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1.
二维超声检测冠心病患者颈动脉粥样硬化病变   总被引:7,自引:1,他引:6  
对103例经选择性冠状动脉造影的患者作双侧颈动脉超声检查,探讨了颈动脉超声检查的方法学以及颈动脉粥样硬化斑块的好发部位和超声分型,发现颈动脉粥样硬化斑块好发于颈动脉分叉处,以左侧多见,且多为扁平斑;颈动脉粥样硬化与冠状动脉粥样硬化之间有着密切的相关关系,冠状动脉病变支数越多,其颈动脉粥样硬化斑块积分也越高,不同冠状动脉病变组之间有非常显著的差异(P<0.001)。  相似文献   

2.
目的通过对老年冠心病患者血清C反应蛋白(CRP)检测,颈动脉内膜中层厚度的测定,冠状动脉钙化积分的测定来探讨冠心病患者颈动脉粥样硬化程度与冠状动脉病变的相关性。方法96例老年冠心病患者分别检测血浆CRP值、颈动脉超声和螺旋CT冠状动脉钙化积分,观察颈动脉内膜中层厚度(IMT)与CRP关系;不同级别颈动脉斑块与CRP的关系;以及颈动脉不同级别斑块与冠状动脉钙化积分关系。结果血清CRP随着IMT的增加而升高(P〈0.05),血清CRP随着颈内动脉斑块级别的增加而升高(p〈0.05)。颈动脉内膜中斑块级别越高,检出冠状动脉钙化积分值越高(p〈0.05)。结论CRP不仅与冠状动脉粥样硬化程度成正比,与颈内动脉斑块的范围及严重程度也成正比。老年冠心病患者颈动脉粥样硬化程度与冠状动脉病变程度相一致。  相似文献   

3.
目的:评价颈总动脉粥样硬化斑块形成对心脑血管预后的影响。方法:198例有冠状动脉(冠脉)粥样硬化性心脏病(冠心病)危险因素并行冠脉造影的患者,依据颈动脉超声检测将有无颈总动脉粥样硬化斑块分为动脉粥样硬化组(AS组)(120例)和对照组(78例),随访、比较2组心脑血管不良事件发生率,应用Cox回归分析与心脑血管预后相关的独立因素。结果:基线时,AS组平均年龄大(P〈0.001)、慢性肾病患者多(P〈0.05)、冠心病患者多(P〈0.001)、血清肌酐(Scr)水平高(P〈0.05)、颈总动脉内膜中膜厚度(IMT)平均值大(P〈0.001)、颈总动脉内径(C-Di)较高(P〈0.05)、服用他汀类药物患者较多(P〈0.001)。在随访期(16±3)个月内,发生终点事件20例,其中主要终点14例,次要终点6例,AS组主要终点事件发生率[10.8%比1.3%,相对危险度(RR)4.13,95%可信区间(CI)1.17-14.59.P=0.028]、所有终点事件发生率(14.2%比3.8%,RR9.36,95%CI1.20~73.03,P=0.010)较对照组均显著升高。Kaplan-Meier曲线分析证实颈总动脉粥样硬化斑块越多无事件生存率越低(Logrank检验P=0.022)。Cox回归分析,结果表明,颈总动脉粥样硬化斑块严重程度(RR3.01,95%CI1.38~6.55,P=0.006)是与心脑血管预后相关的独立影响因素。结论:颈总动脉粥样硬化斑块形成是心脑血管疾病不良事件的独立预测因子。颈动脉超声检测对评估心脑血管预后和指导三级预防具有重要的临床意义。  相似文献   

4.
卢新  阎国辉  张洋  杨庭树 《山东医药》2009,49(37):68-69
目的观察曲美他嗪(TMZ)对冠脉多支病变患者血管内皮功能的作用。方法将113例冠脉多支病变行经皮冠状动脉介入术后患者随机分为TMZ组和对照组,在常规治疗基础上,TMZ组加服TMZ,连用6个月。治疗前后检测两组颈动脉内膜一中层厚度(IMT)及血管扩张变化率(FMD)。结果治疗后,TMZ组总有效率明显高于对照组(P〈0.05);两组FMD均明显改善(P〈0.01或〈0.05),但以TMZ组改善明显(P〈0.05);两组IMT均改善,但组间比较无统计学差异(P〉0.05)。结论TMZ可改善冠脉多支病变患者的临床症状及血管内皮功能,作为治疗心绞痛的辅助药物。  相似文献   

