目的 通过超声检查了解上海市闵行区中老年人群颈动脉粥样硬化现状,分析相关危险因素,为该地区中老年心脑血管疾病的预防和诊治提供依据.方法 选择2013年1月～2014年5月在复旦大学附属上海市第五人民医院行颈动脉超声检查的闵行区中老年人共3100名,年龄40～90岁,其中,男、女分别为1504、1596名,将受试者按年龄段分成五组进行问卷调查、体格检查及颈动脉检查,并对相关危险因素进行统计学分析.结果 ①颈动脉内膜-中层厚度(carotid intima-media thickness,CIMT)增厚及颈动脉粥样硬化(carotid artery atherosclerotic,CAS)斑块检出率分别为61.6％、50.2％,其中,男性分别为33.5％、26.5％,女性为28.1％、23.7％;颈动脉狭窄检出率为12.1％,以轻、中度为主,分别为6.1％、3.4％.②性别、年龄、高血压、糖尿病、脑梗死及吸烟在CIMT增厚组与非增厚组间比较,差异有统计学意义(P＜0.05);性别、年龄、高血压、糖尿病、脑梗死、冠心病及吸烟在CAS斑块组与非斑块组间比较,差异有统计学意义(P＜0.05).③多因素Logistic回归分析显示,CIMT增厚的危险因素为性别、年龄、高血压及吸烟(P＜ 0.05);CAS斑块形成的危险因素为性别、年龄、高血压、脑梗死、冠心病及吸烟(P＜0.05).结论 ①随着年龄的增长,中老年人群CAS程度呈逐渐加重的趋势,且男性CAS程度较女性显著;②性别、年龄、高血压及吸烟是CIMT增厚的独立危险因素;③性别、年龄、高血压、脑梗死、冠心病及吸烟是CAS斑块形成的独立危险因素.

目的 通过超声检查了解上海市闵行区中老年人群颈动脉的现状,为本地区心脑血管疾病的预防和诊治提供基线数据.方法 将3081名研究者按年龄段分成5组进行颈动脉检查,观察并记录相关检测数据.结果 比较不同部位、性别及年龄组之间颈动脉内-中膜厚度(IMT)、IMT增厚及斑块检出率,差异有统计学意义(P＜0.05).检出的颈动脉狭窄以轻、中度为主,分别为52.9％、26.6％;颈动脉分叉处(BIF)的斑块检出率最高(90.0％).不同部位颈动脉IMT与年龄呈线性正相关,其中颈总动脉(CCA)的IMT与年龄线性关系最密切(r左=0.457,r右=0.495,P＜0.05).结论 闵行区中老年人群颈动脉粥样硬化(CAS)随年龄增长呈逐渐加重的趋势;男性CAS程度高于女性;50～59岁人群颈动脉IMT增厚较其他年龄组显著.颈动脉超声检查是早期观察动脉粥样硬化形成的有效方法.

Objective To investigate the adiponectin levels in non-obese first-degree relatives (FDR)of type 2 diabetic subjects and its relation to insulin sensitivity and the intima-media thickness of the common carotid artery (IMT) during 5-year follow-up. Methods Fifty-three FDR subjects and 37 control subjects who were free of type 2 diabetes were enrolled. Plasma adipenectin, lipid profile, blood glucose, fasting insulin, and blood pressure were determined at baseline and after 5-year follow-up. IMT and endothelial-dependent vasodilation (EDVD) were measured by high-resolution B-mode ultrasound imaging. Homeostasis model assessment was used to evaluate insulin resistance (HOMA-IR)and β-cell function (HOMA-β). 29 FDR subjects and 20 control subjects completed the follow-up. Results Comparing with the control, plasma adiponectin levels in non-obese FDR subjects were lower at baseline [(10.06±5.79)vs (14.43±7.91) mg/L, P< 0.05]. Plasma adiponectin were decreased 24.0% in non-obese FDR and 36.7% in control duning 5 year follow-up (both P<0.05). Adiponectin levels were negatively correlated with waist-to-hip ratio (r = -0. 397), fasting blood glucose (r = -0. 373), IMT (r = -0. 372), and HOMA-IR (r=-0. 40)in the non-obese FDR. After adjusting other relevant risk factors,adiponectin was associated with age, high-density lipoprotein-cholesterol, and IMT in multiple regression analyses in non-obese FDR group. In the control group, a similar analysis revealed that low-density lipoprotein-cholesterol and IMT explained 25% of the variability in the adiponectin concentration. Conclusion Plasma adiponectin levels were decreased after 5 years in both non-obese FDR and control subjects. Decreased adiponectin level may be related to IMT increment.

The plasma visfatin,endothelium-dependent artery dilation and intima-media thickness of common carotid arteries were measured in first-degree relatives of type 2 diabetes,obese patients and control subjects.Regional body fat were detected by MRI.The result suggested that plasma visfatin levels were significantly higher in obese subjects than those in non-obese subjects,and hypervisfatinemia is independently associated with fasting blood glucose.

