介入治疗前后冠心病患者颈动脉内-中膜厚度的对比研究

Comparison of carotid intima-media thickness in patients with coronary heart disease before and after percutaneous coronary intervention

目的通过研究冠状动脉粥样硬化性心脏病(冠心病)患者颈动脉内-中膜厚度(intima-media thickness,IMT)在经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗前后的变化,探讨其与冠心病的关系及在冠心病诊断与治疗中的临床应用价值。方法连续选择2005年10月至2007年08月在广西医科大学附属玉林市第一人民医院心内科住院,行冠状动脉造影和PCI治疗的冠心病患者57例为研究对象。检测入选患者治疗前和随访6个月后的IMT、血清总胆固醇、三酰甘油、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇浓度等指标。结果 (1)IMT从术前(1.13±0.27)mm降至术后的(1.04±0.21)mm,差异有统计学意义(P<0.01);其阳性率(≥1.00 mm)从术前73.68%(42/57)降至术后54.39%(31/57),差异有统计学意义(P<0.05)。(2)术前血清总胆固醇、三酰甘油、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇浓度分别为(5.43±1.29)mmol/L、(1.93±1.01)mmol/L、(3.75±1.20)mmol/L、(1.03±0.35)mmol/L,术后则分别为(5.08±0.67)mmol/L、(1.80±0.79)mmol/L、(3.36±0.58)mmol/L、(1.08±0.29)mmol/L;术前、术后比较均差异有统计学意义(P<0.01)。结论经PCI治疗联合应用调脂药物能有效改善IMT和控制血脂,改善动脉硬化及冠心病病情,提示IMT对冠心病发生及其严重程度有一定预测的价值。

Objectives To investigate the variation in carotid intima-media thickness（IMT） in patients with coronary heart disease（CHD） before and after percutaneous coronary intervention（PCI） and to evaluate its relationship with CHD and clinical signification of diagnosis and treatment on CHD.Methods Totally 57 patients with CHD performed PCI and coronary arteriography in Yulin First People＇s Hospital Affiliated to Guangxi Medical University from October 2005 to August 2007 were continuously enrolled.Their IMT was measured and concentrations of serum total cholesterol（TC）,triglyceride（TG）,low-density lipoprotein cholesterol（LDL-C） and high-density lipoprotein cholesterol（HDL-C） were examined before and six months after PCI.Results（1） IMT significantly decreased from（1.13±0.27） mm before PCI to（1.04 ±0.21） mm after PCI（P0.01） and positive rate（≥1.00 mm） decreased from 73.68%（42/57） to 54.39%（31/57）（P0.05）.（2） Concentrations of serum TC,TG,LDL-C and HDL-C before PCI were（5.43±1.29）mmol/L,（1.93±1.01）mmol/L,（3.75±1.20）mmol/L,（1.03±0.35）mmol/L respectively and changed to（5.08±0.67）mmol/L,（1.80±0.79）mmol/L,（3.36±0.58）mmol/L,（1.08±0.29）mmol/L after PCI.The differences were significant（P0.001）.Conclusions PCI with lipid-regulating therapy can improve angiosclerosis and CHD by ameliorating IMT and controling blood lipid,which indicates that IMT has certain predictive value for incidence and severity of CHD.