动态动脉硬化指数、颈动脉超声与冠心病的相关性研究

  本文关键词：动态动脉硬化指数、颈动脉超声与冠心病的相关性研究，由笔耕文化传播整理发布。

        研究背景与目的：动脉血管壁结构和功能的改变与心血管疾病的发病和死亡密切相关。随着年龄的增加,血管僵硬度增加,收缩压及脉压差增大,导致血管壁成分和剪切力改变,进一步加剧血管硬化。由于弹性成分下降,非弹性成分增加,导致动脉血管壁增厚,血管内-中膜厚度增加,同时动脉弹性、血管扩张性下降,动脉僵硬度增加,已被证明可以引起心血管不良预后。作为研究动脉弹性特征的指标,动态动脉硬化指数(AASI)及颈总动脉内中膜厚度(IMT)、斑块形成情况等指标由于其简便、可重复性及无创特点越来越受到临床研究的重视。为了研究无创的外周动脉粥样硬化检测技术与冠心病的相关性及其临床意义,本研究将临床常用的24h动态血压监测技术和颈动脉超声技术相结合,通过计算动态动脉硬化指数、测量颈总动脉内中膜厚度、斑块数量及其形态学特点,并结合冠脉造影、血清学检测,研究动态动脉硬化指数、颈动脉粥样硬化指标、血清hr-CRP与冠状动脉病变的相关性及其临床意义。资料与方法：回顾性分析了我院2009年11月至2011年10月期间468例心内科住院患者的一般资料、冠状动脉造影结果、颈动脉超声检测结果、24h动态血压监测结果。根据颈动脉超声检测结果,我们对双侧颈总动脉IMT、颈动脉斑块数量、斑块评分及颈动脉斑块表面情况及内部回声特点进行评估。分析所有入选对象的24h血压监测结果,通过24h动态血压数据计算各AASI:(AASI)=1-收缩压与舒张压直线回归的斜率。同时,对所有入选对象的冠脉造影结果进行Gensini评分。根据冠状动脉造影所示冠状动脉病变情况将所有入选对象分为2组：冠心病组与非冠心病组(即正常对照组)；又按冠脉造影所示病变血管支数将冠心病组分为3组：冠脉1支病变组、2支病变组、3支病变组；按照冠脉造影所示冠脉狭窄程度将冠心病组分为2组：冠脉轻度狭窄组、重度狭窄组。根据冠脉造影及入院诊断将所有入选者分为稳定性心绞痛组、急性冠脉综合征组及对照组。将各组中的AASI、IMT、斑块积分、斑块发生率、Gensini积分、血清hr-CRP情况进行比较。结果：(1)冠心病组和非冠心病组的性别构成比、年龄、BMI、SBP、DBP、PP、左室舒张末径、射血分数,合并高血压、糖尿病及冠心病家族史等因素差异无统计学意义(P>0.05),冠心病组吸烟者比例、合并高脂血症者比例及血清hr-CRP水平高于对照组,AASI、IMT、颈动脉斑块积分、斑块发生率显著高于对照组(P<0．05)(2)正常对照组、冠脉1支病变组、2支病变组、3支病变组间SBP、DBP和PP差异无统计学意义(P>0.05)。经相关性分析得IMT、颈动脉粥样斑块发生率、血清hr-CRP与冠状动脉病变支数无相关性；AASI、斑块积分、冠脉评分与冠状动脉病变支数呈正相关性,其中AASI的相关系数最大。(3) AASI、粥样硬化斑块积分、冠脉评分与冠脉狭窄程度呈正相关性,其中AASI的相关系数较大,CIMT、颈动脉粥样斑块发生率、hr-CRP与冠状动脉病变程度无相关性。(4)稳定性心绞痛组、急性冠脉综合征组间冠脉评分、CIMT、斑块积分差异无统计学意义(P>0.10)。急性冠脉综合征组颈动脉易损斑块发生率、hs-CRP、 AASI高于稳定性心绞痛组和对照组(P<0.05),稳定性心绞痛组高于对照组(P<0.05),经相关性分析得出颈动脉易损斑块发生率、hs-CRP、AASI与冠心病病情稳定性成正相关性,其中易损斑块发生率的相关系数最大。结论：(1)冠心病患者AASI、颈动脉斑块积分升高比IMT、颈动脉斑块发生率更能提示冠状动脉病变范围广、狭窄程度重。(2)颈动脉易损斑块的检出、hr-CRP及AASI水平增高与冠心病病情稳定性密切相关。(3) Gensini评分是根据冠脉管腔病变范围及狭窄程度对病变严重程度进行评估,而与冠心病病情稳定性无直接关系。

