老年人颈动脉斑块形态学特点与心血管危险因素的相关性研究

Relationship between morphological features of carotid arterial atherosclerosis plaque and cardiovascular risk factors in the aged

目的 探讨老年人颈动脉狭窄程度及颈动脉斑块的形态学特点与心血管危险因素间的相关性.方法 选择我院行脑血管造影检查的老年患者321例,年龄60～83岁,参考颈动脉彩色超声检查结果,分为颈动脉粥样硬化组（斑块组）和颈动脉正常对照组,分析与年龄、性别、总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、尿酸、C-反应蛋白（CRP）、同型半胱氨酸（HCY）、高血压、糖尿病、吸烟、饮酒等心血管病危险因素的相关性.斑块组按颈动脉狭窄程度、斑块表面光顺度等与心血管危险因素进行相关性分析.并随访1年,前瞻性分析各亚组患者心、脑血管事件发生情况.结果 斑块组256例,对照组65例,斑块组TC、LDL-C、尿酸、CRP、吸烟、饮酒、高血压、糖尿病等心血管危险因素均高于对照组;在亚组分析中,年龄、吸烟和糖尿病与颈动脉狭窄程度呈正相关,而CRP、LDL-C、吸烟、糖尿病与颈动脉斑块表面光顺度相关.斑块组46例（18.0%）发生脑血管事件,32例（12.5%）发生心血管事件,颈动脉狭窄程度与脑血管事件呈正相关,而与心血管事件发生差异无统计学意义.颈动脉斑块表面光顺度与心、脑血管事件均呈正相关.结论 老年人颈动脉粥样硬化斑块的发生、发展与心血管危险因素关系密切,颈动脉斑块表面光顺度形态学特点在一定程度上较狭窄程度更能反应老年人动脉粥样硬化水平,并与心、脑血管事件的发生密切相关.

Objective To explore the relationship between morphological features of carotid arterial atherosclerosis plaque and various cardiovascular risk factors in the aged.Methods The 321patients who underwent cerebral angiography were classified into two groups：256 patients with carotid arterial atherosclerosis and 65 patients without plaque.The relationships between carotid arterial plaque and cardiovascular risk factors including age,gender,cholesterol（TC）,triglyceride （TG）,high density lipoprotein cholesterol （HDL-C）,low density lipoprotein cholesterol（LDL-C）,C-reactive protein（CRP）,homocysteine （HCY）,hypertension,diabetes,smoking and drinking were analyzed.The relationships between morphological features,including the stenosis degree,surface fairing of plaque,and cardiovascular risk factors were analyzed.After 1 year follow-up,the prospective cardiovascular and cerebrovascular events were analyzed in the two groups.Results Carotid atherosclerosis was connected with cardiovascular risk factors such as TC,LDL-C,uric acid,CRP,hypertension,diabetes,smoking and drinking.Positive correlation was showed between the stenosis degree of carotid artery and age,smoking and diabetes.Closely correlation was showed between surface fairing of carotid arterial plaque and LDL-C,CRP,smoking and diabetes.The stenosis degree of carotid artery only showed positive correlation with cerebrovascular events,but the morphological features of surface fairing of carotid arterial plaque equally showed positive correlations with cerebrovascular events and cardiovascular events.Conclusions The development of carotid arterial atherosclerosis plaque in the aged is closely related to cardiovascular risk factors.Morphological features of carotid arterial plaque may respond the level of general atherosclerosis better than stenosis degree,and it is also in close correlation with cerebrovascular events and cardiovascular events.