主动脉瓣硬化与动脉粥样硬化关系的研究

目的:探讨主动脉瓣硬化(AVS)与动脉粥样硬化的相关性及其组织病理学特点。方法:对138例已确诊或可疑冠心病患者进行超声心动图检查,根据主动脉瓣的形态学特点,将其分为主动脉瓣硬化组(AVS组)58例和无主动脉瓣硬化组(non-AVS组)80例。两组患者均常规进行颈总动脉超声检查和选择性冠状动脉造影,比较两组间的颈总动脉内-中膜厚度(IMT),粥样斑块发生率和冠心病的发生率,以及两组的血压、血脂和血糖水平。对接受主动脉瓣置换术或因冠心病死亡者的病变瓣膜进行组织病理学分析。结果:AVS组的收缩压、甘油三酯、总胆固醇和脂蛋白(a)明显高于non-AVS组(P<0.05),而高密度脂蛋白胆固醇明显低于non-AVS组(P<0.05);AVS组颈总动脉IMT较non-AVS组明显增厚,颈动脉粥样斑块和冠心病的发生率明显增加(P<0.05);8例主动脉瓣标本均显示出不同程度的粥样硬化性改变。结论:AVS与动脉粥样硬化密切相关,主动脉瓣硬化可作为临床上预测动脉粥样硬化的一项指标。

Relationship between aortic valve sclerosis and atherosclerosis

Objective: To explore the association of aortic valve sclerosis (AVS) with atherosclerosis, and the histopathological characteristics of AVS. Methods: One handred and thirty-eight patients with definite or suspected coronary artery disease (CAD) were performed echocardiogram. According to the morphologic characteristics of the aortic valve, the subjects were divided into two groups: AVS group (58 cases) and non-AVS group (80 cases). The ultrasonography of the common carotid arteries (CCA) and selective coronary angiography were performed in all cases. Risk factors were also analyzed. The aortic valve specimens derived from patients undergoing aortic valve replacement due to severe aortic stenosis or died of CAD were histopathologically studied. Results: Patients in AVS group had higher levels of systolic blood pressure, serum total cholesterol, triglyceride, lipoprotein (a) and lower serum concentrations of high density lipoprotein cholesterol than those in non-AVS group (P<0.05). The inner-mediate thickness (IMT) was thicker in AVS group than that in non-AVS group (P<0.05). The incidences of carotid atherosclerosis and CAD were significantly increased in AVS group (P<0.05) compared with non-AVS group. The histopathology of AVS were characterized by subendothelial thickening on the aortic side of the leaflet, the presence of lipid, macrophages, lymphocytes, and calcium accumulation. Conclusion: There has a significant relationship between AVS and atherosclerosis. Aortic valve sclerosis may serve as a valuable marker for atherosclerosis.