老年高血压患者颈动脉内膜中层厚度及血管内皮依赖性舒张功能

为评价老年高血压患者动脉粥样硬化的发病情况 ,利用高分辨率超声 ,对 6 3例老年高血压患者及 2 0例对照者颈动脉内膜中层厚度及斑块进行检测 ,并观察休息时、反应性充血后肱动脉内径变化。结果发现 ,高血压II期、III期颈动脉内膜中层厚度及斑块发生率较对照组明显增加 (P <0 .0 5 ) ,且随斑块严重程度的增加内膜中层厚度呈增厚趋势。高血压各期肱动脉血流介导性舒张较对照组明显减弱 (P <0 .0 5 )。结果提示 ,颈动脉内膜中层厚度增厚及血管内皮依赖性舒张功能障碍是老年高血压患者动脉粥样硬化的早期表现。     

冠心病患者颈动脉硬化与高敏C反应蛋白水平的关系研究

目的探讨冠心病合并颈动脉粥样硬化与C反应蛋白(hs-CRP)水平增高及其危险因素的关系。方法对入选94例冠心病患者进行颈动脉超声测量观察颈动脉内膜厚度,粥样斑块的数量及部位。定量检测C反应蛋白水平。结果合并颈动脉粥硬化的冠心病患者血清C反应蛋白水平明显高于无颈动脉硬化患者(9.94±8.95mg)VS(4.12±2.85mg),P<0.05。颈动脉内有多个斑块的患者血清C反应蛋白明显高于颈动脉内膜中膜增厚的患者(12.68±8.34)VS(9.94±8.95)mg,P<0.05。结论血清C反应蛋白水平的高低与冠心病颈动脉粥样硬化程度,内膜厚度,斑块数量有一定相关性。合并颈动脉内膜增厚及斑块的患者血清C反应蛋白明显高于无颈动脉硬化患者。     

血浆小而密低密度脂蛋白胆固醇水平与颈总动脉内膜中膜厚度的相关性

目的　评估测定颈总动脉内膜中膜厚度增厚患者小而密低密度脂蛋白胆固醇含量的价值。方法　吴江区第一人民医院2012年6月～2013年6月期间在体检中心行颈动脉超声的体检者130例，经颈动脉彩色多普勒超声检查，以颈总动脉内膜中膜厚度≥0.9　mm作为异常标准，分为正常组62例和增厚组68例；检测这些体检者的血浆小而密低密度脂蛋白胆固醇水平，并与颈总动脉内膜中膜厚度进行相关性分析。结果　颈总动脉内膜中膜厚度增厚组小而密低密度脂蛋白胆固醇显著高于正常组（43.97±11.35　mg/dL比26.01±7.62　mg/dL,P＜0.001），且增厚组小而密低密度脂蛋白胆固醇与颈总动脉内膜中膜厚度厚度显著正相关　（r0.857,P＜0.001）。结论　小而密低密度脂蛋白胆固醇水平对颈总动脉内膜中膜厚度的评价具有价值。     

高血压病患者动态脉压与颈动脉粥样硬化的相关性研究

目的研究高血压病患者24h动态脉压与颈动脉粥样硬化间的关系.方法选择1、2级高血压病患者57例作为研究对象,并与2l例年龄、性别与之无统计学差异的健康者作对照,对所有患者行动态血压监测,作颈动脉血管超声测量颈总动脉内膜-中层厚度、颈总动脉内径,局限性的内膜-中层厚度增厚≥1.3mm定义为斑块.结果高血压病患者其24h脉压均值、白天脉压均值、夜间脉压均值均较对照组明显升高,2级高血压病组脉压大于1级高血压病组;高血压病患者内膜-中层厚度明显增厚,且随着斑块严重程度的增加,内膜-中层厚度逐渐增厚;直线相关分析显示:脉压尤其是夜间脉压与内膜-中层厚度及斑块明显正相关,内膜-中层厚度与斑块正相关.结论颈动脉内膜-中层增厚是动脉粥样硬化的早期表现,脉压,尤其是夜间脉压在评估早期动脉硬化方面有着重要意义.     

