颈动脉粥样硬化与冠状动脉粥样硬化的关系

目的　探讨颈动脉粥样硬化与冠状动脉粥样硬化的关系。方法　对 94例老年患者进行了冠状动脉造影和颈动脉超声检查。颈动脉粥样硬化斑块积分采用Sutton法。结果　单支组及多支组内膜中膜厚度、斑块积分显著高于正常组 ,多支组显著高于单支组 (P<0 .0 5 )。斑块指数与年龄、吸烟、低密度脂蛋白胆固醇与高密度脂蛋白胆固醇的比值、收缩压以及高血压病程的程度呈正相关。结论　颈动脉粥样硬化与冠状动脉粥样硬化的病变是平行的     

Progression of carotid atherosclerosis in Japanese patients with coronary artery disease

The authors investigated the relationship between the progression of carotid atherosclerosis and the severity of coronary artery disease (CAD). The two-year follow-ups of extracranial carotid atherosclerosis in 50 patients with CAD were evaluated by B-mode high-resolution ultrasonography. The summed maximal thickness of carotid plaques increased by 3.2 to 10.1 mm (mean 1.06 mm, SD 2.42 mm). The extent of coronary atherosclerosis (p<0.02) and the serum total cholesterol level (p<0.01) were different between the progressing group (n=20) and the nonprogressing group (n=25) with carotid atherosclerosis. Carotid disease progression was significantly higher in patients with three-vessel coronary disease than in those without significant coronary disease (p<0.005). Age, serum triglyceride, high-density lipoprotein-cholesterol, pack-years of smoking, % smokers, % hypertensives, and % diabetics were not different between the two groups. It was concluded that the severity of CAD was one of the strong predictors for carotid disease progression in patients with CAD.     

冠心病血管内皮功能、颈动脉硬化与冠脉病变的关系

目的：观察冠心病（CAD）患者内皮依赖性舒张功能及颈动脉粥样硬化的状况及与冠状动脉病变的相关性。方法：选经冠状动脉造影确诊为CAD的患者106例（观察组），冠状动脉造影证实无冠状动脉狭窄的健康者40例（正常对照组），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颈动脉粥样硬化病变。颈动脉粥样硬化斑块积分采用Sutton法，并与冠状动脉病变程度进行对比分析。结果：CAD组内皮依赖性血管舒缩功能（FMD）比正常对照组明显降低（P〈0．01），内皮非依赖性血管舒缩功能与正常对照组比较无显著性差异（P〉0．05）；CAD组颈动脉内膜中层厚度（IMT），斑块积分显著高于正常对照组（P〈0．01）。FMD与冠脉病变程度呈负相关（r=-0．651，P〈0．001），颈动脉IMI及斑块积分与冠脉病变程度呈正相关（r=0．871，0．702，P〈0．001）。结论：内皮细胞功能障碍和颈动脉粥样硬化与冠状动脉粥样硬化的病变相平行。     

颈动脉粥样硬化与冠心病关系的研究

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，斑决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痛的诊断提供依据。     

颈动脉粥样硬化与冠心病关系的研究

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。     

外周血管动脉粥样硬化对年轻冠心病患者的预测意义

目的探讨外周血管颈动脉、股动脉粥样硬化对年轻冠状动脉性心脏病（冠心病）的预测作用。方法根据冠状动脉造影结果将58例≤40岁的患者分为冠心病组（37例）和非冠心病组（21例）,采用高分辨彩色多普勒超声同时检查颈动脉、股动脉,分别测量颈动脉内膜-中层厚度（carotid intima media thickness,CIMT）、股动脉内膜-中层厚度（femoral intima media thickness．FIMT）,以内膜-中层厚度（intima media thickness,IMT）≥1．2mm为粥样硬化斑块。比较两组的CIMT、FIMT及斑块检出率．计算斑块对年轻冠心病的预测值。结果冠心病组CIMT、FIMT高于非冠心病组[（1．36±0．51）mm比（0．84±0．38）mm,P〈0．05：（1．48±0．84）mm比（0.74±0．26）mm．P〈0．05]．冠心病组颈动脉、股动脉粥样硬化斑块形成检m牢均明显高于非冠心病组．差异有统计意义i62ck（23／37）比9．5％（2／21）．P〈0．05;57％（21／37）比14％（3／21）,P〈0．05]。颈动脉、股动脉粥样硬化斑块预测年轻冠心病的敏感性分别为62％、57％,特异性为90％、86％,阳性预测值分别为92％、88％,阴性预测值为58％、53％：颈动脉、股动脉联合检测未见明显提高预测值。结论外周血管颈动脉、股动脉粥样硬化与年轻冠心病相关,颈动脉、股动脉粥样硬化斑块对年轻冠心病患者均有预测作用,其特异性、阳性预测值均较高．     

