动态动脉硬化指数和颈动脉超声相关参数与冠状动脉粥样硬化性心脏病的关系

Relationship between dynamic arterial stiffness index,the carotid artery ultrasound parameters and coronary heart disease

目的探讨动态动脉硬化指数(AASI)和颈动脉超声相关参数与冠状动脉粥样硬化性心脏病(以下简称冠心病)的关系。方法对110例冠心病患者行AASI、颈动脉超声及冠状动脉造影检查,根据冠状动脉造影结果分为单支病变组(n=40)、2支病变组(n=37)、3支及以上病变组(n=33);同时根据超声颈动脉检查结果分为颈动脉轻度狭窄组(n=42)、中度狭窄组(n=46)、重度狭窄组(n=22);另选同期健康成人50例为对照组。对比各组入选者的血压、AASI、颈动脉内-中膜厚度(IMT)、颈动脉粥样硬化斑块积分及冠状动脉评分,并进行相关性分析。结果 (1)血压:冠状动脉病变不同支数、颈动脉狭窄不同程度患者收缩压和舒张压比较差异均无统计学意义。(2)AASI:冠状动脉病变不同支数患者AASI由大到小依次为3支及以上病变组、2支病变组、单支病变组及对照组,各组比较差异有统计学意义(P<0.05);颈动脉狭窄不同程度患者AASI由大到小依次为重度狭窄组、中度狭窄组、轻度狭窄组及对照组,各组比较差异有统计学意义(P<0.05)。(3)IMT:冠心病患者IMT显著高于对照组(P<0.05),但各冠状动脉病变组患者IMT比较差异无统计学意义。(4)斑块积分及冠状动脉评分:冠状动脉病变不同支数患者斑块积分及冠状动脉评分由大到小依次为3支及以上病变组、2支病变组、单支病变组及对照组,各组比较差异均有统计学意义(均P<0.05);颈动脉狭窄不同程度患者斑块积分及冠状动脉评分由大到小依次为重度狭窄组、中度狭窄组、轻度狭窄组及对照组,各组比较差异均有统计学意义(均P<0.05);(5)相关性:AASI、斑块积分及冠状动脉评分均与冠状动脉病变支数和颈动脉狭窄程度呈正相关。结论 AASI及颈动脉超声相关参数能够客观反映患者动脉硬化程度和动脉粥样硬化斑块病变程度,早期预测和评估冠心病风险,为临床早期干预提供可靠依据。

Objective To explore the relationship between dynamic arterial stiffness index（AASI）,carotid ultrasound related parameters and coronary heart disease（CHD）. Methods One hundred and ten patients with CHD underwent AASI,carotid ultrasound and coronary angiography,the patients were divided into single lesion group（n=40）,two lesions group（n=37）and 3 or more lesions group（n=33）according to the results of coronary angiography.At the same time,the patients were divided into carotid mild stenosis group（n = 42）,moderate stenosis group（n = 46） and severe stenosis group（n = 22） according to carotid ultrasonography.Fifty healthy physical examination subjects were selected as the control group.The blood pressure,AASI,carotid intima-media thickness（IMT）,carotid atherosclerosis plaque integral and coronary artery score were compared and correlated analyzed among the groups.Results（1） Blood pressure：systolic and diastolic blood pressure had no statistical difference among patients with different number of coronary lesions and different degree of carotid stenosis.（2）AASI：there were significant differences among patients with different number of coronary lesions and different degree of carotid stenosis,the groups with 3 or more lesions group,two lesions group,single lesion group,the control group decreased in turn（all P〈0.05）,and severe carotid stenosis group,moderate stenosis group,mild stenosis group,the control group decreased in turn.（3） IMT：the IMT in CHD patients was significantly higher than that in the control group（P〈0.05）,but IMT had no statistical difference among coronary heart disease groups.（4）Plaque integral and coronary artery score：there were significant differences of plaque integral and coronary artery score among patients with different number of coronary lesions and different degree of carotid stenosis,the groups with 3 or more lesions group,two lesions group,single lesion group,the control group decreased in turn,severe stenosis group,moderate stenosis group,mild stenosis group,the control group decreased in turn（all P〈0.05）.（5）Correlation：AASI,plaque integral and coronary artery score had positive correlation with the number of coronary lesions and the degree of carotid stenosis.Conclusion AASI and related parameters of carotid artery ultrasound can objectively reflect the degree of atherosclerosis and atherosclerotic plaque lesions,predict and assess the risk of CHD,and provide objective and reliable basis for early clinical intervention.