中老年人群颈动脉粥样硬化分布特点及影响因素分析

目的 探讨我国中老年人群颈动脉粥样硬化性病变的分布特点以及与心血管病危险因素的关系.方法 对中美协作研究队列中的石景山人群和多省市队列中的北京大学社区人群2007年9至10月期间的心血管病危险因素以及颈动脉超声的横断面复查结果进行分析.参加调查人数共计2681名,年龄43～81岁.结果 (1)颈动脉内中膜36点厚度平均值为0.68 mm,最大值为1.07 mm.(2)颈动脉斑块检出率为60.3%.男女两性颈动脉膨大部斑块检出率分别为61.2%和51.6%(x~2=23.44,P<0.01).颈内动脉斑块检出率分别为24.7%和12.2%(x~2=69.57,P<0.01).颈总动脉斑块检出率分别为20.9%和13.8%(x~2=23.18,P<0.01).(3)多因素分析:男女两性颈动脉内中膜厚度平均值和最大值随着收缩压、血糖及低密度脂蛋白胆固醇水平的增加而增加.与无危险因素者比较,高血压、糖尿病、吸烟和高低密度脂蛋白胆固醇血症者颈动脉斑块检出率较高(P<0.05).结论 我国中老年人群颈动脉粥样硬化普遍存在,且与多个心血管病危险因素有关联.     

中老年人群颈动脉粥样硬化分布特点及影响因素分析

目的 探讨我国中老年人群颈动脉粥样硬化性病变的分布特点以及与心血管病危险因素的关系.方法 对中美协作研究队列中的石景山人群和多省市队列中的北京大学社区人群2007年9至10月期间的心血管病危险因素以及颈动脉超声的横断面复查结果进行分析.参加调查人数共计2681名,年龄43～81岁.结果 (1)颈动脉内中膜36点厚度平均值为0.68 mm,最大值为1.07 mm.(2)颈动脉斑块检出率为60.3%.男女两性颈动脉膨大部斑块检出率分别为61.2%和51.6%(x~2=23.44,P<0.01).颈内动脉斑块检出率分别为24.7%和12.2%(x~2=69.57,P<0.01).颈总动脉斑块检出率分别为20.9%和13.8%(x~2=23.18,P<0.01).(3)多因素分析:男女两性颈动脉内中膜厚度平均值和最大值随着收缩压、血糖及低密度脂蛋白胆固醇水平的增加而增加.与无危险因素者比较,高血压、糖尿病、吸烟和高低密度脂蛋白胆固醇血症者颈动脉斑块检出率较高(P<0.05).结论 我国中老年人群颈动脉粥样硬化普遍存在,且与多个心血管病危险因素有关联.     

中老年人群血脂水平对新发颈动脉斑块的预测作用

目的 了解2002年至2007年中老年人群颈动脉斑块的变化情况,评价基线血脂水平对新发颈动脉斑块的预测作用.方法 研究样本来自中美队列中的石景山人群和多省市队列中的北京大学社区人群.2002年9月对这两个人群进行基线颈动脉超声检查和心血管病危险因素调查,2007年9至10月复查颈动脉超声.以两次颈动脉检查数据完整的2000名中老年人为研究对象,对基线血脂水平与颈动脉斑块的关系进行分析.结果 (1)2002年至2007年,颈动脉斑块患病率男性从30.3%增加到62.2%,女性从21.5%增加到51.5%;新发斑块率男性为41.8%,女性为34.1%.(2)男女两性颈动脉新发斑块率随着基线总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、非高密度脂蛋白胆固醇(non-HDL-C)及总胆固醇与HDL-C比值(TC/HDL-C)水平的增高而增加,其变化趋势差异均有统计学意义(P＜0.05或P＜0.01).(3)交叉分析显示,LDL-C,HDL-C,甘油三酯对斑块发生率有协同作用.(4)多因素分析显示,高LDL-C、高non-HDL-C和高TC/HDL-C是男女两性新发颈动脉斑块的独立影响因素(男性OR值分别为1.44、1.45、1.59,女性OR值分别为1.47、1.35、1.64,均P＜0.05).结论 2002年至2007年,中老年人群颈动脉斑块患病率在快速增长.高LDL-C、nonHDL-C和TC/HDL-C水平是中老年人群新发颈动脉斑块的独立预测指标.     

