Atherogenic lipid profile is a feature characteristic of patients with early rheumatoid arthritis: effect of early treatment – a prospective, controlled study

The efficiency of activating latent transforming growth factor (TGF)-β₁ in systemic lupus erythematosus (SLE) may control the balance between inflammation and fibrosis, modulating the disease phenotype. To test this hypothesis we studied the ability to activate TGF-β₁ in SLE patients and control individuals within the context of inflammatory disease activity, cumulative organ damage and early atherosclerosis. An Activation Index (AI) for TGF-β₁ was determined for 32 patients with SLE and 33 age-matched and sex-matched control individuals by quantifying the increase in active TGF-β₁ under controlled standard conditions. Apoptosis in peripheral blood mononuclear cells was determined by fluorescence-activated cell sorting. Carotid artery intima-media thickness was measured using standard Doppler ultrasound. These measures were compared between patients and control individuals. In an analysis conducted in patients, we assessed the associations of these measures with SLE phenotype, including early atherosclerosis. Both intima-media thickness and TGF-β₁ AI for SLE patients were within the normal range. There was a significant inverse association between TGF-β₁ AI and levels of apoptosis in peripheral blood mononuclear cells after 24 hours in culture for both SLE patients and control individuals. Only in SLE patients was there a significant negative correlation between TGF-β₁ AI and low-density lipoprotein cholesterol (r = -0.404; P = 0.022) and between TGF-β₁ AI and carotid artery intima-media thickness (r = -0.587; P = 0.0004). A low AI was associated with irreversible damage (SLICC [Systemic Lupus International Collaborating Clinics] Damage Index ≥1) and was inversely correlated with disease duration. Intima-media thickness was significantly linked to total cholesterol (r = 0.371; P = 0.037). To conclude, in SLE low normal TGF-β₁ activation was linked with increased lymphocyte apoptosis, irreversible organ damage, disease duration, calculated low-density lipoprotein levels and increased carotid IMT, and may contribute to the development of early atherosclerosis.     

Is There a Possible Relation Between Atrophic Gastritis and Premature Atherosclerosis?

BACKGROUND: In this study, we have aimed to show the possible relation between atrophic gastritis and premature atherosclerosis via hyperhomocysteinemia. MATERIALS AND METHODS: Thirty-four patients with atrophic gastritis were enrolled to the study. The control group consisted of 35 patients with non-atrophic gastritis. Classical cardiovascular disease risk factors did not significantly differ between atrophic gastritis and control subjects. The presence and degree of atrophic gastritis were assessed histologically and Helicobacter pylori infection was determined by both histologic and serologic methods. Body mass index was measured by standard technique blood fasting glucose, serum creatinine, total cholesterol, triglyceride, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, vitamin B12, folic acid, and homocysteine levels were measured by biochemical methods. Carotid intima-media thickness was measured by B-mode ultrasonography to examine the premature atherosclerosis. RESULTS: Plasma vitamin B12 levels were significantly lower (p = .00) and homocysteine levels were significantly higher (p = .01) in the atrophic gastritis group. There was no statistically significant difference in plasma folic acid levels between the two groups (p = .728). Carotid intima-media thickness was higher in the atrophic gastritis group than in the control group (0.516 mm versus 0.465 mm), but this difference did not show any statistical significance (p = .062). CONCLUSION: Our results showed that atrophic gastritis may cause hyperhomocysteinemia, which is an independent risk factor for atherosclerosis and cardiovascular diseases. However, when compared with controls, carotid intima-media thickness of the atrophic gastritis patients was found to be higher but did not reach statistically significant levels.     

