Study on the Correlation between apolipoprotein and homocysteine levels with carotid atherosclerotic plaque stability and degree of stenosis / 中国综合临床

Objective To investigate the correlation between apolipoprotein and homocysteine levels with the stability of carotid plaque and the degree of stenosis??Methods One hundred elderly patients with acute cerebral infarction from January 2017 to December 2017 were collected continuously in Harbin Fourth Hospital,All patients underwent color Doppler ultrasound examination of carotid artery??They were divided into stable plaque group and unstable plaque group according to the results of color Doppler ultrasound,then according to the degree of stenosis they were divided into intimal thickening group with 23 cases, mild stenosis (stenosis degree＜50%) with 26 cases,moderate stenosis group (50%≤stenosis degree＜70%) with 28 cases,severe stenosis group (70%≤stenosis degree) with 23 cases??All the patients were selected to collect the blood of the elbow in the early morning to detect the level of apolipoprotein B and Hcy??Results Compared with unstable plaque group, smoking, drinking, hemoglobin A1c ( HbA1c), ApoB and Hcy had significant differences (all P＜0??05)??Gender,history of diabetes mellitus,history of hypertension,systolic pressure,diastolic pressure,low density lipoprotein cholesterol (LDL?C),triglyceride (TG) There was no significant difference in total cholesterol ( TC) and total cholesterol ( all P＞0??05)??Multivariate logistic regression was performed after correcting the related risk factors excluding blood lipids??The results showed that alcohol ( OR＝ 1??247 ( 95%CI: 0??626－1??958), P＝ 0??043), Hcy ( OR＝ 3??163 ( 95%CI: 1??824 －4??772),P＝0??045), bloodpressure ( OR＝1??286 ( 95%CI: 0??688－2??005), P＝0??027), HbA1c ( OR＝3??671(95%CI: 1??904－6??630),P＝0??011),ApoB (OR＝1??717(95%CI: 1??005－2??634),P＝0??036), LDL?C(OR＝1??516(95%CI: 0??968－2??489),P＝0??024),TC( OR＝1??403( 95%CI: 0??801－2??343),P＝0??030) and TG ( OR＝1??342 ( 95%CI: 0??712－2??198), P＝0??019) are independent risk factors for unstablecarotid plaque and severe carotid stenosis??Conclusion Apolipoprotein and homocysteine may be independent predictors of unstable carotid plaque and severity of carotid stenosis??

Clinical values of serum visfatin and thrombus precursor protein in the diagnosis of lacunar infarction / 中国基层医药

Objective To explore the changes of serum visfatin and thrombus precursor protein (TpP) levels in patients with lacunar infarction,and the relationship with carotid atherosclerotic plaque ,and to determine the values of the two factors to predict lacunar infarction .Methods Carotid atherosclerosis plaques were detected in 95 cases with lacunar infarction,including 56 cases in unstable plaque group,39 cases in stable plaque group,and another 70 healthy persons were selected as control group .Serum visfatin,high-sensitivity C reactive protein (hs-CRP), interleukin-6(IL-6) and TpP levels were measured.The carotid atherosclerotic plaque was examined by color Doppler ultrasonography.Results The levels of visfatin,hs-CRP and IL-6 in the unstable plaque group and stable plaque group were higher than those in the control group (t =10.886,9.180,11.889,4.990,5.084,9.703,all P <0.05).The levels of visfatin,hs-CRP and IL-6 in the unstable plaque group were (29.10 ±8.85)μg/L,(6.15 ± 2.78)mg/L and (5.98 ±2.66) pg /mL,respectively, which were higher than those in the stable plaque group [(21.47 ±8.39)μg/L,(4.37 ±2.09)mg/L and (4.64 ±2.03)pg/mL,t =4.222,3.385,2.652,all P <0.05]. Pearson linear correlation analysis and multiple linear stepwise regression analysis showed that serum visfatin levels were positively correlated with hs-CRP and IL-6.The TpP levels of 3h,6h and 12h after cerebral infarction in the unstable plaque group and stable plaque group were higher than those in the control group (t =17.342,21.770, 18.138,11.228,15.245,14.306,all P <0.05).The TpP levels of 3h,6h and 12h after cerebral infarction in the unstable plaque group were (18.52 ±6.43)mg/L,(25.95 ±7.98)mg/L,(18.43 ±6.10)mg/L,respectively,which were higher than those in the stable plaque group [(12.40 ±5.37) mg/L,(20.81 ±8.60) mg/L, (13.86 ± 5.04)mg/L,t =3.282,2.991,3.850,all P <0.05].Conclusion The serum levels of visfatin and TpP are highly specific,can be used as important indicators for prediction and diagnosis of lacunar infarction ,and they are related to the stability of carotid atherosclerotic plaque .

