简介:BackgroundMonocytetohighdensitylipoproteinratio(MHR)hasbeenconsideredasanovelparameterrelatedwithadverserenalandcardiovascularoutcomes.InthisstudyweinvestigatedtheassociationofMHRwithmajoradverseclinicalevents(MACEs)inpatientswithtype2diabetesmellitus(T2DM)undergoingelectivepercutaneouscoronaryintervention(PCI).MethodsConsecutiveT2DMpatientstreatedwithelectivePCIwereprospectivelyrecruitedbetweenJuly2008-January2016inDepartmentofCardiologyofPanyuCentralHospital.Subjectswerecategorizedintotwogroups:aspatientswhodevelopedMACEs(MACEs+)andpatientswhodidnotdevelopMACEs(MACEs-)duringhospitalization.MACEsweredefinedasthecompositeendpoints,includingall-causemortality,oracuteheartfailure,ortargetvesselrevascularization,orstrokeorrecurrentangina.ResultsAtotalof418patientswereincludedinthestudy.64patientsdevelopedMACEs(15.3%).IntheMACEs(+)patients,monocyteswerehigher(1.12[0.78-1.42]vs.0.72[0.68-0.92]109/L,P<0.01)andHDLcholesterollevelswerelower(0.87[0.72-1.21]vs.0.96[0.81-1.11]mmol/L,P<0.01).Inaddition,MHRwassignificantlyhigherintheMACEs(+)group(1.12[0.91-2.09]vs.0.73[0.54-0.93]109mmol/L,P<0.01).ThecutoffvalueofMHRforpredictingMACEswas22,withasensitivityof81%andaspecificityof75.1%(areaunderthecurve0.79,P<0.001).Inmultivariatelogisticregressionanalysis,MHRremainedanindependentfactorcorrelatedwithMACEs(OR=3.97,95%CI=1.38-11.5,P<0.01).ConclusionHigherMHRlevelsmaypredictMACEsdevelopmentafterelectivePCIinT2DMpatients.
简介:目的分析研究2型DM(糖尿病)病人在降血糖治疗期间出现低血糖的因素。方法选取2008年3月-2013年1月在我院接受降血糖治疗的患有2型DM病人80例,把药物治疗期间出现低血糖的病人作为实验组,没有出现低血糖的病人作为对照组,对比实验组和对照组病人的相关临床资料,检查糖化血红蛋白以及空腹血糖等相关指标,对发生低血糖的因素进行分析研究。结果实验组和对照组病人在年龄、血清肌酐、体重指数以及病程方面差异具有明显的统计学意义(P〈0.05);通过Logistic回归分析,其中引发低血糖的危险原因有体重指数以及年龄,当中体重指数是2型DM出现低血糖的保护性原因,和低血糖的出现呈负相关,而年龄原因呈正相关。结论2型DM在治疗期间出现低血糖是由于多种原因造成的,避免出现低血糖的重点在于降低危险原因和及时对治疗模式进行调整,同时病人要明确了解其特点以及处理措施,进而使发生低血糖的几率明显减少。
简介:目的探讨急性大脑中动脉M2段闭塞缺血性卒中患者支架取栓治疗的初步应用效果及安全性。方法回顾性连续纳入2014年1月至2019年2月东部战区总医院卒中数据库中注册的大脑中动脉M2段闭塞的急性缺血性卒中患者19例,均接受支架取栓治疗。19例患者中,男12例,女7例;年龄48~83岁,中位年龄69(51,75)岁;合并心房颤动9例,高血压病15例,糖尿病6例,冠心病史4例,卒中史2例[此次发病前改良Rankin量表(mRS)评分均为1分],吸烟史8例;入院时美国国立卫生研究院卒中量表(NIHSS)评分5~28分,中位评分为15(11,22)分;Alberta卒中项目早期CT评分(ASPECTS)3~10分,中位评分为8(6,9)分;急性卒中Org10172治疗试验(TOAST)病因分型为大动脉粥样硬化型9例,心源性栓塞10例。分析其取栓治疗前后NIHSS评分、手术方式、血管再通、颅内出血等情况,并分析术后90d预后。