二维超声检测冠心病患者颈动脉粥样硬化病变

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）。     

Ultrasonic correlates of common carotid atherosclerosis in patients with coronary artery disease

Increased intima-media thickness and plaque development in the extracranial carotid arteries reportedly correlate well with the prevalence of coronary artery diseases. The location of these atherosclerotic lesions in the carotid artery varies with age in patients with coronary artery atherosclerosis. Intima-media thickness, plaque, and calcification in the common carotid artery and bifurcation were assessed with high-resolution B-mode ultrasonography. Forty patients with severe atherosclerosis of the coronary artery and 56 healthy control subjects with no risk factors for coronary atherosclerosis were included in this study. The subjects were divided into a middle-age group (40-59 yr) and an old-age group (60-79 yr). In both groups, the intimamedia thickness in the patients was significantly higher than that in the controls. Intima-media thickness of at least 0.7 mm in the middle-age group and at least 1.0 mm in the old-age group was specific and positively predictive of coronary artery disease. Plaque (> 1.0 mm) and calcification were more significant in patients than in controls. In the middle-age group, intimamedia thickness in the common carotid artery was correlated with coronary atherosclerotic severity. Conversely, in the old-age group, the presence of plaque and calcification at the bifurcation was correlated with coronary atherosclerotic severity. The characteristic manifestation of the atherosclerotic lesion in the carotid artery varied with age in patients with coronary artery disease.     

原发性高血压患者颈动脉粥样硬化与冠状动脉病变关系的探讨

目的研究原发性高血压(EH)患者颈动脉粥样硬化与冠状动脉病变的关系。方法选择114例EH患者,根据冠状动脉造影结果分成4组:正常组、单支病变组、双支病变组和3支病变组,各组分别进行颈动脉超声检查,测量颈动脉舒张末期内颈(DD)、收缩末期内径(DS)、DD与DS之差与DD的变化率DD-DS/DD(%)及粥样斑块。结果随着冠状动脉病变严重程度的增加,颈动脉DS、DD、DD-DS/DD(%)值下降,斑块发生率和斑块的严重程度增加。结论颈动脉超声检查能较好地预测EH患者冠状动脉病变的严重程度。     

冠心病患者冠状动脉粥样硬化程度与颈动脉粥样硬化的相关性研究

目的 探讨冠心病患者颈动脉粥样硬化与冠状动脉硬化程度之间的关系.方法 选取2012年1月至2013年6月河北大学附属医院心内科治疗的冠心病患者350例,依据冠状动脉造影结果将患者分为冠心病组和非冠心病组,其中冠心病组260例,非冠心病组90例;依据造影结果将冠心病组患者进行再次分组,其中单支病变组113例,双支病变组89例,三支病变组58例.比较冠心病组及非冠心病组间及不同冠状动脉病变支数三组间的颈动脉内-中膜厚度（IMT）、斑块积分及Gensini评分;统计分析冠状动脉病变支数与以上观察指标的相关性.结果 冠心病组的颈动脉IMT、斑块积分、Gensini积分分别为（1.37±0.23）、（5.37±3.98）、（23.32±7.33）,均高于非冠心病组,两组间比较差异有统计学意义（P＜0.05）.双支病变组和三支病变组的斑块检出率为79.8％和81.0％,双支病变组及三支病变组患者颈动脉IMT分别为（1.31±0.21）mm和（1.37±0.27）mm,双支病变组和三支病变组患者的斑块检出率与颈动脉IMT值均高于单支病变组,三组间比较差异有统计学意义（P＜0.05）.冠状动脉病变支数与IMT、颈动脉斑块积分呈显著正相关;Gensini评分与IMT及颈动脉斑块积分呈显著正相关.结论 冠状动脉的粥样硬化程度随着患者的颈动脉粥样硬化程度的升高而加重,冠心病的严重程度可以通过颈动脉超声检测反映出来.     

Apolipoprotein E polymorphism is associated with both carotid and coronary atherosclerosis in patients with coronary artery disease

Background and aimsApolipoprotein E (apoE) polymorphism plays a significant role in the development of atherosclerosis and cardiovascular disease. Therefore, the aim of the present study was to examine the association between apoE polymorphism and carotid intima-media thickness (IMT), and severity and extent of coronary artery disease (CAD).Methods and resultsB-mode ultrasound and quantitative coronary angiography (QCA) were used to assess carotid, and coronary artery atherosclerosis in 91 patients with clinically suspected CAD referred for cardiac catheterization. Two apoE phenotype groups were defined: apoE3 (E3/E3) and apoE4 (including E4/E3, E4/E4 phenotypes). Maximum IMT was higher in the apoE4 group than in the apoE3 group (p = 0.022). The global atheroma burden index was similarly higher in the apoE4 group than in the apoE3 group (p = 0.033). ApoE4 subjects had higher levels of apolipoprotein B (apoB) (p = 0.008), triglycerides (p = 0.006), remnant lipoprotein-cholesterol (RLP-C) (p = 0.023), and lipoprotein(a) [(Lp(a)] (p = 0.041) than apoE3 subjects. The mean LDL particle size was smaller in the apoE4 group than in the apoE3 group (p = 0.041).ConclusionsApoE polymorphism was associated with both carotid and coronary atherosclerosis. Patients with the apoE4 isoform had an increased carotid IMT and a more severe and extensive CAD than patients with the apoE3 isoform.     