高血压患者动态脉压与颈动脉重构的相关性研究

目的研究高血压病患者24小时动态脉压与颈动脉结构和功能间的关系.方法选择1、2级高血压病患者57例作为研究对象,设21例年龄、性别与之无统计学差异的健康者作对照,对所有患者所行动态血压监测,作颈动脉血管超声测量颈总动脉内膜-中层厚度、颈总动脉收缩期和舒张期内径.结果高血压病患者其24小时脉压均值、白天脉压均值、夜间脉压均值及颈动脉僵硬度均较对照组明显升高,2级高血压组脉压大1级高血压组;高血压病患者颈动脉内膜中层厚度明显增厚,僵硬度增加,颈动脉可扩张性降低,以2级高血压组明显;直线相关分析显示脉压尤其是夜间脉压、内膜中层厚度、可扩张性、僵硬度及内径均密切相关.结论高血压病患者动态脉压,尤其是夜间脉压增高;颈动脉内膜中层增厚,可扩张性降低,僵硬度增加;脉压,尤其是夜间脉压与颈动脉内膜中层厚度及可扩张性、僵硬度明显相关.     

老年患者颈动脉粥样硬化与冠状动脉病变的相关性

目的　评价老年患者颈动脉与冠状动脉粥样硬化的相关性。方法　对 81例接受冠状动脉造影检查的老年患者进行颈动脉超声检测。结果　冠心病患者颈动脉内膜中层厚度 (IMT)值较对照组明显增大。随冠状动脉病变加重 ,斑块的严重程度增加 ,内膜中层厚度呈增厚趋势。颈总动脉IMT与改良Gensini评分呈正相关。结论　老年患者颈动脉与冠脉粥样硬化之间存在较密切的联系     

冠心病颈动脉内膜中层厚度与左心功能的相关性研究

目的探讨冠心病患者颈动脉内膜中层厚度及颈动脉斑块发生率与左心功能和结构的相关性。方法对70例冠心病患者行颈动脉超声检查测量颈总动脉内膜中层厚度（CCA—IMT）、颈总动脉内径及颈动脉斑块。依据颈总动脉内膜中层厚度厚度将患者分成两组：CCA—IMT〈1mm为正常组,39例;CCA-IMT≥1mam为增厚组,31例。两组患者均行超声心动图检查,分别测量室间隔、左室侧壁及左室下壁的组织多普勒Tei指数（TDI—Tei）和脉冲多普勒Tei指数（PD—Tei）、左室壁厚度、心腔大小,计算左室射血分数。抽取外周静脉血检测血脂及纤维蛋白原水平。结果室间隔TDI-Tei及平均TDI-Tei在两组间比较差异有统计学意义（P〈0．01）。增厚组粥样斑块发生率明显高于正常组（P〈0．05）。年龄、脂蛋白a水平在两组间比较差异有统计学意义（P〈0．05）。PD-Tei指数与下壁、侧壁及平均TDI—Tei指数存在正相关（r分别为0．39、0．40及0．51,P均〈0．05）。结论早期超声检测冠心病患者颈动脉内膜中层厚度,有助于预测患者左心功能的改变。     

超声检测原发性高血压患者颈动脉粥样硬化

高血压是动脉粥样硬化最常见危险因素之一 ,超声能无创地检测亚临床颈动脉粥样硬化的情况 ,但高血压与超声检测的颈动脉粥样硬化之间的关系尚无一致的认识。采用高分辨力超声仪 ,检测 37名无靶器官受损的原发性高血压患者及 33名对照者的早期颈动脉粥样硬化 ,包括测量内膜中层厚度 (IMT)和斑块。高血压组颈动脉IMT较对照组明显增厚 (0 .82± 0 .0 3mmVS 0 .6 0± 0 .0 2mm ,P <0 .0 0 1) ,其斑块发生率及严重程度亦明显增加 (P <0 .0 0 1) ,而 2组间的血管内径并无明显差别。结果提示高血压患者IMT增厚 ,且斑块发生率及严重程度增加 ,高血压是颈动脉粥样硬化的危险因素 ,同时支持超声能在高血压患者出现靶器官损害的临床表现之前发现颈动脉早期粥样硬化的改变。     

