超声对颈动脉内-中膜厚度与冠心病相关性研究

Correlation between carotid artery intima-media thickness and traditional factors of coronary artery disease risk

目的 评价颈动脉内-中膜厚度(IMT)与冠心病主要危险因素的相关性。方法 随机抽取在阜外医院门诊体检的自然人群共769名,应用超声检测颈动脉内膜内表面到中膜外表面的距离即IMT,其中IMT≥1.2mm时定义为斑块,注意观察颈动脉斑块测值、位置、数量及性质等,同时研究其与冠心病的相关性。结果 颈动脉各取样点IMT值,左、右两侧之间差异无统计学意义(左侧各取样点均值分别为[(0.69±0.14)、(0.68±0.15)、(1.29±0.25)、(0.64±0.14)mm;右侧各取样点均值分别为(0.68±0.15)、(0.67±0.14)、(1.30±0.24)、(0.65±0.13)mm;t=1.35、1.34、0.83、1.47,P均>0.05)]。双侧颈总动脉近段IMT值平均为(0.67±0.14)mm,双侧颈动脉分叉处IMT平均值为(1.30±0.24)mm,两者比较,差异有统计学意义(t=3.55,P<0.01);双侧颈总动脉远段IMT平均值为(0.68±0.14)mm,与双侧颈动脉分叉处比较,差异有统计学意义(t=3.16,P<0.01);双侧颈内动脉近段IMT平均值为(0.65±0.13)mm,与双侧颈动脉分叉处比较,差异有统计学意义(t=3.28,P<0.01)。男性颈动脉斑块阳性率(45.4%,189/417)高于女性(29.2%,103/352,χ2=20.91,P<0.01),>45～55岁组男性颈动脉斑块发生率(67.6%,84/124)明显高于女性(39.6%,46/115,χ2=18.51,P<0.01),而35～45岁、>55岁组颈动脉斑块发生率在不同性别间差异无统计学意义,同性别内颈动脉斑块阳性率均随年龄增加而显著增高(女性3个年龄组分别为7.1%、36.9%和86.4%,χ2=19.31,P<0.01;男性3个年龄组分别为10.5%、67.6%和89.6%,χ2=21.45,P<0.01)。年龄、高血压病、吸烟、糖尿病、高血脂症及冠心病家族史是男性颈动脉IMT值增加及斑块发生的危险因素(OR=1.09、1.39、1.46、1.92、1.45、1.48,P均<0.05);而女性颈动脉IMT值增加及斑块发生则同年龄、高血压病、糖尿病和冠心病家族史有关(OR=1.12、2.58、1.46、1.45,P均<0.05)。结论 颈动脉IMT值与冠心病主要危险因素显著相关,颈动脉IMT值可预测冠心病的发生。

Objective To evaluate the relationship between carotid artery intima-media thickness(IMT)and risk factors of coronary arteries disease.Methods A total of 769 subjects were randomly selected from natural multitude for physical examination in Fuwai hospital.Carotid artery IMT were measured by high-frequency ultrasound,and plaque was defined when the value of IMT was higher than 1.2 mm.Meanwhile,the location,quantity and properties of the carotid atherosclerotic plaques were observed and risk factors of coronary heart disease were investigated.Results The measurement of every point of carotid artery had no significant difference between left and right(the mean value of every point of the left were(0.69±0.14),(0.68±0.15),(1.29±0.25) and (0.64±0.14)mm,and those of right were(0.68±0.15),(0.67±0.14),(1.30±0.24) and (0.65±0.13)mm respectively,t=1.35,1.34,0.83,1.47,P>0.05).The mean value of IMT in bilateral carotid artery crotch was significantly higher than those of other points(the mean value of every point were(0.68±0.15),(0.67±0.14),(1.30±0.24),(0.65±0.13)mm,t=3.55,3.16,3.28,P<0.01).Atherosclerotic plaques positive rate of male were significantly higher than that of female[(45.4% ,189/417)vs(29.2%,103/352)respectively,χ2= 20.91,P<0.01]and tended to increase with increasing age in both genders(female respectively 7.1%,36.9% and86.4%,χ2= 19.31,P<0.01;male respectively 10.5%,67.6%,89.6%,χ2=21.45,P<0.01).Group>45-55Y atherosclerotic plaques incidence rate of male was significantly higher than that of female[(67.6%,84/124)vs(39.6%,46/115)respectively,χ2= 18.51,P<0.01].Logistic analysis revealed that the significant independent determinants of carotid artery plaques in male group were age,hypertension,smoking,diabetes,hyperlipidemia and familial history(OR=1.09,1.39,1.46,1.92,1.45,1.48,all P<0.05),and in female group were age,hypertension,diabetes,hyperlipidemia and familial history(OR=1.12,2.58,1.46,1.45,all P<0.01).Conclusions Carotid artery IMT and risk factors of coronary heart disease are closely related.The value of IMT is able to forecast the occurrence of coronary heart disease.