冠状动脉钙化与动脉弹性功能相关性研究

发布时间：2018-08-26 17:48

【摘要】： 目的:冠心病(coronary artery disease CAD)是危害人类健康的主要疾病之一,目前已成为人类死亡的重要原因。冠状动脉粥样硬化(coronary atherosclerosis CAA)是冠心病的主要病理生理基础。冠状动脉钙化(coronary artery calciation CAC)是冠状动脉粥样硬化敏感而特异的标记之一。目前检测冠状动脉钙化的最佳方法是应用多层螺旋CT(multi slice computed tomography MSCT)计算钙化积分(calcium score CS),CS与选择冠状动脉造影(selective coronary angiography SCA)显示的冠状动脉粥样硬化性狭窄有很好的相关性。动脉弹性(elasticity)异常是冠心病的危险因素,它可能通过两种机制影响冠状动脉粥样硬化的发生:一是增大脉压;二是动脉弹性异常与冠状动脉粥样硬化有着相同的发生机制,如内皮功能障碍、钙化等。冠状动脉钙化与动脉弹性变化可能存在某种关系,即冠状动脉钙化与动脉弹性异常可能互为标记,且两者均能揭示冠状动脉粥样硬化。依据脉搏波传导原理推导出的大动脉弹性指数C1和小动脉弹性指数C2是目前反映大动脉弹性功能与小动脉弹性功能变化的理想指标之一,C2与动脉内皮功能密切相关,C2的降低可以作为动脉内皮功能损害的灵敏标识。本试验对80例CS正常者和52例CS异常者进行C1、C2检测,旨在研究CS和C1、C2之间的相关性,同时探讨冠心病危险因素对CS和C1、C2的影响。方法:采用16排螺旋CT(GE-MSCT)及HDI CV Profiler Do-2020无创动脉功能检测仪(美国HDI公司),对132例入选者(其中健康人34例,冠心病人46例,高血压病人52例)分别进行钙化积分(CS)测定及C1、C2的检测,同时记录体重指数(BMI Kg/m2)、收缩压(SBP)、舒张压(DBP)、脉压(PP)、脉率(PR)、平均压(MP)。按照CS测定结果进行分组,以CS值300为界限,CS≥300为异常组,CS300为正常组。结果:1、在健康人组、高血压组及冠心病组中均显示随年龄增长,C1、C2降低,而CS随年龄增长而增大,有显著性差异。2、高血压组及冠心病组与健康人组比较,CS数值在各年龄段均明显高于健康组,(P0.01),冠心病组C1、C2值下降达到统计学差异(P0.05);高血压组C1下降未达到统计学差异,但C2在年轻组中即表现出显著下降(P0.01)。3、冠心病组与高血压组相比,CS随年龄增高达显著性统计学差异,而C1、C2值在两组间无统计学差异。4、CS与C1、C2呈显著性负相关,相关系数分别为-0.102,-0.322(P0.01)。5、CS≥300者较CS300者C1、C2值显著降低。结论:1、冠状动脉钙化积分CS和大动脉弹性指数C1、小动脉弹性指数C2是两种能发现早期动脉硬化的敏感、无创的特异性指标。2、冠状动脉钙化积分CS与C1、C2可同样反映各种心血管危险因素对动脉血管功能及结构的损伤。3、动脉弹性指标C1、C2揭示的是血管病变早期的功能改变,而CS反映的是血管病变的结构改变,两者可作为早期心血管病变的预测指标。4、CS、C1、C2的监测不仅可预示心血管疾病的发生还提示动脉血管病变损害的程度。
[Abstract]:Objective: Coronary artery disease (CAD) is one of the main diseases endangering human health, and has become an important cause of human death. Coronary atherosclerosis (CAA) is the main pathophysiological basis of coronary heart disease. Coronary artery calcification (CAC) is the main cause of coronary atherosclerosis. The best way to detect coronary artery calcification is to use multi-slice computed tomography (MSCT) to calculate calcium score CS, which is well matched with selective coronary angiography (SCA) in detecting coronary artery stenosis. Customs.
Abnormal arterial elasticity is a risk factor for coronary heart disease. It may affect the occurrence of coronary atherosclerosis through two mechanisms: one is to increase arterial pressure; the other is that arterial elasticity abnormalities and coronary atherosclerosis have the same mechanism, such as endothelial dysfunction, calcification and so on. There may be some relationship between coronary artery calcification and arterial elasticity abnormality, and both of them can reveal coronary atherosclerosis. The elastic index C1 and C2 derived from the principle of pulse wave conduction are ideal indicators to reflect the elastic function of large arteries and the elastic function of small arteries. One is that C2 is closely related to arterial endothelial function. The reduction of C2 can be used as a sensitive marker of arterial endothelial dysfunction. C1 and C2 were detected in 80 normal CS subjects and 52 abnormal CS subjects. The aim of this study was to study the correlation between CS and C1 and C2, and to explore the influence of coronary heart disease risk factors on CS and C1 and C2.
Methods: 132 patients (including 34 healthy subjects, 46 patients with coronary heart disease and 52 patients with hypertension) were examined by 16-slice spiral CT (GE-MSCT) and HDI CV Profiler Do-2020 noninvasive arterial function tester (HDI Company). The body mass index (BMI Kg/m2), systolic blood pressure (SBP) and diastolic blood pressure (D) were recorded simultaneously. BP, PP, PR and MP were grouped according to the results of CS. CS value 300 was taken as the limit, CS (> 300) as abnormal group and CS300 as normal group.
Results: 1. In the healthy group, hypertension group and coronary heart disease group, C1, C2 decreased with age, while CS increased with age, there was a significant difference. 2. Compared with the healthy group, the CS values in the hypertension group and coronary heart disease group were significantly higher than those in the healthy group (P 0.01), and the values of C1 and C2 in the coronary heart disease group decreased significantly (P 0.01). There was no significant difference between the two groups in the values of C1 and C2, but the correlation coefficients were - 0.102 and - 0.322 (P 0.01). The values of.5, CS or 300 were significantly lower than those of CS300, C1 and C2 values.
Conclusion: 1. Coronary artery calcification score CS and arterial elasticity index C1, small artery elasticity index C2 are two sensitive and noninvasive specificity indicators to detect early atherosclerosis. 2. Coronary artery calcification score CS and C1, C2 can also reflect the damage of various cardiovascular risk factors to arterial function and structure. 3. Artery elasticity index C1, C2. CS can be used as a predictor of early cardiovascular disease. 4. Monitoring of CS, C1, C2 can not only predict the occurrence of cardiovascular disease, but also indicate the extent of vascular lesion damage.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2007
【分类号】：R363

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