脑梗死患者颈动脉病变与眼底动脉硬化的相关性分析

目的探讨脑梗死患者颈动脉病变与眼底动脉硬化的相关性。方法选择脑梗死患者177例,分别进行头颅CT或MRI、颈动脉超声和眼底照相检查,评价颈动脉内膜中层厚度、颈动脉狭窄及眼底动脉硬化分级。结果177例患者中,颈动脉无病变10例(5.6%),颈总动脉内膜中层厚度增厚22例(12.4%),任意颈动脉斑块形成121例(68.4%),颈动脉狭窄24例(13.6%)。正常35例(19.8%),眼底动脉硬化改变142例(80.2%),其中Ⅰ级69例(39.0%),Ⅱ级31例(17.5%),Ⅲ级42例(23.7%)。眼底动脉硬化与颈动脉内膜中层厚度、颈动脉狭窄相关(P<0.05),但眼底动脉硬化各单项指标与颈动脉内膜中层厚度和颈动脉是否狭窄无相关性(P>0.05)。结论眼底动脉硬化与颈动脉病变存在一致性,眼底照相可作为辅助方法帮助评价全身血管情况,协助颈动脉疾病的诊断。     

原发性高血压患者动态脉压与颈动脉粥样硬化的关系

根据动态全天平均脉压将171例原发性高血压患者分为脉压40～60mmHg组和〉60mmHg组，采用超声检测患者颈动脉内膜中层厚度、血管内径及斑块发生率，以颈总动脉最大内膜中层厚度作为评价颈动脉粥样硬化程度的指标。结果脉压〉60mmHg组患者颈总动脉内径、颈总动脉最大内膜中层厚度、颈动脉斑块发生率明显高于脉压为40—60mmHg组（P〈0．01）。患者平均脉压、年龄、平均收缩压、高血压病程与颈总动脉最大内膜中层厚度呈明显正相关（P〈0．01），而平均舒张压与颈总动脉最大内膜中层厚度呈负相关（P〈0．05）。认为脉压增加可使颈动脉粥样硬化性病变的患病率增加。     

原发性高血压患者缺血性脑血管病与颈动脉粥样硬化及碱性成纤维细胞生长因子的关系

目的探讨原发性高血压患者缺血性脑血管病与颈动脉粥样硬化及碱性成纤维细胞生长因子之间的关系及临床意义。方法采用惠普彩色多普勒仪测定颈动脉,观察颈总动脉、颈内动脉和颈动脉分叉部的图像。采用酶联免疫吸附试验方法测定外周血中碱性成纤维细胞生长因子。结果与高血压不伴缺血性脑血管病组比,高血压伴缺血性脑血管病组碱性成纤维细胞生长因子水平(364.5±91.0mg/L比283.4±91.2mg/L)、软斑检出率(92.3%比52.4%)和右侧颈内动脉收缩期峰值流速(57.65±7.34mm/s比52.41±7.97mm/s)均显著升高(P<0.05或0.01);软斑组碱性成纤维细胞生长因子水平比硬斑组明显升高(319.7±93.6mg/L比252.2±77.9mg/L,P<0.05)。结论碱性成纤维细胞生长因子和动脉粥样硬化斑块的形成在高血压缺血性脑血管病的发生发展过程中起重要作用,对判别高血压病变的程度、预防脑梗死提供了重要依据,有利于临床采取正确的干预治疗措施。     

陈旧性心肌梗死患者颈动脉粥样硬化与危险因素的关系

为探讨陈旧性心肌梗死患者颈动脉粥样硬化情况，对38例陈旧性心肌梗死患者的颈动脉内中膜厚度及斑块进行超声检测，与32例健康者作对照。结果发现，陈旧性心肌梗死患者的颈动脉内中膜厚度、斑块指数及斑块发生率明显高于对照组。多因素回归分析显示，年龄、总胆固醇、收缩压与颈动脉内中膜厚度密切相关。     

Carotid atherosclerosis,intima media thickness and risk factors--an analysis of 1781 asymptomatic subjects in Taiwan