Serum levels of angiogenic cytokines in systemic lupus erythematosus and their correlation with disease activity

We investigated the serum concentration of hepatocyte growth factor (HGF), vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) and transforming growth factor beta1 (TGF-beta1) using an enzyme-linked immunosorbent assay (ELISA) in a group of 60 patients with systemic lupus erythematosus (SLE), and 20 healthy controls. We also examined the possible association between the serum concentrations of these factors and certain clinical, laboratory parameters and SLE activity. HGF, VEGF and TGF-beta1 were detectable in all patients with SLE, and in all normal individuals. bFGF was measurable in 70% of the patients with SLE and in 65% of the healthy controls. The HGF level was higher in active SLE (median 1,019.5pg/ml) than in inactive SLE (median 787.8 pg/ml) (p < 0.005) or in the control group (median 847.0 pg/ml) (p < 0.009). The level of VEGF in active SLE was also higher (203.5 pg/ml) than in inactive disease (116.1 pg/ml) (p < 0.05) or in healthy persons (133.5 pg/ml) (p < 0.04). The levels of bFGF and TGF-beta1 were similar for both the active and inactive SLE, and the control group (p > 0.05). We found a significant, positive correlation between the levels of HGF and bFGF (r = 0.268, p < 0.04), HGF and TGF-beta1 (r = 0.365, p < 0.005) and HGF and VEGF (r = 0.327, p < 0.02) as well as VEGF and TGF-beta1 (r = 0.543, p < 0.001). We found a positive correlation between VEGF serum levels and platelet counts (r = 0.272, p < 0.04), and the TGF-beta1 concentration and platelet count (r = 0.313; p < 0.02). There was also a positive correlation between HGF serum concentration and the SLE activity score (r = 0.435, p < 0.001), as well as between the level of VEGF and SLE activity (r = 0.252, p = 0.05). In conclusion, serum levels of the angiogenic factors HGF and VEGF may be relevant in SLE pathogenesis. Their concentrations seem to be markers of SLE activity.     

Familial hypercholesterolemia in children

PURPOSE OF THIS REVIEW: This review provides an update on recent advances in the diagnosis and management of children with familial hypercholesterolemia. RECENT FINDINGS: A large cross-sectional cohort study of paediatric familial hypercholesterolemia demonstrated that affected children had a 5-fold more rapid increase of carotid arterial wall intima-media thickness during childhood years than their affected siblings. This faster progression led to a significant deviation in terms of intima-media thickness from the age of 12 years and onwards. Low-density lipoprotein cholesterol was a strong and independent predictor of carotid artery intima-media thickness in these children, which confirms the pivotal role of low-density lipoprotein cholesterol for the development of atherosclerosis. In this condition lipid lowering by statin therapy is accompanied by carotid intima-media thickness regression in familial-hypercholesterolemic children, which suggests that initiation of low-density lipoprotein cholesterol-reducing medication in childhood already can inhibit or possibly reduce the faster progression of atherosclerosis. Furthermore, these trials demonstrated that statins are safe and do not impair growth or sexual development in these children. Conversely, products containing plant sterols reduced low-density lipoprotein cholesterol levels by 14%, but did not improve endothelial dysfunction as assessed by flow-mediated dilatation. SUMMARY: Children with familial hypercholesterolemia clearly benefit from lipid-lowering strategies. Statins are safe agents and have been proven to reduce elevated low-density lipoprotein cholesterol levels significantly. In addition, statins improve surrogate markers for atherosclerosis. Therefore these agents should become the pivotal therapy in children with familial hypercholesterolemia.     

Visceral fat thickness is associated with carotid atherosclerosis in peritoneal dialysis patients

Visceral fat has been known to associate with atherosclerosis, inflammation, and insulin resistance. However, the influence of visceral fat on cardiovascular disease (CVD) in peritoneal dialysis (PD) patients has never been elucidated. We investigated whether visceral fat thickness (VFT) has a predictive role in carotid atherosclerosis determined by carotid intima-media thickness (cIMT) in PD patients. A cross-sectional study was undertaken in 88 prevalent PD patients. BMI and waist circumference (WC) were measured as anthropometric indexes of obesity. VFT and subcutaneous fat thickness (SFT) were determined by sonographic measurement of abdominal fat. Carotid atherosclerosis was defined as increased cIMT (>1.0 mm) or presence of plaque. Thirty-two (36.3%) patients had carotid atherosclerosis. Patients with carotid atherosclerosis showed significantly higher VFT, BMI, and WC. In univariate logistic analysis, BMI, WC, and VFT except SFT were significant risk factors of carotid atherosclerosis. However, multivariate analysis revealed VFT was an independent factor associated with carotid atherosclerosis after adjusting for demographic, biochemical parameters, and anthropometric indexes (per 1 mm increase, odds ratio (OR) = 2.294, 95% confidence interval: 1.048-5.021, P = 0.038). When the patients were divided into three groups according to VFT, log high sensitivity C-reactive protein (hs-CRP), and homeostasis model assessment-insulin resistance (HOMA(IR)) were both higher in the third tertile compared to other tertiles. In conclusion, VFT, not SFT, is independently associated with carotid atherosclerosis in PD patients. Therefore sonographic measurement of VFT could be useful to stratify the risk of cardiovascular disease in PD patients.     

