【作者】 张春东；

【导师】 王建华； 李治安；

【作者基本信息】 河北医科大学 ， 影像医学与核医学， 2008， 硕士

【摘要】 冠状动脉造影是诊断冠状动脉狭窄的金标准,但对早期及亚临床病变的诊断意义不大。以往主要以颈动脉形态学指标如内-中膜厚度(IMT)、斑块来反映并预测冠状动脉粥样硬化病变程度。有些研究表明冠心病患者的冠状动脉病变程度与颈动脉病变呈正相关,而有些研究表明冠心病患者的冠状动脉病变程度与颈动脉病变无明显相关。近年对动脉功能的检测逐渐成为临床研究的热点,血管回声跟踪技术(ET)是一种对动脉血管弹性进行检测和评估的方法,其测量管壁位移精确度达0.007-0.013mm,以往有学者应用ET技术评价高血压、糖尿病、高脂血症及围绝经期妇女颈总动脉弹性改变,但尚未见应用ET技术对青年冠心病患者颈总动脉弹性与冠状动脉病变程度相关性研究。目的:应用常规超声及ET技术检测青年(<45岁)冠心病患者颈总动脉形态学及弹性参数,评价颈动脉病变与冠状动脉病变及程度的相关性,探讨ET技术对冠心病早期预警的价值。材料和方法:对137例青年冠心病住院患者在进行冠状动脉造影前/后一周内进行颈动脉超声检查,记录颈动脉IMT值及斑块数目、大小。根据颈动脉有无IMT增厚及斑块分为病例Ⅰ组(62例)和病例Ⅱ组(75例),再根据冠状动脉造影显示的单、多支病变分别将上述两病例组分为Ⅰa亚组(32例)、Ⅰb亚组(30例)和Ⅱa亚组(39例),Ⅱb亚组(36例),并搜集冠心病患者临床资料、吸烟情况及是否有高血压、高脂血症、糖尿病。分别选取与病例Ⅰ、Ⅱ组性别、年龄匹配健康人作为对照Ⅰ组(33例)、对照Ⅱ组(42例)。对无IMT增厚及斑块的病例Ⅱ组及相应对照Ⅱ组利用血管回声跟踪技术检测颈总动脉僵硬度(β),压力弹性系数(Ep),顺应性(AC),脉搏波传导速度(PWVβ)等弹性参数。结果:对照Ⅰ组及颈动脉有形态学改变的单、多支冠脉病变亚组患者(Ⅰa、Ⅰb亚组)间IMT逐步增厚,差异有统计学差异,且Ⅰb亚组颈动脉斑块发生比例高于Ⅰa亚组,差异有统计学差异。对照Ⅱ组及颈动脉无形态学改变的单、多支冠脉病变亚组(Ⅱa组,Ⅱb亚组)患者间各项颈总动脉弹性参数有统计学差异,颈总动脉Ep、β、PWVβ逐步增高,AC逐步减低。结论:1.血管弹性是早期评价血管病变较为敏感的指标。2.颈动脉病变与冠状动脉病变及程度具有良好相关性。颈动脉有形态学改变时其IMT、斑块等形态学指标与冠状动脉病变及程度有良好相关性;颈动脉无明显形态学改变时,颈总动脉各项弹性参数与冠状动脉病变及程度有良好相关性。提示动脉弹性参数有可能成为早期预警冠心病的敏感指标。3.吸烟及性别是影响青年颈动脉病变及冠状动脉病变的独立危险因素。4.影响冠状动脉病变的危险因素同时也可能是影响颈动脉弹性的危险因素。5.血管回声跟踪技术是动脉弹性的无创性检查方法,具有较高的准确性,敏感性及可重复性,有望成为一种早期预警冠心病的检查手段,并可用于评价防治动脉硬化药物的疗效。更多还原

【Abstract】 Coronary artery angiography (CAG) is the golden standard for diagnosing coronary artery stenosis. But there is no significant meaning for early and sub-clinical events. Carotid artery intima-media thickness(IMT) and plaque could be used to reflect the extent of coronary artery atherosclerosis. Some studies showed there were positive correlations between the extent of coronary artery and carotid artery atherosclerosis, whereas other studies showed opposite results. Recently, detection of arterial function become hot in atherosclerosis studies. The precision of e-Tracking (ET) technique can reach 0.007—0.013mm as a method for checking and evaluating the artery elasticity. ET technique had been used to evaluate the elastic changes of hypertension, diabetes, hyperlipidemia and perimenopausal women, but now it was no related studies on the relation between carotid elasticity and the extent of coronary artery atherosclerosis in younger coronary artery disease (CAD) patients.Objective:To assess the relationship between carotid arterial elasticity and the extent of coronary arterial atherosclerosis in younger(<45y) CAD patients using ET technique and to discuss the value of ET technique for early stage CAD patients.Methods:137 young CAD patients who were established coronary artery stenosis by CAG were enrolled in our study. Before or after 1 week of CAG, carotid artery ultrasound was performed to recording the IMT, numbers and size of plaques in all CAD patients. According with or without IMT abnormality and plaques, all CAD patients were divided into two groups (patient group I, 62 cases; (patient group II, 75 cases). After that, both the patient groups were divided respectively into sub-group Ia (32 cases), sub-group Ib (30 cases) and sub-group IIa (39 cases), sub-group IIb (36 cases) according to single or multi-vessels stenosis in coronary artery. All patients characteristics such as hypertension, hyperlipidemia, diabetes and smoking were collected. Seventy-five normal subjects were selected as control group and matched with patients groups (control group I, 33 cases, control group II, 42 cases,). ET technique was used to detect the stiffness parameter (β), pressure-strain elasticity modulus (Ep), arterial compliance (AC), one-point pulse wave velocity (PWVβ) in control group II and patients group II.Results:IMT was increased gradually in control group I and patients sub-group Ia and Ib and had significant differences. Also, there were significant differences between sub-group Ia and Ib and sub-group Ib had higher carotid artery plaque occurrence than sub-group Ia. The arterial elastical parameters were significant differences between control group II and sub-group IIa and IIb.β、Ep、PWVβincreased and AC decreased gradually.Conclusions:1. Arterial elasticity is a sensitive parameter to evaluating the early stage of artery atherosclerosis.2. There have good correlation between the extent of carotid artery and coronary artery atherosclerosis. When carotid artery IMT increasing and carotid artery plaque appear, it has nice correlation with coronary artery atherosclerosis. When carotid artery IMT was normal or without plaque, there are good correlation between carotid artery elastical parameters and coronary artery atherosclerosis. So it suggested that arterial elasticity could be a sensitive parameter to assess CAD.3. Smoking and gender are independent risk factors of effecting carotid artery and coronary artery atherosclerosis in young patients.4. The risk factors effecting coronary artery disease could also be the risk factors which affect carotid arterial elasticity.5. ET technique is an invasive method for detecting arterial elasticity with higher accuracy, sensitivity and repeatability. It is possible to become an useful method for evaluating early stage CAD, and for assessing the curative effect of anti-atherosclerosis medicine.更多还原