心血管疾病患者颈动脉彩色超声参数及血液指标与颈动脉斑块形成的关系(英文)

Relationship of color ultrasonic indexes of carotid and blood marker with the formation of carotid plaque in patients with cardiovascular disease

背景：随着动脉粥样硬化发病率的增多，彩色超声逐渐成为评价颈动脉乃至全身血管病变程度的首选监测手段。 目的：对心血管疾病患者的颈动脉彩超表现与血脂、血糖和血黏度进行对照分析，探讨颈动脉斑块的发生机制及其早期症状。 设计：病例对比观察。 单位：上海第二医科大学附属第九人民医院的超声诊断科和心内科。 对象：选择2002-10／2003-12在上海第二医科大学附属第九人民医院心内科住院的首诊心血管疾病患者154例，均知情同意。 方法：应用LOGIQ700及DU-5彩超仪，纵切面和横切面扫查整个颈动脉观察全部情况。测量患者的血液检验指标，如总胆固醇、三酰甘油、果糖胺、血清血糖、高、低密度脂蛋白胆固醇及红细胞比容等，评估其与斑块形成的关系。 主要观察指标：①颈动脉的管径、扭曲程度。②有无斑块。③患者的甲状腺段颈总动脉测量频谱参数及验血指标。 结果：154例患者全部进入结果分析，无脱落。①患者颈动脉形态的相关彩超参数：颈总动脉前后径(9．10±0．94)mm，横径(9．02±1．03)mm。扭曲有25例，大多数为单个扭曲。内中膜增厚最明显者为4．9mm。有斑块64例，较大斑块长8．7mm，宽5．6mm，厚4．3mm。②患者的血液检验指标结果：血清总胆固醇、三酰甘油在斑块形成过程中具有显著性意义(X^2=4．686，4．529，P<0．05)。有斑块组患者的血清总胆固醇、三酰甘油水平均处于正常范围内[(4．45±0．98)，(1．36±0．60)mmol／L(正常值上限：5．2mmol／L；2．25mmol／L)]。③甲状腺段颈总动脉有无斑块患者的频谱参数：频带较宽为10cm／s左右，都有声窗。 结论：血管内膜功能异常，正常水平的胆固醇或三酰甘油也会引起斑块。说明引起颈动脉粥样硬化的主要因素是血管内膜功能，而血清胆固醇和三酰甘油水平是次要因素。动脉粥样硬化病变在血管壁上的反映可能早于血液检验。

BACKGROUND： With the increase of incidence of atherosclerosis, color ultrasound becomes the first method to evaluate carotid and angiopathical lesion of the whole body.OBJECTIVE： To investigate the initial mechanism and earlier symptom of carotid plaque with the analysis of the findings of color ultrasound of carotid artery in comparison with blood lipid, blood glucose and blood viscosity of patients with cardiovascular disease.DESIGN： Case-controlled study.SETTING： Department of Ultrasonic Diagnosis and Department of Cardiology, the Ninth People＇s Hospital Affiliated to Shanghai Second Medical University.PARTICIPANTS： Totally 154 patients with cardiovascular disease were selected from the Cardiological Department of the Ninth People＇s Hospital Affiliated to Shanghai Second Medical University from October 2002 to December 2003. All patients agreed to participate in the investigation.METHODS： Carotid artery was scanned from longitudinal section to transverse section with LOGIQ700 and DU-5 color ultrasound. Blood markers of patients were measured, such as total cholesterol, triacylglycerol,fructosamine, blood serum, blood glucose, high density lipoprotein, low density of lipoprotein and hematocrit; meanwhile, their relationships with plaque formation were also evaluated. MAIN OUTCOME MEASURES： ① Calibre and curved level of carotidartery; ② With or without plaque; ③ Spectral parameters of common carotid artery and indexes of blood test at thyroid.RESULTS： Totally 154 patient entered the final analysis without any loss. ①Correlative indexes of color ultrasound of carotid artery： Occipitofrontal diameter of common carotid artery was （9.10±0.94） mm, and transverse diameter was （9.02±1.03） mm. There were 25 cases with curvature, especially single curvature. The most obvious thickening tunica intima-media in carotid canal wall was 4.9 mm. Totally 64 cases had plaque with the bigger one of 8.7 mm in length, 5.6 mm in width and 4.3 mm in depth. ② Results of blood test： Serum total cholesterol and triacylglycerol were significantly different during the formation of plaque （x^2=4.686, 4.529, P 〈 0.05）. Level of serum total cholesterol and triacylglycerol of patients in the plaque group was in a normal range [（4.45±0.98）, （1.36±0.60） mmol/L （superior limit of normal value： 5.2 mmol/L; 2.25mmol/L）]. ③ Spectral parameters of common carotid artery of patients with or without plaque in thyroid： Frequent zone was 10 cm/s or so in the wider ones and all with sound window.CONCLUSION： Tunica intima function of vessel is abnormal, and cholesterol or triacylglycerol in the normal level may cause the formation of plaque. This suggests that tunica intima function of vessel is the main factor to induce carotid atherosclerosis, but the level of serum cholesterol and triacylglycerol are the secondary factors. Reaction of atheromatosis lesion in vascular wall is earlier than that of blood test.