B超检测老年冠心病患者颈动脉内-中膜厚度和肱动脉舒张功能的变化

Changes in the thickness of intima-media of carotid artery and the vasodilation of brachial artery in elderly patients with coronary heart disease by B ultrasound

目的 观察老年冠心病患者的颈动脉内 中膜厚度 (IMTc)及高脂餐后肱动脉舒张功能的变化。 方法 采用高分辨超声检测技术观察老年冠心病患者 (30例 )、老年健康人 (2 2例 )及非老年健康人 (11例 )的IMTc及高脂餐前后肱动脉血流介导的血管舒张功能 (FMD)的变化。 结果 老年冠心病组的IMTc〔(1 13± 0 2 3)cm〕显著高于老年健康组〔(0 94± 0 2 0 )cm〕及非老年健康组〔(0 78± 0 14)cm〕 ,差异均有非常显著性 (均为P <0 0 1)。老年冠心病组的空腹FMD〔(3 4± 1 7) %〕显著低于老年健康组〔(5 3± 3 3) % ,P <0 0 5〕及非老年健康组〔(8 1± 3 9) % ,P <0 0 1〕。年龄与IMTc呈正相关 (r=0 44 4,P <0 0 5 ) ,与空腹FMD呈负相关 (r =- 0 6 5 0 ,P <0 0 0 1) ;高脂餐后 3组受试者的FMD显著减弱〔分别为 (0 6± 0 7) %、(2 6± 2 0 ) %及 (4 2± 2 8) % ;均为P <0 0 0 1〕 ,其中老年冠心病组的FMD下降程度〔ΔFMD % ,(76 7± 10 4) %〕显著高于老年健康组〔(5 4 1± 3 7) %〕及非老年健康组〔(5 0 8± 3 3) %〕 ,差异有显著性 (均为P <0 0 5 )。 结论 老年冠心病患者存在严重的颈动脉粥样硬化与血管舒张功能失调 ,高脂餐后血管舒张功能的进一步减弱 ,可能是诱发急性冠状动脉事?

Objective To explore the carotid atherosclerosis and the change in brachial artery vasodilation after a high fat meal in elderly patients with coronary heart disease(CHD). Methods The intima-media thickness of carotid artery ( IMTc) and the brachial artery flow mediated vasodilation ( FMD ) before and after a high fat meal (800 calories; 50 g fat) were measured by high resolution ultrasound technique in 30 elderly patients with coronary heart disease, 22 cases of healthy elderly subjects, 11 cases of healthy non-elderly subjects. Results The IMTc in elderly CHD patients 〔(1.13±0.23) cm〕was significantly thicker than those in healthy elderly subjects and healthy non-elderly subjects 〔(0.94±0.20)cm and (0.78±0.14)cm, all P<0.01〕. The FMD in elderly CHD patients 〔(3.4±1.7)%〕 was significantly impaired when compared with those in other two groups 〔(5.3±3.3)% and (8.1±3.9)%,P<0.05 and 0.01〕. The IMTc increased (P<0.05) while the FMD decreased (P<0.001)with aging. The FMD significantly aggravated after a high fat meal in three groups (P<0.001), and the percent decrement of FMD in elderly CHD patients was obviously higher than those in other two groups (P<0.05). Conclusions The elderly CHD patients are accompanied with severe carotid atherosclerosis and vasodilation dysfunction. Further aggravation of vasodilation after a high fat meal may become one of the important causes of acute coronary attacks.