HIV-infected patients with lipodystrophy have higher rates of carotid atherosclerosis: the role of monocyte chemoattractant protein-1

Individuals with HIV-1 infection are at increased risk for cardiovascular events, and lipodystrophy is generally associated with pro-atherogenic metabolic disturbances. We conducted a case-control study to assess the presence of sub-clinical atherosclerosis in HIV-1-infected patients with or without lipodystrophy (LD) and to evaluate the influence of monocyte chemoattractant protein-1 (MCP-1) on the development of both carotid atherosclerosis and LD. The study population consisted of 43 patients with LD and 86 patients without LD. We determined carotid intima-media thickness (IMT), MCP-1 concentrations in plasma, and MCP-1 genotype (presence or absence of the -2518G allele). HIV-1-infected patients with LD showed increased risk (OR=3.71, 95% CI=1.10-12.47, p=0.03) for sub-clinical atherosclerosis, and MCP-1 plasma concentration was significantly correlated with IMT in these patients (Pearson=0.31, p=0.03). Furthermore, presence of LD was a determinant for MCP-1 plasma concentration (beta=0.18, p=0.05). In summary, HIV-1-infected patients with clinically manifest LD are at higher risk for atherosclerosis and our observations support the relationship between inflammation and atherosclerotic disease.     

急性脑出血患者颈动脉斑块与血清hs CRP 及HbAlc的相关性研究

目的:探究急性脑出血患者颈动脉斑块与血清超敏C反应蛋白(hs-CRP)及糖化血红蛋白(Hb Alc)的相关性。方法:随机选取我院2013年5月至2015年1月脑科收治的急性脑出血患者84例,根据颈动脉粥样硬化标准将所有患者分为单纯脑出血组(n=25)、轻度粥样硬化组(n=34)和重度粥样硬化组(n=25)三组,另选取同期我院健康体检者50人(对照组)。对比分析四组颈总动脉膜厚度(IMT)空腹血糖(FPG)、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、hs-CRP与Hb Alc水平,分析急性脑出血患者颈动脉斑块的危险因素。结果:四组的IMT、TC、TG、HDL、LDL、hs-CRP和Hb Alc水平差异均具有统计学意义(P0.05),其中hs-CRP和Hb Alc水平在单纯脑出血组轻度粥样硬化组重度粥样硬化组(P0.05);IMT与hs-CRP和Hb Alc均呈现正相关(r=0.388、0.420,P0.05);IMT、hs-CRP和Hb Alc均为颈动脉粥样硬化的危险因素(OR=3.065、1.978、1.647,P0.05)。结论:急性脑出血患者体内hs-CRP及Hb Alc水平是颈动脉斑块形成的危险因素。     

痛风患者血管内皮功能及颈动脉粥样硬化的临床研究

目的:观察痛风患者氧化应激指标与颈动脉内膜中层厚度(IMT)的变化,探讨高尿酸引起内皮功能损伤和颈动脉粥样硬化的机制。方法:选择痛风患者123例,正常健康者116例,检测两组患者血尿酸、细胞间粘附分子1(ICAM-1)、内皮素-1(ET-1)、一氧化氮(NO)、纤溶酶原激活抑制剂-1(PAI-1)、收缩压、舒张压、空腹血糖、HDL-C、LDL-C、TC、TG等糖、脂代谢指标及颈动脉内膜中层厚度(IMT)。分析痛风患者内皮损伤相关因子水平和颈动脉IMT的关系。结果:痛风组血清细胞间粘附分子1(ICAM-1)、内皮素-1(ET-1)、纤溶酶原激活抑制剂-1(PAI-1)水平较对照组增高,颈动脉IMT明显增厚,NO水平较对照组降低,差异均有统计学意义(P0.05)。血尿酸水平、ICAM-1、ET-1、PAI-1与IMT密切相关(P0.01)。结论:痛风患者较对照组存在更明显的代谢紊乱,血管内皮功能损伤,更易发生动脉粥样硬化。     