颈动脉内中膜厚度与脑梗死的相关性研究

目的 探讨颈动脉内中膜厚度(IMT)以及粥样硬化斑块的发生情况与脑梗死的相关性.方法 采用彩色多普勒超声仪对102例脑梗死患者及98例非脑血管病患者行颈动脉超声检查,测量IMT以及观察粥样硬化斑块的发生情况,并作对比分析.结果 脑梗死组IMT,左侧为1.39 mm±0.13 mm,右侧为1.27 mm±0.14 mm;非脑血管病组IMT,左侧为0.79 mm±0.18 mm,右侧为0.62 mm±0.05 mm.脑梗死组左右两侧颈动脉IMT明显高于非脑血管病组(P<0.01).脑梗死组颈动脉粥样硬化斑块发生率为71.8%(73/102),其中软斑检出率63.1%,硬斑检出率为21.7%,混合斑检出率为15.2%;非脑血管病组颈动脉粥样硬化斑块发生率为35.7%(35/98),其中软斑检出率34.3%,硬斑检出率为65.7%,未检出混合斑.组间比较,脑梗死组斑块发生率、软斑检出率及混合斑栓出率均高于非脑血管病组,而硬斑检出率则低于非脑血管病组(P<0.01).结论 颈动脉IMT以及粥样硬化斑块,尤其是不稳定斑块的发生与脑梗死密切相关,是脑梗死不可忽视的危险因素.     

辛伐他汀干预对缺血性脑卒中患者颈动脉粥样硬化斑块的影响

目的 评价辛伐他汀对缺血性脑卒中患者血脂及颈动脉粥样硬化斑块的影响.方法 40例缺血性脑卒中伴颈动脉粥样硬化的患者口服辛伐他汀20mg,每晚1次,治疗12个月,分别测定其治疗前后总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、颈动脉内中膜厚度(IMT)及颈动脉斑块最大长度和厚度.结果 辛伐他汀治疗12个月后,患者TC、TG、LDL-C显著低于治疗前水平(P＜0.01),HDL-C水平明显升高(P＜0.01).颈动脉IMT及颈动脉斑块大小明显下降,与治疗前比较差异有统计学意义(P＜0.01).结论 辛伐他汀通过调脂,减少颈动脉内中膜厚度,对改善缺血性脑卒中患者颈动脉粥样硬化及稳定斑块有重要作用.     

中国缺血性脑卒中住院患者颈动脉粥样硬化病变性别差异的分析

目的:描述我国急性缺血性脑卒中住院患者颈动脉粥样硬化的分布特征,探讨传统危险因素与颈动脉粥样硬化的关系。方法:研究病例来自全国25个省市41家三级甲等医院,连续收集2011年1月至2011年5月,住院的脑梗死患者,对资料完整且年龄≥18岁的12 424例脑卒中患者进行分析。结果:住院缺血性脑卒中患者的颈动脉斑块患病率为76.9%,颈动脉内膜(IMT)增厚率为54.3%,狭窄率≥70%的患者占7.0%,男性的颈动脉粥样硬化患病率高于女性(P0.001),男女两性的颈动脉粥样硬化患病率随年龄的增加呈线性增加(男性:β=8.550,P=0.012;女性:β=11.100,P=0.002),但男女两性间的差异随年龄的增加逐渐减少。多因素Logistic回归分析显示,年龄、高血压和糖尿病,是男女两性脑卒中患者颈动脉粥样硬化患病的共同危险因素,高LDL与男性颈动脉斑块患病率有关,心房颤动病史与男性颈动脉IMT增厚率密切相关,吸烟仅与男性颈动脉斑块和颈动脉IMT增厚率有关。结论:我国缺血性脑卒中住院患者中颈动脉粥样硬化病变普遍存在,男性脑卒中患者的颈动脉粥样硬化患病率高于女性,传统危险因素与颈动脉粥样硬化指标间的关系存在性别差异。     

脑梗死患者颈动脉硬化及其危险因素分析

目的 探讨脑梗死患者颈动脉粥样硬化与血压、血脂、纤维蛋白原(FIB)、C反应蛋白(CRP)、血尿酸、糖化血红蛋白(GhbA1C)等危险因素之间的关系.方法 将125例脑梗死患者分为颈动脉粥样硬化斑块组和颈动脉粥样硬化非斑块组,将其与体检中心63名体检者对照组,分别检测3组颈部血管多普勒、血压、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、血尿酸、FIB、CRP、GhbA1C.结果 颈动脉粥样硬化斑块组血压、LDL-C、TG、FIB、CRP、血尿酸、GhbA1C水平显著高于颈动脉粥样硬化非斑块组(P<0.05或 P<0.01).颈动脉粥样硬化非斑块组血压、LDL-C、TG、FIB、CRP、血尿酸、GhbA1C水平明显高于对照组(P<0.05或 P<0.01).结论 血压、LDL-C、TG、血尿酸、FIB、CRP、GhbA1C水平是颈动脉粥样的独立危险因素.     