改良脑梗死溶栓(mTICI)分级2b~3级为血管成功再通;mRS评分0~2分为临床预后良好,mRS评分3~6分为预后不良。结果19例患者发病至穿刺时间137~545min,中位时间为265(184,347)min,穿刺至再通时间中位数为75(58,98)min;17例患者仅使用取栓支架,2例患者联合使用球囊再通,中位取栓次数为1(1,2)次;成功再通占比为16/19,3例为mTICI分级2a级。术后24hNIHSS评分1~30分,中位评分为17(4,21)分,出院时NIHSS评分1~30分,中位评分为11(2,15)分。7例患者发生颅内出血,其中1例为症状性颅内出血,另12例未发生颅内出血。90d时随访,19例患者中死亡3例,分别为脑疝形成、糖尿病肾病导致肾功能不全、脑出血各1例;mRS评分中位数为2(1,4)分,预后良好占比为11/19(包括成功再通者10例),预后不良占比为8/19(包括成功再通者6例)。结论对急性大脑中动脉M2段闭塞缺血性卒中患者支架取栓治疗效果进行初步分析认为安全、有效,但结论有待于进一步验证。
简介:摘要目的采用家庭式多种饮食调配对Ⅱ型糖尿病合并脑梗塞患者预后的影响。方法选取我科2014年3月~2016年3月收治的Ⅱ型糖尿病合并脑梗塞患者66例,随机分为两组,所有病例给予抗血小板凝集,改善循环,降血脂、降血糖等治疗;对照组给予常规的糖尿病饮食,研究组给予家庭式多种饮食调配。两组在治疗前和治疗三个月后对血糖水平,血脂五项(总胆固醇(TC)、甘油三酯(TG)、脂蛋白a(Lpa)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)指标及脑卒中量表(CCS)对神经功能缺损、生活自理能力进行评分,并进行比较分析。结果研究组血糖水平、血脂五项指标均低于对照组,神经功能缺损、生活自理能力评分均高于对照组,差异有统计学意义(P<0.05);结论家庭式多种饮食调配可稳定及降低血糖水平,降低血脂指数,减少患者脑梗死并发症的发生,提高患者的生活质量。关键词饮食;Ⅱ型糖尿病合并脑梗死;预后
简介:BackgroundComparedtoclopidogrel,Ticagrelorsignificantlyreducestheriskofcardiovasculareventsinpatientswithacutemyocardialinfarction(AMI)howeverincreasestheincidenceofbleedingandtheriskoffatalintracranialhemorrhage.Inthisstudy,wescreenedtheAMIpatientswithclopidogrelresistence,anddeterminedwhetherticagrelorsequentialtherapycouldreducetheriskofcardiovasculareventsandbleedingrisk.MethodsAtotalof319AMIpatientswereenrolledinthisprospectiveclinicalstudy.Theplateletinhibitionratesinadenosine5'-diphosphate(ADP)pathwaysweremeasuredbyathrombelastography(TEG)system.ThepatientswithclopidogrelresistanceweredividedintoTicagrelorsequentialtherapygroup(ticagrelorfor3monthsandclopidogrelfor9months,n=143)andClopidogrelgroup(clopidogrelfor12months,n=176).Theriskofmajoradversecardiacevents(MACE)andthesafetyendpointsat1-yearfollow-upwereanalyzed.ResultsTheratesofstentthrombosis(ST)(2.1%vs.8.0%,P=0.017)orMI(2.8%vs.10.2%,P=0.009)werelowerintheticagrelorsequentialtherapygroupthanintheclopidogrelgroup.Dyspneawasmoreoftenintheticagrelorsequentialtherapygroupthanintheclopidogrelgroup(17.5%vs.4.5%,P<0.001).Nosignificantdifferenceintherateofmajorbleedingwasfoundbetweenthegroups(3.4%vs.3.9%,P=0.528).ConclusionsInAMIpatientswithhyporesponsivenesstoclobidogrelticagrelorsequentialtherapygroupsignificantlydecreasedtheratesofSTandMIwithoutincreasedriskofmajorbleedingascomparedwithclopidolgrel.