5.
目的探讨颈动脉粥样硬化斑块与冠状动脉病变的临床相关性。方法选择行冠状动脉造影确诊的冠状动脉病变患者133例。根据冠状动脉造影检查结果,按照病变严重程度,分为轻度狭窄组、中度狭窄组和重度狭窄组;按照冠状动脉病变支数,分为单支病变组、双支病变组和三支病变组;按照SYNTAX积分,分为0~22分组、23~32分组和≥33分组。超声检测入选患者颈总动脉、颈内动脉、颈外动脉及其分叉处有无斑块形成并进行粥样硬化斑块积分(AS积分),分析各组颈动脉粥样硬化斑块及积分与冠状动脉病变的相关性。结果颈动脉粥样斑块形成例数及粥样硬化斑块积分与冠状动脉病变严重程度呈正相关(r分别为0.632、0.751);与冠状动脉病变支数呈正相关(r分别为0.597、0.655);与SYNTAX积分呈正相关(r分别为0.643、0.597)。冠状动脉轻度狭窄组与中度及重度狭窄组比较,单支病变组与双支及三支病变组比较,冠状动脉SYNTAX积分0~22分组与23~32分组及≥33分组比较,颈动脉粥样斑块形成例数及粥样硬化斑块积分差异均具有统计学意义(P〈0.05~0.01);冠状动脉中度与重度狭窄组比较,双支及三支病变组比较,SYNTAX积分23~32分组比较与≥33分组比较,颈动脉粥样斑块形成例数及粥样硬化斑块积分差异无统计学意义(P均〉0.05)。结论颈动脉粥样斑块检查能够反映冠状动脉病变的情况,适合临床冠心病的普查及随访。  相似文献   

6.
目的:通过分析颈动脉斑块与冠状动脉粥样硬化的关系探讨颈动脉超声预测冠状动脉粥样硬化的意义。方法:对122例临床疑诊为冠心病或胸痛待查的患者行颈动脉超声检查,观察颈动脉有无斑块及斑块数量,计算其积分;对颈动脉有斑块的患者行冠状动脉多层螺旋CT血管造影(MSCTA,75例)或者冠状动脉造影(CAG,47例),并将颈动脉超声结果与MSCTA或者CAG结果进行对比分析。结果:超声颈总动脉内中膜厚度(IMT)对CAG诊断冠状动脉硬化的敏感性、特异性、准确性分别为82%、33%、84%;对MSCTA诊断冠状动脉硬化的敏感性、特异性、准确性分别为79%、33%、86%;超声颈总动脉斑块对CAG诊断冠状动脉硬化的敏感性、特异性、准确性分别为89%、55%、89%;对MSCTA诊断冠状动脉硬化的敏感性、特异性、准确性分别为87%、58%、92%。冠状动脉单支、双支和三支病变组颈动脉粥样硬化等级分和斑块数均明显高于无病变组(P〈0.05~〈0.01),双支和三支病变组的IMT等级分和颈动脉超声斑块数又明显高于单支病变组(P〈0.01),而双支和三支病变组间的IMT等级分和颈动脉超声斑块数无显著差异(P〉0.05)。结论:颈动脉超声检测可以方便及时地发现颈动脉粥样硬化病变,对冠状动脉粥样硬化的预测有一定意义。  相似文献   

7.
目的探索高血压前期外周动脉血管粥样硬化和血管内皮功能的改变。方法检测颈动脉内-中膜厚度(IMT)和肱动脉内皮舒张功能。结果高血压前期组颈动脉分叉、颈总动脉处内-中膜厚度均较正常血压组增厚(P〈0.05);高血压前期组反应性充血后肱动脉内径变化率(FMD)显著低于正常血压组(P〈0.05);含服硝酸甘油后肱动脉内径FMD高血压前期组与正常血压组无明显差异(P〉0.05)。结论高血压前期已存在颈动脉内-中膜增厚,血管内皮功能已经受损。  相似文献   

8.
目的:通过颈动脉内-中膜厚度(IMT)的测定,分析颈动脉粥样硬化与冠心病的关系。方法:对158例接受脉造影的患者行颈动脉IMT及斑块超声检查,比较有无冠脉病变及不同程度冠脉病变与颈动脉IMT的关系。结果:无冠心病者50例,冠心病单支病变组53例,多支病变组55例。冠心病患者的颈动脉IMT[单支病变(0.91±0.1)mm),多支病变(1.08±0.15)min]分别明显高于非冠心病者[(0.83±0.08)mm,P均〈0.057,冠心病患者的斑块检出率[单支病变52.6%,多支病变65.7%]分别明显高于非冠心病者的32%(P均〈0.05)。多支冠状动脉病变组的颈动脉IMT及斑块检出率明显高于单支冠状动脉病变组(P均〈0.05)。结论:颈动脉粥样硬化对冠心病有一定的预测价值,颈动脉IMT可作为间接反映冠状动脉病变程度的指标。  相似文献   

