颈动脉内膜—中层厚度的超声评价与冠心病相关性研究

【摘要】 目的 观察颈动脉内膜-中层厚度(intima-media thickness，IMT)和 冠状动脉粥样硬化性心脏病(coronary arteriosclerotic heart disease,CAD)的关系。方法 将65 例患者根据冠状动脉造影结果分为对照组与冠心病组。并测量这些患者的IMT及斑块的形态。结果 CAD各组颈动脉的IMT、斑块发生率与对照组相比明显增高,(P<0.05);多支病变组颈动脉的IMT、钙化斑块发生率明显高于单支病变组,(P<0.05);颈动脉IMT值与CAD具有明显相关性。结论 在CAD患者及具有其危险因素人群中，进行颈动脉的IMT高频超声检查，可间接反映冠状动脉情况，并且有助于对冠脉狭窄程度作出判断，可成为早期诊断CAD的间接指标。

【关键词】 颈动脉内膜-中层厚度;冠状动脉粥样硬化性心脏病; 纤维斑块; 钙化斑块

Abstract: Objective To study the correlation between carotid arterys intima-media thickness and coronary arteriosclerotic heart disease. Methods 65 patients were divided into two groups according to the results of angiography. The examination was performed by using a GEVV3 device and the intima-media thickness was measured. Results Carotid arterys IMT and the incidence of mottling in CAD groups were significantly higher than that in normal groups (P<0.05)， carotid arterys IMT and the incidence of Calcification mottling in multi-vessel disease groups were significantly higher than that in single vessel disease groups (P<0.05). Positively statistical significance was obtained in the correlation between the carotid arterys IMT and CAD. Conclusions Inpatients with CAD and persons with CAD risk factors,examined in carotid using high-frequency ultrasound,the method is very useful in the detection of the presence of coronary atherosclerosis and in the juguement of the extent.It can be a surrogate for diagnosing CAD in earlier period.

Key words: intima-media thickness (IMT); coronary arteriosclerotic heart disease (CAD); textile fiber mottling; Calcification mottling

1 实验资料与方法

2 结 果

2.2 颈动脉IMT值与CAD进行相关性分析，IMT值与CAD的相关系数为r=0.57(P<0.01)，见图1。

3 讨 论

外周动脉与冠状动脉粥样硬化之间存在着相似的发病机制和病理生理基础[2,3]。CHD的病因是冠状动脉粥样硬化改变，冠状动脉硬化发展是一个漫长的过程，为了降低发病率和死亡率，对CAD高危患者及无症状患者进行早期检测及干预是非常重要的。本实验对颈动脉的IMT及斑块形态的检测，评价动脉壁结构及其与CAD的相关性。

随着超声技术的发展及病理标本检测，多数学者认为，IMT值的增加是动脉粥样硬化早期表现。研究显示动脉IMT增厚先于斑块发生。颈动脉钙化斑块是包括冠状动脉在内的全身动脉粥样硬化及进展的标志。Pignoli[4]等认为这种血管厚度的早期改变会导致以后粥样斑块发生，因此超声检测IMT对研究动脉粥样硬化有重要意义。我们的实验结果显示CAD各组与对照组比较，随着冠脉病变程度加重，颈动脉的IMT测值增加。尤以多支病变显著。颈动脉IMT值与CAD具有明显的相关性。表明颈动脉的IMT增厚是冠状动脉粥样硬化的一个预测因子。颈动脉纤维斑块对CAD诊断的阳性预测值为84.3%，钙化斑块对CAD诊断的阳性预测值90.9%。CAD各组斑块发生率与对照组相比明显增高。多支病变组钙化斑块发生率明显高于单支病变组。因此不仅要观察IMT的厚度，还要观察斑块的形态。动脉粥样硬化是沿着脂纹-纤维板块-粥样斑块的病理变化演变，其中粥样斑块内可见胆固醇结晶及钙化，是硬化发展的终末阶段。因此钙化斑块的出现提示冠状动脉病变严重的可能性增大。其对CAD诊断的阳性预测值更高。Wald[5，6]等研究后得出结论颈动脉IMT结合斑块来筛查冠心病要优于它们两个任何一项的单独筛查。Lisowska等的实验认为股动脉的动脉粥样硬化损伤比颈动脉严重，因此应采用外周动脉多部位的复合超声评价来预测冠心病及其严重程度更有意义。

【参考文献】
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[6] A Lisowska, W Musial, M Knapp, et al. Carotid and femoral atherosclerotic lesions in patients with coronary heart disease confirmed by angiography[J]. Kardiol Pol ,2007, 63: 636-642 .