冠心病患者颈动脉粥样硬化与内皮舒张功能的超声检测及临床意义

目的　探讨颈动脉粥样硬化病变的发生与冠心病的关系 ,研究冠心病患者内皮功能的变化。方法　应用高频超声检测 1 2 0例住院接受冠脉造影患者的颈动脉内中膜厚度 (IMT)及粥样硬化斑块 ,同时检测肱动脉血流介导和硝酸甘油 (GTN)引起的舒张反应。结果　根据冠状动脉造影结果将 1 2 0例患者分为冠心病组 (90例)和对照组 (30例 ) ,冠心病组IMT明显大于对照组 ,但不同病变支数的冠心病患者之间无差异。冠心病组颈动脉硬化斑块的检出率 (以分叉部为最高 ,其次为颈总动脉和颈内动脉 )明显高于对照组 ,且与冠脉病变的严重程度有关。总胆固醇、低密度脂蛋白、胆固醇水平及高血压、糖尿病发病率在冠心病组中明显高于对照组。冠心病组的肱动脉基础内径略大于对照组 ,但差异无统计学意义 (P >0 0 5 )。冠心病组由血流介导和硝酸甘油引起的肱动脉舒张反应均明显低于对照组(P <0 0 1 )。结论　颈动脉粥样硬化严重程度与冠心病发生呈正相关。颈动脉超声检测对冠心病有一定的预测价值。颈动脉超声及血管内皮功能检查不仅可能为早期发现、预防和治疗冠心病提供依据 ,还可能作为监测和评估病情变化的指标

Ultrasonographic examination for carotid atherosclerosis and vasodilatation function of endothelium in patients with coronary heart disease and its clinical implication

Objective To explore the relationship between artenosclerotic changes in the carotid arteries and the development of coronary beart disease (CHD), and also to study the changes in endothelial function in patients with CHD, with the aid of ultrasonographic examination. Methods One hundred and twenty inpatients were divided into CHD group ( n =90) and control group ( n =30) according to the results of coronary arteriogram. In intima media thickness (IMT) and arteriosclerotic plaques were determined in carotid arteries with B mode ultrasonography. Dilatation of the brachial arteries during reactive hyperemia and after sublingual administration of glyceryl trinitrate (GTN) were determined at the same time. Results The intimia media thickness of CHD group was significantly higher than that of the control group, and had no significant but there was no significant difference among groups of 1,2,or 3 diseased vessel groups. Atherosclerotic plaques were mostly found in the carotid bifurcation and common carotid artery segments. The discovery rate was higher in patients with 2 or 3 diseased coronary arteries. The contents of TC and LDL C, and incidence rate of hypertension and diabetes mellitus were higher in CHD group. The flow mediated dilatation and GTN induced dilatation of brachial arteries in patients with CHD were significantly reduced compared with those in control group( P <0 01). Conclusions CHD is associated with a higher incidence of and more extensive atherosclerosis in the carotid artery. Using B mode ultrasonography to assess atherosclerosis in the carotid artery and the endothelial vasodilatory function may lend a diagnostic clue of CHD in earlier period, also can monitor patient's condition and prognosis for the patients with CHD and persons with risk factors of CHD