高分辨率超声测量动脉内膜厚度的影响因素及其诊断冠心病的价值  

Intima thickness evaluated with high resolution ultrasound:Impact factors and value for diagnosing coronary heart disease

作　　者：林培鑫 万晓钰 徐铭俊[2] 张瑜[2] 张运[2] 张梅[2] LIN Peixin;WAN Xiaoyu;XU Mingjun;ZHANG Yu;ZHANG Yun;ZHANG Mei(Department of Ultrasound,Shandong Maternity and Child Healthcare Hospital,Jinan 250000,China;Department of Cardiology,Qilu Hospital of Shandong University,Jinan 250000,China)

机构地区：[1]山东省妇幼保健院超声科,山东济南250000 [2]山东大学齐鲁医院心内科,山东济南250000

出　　处：《中国医学影像技术》2022年第8期1172-1176,共5页Chinese Journal of Medical Imaging Technology

基　　金：国家自然科学基金(82001834)。

摘　　要：目的观察高分辨率超声所测颈动脉和外周动脉内膜厚度的相关影响因素,以及内膜厚度诊断冠心病(CHD)的价值。方法纳入95例CHD患者(CHD组)和50例非CHD患者(对照组),以24 MHz高频超声测量颈动脉、桡动脉及足背动脉内膜/中膜/内-中膜厚度(cIT/cMT/cIMT、rIT/rMT/rIMT、pIT/pMT/pIMT),比较组间基本资料和超声指标差异;分析内膜厚度的相关影响因素,绘制受试者工作特征曲线,计算曲线下面积(AUC),评价各超声指标诊断CHD的价值及差异。结果CHD组患者年龄、体质量指数(BMI),高血压、高血脂、糖尿病史和服用他汀类药物者占比,以及甘油三酯、同型半胱氨酸水平均高于对照组(P均<0.05),而总胆固醇、高密度脂蛋白胆固醇(HDL-C)及低密度脂蛋白胆固醇水平均低于对照组(P均<0.001)。相比对照组,CHD组cIT、rIT、pIT、cIMT、rIMT及pIMT均增厚(P均<0.05);组间cMT、rMT、pMT差异均无统计学意义(P均>0.05)。cIT、rIT及pIT的主要影响因素包括患者年龄、BMI、高血压史、糖尿病史、吸烟史及HDL-C水平。超声模型(cIT+rIT+pIT)诊断CHD的效能优于单独cIT、rIT及pIT,其AUC=0.950、0.919、0.879及0.833(P均<0.05);相比单一临床模型(高血压史、高血脂史、糖尿病史、吸烟史及BMI≥28kg/m2,AUC=0.888),临床模型分别联合cIT、rIT、pIT及超声模型均可提高诊断效能(AUC=0.941、0.936、0.927及0.954,P均<0.05)。对于判断同一动脉的内膜厚度及IMT,cIT的效能优于cIMT(AUC=0.919、0.773,P<0.05),rIT优于rIMT(AUC=0.879、0.732,P<0.05),pIT优于pIMT(AUC=0.833、0.608,P<0.05)。结论cIT、rIT及pIT增厚的主要影响因素相似,均包括患者年龄、BMI及高血压史等;cIT、rIT及pIT对CHD的独立和联合诊断价值均较高并优于IMT;在传统临床危险因素基础上引入内膜厚度可提高诊断CHD效能。Objective To explore the impact factors of intima thickness of carotid artery and peripheral arteries measurdde with high-resolution ultrasound and the value for diagnosing coronary heart disease(CHD).Methods Totally 95 patients with CHD(CHD group)and 50 non-CHD patients(control group)were enrolled.Intima/media/intima-media thickness of carotid,radial artery and dorsal pedis artery(cIT/cMT/cIMT,rIT/rMT/rIMT,pIT/pMT/pIMT)were measured with 24 MHz high-frequency ultrasound.Then the clinical data and ultrasonic parameters were compared between groups,and the related factors affecting intima thickness were analyzed.The receiver operating characteristic curves were drawn,the areas under the curves(AUC)were calculated to evaluate the diagnostic value and difference of each ultrasonic index for diagnosing CHD.Results Patients’age,body mass index(BMI),proportion of hypertension,hyperlipidemia,diabetes and using Statin,also triglyceride and homocysteine levels were all higher(all P<0.05),while the levels of total cholesterol,high density lipoprotein cholesterol(HDL-C)and low density lipoprotein cholesterol were lower in CHD group than those in control group(all P<0.001).cIT,rIT,pIT,cIMT,rIMT and pIMT were all thicker in CHD group than those in control group(all P<0.05).There was no significant difference of cMT,rMT nor pMT between groups(all P>0.05).The main impact factors of cIT,rIT and pIT included age,BMI,hypertension,diabetes,smoking and HDL-C.The effecacy of ultrasound model(cIT+rIT+pIT)for diagnosing CHD was better than that of cIT,rIT and pIT alone(AUC=0.950,0.919,0.879,0.833,all P<0.05).Compared with clinical models(hypertension,hyperlipidemia,diabetes,smoking and BMI≥28 kg/m~2,AUC=0.888),clinical models combined with cIT,rIT,pIT and ultrasound models showed improved diagnostic efficacy(AUC=0.941,0.936,0.927,0.954,all P<0.05).A separate comparison of diagnostic efficacy of the intima thickness and IMT in same artery showed that cIT was better than cIMT(AUC=0.919,0.773,P<0.05),rIT was better than rIMT(AUC=0.879

关 键 词：冠心病 颈动脉 外周动脉 内膜厚度 超声检查 

分 类 号：R541.4[医药卫生—心血管疾病] R445.1[医药卫生—内科学]