颈动脉多普勒超声与心绞痛患者冠状动脉病变的关系

Relationship between carotid artery atherosclerosis and coronary artery lesion in patients with angina pectoris

目的采用彩色多普勒超声仪分析心绞痛患者颈动脉病变,探讨其在冠状动脉病变中的临床诊断价值。方法选择因心绞痛行冠状动脉造影的住院患者328例,根据冠状动脉造影结果分为4组:对照组(80例)、单支病变组(102例)、2支病变组(62例)和多支病变组(84例)。用彩色多普勒超声仪测量颈总动脉内膜中层厚度(intimamediathickness,IMT)及颈动脉分叉处IMT,记录颈动脉斑块的位置、数量。结果与对照组比较,2支病变组分叉处IMT和斑块积分明显增高,多支病变组颈总动脉IMT、分叉处IMT和斑块积分明显增高,差异有统计学意义(P<0.05,P<0.01)。与对照组比较,多支病变组颈总动脉IMT增厚比例明显增高,差异有统计学意义(P<0.05);与单支病变组比较,多支病变组颈总动脉IMT增厚比例明显增高,差异有统计学意义(P<0.05)。糖尿病是冠状动脉病变的主要危险因素(OR=2.8,95% CI:1.18～6.63)。结论颈动脉粥样硬化与冠状动脉病变有相关性,采用彩色多普勒超声分析颈动脉病变情况,对冠心病患者具有较好的筛查及预测价值。

Objective To investigate the extent of carotid atherosclerosis using color Doppler ultrasonography in order to study its diagnostic value in coronary heart disease in angina patients. Methods Coronary angiography was performed in 328 patients with angina pectoris. According to the results of coronary angiography, all patients were divided into 4 groups： one-vessel lesion group （n = 102） ,two-vessel lesion group （n = 62） ,multi-vessel lesion group （n = 84） and normal control group （n = 80）. The intima-media thickness（IMT） of carotid artery and the degree of carotid atheroselerosis were compared among the 4 groups. The location and number of plaques in carotid artery were recorded. Results Compared with control group, IMT of carotid bifurcation and plaque score in two-vessel lesion group were significantly increased, and in multi-vessel lesion group,IMT of common carotid artery, IMT and plaque score at bifurcation were significantly increased （P 〈 0.05, P 〈 0.01）. The percentage of increased carotid artery IMT was higher in multi-vessel lesion group than in one-vessel lesion group and control group （P 〈 0.05）. Diabetes mellitus was the main risk factor for coronary artery lesion （OR = 2.8,95% CI ：1.18-6.63）. Conclusion The results indicate that the carotid atherosclerosis is a good predictive marker for coronary heart disease. The ultrasound study of carotid artery can identify the patients with high risk for coronary artery disease.