Estimation of cardiovascular risk and detection of subclinical carotid atheromatosis in patients with diabetes without a history of cardiovascular disease

ABSTRACT Objectives Cardiovascular risk estimated by several scores in patients with diabetes mellitus without a cardiovascular disease history and the association with carotid atherosclerotic plaque (CAP) were the aims of this study. Materials and methods Cardiovascular risk was calculate using United Kingdom Prospective Diabetes Study (UKPDS) risk engine, Framingham risk score for cardiovascular (FSCV) and coronary disease (FSCD), and the new score (NS) proposed by the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol. Ultrasound was used to assess CAP occurrence. A receiver operating characteristic (ROC) analysis was performed. Results One hundred seventy patients (mean age 61.4 ± 11 years, 58.8% men) were included. Average FSCV, FSCD and NS values were 33.6% ± 21%, 20.6% ± 12% and 24.8% ± 18%, respectively. According to the UKPDS score, average risk of coronary disease and stroke were 22.1% ± 16% and 14.3% ± 19% respectively. Comparing the risks estimated by the different scores a significant correlation was found. The prevalence of CAP was 51%, in patients with the higher scores this prevalence was increased. ROC analysis showed a good discrimination power between subjects with or without CAP. Conclusion The cardiovascular risk estimated was high but heterogenic. The prevalence of CAP increased according to the strata of risk. Understanding the relationship between CAP and scores could improve the risk estimation in subjects with diabetes.

Comparative analysis of effect of atorvastatin calcium with different doses on inflammatory cytokine and carotid atherosclerotic plaque of patients with cerebral infarction / 药物评价研究

Objective To investigate the effect of atorvastatin calcium with different doses on inflammatory cytokine and carotid atherosclerotic plaque of patients with cerebral infarction.Methods One hundred and seventy-eight patients with cerebral infarction admitted into our hospital from January 2014 to June 2015 were divided into low dose (LD) group and high dose (HD) group.Ninety patients in LD group were treated with atorvastatin calcium in a dose of 10 mg/d,and eighty-seven patients in HD group were treated with atorvastatin calcium in a dose of 20 mg/d.The serum levels of lipid including TC,TG,LDL-C,HDL-C,inflammatory cytokine including hs-CRP,IL-6,TNF-α,and carotid atherosclerotic plaque of both groups were analyzed and compared before and after treatment.Results After six months of treatment,the serum levels and inflammatory cytokine of patients in both groups showed remarkable improvement (P ＜ 0.05),and those in HD group were significantly better than those of LD group (P ＜ 0.05).Additionally,compared with those before treatment,changes in carotid atherosclerotic plaque of patients in LD group were not obvious,while those in HD group markedly decreased,and which were significantly lower than those of LD group (P ＜ 0.05).Conclusion Atorvastatin calcium with HD of 20 mg/d showed a better capability on improving serum levels of lipid,inflammatory cytokine,and carotid atherosclerotic plaque of patients with cerebral infarction than those with LD of 10 mg/d.

Xinnaoxuemianning Combined with Statins on Carotid Atherosclerotic Plaque in Patients with Cerebral Infarction / 中国生化药物杂志

Objective To investigate the effects of Xinnaoxuemianning combined with statins on carotid atherosclerotic plaque in patients with cerebral infarction. Methods 180 cerebral infarction patients were divided into the observation group (90cases) and the control group (90cases) by random number table method. The control group was given atorvastatin calcium tablets and the observation group was given additionally Xinnaoxuemianning. The changes and prognosis of carotid atherosclerotic plaques were evaluated before and after treatment, and the incidence of adverse reactions was counted. Results There were no differences in the carotid atherosclerotic plaque, TCM syndrome score and neurological deficit severity between the two groups before treatment. After treatment, the above indexes were significantly improved, and the increasing degree of the observation group was better than that of the control group. The incidence rate of adverse reactions was lower in the observation group than that in the control group (5.56％ vs.13.33％) (P<0.05). Conclusion Xinnaoxuemianning can reduce the carotid atherosclerotic plaque area and correct the unstable plaques in patients with cerebral infarction.

