颈动脉病变与冠状动脉病变关系的探讨

Relationship between carotid artery disease and coronary artery disease

目的：通过分析超声检查颈动脉病变和冠脉CT血管造影（CTA）检查冠脉病变之间的联系,并以颈动脉超声参数预测冠状动脉疾病。方法：对598例临床疑诊CHD患者行颈动脉超声和冠脉CTA检查。分析比较颈动脉IMT、斑块与冠脉病变程度、数量的关系,并通过逐步Logistic回归分析得出冠脉血管病变的预测因子。结果：单因素分析结果示性别、年龄、高密度脂蛋白、糖尿病、高血压、吸烟、颈动脉斑块、颈动脉IMT≥1 mm在有、无冠脉病变两组间差异有统计学意义（P〈0.05）。冠脉狭窄组、多支病变组颈动脉IMT均显著高于无病变组（P〈0.05）。冠脉无狭窄、狭窄程度为0%-25%、25%-50%、50%-75%、75%-100%时各组间颈动脉斑块的发生率分别为56.8%、64.3%、80.7%、83.5%、90.0%,差异有统计学意义（P〈0.01）。0支、1-2支、3支及4支冠脉病变各组间颈动脉斑块的发生率分别为56.8%、75.3%、89.6%、81.0%,差异有统计学意义（P〈0.01）。逐步Logistic回归分析提示,男性、老年、高血压、颈动脉斑块、颈动脉IMT≥1mm和结合颈动脉斑块与颈动脉IMT≥1mm二指标来预测冠脉血管病变的OR分别为2.037、3.074、1.968、1.615、1.829及2.258。结论：颈动脉斑块和增加的颈动脉IMT与冠脉病变的存在、严重程度及其病变数量相关。颈动脉斑块、颈动脉IMT≥1mm为独立于性别、年龄及高血压的冠脉血管病变的预测因子;并且两者结合起来预测冠脉病变更有意义。

Objective：To explore the relationship between carotid artery disease and coronary disease by using ultrasound and coronary computed tomography angiography,respectively,and to predict coronary artery disease by carotid ultrasound parameters.Method：A total of 598 patients who were suspected of coronary heart disease received carotid ultrasound and coronary computed tomography angiography.Coronary artery disease was compared with carotid artery disease by categorical severity and number of coronary artery atherosclerosis and carotid IMT.Our study found independent predictors of coronary artery disease by stepwise Logistic regression.Result：The univariate analysis showed significant differences in sex,age,HDL,diabetes,hypertension,smoking,carotid plaque and carotid IMT≥1mm between the two groups of patients with and without coronary artery disease（P〈0.05）.Carotid IMT in coronary artery narrow groups and triple and fourfold vessel coronary disease groups were significantly higher than those of no narrow group（P〈0.05）.The incidence rate of carotid plaque in none,0%-25%,25%-50%,50%-75% and 75%-100% coronary artery narrow groups were 56.8%,64.3%,80.7%,83.5%and 90.0%,respectively（P〈0.01）.The incidence rate of carotid plaque in none,single-double,triple and fourfold vessel coronary disease groups were 56.8%,75.3%,89.6% and 81.0%,respectively（P〈0.01）.Stepwise Logistic regression analysis showed that the adjusted odds ratio of male,elderly,hypertension,carotid plaque,carotid IMT ≥1mm and combining carotid plaque with carotid IMT ≥1mm causing coronary arteries disease was 2.037,3.074,1.968,1.615,1.829 and 2.258 respectively.Conclusion：Carotid plaque and increased carotid IMT are associated with the presence,severity and number of coronary artery disease.Carotid plaque and carotid IMT≥1mm may be predictors for coronary arteries disease independent of age,sex and hypertension.Combining carotid plaque with carotid IMT≥1mm is better than using either alone for predicting coronary arteries disease.