周围动脉内膜-中层增厚的诊断和药物干预的研究

Study of diagnostic criteria of intima-media thickening and effects of drugs on peripheral arteries

目的 探讨颈动脉、股动脉、胸主动脉粥样硬化的超声诊断标准、自然演变及药物的干预作用。方法 研究对象包括259名正常人和102例动脉粥样硬化(AS)患者。在125名正常人及AS患者中进行了体表高频超声技术检查,在134名正常人中进行了经食管超声检查。将AS患者随机分为辛伐他汀组、普罗布考组、卡托普利组,测量颈动脉和股动脉后壁正常部位内膜-中层厚度(IMT)包括正常部位IMT值(IMTA),最大IMT(IMTB),4条动脉最大IMT平均值(IMTC),4条动脉中单个最大IMT(IMTD),分别服用辛伐他汀、普罗布考、卡托普利,3年后复查。结果 随年龄增加,胸主动脉、颈动脉及股动脉IMT呈增加趋势;正常人颈动脉、股动脉和胸主动脉IMT分别为0.63 mm±0.15 mm、0.68 mm±0.21 mm、1.02 mm±0.22 mm,上限分别为0.93 mm、1.10 mm、1.46 mm。IMTA的平均年增长速度为0.023 mm。各组治疗前后斑块部位IMT有增加趋势,但各治疗组IMT。增加的幅度显著低于对照组。结论 正常人颈动脉、股动脉及胸主动脉的IMT呈增龄性改变。建议颈动脉、股动脉和胸主动脉IMT增厚的超声诊断标准应分别为>0.93 mm,>1.10 mm和>1.46 mm。药物治疗具有延缓动脉粥样硬化进展的作用,高频超声技术能够可靠的观察颈动脉和股动脉动脉粥样硬化的消长改变。

Objective To establish the diagnostic criteria of intima-media thickening (IMT) of the carotid artery, femoral artery and thoracic aorta in normal subjects and evaluate the effects of drugs on IMT in patients with atherosclerosis with high-frequency ultrasound imaging. Methods 259 normal subjects and 102 patients with atherosclerosis (AS) were studied. 134 normal subjects were examined by transesophegeal echocardiography. 102 patients with AS were randomly divided into 4 groups: simvastatin group, probucol group, captopril group, and placebo group. The values of IMT, including IMT of the normal segment (IMTA ) and the maximal IMT of each artery (IMTB ) of the carotid and femoral arteries, and thoracic aorta, the mean maximal IMT of the 4 arteries (IMTC) , and the single maximal IMT among the 4 arteries (IMTD) were measured. The examinations were repeated in 3 years after treatments. Results In carotid , and femoral arteries and thoracic aorta, IMT increased with aging. The IMT values of the carotid and femoral arteries and thoracic aorta were 0. 63 mm ± 0. 15 mm, 0. 68 mm ± 0. 21 mm, 1. 02 mm ± 0. 22 mm respectively with the upper limits of 0. 93 mm, 1. 10 mm, and 1. 46 mm respectively. IMTA increased 0. 023 mm per year. The progression value of IMTD in all therapeutic groups were significantly lower than that of the control group (all P <0. 05). Conclusion It is suggested that the IMT > 93 mm, >. 10 mm, and > 1. 46 mm is be defined as indicators of IMT in carotid and femoral arteries and thoracic aorta respectively. Drug therapy can decrease the progression of atherosclerosis but has no effects on the IMT in normal segment of arteries. High frequency ultrasound technique is reliable in monitoring the progression or regression of atherosclerosis in peripheral arteries.