<正>资料和方法一、病例资料选择本院2004年1月-2006年2月期间的门诊及住院患者中,因一侧上肢肿胀、疼痛不适就诊。临床考虑为急性上肢静脉血栓病变的患者58例,男性27例,

目的:探讨肥胖患者脂联素变化及与胰岛素抵抗、内皮依赖性舒张功能之间的关系.方法:采用彩色多普勒超声检测仪检测肥胖组(O)53例和正常对照组(C)24例右肱动脉内皮依赖性舒张功能、颈总动脉内膜-中层厚度(IMT),并测定血脂、血糖、空腹胰岛素(FINS)、血管性血友病因子(vWF)、纤溶酶原激活剂抑制物-1(PAI-1)和脂联素(adiponectin).采用稳态模式(HOMA-IR)评价胰岛素抵抗.结果:O组腰臀比(WHR)、体重指数(BMI)、体内脂肪含量(BF)、收缩压(SBP)、舒张压(DBP)、载脂蛋白B(ApoB)、空腹血糖(FBG)、FINS和HOMA-IR高于C组(P＜0.05),脂联素明显低于C组(P＜0.05).脂联素与性别(男=1,女=2)、高密度脂蛋白-胆固醇(HDL-C)呈正相关(r分别为0.354、0.438,P值分别为0.027、0.005);与体重、腰围(W)、甘油三酯(TG)、WHR、FINS和HOMA-IR呈负相关(r分别为-0.358、-0.359、-0.449、-0.375、-0.363、-0.319,P值分别为0.025、0.025、0.004、0.019、0.027、0.054).多元逐步回归分析显示,BMI和BF是影响脂联素独立的危险因素.结论:肥胖患者脂联素降低,并且与胰岛素抵抗密切相关.

目的探讨血清睾酮与脂联素、颈动脉粥样硬化之间的关系.方法入选研究对象共90例,男性35例,女性55例.根据体内脂肪含量(BFC)均数,分为男性高脂肪含量组和低脂肪含量组、女性高脂肪含量组和低脂肪含量组.评价颈总动脉内膜-中层厚度(IMT),并测定脂联素和血清睾酮水平.结果男性组脂联素水平低于女性组(P<0.05),颈总动脉IMT、斑块发生率和血清睾酮水平高于女性组(P<0.05).男性高脂肪含量组脂联素水平低于女性低脂肪含量组(P<0.05),两组BFC差异无显著性(P>0.05).Spearman相关分析显示,血清睾酮水平与颈动脉IMT呈正相关;与脂联素呈负相关.结论高睾酮血症可能与动脉粥样硬化和低脂联素血症密切相关.

Objective To investigate level of adiponectin and carotid atherosclerosis in subjects with metabolic disorder. Methods The endothelium-dependent relaxing function and carotid intima-media thickness(IMT) was detected and adiponectin were measured in 90 subjects. The subjects were divided into four groups: no metabolic disorder(M 0), one metabolic disorder(M 1), two metabolic disorders(M 2) and more than two metabolic disorders(M 3). Results M 2 and M3 groups had higher carotid IMT than M 1 or M0 groups(P0.05). M 3 group had higher plaque occurrence rate than M 0 group and lower adiponectin levels compared with M 1 group(P0.05). After adjustments for affecting factors in M 3, adiponectin levels were still negatively correlated with HOMA-IR. Conclusion The patients with metabolic disorder had lower adiponectin levels and accelerated the course of atherosclerosis.

目的探讨彩色多普勒超声对上肢动脉病变的诊断价值.方法对我院2001年2月至2003年8月期间200例拟诊为上肢动脉疾病患者的彩色多普勒超声检查结果进行总结.结果检出上肢动脉疾病57例,阳性率为28.5%,疾病种类包括动脉硬化斑块、动脉扭曲、多发性大动脉炎、胸廓出口综合征、肢端动脉痉挛病(雷诺氏病)、动脉瘤、急性动脉栓塞和锁骨下动脉盗血综合征.其中,以动脉粥样硬化病变常见.结论彩色多普勒超声对上肢动脉病变的诊断和鉴别具有准确性和实用性.

Serum adiponectin, the endothelium-dependent relaxing function of right brachial artery and intima-media thickness of common carotid arteries were determined in nondiabetic first-degree relatives of type 2 diabetics (FDR) and control subjects. The results show that serum adiponectin level is reduced in obese nondiabetic FDR of type 2 diabetics and hypoadiponectineamia is associated with insulin resistance.