Evaluation of the correlation between neovascularization and clinical symptoms in carotid atherosclerotic plaque by superb micro-vascular imaging technique / 新乡医学院学报

Objective To investigate the value of superb micro-vascular imaging (SMI) in evaluating the relationship between neovascularization in carotid atherosclerotic plaque and clinical symptoms.Methods A total of 146 patients with carotid atherosclerotic plaque which were found by ultrasonography were selected from March 2015 to February 2017 in the Central Hospital of Jiading District of Shanghai.The patients were divided into clinical symptom group(n =96) and symptomless group (n =50) according to cerebrovascular events.The neovessels of carotid atherosclerotic plaque was observed and classified by SMI and contrast-enhanced ultrasound (CEUS).The relationship between the degree of neovascularization and clinical symptoms was analyzed by univariate analysis and multivariate analysis.SMI and GEUS were compared by consistency analysis,and the sensitivity and specificity of the two methods were analyzed.Results The average thickness of carotid atherosclerotic plaques in clinical symptoms group and symptomless group was (3.09 ± 0.79) and (2.89 ± 0.49) mm respectively,there was no significant difference between the two groups (P ＞ 0.05).There were 80 (83.33％) patients with neovascularization in carotid atherosclerotic plaque in the clinical symptoms group,and there were 20 (40.00％) patients with neovascularization in carotid atherosclerotic plaque in the symptomless group,the proportion of patients with neovascularization in carotid atherosclerotic plaque in the clinical symptoms group was significantly higher than that in the symptomless group (Z =-6.488,P ＜0.05).The SMI classification was in good agreement with the CEUS classification in the two groups (P ＜ 0.05).SMI showed the blood flow signal within carotid plaque in 100 cases,including 80 cases in the clinical symptoms group and 20 cases in the symptomless group.SMI showed no blood flow signal within the carotid plaques in 46 cases,including 16 cases in the clinical symptoms group and 30 cases in the symptomless group.GEUS showed the blood flow signal within carotid plaque in 109 cases,including 81 cases in the clinical symptoms group and 28 cases in the symptomless group.GEUS showed no blood flow signal within the carotid plaques in 37 cases,including 15 cases in the clinical symptoms group and 22 cases in the symptomless group.The sensitivity and specificity of SMI predicting the occurrence of clinical symptoms was 83.3％ and 40.00％ respectively.The sensitivity and specificity of GEUS predicting the occurrence of clinical symptoms was 84.4％ and 56.00％ respectively.Conclusions SMI can easily detect neovessels in carotid atherosclerotic plaques,and the degree of neovascularization is related to the occurrence of clinical symptoms.SMI technique plays an important role in evaluating the neovascularization in carotid plaques.

Clinical Research on Bushen Huoxue Decoction in Treating Carotid Atherosclerotic Plaque / 中国中医药信息杂志

Objective To investigate the efficacy and safety of Bushen Huoxue Decoction in the treatment of carotid atherosclerotic plaque. Methods Totally 50 patients of carotid atherosclerotic plaque were collected to conduct health education. At the same time, they were given Bushen Huoxue Decoction, one dosage a day, twice a day, decoction, for 12 weeks. The correlation indexes of carotid artery before and after treatment were observed, and TCM syndrome integrals were evaluated before and after 4, 8 and 12 weeks treatment. FBG, TC, LDL-C, CRP HCY, IL-6, IGF-1, and OPG were detected before and after treatment. Hematuria routine, liver and renal function were monitored. Results After treatment, the Crouse score and the plaque grade score of carotid atherosclerotic plaque showed a tendency to decrease, without statistical significance (P=0.060, P=0.336). Carotid maximal plaque area and modified total score of carotid atherosclerotic plaque were significantly reduced compared with that before treatment (P<0.05). TCM syndrome integrals were significantly reduced compared with that before treatment (P<0.05), and the scores decreased significantly with the prolongation of treatment time. TCM syndrome integrals after 4, 8, and 12 weeks were significantly reduced compared with that before treatment (F=160.352, P<0.001). Total effective rate of treatment in the efficacy of TCM syndrome was 85.11％ (40/47). Serum levels of FBG and TC decreased significantly after the treatment compared with that before the treatment, with statistical significance (P<0.05). Serum levels of LDL-C, HCY, CRP, IL-6, IGF-1, and OPG all showed a tendency to decrease, without statistical significance (P>0.05). No abnormality in hematuria routine, liver and renal function examinations were found during the research. Conclusion Bushen Huoxue Decoction has obvious clinical efficacy for carotid atherosclerotic plaque, which can improve clinical symptoms of patients, it also could stabilize and reduce plaque with high safety.