9.
刘雪玲  雷蓓  骆峰  伍业冬  李坚 《内科》2008,3(6):833-835
目的探讨肥胖型原发性高血压青年患者肱动脉内皮功能及颈动脉内中膜厚度的变化。方法通过应用高分辨率超声对40例肥胖型原发性高血压青年,30例血压正常肥胖青年及35例正常对照组,测量血流介导的肱动脉内皮依赖性舒张功能(FMD)及颈动脉内中膜厚度(IMT)。结果肥胖型原发性高血压青年组及血压正常肥胖青年组FMD明显低于正常对照组(P〈0.05);肥胖型原发性高血压青年组IMT与对照组比较差异有统计学意义(P〈0.05)。结论青年人肥胖和原发性高血压与血管内皮功能及颈动脉内中厚度关系密勃。  相似文献   

10.
目的探讨冠心病患者冠状动脉病变血管数与高敏C反应蛋白(hsCRP)、内皮依赖血管舒张功能、颈动脉内膜中层厚度(IMT)和斑块积分的相关性。方法采用高分辨率血管超声法检测76例冠心病患者与30例非冠心病对照组肱动脉血流介导的内皮依赖性血管舒张功能(FMD)、颈动脉IMT及斑块积分;并检测患者血液中hsCRP水平,对冠心病患者进行冠状动脉造影,根据冠状动脉病变血管数将冠心病患者分为3组:单支病变组、双支病变组及三支病变组。结果冠心病患者的血浆hsCRP显著高于对照组,FMD在冠心病各亚组中明显降低,与对照组比较差异有统计学意义(均为P<0.05);IMT在冠心病组中明显增厚,与对照组比较差异有统计学意义(均为P<0.05);颈动脉斑块积分在冠心病各亚组间比较差异有统计学意义(P<0.05)。冠心病患者冠状动脉病变血管数与血浆hsCRP及斑块积分呈正相关,与FMD呈负相关。结论血浆hsCRP、FMD及颈动脉斑块积分的检测与冠心病患者冠状动脉病变支数相关。  相似文献   

11.
老年冠心病患者血管内皮功能与动脉粥样硬化的关系   总被引:2,自引:2,他引:0  
目的 观察老年冠心病(CAD)患者血管内皮舒张功能、动脉硬化的状况及与冠状动脉病变的相关性.方法 选择经冠状动脉造影确诊为CAD的患者90例(CAD组),冠状动脉造影证实无冠状动脉狭窄并无其他疾病史的患者30例为对照组,采用二维超声检测肱动脉内皮依赖性和非依赖性舒张功能及动脉内膜的变化,应用二维彩色多普勒超声检查颈动脉、股动脉,观察管腔、管径、内膜及有无斑块、血流变化、血流频谱形态及性质.动脉粥样硬化斑块积分采用Crouse法.对血管内皮细胞功能、动脉硬化与冠状动脉病变程度进行分析.结果 反应性充血引起的肱动脉内径变化在单支组及多支组明显减弱[(9.08±2.28)%、(6.14±2.21)%],与对照组[(15.58±2.20)%]比较,差异有统计学意义(P<0.01).CAD组颈动脉内膜中层厚度(IMT)高于对照组(P<0.05).结论 内皮细胞功能障碍和动脉粥样硬化与冠状动脉粥样硬化的病变密切相关.  相似文献   

12.
目的探讨颈动脉粥样硬化斑块发生率、颈动脉内-中膜厚度(IMTc)及肱动脉血流介导的舒张功能(FMD)与冠心病的关系。方法应用高分辨率超声检测112例患者的颈动脉粥样硬化斑块、IMTc,同时检测肱动脉FMD,据造影结果将患者分为冠心病组79例与对照组33例,对冠状动脉病变程度进行Gensi-ni评分。结果冠心病组与对照组比较,颈动脉粥样硬化斑块发生率、FMD及IMTc差异具有统计学意义(P<0.05)。直线相关分析表明,FMD与冠状动脉病变Gensini积分呈负相关,(r=-0.362,P<0.01),IMTc与冠状动脉病变Gensini积分呈正相关(r=0.296,P<0.01)。结论联合应用无创高分辨率超声检测颈动脉粥样硬化斑块、IMTc及FMD可间接反映冠心病发生的可能性以及预测冠状动脉病变程度,而且方法简单、无创,为早期诊断冠心病提供了一种安全可靠的手段。  相似文献   

