颈总动脉内膜中膜厚度和冠状动脉斑块形态与急性冠状动脉综合征危险分层的关系  

The Roles of Common Carotid Artery Intima-Media Thickness and Complex Coronary Lesions in Risk Stratification of Non-ST-Elevation Acute Coronary Syndromes

作　　者：梅卫义[1] 杜志民[2] 王强[1] 许庆[1] 郑东诞[1] 陈国伟[2] 

机构地区：[1]中山大学附属第一医院黄埔院区心内科,广东省广州市510700 [2]中山大学附属第一医院心内科,广东广州510080

出　　处：《中国动脉硬化杂志》2009年第9期743-746,共4页Chinese Journal of Arteriosclerosis

基　　金：广东省医学科研基金项目(A2008176)

摘　　要：目的探讨颈总动脉内膜中膜厚度及冠状动脉病变形态与急性冠状动脉综合征患者TIMI危险积分的关系，进而评估颈总动脉内膜中膜厚度在急性冠状动脉综合征患者危险分层中的作用。方法检测132例非ST段抬高型急性冠状动脉综合征患者的颈总动脉内膜中膜厚度，分析冠状动脉造影以观察有无多个复杂冠状动脉狭窄病变，考察他们与TIMI危险积分及其各个变量之间的关系。结果123例（99．2％）患者获得满意的颈动脉超声显像，颈总动脉内膜中膜厚度为0．83±0．22mm，62例（50．4％）患者的颈总动脉内膜中膜厚度值有病理意义（≥0．8mm）；仅有单个冠状动脉复杂病变患者为52例（39．4％），多个复杂病变患者有80例（60．6％）。同无病理意义颈总动脉内膜中膜厚度（〈0．8mm）的患者相比，在具有病理意义颈总动脉内膜中膜厚度的患者中，年龄≥65岁、糖尿病以及既往有缺血性心脏病史的患者比例均增多（均有P〈0．05）；而同仅有单个复杂冠状动脉病变患者相比，有多个复杂寇状动脉病变患者中，年龄≥65岁、糖尿病：既往有缺血性心脏病史的患者比例也增多（均有P〈0．05）。颈总动脉内膜中膜厚度与TIMI危险积分显著相关（r=0．25，P=0．004），多个复杂病变也与TIMI危险积分相关（r=0．31，P〈0．01）。Logistic回归分析显示，年龄≥65岁[OR：3．52（CI：1．48～9．37），P=0．001]和糖尿病[OR：3．83（CI：1．66～8．91），P=0．004]为有病理意义颈总动脉内膜中膜厚度的的预测因子，有多个复杂冠状动脉病变也与年龄≥65岁[OR：17．32（CI：6．53～52．34），P〈0．001]和糖尿病[OR：3．06（CI：1．84～8．73），P=0．006]有关。结论非ST段抬高型急性冠状动脉综合征患者的颈总动脉内膜中膜厚度及有无多个冠状动脉复杂病变均与TIMI危险积分有一定程度的关联，颈�Aim To explore the relationship of common carotid intima-media thickness （ CIMT） and the coronary lesions＇ morphology with the thrombolysis in myocardial infarction （TIMI） risk score for non-ST-elevation acute coronary syndrome （NSTEACS）. And evaluate the roles of CIMT in risk stratification of NSTEACS. Methods One hundred and thirty-two patients with NSTEACS were recruited. CIMT were measured, and the coronary angiographies were analysed to detect the single or multiple complex coronary stenostic lesions. Their correlation with TIMI risk score and its variables were investigated. Results Satisfying images of CIMT were obtained in one hundred and twenty-three patients （99.2%）, and the general CIMT was 0. 83 ± 0. 22 mm. Sixty-twopatients （50.4%） had an abnormal （≥0.8mm） CIMT, whilst 52 patients （39.4%） only had single complex coronary lesions and 80 （60.6%） had multiple complex coronary lesions. In patients with abnormal CIMT, more of them were ≥65 years old, had diabetes, or with previous ischemic heart disease, than in these without abnormal CIMT; In patients with multiple complex coronary lesions, more of them were 365 years old, had diabetes, or with previous ischemic heart disease, than in those with single complex coronary lesions. CIMT was correlated with TIMI risk score （ r = 0.25, P = 0.004 ）, whilst the presence with multiple complex lesions was associated with TIMI risk scale （ r = 0.31, P 〈 0.01 ）. Using a Logistic regression analysis, the presence of an abnormal CIMT was only related to age ≥65 [ OR： 3.52 （ CI ： 1.48 - 9.37）, P = 0. 001 ] and diabetes mellitus [ OR： 3.83 （CI： 1.66 -8.91 ）, P = 0.004 ]. The presence with multiple complex lesions was also associated with age ≥65 [OR： 17.32 （CI： 6.53-52.34）, P〈0.001 ] and diabetes mellitus[OR： 3.06 （CI： 1.84 -8.73）, P=0.006]. Conclusion CIMT and the presence of multiple complex lesions in patients with NSTEACS are correlated with TIMI risk score. Both variables were re

关 键 词：颈总动脉内膜-中膜厚度 超声多普勒 冠状动脉造影 急性冠状动脉综合征 心血管危险因素 

分 类 号：R5[医药卫生—内科学]