Atherosclerotic plaques occur in absence of intima-media thickening in both systemic sclerosis and systemic lupus erythematosus: a duplexsonography study of carotid and femoral arteries and follow-up for cardiovascular events

Introduction

The objective of this cross-sectional and retrospective cohort study was (1) to determine the usefulness of intima-media thickness (IMT) in contrast to plaque assessment, (2) to examine the value of additive femoral artery sonography and (3) to identify potential risk factors for atherosclerosis and incident cardiovascular events in systemic sclerosis (SSc) and systemic lupus erythematosus (SLE) patients.

Methods

In this study, 90 SSc and 100 SLE patients were examined by duplexsonography. IMT was measured in common carotid and common femoral arteries, plaques were assessed in common, internal and external carotid and common, proximal superficial and deep femoral arteries. Different definitions of pathological IMT (pIMT) were compared with the presence of plaque. Results were evaluated in relation to traditional and non-traditional risk factors for baseline atherosclerosis (logistic regression) and their predictive value for cardiovascular events during follow-up (cox regression).

Results

Definite atherosclerosis occurred frequently without signs of subclinical atherosclerosis in both diseases: pIMT >0.9 mm was present in only 17/59 (28.9%) SSc and 13/49 (26.5%) SLE patients with already present atherosclerotic plaques. Using age-adjusted pIMT definitions, this rate was even lower (5.1-10.3% in SSc, 14.3-26.5% in SLE). Plaques were located only at the carotid or only at the femoral arteries in 26 (13.7%) and 24 (12.6%) patients, respectively. Age and nicotine pack-years were independently associated with atherosclerotic plaques in SLE and SSc patients, as well as the cumulative prednisolone dose in SSc subgroup, and ssDNA positive SLE patients had a lower risk for atherosclerotic plaque. During follow-up (available for 129/190 (67.9%) patients, 650 person-years), cardiovascular events occurred more often in patients with coronary heart disease (adjusted-hazards ratio (HR) 10.19, 95% confidence interval (CI) 3.04 to 34.17, P <0.001), male patients (adjusted-HR 8.78, 95% CI 2.73 to 28.19, P <0.001) and in patients with coexistent carotid and femoral plaques (adjusted-HR 5.92, 95% CI 1.55 to 22.67, P = 0.009). Patients with solely carotid or femoral plaque were not at higher risk.

Conclusion

Atherosclerotic plaque lesions can be found frequently in absence of intima-media thickening in both SSc and SLE patients. As well as routine sonography of carotid arteries, the sonography of femoral arteries is recommended to identify additional atherosclerotic lesions and to detect patients at a high risk for cardiovascular events.     

Genetics of intima-media thickness

PURPOSE OF REVIEW: Increased carotid artery intima-media thickness is associated with an increased risk of coronary heart disease or cerebrovascular disease and is a powerful predictor of cardiovascular and cerebrovascular outcomes. Consequently, the measurement is now used in a number of case control, cohort and familial and linkage studies as an intermediate phenotype for the investigation of the genetic and environmental determinants of atherosclerosis. The aim of this paper is to review the most recent available data on the genetic determinants of carotid intima-media thickness. RECENT FINDINGS: Genes could account for a significant amount of variation in carotid intima-media thickness: up to 30-66%. Carotid intima-media thickness progressed more rapidly with age in familial hypercholesterolemia patients than in patients without his condition. Familial hypercholesterolemia patients with a null LDL receptor allele tended to have higher carotid intima-media thickness than patients carrying the LDL receptor defective allele. Small association studies showing positive or negative results with the angiotensinogen gene variants as well as with the angiotensin converting enzyme I/D polymorphism add to the confusion in this largely controversial area. Differing results may depend on the vascular territory and genetic background. New associations have been described in small studies. SUMMARY: Studies on the association of polymorphisms and intima-media thickness are frequently disappointing and lead occasionally to conflicting results. Among study limitations is the fact that mostly single gene effects are considered; longitudinal cohort studies may be more appropriate than case control studies. Ongoing large prospective population studies and clinical trials have integrated the measurements of intima-media thickness and genotype determination with a genomic approach. As a result, in the near future we may see more important and robust results with significant consequences on our understanding of genetic determinants of atherosclerotic cardiovascular disease.     

