冠心病伴发颈动脉狭窄的分析

The prevalence of carotid artery stenosis in patients with coronary artery disease

目的评估冠心病(CAD)伴发颈动脉狭窄(CS)的发生率。方法97例经冠状动脉造影确诊的患者同时行颈动脉血管造影,以冠状动脉狭窄≥50%及累及情况,将 CAD 患者分为1、2、3支病变组(包括左主干受累);以 CS≥70%为切分点,比较 CS 在不同亚组问的伴发情况;同时将年龄、体重指数(BMI)、高血压病史及相关生化危险因素作为独立危险因素行 Logistic 回归分析。结果97例 CAD 患者中,1支病变25例(25.8%)、2支病变34例(35.0%)、3支病变38例(39.2%)(包括左主干受累);32例(33.0%)CS≥70%,包括颈动脉闭塞6例。CS 分布情况:1支病变组4%(1/25)、2支病变组38.2%(13/34)、3支病变组47.4%(18/38)。单因素 Logistic 回归分析显示年龄和高血压病史与 CS 密切相关(P<0.05)。结论单支病变合并1个或多个危险因素、多支病变欲行冠状动脉搭桥术的 CAD 患者,冠状动脉造影的同时应行颈动脉造影。

Objective To determine the prevalence, distribution and severity of carotid artery stenosis （CS） in patients with coronary artery disease （CAD）. Methods Ninety-seven patients with CAD accepted coronary angiography and carotid artery angiography simultaneously. According to the involved vessels（ ≥50% stenosis）, patients were classified into three groups： group 1 with 1-vessel involved; group 2 with 2-vessel involved; group 3 with 3-vessel or left main stem （LMS） involved. Taking CS≥70% as a cutoff point, we assessed the prevalence and distribution of CS in different groups. Age, BWI , hypertension and biochemical and lipid risk factors related to CAD were recruited to indentify independent risk factors associated with significant CS using logistic regression. Results Twenty-five （25.8%） had 1-vessel involved, 34 （ 35.0% ） 2-vessel involved, 38 （ 39. 2% ） 3-vessel or left ma/n stem （LMS） involved. CS （ lumen diameter stenosis ≥70% ） was present in 4% （ 1/25 ）, 38. 2% （ 13/34）, 47.4% （ 18/38 ） in three groups, respectively. Only age and hypertension were found to be independently significant （ P 〈 0. 05） for predicting ≥70% CS by logistic regression. Conclusion Carotid artery angiography should be performed simultaneously when coronary angiography shows 1-vessel involved with one or more risk factors and 2-or 3-vessel involved.