彩色多普勒超声评价颈总动脉壁厚度及血管阻力指数与代谢综合征患者急性心肌梗死发生的关系

Correlation between wall thickness or resistance index of common carotid artery and acute myocardial infarction development in patients with metabolic syndrome

目的应用彩色多普勒超声评价颈总动脉壁厚度及血管阻力在预测代谢综合征(MS)患者急性心肌梗死(AMI)发生中的作用。方法 102例MS患者中合并AMI者57例,未合并AMI者45例。彩色多普勒超声观察颈总动脉(CCA)内膜-中层厚度(IMT)、外膜厚度(AT)及阻力指数(RI),分析评价上述指标与MS患者AMI发生的关系及与其他AMI危险因素间的相关性。结果 MS合并AMI组较MS未合并AMI组IMT和AT显著升高(P<0.01,P<0.05),且与AMI发生密切相关(P<0.01,P<0.05);AMI组IMT及AT阳性率高于RI(P<0.001),非AMI组IMT阳性率高于AT及RI(P<0.005)。AMI组IMT与收缩压、餐后2h血糖及血清纤维蛋白原(FIB)水平呈正相关(r=0.830,r=0.835,r=0.753,P均<0.001),与高密度脂蛋白胆固醇水平(HDL-C)呈负相关(r=-0.840,P<0.001);AT与FIB呈正相关(r=0.828,P<0.001),与HDL-C呈负相关(r=-0.798,P<0.001);RI与HDL-C呈负相关(r=-0.671,P<0.001)。结论同时测量MS患者CCA的IMT及AT可提高早期预测AMI的准确性,为及时采取防治措施提供了超声学依据。

Objective To evaluate the efficacy of acute myocardial infarction （AMI） prediction in patients with metabolic syndrome （MS） by color Doppler ultrasound. Methods Of all 102 cases, MS patients with AMI were 57 cases and 45 cases had no AMI. Intima-media thickness （IMT）, adventitial thickness （AT） and resistance index （RI） of common carotid artery （CCA） were measured in 102 patients with MS by color Doppler ultrasound. The relationships between CCA indexes and AMI development as well as AMI risk factors were analyzed. Results IMT and AT were increased in MS patients with AMI compared with those without AMI. There was significant correlation between development of AMI and IMT or AT （P0.01, P0.05）. The detection rates of IMT and AT were greater than RI in AMI group （P0.001）, while that of IMT was the greatest in the non-AMI group （P0.005）. In AMI patients, IMT was correlated with systolic blood pressure, 2-hour postprandial blood sugar and fibrinogen （FIB） positively correlated （r=0.830, r=0.835, r=0.753, respectively,P0.001） with high density lipoprotein cholesterol （HDL-C） negatively （r=-0.840,P0.001）. AT was positively correlated with FIB （r=0.828,P0.001）, and negatively with HDL-C （r=-0.798,P0.001）. RI was negatively correlated with HDL-C （r=-0.671,P0.001）.Conclusion IMT and AT measurement in MS patients could increase accuracy of AMI incidence prediction,and provide ultra-acoustic evidence for early prevention and treatment measures.