Estratificación del riesgo cardiovascular con diferentes puntajes de riesgo en prevención primaria y sus implicaciones en la indicación de estatinas / Use of Different Scores for Cardiovascular Risk Stratification in Primary Prevention and Their Implications in Statin Indication

Introducción: En nuestro medio no contamos con un puntaje de riesgo cardiovascular surgido de un estudio epidemiológico local, por lo que habitualmente se emplean puntajes desarrollados a partir de grandes estudios epidemiológicos de otras regiones que, si bien resultan herramientas muy útiles en la práctica clínica, tienen limitaciones relacionadas con la calibración y la capacidad de discriminación. Objetivos: 1) Estratificar el riesgo cardiovascular de una población en prevención primaria utilizando diferentes puntajes. 2) Estimar la concordancia entre dichos puntajes. 3) Analizar la recomendación de estatinas. 4) Estimar la prevalencia de placa aterosclerótica carotídea (PAC) y el punto de corte óptimo (PCO) del nuevo puntaje americano (NP) que discrimine entre sujetos con PAC o sin PAC. Material y métodos: Se incluyeron pacientes en prevención primaria, sin diabetes ni tratamiento hipolipemiante. Se calcularon los puntajes de Framingham (PF), europeo (PE), el recomendado por la OMS (POMS) y el propuesto por las nuevas guías americanas y se analizó la concordancia entre los diferentes puntajes. La indicación de estatinas se consideró en base a cada función de riesgo. La prevalencia de PAC se determinó mediante ultrasonido. Se realizó un análisis ROC. Resultados: Se analizaron 772 pacientes (edad 52 ± 11 años, 66% mujeres), de los cuales de acuerdo con los puntajes P F, PE y POMS se clasificaron de "riesgo bajo" el 76,8%, el 50,9% y el 91,7%, respectivamente. La concordancia fue pobre entre los tres puntajes (kappa 0,14). El 23,6%, el 7% y el 33% de los casos tenían indicación absoluta de estatinas en base al P F, el PE y el N P, respectivamente. Cuando no existía dicha indicación y utilizando los mismos puntajes, el 23,5%, el 50% y el 18% de los sujetos tenían una recomendación opcional. Aplicando el POMS, solo se trataría al 3% de los pacientes. La prevalencia de PAC fue más alta en los estratos de mayor riesgo, aunque no despreciable en sujetos con riesgo bajo. El PCO del NP fue 5,2%. Conclusiones: La estratificación del riesgo y la indicación de estatinas varían según la función de riesgo utilizada. Conocer la relación entre la presencia de PAC y los puntajes podría mejorar la estimación del riesgo en nuestra población.

Background: Our setting lacks a cardiovascular risk score arising from a local epidemiological study, and so scores developed from great epidemiological studies in other regions are used. However, although these scores are very useful in clinical practice, they have limitations associated to calibration and discrimination capacity. Objectives: The purpose of this study was to 1) to stratify cardiovascular risk in a primary prevention population using different scores; 2) to estimate the concordance between these scores; 3) to analyze statin use recommendations; and 4) to estimate the prevalence of carotid atherosclerotic plaque (CAP) and the optimal cut-off point (OCP) of the new American score (NS) to discriminate between subjects with or without CAP. Methods: Primary prevention patients without diabetes or lipid-lowering therapy were included in the study. The Framingham score (FS), the European score (ES), the score recommended by the World Health Organization (WHOS) and the NS proposed by the new American guidelines were calculated, analyzing the concordance among them. The indication of statins was based on each score. Ultrasound was used to assess CAP occurrence. A ROC analysis was performed to analyze results. Results: The study included 772 patients. Mean age was 52 ± 11 years and 66% were women. According to FS, ES and WHOS, 78.8%, 50.9% and 91.7% of the population were respectively classified at "low risk". A poor level of agreement between scores was found (kappa 0.14). The percentage of cases with absolute indication for statins based on FS, ES and NS was 23.6%, 7% and 33%, respectively. When there was no such indication and using the same scores, 23.5%, 50% and 18% of subjects had an optional recommendation. Applying WHOS, only 3% of patients would have been treated. The prevalence of CAP was greater in higher risk strata, though not negligible in low risk subjects. The OCP for NS was 5.2%. Conclusions: Risk stratification and the use of statins vary according to the cardiovascular score used. Knowledge of the relationship between presence of CAP and scores could improve the estimation of risk in our population.