简介:BackgroundTheearlyendothelialdysfunctionofcarotidarteryinpatientswithtype2diabetesmellitus(T2DM)hasbeenrecognized.However,thefeasibilityandsignificanceofcarotidarteryendothelialdysfunctiondetectedbyultrasoundradio-frequencytechnologyhasbeenseldomstudied.MethodsThe2Dultrasoundimagesofthebilateralcommoncarotidarteriesfrom112casesofT2DMpatientsand50casesofnormalsubjectsinourhospitalwerecollectedtomeasureintima-mediathicknessmeans(IMTm),end-systolicinnerdiameter(Ds),end-diastolicinnerdiameter(Dd),resistanceindex(RI),pulseindex(PI),andthesystole/diastoleratio(S/D).Wealsoobservedthevariationoftheintima-mediathickness(IMT)aswellastheelasticityindexesofthecommoncarotidartery,suchasthecompliancecoefficient(CC),elasticitycoefficient(β),pulsewavevelocity(PWV)andaugmentationindex(AIx)throughinstrumentswithbuilt-inultrasoundradio-frequencytechniques,includingquantitativeintima-mediathickness(QIMT)andquantitativeanalysisofarterialstiffness(QAS).Thedifferencesoftheabove-mentionedparametersbetweenthetwogroupswereanalyzed.ResultsTherewerenostatisticallysignificantdifferencesinIMTm,Ds,Dd,RI,PIandS/DraitoofthecommoncarotidarteriesbetweengroupT2DMandthenormalgroup(P>0.01).Theβ,PWVandAIxingroupT2DMwereremarkablyhigherthanthoseinthecontrolgroup,withCCvaluebeingsignificantlylowerthanthelater(P<0.01or0.05).ConclusionUltrasoundradio-frequencytechniqueoffersearlierandmoreeffectiveevaluationofcarotidarteryendothelialdysfunctioninT2DMpatientswhencomparedwithconventional2Dultrasound,establishingimagingfoundationfortheearlypreventionandtreatmentofcardio-cerebrovascularcomplicationsinT2DMpatients.
简介:目的观察培哚普利治疗原发性高血压合并2型糖尿病的疗效及安全性。方法将112例临床确诊的原发性高血压患者分为两组,55例原发性高血压合并2型糖尿病为A组,57例单纯原发性高血压为B组,均给予培哚普利治疗,2、4、6周末测血压,治疗前及治疗6周后监测肝肾功能、电解质、心电图、血脂及血糖。结果6周后A组显效率47.2%,总有效率79.3%,B组显效率50.9%,总有效率78.9%,组间比较差异无统计学意义(P〉0.05);2、4、6周末两组血压均较治疗前显著降低(P〈0.05),组间比较差异无统计学意义(P〉0.05);6周末与治疗前比较,肝肾功能、电解质、心电图、血脂及血糖无明显变化(P〉0.05),不良反应A组9.1%,B组7.2%。结论培哚普利治疗原发性高血压合并2型糖尿病降压疗效好且安全。
