超声评估老年退行性心脏瓣膜病与颈动脉粥样硬化的关系

Assessment of senile degenerative valvular heart disease and carotid atherosclerosis by ultrasound

目的探讨老年退行性心脏瓣膜病(SDHVD)与颈动脉粥样硬化(CAS)之间的关系。方法高频超声对256例SDHVD患者(SDHVD组)及108例无SDHVD患者(对照组)先进行超声心动图检查心脏二尖瓣和主动脉情况,再采用颈动脉超声检查患者颈动脉内中膜厚度(IMT)、是否发生粥样硬化斑块以及管腔是否存在狭窄并进行评估分析。结果 SDHVD组与对照组比较冠心病、高血压、高脂血症与糖尿病患者比例明显偏高(P<0.01);SDHVD组IMT明显高于对照组(P<0.01);SDHVD组颈动脉粥样硬化斑块发生率为97.26%,明显高于对照组70.37%(P<0.01);SDHVD组颈动脉管腔狭窄发生率为91.02%,明显高于对照组47.22%(P<0.01)。根据老年退行性心瓣膜病钙化累及部位数分级,颈动脉IMT、斑块积分、斑块检出率在不同分级间差异具有统计学意义(P<0.01),且随分级的增高颈动脉IMT和斑块积分有逐渐增高的趋势,而随着分级的增高颈动脉管腔狭窄在50%～70%及70%～99%的发生率亦有逐渐增高趋势。结论 SDHVD与CAS之间存在密切关系,临床工作中对于SDHVD患者应该进行常规颈动脉粥样硬化的检测。

Objective To determine the relations between the presence of senile degenerative valvular heart disease（SDHVD） and carotid atherosclerosis（CAS）.Methods A total of 256 patients with SDHVD and 108 patients without SDHVD were assessed by color Doppler ultrasound.Results Compared with the control group,the ratios of patients with coronary heart disease or hypertension or hyperlipaemia or diabetes in the SDHVD group was significant higher than those in the control group（P0.01）;Carotid IMT was significantly thicker in the SDHVD group than those in the control group（P0.05）;The ratios of occurrence of CAS and carotid cavity in the SDHVD group were higher than those in the control group（70.37% 47.22%,P0.01）.According to rank of SDHVD calcification,carotid IMT,the ratios of plaques and the integral value of CAS plaque were significant different（P0.01）.Carotid IMT and the course＇s score of CAS plaque increased along with rank increase.The rates of plaques in different rank were significant different（P0.01）.The ratio of occurrence for carotid cavity stricture was higher while the degree of carotid cavity stricture was 50%~70% or 70%~99%.Conclusion The significant relation between the presence of SDHVD and CAS was observed and high frequency ultrasound of the carotid artery was routinely recommended in patients with SDHVD.