国内动态

肥胖对高血压病患者颈动脉粥样硬化的作用心肺血管病杂志,2005,24(1):16-17.肥胖是心脑血管病的危险因素,而关于肥胖与颈动脉粥样硬化的关系尚不清楚。方法:通过多普勒超声检查高血压病患者颈动脉粥样硬化的方法,选择82例高血压病患者血压一直控制较好,其中男性66例,女性16例,年龄52～80岁,不伴冠心病、糖尿病、脑血管疾病,总胆固醇<5.7mmol/L,甘油三酯<1.7mmol/L,低密度脂蛋白<3.1mmol/L。观察体重指数与颈动脉粥样硬化斑块的发生率及内中膜厚度的相互关系。结果:体重指数高的患者其颈动脉粥样硬化斑块的发生率及内中膜的厚度也高(P<0.05…     

短暂性脑缺血发作患者颈动脉斑块稳定性及其相关因素研究

目的 探讨短暂性脑缺血发作(TIA)患者颈动脉粥样硬化斑块稳定性及其相关危险因素.方法 对140例短暂性脑缺血发作患者行颈部血管超声及血液检查;根据颈部血管超声结果分为不稳定斑块组和稳定斑块组,比较两组间颈动脉粥样硬化斑块的稳定性及危险因素的差异.结果 不稳定组血清总胆固醇(CHOL)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)、纤维蛋白原(FIB)、同型半胱氨酸(HCY)、性别、糖尿病史、吸烟与稳定组比较,差异有统计学意义(P＜0.05).TIA患者颈动脉粥样硬化斑块发生率84.29%.结论 TIA患者颈动脉粥样硬化斑块稳定性与CHOL、HDL-C、LDL-C、TG、HCY、FIB、性别、糖尿病史、吸烟有关,控制其危险因素有重要临床意义.     

肥胖对高血压病患者颈动脉粥样硬化的作用

目的肥胖是心脑血管疾病的危险因素,而关于肥胖与颈动脉粥样硬化的关系尚不清楚。方法通过多普勒超声检查高血压病患者颈动脉粥样硬化的方法,观察了82例高血压病患者体重指数与颈动脉粥样硬化斑块的发生率及内中膜厚度的相互关系。结果体重指数高的患者其颈动脉粥样硬化斑块的发生率及内中膜的厚度也高(P<005,P<001)。结论体重指数与颈动脉粥样硬化斑块和内中膜厚度相关,肥胖可能参与动脉粥样硬化的形成和发展。     

Carotid plaque compared with intima-media thickness as a predictor of coronary and cerebrovascular disease

Atherosclerosis is the underlying cause of most myocardial infarction (MI) and ischemic strokes. B-mode ultrasound of carotid arteries provides measures of intima-media thickness (IMT) and plaques, both widely used as surrogate measures of cardiovascular disease. Although IMT and plaques are highly inter-correlated, IMT’s role as a marker of atherosclerosis has been questioned, especially when measurements include the common carotid artery (CCA) only. Plaque and intima-media thickening may reflect different biological aspects of atherogenesis with distinctive relations to clinical vascular disease. Plaque measured in the carotid bulb or internal carotid artery is stronger related to hyperlipidemia and smoking and is a stronger predictor for MI, whereas CCA-IMT is stronger related to hypertension and ischemic stroke. Echolucent plaque morphology (ie, lipid-rich plaques) seems to increase the risk for MI and stroke. New evidence suggests that total plaque area is the most strongly predictive of cardiovascular risk of the ultrasound phenotypes.     

Tissue characterization identifies subjects with high risk of cardiovascular diseases

OBJECTIVE: This study was conducted to examine whether tissue characterization of the carotid artery wall by determining integrated backscatter (IBS) can identify subjects with a recent history of acute coronary syndrome (ACS) or atherothrombotic infarction (ATI). RESEARCH DESIGN AND METHODS: The maximum thickness (Max-IMT) and IBS value (corrected-IBS) of the carotid artery intima-media complex were measured ultrasonographically for 132 type 2 diabetic subjects (62.9+/-8.5 (+/-S.D.) years old, 87 men and 45 women) with or without cardiovascular diseases. RESULTS: The diabetic patients with recent ACS or ATI had a significantly lower corrected-IBS and higher Max-IMT than those with Max-IMT > or = 1.1mm but without cardiovascular diseases. The product of Max-IMT and corrected-IBS (IMT-IBS product) of the patients with recent ACS was significantly lower than that of the patients with chronic stable angina. The multiple logistic model showed that only the IMT-IBS product was associated with a recent history of ACS (odds ratio 0.94, P<0.05) and ATI (odds ratio 0.90, P<0.005). CONCLUSIONS: Diabetic patients who had a recent history of ACS or ATI showed a lower IBS value and higher IMT for their carotid artery. Both the size and tissue characteristics of the carotid plaque may identify subjects with a high risk of cardiovascular disease.     

