）。绘制ROC曲线提示ABI≤0．9且CIMT≥1．5mm时对PAD无症状性冠心病有较好的预测价值（曲线下面积0．909±0．023，95％C10．864—0．955，P〈0．01）。结论ABI联合CIMT对可用于识别冠心病的高危人群，为临床工作中对PAD患者无症状性冠心病的早期发现提供一个无创、价廉、简单、可重复的有效手段。

老年人周围动脉疾病与颈动脉内膜中层厚度的关系以及危险因素分析

目的探讨老年人周围动脉疾病(PAD)与颈动脉内膜中层厚度(I MT)的关系,分析其危险因素。方法测定了126例老年人的踝肱指数(ABI),≤0.9定义为PAD。同时测定I MT和C反应蛋白(CRP)。结果PAD发生率为19.8%(70～79岁,80～89岁和≥90岁年龄组的发生率分别为16.3%,20.6%和33.3%)。I MT≥1.5 mm组的ABI显著低于其他各组(P<0.05)。PAD患者的I MT(1.52±0.34)mm较无PAD者(1.04±0.15)mm明显增加(P<0.01)。PAD患者的CRP(中位数5.00 mmol/L)较无PAD者(中位数2.22 mmol/L)升高(P<0.05)。PAD与I MT相关(r=0.649,P<0.01)。Logistic回归分析显示,糖尿病、高血压、低的高密度脂蛋白和年龄是PAD的危险因素。结论老年人PAD发病率较高,随年龄增加患病率增加。I MT与PAD密切相关,可以作为判断PAD的指标之一。糖尿病、高血压、低的高密度脂蛋白和年龄是PAD的危险因素。PAD患者的心血管事件风险明显增加。

超声评价糖尿病患者外周动脉病变与血管内皮舒张功能的关系

目的:通过超声检测2型糖尿病患者胭动脉内膜-中层厚度(Intima-media Thickness,IMT),肱动脉内皮依赖性舒张功能,探讨其在2型糖尿病患者外周动脉病变中的早期诊断价值。方法:将2型糖尿病患者46例按照是否合并下肢血管病变分成二组,将正常对照组24例为一组,共分三组。应用彩色多普勒超声诊断仪分别测量各组的腘动脉IMT值以及血流介导的肱动脉内径扩张值(Flow-mediated Dilation,FMD),然后将各组指标对照分析。结果:糖尿病患者未出现下肢血管病变组与正常对照组比较,肱动脉FMD值明显降低,有显著性意义(P<0.01);FMD值与糖尿病患者的IMT值呈显著负相关,r=-0.745(P<0.05)。结论:超声可以通过测量肱动脉FMD值比IMT值更早出现改变,来说明糖尿病患者在合并下肢动脉病变之前,已存在血管内皮功能损害,而且,FMD值与IMT值呈显著负相关。

外周血指标联合颈动脉彩色超声检查在ACI中的应用

目的探讨外周血指标[血清超敏C反应蛋白(hs-CRP)、同型半胱氨酸(Hcy)、血浆胱抑素C(CysC)及D-二聚体(D-D)]检测联合颈动脉彩色超声检查在动脉粥样硬化性脑梗死中的应用价值。方法选取2016年1月—2017年7月本院收治的动脉粥样硬化性脑梗死(ACI)患者148例作为研究对象。根据颈动脉内膜中层厚度(IMT),将其分为IMT正常组(35例)、IMT增厚组(61例)以及斑块形成组(52例)。测定各组患者血清hs-CRP、Hcy、CysC、D-D并进行统计学分析,采用Spearman相关分析hs-CRP、Hcy、CysC、D-D与IMT值的相关性。结果 IMT增厚组、斑块形成组ACI患者的hs-CRP、Hcy、CysC及D-D水平均高于IMT正常组,斑块形成组ACI患者的hs-CRP、Hcy、CysC及D-D水平均高于IMT增厚组,差异具有统计学意义(P <0.05)。ACI患者hs-CRP、Hcy、CysC、D-D水平均与IMT值呈正相关(r依次为0.846、0.941、0.853、0.802,均P <0.05);且ACI患者hs-CRP、Hcy、CysC、D-D水平两两之间也呈正相关(均P <0.05)。结论 ACI患者血清hs-CRP、Hcy、Cys C、D-D水平与IMT值均呈正相关,可作为脑梗死早期诊断的重要指标。

外周动脉内膜-中层厚度与冠状动脉粥样硬化的相关性

目的研究外周动脉(颈总动脉、颈动脉窦和股动脉)内膜-中层厚度(IMT)与冠心病患者冠脉病变的相关性。方法将300例拟诊为"冠心病"的住院患者行冠状动脉造影,并对所有研究对象进行外周动脉IMT和斑块的超声检测,而后评估外周动脉IMT与冠心病患者冠脉病变程度的相关性。结果在冠心病组外周动脉IMT值明显高于正常对照组(颈动脉0.94 vs 0.58毫米,颈动脉窦1.27 vs 0.65,股动脉1.47 vs 0.70,P值均<0.01)。而且三支冠脉病变组IMT值高于单支组和双支组(P<0.05)。结论外周动脉IMT值可作为早期动脉粥样硬化的标志并且可能反映冠状动脉粥样硬化病变的严重性。