颈动脉粥样硬化及主动脉瓣钙化与动脉粥样硬化性肾动脉狭窄的关系

目的:探讨颈动脉粥样硬化、主动脉瓣膜钙化(aortic valve calcification,AVC)与动脉粥样硬化性肾动脉狭窄(atherosclerotic renal artery stenosis,ARAS)的关系。方法:对我院162例行选择性冠脉造影合并肾动脉造影的患者进行颈动脉超声和超声心动图检查,测量颈动脉内中膜厚度(carotid artery intima-media thickness,CIMT)和主动脉瓣钙化的情况,根据患者是否患有ARAS进行分组,比较两组的性别、年龄、吸烟、病史、血脂水平、CIMT、颈动脉粥样硬化发生率和AVC发生率,计算颈动脉粥样硬化和AVC对ARAS的预测价值。结果:ARAS组高血压病史患者的构成比、胆固醇水平、CIMT、颈动脉粥样硬化发生率、AVC发生率均显著高于对照组,有明显的统计学差异(P0.05)。颈动脉粥样硬化预测ARAS的灵敏度较高,特异度偏低;AVC的灵敏度低,而特异度高;二者联合特异度明显增高。结论:颈动脉粥样硬化、AVC对ARAS的诊断有一定的参考价值,可用于排除诊断。     

Carotenoids and asymptomatic carotid atherosclerosis

High plasma concentrations of lycopene and beta-carotene have been associated with reduced prevalence of cardiovascular disease. The aim of this study is to compare plasma concentrations of these carotenoids in subjects with or without ultrasonic evidence of asymptomatic carotid atherosclerosis. One hundred and sixty-five subjects underwent physical examination and ultrasonic measurement of common carotid artery intima-media thickness. Analysis of variance and logistic regression methods were used to determine whether differences existed between participants with or without ultrasonic evidence of asymptomatic carotid atherosclerosis. Of the 165 participants, 80 exhibited evidence of carotid atherosclerosis (carotid intima-media thickness>0.8 mm), while 85 did not (carotid intima-media thickness>0.8 mm), while 85 did not (carotid intima-media thickness<0.8 mm). Participants with ultrasonic evidence of carotid atherosclerosis exhibited significantly greater body mass index, significantly higher serum concentrations of total cholesterol, LDL-associated cholesterol and triglycerides, and significantly higher plasma concentrations of uric acid, C-reactive protein and fibrinogen. In contrast, participants with ultrasonic evidence of carotid atherosclerosis exhibited significantly lower plasma concentrations of lycopene and beta-carotene. These results suggest that lycopene and beta-carotene may play important roles in delaying the development of the early asymptomatic stage of carotid atherosclerosis. Encouraging adequate intakes of antioxidant carotenoids may provide an important public health service.     

Association study of MIA3 rs17465637 polymorphism with cardiovascular disease in rheumatoid arthritis patients

Rheumatoid arthritis (RA) is a complex polygenic inflammatory disease associated with accelerated atherosclerosis. Melanoma inhibitor protein 3 (MIA3) is required for the export of collagen VlI (COL7A1) from the endoplasmic reticulum and it appears to be a tumor suppressor of malignant melanoma. Genome-wide association studies have described an association between MIA3 rs17465637 A/C polymorphisms and coronary artery disease and myocardial infarction. Because of that, we assessed the MIA3 rs17465637 polymorphism in 1505 RA Spanish patients stratified according to the presence/absence of cardiovascular (CV) disease. Also, a subgroup of patients without CV events was assessed for the presence of subclinical atherosclerosis using carotid ultrasound to establish carotid intima-media wall thickness and carotid plaques and brachial ultrasonography to determine the presence of endothelial dysfunction by flow-mediated endothelium-dependent and independent vasodilatation. MIA3 rs17465637 allele A showed a trend for association with the presence of carotid plaques (odds ratio 1.56, 95% confidence interval [0.96-2.51]; p=0.07). However, apart from an association of the MIA3 rs17465637 A allele with the risk of CV events in RA patients with dyslipidemia (p=0.018), no other significant associations were found between the presence of MIA3 rs17465637 A allele and the risk of suffering CV events or other surrogate markers of atherosclerosis. In conclusion, our results suggest a potential association of the MIA3 rs17465637 with CV disease in dyslipidemic patients with RA. However, additional studies are required to better establish the role of the MIA3 gene in mechanisms leading to the accelerated atherogenesis observed in RA.     