目的探讨超声检测初诊2型糖尿病患者下肢动脉的临床意义.方法初诊2型糖尿病患者69例,根据有无临床症状分为有症状组49例(A组)和无症状组20例(B组),检测其髂股动脉、股浅动脉、(月国)动脉、胫前动脉和足背动脉的管径、IMT、斑块和血流频谱,与同龄的健康对照组(C组)比较.结果 (1)B组下肢动脉各段IMT界于A组和C组之间;与C组比较,A组患者下肢动脉各段、B组(月国)动脉段和足背动脉段IMT增加且差异有显著性(P＜0.05).(2)A组(月国)动脉段和足背动脉段微小斑块和斑块检出差异均无显著性(P＞0.05);(3)三组间下肢动脉内径和血流频谱比较差异均无显著性(P＞0.05).结论初诊2型糖尿病已存在早期动脉粥样硬化(IMT增厚、微小斑块形成)表现;无症状的B组的程度介于正常组C和有症状组A之间.

患者女,49岁,尿毒症行肾移植术后5年,一直服用抗排斥药物,因右侧颈部持续疼痛2周,胸闷,端坐呼吸4天就诊.查体:神志清楚,端坐位,无紫绀,右侧颈部无红肿及颈静脉怒张,上颈部(平下颌骨处)局部压痛明显,无包块.血压:120/80mmHg(右上肢),150/60mmHg(左上肢),心率87次/分,律不齐,心界向左下扩大,偶发房颤.心电图检查:完全性右束支传导阻滞,偶发房颤.胸片提示:心影增大,心功能不全.B超检查:右侧髂窝处可见移植肾回声,大小53mm×114mm,结构回声清晰.CDFI:血流树显示清楚,肾动脉峰值流速68cm/s,RI:0.69.右肾30mm×65mm,左肾46mm×77mm,实质回声增强,与集合系统分界不清.右侧颈部检查,横切时见颈总动脉内径11mm,无名动脉内径19mm,内带状强回声,将动脉分成内侧大外侧小的两个腔,纵切时该强回声带从无名动脉一直延续到颈总动脉分叉处,随动脉血流而波动(如图).两个腔内可见不同时期的血流信号,外侧的腔内先充盈血流,强回声带向内侧移动,然后内侧的腔内充满血流,血流速度降低,频谱形态尚正常,外侧的腔与右侧锁骨下动脉相通.左侧颈动脉未见异常回声,诊断:右侧颈动脉夹层(颈总动脉和无名动脉或主动脉).MRI检查:无名动脉到右侧颈动脉分叉处内侧壁见条状信号,约占管径的1/3.提示:夹层动脉瘤.四天后因心衰而死亡.

患者,女,42岁.因上腹部不适伴恶心、呕吐1月就诊.无发热、头痛、腹痛、腹泻.查体:BP110/75mmHg,心率82次/分,腹部平软,未触及明确肿块.实验室检查:Hb110g/1,免疫酶标:Vin(++),CgA(++),Syn(++).超声检查:近胰尾处见一实质性肿块,44mm×54mm×46mm,边界清楚,球体感明显,外周有一圈低回声的声晕,内部回声欠均匀,为低、中回声,未见钙化和液化区(图1),不活动,胰腺头、体部显示清楚.左肾上腺区未见肿块,腹水(-).CDFI:肿块内未检出血流信号显示,其旁的腹主动脉及脾静脉近段显示清楚.提示:后腹膜实质性占位:良性可能性大.

患者女,53岁.发现双小腿跟腱处肿块8年,逐渐增大,有酸胀感,无发热,有高脂饮食习惯,无外伤史.检查:无肥胖体征,双小腿跟腱处增粗,局部无红肿,皮肤粗糙,无皮疹和结节;可触及质地偏硬的肿块,表面不光滑,活动度差,有轻压痛.

Objective:To inv es tigate the usage of low extremity artery color Doppler imaging in elderly pati ents with type II diabetes mellitus (DM)and its clinical significance.Methods :The elderly patients with DM in our hospital accepted the ex-amination of l ow extremity artery color Doppler imaging from bottom to top.The inner caliber ,IMT,atheromatous plaques and blood flow spectrum of lower extremity artery w ere measured and compared with the control 's.Results:①The thickness of IMT and atheromatous plaques were thicker than the control group's(P0.01 ).②The check-out rates of marked narrow segments and occlusive segments in the low extremity artery in patients group were significantly higher than the c ontrol group's (12.64%vs3.19%and1.39%vs0,P0.01,respe ctively),the most of marked narrow segments and occlusive segments were locat ed in the small arteries under the knees(90.11%and91.30%,respectiv ely).③18.8%of non-symptoms patients had marked narrow and?or occlus ive arteries and the check-out rates of narrow segments and occlusive segment s in patients with symptoms were higher than the non-symptoms '.Conclusion: The tunica intima and plaque of low extremity artery in elderly patients with type II DM could be clearly displayed by the high resolving power B-mode ultras ound.The narrow extent and occlusive segments could be judged by united with C DFI and the measurement of frequency spectrum,the measurement was especiall y suitable for the small arteries under knees.