超声三维成像技术评估颈动脉斑块体积及其对冠心病患者发病风险的预测

The value of three-dimensional ultrasound in evaluating carotid artery plaque volume and predicting risk events in coronary heart disease patients

目的利用超声三维成像技术评估颈动脉斑块体积,与传统斑块厚度比较,斑块体积能否更早预测冠心病患者心血管事件的发病风险。方法共收集99例患者,其中无症状单纯颈动脉斑块组66例,冠心病合并颈动脉斑块组33例,所有患者均行颈动脉超声三维成像检查。冠心病合并颈动脉斑块组患者均行冠脉造影检查,并计算冠脉Gensini积分。比较组间斑块厚度、面积及体积,分析斑块体积与冠脉Gensini积分的相关性及与其他心血管风险因素的关系。结果冠心病组斑块体积[(1 312.38±513.70)mm3]高于无症状组[(947.54±321.41)mm3],组间差异有统计学意义(P=0.023),而斑块厚度及斑块面积的组间差异没有统计学意义(P>0.05)。斑块体积与冠脉Gensini积分呈正相关(r=0.519,P=0.002),与心血管事件危险因素如糖尿病史、血糖、糖化血红蛋白呈正相关,与同型半胱氨酸呈正相关(r=0.569,P=0.002),与心血管事件保护因素如高密度脂蛋白呈负相关(r=-0.387,P=0.038)。结论与斑块厚度相比,超声三维成像技术所评估的颈动脉斑块体积可更好地预测冠心病患者发生心血管事件的风险。

Objective To assess whether the plaque volume of carotid artery evaluated by three-dimensional ultrasound can predict the risk of cardiovascular events earlier in patients with coronary heart disease, in comparison with plaque thickness. Methods A total of 99 patients were enrolled, including 66 patients with asymptomatic carotid plaque and 33 patients with coronary heart disease （CHD） and carotid plaque. Three-dimensional ultrasound was performed in all the patients. Coronary angiography was performed in all the patients in CHD group. Coronary artery Gensini score was calculated. Plaque thickness, plaque area and plaque volume were compared between the two groups. We analyzed the relationship of plaque volume with Gensini score and other cardiovascular risk factors. Results Plaque volume was significantly higher in CHD group [-（1 312.38 ± 513.70）mm^3] than in asymptomatic group [（947.54 ± 321.41）mm^3] （P = 0. 023）. However, plaque thickness and plaque area were not significantly different between the two groups （P〉0.05）. Plaque volume was positively correlated with Gensini score （r= 0.519, P=0. 002）, homocysteine （ r = 0.569, P = 0. 002 ）, and cardiovascular risk factors such as diabetes, blood glucose and glycosylated hemoglobin. There was a negative correlation between plaque volume and high-density lipoprotein （HDL）, a factor protecting against cardiovascular events （r= 0. 387, P = 0. 038）. Conclusion Compared with plaque thickness, the volume of carotid plaques assessed by three-dimensional imaging technique may be a better predictor of the risk of cardiovascular events in patients with coronary heart disease.