高分辨率超声测量动脉内膜厚度的影响因素及其诊断冠心病的价值

目的观察高分辨率超声所测颈动脉和外周动脉内膜厚度的相关影响因素,以及内膜厚度诊断冠心病(CHD)的价值。方法纳入95例CHD患者(CHD组)和50例非CHD患者(对照组),以24 MHz高频超声测量颈动脉、桡动脉及足背动脉内膜/中膜/内-中膜厚度(cIT/cMT/cIMT、rIT/rMT/rIMT、pIT/pMT/pIMT),比较组间基本资料和超声指标差异;分析内膜厚度的相关影响因素,绘制受试者工作特征曲线,计算曲线下面积(AUC),评价各超声指标诊断CHD的价值及差异。结果CHD组患者年龄、体质量指数(BMI),高血压、高血脂、糖尿病史和服用他汀类药物者占比,以及甘油三酯、同型半胱氨酸水平均高于对照组(P均<0.05),而总胆固醇、高密度脂蛋白胆固醇(HDL-C)及低密度脂蛋白胆固醇水平均低于对照组(P均<0.001)。相比对照组,CHD组cIT、rIT、pIT、cIMT、rIMT及pIMT均增厚(P均<0.05);组间cMT、rMT、pMT差异均无统计学意义(P均>0.05)。cIT、rIT及pIT的主要影响因素包括患者年龄、BMI、高血压史、糖尿病史、吸烟史及HDL-C水平。超声模型(cIT+rIT+pIT)诊断CHD的效能优于单独cIT、rIT及pIT,其AUC=0.950、0.919、0.879及0.833(P均<0.05);相比单一临床模型(高血压史、高血脂史、糖尿病史、吸烟史及BMI≥28kg/m2,AUC=0.888),临床模型分别联合cIT、rIT、pIT及超声模型均可提高诊断效能(AUC=0.941、0.936、0.927及0.954,P均<0.05)。对于判断同一动脉的内膜厚度及IMT,cIT的效能优于cIMT(AUC=0.919、0.773,P<0.05),rIT优于rIMT(AUC=0.879、0.732,P<0.05),pIT优于pIMT(AUC=0.833、0.608,P<0.05)。结论cIT、rIT及pIT增厚的主要影响因素相似,均包括患者年龄、BMI及高血压史等;cIT、rIT及pIT对CHD的独立和联合诊断价值均较高并优于IMT;在传统临床危险因素基础上引入内膜厚度可提高诊断CHD效能。

幽门螺杆菌感染与老年2型糖尿病患者动脉粥样硬化的相关性研究

目的研究感染与老年2型糖尿病患者颈动脉粥样硬化及外周动脉疾病(PAD)的关系。方法收集413例老年2型糖尿病患者,根据有无感染分为阳性组及阴性组。比较2组血压、血糖、血脂、超敏CRP(hs-CRP)、尿蛋白/肌酐比(ACR)、颈动脉内中膜厚度(IMT)及外周动脉疾病(PAD)发病情况,并行二元Logistic回归分析,探讨感染与动脉粥样硬化的关系。结果 2组在糖尿病病程、血压、血糖,血脂及吸烟等方面比较差异无统计学意义(>0.05)。阳性组hs-CRP及ACR较阴性组升高且差异有统计学意义(<0.05)。阳性组颈总动脉IMT(0.99±0.38)mm高于阴性组(0.88±0.29)mm(<0.01),颈内动脉IMT(0.80±0.29)mm亦高于阴性组(0.74±0.22)mm(<0.05)。阳性组发生PAD比例为48.89%(88/180),多于阴性组32.19%(75/233)(<0.01)。回归分析提示,感染为颈总动脉IMT升高(OR=2.33,<0.001)及PAD的独立危险因素(OR=2.72,<0.001)。结论感染与老年2型糖尿病患者发生颈动脉粥样硬化及PAD有关。

丹参葛根胶囊辅助治疗外周血管病伴间歇性跛行--一项随机双盲安慰剂对照的临床试验

目的评估加用丹参葛根辅助治疗外周动脉性疾病伴间歇性跛行的疗效与安全性。方法随机双盲安慰剂对照设计,对符合入选标准的98例受试者随机分为2组,每组49例,口服丹参葛根胶囊或安慰剂,为期24周。比较两组治疗前后颈动脉内膜中层厚度(intima-media thickness,IMT)、最大行走距离(maximalwalking distances,MWD)及无痛行走距离(pain-free walking distances,PFWD)的变化。结果丹参葛根胶囊组治疗24周后IMT与治疗前比较降低2.67%,差异有统计学意义(P=0.066);安慰剂组24周后IMT与治疗前比较,差异无统计学意义(P=0.995)。丹参葛根胶囊组MWD比治疗前增加21.8%,差异有统计学意义(P=0.057);安慰剂组MWD比治疗前增加7.2%,但差异无统计学意义(P=0.499)。结论丹参葛根能改善患者的血管功能,增加患者MWD步行距离,改善患者日常步行能力。

