冠心病血管内皮功能、颈动脉硬化与冠脉病变的关系

Correlation among brachial endothelium dysfunction,carotid atherosclerosis and coronary atherosclerosis in patients with coronary artery disease

目的:观察冠心病(CAD)患者内皮依赖性舒张功能及颈动脉粥样硬化的状况及与冠状动脉病变的相关性。方法:选经冠状动脉造影确诊为CAD的患者106例(观察组),冠状动脉造影证实无冠状动脉狭窄的健康者40例(正常对照组),采用二维超声检测肱动脉内皮依赖性和非依赖性舒张功能及颈动脉粥样硬化病变。颈动脉粥样硬化斑块积分采用Sutton法,并与冠状动脉病变程度进行对比分析。结果:CAD组内皮依赖性血管舒缩功能(FMD)比正常对照组明显降低(P<0.01),内皮非依赖性血管舒缩功能与正常对照组比较无显著性差异(P>0.05);CAD组颈动脉内膜中层厚度(IMT),斑块积分显著高于正常对照组(P<0.01)。FMD与冠脉病变程度呈负相关(r=-0.651,P<0.001),颈动脉IMI及斑块积分与冠脉病变程度呈正相关(r=0.871,0.702,P<0.001)。结论:内皮细胞功能障碍和颈动脉粥样硬化与冠状动脉粥样硬化的病变相平行。

Objective： To investigate the correlation among brachial endothelium dysfunction, carotid atherosclerosis and coronary atherosc/erosis in patients with coronary artery disease （CAD）. Methods： Two-dimensional echocardiography （2-DE） was used to measure the brachial artery inner diameter [fore endothelium dependant （FMD） and endothelium no-dependant diastolic-systolic function （NMD）] and intimate media thickness （IMT） and plague of carotid arteries in 106 CAD patients who had been examined by coronary angiography. Carotid plaque score was calculated using Sutton＇s method to quantify the extent of carotid atheroasclerosis. The brachial endothelium function, carotid atheroclerosis and coronary atherosclerosis of CAD patients were analyzed and compared, The 40 normal persons who had been examined by coronary angiography were regard as normal control group. Results： Endothelium dependant vascular diastolic-systolic function significantly decreased in CAD group as compared with control group （P〈0.01）; while endothelium no-dependant diastolic-systolic function was no significant difference in two groups （P〉0.05）. The carotid intimate media thickness and carotid plaque score significantly increased in CAD group than those in control group （P〈0.01）. There was negative correlation between FMD and coronary lesion （r=-0.651, P〈0.001）. There were positive correlation among IMI, plague of carotid arteries and coronary lesion （r= 0, 871, 0,702, P〈 0. 001）. Conclusion： Endothelium dysfunction and carotid atherosclerosis are parallel with coronary atherosclerosis.