冠状动脉粥样硬化性心脏病患者颈总动脉中内膜厚度与冠状动脉病变的关系

目的 探讨冠状动脉粥样硬化性心脏病（冠心病）患者颈总动脉中内膜厚度与冠状动脉狭窄程度与狭窄范围的关系.方法 将211例怀疑冠心病的患者,根据冠状动脉造影结果,依有无狭窄及狭窄程度分为3组：A组（60例）为轻度狭窄组,狭窄程度＜50％;B组（97例）为中重度病变组,狭窄程度＞50％;对照组为54例冠状动脉造影阴性者.157例冠状动脉狭窄患者又依狭窄程度分为单支病变亚组（49例）、双支病变亚组（37例）、三支病变亚组（71例）.采用彩色多普勒声像仪测取颈总动脉中内膜厚度,并比较分析各组颈总动脉中内膜厚度.结果 对照组、A组、B组比较,颈动脉总中内膜厚度依次增高,对照组、A组、B组两两比较差异有统计学意义[（0.812 5±0.118 6）mm vs.（0.893 6±0.133 1）mm vs.（1.038 9±0.141 1）mm,P＜0.05].在以病变范围为基础的分组中,各亚组与对照组比较,颈动脉中内膜明显增厚,且两两比较差异有统计学意义（P＜0.05）;单支病变亚组与双支病变亚组比较,差异有统计学意义[（0.920 4±0.141 5）mm vs.（0.990 6±0.144 3）mm,P＜0.05],但双支病变组与三支病变组比较,差异无统计学意义[（0.990 6±0.144 3）mm vs.（1.031 7±0.149 6）mm,P＞0.05].结论 颈总动脉中内膜厚度能很好地反映冠状动脉狭窄程度,但无法很好地反映病变范围.

Relationship between carotid artery intima-media thickness and coronary stenosis in patients with coronary heart disease

Objectives To evaluate the impacts of carotid artery intima-media thickness on the severity and extent of coronary artery stenosis in patients with coronary hcart discase （CHD）.Methods Totally 211 suspected coronary artery disease patients were stratified into 3 groups based on the results of coronary angiography （CAG）：mild group （group A,n=60,stenosis〈50%）,moderate-to-severe group （group B,n=97,stenosis〉50%）,negative group （contrast group,n=54）.The 157 stenosis patients were further stratified into 3 subgroups based on the extent of stenosis：single-vessel subgroup （n=49）,double-vessel subgroup （n =37）,three-vessel subgroup （n=71）.All the patients received color Doppler ultrasonic imaging to measure and compare the carotid artery intima-media thickness.Results Carotid artery intima-media thickness were significantly different among contrast group,group A and group B.Carotid artery intimamedia thickness increased as the severity of stenosis aggravating [（0.812 5±0.118 6） mm vs.（0.893 6±0.133 1） mm vs.（1.038 9±0.141 1） mm,P〈0.05].For the subgroups stratified based on the extent of stenosis,carotid artery intima-media thickness were significantly different between each subgroup and contrast group （P〈0.05）; and there was a significant difference between single-vessel subgroup and double-vessel subgroup [（0.920 4±0.141 5） mm vs.（0.990 6±0.144 3） mm,P〈0.05]; but there was no significant difference between double-vessel subgroup and three-vessel subgroup [（0.990 6±0.144 3） mm vs.（1.031 7±0.149 6） mm,P〉0.05].Conclusions Carotid artery intima-media thickness can effectively reflect the severity of coronary artery stenosis,but cannot reflect its extent with a satisfactory result.