颈动脉窦粥样硬化与冠状动脉粥样硬化程度的相关性

背景:颈动脉内中膜厚度可用作冠状动脉粥样硬化的替代指标,但它与冠状动脉事件的关系尚未得到充分研究。目的:探讨颈动脉内中膜厚度在预测冠状动脉粥样硬化性心脏病及其程度中的价值。设计:病例分析。单位:解放军总医院心内科。对象:实验于2000-01/2002-01在解放军总医院完成。将285例可疑冠状动脉粥样硬化性心脏病患者按造影结果分为0支组,1支组,2支组,3支组4组,年龄33～74岁,平均(54.48±9.44)岁,其中男164例,女121例。方法:①测量体质量、身高,计算体质量指数(BMI)=体质量(kg)/身高(m)2。②测量卧位左臂血压。③采静脉血检测血脂。④用高分辨率B型超声,10MHz线性探头检测颈总动脉,颈内动脉,颈外动脉和颈动脉窦。将颈动脉内中膜厚度≥1.0mm定义为颈动脉粥样硬化。用标准的Judkins技术作冠状动脉造影。根据管腔狭窄≥50%的病变血管支数将冠状动脉粥样硬化性心脏病的程度记录为0,1,2,3。左主干狭窄≥50%定义为2支病变,左主干合并右冠病变定义为3支病变。主要观察指标:①不同冠状动脉病变程度患者不同测量位点的内中膜厚度。②冠状动脉粥样硬化性心脏病严重程度的预测因子。③颈动脉不同位点内中膜厚度值对冠状动脉粥样硬化性心脏病的预测价值。④不同危险因子与内中膜厚度的关系。结果:285例患者全部完成实验进入结果分析。①不同冠状动脉病变程度患者不同测量位点的内中膜厚度经卡方检验,左、右颈动脉窦的F值最大,分别为65.64和63.24。左、右颈动脉窦的内中膜厚度值随冠状动脉病变程度的加重而增厚。②对冠状动脉粥样硬化性心脏病严重程度的预测因子进行回归分析表明,男性、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、左颈动脉窦、右颈动脉窦、右颈内动脉、右颈外动脉的内中膜厚度为冠状动脉粥样硬化性心脏病严重程度的独立预测因子。左颈动脉窦和右颈动脉窦是冠状动脉粥样硬化性心脏病的最重要的预测因子(t=3.61,P=0.391;t=2.58,P=0.247)。③颈动脉不同位点内中膜厚度值对冠状动脉粥样硬化性心脏病的预测价值中左右颈动脉窦的阳性预测值最高,分别为是89.9%,88.8%。④对不同危险因子与内中膜厚度的关系行多元回归分析,其结果是:年龄,体质量指数,胆固醇,三酰甘油,高密度脂蛋白胆固醇和低密度脂蛋白胆固醇是左颈动脉窦处动脉粥样硬化的危险因子。结论:颈动脉窦内中膜厚度与冠状动脉粥样硬化性心脏病程度明显相关。二者有共同的病理与血液动力学基础。颈动脉窦内中膜厚度可以作为筛选冠状动脉粥样硬化性心脏病的指标。

Relation of carotid bifurcation atherosclerosis and the severity of coronary atherosclerosis

BACKGROUND: Carotid intima-media thickness (IMT) is the substitution index of coronary atherosclerosis, but the precise relation between IMT and coronary artery disease (CAD) is still unknown.OBJECTIVE: To investigate the role of carotid IMT in coronary atherosclerotic heart disease (CAHD).DESIGN: A case analysis.SETTING: Department of Cardiology, Chinese PLA General Hospital.PARTICIPANTS: The study was carried out in the Department of Cardiology, Chinese PLA General Hospital from January 2000 to January 2002. Totally 285 inpatients aged 33-74 years, mean (54.48±9.44)years with suspected CAHD, including 164 males and 121 females, were involved in this study. According to angiographic results, they were divided into 4 groups: 0-vessel group, 1-vessel group, 2-vessel group and 3-vessel group.METHODS: ①The weight and height of patients were measured, and body mass index (BMI) = weight (kg)/height (m)2.②In the supine position, the blood pressure of left arm were measured. ③Venous blood was sampled todetect blood lipid. ④High-resolution B-mode ultrasound and 10 MHz linear transducer was used to evaluate the common carotid artery,internal carotid artery, external carotid artery and carotid bifurcation.Carotid IMT ≥ 1.0 mm was defined as carotid atherosclerosis. The results of coronary angiography by standard Judkins technique showed that, CAHD extent (0, 1, 2 and 3) was determined by the number of diseased vessels,where luminal stenosis was ≥ 50%. Left stem stenosis ≥ 50% was defined as 2-vessel while left stem merging right coronary affection were taken as 3-vessel.MAIN OUTCOME MEASURES: ①IMT values at different detection sites of the patients with different CAHD lesions; ②The predictors of the CAHD severity;③The predictive values of IMT at different carotid sites on CAHD; ④The relationof different risk factors and IMT.RESULTS: Totally 285 patients were involved in the result analysis.①IMT values at different detection sites of CAD patients: The chi square test demonstrated that, left and right carotid bifurcations took the maximal F value among groups (left: 65.64, right: 63.24). And the IMT values of left and right carotid bifurcations were elevated with the increasing CAHD severity. ②The predictors of the CAHD severity: The regression analysis implied that male, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), and IMT of left carotid bifurcation, right carotid bifurcation, right internal carotid artery and right external carotid artery were the independent predictors of CAHD severity, while left and right carotid bifurcation were the most important (t=3.61, P=0.391; t=2.58,P=0.247). ③The predictive values of IMT at different carotid sites on CAHD: The left and right carotid bifurcations also found the maximal positive predictive value for detecting CAHD (left: 89.9%, right: 88.8%).④Multivariate regression analysis revealed that age, BMI, cholesterol,triglyceride, HDL-C and LDL-C were the risk factors of left carotid bifurcation atherosclerosis.CONCLUSION: IMT in the carotid bifurcation is related significantly with the presence and extent of CAHD. They share common pathological and hemodynamic basis. Carotid bifurcation IMT may be used as a surrogate marker for CAHD.