简介:目的评价覆膜Cheatham-Platinum(CP)支架治疗儿童先天性主动脉缩窄的近期疗效。方法2010年7~12月在我院确诊为主动脉缩窄的患者2例,根据心导管造影检查选择合适的支架和BIB球囊。经股动脉穿刺送入支架/球囊导管到达缩窄段并准确定位,在右室快速临时起搏下当血压下降50%时先后充盈BIB内外球囊扩张支架。结果2例患者均系男性,年龄11岁和15岁,体重23.8kg和42kg。术前超声检查病变处跨缩窄段收缩压差(△P)分别是63mmHg、57mmHg。经12F输送鞘和9FBIB球囊(外球囊16mm×4.0cm),分别成功植入NuMED覆膜CP支架(8Zig×3.4cm)各一枚。心导管检测病变处△P分别由术前72mmHg、26mmHg降至术后即刻2mmHg和8mmHg,最窄处血管直径由术前3mm、4.8mm各增加至术后16mm、15mm。随访2~5个月。超声检查△P分别为20mmHg、18mmHg,无股动脉损伤、支架移位、血管瘤和血管夹层并发症。结论儿童先天性主动脉缩窄有适应证者可植入CP覆膜支架治疗,近期疗效满意。
简介:目的探讨依达拉奉对脑梗死患者的治疗作用及对血清中基质金属蛋白酶-2(MMP-2)和基质金属蛋白酶-9(MMP-9)的影响。方法选择35例正常体检者作为对照组,选择住院诊治的110例急性脑梗死患者,随机分为两组,常规治疗组40例采用常规治疗,依达拉奉组70例在常规治疗的基础上加用依达拉奉治疗。两组在治疗前、后行NIHSS评分判定疗效,并应用酶联免疫吸附实验(ELISA)检测治疗前、后患者血清中MMP-2和MMP-9的表达。结果依达拉奉组和常规治疗组治疗后的MMP-2和MMP-9表达均下降,依达拉奉组更明显。结论与常规治疗组相比,依达拉奉治疗脑梗死的效果明显,并能调节血清中MMP-2和MMP-9的表达。
简介:BackgroundTreatmentofratswiththebeta-adrenergicagonistIsoprenaline(ISO)resultsincardiachypertrophyandmyocardialfibrosis.Inthepresentwork,weaimedtostudytheinvivoeffectsofISOonserumlevelsofmonocytechemoattractantprotein-1andtissueinhibitorofmatrixmetalloproteinasestypeIinWistarrats.MethodsISO(5mg·kg-1)orSalinewereinjectedsubcutaneouslyintoWistarratsonceadayfor3or7consecutivedays.Ventricularremodelingandcardiacfunctionwereevaluatedbyechocardiography.Sectionsofheartwerestainedwithhematoxylin-eosin(HE)forhistopathologyorwithMassonstrichromeforcollagenvisualization.Inaddition,hearttissueimmunohistochemistryforɑ-SMAwasalsoanalyzed.TheserumlevelsoftissueinhibitorofmatrixmetalloproteinasestypeI(TIMP-1)andmonocytechemoattractantprotein-1(MCP-1)weredeterminedbyLuminexmultiplextechnology.ResultsISOinducedcardiacdysfunctioninratsafter3or7daysoftreatment.ISOcausedsignificantincreaseofmyocardialdisorderandfibrosiswithincreasedɑ-SMAexpression.ISOtreatedaatsshowedasignificantincreaseintheserumlevelsofTIMP-1andMCP-1.ConclusionsOurstudysuggeststhatISOinducesprofoundcardiacremodelingaccompaniedwithincreaseofserumTIMP-1andMCP-1.
简介:目的研究自发性脑出血患者血清基质金属蛋白酶-9(MMP-9)及其抑制因子基质金属蛋白酶抑制因子-1(TIMP-1)的含量及临床意义。方法采用酶联免疫吸附法对62例48小时内入院的脑出血患者血清MMP-9和TIMP-1水平进行测定,与正常对照组进行比较,同时用免疫比浊法测高敏C-反应蛋白(hs-CRP)水平,并与CT所示血肿周围水肿体积和神经功能评分进行相关分析。结果脑出血患者血清MMP-9及TIMP-1水平较正常对照组明显升高(P〈0.01),脑出血组MMP-9的含量与CT所示出血灶周围水肿区体积呈显著正相关(r=0.627,P〈0.01)。结论脑出血患者血清MMP-9及TIMP-1水平明显增高,血清MMP-9可能成为早期反映脑出血患者血肿周围水肿严重程度和预后的指标。