无心脑血管疾病危险因素成年受检者颈动脉管腔结构与血流速度分布特征及相关性分析

Distribution characteristics and correlation analysis of carotid artery lumen structure and blood flow velocity in adult subjects without risk factors for cardiovascular and cerebrovascular disease

目的分析无心脑血管病史及危险因素的成年受检者不同年龄、性别、侧别的颈动脉管腔结构、血流速度差异性,以及血流速度与颈动脉指数(CI)的相关性。方法纳入2019年12月至2021年12月国内53家医院筛查既往无心脑血管病史及其危险因素的健康成年受检者2738例(男787例,女1951例),记录颈动脉超声检查结果,分析年龄[40岁以上年龄组(≥40岁组)与40岁以下年龄组(<40岁组)]、性别、左右侧别之间颈总动脉(CCA)、颈动脉球部(BULB)、颈内动脉(ICA)的内径(D_(CCA)、D_(BULB)、D_(ICA))及血流速度[收缩期峰值流速(PSV),包括双侧CCA和ICA的PSV(PSV_(CCA)、PSV_(ICA));舒张期末流速(EDV),包括双侧CCA和ICA的EDV(EDV_(CCA)、EDV_(ICA))]的差异性。分析组间CI[CI_(BULB/ICA)(D_(BULB)与D_(ICA)比值)、CI_(BULB/CCA)(D_(BULB)与D_(CCA)比值)、CI_(ICA/CCA)(D_(ICA)与D_(CCA)比值)]的差异性并与对应颈动脉血流速度进行相关性分析。结果(1)≥40岁组D_(CCA)、D_(BULB)、D_(ICA)均大于<40岁组[分别为6.2(5.7,6.7)mm比6.0(5.6,6.4)mm,7.0(6.4,7.8)mm比6.7(6.1,7.4)mm,4.6(4.1,5.1)mm比4.5(4.1,5.0)mm]。男性D_(CCA)、D_(BULB)、D_(ICA)均大于女性[分别为6.2(5.8,6.7)mm比6.0(5.6,6.4)mm,7.1(6.4,7.8)mm比6.7(6.1,7.4)mm,4.8(4.4,5.3)mm比4.4(4.1,4.9)mm],差异均有统计学意义(均P<0.01)。左侧D_(CCA)小于右侧[6.0(5.6,6.5)mm比6.1(5.7,6.5)mm],右侧D_(ICA)小于左侧[4.5(4.0,5.0)mm比4.5(4.1,5.0)mm],差异均有统计学意义(均P<0.05)。(2)<40岁组受检者的PSV_(CCA)、PSV_(ICA)、EDV_(CCA)、EDV_(ICA)均高于≥40岁组[分别为95(80,112)cm/s比77(63,92)cm/s,85(72,98)cm/s比77(65,92)cm/s,28(24,33)cm/s比26(21,31)cm/s,33(28,39)cm/s比32(26,38)cm/s],女性PSV_(ICA)、EDV_(CCA)、EDV_(ICA)均高于男性[分别为84(71,97)cm/s比79(66,95)cm/s,28(23,33)cm/s比27(22,32)cm/s,34(28,40)cm/s比30(25,35)cm/s],左侧PSV_(CCA)、EDV_(CCA)均高于右侧[分别为91(75,108)cm/s比87(72,104)cm/s,28(23,33)cm/s比27(22,32)cm/s],差异均有统计学意义(均P<0.01)。(3)≥40岁组CI_(BULB/CCA)、CI_(BULB/ICA)均高于<40岁组[1.14(1.04,1.25)比1.12(1.03,1.21),1.53(1.38,1.69)比1.47(1.33,1.60)],CI_(ICA/CCA)低于<40岁组[0.74(0.68,0.82)比0.75(0.69,0.82)],且女性CI_(BULB/ICA)大于男性[1.50(1.36,1.64)比1.45(1.33,1.61)],而CI_(ICA/CCA)小于男性[0.75(0.69,0.81)比0.76(0.70,0.84)],差异均有统计学意义(均P<0.01)。左侧CI_(BULB/CCA)、CI_(ICA/CCA)大于右侧[分别为1.13(1.04,1.23)比1.12(1.03,1.22),0.75(0.69,0.83)比0.75(0.69,0.81)],差异均有统计学意义(均P<0.01)。(4)CI_(ICA/CCA)与PSV_(CCA)、EDV_(CCA)之间均呈正相关(r_(s)值分别为0.122、0.056,均P<0.01),与PSV_(ICA)、EDV_(ICA)之间均呈负相关(r_(s)值分别为-0.050、-0.201,均P<0.01)。CI_(BULB/ICA)与PSV_(CCA)、EDV_(CCA)均呈负相关(r_(s)值分别为-0.111、-0.069,均P<0.01),与EDV_(ICA)呈正相关(r_(s)值为0.064,P<0.01)。CI_(BULB/CCA)与PSV_(ICA)、EDV_(ICA)均呈负相关(r_(s)分别为-0.057、-0.151,均P<0.01)。结论无心脑血管疾病危险因素的成年人颈动脉管腔、血流速度存在年龄、性别及侧别的差异性。CI与血流速度的变化相关。

