最大颈动脉内膜中层厚度及颈动脉斑块对冠心病预测的相关性研究

Maximum carotid intima-media thickness and carotid plaques for predicting coronary heart disease

目的：探讨最大颈动脉内膜中层厚度（cIMT）及颈动脉斑块对冠心病（coronary heart disease,CHD）的诊断预测作用。方法：将无CHD史的214例患者经冠状动脉（冠脉）CT或冠脉造影证实冠脉狭窄≥50%分为CHD组82例和无CHD组132例。记录一般情况、入院血压及血脂数据,测量最大cIMT以及记录颈动脉斑块位置。结果：CHD组中最大cIMT明显大于无CHD组,差异有统计学意义[（1.09±0.20）∶（0.99±0.20）,P〈0.01]。CHD组颈总动脉斑块和颈动脉窦斑块发生概率与无CHD组相比有显著增加（P〈0.01）。而两组的颈内动脉斑块发生概率则无显著差异。将入组的CHD危险因素、最大cIMT及颈动脉斑块进行logistic回归后退法分析,发现高血压（OR=3.052,95%CI1.671～5.782,P〈0.01）和颈总动脉斑块（OR=2.757,95%CI1.283～5.924,P〈0.01）、颈动脉窦斑块（OR=2.635,95%CI1.425～4.873,P〈0.01）与CHD的发生明显相关,是CHD的强预测因素。结论：颈总动脉斑块及颈动脉窦斑块是CHD的强预测因素,可作为临床辅助预测CHD的简便、无创、有效的诊断预测指标。

Objective：The purpose of this study was to evaluate the value of maximum carotid intima-media thickness （cIMT） and carotid plaques for predicting coronary artery disease （CHD）. Method： Two hundred and fourteen patients with no history of coronary heart disease underwent computed tomography angiography or coro- nary angiography. And then divided into CHD group （n=82） and non-CHD group （n= 132） which due to coro- nary artery stenosis≥50% ,measured blood pressure and blood fat, and measured maximum clMT and recorded the position of carotid plaques. Result=Maximum eIMT was significantly higher in CHD group than which in non- CHD group（1.09=1=0.20 vs 0. 99±0. 20,P〈0. 01）. The incidence of plaque in common carotid artery（CCA） and carotid blub（CB） in CHD group were significantly increased than non-CHD group （P〈0.01）. But there was no significant difference in internal carotid artery（ICA）. Multiple logistic regression backward analysis reveals that hypertension （OR=3.052,95%CI 1. 671- 5. 782, P〈0. 01） and CCA plaque （OR=2.757,95%CI 1.283 5.924,P〈0.01）,CB plaque （OR=2. 655,95% CI 1. 42544. 875,P〈0. 01） were associated with CHD,which were stronger predictor of CHD. Conclusion： CCA plaque and CB plaque were stronger predictor of CHD which could be used as a simple,noninvasive and useful marker for prediction of CHD.