【作者】 戴健；

【导师】 汪太平；

【作者基本信息】 安徽医科大学 ， 内科学， 2002， 硕士

【摘要】 目的 探讨原发性高血压病(EH)患者颈动脉粥样硬化(CAS)的发病情况和特点，以及其临床意义。方法 选择180例EH患者，男性，144例，女性，36例，平均年龄63． 4±7． 22岁。按照WHO的三期分期法标准将EH患者分成Ⅰ期、Ⅱ期、Ⅲ期三组，应用高分辨率超声多谱勒对三组EH患者双侧颅外段颈总动脉(CCA)、颈内动脉(ICA)、颈外动脉(ECA)进行超声检查(包括M超、二维显像、彩色多谱勒、脉冲多谱勒)，测量颈总、颈内动脉平均血流速度(Vm)、血管搏动指数(PI)、血管阻力指数(RI)、内-中膜厚度(IMT)、动脉内径，测定颈动脉斑块指数(plaque score)等指标，并与100例健康对照者进行比较，用SPSS统计软件分析。结果 (1) Ⅰ期EH组患者CCA和ICA的Vm、PI、RI与健康对照组比较差异无显著性(P>0． 05) ；Ⅱ、Ⅲ期EH患者CCA和ICA的Vm、PI、RI与健康对照组比较差异有显著性(P<0． 05，P<0． 01) ，EH患者颈动脉血流动力学改变表现为Vm降低，PI、RI增高；Spearman’s相关分析结果表明，EH患者CCAVm与年龄呈负相关(r=-0． 42,P<0． 01) ，PI与年龄呈正相关(r=0． 65，P<0． 01) ；(2) Ⅰ期EH组患者CCA和ICA的IMT、血管内径、IMT／血管内径比值与健康对照组比较差异无显著性(P>0． 05) ；Ⅱ、Ⅲ期EH组CCA和ICA的IMT、血管内径、IMT／血管内径比值与健康对照组比较差异有显著性(P<0． 05) ，表现为颈动脉IMT增厚、血管内径增宽、IMT／血管内径比值显著性增高；(3) Ⅰ、Ⅱ、Ⅲ期EH组颈动脉斑块检出率分别为37． 5％、78． 6％、83． 3％，与健康对照组(18％)比较差异均有显著性(P<0． 05，P<0． 01) ；随着EH严重程度增加，颈动脉斑块检出率有增加趋势；(4) 有中、重度斑块者CCAIMT同无斑块和有轻度斑块者CCAIMT比较，IMT厚度增加差异有显著性(P<0． 05) ，且随斑块的严重程度增加，其IMT呈增厚趋势；(5) 经逐步回归分析安徽医科大学硕士学位论文表明：年龄、吸烟量、收缩压、EH患者病程和严重程度均与CCAIMT厚度密切相关。结论 门）EH患者颈动脉病变多以血流速度减慢、血管阻力增高及顺应性降低、IMT增厚、血管内径扩大、粥样硬化斑块形成为主要特点，颈动脉Vin、PI、、RI、IMT厚度等是超声检查CAS的可靠指标；（2）颈动脉IMT厚度增加可能是CAS的早期表现；（3）超声多谱勒能无创、直观动态地了解CAS程度，能为全面评价大、中动脉粥样硬化提供一个窗口；对临床诊治、预防心脑血管疾病具有重要的实用价值：抗高血压治疗的同时应兼顾防治动脉粥样硬化（＊S人更多还原

【Abstract】 Objective This study was designed to determine the prevalence of carotid artery atherosclerosis(CAS) in patients with Essential Hypertension(EH).Methods 180 patients with EH were selected, 144 male, 36 female; 100 normotensive control subjects were selected, 79 male, 21 female. Doppler scans ultrasonics were performed on 180 participants of the EH in the patients and on 100 normotensive control subjects. To investigate the changes of carotid artery hemodynamics, the mean blood velocity(Vm), blood pulse index(PI) and blood resisent index(RI) of common carotid artery(CCA) and internal carotid artery(ICA) were measured; To quantify the extent of CAS, the intima-media thickness ( IMT ) and the intima-media thickness/diameter of CCA and ICA were measured, the maximal thickness measurements of all plaques were summed for an individual plaque score.Results (1) Vm of CCA and ICA in the second or third stage of EH was decreased significantly versus control group(P<0.01) and Vm of CCA in essential hypertensive group negatively correlated with age(P<0.01); but PI and RI of CCA and ICA in the second or third stage of EH increased significantly versus controls(f<0.05) and PI of CCA positive correlation with age(P<0.01); (2) IMTs of CCA and ICA were high significantly in the second or third stage of EH than those in normal subjects(P<0.05,P<0.01). There was an increasing trend for IMT with the severity of carotid artery plaque. In multiple linear regression stepwise analysis of all the subjectsrevealed that age, cigarette smoking, systolic blood pressure, length and severity of hypertension were independently associated with IMT of CCA. (3) The ratio of carotid artery plaque and plaque score were significantly increased in hypertensive groups versus control group(P<0.01).Conclusions (1) Formation of atherosclerosis plaque , reduction of blood flow speed, increases in the PK RI and IMT of carotid artery are the frequent abnormal findings in carotid arteries in essential hypertensive patients .(2) Increase in IMT of carotid arteries are clearly related to atherosclerosis plaque . (3) The severity of CAS may be used as a reference index for the prediction of cerebrovascular disease.更多还原