Objective The differences of carotid artery structure and blood flow velocity among adult subjects without risk factors of cardiovascular and cerebrovascular disease regarding different age,gender,side,blood flow velocity difference and the correlation of blood flow velocity with common carotid artery index(CI)were analyzed.Methods All of the 2738 adults(787 males,1951 females)without risk factors for cardiovascular and cerebrovascular diseases were continuously included in the multicenter carotid ultrasound database of 53 hospitals in China from December 2019 to December 2021.Carotid ultrasound results were recorded.The differences of the diameter of common carotid artery(CCA,D_(CCA)),carotid bulb(BULB,D_(BULB)),internal carotid artery(ICA,D_(ICA))and blood flow velocity(peak systolic flow velocity[PSV],including bilateral CCA and ICA PSV[PSV_(CCA),PSV_(ICA)];end-diastolic flow velocity(EDV),including bilateral CCA and ICA EDV[EDV_(CCA),EDV_(ICA)])between age(over 40 years old and under 40 years old),gender,left and right side were analyzed.The differences of CI(CI_(BULB/ICA)[ratio of D_(BULB) to D_(ICA)],CI_(BULB/CCA)[ratio of D_(BULB) to D_(CCA)],CI_(ICA/CCA)[ratio of D_(ICA) to D_(CCA)])between groups were analyzed,and the correlation with corresponding carotid artery blood flow velocity was analyzed.Results(1)The D_(CCA),D_(BULB) and D_(ICA) in age group over 40 years old were greater than those in age group under 40 years old(6.2[5.7,6.7]mm vs.6.0[5.6,6.4]mm,7.0[6.4,7.8]mm vs.6.7[6.1,7.4]mm,4.6[4.1,5.1]mm vs.4.5[4.1,5.0]mm).D_(CCA),D_(BULB) and D_(ICA) in male were higher than those in female(6.2[5.8,6.7]mm vs.6.0[5.6,6.4]mm,7.1[6.4,7.8]mm vs.6.7[6.1,7.4]mm,4.8[4.4,5.3]mm vs.4.4[4.1,4.9]mm).The differences were statistically significant(P<0.01 for all).D_(CCA) on the left side was smaller than that on the right side(6.0[5.6,6.5]mm vs.6.1[5.7,6.5]mm),and D_(ICA) on the right side was smaller than that on the left side(4.5[4.0,5.0]mm vs.4.5[4.1,5.0]mm),with statistical significance(both P<0.05).(2)The PSV_(CCA),PSV_(ICA),EDV_(CCA) and EDV_(ICA) of subjects under 40 years old were higher than those over 40 years old(95[80,112]cm/s vs.77[63,92]cm/s,85[72,98]cm/s vs.77[65,92]cm/s,28[24,33]cm/s vs.26[21,31]cm/s,33[28,39]cm/s vs.32[26,38]cm/s).The PSV_(ICA),EDV_(CCA) and EDV_(ICA) of female were higher than those of male(84[71,97]cm/s vs.79[66,95]cm/s,28[23,33]cm/s vs.27[22,32]cm/s,34[28,40]cm/s vs.30[25,35]cm/s).The left PSV_(CCA) and EDV_(CCA) were higher than the right(91[75,108]cm/s vs.87[72,104]cm/s,28[23,33]cm/s vs.27[22,32]cm/s).The differences were statistically significant(all P<0.01).(3)CI_(BULB/CCA) and CI_(BULB/ICA) in the age group above 40 years old were higher than those in the age group below 40 years old(1.14[1.04,1.25]vs.1.12[1.03,1.21],1.53[1.38,1.69]vs.1.47[1.33,1.60]),while CI_(ICA/CCA) was lower than that in the age group below 40 years old(0.74[0.68,0.82]vs.0.75[0.69,0.82]),and CI_(BULB/ICA) in female was higher than that in male(1.50[1.36,1.64]vs.1.45[1.33,1.61]),CI_(ICA/CCA) in female was smaller than that in male(0.75[0.69,0.81]vs.0.76[0.70,0.84]).The differences were statistically significant(all P<0.01).CI_(BULB/CCA) and CI_(ICA/CCA) on the left were larger than those on the right(1.13[1.04,1.23]vs.1.12[1.03,1.22],0.75[0.69,0.83]vs.0.75[0.69,0.81]),and the differences were statistically significant(all P<0.01).(4)CI_(ICA/CCA) was positively correlated with PSV_(CCA) and EDV_(CCA)(r_(s) were 0.122 and 0.056,respectively,both P<0.01),and negatively correlated with PSV_(ICA) and EDV_(ICA)(r_(s) were-0.050 and-0.201,respectively,both P<0.01).CI_(BULB/ICA) was negatively correlated with PSV_(CCA) and EDV_(CCA)(r_(s) were-0.111 and-0.069,respectively,both P<0.01),and positively correlated with EDV_(ICA)(r_(s) was 0.064,P<0.01).CI_(BULB/CCA) was negatively correlated with PSV_(ICA) and EDV_(ICA)(r_(s) were-0.057 and-0.151,respectively,both P<0.01).Conclusions There were age,gender and lateral side differences in carotid artery structure and blood flow velocity in adults without risk factors for cardiovascular and cerebrovascular disease.There was a correlation between CI and blood flow velocity.