13.
颈动脉粥样硬化与冠心病关系的研究   总被引:7,自引:0,他引:7  
目的:研究颈动脉粥样硬化与冠心病的关系。方法:对301例冠状动脉造影的患者作双侧颈动脉超声检查,根据冠脉造影结果分为正常组及冠心病组,冠心病组根据冠状动脉病变支数再分为一支病变组,二支病变组,三支病变组3个亚组。测量颈总动脉后壁内中膜厚度(IMT),斑块厚度,计算斑块积分及粥样斑块发生率。结果:(1)冠心病组IMT,斑块积分及斑块发生率明显高于正常对照组(P<0.01)。(2)随冠脉病变支数增加,斑块积分及IMT增加,亚组比较有显著性差异(P<0.01)。(3)以IMT>0.85mm和(或)出现粥样斑块预测冠心病,特异性75.3%,敏感性84.6%,阳性预测率88.4%。结论:通过颈动脉超声检查可为冠心病的诊断提供依据。  相似文献   

14.
Signs of plaque inflammation in carotid arteries may serve as a window to the entire cardiovascular system, to identify “vulnerable” patients. Moreover, flow-mediated vasodilation in the brachial artery and intima media thickness (IMT) in the carotid artery could represent a surrogate diagnostic method for assessment of coronary artery disease (CAD) severity. Renal function is an important predictor of the presence and severity of angiographic CAD in patients without severe renal impairment with incremental value over traditional risk factors for CAD and IMT. It has also been reported ,that renal dysfunction may exert differential effects on the development of coronary and peripheral atherosclerosis. An accumulating burden of hypertension, diabetes, and smoking is important in the progression of atherosclerosis from the coronary to the carotid circulation. We present an unusual case of lack of correlation of carotid atherosclerosis and coronary atherosclerosis.  相似文献   

15.
The correlation of peripheral endothelial dysfunction and intima-media thickness (IMT) in patients with suspected coronary artery disease (CAD) has been unclear. Inflammation and thrombosis may play a role at early stages of atherosclerosis. Thus, early atherosclerosis was noninvasively examined morphologically by IMT of carotid arteries, and functionally by flow mediated dilation (FMD) of brachial arteries in patients who were suspected of CAD and had undergone coronary angiography. Plasma antigen levels of tumor necrosis factor (TNF)-alpha and interleukin (IL)-6, representative atherogenic cytokines, tissue factor (TF) and tissue factor pathway inhibitor (TFPI), markers of coagulation, and plasma activity level of plasminogen activator inhibitor type-1 (PAI-1), a marker of defective fibrinolysis, were measured. Patients with coronary atherosclerosis in one or more vessels with lesion > or = 50% had significantly reduced FMD compared with those with angiographically normal coronary arteries. Carotid artery IMT increased significantly only in patients with advanced coronary atherosclerosis in one or more vessels with lesion > or = 90%. Plasma antigen levels of IL-6 were significantly increased in patients with reduced FMD (< 5%) compared to those in patients with FMD between 10 and 15%. Plasma antigen levels of TF, total and free TFPI, and PAI-1 activity tended to increase with a reduction in FMD. Thus, (1) FMD was reduced at early stages of CAD while IMT was increased in advanced CAD, and (2) inflammation and thrombosis may play a role in the early stages of the atherosclerotic process.  相似文献   

16.
Background: Multidetector row computed tomography (MDCT) is an attractive noninvasive alternative to assess overall coronary artery disease (CAD) burden and may reveal coronary plaques, which may be underestimated by conventional coronary angiography. The aim of this study was to determine whether brachial artery flow‐mediated dilation (FMD) and carotid artery intima‐media thickness (CIMT) might accurately predict patients with occult coronary plaques whose conventional coronary angiographies revealed normal coronary arteries (NCA). Methods: Thirty‐five patients with angiographically NCA were consecutively recruited into the study. They underwent MDCT and were divided into NCA group (18 patients; 8 male; 47 ± 9 years) and occult CAD group (17 patients; 11 male; 50 ± 10 years) according to presence of coronary plaque. Nineteen consecutive patients with evident CAD (16 male; 54 ± 7 years) and 19 healthy subjects (10 male; 50 ± 6 years) were included as control groups. FMD and CIMT were measured by brachial and carotid artery ultrasonography. Results: Occult CAD group had significantly lower FMD and insignificantly higher CIMT than NCA group whereas they had significantly higher FMD and insignificantly lower CIMT than evident CAD group. NCA group had significantly lower CIMT than evident CAD group. Receiver operating characteristic curve analysis demonstrated FMD < 8% (sensitivity: 94.4%; specificity: 73.0%; PPV: 77.3%; NPV: 93.1%) and CIMT ≥ 0.65 cm (sensitivity: 72.2%; specificity: 62.2%; PPV: 65.0%; NPV: 69.7%) could predict patients with CAD. FMD and CIMT were independent predictors of CAD (P < 0.001; OR: 45.630; 95%CI: 5.38–386.983 and P = 0.015; OR: 14.226; 95%CI: 1.666–121.467, respectively). Conclusion: FMD and CIMT might predict patients with occult CAD and be helpful in selecting patients for MDCT. (Echocardiography 2011;28:1141‐1147)  相似文献   

