动脉粥样硬化高、低发区年轻人冠状动脉管壁结构重塑与动脉粥样硬化的关系

Relationship between coronary arteries remodelling and atherosclerosis in youth in different geographic locations of China

由于动脉粥样硬化病变主要发生在内膜,在冠状动脉左前降支近侧端居首位,故对我国动脉粥样硬化高（北京）、低（南宁、宁波渔区）发区327例意外死亡年轻人冠状动脉左前降支近侧端做了多参数形态测量,所得数据进行统计学处理,以探讨动脉粥样硬化高、低发区同龄年轻人冠状动脉管壁结构重塑的差异及与动脉粥样硬化的关系。发现北京年轻人冠状动脉管壁结构重塑改变早、进展快,各项指标明显高于低发区同龄年轻人,其中35～39岁组冠状动脉管腔狭窄检出率达10.7％,与动脉粥样硬化中、晚期病变的高检出率相符;宁波渔区居民总趋势与北京相似,但管腔狭窄检出率4.7％;南宁年轻人管壁结构重塑晚于北京两个年龄组,程度轻、进展慢,管腔狭窄检出率1.8％。说明三地区同龄年轻人在增龄过程中,由于环境因素等的影响,冠状动脉管壁结构的重塑存在明显差异,与动脉粥样硬化病变的发生发展密切相关。血管壁结构重塑;冠状动脉;年轻人;动脉粥样硬化;

To investigate the characteristics/differences of age-related coronary artery remodelling in subjects from regions with high (Beijing) and low (Nanning and Ningbo) prevalence of atherosclerosis in China, and the relationship between coronary artery of remodelling and atherosclerosis, left anterior descending (LAD) coronary arteries were measured by morphomet-ric quantification in 327 necropsy cases collected from 1985 to 1993. Results: Not only the intimal thickness in youth in Beijing (n = 131) was obviously thicker than that in Nanning (n=110) or Ningbo (n = 86) , but also the thickening speed with ageing was faster. The percentage of luminal stenosis in Beijing samples was higher than that in Nanning or Ningbo. The detectable rate of coronary artery lumen narrowing in Beijing was as high as 10.7%, while those in Ningbo and Nanning were 4. 7% and 1. 8%, respectively. Although the total cross section (lumen+intima + media) area of the LAD in Beijing was greater than that in Nanning or Ningbo,yet the lumen areaand lumen area/total cross section area reflecting effective blood flow area of LAD were smaller. The detectable rate of IEL correlated positively with the thickness of the intima (r= 0. 99, P>0. 05); however, the thickness of media showed no such change with age, sex and locality. The overall tendency was that coronary artery remodelling in Nanning was 10 years later than that in Beijing. Conclusion: There are obvious differences in coronary artery remodelling, which is an important factor underlying the causation of high and low prevanlence of atherosclerosis in youth in the three locations.