超声评价下肢动脉粥样硬化性疾病患者股动脉与颈动脉的结构重构和僵硬度改变

Assessment of peripheral arterial structural and stiffness changes in patients with lower extremity atherosclerotic disease by quality intima-media thickness and quality arterial stiffness techniques

目的 评价下肢动脉粥样硬化性疾病（LEAD）患者股总动脉、颈总动脉的形态与功能重构特征.方法 选取31例LEAD患者与34例健康对照者,应用超声射频血管内中膜定量分析（QIMT）和动脉僵硬度定量分析（QAS）技术测量双侧股总动脉与颈总动脉内中膜厚度（IMT）、管腔内径（D）、局部僵硬度参数（β和PWVβ）,并分析影响LEAD患者股动脉僵硬度的相关因素.结果 ①LEAD组收缩压（SBP）、脉压（PP）、吸烟量及吸烟程度均高于对照组（P＜0.05）.②与对照组比较,LEAD组双侧股总动脉的IMT显著增厚,内中膜厚度与管径比值（IMT/D）明显增大,差异有统计学意义（P＜0.01）.左侧颈总动脉IMT显著增厚（P＜0.05）,右侧颈总动脉IMT稍增厚（P=0.06）;双侧颈总动脉内径（D）显著增宽（P＜0.01）.LEAD患者双侧颈总动脉、股总动脉平均IMT（mIMT）显著增厚（P＜0.05）.左侧颈总动脉局部僵硬度参数（β）及双侧颈总动脉局部脉搏波传导速度（PWVβ）显著增高,双侧股动脉β、PWVβ测值均显著增高（P＜0.05）.双侧颈总动脉、股总动脉平均β（mβ）、PWVβ（mPWVβ）增高（P＜0.01）.颈总动脉与股总动脉局部僵硬度指标间呈显著正相关（P＜0.01）.③股动脉mβ及mPWVβ与mIMT、SBP、吸烟量及吸烟程度呈正相关,股动脉mPWVβ与年龄呈正相关（P＜0.05）.逐步多元线性回归显示：mIMT、PP是股动脉mβ的独立相关因素;SBP、吸烟程度及mIMT是股动脉mPWVβ的独立相关因素.结论 LEAD患者的外周动脉发生血管重构,股动脉及颈动脉僵硬度明显增高,以股动脉更显著.下肢动脉僵硬度与内中膜厚度、动脉血压及吸烟程度有关.

Objective To assess the peripheral arterial structural and elastic remodeling in patients with lower extremity atherosclerotic disease （LEAD）.Methods Thirty-one patients with LEAD and 34 age-,sex-matched healthy subjects （control group） were enrolled in this study.The intima-media thickness （IMT）,diameter （D） and parameters of arterial stiffness （β,pulse wave velocity （PWVβ）） were measured by acquiring the longitudinal view of left and right common femoral artery （LCFA,RCFA） and common carotid artery （LCCA,RCCA） by quality intima-media thickness （QIMT） and quality arterial stiffness （QAS） techniques.The factors correlated with arterial stiffness in LEAD patients were analyzed.Results ① The systolic blood pressure（SBP）,pulse pressure（PP）,smoking pack-year and smoking extent （nonsmoker,smoker with 〈40 pack-year,or smoker with ≥40 pack-year） were significantly higher in LEAD group than those in the control group （P 〈0.05）.②IMT of the LCCA and the diameters （D） of LCCA and RCCA were significantly increased in the LEAD group （P 〈0.05-0.01）.As to the both sides CFA,IMT and IMT/D values were significantly increased （P 〈 0.01）.The mean IMT （mIMT） of both sides of CCA and CFA were increased （P 〈0.05）.The values of β,PWVβ of LCCA and PWVβ of RCCA were significantly increased,and β and PWVβ values of both sides of CFA were significantly increased in the LEAD group （P 〈 0.05）.There was a positive correlation between the stiffness indexes of the carotid artery and that of the femoral artery （P 〈0.01）.③The femoral mβ was correlated with femoral mIMT,SBP,PP,smoking amount and smoking extent,and the femoral mPWVβ was also correlated with mIMT,age,SBP,PP,smoking pack-year and smoking extent （P 〈0.05-0.01）.In multivariable stepwise regression analysis,mIMT and PP were factors independently correlated with femoral mβ.And SBP,smoking extent,and mIMT were independently correlated with femoral mPWVβ.Conclusions Peripheral arteries in patients with LEAD experience vascular remodeling,as well as increased carotid and femoral stiffness.Femoral stiffness is correlated with IMT,arterial blood pressure and smoking extent.