颈动脉斑块与冠状动脉粥样硬化相关性研究

A Study on the Correlation Between Carotid Plaque and Coronary Atherosclerosis

目的通过超声检查判定颈动脉斑块性质,并分析其与冠心病(CHD)冠脉病变的关系。方法选取2016年1月至2017年1月张家口市建国医院心内科收治的CHD患者214例,经冠脉造影检查显示:冠脉轻度狭窄患者36例(轻度组),中度狭窄患者72例(中度组),重度狭窄患者106例(重度组),采用彩色多普勒超声诊断仪对入选患者颈动脉粥样硬化斑块类型及形态进行检查,并分析其与冠脉病变之间的关系;同时设置同期来院体检正常者30例(对照组)进行对照观察。结果 CHD3个亚组患者颈动脉内中膜厚度(IMT)、斑块数量、体积均明显高于对照组,差异有统计学意义(P<0.05);重度组IMT、斑块数量均明显高于轻、中度组,差异有统计学意义(P<0.05);中度组IMT、斑块数量明显高于轻度组,差异有统计学意义(P<0.05);重度组患者颈动脉不稳定斑块检出率明显高于中、轻度组,差异有统计学意义(P<0.05);中度组患者颈动脉不稳定斑块检出率明显高于轻度组,差异有统计学意义(P<0.05);重度组、中度组患者颈动脉稳定斑块检出率均明显高于轻度组,差异有统计学意义(P<0.05);重度组及中度组患者中颈动脉稳定斑块检出率比较,差异无统计学意义(P>0.05)。Logistic相关性分析显示,颈动脉Crouse积分与冠脉Gensini评分均具有相关性(P<0.05)。结论 CHD患者颈动脉不稳定斑块检出率越高,预示CHD患者冠脉硬化程度越重,颈动脉斑块性质与CHD患者冠脉病变程度密切相关。

Objective To estimate the nature of carotid plauqe by ultrasound and analyze its correlation with coronary lesions in patients with coronary heart disease （CHD）. Methods A total of 214 CHD patients who were treated in Jianguo Hospital of Zhangjiakou from January of 2016 to January of 2017 were selected in the study and divided into the mild stenosis group （n= 36）, moderate stenosis group （n= 72） and severe stenosis group （n= 106） according to the results of coronary angiography （CAG）. The color Doppler ultrasound was used to detect the type and form of carotid atherosclerotic plaque and analyze its correlation with the coronary lesions. A total of 30 healthy individuals who came for physical examinations over the corresponding period were classified into the control group. Results The carotid intima-media thickness （IMT） and the number and area of plaque in each subgroup of CHD patients were significantly more than those in the control group respectively （P〈0.05）. IMT and the plaque number were significantly more in the severe stenosis group than in the mild and moderate stenosis group respectively （P〈 0.05）, and they were significantly more in the moderate stenosis group than in the mild group （P〈0.05）. The detection rate of unstable carotid plaque was significantly higher in the severe stenosis group than in the moderate and mild stenosis group respectively （P〈0.05）, and that was significantly higher in the moderate group than in the mild group （P〈0.05）. The detection rate of stable carotid plaque was significantly higher in the severe and mild stenosis groups than in the mild group respectively（P〈0.05）, while there were significant differences between the severe and mild stenosis groups in the detection rate of stable carotid plaque （P〈0.05）. The results of logistic regression analysis showed that the carotid Crouse score was correlated with the coronary Gensini score （P〈0.05）. Conclusion The higher detection rate of unstable plaques in CHD patients indicates that the coronary atherosclerosis is much severer. The nature of carotid plaque is closely correlated with the coronary lesion degree in CHD patients.