2型糖尿病患者趾臂指数与颈动脉及下肢动脉内中膜厚度的相关性研究

目的分析2型糖尿病(T2DM)患者趾臂指数(TBI)与外周动脉内中膜厚度(IMT)的相关性及TBI降低的危险因素。方法选择该院内分泌科住院的T2DM患者292例作为研究对象,分析其TBI与颈、股、腘动脉IMT的相关性及TBI降低的危险因素。结果 TBI降低组(TBI<0.7)与TBI正常组(TBI≥0.7)比较,年龄,DM病程,收缩压(SBP),颈、股、腘动脉IMT,DN患病人数差异均有统计学意义(P<0.05);TBI与颈、股、腘动脉IMT均呈负相关(r=-0.331、-0.288、-0.350,P<0.001);TBI降低的危险因素为年龄(OR=1.060、P<0.001、95%CI:1.027~1.095)、DM病程(OR=1.073、P=0.001、95%CI:1.027~1.121)、SBP(OR=1.021、P=0.018、95%CI:1.004~1.039)和吸烟史(OR=2.406、P=0.008、95%CI:1.251~4.626)。结论 T2DM患者TBI与颈、股、腘动脉IMT均呈负相关,年龄、糖尿病病程、SBP和吸烟史是TBI降低的危险因素。

柔肝化纤颗粒联合西药治疗慢性乙肝肝纤维化随机平行对照研究

[目的]观察柔肝化纤颗粒联合西药治疗慢性乙肝肝纤维化疗效。[方法]使用随机平行对照方法,将52例门诊及住院患者按抛硬币法随机分为两组。对照组26例保肝对症治疗,维生素C、肝泰乐以及肌苷、甘利欣等。治疗组26例柔肝化纤颗粒(大枣、鸡内金各15g,黄芪45g,虎杖、枸杞、黄精各20g,牡丹皮12g,橘红10g,薏苡仁45g,牡蛎、泽兰、鳖甲30g),磨粉冲服,150g/次,2次/d。西药治疗同对照组。连续治疗半年为1疗程。观测临床症状、肝功能指标、脾脏厚度、门静脉内径、门静脉流速(A/P)、肝动脉收缩期最大流速、血清肝纤维化、不良反应。治疗1疗程(半年),判定疗效。[结果]治疗组痊愈5例,显效10例,有效9例,无效2例,总有效率92.31%。对照组痊愈1例,显效7例,有效10例,无效9例,总有效率65.38%。治疗组疗效优于对照组(P<0.05)。肝功能两组均有改善(P<0.05),治疗组改善优于对照组(P<0.05)。两组血清纤维化指标及门脉内径、A/P、脾脏厚度均有改善(P<0.05),治疗组改善优于对照组(P<0.05)。外周血免疫活性细胞绝对值两组改善治疗组优于对照组(P<0.05)。[结论]柔肝化纤颗粒联合西药治疗慢性乙肝肝纤维化效果显著,值得推广。

外周动脉疾病患者脂联素、氧化型低密度脂蛋白与IMT的相关性

目的探讨脂联素在外周动脉疾病患者中与动脉硬化的关系及机制。方法酶联免疫吸附测定(ELISA)法分别测定77例外周动脉疾病患者(包括颈动脉狭窄33例、肾动脉狭窄29例及腹主动脉瘤15例)、33例对照组血浆脂联素及氧化型低密度脂蛋白浓度,超声测定颈动脉内膜中层厚度(intima media thickness,IMT),分析三个指标之间的相关性。结果平方根转换后外周动脉疾病患者血浆脂联素浓度较对照组显著降低[(2.39±0.07)Sqrt mg/L vs.(3.58±0.14)Sqrt mg/L,P<0.001],氧化型低密度脂蛋白浓度显著高于对照组[(3.20±0.17)Sqrtμg/Lvs.(1.55±0.24)Sqrtμg/L,P<0.001)。血浆脂联素与氧化型低密度脂蛋白浓度的平方根呈负相关(r=-0.526,P<0.001),与颈动脉IMT呈负相关(r=-0.384,P<0.001);氧化型低密度脂蛋白浓度的平方根与颈动脉IMT呈正相关(r=0.336,P<0.001)。偏相关分析校正年龄、吸烟年支数、血糖、血脂指标后,血浆脂联素与氧化型低密度脂蛋白浓度的平方根仍呈负相关(r=-0.235,P<0.05),与颈动脉IMT呈负相关(r=-0.175,P<0.05);血浆氧化型低密度脂蛋白浓度的平方根与颈动脉IMT呈正相关(r=0.157,P<0.05)。结论血浆脂联素浓度与外周动脉疾病的发生、发展以及机体的氧化应激相关。