冠状动脉粥样硬化性心脏病患者升主动脉弹性与颈动脉内-中膜厚度的相关性

Relationship between the aorta ascendens elasticity and intima-media thickness of carotid arteries in patients with coronary atherosclerotic heart disease

目的:观察冠状动脉粥样硬化性心脏病(简称冠心病)患者升主动脉弹性与颈动脉内膜-中层厚度及粥样斑块发生的相关性。方法:于2005-08/2006-04选择石河子大学医学院第一附属医院心内科行冠状动脉造影检查患者97例,根据冠状动脉造影结果分为正常对照组41例和冠心病组56例,对两组患者进行超声检查,分别测量升主动脉扩张性D、僵硬度指数β、测量升主动脉前壁收缩期S波以及舒张期E波、A波的速度、颈动脉内膜-中层厚度及粥样斑块发生率。僵硬度指数β=In(收缩压/舒张压)/[(收缩期内径-舒张期内径)/舒张期内径]。动脉扩张性D=2(收缩期内径-舒张期内径)/[舒张期内径(收缩压-舒张压)]×10-3m2/N。结果:纳入患者97例,均进入结果分析。①冠心病组升主动脉扩张性D低于正常对照组,差异有显著性意义[分别为(15.02±9.99)×10-4,(34.75±20.80)×10-3m2/N,P=0.001];僵硬度指数β高于正常对照组(分别为28.20±21.06,15.23±25.32,P=0.001);升主动脉前壁S波和E波速度低于正常对照组[分别为(0.08±0.01),(0.10±0.03)m/s;(0.05±0.01),(0.07±0.02)m/s,P=0.001];颈动脉内膜-中层厚度和颈动脉斑块发生率高于正常对照组[分别为(0.90±0.15),(0.66±0.09)mm;41.03%,5.88%,P=0.001]。②升主动脉前壁S波速度与扩张性呈正相关(r=0.43,P=0.003),与僵硬度指数呈负相关(r=-0.47,P=0.002)。升主动脉前壁E波速度与扩张性呈正相关(r=0.47,P=0.002),与僵硬度指数无相关性。升主动脉前壁A波速度与扩张性和僵硬度指数均无相关性。③升主动脉扩张性D与颈动脉内膜-中层厚度呈负相关(r=-0.49,P=0.004),而僵硬度指数β与内膜-中层厚度则呈正相关(r=0.46,P=0.003)。S波速度与内膜-中层厚度无相关性(r=-0.26,P=0.15)。结论:冠心病患者升主动脉弹性降低即动脉扩张性降低、僵硬度指数升高、升主动脉前壁S波速度下降,颈动脉内膜-中层厚度增厚及粥样斑块发生率增高,将这些参数结合可作为冠心病很有价值的预测指标。

AIM： To observe the change in aorta ascendens elasticity and the carotid arteries intima-media thickness or plaque of cases and the association between them in patients with coronary atherosclerotic heart disease （CAHD）. METHODS： From August 2005 to April 2006, coronary angiography （CAG） was done in 97 patients at Department of Cardiology, First Affiliated Hospital, Medical College, Shihezi University. The subjects were divided by CAG into two groups as normal control group with 41 cases and CAHD group with 56 cases and received CAG. The 97 patients ware examined the ascending aortic distensibility coefficient （D） and stiffness index （β）, anterior aortic wall velocities of systolic phase S wave and diastolic phase E wave, A wave, and the carotid arteries intima-media thickness or plaque by ultrasound, respectively. The stiffness index （6） was equal to In（systolic blood pressure/diastolic blood pressure）/[（systolic dimension-diastolic dimension）/diastolic dimension]. The aortic distensibility coefficient （D） was equal to 2（systolic dimension-diastolic dimension）/[diastolic dimension（systolic blood pressUre-diastolic blood pressure）]×10^-3 m^2/N. RESULTS： The 97 included patients ware involved in the result analysis. ①CAHD group was lower than that in the normal control group in ascending aortic distensibility coefficient D, and there was significant difference [（15.02±9.99）×10^-4, （34.75±20.80）×10^-3 m^2/N, P =0.001]; while in aortic stiffness （β）, CAHD group was higher than that in the normal control group [（28.20±21.06）, （15.23±25.32）, P =0.001]. Anterior aortic wall tissue velocities （Sao and Eao）, CAHD group was lower than those in the normal control group [（0.08±0.01）, （0.10±0.03） m/s; （0.05±0.01） , （0.07±0.02） m/s, P =0.001]; CAHD group was higher than the normal control group in the incidence rates of carotid arteries intima-media thickness and the plaque [（0.90±0.15）, （0.66±0.09） mm; 41.03%, 5.88% ,P =0.001]. ②Anterior aortic wall tissue velocities （Sao） was positively correlated with aortic distensibility （r =0.43, P = 0.003）, and negatively correlated with aortic stiffness （r =-0.47, P =0.002）. Anterior aortic wall tissue velocities （Eao） was positively correlated with aortic distensibility （r =0.47, P =0.002）, but was not correlated with aortic stiffness. Anterior aortic wall tissue velocities （Aao） was not correlated with the above two. ③Ascending aortic distensibility coefficient （D） was negatively correlated with intima-media thickness （r =-0.49, P =0.004）, while aortic stiffness （β） was positively correlated with intima-media thickness （r =0.46, P =0.003）. Anterior aortic wall tissue velocities （Sao） was not correlated with intima-media thickness （r =-0.26, P =0.15）. CONCLUSION： Reduced ascending aortic distensibility coefficient （D）, increased aortic stiffness （β） and decreased anterior aortic wall tissue velocities （Sao） all shows that elastic properties of aorta is reduced. While the carotid artedes intima-media thickness becomes thicker and the plaque of cases is increased. These index are valuable predictors of CAHD.