The aim of this study was to investigate the association of intima media thickness (IMT) and plaque with risk factors for atherosclerosis in asymptomatic subjects in Taiwan. Between 1998 and 2001, the study recruited 1781 asymptomatic subjects (1131 men and 650 women [mean age, 49 years; range 18-85 years]). These were examined by B-mode ultrasound to measure the IMT at the far wall of the common carotid artery (CCA) and the extent of plaque formation. A wide range of vascular risk factors including age, gender, smoking, body mass index, blood chemistry, and previous history were surveyed. The mean (+/-S.D.) IMT observed was 0.68 (+/-0.12) and 0.66 (+/-0.11) mm for men and women, respectively, (P=0.0008). The mean (S.D.) IMT of the CCA was 0.66 (+/-0.12) mm on the right side and 0.68 (+/-0.12) mm on the left side (P=0.0004). IMT increased with aging, according to the equation IMT=(0.005xage in years)+0.403 [corrected]. Higher IMT was associated with male gender, and IMT was greater in the left CCA. About 36.9% of subjects had carotid plaques. The percentage of plaque increased with aging. The plaque prevalence was positively associated with IMT. The value of IMT over the cut point of 0.68 mm correlated with obviously increased risk of carotid atherosclerosis. Age, systolic blood pressure and fasting blood sugar were independent risk factors related to both carotid atherosclerosis and thick IMT.     

Common carotid intima-media thickness is correlated with myocardial flow reserve in patients with coronary artery disease: a useful non-invasive indicator of coronary atherosclerosis

BACKGROUND: The common carotid intima-media thickness (IMT) is correlated with the angiographically determined coronary artery stenosis. However, their correlation is weak, which limits the clinical application of the IMT as a predictor of coronary artery stenosis. The IMT reflects diffuse early-phase atherosclerosis, whereas the angiographically determined coronary artery stenosis is a late-phase phenomenon. The latter is localized and rapidly progressive with plaque rupture and acute thrombosis. Instead of the angiographically determined coronary artery stenosis, we employed myocardial flow reserve (MFR) that reflects diffuse early-phase coronary atherosclerosis and impaired coronary vasodilatation function. We evaluated the relationship between the IMT and the MFR. METHODS: Twenty-three patients with angiographically diagnosed coronary artery disease (CAD) underwent B-mode ultrasound examination to measure their common carotid IMT and positron emission tomography (PET) with dipyridamole intervention to obtain their MFR. We also performed B-mode ultrasound examination in 21 patients with hypertension without CAD and in 15 control subjects. RESULTS: The common carotid IMT in patients with CAD was thickened (0.92+/-0.15 vs. 0.81+/-0.14 mm in patients with hypertension (P<0.05) and 0.69+/-0.13 mm in control subjects (P<0.01)). The IMT was inversely correlated with the MFR (r=0.51, P<0.01). The correlations between the MFR and most of the coronary risk factors (age, blood pressure, serum cholesterol level and triglyceride level, HbA1c level, smoking index) did not reach statistical significance. CONCLUSIONS: Thickened common carotid IMT is also an indicator of reduced MFR or early-phase coronary atherosclerosis.     

高频超声评价颈动脉粥样硬化与冠状动脉病变的关系

目的利用高频超声检测颈动脉内中膜厚度(IMT)、斑块形成情况,并与冠状动脉(冠脉)病变程度的关系进行分析。方法应用ASPEN彩色多普勒超声诊断仪,对428例健康人(对照组)及89例冠心病患者(冠心病组)进行颈动脉IMT、斑块形成的检测。冠心病组患者以冠脉病变支数分为3个亚组。结果冠心病组患者颈动脉IMT为(1.19±0.14)mm,而对照组为(0.92±0.13)mm,(P<0.01);IMT增厚检出率及斑块形成检出率冠心病组为43.21%、74.65%,而对照组为14.49%、34.35%,(P<0.01)。1支冠脉病变组IMT为(1.00±0.014)mm,斑块形成检出率为42.86%;2支冠脉病变组IMT为(1.15±0.018)mm,斑块形成检出率为65.52%;3支及以上冠脉病变组IMT为(1.31±0.018)mm,斑块形成检出率为74.49%,(P<0.01)。结论颈动脉IMT增厚、斑块形成对冠心病具有预测价值;颈动脉IMT增厚、斑块形成与冠脉病变严重程度呈正相关。     

The presence of a calcific plaque in the common carotid artery as a predictor of coronary atherosclerosis