冠心病患者血脂水平与颈动脉及冠状动脉粥样硬化病变的关系

背景与目的血浆脂质水平与动脉粥样硬化程度密切相关，大多数的冠心病患者均有高脂血症，但并非所有高脂血症患者都有动脉及冠状动脉粥样硬化或冠心病。本文旨在研究血浆脂质的不同成份与颈动脉及冠状动脉粥样硬化病变之间的关系。材料与方法对125例因心绞痛、不明原因胸病或心肌梗塞而入院行选择性冠状动脉造影的患者作双侧颈动脉超声检查及血浆脂质水平测定，用Gensini法计算冠脉病变积分，用Crouse法计算颈动脉斑块积分，研究各血脂指标与冠脉病变支数、冠脉病变积分、颈动脉斑块积分之间的关系。结果与结论血浆总胆固醇浓度、低密度脂蛋白浓度及高脂血症病史，与冠脉病变支数、冠脉病变积分及颈动脉斑块积分均呈显著的正相关；高密度脂蛋白浓度则与上述各参数呈显著负相关。     

老年冠心病患者血管内皮功能与动脉粥样硬化的关系

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.     

Diffuse extent of coronary atherosclerosis in fatal coronary artery disease

In 4 subsets of patients with coronary artery disease, the amounts of narrowing of the 4 major epicardial coronary arteries were compared (left main, left anterior descending, left circumflex and right) by atherosclerotic plaques. Among 129 patients studied at necropsy, an average of 2.7 of the 4 arteries were narrowed greater than 75% in cross-sectional area at some point; in control subjects, narrowing was seen in an average of 0.7 arteries. Patients with unstable angina pectoris had a greater incidence of narrowing (3.2 arteries) than did patients with sudden coronary death (2.8), acute myocardial infarction (MI) (2.7) or healed MI (2.3). Each of the 4 major arteries was divided into segments 5 mm in length, and histologic sections were prepared and stained by the Movat method. A total of 6,461 segments were analyzed from the 129 patients and 1,849 from the 40 controls. In the 129 patients, 35% of the 5-mm segments were narrowed 75 to 100% in cross-sectional area (compared with 3% in control subjects). The group with unstable angina had the highest percentage (48%) of severely narrowed segments compared with the groups with sudden coronary death (36%), acute (34%) and healed MI (31%). Only 8% of the 6,461 segments were narrowed less than or equal to 25% in cross-sectional area, and virtually none of the 6,461 segments was normal; thus, 92% of the coronary segments were narrowed greater than 25% in cross-sectional area by atherosclerotic plaque alone. Among patients with fatal coronary artery disease studied at necropsy, therefore, the atherosclerotic process is severe and diffuse in the major epicardial coronary arteries.     

严重冠心病患者MCP-1、bFGF与冠状动脉粥样硬化的关系

目的：探讨冠状动脉严重狭窄患者血清单核细胞趋化蛋白-1（MCP-1）、碱性成纤维细胞因子（bFGF）浓度与冠状动脉粥样硬化程度的关系。方法：80例冠状动脉严重狭窄的患者，采用酶联免疫法检测患者血清MCP-1、bFGF浓度，应用Gensini积分系统评价患者的冠状动脉粥样硬化病变程度。结果：（1）冠脉单支血管病变患者MCP-1血清水平（69．28±34．97pg／ml）明显低于冠脉多支血管病变组（96．97±43．01pg／ml，P〈0．05），而bFGF血清水平在单支组和多支病变组差别没有统计学意义（P=0．647）；（2）相关分析发现MCP-1血清浓度与Gensini积分呈正相关（r=0．304，P〈0．05），而bFGF血清浓度与Gensini积分无明显相关性（P〉0．05）。结论：在严重的冠心病患者中，MCP-1血清浓度与冠状动脉粥样硬化程度密切相关。     

