【作者】 李晓艳；

【导师】 岳文胜；

【作者基本信息】 川北医学院 ， 影像医学与核医学， 2012， 硕士

【摘要】 第一部分代谢综合征颈动脉粥样硬化血管外膜重构的超声评价目的:应用体表高频超声定量测定代谢综合征(Metabolic Syndrome，MS)患者颈动脉血管外膜厚度（adventitial thickness，AT）变化，同时分析其与颈动脉内-中膜厚度(intmia media thickness, IMT)的相关关系。方法：选取2010年10月-2011年7月川北医学院附属医院门诊、住院和体检中心受检的MS患者161例和年龄性别匹配的健康对照组94例，将MS患者分为斑块组(MS-P，n=70)和无斑块组(MS-NP，n=91)，采用体表高频超声获取颈动脉平均IMT、管壁厚度和AT进行分析比较，同时对AT与IMT进行相关性分析。结果: MS-P组和MS-NP组患者的平均IMT(分别为0.981±0.204 mmvs. 0.687±0.103 mm, P<0.001和0.760±0.096 mm vs. 0.687±0.103 mm,P=0.002)和管壁厚度(分别为1.612±0.156 mm vs. 1.332±0.122 mm, P<0.001和1.421±0.087 mm vs. 1.332±0.122 mm, P=0.041)显著高于健康对照组，MS-P组平均AT高于健康对照组(0.768±0.128 mm vs. 0.659±0.113 mm,P<0.001)和MS-NP组(0.768±0.128 mm vs. 0.692±0.131 mm, P<0.001)，MS-NP组与健康对照组颈动脉平均AT没有显著性差异（P >0.05），颈动脉平均AT与IMT在MS-P组、MS-NP组和健康对照组有一定的相关关系(分别为r= 0.603, P<0.001；r= 0.325, P=0.005和r=0.344, P=0.004)。结论:1 MS-P组中AT出现增厚改变，AT与IMT在健康对照组和MS组伴或不伴有斑块的患者中有着较一致的变化，提示动脉外膜是血管重构中重要组成部分。2采用高频超声技术进行动脉外膜定量分析，将是未来血管重构评价的方法。第二部分循环内皮祖细胞与血管内皮功能在2型糖尿病和2型糖尿病合并冠心病患者中的相关性研究目的:对比研究2型糖尿病(T2DM)和T2DM合并稳定性冠心病（T2DM-CHD）患者的循环内皮祖细胞（EPCs）与血管内皮功能的变化。方法：测取88例健康对照组、73例T2DM和79例T2DM-CHD患者的内皮依赖性血管舒张功能(FMD)，非内皮依赖性血管舒张功能(GTN)和循环EPCs水平。结果: T2DM和T2DM-CHD组的循环EPCs水平较健康对照组明显降低(P<0.001)，T2DM组循环CD133+KDR+EPCs%与循环CD34+KDR+EPCs%高于T2DM-CHD组（分别为0.519%±0.288% vs0.303%±0.357%, P=0.042和1.038%±1.252% vs 0.672%±0.220%, P=0.028）。T2DM和T2DM-CHD组相比，肱动脉FMD没有显著性差异(6.62%±2.86% vs 6.13%±2.51%，P=0.335)，然而，肱动脉GTN有显著性差异(16.80%±6.47% vs 13.26%±4.49%, P=0.017)。三组中CD34+KDR+EPCs%和CD133+KDR+EPCs%与肱动脉FMD有着较高的相关关系，多元回归分析循环CD133+KDR+EPCs%、CD34+KDR+EPCs%和HbA1c是肱动脉FMD的独立预测指标。结论:1高血糖状态可以减少循环EPCs的数量，减弱糖尿病患者的血管内皮细胞功能。2与T2DM组相比，T2DM-CHD组的循环EPCs水平和肱动脉GTN明显降低，血管平滑肌层受损程度更加严重。更多还原