Many contradictory reports have been published investigating the relationship between coronary artery disease (CAD) and the increased intima-media thickness (IMT) in the common carotid artery (CCA). However, only a limited number of studies evaluate the relationship between CAD and CCA disease as reflected by both the plaque morphology (fibrous and calcific plaques) and IMT. We have studied the associations between CAD and the wall morphology of CCA by B-mode ultrasound (US). One hundred and forty-four subjects, whose angiography was planned on the basis of suspected CAD, were included into the study. The patients were divided into 4 groups on the basis of B-mode US findings; Group I: normal, Group II: increased IMT (IMT >/= 0.8 mm and plaque absent), Group III: fibrous plaque, Group IV: calcific plaque. Coronary artery disease was diagnosed in 63 patients. A statistically significant correlation was found between CAD and CCA wall morphology (r =0.42, CI (95%) = 0.30-0.51, p<0.001). Positive predictive values were 45.0%, 48.4%, and 75.0% in patients with increased IMT, fibrous plaque, and calcific plaque, respectively. None of the women with normal CCA wall morphology had significant coronary artery lesion. With respect to the normal group, the risk for CAD increased by 4.3 fold with the existence of fibrous plaque (p=0.02) and by 9.9 fold with the existence of calcific plaque (p<0.001). It has been shown that the CCA wall morphology determined by B-mode US is correlated with CAD in patients with chest pain, and the presence of calcific plaque is a better predictor for CAD than that of fibrous plaque and increased IMT. Women with chest pain and normal CCA wall morphology may not need coronary angiography.     

高频体表超声检测急性冠状动脉综合征患者颈动脉结构及功能

应用高频体表超声观察急性冠状动脉综合征患者颈动脉结构及血管内皮功能的变化 ,探讨动脉粥样硬化结构和功能与急性冠状动脉综合征的关系。对 35例急性冠状动脉综合征患者检测了颈动脉粥样硬化斑块、内膜中膜厚度、肱动脉内皮功能的变化 ,并与 2 7例稳定型心绞痛及 31例正常对照组进行比较。结果发现 ,内膜中膜厚度和内皮依赖性血管舒张功能在急性冠状动脉综合征组 (分别为 0 .10± 0 .0 2和 3.98± 1.6 5 )和稳定型心绞痛组(分别为 0 .11± 0 .0 4和 4 .76± 2 .37)与对照组 (分别为 0 .0 7± 0 .0 1和 9.33± 3.4 7)有显著差异 (P <0 .0 5 ) ,斑块积分和斑块指数在急性冠状动脉综合征组 (分别为 4 .0 6± 2 .2 1和 3.14± 1.97)与稳定型心绞痛组 (分别为 4 .17± 1.76和3.2 1± 1.88)间无差异 (P >0 .0 5 ) ,急性冠状动脉综合征组颈动脉粥样硬化斑块以不稳定型为主。研究结果提示 ,外周血管超声检查可观察动脉粥样硬化病变 ,颈动脉结构及血管内皮功能与冠状动脉粥样硬化有关。     

Carotid Intima-Media Thickness and Plaque in Cardiovascular Risk Assessment

Carotid intima-media thickness (CIMT) has been shown to predict cardiovascular (CV) risk in multiple large studies. Careful evaluation of CIMT studies reveals discrepancies in the comprehensiveness with which CIMT is assessed—the number of carotid segments evaluated (common carotid artery [CCA], internal carotid artery [ICA], or the carotid bulb), the type of measurements made (mean or maximum of single measurements, mean of the mean, or mean of the maximum for multiple measurements), the number of imaging angles used, whether plaques were included in the intima-media thickness (IMT) measurement, the report of adjusted or unadjusted models, risk association versus risk prediction, and the arbitrary cutoff points for CIMT and for plaque to predict risk. Measuring the far wall of the CCA was shown to be the least variable method for assessing IMT. However, meta-analyses suggest that CCA-IMT alone only minimally improves predictive power beyond traditional risk factors, whereas inclusion of the carotid bulb and ICA-IMT improves prediction of both cardiac risk and stroke risk. Carotid plaque appears to be a more powerful predictor of CV risk compared with CIMT alone. Quantitative measures of plaques such as plaque number, plaque thickness, plaque area, and 3-dimensional assessment of plaque volume appear to be progressively more sensitive in predicting CV risk than mere assessment of plaque presence. Limited data show that plaque characteristics including plaque vascularity may improve CV disease risk stratification further. IMT measurement at the CCA, carotid bulb, and ICA that allows inclusion of plaque in the IMT measurement or CCA-IMT measurement along with plaque assessment in all carotid segments is emerging as the focus of carotid artery ultrasound imaging for CV risk prediction.     

