健康体检中颈动脉超声及血生化检测辅助冠状动脉CTA筛查冠状动脉粥样硬化的意义

Significance of carotid artery ultrasonography and blood biochemical examination assisting coronary computed tomography angiography for screening coronary arteriosclerosis

目的探讨应用颈动脉超声及血生化检测辅助冠状动脉CT血管成像(CTA)联合筛查无症状冠状动脉粥样硬化的意义。方法选取2015年3~12月在北京航天总医院健康管理中心体检的VIP客户124例,根据冠状动脉CTA检查结果分为冠状动脉粥样硬化组和正常组,应用SPSS17.0软件对两组各项指标的差异进行比较,并应用颈动脉超声以及血生化检验对两组受检者分别进行检测,对各项检测指标进行Logistic回归分析,分析各指标与冠状动脉粥样硬化的相关性。结果 124例受检者中共检出冠状动脉粥样硬化53例,检出率为42.7%,病变主要累及前降支、右冠和左主干。31例冠状动脉狭窄,其中6例冠状动脉脉血管狭窄超过75%,5例冠状动脉血管狭窄在50%~75%之间,20例冠状动脉狭窄小于50%。冠状动脉粥样硬化组平均年龄(64.6±10.9)岁,正常组平均年龄(50.7±12.5)岁,两组间的年龄差异有统计学意义(P<0.05)。行颈动脉超声检查和血生化检测后,经Logistic回归分析,冠状动脉粥样硬化组颈动脉内中膜厚度(IMT)明显高于正常组,差异有统计学意义(P<0.05)。血生化检测冠状动脉粥样硬化组收缩压(SBP)、空腹血糖、糖化血红蛋白(Hb Alc)、高敏C反应蛋白(hs-CRP)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)均高于正常组,差异均有统计学意义(P<0.05),两组间的体重指数(BMI)、舒张压(DBP)、腰臀比(WHR)、血尿酸、甘油三酯(TG)、血小板平均体积(MPV)、血小板体积分布宽度(PDW)、血清促甲状腺激素(TSH)、血清游离T3(FT3)、血清游离甲状腺素(FT4)比较差异均无统计学意义(P>0.05)。结论在健康体检中应用颈动脉超声及血生化检测进行辅助筛查,对比分析颈动脉内中膜厚度以及血脂、胆固醇等指标,可以有效地辅助冠脉CTA早期筛查冠状动脉粥样硬化。尤其对40岁以上受检者,进行颈动脉超声检查及时发现检测异常的高危人群,通过冠状动脉CTA对冠心病进行进一步筛查,对早期冠心病的防治有着相当重要的意义。

Objective To evaluate the significance of combined detection of carotid artery ultrasonography and blood biochemical examination assisting coronary computed tomography angiography（CTA） for screening coronary arteriosclerosis. Methods From March to December in 2015, 124 VIP customers who had physical examination in the Health Management Center of Beijing Aerospace General Hospital were divided into two groups： atherosclerosis group and healthy group, according to the results of CTA. The subjects also received carotid artery ultrasonography and blood biochemical examination. SPSS17.0 software was utilized to analyze the differences of indexes between the two groups,and logistic regression analysis was used to compare the relation between indexes and diagnosis of coronary arteriosclerosis. Results Of the 124 cases, there were 53（42.7%） cases with coronary artery atherosclerosis, and the lesions mainly involved anterior descending branch, right coronary artery and left main stem. A total of 31 cases were detected with coronary artery stenosis, of which 6 cases were more than 75%, 5 cases were between 50% and 75%, 20 cases were less than 50%. The average age of atherosclerosis group was（64.6 ± 10.9） years, as compared with（50.7 ± 12.5） years in healthy group（P〈0.05）. Logistic regression analysis showed that carotid artery intima-media thickness（IMT） of atherosclerosis group was significantly higher than that of healthy group（P〈0.05）. Systolic blood pressure（SBP）, fasting blood glucose, glycosylated hemoglobin（Hb Alc）, high sensitive C-reactive protein（hs-CRP）, total cholesterol（TC）, low density lipoprotein cholesterol（LDL-C） of atherosclerosis group were significantly higher than those in the healthy group（P〈0.05）, but body mass index（BMI）, diastolic blood pressure（DBP）, waist to hip ratio（WHR）, blood uric acid,triglyceride（TG）, mean platelet volume（MPV）, platelet volume distribution width（PDW）, serum thyroid stimulating hormone（TSH）, serum free triiodothyronine（FT3）, serum free thyroxine（FT4） between the two groups showed no statistically significant difference（P〈0.05）. Conclusion The application of carotid artery ultrasound and blood biochemical detection in the health examination, as well as comparative analysis of carotid artery IMT, fasting blood glucose,HAB and blood lipid, could effectively assist the coronary CTA for screening coronary atherosclerosis. For the 40 years old or above, carotid artery ultrasonography could find high-risk cases, and coronary CTA could further screen coronary heart disease（CHD）, which have a very important significance for prevention and treatment of CHD.