17.
颈动脉粥样硬化与冠心病的相关性研究   总被引:15,自引:8,他引:7  
目的:探讨颈动脉粥样硬化与冠心病的相关性。方法:对84例拟诊冠心病的患者,行颈动脉超声和冠状动脉造影检查。结果:发现心绞痛组和心肌梗死组的颈动脉粥样硬化(AS)等级积分、Crouse积分和斑块数均明显高于非冠心病组(P<0.01和P<0.001),冠脉单支和多支病变组与非冠心病组的颈动脉粥样硬化指标亦有明显差异(<0.001和P<0.0001);冠脉造影积分和冠脉病变支数与颈动脉粥样硬化的等级积分、Crouse积分和斑块数均呈显著的正相关。颈动脉超声的敏感性为86.4%,特异性为64.0%,总的诊断符合率为79.8%。结论:测定颈动脉粥样硬化斑块的超声病理分型对冠心病的预测具有临床意义。  相似文献   

18.
目的采用彩色多普勒超声仪分析心绞痛患者颈动脉病变,探讨其在冠状动脉病变中的临床诊断价值。方法选择因心绞痛行冠状动脉造影的住院患者328例,根据冠状动脉造影结果分为4组:对照组(80例)、单支病变组(102例)、2支病变组(62例)和多支病变组(84例)。用彩色多普勒超声仪测量颈总动脉内膜中层厚度(intimamediathickness,IMT)及颈动脉分叉处IMT,记录颈动脉斑块的位置、数量。结果与对照组比较,2支病变组分叉处IMT和斑块积分明显增高,多支病变组颈总动脉IMT、分叉处IMT和斑块积分明显增高,差异有统计学意义(P0.05,P0.01)。与对照组比较,多支病变组颈总动脉IMT增厚比例明显增高,差异有统计学意义(P0.05);与单支病变组比较,多支病变组颈总动脉IMT增厚比例明显增高,差异有统计学意义(P0.05)。糖尿病是冠状动脉病变的主要危险因素(OR=2.8,95% CI:1.18~6.63)。结论颈动脉粥样硬化与冠状动脉病变有相关性,采用彩色多普勒超声分析颈动脉病变情况,对冠心病患者具有较好的筛查及预测价值。  相似文献   

19.
BACKGROUND: Endothelial dysfunction is the first step in the progression to atherosclerosis, but little is known regarding whether there is a correlation in endothelial function between the coronary and peripheral arteries. HYPOTHESIS: We investigated the relationship between coronary and peripheral endothelial function. METHODS: In 41 patients (mean age 63 years; 23 men, 18 women) with angiographically normal coronary arteries, changes in brachial artery diameter in response to hyperemic flow and sublingual nitroglycerin (NTG) were measured by high-resolution ultrasonography. During coronary angiography, acetylcholine (ACh, 3 and 30 microg/min) and NTG were infused into the left coronary ostium. The diameter of the coronary artery was quantitatively measured and coronary blood flow (CBF) was calculated by quantitative angiography and Doppler flow velocity measurements. Changes in these parameters in response to each drug infusion were expressed as the percent change from the baseline values. RESULTS: Flow-mediated dilation (FMD) of the brachial artery was 5.0 +/- 3.5% and correlated positively not only with the change in coronary diameter (ACh at 30 microg/min, r = 0.31, p < 0.05) but also with the change in CBF (ACh at 3 microg/min, r = 0.39, p < 0.05; ACh at 30 microg/min, r = 0.46, p < 0.01). Multivariate analysis demonstrated that FMD was one of the factors associated with the changes in coronary diameter and CBF. CONCLUSIONS: These results suggest that brachial endothelial function is associated with coronary endothelial function in patients with angiographically normal coronary arteries, suggesting that impairment of endothelial function may occur simultaneously in both coronary and peripheral arteries.  相似文献   

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