【Abstract】 Part OneAssessment of Carotid Adventitial Remodeling in Metabolic SyndromePatients Using High-frequency UltrasoundObjective: The aim of this study is to evaluate carotid adventitialthickness（AT）and intmia-media thickness(IMT) and their relationship inmetabolic syndrome (MS) patients using high-frequency ultrasound.Methods：We measured mean AT and mean IMT in 161 MS patientsand compared them with 94 age- and sex-matched controls as determined byhigh-frequency ultrasound between 2009-2011. 161 patients were dividedinto MS with plaque (MS-P, n=70) and MS without plaque (MS-NP, n=91)group further.Results：MS-P and MS-NP patients had significantly higher mean IMT(0.981±0.204 mm vs. 0.687±0.103 mm, P<0.001 and 0.760±0.096 mm vs.0.687±0.103 mm, P=0.002, separately) and carotid artery wall thickness(1.612±0.156 mm vs. 1.332±0.122 mm, P<0.001 and 1.421±0.087 mm vs.1.332±0.122 mm, P=0.041 separately) than controls. Moreover, MS-Ppatients had significantly higher mean AT than controls (0.768±0.128 mm vs. 0.659±0.113 mm, P<0.001) and MS-NP patients (0.768±0.128 mm vs.0.692±0.131 mm, P<0.001). Among those MS patients, MS-P patients hadsignificantly higher mean IMT, mean AT and carotid artery wall thicknesscompared with MS-NP patients (all P<0.05). The mean AT was positivelycorrelated with mean IMT in controls, MS-P and MS-NP patients(r=0.603,P<0.001,r=0.325,P=0.005 and r=0.344,P=0.004, separately).Conclusion：This study demonstrated that IMT and AT thickened inMS patients with plaques, AT was associated with IMT in controls and MSpatients with and without plaques. The adventitial remodeling is animportant component of vascular remodeling in atherosclerosis. Part TwoThe Comparative Study of Circulating Endothelial Progenitor Cellsand Endothelium Function in Type 2 Diabetes and Type 2 Diabetes withCoronary Heart Disease PatientsObjective: The purpose of this study is to evaluate circulating EPCs,endothelial dysfunction and their relationships between type 2 diabetes (T2DM) and type 2 diabetes with coronary heart disease(T2DM-CHD)patients.Methods: The subjects were recruited from Affiliated Hospital of NorthSichuan Medical College between 2009-2011, consisted of 88 consectivehealthy subjects, 73 T2DM and 79 T2DM-CHD patients by coronaryangiography diagnosed. The circulating EPCs were determined by flowcytometry and detail echocardiography was performed to assess thedilatation changes of endothelium dependent flow-mediated dilation(FMD)and endothelium-independent, glyceryl trinitrate-mediated vasodilation(GTN).Results: Circulating EPCs% declined obviously in T2DM andT2DM-CHD patients, circulating CD133+KDR+EPCs% and CD34+KDR+EPCs% in T2DM patients were higher than in T2DM-CHD patients(0.519%±0.288% vs 0.303%±0.357%, P=0.042 and 1.038%±1.252% vs 0.672%±0.220%, P=0.028), FMD was no significant differencebetween T2DM and T2DM-CHD patients (6.62%±2.86% vs 6.13%±2.51%,P=0.335). However, GTN had significant difference between in T2DM andT2DM-CHD patients (16.80%±6.47% vs 13.26%±4.49%, P=0.017). Therewere high relationship between circulating CD133+KDR+EPCs%,circulating CD34+KDR+EPCs% and FMD in T2DM patients, T2DM-CHD patients and control subjects, circulating CD133+KDR+EPCs%, circulatingCD34+KDR+EPCs% and HbA1c were strong predictors of endothelialdysfunction.Conclusions: Hyperglycemia could reduce circulating EPCs level andweaken endothelial function in diabetic subjects. The damages of arteryvascular smooth muscle in T2DM-CHD patients were more serious than inT2DM patients.更多还原