高血压及心脑血管疾病与颈动脉粥样硬化

Associationofcarotidatherosclerosiswithhypertensionandcardiocerebrovasculardiseases

经超声检测１３６例高血压及心脑血管并发症病人的颈动脉，与３２例非高血压心脑血管疾病患者和３８例正常人作对照。结果表明，各疾病组颈动脉内中膜厚度和斑块指数明显高于对照组，以心脑血管并发症组增加最为明显。高血压各组颈动脉管径与血压比值降低，心脑血管并发症组搏动指数和阻力指数高于无并发症组和对照组。经逐步回归分析表明：年龄、体重指数、吸烟、血压、高血压病程和严重程度、高密度脂蛋白胆固醇，低密度脂蛋白胆固醇／高密度脂蛋白胆固醇比值，以及冠心病和脑血管病的存在均与颈动脉粥样硬化密切相关。提示，颈动脉粥样硬化程度可作为预测心脑血管病存在的参考指标。

ThecarotidarterieswereexaminedbycolorDopplerflowimagingin136hypertensivepatientswhichweredividedintothefolowinggroups:(1)Hypertension(ET)group(n=39,59±10years),(2)Hypertensionwithcerebrovasculardisease(ET-S)group(n=30,60±8years),(3)Hypertensionwithcoronaryarterydisease(ET-C)group(n=31,60±7years),and(4)Hyperten-sionwithhyperlipidemia(ET-HL)group(n=36,59±8years);32normotensiveswithcardiocere-brovasculardiseases(CCVD)orhyperlipidemia(N-EH)group(n=32,60±10years),and38age-matchednormalcontrols.Theresultsshowedthatthecarotidintima-mediathicknessandplaquein-dexweresignificantlyincreasedinalofthediseasedgroupsversuscontrols(P<0.05).Theratioofthecarotidarterydiametertobloodpressureweresignificantlyreducedinthefourhypertensiongroups(vscontrolsandN-EH,P<0.05).ThepulsatileindexwashigherinthegroupswithCCVD(groups2,3andN-EH)versusgroupswithnoCCVD(groupETandET-HL)andcontrols(alP<0.05),whiletheresistanceindexwashigherintheET-Sgroupversustheothergroups(alP<0.05).Multipleregressionstepwiseanalysisofalthesubjectsrevealedthatage,bodymassindex,cigarettesmoking,bloodpressure,lengthandseverityofhypertensionhigh-densitylipoproteincholesterol(HDL-C),ratiooflow-densitylipoproteincholesterol(LDL-C)andHDL-Cwereinde-pendentlyassocaitedwithcarotidatherosclerosis.Thepresenceofcoronaryarterydiseaseandcere-brovasculardiseasealsoassociatedwithcarotidatherosclerosis.Inconclusion,theseverityofcarotidatherosclerosismaybeusedasareferenceindexforthepredictionofcardiocerebrovasculardiseases.