The study on the change of carotid atherosclerotic plaque and blood vessels active matter in patients with cerebral infarction / 中国综合临床

Objective To study the relationship between carotid atherosclerotic plaque and levels of plasma IL-18,CRP,adiponectin(APN)in cerebral infarction patients with diabetes mellitus(DM).Methods Fouty cases of cerebral infarction patients with DM(A group)and 40 case without DM(B group)were randomly selected.All patients with CI were examined on carotid arteries using color Doppler Ultrasonography.Levels of plasma IL-18,CRP and APN were examined and analyzed.Results There were 36 patients(90％)with atberosclerotic plaque and 4 patients(10％)without in group A,among them,28 cases(70％)with vulnerable plaque and 8 cases(20％)with non-vulnerable plaque.There were 26 patients(65％)with atherosclerotic plaque and 14 patients(35％)without in group B,among them,16 cases(61.4％)with vulnerable plaque and 10 cases (38.6％)with non-vulnerable plaque.The level of plasma adiponectin([5.22 ± 1.79]mg/L)in group A was significantly lower than that([7.24 ± 2.31]mg/L)in group B,and there was significant difference between these two groups(t =2.42,P ＜ 0.05).The levels of IL-18([213.5 ± 25.24]μg/L)and CRP([5.42 ± 2.14]mg/L)in group A were obviously higher than those([187.86 ± 23.13]μg/L and[3.57 ± 1.12]mg/L)in group B,and there was significant difference between these two groups(t =5.72,3.551 resectively,P ＜ 0.05)Conclusions Adipenectin might be a protective factor in the development of atherosclemsis in diabetes mellitus.The elevation level of IL-18 and CRP may related with instability of plaque and the occurrence of cerebral infarction.

Carotid Atherosclerotic Plaque and Ischemic Cerebrovascular Diseases / 国际脑血管病杂志

This article summarizes the components,the formation and development of carotid atherosclerotic plaque,the factors affecting the stability of plaque,the mechanisms of plaquecaused ischemic cerebrovascular disease as well as the diagnosis of plaques and the treatmentstatus.

Clinical Efficacy of Atorvastatin for Patients with Cerebral Infarction Complicating Carotid Atherosclerotic Plaque / 中国药房

OBJECTIVE:To study the therapeutic efficacy of atorvastatin for patients with carotid atherosclerotic plaques complicating cerebral infarction and the possible mechanism.METHODS:A total of 150 patients with cerebral infarction coexisting carotid atherosclerotic plaques were randomized to either control group (routine therapy against platelet aggregation) or trial group (routine therapy against platelet aggregation plus atorvastatin 20 mg?d-1).The scores of carotid atherosclerotic plaques,levels of blood lipid and C-reactive proteins (CRP) were compared between the two groups.RESULTS:At 6 and 12 months of follow-up,the scores of carotid atherosclerotic plaques in the trial group were significantly less than in the control group(P

Relationship between carotid atherosclerotic plaque and its related factors and cerebral infarction / 临床神经病学杂志

Objective To investigate the relationship between carotid atherosclerosis(CAS)plaque and its related factors and cerebral infarction(CI).Methods The 91 patients with CI were detected by Color Doppler and the levels of plasma lipid,blood glucose(BG)and fibrinogen(Fbg)were evaluated,and compared with normal control(NC)group.Results(1)Compare with NC group,the IMT,prevalence of CAS plaque,the rates of soft plaque in CI group were significantly higher(all P

Relationship between carotid atherosclerotic plaque and white blood cell,levels of plasma lipid,fibrinogen in the patients with cerebral infarction / 临床神经病学杂志

Objective To study the relationship between carotid atherosclerotic plaque and white blood cell(WBC),levels of plasma lipid,fibrinogen(Fib) in the patients with cerebral infarction(CI).Methods 38 patients with CI were examined on carotid arteries using magnetic resonance imagine(MRI) to discover the atherosclerotic plaques and ascertain their stability.WBC,the levels of plasma lipids [including total cholesterol,triglyceride,high density lipoprotein,low density lipoprotein(LDL),lipoprotein(a)] and Fib were detected in CI patients and 31 healthy subjects(normal control group,all subjects were examined carotid arteries with color dopper ultrasonography and no plaques were found)].Results 26 patients with CI(68.4 %) showed carotid plaques and 12 patients with CI(31.6%)did not.Of these,the patients with unstable versus stable plaque were 20(52.6%) versus 6(15.8%) respectively.The levels of plasma Fib in the CI group(including CI without plaque,CI with stable plaque and CI with unstable plaque) were significantly higher than that in the normal control group(all P