慢性阻塞性肺疾病与代谢综合征及颈动脉内膜厚度的相关性研究

目的:研究慢性阻塞性肺疾病与代谢综合征及颈动脉内膜厚度的关系。方法:选择2014年8月至2015年4月在我院就诊的慢性阻塞性肺疾病患者60例作为研究组,另选择同期在我院接受健康体检的60名志愿者作为对照组。比较两组空腹血糖、甘油三酯及高密度脂蛋白胆固醇水平、代谢综合征的发生率、颈动脉内膜厚度以及合并与不合并代谢综合征的慢性阻塞性肺疾病患者的肺功能和颈动脉内膜厚度,并采用多元回归分析颈动脉内膜厚度与慢性阻塞性肺疾病及代谢综合征的相关性。结果:与对照组相比,研究组患者空腹血糖(FPG)明显升高,而甘油三酯(TG)水平明显降低,差异具有统计学意义(P0.05);两组高密度脂蛋白胆固醇(HDL-C)比较差异无统计学意义(P0.05)。研究组代谢综合征的发病率、颈动脉内膜厚度均明显高于对照组,差异具有统计学意义(P0.05);慢性阻塞性肺疾病合并代谢综合征患者的肺功能明显优于无代谢综合征的慢性阻塞性肺疾病患者,差异具有统计学意义(P0.05);合并代谢综合征的慢性阻塞性肺疾病患者FEV1占预计值百分比及FEV1/FVC均明显高于无代谢综合征慢性阻塞性肺疾病患者的对应值,差异具有统计学意义(P0.05)。Logistic回归分析结果显示慢性阻塞性肺疾病与颈动脉内膜厚度呈独立相关性,而代谢综合征与颈动脉内膜厚度无直接相关性。结论:慢性阻塞性肺疾病与颈动脉内膜厚度呈独立相关,且慢性阻塞性肺疾病合并代谢综合征患者发生颈动脉粥样硬化的风险更高。     

Intima media thickness of common carotid arteries is associated with traditional risk factors and presence of ischaemic heart disease in hemodialysis patients

Patients with chronic renal failure are prone to cardiovascular complications. The mechanisms and the assessment of the risk of cardiovascular diseases (CVD) in this population are of interest. The purpose of this study was to investigate the traditional and potential risk factors for the development of CVD and their contribution to ischemic heart disease (IHD) and variation in carotid intima media thickness (IMT) in hemodialyzed patients (HD). Twenty-one chronically HD patients and nineteen healthy volunteers were recruited. Studied parameters were intima-media thickness, body mass index (BMI), mean arterial blood pressure (MAP), hemoglobin, fibrinogen (Fbg), serum lipids, lipoprotein (a) [Lp(a)], total homocysteine (tHcy). Mean carotid IMT, tHcy, Fbg and Lp(a) were higher in HD patients compared to the control group. There were no differences in cholesterol (tCh) and triglycerides between these groups. Patients with ischemic heart disease were older and they had higher values of carotid IMT, tCh, triglycerides, Fbg and Lp(a). There were no differences in MAP, time on dialysis and tHcy between the two subgroups (with vs without IHD). Carotid IMT correlated positively with age (r = 0.68, p = 0.001), BMI (r = 0.50, p = 0.02), tCh (r = 0.58, p < 0.01), LDL- cholesterol (r = 0.55, p = 0.01) and Fbg (r = 0.57, p < 0.01) but not with tHcy or Lp(a) in the patients group. Carotid intima media thickness thus reflects the risk for ischemic heart disease in hemodialyzed patients. Elevated fibrinogen concentration and dyslipidemia influence arterial remodelling.     