    Background and Purpose:The changes in the structure and function of arterial wall are closely related with the morbidity of cardiovascular disease. With age increasing, vascular stiffness increases and systolic blood pressure and pulse pressure increases, so that the composition of the vessel wall and shear stress change, further exacerbating the hardening of the arteries. As the elastic component decreased and the inelastic component increased, the thickness of arterial wall and vascular intima-media are thickening, the vasodilator and elasticity of arterial are decreasing, and the arterial stiffness are increasing. Those have been shown to cause adverse cardiovascular prognosis. In order to study the relation between the arterial elastic properties and coronary artery disease and its clinical significance, the ambulatory arterial stiffness index (AASI), intima-media thickness (IMT) and plaque formation index have been used increasingly in clinical studies as they are the simple and reproducible non-invasive techniques. In this paper,24h ambulatory blood pressure monitoring and carotid ultrasound technology are combined, and research the correlation and its clinical significance between AASI, carotid atherosclerosis, serum hr-CRP and coronary artery disease.Materials and Methods:Retrospectively analyzed the general information, coronary angiography, carotid ultrasound test results and24h ambulatory blood pressure monitoring data of468hospitalized patients in the Cardiology Department from2009November to2011October. The IMT, carotid artery plaque number, plaque score, plaque surface conditions and internal echo are assessed based on carotid ultrasound test results. Analysis the24h blood pressure monitoring results of all selected objects and calculate the AASI. At the same time, we calculate the Gensini’ score for all selected objects through coronary angiography. All subjects were divided into coronary heart disease group (CHD) and non-coronary heart disease group (control group) by coronary angiography; The patients in the CHD group were divided into three groups:single vascular disease group, double vascular disease group, triple vascular disease group; According to coronary angiography, the patients in the CHD group were divided into two groups:narrow group and occlusion group. All selected subjects were divided into ACS group, AS group and control group. To analyze the AASI, IMT, plaque score, plaque incidence and Gensini’scores of each group, and to determine its clinical significance.Results:(1)The gender composition, age, BMI, SBP and DBP, PP, left ventricle diastole diameter, ejection fraction, hypertension, diabetes and coronary heart disease and family history between CHD group and normal control group were no significant differences.In CHD group, smoking, Hyperlipidemia, hr-CRP, AASI, IMT, carotid plaque score and carotid artery plaque incidence was significantly higher than these in normal control group.(2) SBP, DBP and PP between the three groups were no significant differences. CIMT and hr-CRP ware no related with coronary artery lesions; AASI and plaque score coronary score was positively correlated with coronary artery lesions.(3) The difference of SBP, DBP and PP between the three groups was no statistically significant; AASI, atherosclerotic plaque score and coronary score was positively correlated with coronary artery stenosis.(4) AASI,hr-CRP and carotid artery atherosclerotic plaque incidence comparison:ACS group>SA group>control group.Conclusion:(1) AASI, plaque score in patients are more important to prompted the range and severerity of coronary lesions than IMT and carotid artery plaque incidence.(2) AASI, hr-CRP and carotid artery atherosclerotic plaque was more correlated with CHD stability than IMT.(3) Gensini score is not directly related to the stability of CHD condition.

          动态动脉硬化指数、颈动脉超声与冠心病的相关性研究

中文摘要4-6Abstract6-7縮略语/符号说明9-10前言10-12    研究现状、成果10    研究目的10-12资料与方法12-16    1 研究对象12    2 研究方法12-15    3 统计学处理15-16结果16-19    1 冠心病组和正常对照组间一般资料比较16    2 冠心病组和正常对照组间AASI及超声参数比较16-17    3 4组间AASI、IMT与冠脉病变支数的比较17-18    4 4组间AASI、IMT与冠脉狭窄程度的比较18    5 各参数在稳斑组、易损斑组及对照组的比较18-19讨论19-29结论29-30参考文献30-34发表论文和参加科研情况说明34-35综述35-53    综述参考文献48-53致谢53

  本文关键词：动态动脉硬化指数、颈动脉超声与冠心病的相关性研究，，由笔耕文化传播整理发布。