可溶性糖蛋白130与稳定型冠心病患者冠状动脉粥样硬化严重程度之间关系

目的: 评估稳定型冠状动脉疾病（stable coronary artery disease, CAD）患者血清白细胞介素-6（IL-6）、可溶性IL-6受体（sIL-6R）和可溶性糖蛋白130（sgp130）浓度及与冠状动脉粥样硬化严重程度间的关系。方法：纳入2017年1月到2019年1月间于惠州市第六人民医院心内科具有动脉造影适应症疑似冠心病患者89例,根据冠状动脉造影结果将患者分成两组：存在冠状动脉粥样斑块CAD组,即粥样斑块组,共64例;不存在冠状动脉粥样斑块CAD组,即非粥样斑块组,共25例。采用ELISA法检测两组患者血清IL-6、sIL-6R和sgp130浓度,Spearman相关分析sgp130浓度与受累冠脉数目及Gensini评分的相关性,多因素logistic回归分析冠状动脉粥样硬化斑块病变的预测因子。结果： 粥样斑块组与非粥样斑块组在年龄、BMI、高血压、糖尿病、血脂参数上无统计学差异（P>0.05）, 粥样斑块组患者男性吸烟者居多（P<0.05）。粥样斑块组血清sgp130浓度显著低于非粥样斑块组（314.97±84.39 VS 399.08±79.99 ng/ml, P<0.001）,粥样斑块组血清IL-6浓度显著高于非粥样斑块组（P<0.05）, 粥样斑块组血清sIL-6R浓度和C-反应蛋白浓度(CRP)与非粥样斑块组比较差异无统计学意义。多因素logistic回归分析示血清sgp130浓度是冠状动脉粥样硬化斑块病变存在的预测因子（P=0.018）。血清sgp130浓度与受累冠状动脉数目间呈负相关（r=-0.310,P=0.007）,Gensini评分指数与血清sgp130浓度呈负相关（r=-0.410, P=0.001）,稳定型CAD患者sgp130浓度是Gensini评分指数独立危险因素。结论：稳定型CAD患者血清sgp130浓度与冠状动脉损伤严重程度呈负相关,血清sgp130水平是冠状动脉粥样硬化严重程度血清标志物。     

Assessment of aortic atherosclerosis and carotid atherosclerosis in coronary artery disease

The present study investigated the relationship between aortic atherosclerosis and carotid atherosclerosis, and studied the effects of coronary risk factors for these arteries. The subjects consisted of 78 patients with coronary artery disease (CAD) and 69 patients without CAD. All subjects underwent enhanced computed tomography and B-mode ultrasonography within a short time period to determine the extent of aorta and carotid atherosclerosis. Significant correlations between maximal aortic wall thickness (MAWT) and aortic wall volume (AWV) with carotid intima-media thickness (IMT) were demonstrated. MAWT, AWV and IMT were significantly higher in patients with CAD compared with controls (p=0.009, p=0.024, p=0.001, respectively). Furthermore, there were significant differences in MAWT, AWV and IMT among groups classified by the number of coronary artery stenoses, and no significant differences among groups classified by risk factors, but it was shown that MAWT, AWV and IMT increased gradually as the risk factors increased in number. MAWT, AWV and IMT had positive correlations with age, systolic blood pressure and triglyceride, and a negative correlation with high density lipoprotein-cholesterol. This study demonstrated that both aortic atherosclerosis and carotid atherosclerosis are closely correlated with coronary atherosclerosis, and that the atherosclerosis indices are independently associated with age and hyperlipidemia.     

Subclinical coronary artery atherosclerosis in patients with erectile dysfunction.

OBJECTIVES: The purpose of our study was to assess the prevalence and extent of coronary artery atherosclerosis in asymptomatic patients with vascular erectile dysfunction (ED). BACKGROUND: An association between ED and ischemic heart disease has been suggested, but it is unknown if it represents a marker of subclinical coronary atherosclerosis. METHODS: We studied 70 consecutive patients with vascular ED, evaluated by penile Doppler, and 73 control subjects with no history of coronary artery disease. We measured traditional coronary risk factors, circulating levels of C-reactive protein (CRP), endothelial function by ultrasound of brachial artery, and coronary artery calcification by multi-slice computed tomography. RESULTS: The patients and the control group were similar for age, race, and coronary risk score. Patients with ED had significantly higher high-sensitivity C-reactive protein levels (2.62 vs. 1.03 mg/l, p < 0.001). Flow-mediated dilation of the brachial artery was more impaired in patients with ED than in controls (2.36 vs. 3.92, p < 0.001). Coronary artery calcification was more frequent in individuals with ED than in control subjects (p = 0.01). Multiple logistic regression analysis showed that patients with ED had an overall odds ratio of 3.68 for having calcium score above the 75th percentile, compared to the controls. CONCLUSIONS: Coronary atherosclerosis is more severe in patients with vascular ED; ED predicts the presence and extent of subclinical atherosclerosis independent of traditional risk factors for cardiovascular disease. Thus, ED may be considered an additional, early warning sign of coronary atherosclerosis.