【作者】 沈敏；

【导师】 李兰荪；

【作者基本信息】 中国人民解放军第四军医大学 ， 内科学， 2003， 硕士

【摘要】 目的：①通过对颈动脉内中膜厚度(IMT)及颈动脉粥样硬化斑块的检测，探讨颈动脉粥样硬化病变的发生与冠心病的关系及其与冠心病危险因素的关系。②超声检测内皮依赖性及非依赖性舒张功能，研究冠心病患者内皮功能的变化。③探讨炎症反应与不稳定型心绞痛发生、发展的关系及其临床意义。④研究3羟基-3甲基戊二酰辅酶A(HMG-CoA)还原酶抑制剂——阿托伐他汀在改善内皮功能、抑制炎性反应及延缓粥样斑块进展等方面的作用。 方法：①120例被检查者均为住院治疗并接受冠脉造影的患者，应用高频超声检测IMT及粥样硬化斑块，并与冠心病的多种危险因素进行分析。②利用高频超声检测肱动脉血流介导的及硝酸甘油引起的舒张反应，并观察阿托伐他汀治疗10～12周后内皮舒张功能的变化，及治疗9个月后颈动脉粥样硬化的改善情况，包括IMT、斑块本身及背向散射积分(IBS)。③检测30例不稳定型心绞痛(UAP)患者、20例稳定型心绞痛(SAP)患者及20例正常对照的血清CRP、IL-6、IL-10、sICAM-1浓度。④对UA患者予以阿托伐他 第 四军 医 大学硕士学位论文汀 10mg 日月，l次／d，疗程 10～ 12 周，观察治疗前后 C班、IL一6、IL一 10、SICAM－l的情况。 结果：①冠心病组中，IMT明显大于对照组，但冠脉病变组之间无差异。冠心病组的颈动脉硬化斑块的检出率明显高于对照组，且与冠脉病变的严重程度有关，以分叉部为最高，依次为颈总动脉和颈内动脉。总胆固醇（TC）。低密度脂蛋白胆固醇（LDL－C）水平及高血压、糖尿病发病率在冠心病组中明显高于对照组。②冠心病组的脑动脉基础内径略大于对照组，但无统计学意义（尸＞0刀5）。冠心病组由血流介导的以及＊TN引起的防动脉舒张反应，均明显低于对照组（P＜0．of人③UA组患者血 C肚、IL七、SICAM水水平显著高于 SA组（P＜0．05）及健康对照组（P＜0，05），UA组患者血L－10水平显著低于SA组（P＜0刀5），但高于健康对照组（P＜0刀5）。④经阿托伐他订治疗后，冠心病患者的内皮舒张功能有明显改善（尸＜0刀5），不稳定型心绞痛患者血清＊RP、1卜6、SI＊＊＊－1水平显著降低u＜0刀5），ILIO水平显著升高（P＜0刀5）。颈动脉1＊T有明显减低u＜0刀5），除扁平斑的厚度有明显减低（尸＜0刀5）外，其他斑块未见明显的改善，斑块的185值有所增加，但无明显的统计学意义（P＞0刀5）。 结论：①颈动脉粥样硬化严重程度与冠心病发生成正相关。颈动脉超声检测对冠心病有一定的预测价值。②在冠心病患者和有危险因素的人群中开展颈动脉超声及血管内皮功能检查，不仅为早期发现、预防和治疗冠心病提供依据，还可作为监测和评估病情变化的指标。③不稳定型心绞痛患者血清CRP、IL七及SICAM．1的含量明显增高，提示存在炎性反应。④阿托伐他汀具有抗炎、延缓粥样斑块进展及改善内皮功能等作用。更多还原

【Abstract】 OBJECTIVE:CDTo investigate the intima-media thickness(IMT) and plaques on carotid artery, and evaluate the relationship between coronary heart disease(CHD), at the same time, to analyze risk factors of CHD. ㏕o investigate the dilatation changes of brachial arteries during reactive hyperemia and after sublingual administraction of glyceryl trinitrate(GTN).(3)To explore the role and clinic value of inflammation in patients with unstable angina pectoris (UAP).?To study the effect of atorvastatin on inflammation, endothelial function and postponing progression of atheromatous plaques.METHODS: ︰sing B-mode ultrasonography, measuring the intimia--media thickness of carotid artery and analyzing risk factors of CHD on 90-3-patients with CHD,and 30 subjects with normal coronary arteries (Control). (D Using B-mode ultrasonography, measuring the dilatation of brachial arteries during reactive hyperemia and after sublingual administraction of glyceryl trinitrate(GTN). To investigate endothelium dilatation changes after 10-12 weeks’ treatment of atorvastatin, and improvement of carotid atherosclerosis after 9 months’treatment of atorvastatin, including IMT, plaques and Integrated backscatter(IBS)(3) Plasma levels of CRP, IL-6, IL-10 and sICAM-1 were determind in patients with unstable angina pectoris (UAP) and patients with stable angina pectoris (SAP) using enzyme linked immunosorbent assay(ELISA). @ Patients with unstable angina received oral atorvastatin lOmg for 10-12 weeks.RESULTS: ?The intimia-media thickness of CHD group was significantly higher than those of the control group, and had no significant variance of the 1,2,3-vessel group. Atherosclerotic plaques were found mostly in the carotid bifurcation and common carotid artery segments. The discovery rate was greater in 2,3-vessel group. The content of TC, LDL-C and incidence rate of hypertension, diabetes mellitus were higher in CHD group. (2) The flow-mediated dilatation and GTN-induced dilatation of brachial arteries in patients with CHD were significantly reduced as composed with those in control group (P<0.01) .?Plasma levels of CRP, IL-6 and sICAM-1 are significantly higher in patients with UAP than those in patients with SAP (P<0.05 ) and health controls ( P<0.05 ) , but no difference between the latter two groups(P>0.05) .Plasma level of IL-10 is singinficantly lower in patients with UAP than those in patients with SAP (P<0.05) , but higher than health controls(P<0.05) .? After treatment of atorvastatin, the endothelial function of patients-4-significantly (P<0.05) .the average levels of CRP, IL-6, sICAM-1 were lowed significantly (P<0.05) , IL-10 tightened (P<0.05) . There is no significant improvement in plaques, but ther is significant decrease of IMT (PO.05). There is a increseing tendency of IBS of carotid atherosclerosis (P>0.05). Maybe that is related to short time of investigation and a small quantity of cases.CONCLUSION: ?CHD is associated with a higher incidence of and more extensive atherosclerosis in carotid artery. Using B-mode ultrasonography on carotid artery has definitely prognosticative value for CHD. ?) During patients with CHD and persons with CHD risk factors, Using B-mode ultrasonography to investigate atherosclerosis in carotid artery and the endothelial function, these methods can provide evidences of CHD in earlier period, also can monitor patient’s condition and prognosis. ? Patients with unstable angina have high levels of CRP, IL-6 and sICAM-1, all these hint that inflammation plays an important role in unstable angina. ?The results demonstrate that atorvastatin has the role of anti-inflammation, postponing progression of atheromatous plaques and improving the endothelial function.更多还原