老年冠心病患者血管内皮功能、颈动脉内中膜厚度、冠状动脉钙化积分变化的研究

Study on variations of vascular endothelial function,carotid arterial intima-media thickness and coronary artery calcification score in elderly patients with coronary heart disease

目的 探讨老年冠心病患者的血管内皮功能、颈动脉内中膜厚度及斑块、冠状动脉钙化积分的变化及相互关系。方法 对 30例老年冠心病组 ,2 4例无冠心病老年对照组采用高分辨超声检测肱动脉基础动脉内径 (D0 )、内皮依赖性血流介导的舒张功能 (FMD)、非内皮依赖性硝酸甘油介导的舒张功能 (NID) ,颈动脉超声检测颈动脉内中膜厚度 (IMTc)及斑块 ,螺旋CT检测各冠状动脉钙化积分 (CS)及冠脉总钙化积分 (TCS)。结果 冠心病组的FMD、NID低于对照组 (P <0 .0 0 1) ,D0 两组差别无统计学意义 (P >0 .0 5 ) ;IMTc、CS及TCS明显高于对照组 (P <0 .0 1) ,颈动脉多发性硬斑发生率高于对照组 (P <0 .0 1)。IMTc与CS、TCS呈正相关 (P <0 .0 1) ,IMTc、CS、TCS与FMD、NID呈负相关 (P <0 .0 1)。结论 老年冠心病患者存在较严重的血管内皮功能失调、颈动脉粥样硬化及冠状动脉钙化。肱动脉舒张功能、颈动脉内中膜厚度及斑块。

Objective To probe into the variations on vascular variations of vascular endothelium functions,the carotid arterial untima-media thickness and coronary artery calcification score.Methods On both coronary heart disease(Group A) with 30 cases of elderly patients suffering from coronary heart disease and control group(Group B) with 24 healthy elders,the high-resolution ultrasound technique was employed to measure the baseline inner diameter of brachial artery (D 0),the endothelium-dependent blood flow mediated vasodilation (FMD) and non-endothelium-dependent nitroglycerin induced vasodilation (NID),while the colordoppler ultrasonography of carotid arterial was adopted to measure the carotid arterial intima-media thickness (IMTc) and plaques,and spiral CT was used to measure the coronary artery calcification score (CS) and total coronary artery calcification score(TCS).Results The values of FMD and NID for Group A were lower than those for Group B (P< 0.001); the values of D 0 showed no significant difference (P> 0.05) between the two Groups; the values of IMTc,CS,TCS for Group A were significantly higher than those for Group B (P< 0.01),while the incidence of multiple carotid plaques for Group A was significantly higher than that for Group B (P< 0.05).A positive correlation was observed between IMTc,and CS,TCS (P< 0.01),while the negative correlation-between IMTc,CS,TCS and FMD,NID.Conclusion The elderly patients with coronary heart disease showed relatively severe symptoms on vascular endothelial malfunctions,carotid and coronary atherosclerosis.The determinations on arterial brachialis vasodilation function,carotid arterial intima-media thickness and plaques,and coronary artery calcification score are,therefore,having great significance on predicting preventing, and curing coronary heart disease.