经食管超声心动图检测主动脉粥样硬化斑块与冠状动脉病变严重程度的相关性研究  

Relationship of atherosclerotic plaque of aorta detected by transesophageal echocardiography and the severity of coronary artery disease

作　　者：何怡华[1] 李治安[1] 谷孝艳[1] J.V.(Ian)Nixon 

机构地区：[1]首都医科大学附属北京安贞医院超声诊断科,北京100029 [2]Pauley Heart Center,Virginia Commonwealth University,USA

出　　处：《中华超声影像学杂志》2009年第10期832-835,共4页Chinese Journal of Ultrasonography

基　　金：北京市优秀人才基金项目（2005ID0300619）;2008年北京市卫生局十百千项目

摘　　要：目的通过经食管超声心动图检测主动脉的不同部位不同斑块性质与冠状动脉血管病变严重程度进行对比研究，寻找冠状动脉病变严重程度的预测因素。方法对118例同时进行了经食管超声心动图及冠状动脉造影检查的患者进行对比研究。冠状动脉造影显示血管内径狭窄≥70％定义为冠状动脉病变。粥样硬化斑块厚度大于4mm，有漂浮物形成或斑块溃疡定义为复杂斑块；其他大于2mm并小于4mm的斑块定义为简单斑块。根据冠状动脉病变支数将研究对象分为4组：A组（0支病变）99例，B组（1支病变）31例，C组（2支病变）8例，D组（3支病变）30例，比较各组间粥样硬化斑块的发生部位及程度特征。结果与A组0支病变的99例相比，有血管狭窄的89例患者（包括B，C，D组）的主动脉内粥样斑块的发生率、严重度均明显增高（P〈0．05）。多元回归分析显示高血压（优势比3．0，95％可信区间1．3～7．0，P=0．013）、糖尿病（优势比2．4，95％可信区间1．1～4．9，P=0．022）及主动脉斑块（优势比3．8，95％可信区间1．8～8．2，P=0．001）与冠状动脉病变发生明显相关。简单及复杂斑块均与冠状动脉病变严重度明显相关（P〈0．001）。多元回归分析显示主动脉降部复杂斑块是冠状动脉病变的最强预测因子（优势比5．4，95％可信区间1．8～16．4，P=0．003）。结论主动脉内简单及复杂粥样斑块均与冠状动脉病变严重度明显相关。降主动脉复杂斑块是冠状动脉病变的最强预测因子。Objective To determine whether simple or complex aortic plaques seen on transesophageal echocardiograpy（TEE） correlated with the extent, location and severity of aortic atherosclerosis with coronary artery disease（CAD）. Methods The study population consisted of 188 TEE patients who also underwent coronary angiography. Atherosclerotic plaques seen on TEE were defined as （1） complex plaques in the presence of protruding atheroma 〉4 mm thickness,mobile debris,or plaque ulceration,or （2）simple plaques in the absence of findings consistent with complex plaques. The extent of CAD was grouped into four groups according to the number of coronary vessels with ≥70% stenosis. The patients were divided into 4 groups according to this too. Group A was patients with 0 vessel diseases and the number were 99,Group B was patients with I vessel diseases and the number were 31, Group C was patients with 2 vessel diseases and the number were 28, Group D was patients with 3 vessel diseases and the number were 30. Results Compared to group A, patients with CAD （including group B, C and D） had a significantly greater prevalence of aortic atherosclerotic plaques,irrespective of the degree of plaque complexity or location （ P 〈0. 05）. Multivariate analysis found that hypertension （odds ratio 3.0,95%CI 1.3 to 7.0, P = 0. 013） ,diabetes mellitus （odds ratio 2.4,95%CI 1.1 to 4.9, P = 0. 022） and aortic plaque （odds ratio 3.8,95% CI 1.8 to 8.2, P = 0. 001） were significantly associated with CAD. There was a significant relationship between simple and complex aortic plaques and the increasing severity of CAD （ P〈0. 001）. Multivariate logistic regression analysis showed that the complex plaque in the descending aorta （Odds ratio 5.4,95% CI 1.8 to 16.4, P = 0. 003） was the strongest predictor of CAD. Conclusions Both simple and complex thoracic atherosclerotic plaques detected by TEE are associated with the increasing severity of CAD. Complex plaque in the descending aorta was the strongest as

关 键 词：超声心动描记术 经食管 主动脉 动脉粥样硬化 冠状动脉疾病 

分 类 号：R686[医药卫生—骨科学]