H 型高血压患者血清Hcy、Cyst-C及UA水平变化及其在颈动脉粥样硬 化中的预测价值

目的:探讨H型高血压患者血清同型半胱氨酸(Hcy)、尿酸(UA)及胱抑素C(Cyst-C)水平对颈动脉粥样硬化发生的预测价值。方法:本研究于2014年5月~2015年5月期间,选择我院收治确诊为H型高血压患者163例为研究对象,根据其颈动脉内膜中层厚度(c IMT)的不同分为c IMT正常组(51例)、c IMT增厚组(54例)和颈动脉斑块组(58例)。检测并比较三组间性别、年龄、血清Hcy、Cyst-C、UA、血糖(GLU)、血脂、血尿素氮(Bun)、血肌酐(Scr)水平,分析其与颈动脉c IMT的关系,并采用logistic回归分析颈动脉粥样硬化的影响因素。结果:三组间HDL-C、Hcy、Cyst-C、UA水平比较,差异均存在统计学意义(均P0.05);c IMT与Hcy、Cyst-C、UA均呈现正相关关系(r=0.23,0.32,0.30;P0.05),与HDL-C水平呈现负相关关系(r=-0.410,P0.05);Logistic回归分析显示Hcy、Cyst-C、UA水平是颈动脉粥样硬化危险因素(OR=1.203,6.395,1.023;均P0.05)。结论:H型高血压患者血清Hcy、Cyst-C及UA水平均与c IMT正相关,是导致颈动脉粥样硬化的独立危险因素,可用于临床早期预测动脉粥样硬化发生与发展。     

血管内超声评价川崎病晚期患儿颈动脉功能、颈动脉内膜-中膜厚度和组织特征的临床研究

摘要 目的：探究血管内超声评价川崎病晚期患儿颈动脉功能、颈动脉内膜-中膜厚度和组织特征的临床价值。方法：选取81例川崎病晚期患儿作为本研究的川崎病组,同时选择同一时期的81例健康体检者作为本研究的对照组。所有受试者均通过血管内超声检查,对比分析两组一般临床资料、颈动脉功能、颈动脉内膜-中膜厚度、组织特征、颈动脉血流动力学和血管内皮功能。结果：川崎病组和对照组儿童的一般临床资料比较,差异均无统计学意义（P>0.05）。川崎病组患儿颈动脉血管僵硬度、脉搏波传导速度、颈动脉内膜-中膜厚度、血管的压力-应变弹性系数、硬度指数、颈动脉阻力指数和颈动脉僵硬度均显著高于对照组,而血管顺应性、血管径向应变率、动脉最大剪切率、颈动脉最小剪切率、颈动脉搏动指数和血管内皮依赖性舒张功能则显著小于对照组（P<0.05）。结论：血管内超声可有效评价川崎病晚期患儿颈动脉功能、颈动脉内膜-中膜厚度和组织特征,能够为后续疾病的治疗及预后提供重要参考,值得推广使用。     

Soluble cell adhesion molecules s-VCAM-1 and s-ICAM-1 in subjects with familial combined hyperlipidemia

Familial combined hyperlipidemia (FCH) is the most common familial hyperlipidemia with a high risk for early atherosclerosis. The aim of this study was to compare levels of soluble intercellular cell adhesion molecule 1 (s-ICAM-1) and soluble vascular cell adhesion molecule 1 (s-VCAM-1) in asymptomatic members of FCH families with healthy controls and to determine the relation between s-ICAM-1, s-VCAM-1 and risk factors accompanying FCH. We also investigated the association between adhesion molecules and the intima-media thickness (IMT) of the common carotid artery, a recognized morphological marker of early atherosclerosis. 82 members of 29 FCH families were divided into the 2 groups: HL (probands and hyperlipidemic first-degree relatives, n = 47) and NL (normolipidemic first-degree relatives, n = 35). The control groups--HL-C (n = 20) and NL-C (n = 20)--consisted of sex- and age-matched healthy individuals. Hyperlipidemic members had significantly higher concentration of s-ICAM-1 (633.7 +/- 169.6 ng/ml versus 546.2 +/- 155.9 ng/ml, p < 0.05). The elevation of s-VCAM-1 was not significant (880.8 +/- 202.9 ng/ml versus 826.5 +/- 174.6 ng/ml, N.S.). Levels of s-ICAM-1 and of s-VCAM-1 in normolipidemic relatives were not significantly different from the control group (530.8 +/- 113.9 ng/ml versus 530.0 +/- 101.0 ng/ml and 860.2 +/- 265.7 ng/ml versus 822.1 +/- 197.0 ng/ml respectively). There was a significant correlation between s-ICAM-1 and apoB (r = 0.42; p < 0.01) in hyperlipidemic subjects and between s-ICAM-1 and proinsulin (r = 0.54; p < 0.01) in normolipidemic subjects. S-ICAM-1 correlated with IMT (r = 0.32; p < 0.05) in all members of FCH families. The increase of s-ICAM-1 in asymptomatic hyperlipidemic members of FCH families reflects their high cardiovascular risk. The positive association between s-ICAM-1 and IMT could indicate s-ICAM-1 as a potential predictor of atherosclerosis manifestation.     

