彩色多普勒超声在老年原发性高血压颈动脉粥样硬化评估中的应用价值

Color Doppler ultrasonography for judging the carotid artery atherosclerosis in elderly patients with essential hypertension

对160例高血压Ⅰ～Ⅲ级的老年原发性高血压患者采用高频超声（美国ATL公司HDI3500型彩色超声诊断仪）对颈总动脉、颈内动脉及颈外动脉进行检测,着重测量动脉内膜-中层厚度、血流动力学指标,并以同龄健康老年人110例为对照组。结果显示随着高血压分级的逐渐增加,颈动脉内膜-中层厚度逐渐增厚,且以高血压Ⅲ级者最厚,与高血压Ⅱ级、Ⅰ级组及对照组比较差异有显著性意义（P〈0.01）,颈动脉内-中层厚度与高血压的分级呈显著正相关;随着高血压程度的不断加重,斑块的发生率和严重程度也不断增加;血流动力学检测显示老年高血压Ⅱ级组、Ⅲ级组颈总动脉、颈外动脉的收缩期峰值速度、舒张末期速度低于对照组（P〈0.05）,阻力指数、搏动指数高于对照组（P〈0.01）。提示彩色超声多普勒可通过无创性检查颈动脉硬化程度,颈动脉内-中层厚度厚度、动脉粥样硬化斑块大小以及血流动力学指标,对判断高血压患者有无动脉硬化及两者之间的关系具有重要意义。

A total of 160 elderly patients with Ⅰ -Ⅲ essential hypertension were enrolled in the study and examined with high-frequency color Doppler ultrasonography （America ATL Company HDI3500 type color ultrasonoscope）. Common carotid artery （CCA）, internal carotid artery and external carotid artery （ECA） were detected, including carotid artery intima-media thickness （CAIMT） and hemodynamic index. At the same time, 110 healthy elders were taken as contrast group. With the increased degree of hypertension, CAIMT was gradually enhanced and the most obviously in patients of grade Ⅲ hypertension. There were significant differences in grade Ⅲ, Ⅱ, Ⅰand contrast group （P 〈 0.01）. CAIMT was positively elated with the grade of hypertension, With the increased grade of hypertension, the incidence and size of atheromatous plaque became higher and larger. The peak systolic velocity and end-diastolic velocity in CCA and ECA on elderly patients of hypertension grade Ⅱ, Ⅲ were lower （P 〈 0.05）, whereas resistant index and pulsatility index were higher than that of contrast group （P 〈 0.01）. High-frequency color Doppler ultrasonography is a non-invasive method to detect the degree of carotid artery atherosclerosis. CAIMT, atheromatous plaque and hemodynamic checking are very important indices in judging atherosclerosis in hypertension and their relationship.