周围血管颈动脉和股动脉粥样硬化与冠状动脉粥样硬化的关系

The Relationship of atherosclerosis between coronary artery and carotid and femoral arteries

目的探讨颈动脉（CAS）、股动脉粥样硬化（FAS）与冠状动脉粥样硬化（CAAS）的关系。方法以高分辨率B-型超声探查曾作选择性冠状动脉造影（CAG）病人双侧颈动脉220例及同时探查股动脉58例，检测斑块，累计每例各部位斑块厚度，分别得颈动脉、股动脉斑块积分（ffe、ny），并与冠状动脉造影对照。结果：（1）CAS、FAS、CAS＋FAS预测冠心病敏感性分别为91％、85％、97％，特异性为57％、70％、65％，阳性预测值为77％、81％、81％，阴性预测值为80％、76％、94％；（2）CAS、FAS、CAS＋FAS预测CAAS敏感性分别88％、83％、95％，特异性为77％、82％、76％，阳性预测值为92％、91％、91％，阴性预测值为67％、67％、87％；（3）CAS、FAS、CAS＋FAS与CAAS病变程度相关，相关系数分别为0．71、0．63、0．77（P＜0．001），（4）冠状动脉病变支数越多，PSc越高，PSc预测冠脉正常、轻度狭窄、单支、多支病变，总正确率70％。结论（1）CAS、FAS预测CAD或CAAS均有价值，但后者阳性预测值更高;（2）同时检测CAS与FAS，可提高阴性预测值；（3）CAS程度可以预测CAAS程度。

Objective: To study the relationship of carotid atherosclerosis (CAS) or femoral atherosclerosis (FAS) to coronary atherosclerosis (CAAS). Method 220 subjecto examined with coronary arterography (CAG) were enlisted into the study. A high resolution B mode ultrasound was used to scan the bilateral common cartid arteries, cartid bulbs and internal carotid arteries of all the 220 patientS, of them 58 took similar examination of the femoral arteries, too. Intima - media thickness (IMT) was measured and the atherosclerotic lesion was defined as plague when IMI≥ 1.2 mm. Plaque score of carotid (PSc) and that of femoral (PSf) were gained by accumulating the thickness of plaques of all the sites of carotid or femoral arteries ineach patient respectively, and compared to the results in CAG. Rasults (1) CAS, FAS andCAS plus FAS could predict CAD, their sensitivities were 91 %, 85% and 97%, and the specifities 57%, 70% and 65% respectively. Their posihve predicition values were 77%, 81% and81%, and the negative prediction values 80%, 76% and 94% respectively. (2) CAS, FAS andCAS plus FAS could also predict CAAS, their sensitivities were 88%, 83% and 95%, and thespecifities 77%, 82% and 76% respechvely. The positive prediction values were 92%, 91 %and 91 %, and the negative prediction values 67%, 67% and 87% respechvely. (3) The degree of CAS, FAS or CAS plus Fad was related to that of CAAS, and the correlation coefficientwas 0. 71, 0. 63 and 0. 77, respectively (P < 0.001 ). (4) As CAAS aggravates, PSc increasesaccordingly, and PSc could reveal coronary normality, light stenosis and uni -vessel, multiple vessel CAD, and its correctness rate was 70%. Conclusions (1) Atherosclerosis of carotidand femoral arteries is valuable in predicting CAD or coroner artery atherosclerosis, but the positing prediction values in CAAS are higher than in CAD; (2) Integrated CAS with FAS, the negative prediction values for CAD and CAAS would be increased; (3) The degree of CAS can predictthat of CAAS.