颈动脉粥样硬化和肱动脉内皮功能与冠状动脉病变的关系

Relationship Between Carotid Atherosclerosis,Brachial Artery Endothelial Function and Coronary Artery Disease

目的探讨颈动脉不同部位内膜中膜厚度及斑块积分,反应性充血后肱动脉血管内径变化与冠状动脉粥样硬化程度的关系,从而为临床筛查冠状动脉粥样硬化积累新的临床资料与经验。方法入选对象31例,依冠状动脉积分分为高、中、低三组,对每组对象行超声检测颈动脉不同部位内膜中膜厚度和肱动脉血流介导的血管舒张功能。结果颈动脉各部位内膜中膜厚度与冠状动脉粥样硬化病变程度呈正相关,且分叉处的内膜中膜厚度与冠心病有更强的相关性(r=0.679,P<0.01);颈动脉粥样斑块积分与冠状动脉粥样硬化病变程度呈正相关,颈动脉分叉处最易形成斑块(P<0.05);肱动脉血管内皮舒张功能与冠状动脉粥样硬化病变程度呈负相关(r=-0.646,P<0.01)。硝酸甘油诱导的非内皮依赖性血管舒张功能在三组间虽呈现逐渐减弱的趋势,但未达到统计学差异(P>0.05)。结论颈动脉内膜中膜厚度及肱动脉血流介导的血管舒张功能测定可较好地反映冠状动脉硬化程度。

Aim To investigate the relationship of carotid artery segments-specific intima-media thickness（IMT）,plaque summary score,brachial artery flow-media dilatation and extent of coronary artery atherosclerosis. Methods 31 consecutive eligible patients were divided into three groups with low,medium and high score.Intima-media thickness of the right and left carotid artery（the common carotid artery,internal carotid artery,bifurcation） were measured with external vascular ultrasound,the brachial artery flow-mediated dilatation of all subjects was measured noninvasively by the same ultrasound machine. Results A significant positive correlation between the intima-media thickness of various segments carotid artery and the extent of coronary atherosclerosis was found in all of the subjects,and a better correlation could be got between the intima-media thickness of bifurcation and the extent of coronary atherosclerosis（r=0.679,P〈0.01）.There was a significant positive correlation between plaque Crouse summary score and the extent of coronary atherosclerosis in all of the subjects,and it was easy formate plaque at the bifurcation（P〈0.05）.A significant negative correlation among percent FMD and the extent of coronary atherosclerosis was found in all of the subjects（r=-0.646,P〈0.01）.Nitroglycerin-induced endothelium-independent vasodilation among the three groups showed the trend of gradually weakening,but did not reach statistical significance（P〉0.05）. Conclusion Carotid IMT and brachial artery FMD may be a better reflection of the determination of coronary artery sclerosis.