颈动脉内中膜厚度、背向散射积分及肱动脉内皮依赖性舒张功能对冠心病及其危险因素的诊断作用

目的:探讨颈动脉内中膜厚度(intima-media thickness,IMT)、颈动脉内中膜背向散射积分(mtegrated backscatter,IBS)及肱动脉内皮依赖性舒张功能(endothelial dependent vasodilation,EDV)对冠心病及其危险因素的诊断作用.方法:年龄、性别相匹配的单纯高血压、单纯糖尿病、高血压合并糖尿病、冠心病(冠状动脉造影发现单支或双支阻塞＞50%)患者各50例以及体检健康志愿者50名,采用SONOS HP5500彩色多普勒超声诊断仪(7.5 MHz探头),分别测定各组颈动脉IMT、颈动脉内中膜校正的IBS值(C-IBS,C-IBS=内中膜IBS-外膜IBS)和肱动脉EDV,比较三者在各组中的变化趋势.结果:颈动脉IMT在单纯高血压、单纯糖尿病及高血压合并糖尿病3组间均无明显差别,但3组均厚于正常对照组(P＜0.05),薄于冠心病组(P＜0.05).颈动脉内中膜C-IBS在单纯高血压和单纯糖尿病2组间无明显差别,但均高于正常对照组、高血压合并糖尿病组和冠心病组(P＜0.05);而在高血压合并糖尿病组和冠心病组2组间C-IBS无明显差别,但均低于正常对照组(P＜0.05).肱动脉EDV在单纯高血压、单纯糖尿病及高血压合并糖尿病3组间均无明显差别,但3组均小于正常对照组(P＜0.05),明显大于冠心病组(P＜0.05).结论:颈动脉内中膜C-IBS能够帮助发现导致冠心病的高危因素病变,肱动脉EDV有助于冠心病的诊断.

Carotid intima-media thickness, integrated backscatter and brachial artery endothelial dependent vasodilation in diagnosis of coronary artery diseases

Objective:To evaluate the diagnostic value of carotid intima-media thickness(IMT), integrated backscatter(IBS) and brachial artery endothelial dependent vasodilation(EDV) for coronary artery diseases(CAD). Methods:There were 5 groups in our study: coronary artery disease, hypertensive, diabetes mellitus(DM), hypertensive combined with DM, CAD(angiographically documented 1 or 2 vessels obstruction >50%) and healthy volunteers(n=50, age and gender matched). IMT measurement, calibrated IBS(C-IBS, C-IBS=intima-media IBS-adventitia IBS) analysis and brachial artery EDV measurement were done with 7.5 MHz transducer of SONOS HP 5500, and the results were compared in the 5 groups. Results:IMT was similar in hypertensive, DM and hypertensive combined with DM groups, thicker than that in healthy volunteers(P<0.05) and thinner than in CAD groups(P<0.05); C-IBS was similar in hypertensive and DM groups, but both were significantly higher than hypertensive combined with DM and CAD groups(P<0.05); there was no significant difference between hypertensive combined with DM and CAD groups, and both groups were lower than that of normal control (P<0.05). Brachial EDV was similar in hypertensive, DM and hypertensive combined with DM groups, but was larger in healthy controls(P<0.05) and smaller in CAD group (P<0.05). Conclusion:C-IBS may provide prognostic information to identify a high risk lesions, and brachial EDV is helpful for the diagnosis of CAD.