原发性高血压患者颈动脉病变与冠状动脉狭窄的相关性研究  

Correlation between carotid artery lesions and coronary artery stenosisin patients with essential hypertension

作　　者：张俊仕[1] 杨晓萍[2] ZHANG Junshi;YANG Xiaoping(Hypertension Department of the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054;Health Examination Department,School of Health Management,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院高血压科,新疆乌鲁木齐830054 [2]新疆医科大学第一附属医院健康管理学院健康体检部,新疆乌鲁木齐830054

出　　处：《西安交通大学学报(医学版)》2025年第1期138-143,共6页Journal of Xi’an Jiaotong University(Medical Sciences)

基　　金：新疆维吾尔自治区自然科学基金资助(No.2022D01C238)。

摘　　要：目的 探究颈动脉超声病变指标在预测原发性高血压患者冠状动脉狭窄中的价值,并分析其与冠状动脉狭窄程度的相关性。方法 选取2020年1月至2023年9月期间就诊于我院心脏中心并确诊为原发性高血压的4 691例患者作为研究对象,所有入选患者均已完成颈动脉超声和冠状动脉造影检查。收集临床基线资料,通过Gensini积分对冠状动脉狭窄程度进行了量化,结合颈动脉超声指标,包括阻力指数(resistance index, RI)和搏动指数(pulsatility index, PI)值、颈动脉内中膜厚度(intima-media thickness, IMT)值、内膜增厚、斑块形成、管腔狭窄进行详细评估,为消除混杂因素的影响,对颈动脉病变分层数据,构建了6个多因素Logistic回归模型进一步分析。结果 Pearson相关性分析显示,高血压患者的PI、RI、IMT与冠状动脉狭窄的Gensini积分均呈显著正相关(PI左:r=0.041,P=0.005;PI右:r=0.035,P=0.017;RI左:r=0.119,P<0.001;RI右:r=0.032,P=0.027;IMT:r=0.043,P=0.003)。多因素Logistic回归分析结果显示,颈动脉斑块形成和狭窄状态与高血压患者发生冠状动脉粥样硬化性心脏病(CAD)的风险增加显著相关(P<0.001),而在校正性别、年龄、学历、吸烟史、收缩压等因素的模型2和进一步校正血液指标如白细胞计数、肌酐、血脂等的模型3中,内膜增厚与CAD风险降低显著相关(P=0.009)。颈动脉病变分层分析表明,在内膜增厚合并斑块形成的模型5和斑块形成合并狭窄的模型6中,颈动脉内膜增厚+斑块形成、颈动脉斑块形成+狭窄与CAD风险增加显著相关(P<0.001),而在单纯内膜增厚的模型4中的差异无统计学意义(P=0.127)。结论 颈动脉超声的病变特征与原发性高血压患者冠状动脉狭窄风险密切相关,颈动脉病变可作为评估高血压患者冠状动脉疾病风险的有效工具。Objective To investigate the value of carotid ultrasonographic lesion indices in predicting coronary artery stenosis in patients with essential hypertension,and to analyze their correlation with the degree of coronary artery stenosis.Methods A total of 4691 patients diagnosed with essential hypertension who visited our cardiac center between January 2020 and September 2023 were included in this study.All the patients underwent carotid ultrasound exam and coronary angiography.Their baseline clinical data were collected,and the severity of coronary artery stenosis was quantified using the Gensini score.Carotid ultrasound parameters,including resistance index(RI),pulsatility index(PI),intima-media thickness(IMT),intimal thickening,plaque formation and luminal stenosis,were evaluated in detail.To control for potential confounders,six multivariate Logistic regression models were constructed to analyze the stratified data on carotid artery lesions.Results Pearson correlation analysis revealed significant positive correlations of PI,RI and IMT with the Gensini score of coronary artery stenosis in hypertensive patients(left PI:r=0.041,P=0.005;right PI:r=0.035,P=0.017;left RI:r=0.119,P<0.001;right RI:r=0.032,P=0.027;IMT:r=0.043,P=0.003).Multivariate Logistic regression analysis indicated that carotid plaque formation and stenosis were significantly associated with an increased risk of coronary artery disease(CAD)in hypertensive patients(P<0.001),while intimal thickening was associated with a significantly decreased risk of CAD(P=0.009).Model 2 adjusted for sex,age,educational level,smoking history,systolic blood pressure,and other variables,while Model 3 further adjusted for blood parameters,including white blood cell count,creatinine,and lipid profiles.Stratified analysis of carotid artery lesions showed that intimal thickening combined with plaque formation(Model 5)and plaque formation combined with stenosis(Model 6)were significantly associated with an increased risk of CAD(P<0.001).In contrast,the difference in patien

关 键 词：原发性高血压 颈动脉病变 冠状动脉狭窄 

分 类 号：R544.1[医药卫生—心血管疾病] R543[医药卫生—内科学] R651.1[医药卫生—临床医学]