Intelligence in Childhood and Atherosclerosis of the Carotid and Peripheral Arteries in Later Life: The Lothian Birth Cohort 1936

Objective

There is some evidence that people who score higher on tests of intelligence in childhood have lower carotid intima-media thickness and higher ankle brachial index in middle age. These findings need replicating in other, older populations. We investigated the prospective relationship between intelligence in childhood and atherosclerosis in the carotid and peripheral arteries at age 73 years.

Methods

Participants were 713 members of the Lothian Birth Cohort 1936 whose intelligence was assessed at age 11 years. At age 73 years, carotid intima-media thickness and degree of stenosis were measured using ultrasound imaging; ankle-brachial index was measured using Doppler ultrasound.

Results

There were no significant associations between intelligence at age 11 and measures of atherosclerosis at age 73. In age- and sex-adjusted analyses, for a standard deviation higher score in intelligence, intima-media thickness (x 10) was lower by 0.07 (-0.20, 0.06) mm and ankle brachial index (x 10) was lower by 0.09 (-0.24, 0.07); odds ratios for having carotid stenosis >25% or peripheral arterial disease were 0.98 (0.82, 1.16) and 1.05 (0.81, 1.36) respectively.

Conclusion

In this study of people aged 73 years, higher childhood intelligence was not associated with reduced risk of atherosclerosis in the carotid or peripheral arteries.     

彩色多普勒超声检查评估老年退行性心脏瓣膜病与颈动脉粥样硬化的相关性研究

目的:应用彩色多普勒超声评估老年退行性心脏瓣膜病(SDHVD)与颈动脉粥样硬化相关性。方法:选择2016年5月-2018年7月中国医科大学航空总医院收治的老年SDHVD患者240例作为观察组,根据心瓣膜钙化程度分级标准将所有患者分为1级组61例、2级组84例以及3级组95例。另取同期于我院住院治疗的非SDHVD患者100例作为对照组。所有患者均接受彩色多普勒超声检查,比较观察组与对照组患者的基础疾病合并情况,对比不同组别患者颈动脉内膜中层厚度(IMT)、颈动脉斑块积分以及颈动脉管腔狭窄程度情况,分析SDHVD与颈动脉粥样硬化相关性。结果:观察组冠心病、糖尿病、高血压以及高脂血症发生率分别为47.08%、50.42%、93.75%、81.67%,均分别高于对照组的24.00%、29.00%、68.00%、52.00%(P0.05)。对照组、1级组、2级组、3级组的IMT以及颈动脉斑块积分比较存在统计学差异,且随着心瓣膜钙化程度分级的逐渐提高,IMT以及颈动脉斑块积分呈逐渐上升趋势(P0.05)。随着心瓣膜钙化程度分级的逐渐升高,颈动脉管腔狭窄程度在50%-70%以及71%-99%中的发生率呈逐渐升高趋势(P0.05)。经Pearson相关性分析显示:SDHVD严重程度与IMT、颈动脉斑块积分以及颈动脉管腔狭窄程度均呈正相关(P0.05)。结论:彩色多普勒超声检查可有效评估SDHVD与颈动脉粥样硬化的严重程度,且SDHVD患者多并发基础疾病,临床应积极预防。