颈动脉超声检查预测冠状动脉硬化的价值

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。

Predictive value of carotid ultrasonography on coronary atherosclerosis

Objective： To explore prective value of carotid ultrasonography on coronary atherosclerosis. Methods： A total of 122 patients suspected coronary heart disease or unknown chest pain received carotid ultrasonography. Ca- rotid artery with or without plaques and number of plaques were observed; patients with carotid plaques received coronary multi-slice spiral CT angiography （MSCTA, 75 cases） or coronary angiography （CAG, 47 cases）. Results of carotid ultrasonography were compared with those of coronary MSCTA or CAG. Results： Sensitivity, specificity and accuracy of IMT of carotid ultrasonography for CAG diagnosing coronary atherosclerosis were 82%, 33% and 84% respectively; for MSCT diagnosing coronary atherosclerosis were 79%, 33% and 86% respectively; Sensitivi- ty, specificity and accuracy of carotid plaques for CAG diagnosing coronary atherosclerosis were 89%, 55% and 89% respectively, for MSCT diagnosing coronary atherosclerosis were 87%, 58% and 92%. Carotid atherosclerot- ic scores and number of plaques in single, double and triple vessel coronary disease groups were significantly higher than those of no lesion group （P〈0.05 -〈0.01）, and those of double and triple vessel coronary disease groups were significantly higher than those of single vessel coronary disease group （P〈0.01）, but those between double and triple vessel coronary disease groups were no significant difference （P〉0.05）. Conclusion： Carotid ultrasonog-raphy can find corotid atherosclerotic lesion in time and conveniently, and it＇s of important significance for predic- ting coronary atherosclerosis.