Association of plasma viscosity and carotid thickening in a French working cohort

Plasma viscosity and intima-media thickness (IMT) are frequently associated with cardiovascular disease and its risk factors. We evaluated the association of rheologic and vascular factors in asymptomatic subjects. Plasma viscosity (coaxial cylinder viscometry) and both preintrusive and intrusive atherosclerosis in the carotid arteries (ultrasonography) were investigated in 246 men and 337 women aged 17 to 65 years from the AXA study, a prospective cohort of healthy workers. Plasma viscosity was positively related to age-adjusted mean bifurcation carotid artery IMT (P < .01 for men; P < .04 for women) and maximum carotid artery IMT (P < .01 for men; P < .02 for women), but not to mean common carotid artery IMT. Multivariate adjustment affected these relations to a greater extent in men than in women. The odds ratio (range) of having intrusive atherosclerosis in relation to 1 SD greater plasma viscosity was 2.27 (1.52 -3.38) in men and 1.63 (1.17-2.26) in women. Adjustment of age, waist-to-hip ratio, smoking, hypercholesterolemia, hypertension, diabetes, and fibrinogen had very little effect on the magnitude of these odds ratios. Thus, plasma viscosity was associated with carotid thickening, suggesting that rheologic factors are involved in the subclinical phase of atherosclerosis.     

25羟维生素D3与2型糖尿病患者颈动脉内膜中层厚度的相关性研究

目的 探讨2型糖尿病患者颈动脉内膜中层厚度（IMT）与25羟维生素D3浓度的关系.方法 选取2型糖尿病患者295例,均符合1999年WHO制定的2型糖尿病诊断标准,根据眼底照相结果分为无颈动脉斑块组（96例）、颈动脉增厚组（110例）和颈动脉斑块组（89例）.比较三组患者25羟维生素D3浓度的差异.两个连续随机变量的相关性研究采用Pearson相关分析,应用多因素非条件Logistic逐步回归分析法对动脉硬化的危险因素进行分析.结果 25羟维生素D3浓度颈动脉无异常组为（9.80±4.12）ng/ml,颈动脉增厚组为（8.80±3.00）ng/ml,颈动脉斑块组为（7.60±1.09）ng/ml,颈动脉斑块组25羟维生素D3浓度低于颈动脉增厚组,而颈动脉增厚组25羟维生素D3浓度低于颈动脉无异常组,差异均有统计学意义（P＜0.05）.两个连续随机变量Pearson相关分析显示,颈动脉IMT与25（OH）D3呈显著负相关（r=-0.259,P＜0.01）.以有无颈动脉斑块为因变量行多因素非条件Logistic逐步回归分析显示,血清25（OH）D3是预防颈动脉斑块的保护因素（OR=0.878,P＜0.05）;FBG、hs-CRP、LDL-C、HbA1C是颈动脉斑块危险增加的独立危险因素（OR=1.115、1.130、1.786、1.556）.结论 25羟维生素D3浓度与2型糖尿病患者颈动脉内膜中层厚度相关,通过测定25（OH）D3的浓度可以预测2型糖尿病患者全身动脉粥样硬化情况,适当补充可以预防糖尿病患者大血管并发症的发生.     

Echographic assessment of carotid and femoral arterial structure in men with essential hypertension

Extracoronary in vivo structural arterial changes were studied in asymptomatic essential hypertension. Carotid and femoral arteries were examined with B-mode echography for the presence or absence of plaque (the whole vascular segments of each vessel in the both sides) and for automated measurement of the far wall intima-media thickness (the vascular segment of each vessel proximal to the bifurcation in the right side) in 53 never treated hypertensive men and 133 normotensive men similar with regard to age, serum cholesterol levels, and smoking history. In the hypertensive group carotid plaque was more frequent (P < .05) and carotid and femoral intima-media thicknesses were greater (P < .001) than in the normotensive group. In the overall normotensive and hypertensive population intima-media thickness was independently associated with age and systolic pressure in both arteries (P < .001) and with cholesterol in the femoral artery (P < .05) while plaque was associated with systolic pressure (P < .01), and cholesterol (P < .01) in the carotid arteries and with age (P < .01), cholesterol (P < .05), and smoking (P < .001) in the femoral arteries. No significant difference in intima-media thickness in both arteries existed between hypertensive subjects with plaque and those without.Wall thickening and plaque were more frequent in hypertensive patients. Thickening was distributed homogeneously to both arteries, while plaque affected preferentially the femoral bed. The influence of age and pressure was more marked on intima-media thickness than on plaque. The lack of association between wall thickening and plaque suggested that vascular hypertrophy and early atherosis might be two different structural changes.     

