应用血管内超声显像技术评价冠状动脉病变与颈动脉病变相关性

目的 通过研究血管内超声、冠状动脉造影检查结果与体表颈动脉超声检测的颈动脉病变的相关性,分析颈动脉粥样硬化与冠心病的关系,进一步探讨颈动脉粥样硬化对冠心病发病的预测价值.方法 38例拟诊为冠心病的患者行冠状动脉造影、血管内超声和体表颈动脉超声检查,其中8例患者经冠状动脉造影和血管内超声检查未发现冠状动脉有明显狭窄病变为对照组;30例经冠状动脉造影和血管内超声检查发现冠状动脉有明显狭窄病变为冠心病组,其中不稳定型心绞痛18例,稳定型心绞痛12例.将血管内超声及冠状动脉造影检查结果与颈动脉超声指标进行分析比较.结果 30例冠心痛患者冠状动脉造影平均直径狭窄率71.21%±9.81%,血管内超声示有不同类型的动脉粥样硬化斑块,平均面积狭窄率80.88%±7.77%;8例对照组无动脉粥样硬化斑块.冠状动脉造影平均直径狭窄率与血管内超声平均面积狭窄率之间差异有显著性(P<0.01);冠状动脉造影平均直径狭窄率与血管内超声平均面积狭窄率之间有显著相关性(r=0.663,P<0.01).根据冠状动脉造影平均直径狭窄率计算的Gensini积分分别与颈动脉粥样硬化的等级积分、Crouse积分和斑块数三项指标间均有相关性(P<0.01).颈动脉斑块对冠心痛的阳性预测值为70%(21/30),阴性预测值为75%(6/8).结论 应用血管内超声显像技术能准确诊断冠状动脉斑块的性质并测量冠状动脉狭窄率;与冠状动脉造影相比,血管内超声对评价冠状动脉病变更准确.颈动脉粥样硬化严重程度与冠状动脉血管内超声检查结果有很好的相关性;颈动脉超声检测对冠心病的诊断有一定的预测价值.

The Relationship Between Carotid and Coronary Atherosclerosis with Intravascular Ultrasound

Aim By studying intravascular ultrasound (IVUS), coronary angiography (CAG) and the results of carotid body ultrasonic testing of carotid artery disease to analyze the relationship between carotid atherosclerosis and coro-nary heart disease, to further explore carotid atheroselerosis on the predictive value of coronary heart disease.Methods 38 cases of initial diagnosis for patients with coronary heart disease accepted CAG and IVUS examination, surface carotid artery ultrasound testing. 8 patients with no significant coronary artery stenosis (non-coronary heart disease) were used as the control group;30 cases with significant coronary artery stenosis were divided into groups of coronary heart disease, in-cluding 18 cases of unstable angina pectoris (UAP) and 12 cases of stable angina peetofis (SAP). The results of carotid ultrasound indicators, CAG and IVUS examination were analyzed and compared.Results The average diameter steno-sis rate of CAG was 71.21% ±9.81% in 30 cases with coronary heart disease. IVUS showed that 30 eases of coronary heart disease in patients with different types of atheroselerofic plaque and the average rate of the narrow area was 80.88%±7.77%;There were significant difference between the average diameter stenosis rate of CAG and the average rate of the narrow area of IVUS (P <0.01);They also had significant correlation between the two indicators (r =0.663, P <0.01).It prompted that CAG underestimated the degree of stenosis of coronary lesions to some extent compared with IVUS.The coronary Gensini integral according to the calculation of CAG had a significant correlation with the carotid atherosclerosis grade integral, Crouse integral, plaque volume (P < 0.01). Carotid artery plaque on the positive predictive value of coronary heart disease was 70% (21/30)and the negative predictive value was 75% (6/8).Conclusion It can clearly show the coronary artery wall structure and accurately diagnose coronary artery plaque on the nature, accurately measure the rate of coronary artery stenosis by application of the IVUS imaging. IVUS assessment of coronary artery disease is more accurate compared with CAG. There are very good correlation between the carotid atherosclerosis and the severity of coronary artery IVUS results. Carotid ultrasound detection has some predictive value to coronary heart disease.