Effect of carotid ultrasound indicators and dynamic arterial stiffness index on risk prediction for coronary heart disease
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摘要:
目的 探讨颈动脉超声相关指标、动态动脉硬化指数与冠心病的关系。 方法 检测110例冠心病患者动态动脉硬化指数、颈动脉超声、冠状动脉造影，根据冠状动脉造影结果分为单支病变组（n=40）、2支病变组（n=37）、3支及以上病变组（n=33），同时根据超声颈动脉检查分为颈动脉轻度狭窄组（n=42）、中度狭窄组（n=46）、重度狭窄组（n=22），选取同期健康查体人员50例作为正常对照组，对比4组患者血压、动态动脉硬化指数、颈动脉内中膜厚度、颈动脉粥样硬化斑块积分、冠状动脉评分，进行相关性分析。 结果 不同冠脉病变支数、不同颈动脉狭窄程度患者收缩压、舒张压比较差异无统计学意义（P>0.05）；关于动态动脉硬化指数的比较，3支病变组>2支病变组>单支病变组>对照组（P<0.05），重度颈动脉狭窄组>中度狭窄组>轻度狭窄组>对照组（P<0.05）；冠心病患者的颈动脉内中膜厚度均显著高于对照组（P<0.05），但冠心病各组间颈动脉内中膜厚度差异无统计学意义（P>0.05）；斑块积分及冠脉评分在各组间的比较，3支病变组>2支病变组>1支病变组>对照组(P<0.05)，重度狭窄组>中度狭窄组>轻度狭窄组>对照组（P<0.05）；动态动脉硬化指数与冠脉病变支数、颈动脉狭窄程度均呈正相关（r=0.72，0.65，P<0.05），斑块积分、冠脉评分均与冠脉病变支数、颈动脉狭窄程度均呈正相关（r=0.88，0.19，0.42，0.31，P<0.05）。 结论 颈动脉超声相关指标及动态动脉硬化指数能够客观反映患者动脉硬化程度、动脉粥样硬化斑块病变程度，早期对冠心病的风险进行预测和评估，为临床早期干预提供客观可靠的依据。 Abstract:Objective To explore the correlation of carotid ultrasound parameters, dynamic arterial stiffness index (AASI) and coronary heart disease (CHD). Methods AASI, carotid ultrasound and coronary angiography were detected in 110 patients with CHD. According to the result of coronary angiography, patients were divided into single lesion group (n=40), two lesion group (n=37) and 3 or more lesion group (n=33). Based on carotid ultrasound examination, patients were divided into carotid mild stenosis group (n=42), moderate stenosis group (n=46) and severe stenosis group (n=22). Fifty cases with healthy physical examination were selected as the normal control group. Blood pressure, AASI, carotid intima-media thickness (IMT), carotid atherosclerosis plaque integral and coronary artery score were compared in 4 groups with correlation analysis. Results There were no significant differences in systolic blood pressure and diastolic blood pressure between patients with different coronary lesions and different degrees of carotid stenosis (P>0.05). The differences of AASI between 3 lesions group, two single lesion group and the control group were significant (P<0.05). The differences of AASI between severe carotid stenosis group, moderate stenosis group, mild stenosis group and the control group were significant (P<0.05). IMT of patients with CHD were significant higher than that of control group (P<0.05). But IMT between coronary heart disease group were not significant different (P>0.05). Coronary plaque integral score between 3 lesion group, two lesions in group 1 lesion group and control group were significant different (P<0.05). Coronary plaque integral score between severe stenosis, moderate stenosis group, mild stenosis group and control group were significant different (P<0.05). AASI and coronary lesions, stenosis were correlated positively (r=0.72, 0.65, P<0.05). Plaque scores and scores of coronary artery were positively related to the coronary lesions and carotid artery stenosis (r=0.88, 0.19, 0.88, 0.19, P<0.05). Conclusion The parameters of carotid artery ultrasound and AASI can objectively reflect the degree of atherosclerosis and atherosclerotic plaques. It can early predict, evaluate the risk of coronary heart disease and provide reliable basis for early clinical intervention. -
表 1 不同冠脉病变支数患者血压、AASI、IMT比较（
$\bar x \pm s$ ）组别 n 收缩压(mmHg) 舒张压(mmHg) AASI IMT 对照组 50 127.55±12.21 74.33±12.22 0.36±0.13 0.78±0.11 单支病变组 40 132.53±11.21 76.38±12.82 0.39±0.12 1.18±0.10* 2支病变组 37 129.53±12.21 75.39±12.92 0.42±0.11 1.22±0.11* 3支病变组 33 128.58±11.25 75.53±10.21 0.47±0.13 1.19±0.12* F 1.41 0.2153 5.667 —— P 0.2428 0.8856 0.0010 —— *P<0.01 vs对照组. 
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表 2 不同冠脉病变支数患者颈动脉粥样硬化斑块积分、冠脉积分比较（
$\bar x \pm s$ ，分）组别 n 斑块积分 冠脉评分 对照组 50 0.92±0.72 1.22±0.26 单支病变组 40 2.96±1.11 11.12±6.22 2支病变组 37 3.43±2.21 24.21±12.11 3支病变组 33 4.19±2.34 29.88±15.02 F 31.123 76.235 P 0.0000 0.0000
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表 3 不同颈动脉狭窄程度患者血压、AASI、IMT比较（
$\bar x \pm s$ ）组别 n 收缩压(mmHg) 舒张压(mmHg) AASI IMT(mm) 对照组 50 127.55±12.21 75.33±12.22 0.36±0.21 0.78±0.21 轻度狭窄组 42 130.53±11.20 75.38±12.82 0.43±0.20* 1.26±0.22* 中度狭窄组 46 129.03±12.01 75.39±12.92 0.50±0.21*# 1.24±0.21* 重度狭窄组 22 128.50±11.26 76.21±10.21 0.58±0.22*#△ 1.23±0.27* F 0.498 0.03 5.575 —— P 0.6840 0.9930 0.0012 —— *P<0.01 vs对照组; #P<0.05 vs轻度狭窄组; △P<0.05 vs中度狭窄组.
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表 4 不同颈动脉狭窄程度患者颈动脉粥样硬化斑块积分、冠脉评分比较（
$\bar x \pm s$ ，分）组别 n 斑块积分 冠脉评分 对照组 50 0.92±0.89 1.22±0.26 轻度狭窄组 42 3.16±1.11* 21.12±6.22* 中度狭窄组 46 3.93±2.23*# 36.21±12.11*# 重度狭窄组 22 4.49±2.22*#△ 41.18±19.02*#△ F 37.83 128.5 P 0.0000 0.0000 *P<0.05 vs对照组; #P<0.05 vs轻度狭窄组; △P<0.05 vs中度狭窄组.
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