Rapid Screening for Subclinical Atherosclerosis by Carotid Ultrasound Examination: The HAPPY (Heart Attack Prevention Program for You) Substudy

BackgroundCardiovascular disease (CVD)-related death rates have been escalating in emerging economies such as India. A strategy to initiate prophylactic medical intervention by direct identification of subclinical atherosclerotic burden may be appropriate in rural populations where assessment based on traditional risk factors is not available.ObjectivesThis study sought to investigate the feasibility of performing rapid automated carotid ultrasound studies in a rural setting and to measure the prevalence of carotid plaques and age-specific distribution of carotid intima-media thickness (IMT) as an index of subclinical atherosclerosis.MethodsScreening of the extracranial carotid system with automated B-mode ultrasound was performed along with health questionnaire assessments in 771 asymptomatic volunteers (ages 40 ± 14 years; 626 men and 145 women) with no known CVD. Measurements of IMT were recorded as the mean of 24 spatial measurements performed over a 1-cm region in the far wall of the common carotid artery at end diastole; the prevalence of the plaque (focal IMT >1.5 mm) was determined.ResultsA total of 69 (8.9%) subjects had atherosclerotic plaques. Of these, 16 (2.1%) exhibited bilateral plaques, 28 (3.6%) left carotid plaque only, and 25 (3.2%) had right carotid plaques. Patients even under 50 years showed a high prevalence of carotid plaques (7%), which increased with age (25% and 35% for 51 to 70 and >70 years, respectively). Only 3 (4.3%) participants with plaques were former smokers. Global mean IMT was 0.55 ± 0.13 mm and correlated with age for both left and right carotid arteries (r = 0.61 and 0.60, p < 0.001 for both) in male as well as female subjects (r = 0.70 and 0.67, p < 0.001 for both), respectively.ConclusionsRapid community screening for subclinical atherosclerosis is feasible with automated carotid ultrasound examination and may be beneficial in rural communities of industrializing nations where traditional CVD risk factor data are not yet readily available.     

Carotid and femoral atherosclerotic lesions in patients with coronary heart disease confirmed by angiography

INTRODUCTION: Clinically evident atherosclerosis is preceded by preclinical changes in the arterial wall. These changes are characterised by increased thickness of the intima-media complex (IMT). AIMS: A complex ultrasound assessment of the peripheral vessels as well as an attempt to find ultrasound parameters correlating with the burden of atherosclerotic lesions of the coronary arteries. METHODS: 231 patients who underwent both coronary angiography and ultrasound examination of the following arteries: common carotid artery (CCA), carotid bulb and common femoral artery (CFA) were enrolled. The IMT value, presence of plaque and Doppler blood flow parameters were evaluated. Selected clinical and biochemical risk factors of atherosclerosis were assessed. Two groups of patients were analysed: 200 patients with coronary artery disease confirmed by angiography (study group), and 31 patients with normal coronary arteries (control group). RESULTS: Significantly higher values of the IMT in the peripheral arteries were observed in patients with coronary artery lesions than in those without (CCA - 0.91 vs 0.61 mm, carotid bulb -- 1.31 vs 0.67 mm, CFA -- 1.38 vs 0.63 respectively, p<0.0001). Atherosclerotic plaques were present only in patients with coronary artery disease. Additionally, IMT values of the CCA, carotid bulb and CFA were significantly higher in patients with severe coronary artery disease (three vessel disease) than in patients with lesions in one or two coronary arteries. CONCLUSIONS: Patients with coronary lesions present with increased IMT values and higher plaque occurrence. Complex ultrasound evaluation of different peripheral arteries (CCA, carotid bulb and CFA) may be used as part of the cardiovascular risk stratification.