冠心病患者颈部动脉粥样硬化病变高频超声体表标识表现分析

目的：分析冠心病患者颈动脉粥样硬化（CAS）病变高频超声体表标识表现。方法：连续选择521例接受冠状动脉造影的住院患者,造影后同时进行颈部动脉体表血管彩色多普勒超声检查。结果：521例人选对象中．冠状动脉正常者81例（对照组）。确诊冠心病患者440例,其中轻度狭窄组36例、中度狭窄组90例和重度狭窄组314例。冠心病各组的内膜一中层厚度（IMT）、IMT增厚率、斑块总面积和斑块发生率均明显高于对照组,冠心病中、重度狭窄组的IMT和斑块总面积也显著多于轻度狭窄组（P〈0．05～0．01）。冠心病各组各种斑块明显多于对照组（P〈0．05～0．01）．中及重度狭窄组软斑、硬斑数显著多于轻度狭窄组（P均〈0．05）。在CAS超声分级比较中．冠心病各组狭窄超声级别均明显多于对照组．同时重度狭窄组c、D级例数明显多于后者（P〈0．05～0．01）。结论：冠心病患者颈部动脉病灶超声体表标识可作为冠状动脉粥样硬化严重程度的间接判定指标。     

Association between abnormal uterine artery Doppler flow velocimetry, risk of preeclampsia, and indices of arterial structure and function: a pilot study

Preeclampsia increases the risk of future cardiovascular disease. The association between abnormal uterine artery Doppler flow velocimetry, risk of preeclampsia, and indices of arterial structure and function is investigated in this study. The carotid intima-media thickness of 34 pregnant women with normal uteroplacental flow was compared with 30 women with abnormal uterine artery Doppler analysis during the transvaginal assessment of the uterine arteries at the routine anomaly scan (20-23 weeks of gestation). Women with abnormal uterine artery Doppler results had a greater mean internal (but not common) carotid intima-media thickness (0.58 +/- 0.06 vs 0.53 +/- 0.08, respectively, P = .005) and risk of developing preeclampsia (6 of 30 vs 0 of 34 or 20% vs 0%, respectively, P = .0079) compared with those with normal uteroplacental flow. Women with abnormal uterine artery Doppler results may be at increased risk not only for developing subsequent preeclampsia but also for future cardiovascular disease.     

Carotid parameters measured by ultrasonography as a marker of atherothrombotic infarction and lacunar infarction in high risk elderly people

AIM: Many studies have reported that carotid parameters measured by ultrasonography were predictors for stroke. The aim of this study was to investigate by cross-sectional study in elderly people having cardiovascular risk factors whether those carotid parameters are markers for atherothrombotic infarction (AI) and lacunar infarction (LI). METHODS: Subjects of this study were 314 patients aged 65 years or older who had controlled cardiovascular risk factors and assessed carotid artery by ultrasonography. Subjects were categorized into control, AI and LI group. Clinical characteristics (biochemical analysis, body mass index, systolic/diastolic blood pressure, smoking habits, hypertension, diabetes mellitus and statin therapy) and carotid parameters (maximum intima-media thickness (Max-IMT), plaque score (PLQ-S) and Maximum pulsatility index (Max-PI)) were compared among three groups. RESULTS: PLQ-S, Max-PI, frequency of PLQ-S > or = 10mm and frequency of Max-PI > or = 2.0 in the AI group were significantly higher than in the control group. There were no significant differences between control and LI group concerning those carotid parameters. Multivariate logistic regression analysis showed that there were significant correlations between AI and PLQ-S > or = 10mm (odds ratio 2.980; P = 0.011), AI and Max-PI > or = 2.0 (odds ratio 2.458; P = 0.038), but there was no significant correlation between those carotid parameters and LI. CONCLUSION: This study suggests that in high risk elderly people, PLQ-S and PI are better markers for AI than IMT, but those carotid parameters have poor associations with LI.