颈动脉内膜—中层厚度的超声评价与冠心病相关性研究
【摘要】 目的 观察颈动脉内膜-中层厚度(intima-media thickness，IMT)和 冠状动脉粥样硬化性心脏病(coronary arteriosclerotic heart disease,CAD)的关系。方法 将65 例患者根据冠状动脉造影结果分为对照组与冠心病组。并测量这些患者的IMT及斑块的形态。结果 CAD各组颈动脉的IMT、斑块发生率与对照组相比明显增高,(P<0.05);多支病变组颈动脉的IMT、钙化斑块发生率明显高于单支病变组,(P<0.05);颈动脉IMT值与CAD具有明显相关性。结论 在CAD患者及具有其危险因素人群中，进行颈动脉的IMT高频超声检查，可间接反映冠状动脉情况，并且有助于对冠脉狭窄程度作出判断，可成为早期诊断CAD的间接指标。
【关键词】 颈动脉内膜-中层厚度;冠状动脉粥样硬化性心脏病; 纤维斑块; 钙化斑块
Abstract: Objective To study the correlation between carotid artery?s intima-media thickness and coronary arteriosclerotic heart disease. Methods 65 patients were divided into two groups according to the results of angiography. The examination was performed by using a GEVV3 device and the intima-media thickness was measured. Results Carotid artery?s IMT and the incidence of mottling in CAD groups were significantly higher than that in normal groups (P<0.05)， carotid artery?s IMT and the incidence of Calcification mottling in multi-vessel disease groups were significantly higher than that in single vessel disease groups (P<0.05). Positively statistical significance was obtained in the correlation between the carotid artery?s IMT and CAD. Conclusions Inpatients with CAD and persons with CAD risk factors,examined in carotid using high-frequency ultrasound,the method is very useful in the detection of the presence of coronary atherosclerosis and in the juguement of the extent.It can be a surrogate for diagnosing CAD in earlier period.
Key words: intima-media thickness (IMT); coronary arteriosclerotic heart disease (CAD); textile fiber mottling; Calcification mottling
冠心病是严重危害人们健康的常见病，在我国约占心脏病死亡人数的10%～20%。国外资料统计超过50%的心血管疾病患者以心肌梗死或急性冠脉综合征为冠心病的首发症状[1]。而经胸超声心动图在诊断冠心病的敏感性及特异性方面均有一定的限制。因此我们需要一种新的诊查手段，对经胸超声心动图阴性的非典型心绞痛、典型心绞痛患者、CAD高危患者及无症状患者进行早期诊断及干预。
1 实验资料与方法
1.1 一般资料 选择65 例住院患者，均行冠状动脉造影检查，根据造影结果分为对照组(冠脉造影正常者)20 例;冠心病组(阳性诊断标准为冠脉造影狭窄程度>50%)45 例：单支病变组20 例、多支病变组25 例。
1.2 实验方法 采用我院的GEVV3彩色多普勒超声诊断仪，探头频率7.5MHz。首先对颈动脉进行二维超声图像检测。患者平卧位，头偏向检查对侧，充分暴露颈部，沿胸锁乳突肌外缘纵切、横切扫描检查，显示颈总动脉全长，观察颈动脉有无斑块，测量颈总动脉后壁最厚处内膜-中层厚度，在舒张末期测量。我们定义IMT>1.3 mm为动脉粥样硬化斑块形成(纤维斑块)，强回声光斑为钙化斑块。
1.3 统计分析方法 测值均以(±s)表示，统计学分析用方差分析及q检验，计数资料采用χ2检验。直线相关分析方法用于检验两参数之间的相关性，P<0.05为差别有显著性意义。
2 结 果
2.1 正常对照组的颈动脉IMT平均值(0.74±0.15)mm，纤维斑块发生率10.00%，钙化斑块发生率5.0%;CAD单支病变组颈动脉IMT平均值(1.31±0.92)mm，纤维斑块发生率55.0%，钙化斑块发生率40.0%;CAD多支病变组颈动脉IMT平均值(2.08±1.22)mm，纤维斑块发生率64.0%，钙化斑块发生率88.0%。CAD各组颈动脉的IMT、斑块发生率与对照组相比明显增高P<0.05;多支病变组颈动脉的IMT、