發(fā)布時間：2018-08-26 17:48

【摘要】： 目的:冠心病(coronary artery disease CAD)是危害人類健康的主要疾病之一,目前已成為人類死亡的重要原因。冠狀動脈粥樣硬化(coronary atherosclerosis CAA)是冠心病的主要病理生理基礎。冠狀動脈鈣化(coronary artery calciation CAC)是冠狀動脈粥樣硬化敏感而特異的標記之一。目前檢測冠狀動脈鈣化的最佳方法是應用多層螺旋CT(multi slice computed tomography MSCT)計算鈣化積分(calcium score CS),CS與選擇冠狀動脈造影(selective coronary angiography SCA)顯示的冠狀動脈粥樣硬化性狹窄有很好的相關性。 動脈彈性(elasticity)異常是冠心病的危險因素,它可能通過兩種機制影響冠狀動脈粥樣硬化的發(fā)生:一是增大脈壓;二是動脈彈性異常與冠狀動脈粥樣硬化有著相同的發(fā)生機制,如內皮功能障礙、鈣化等。冠狀動脈鈣化與動脈彈性變化可能存在某種關系,即冠狀動脈鈣化與動脈彈性異�？赡芑闃擞�,且兩者均能揭示冠狀動脈粥樣硬化。依據脈搏波傳導原理推導出的大動脈彈性指數C1和小動脈彈性指數C2是目前反映大動脈彈性功能與小動脈彈性功能變化的理想指標之一,C2與動脈內皮功能密切相關,C2的降低可以作為動脈內皮功能損害的靈敏標識。本試驗對80例CS正常者和52例CS異常者進行C1、C2檢測,旨在研究CS和C1、C2之間的相關性,同時探討冠心病危險因素對CS和C1、C2的影響。 方法:采用16排螺旋CT(GE-MSCT)及HDI CV Profiler Do-2020無創(chuàng)動脈功能檢測儀(美國HDI公司),對132例入選者(其中健康人34例,冠心病人46例,高血壓病人52例)分別進行鈣化積分(CS)測定及C1、C2的檢測,同時記錄體重指數(BMI Kg/m2)、收縮壓(SBP)、舒張壓(DBP)、脈壓(PP)、脈率(PR)、平均壓(MP)。按照CS測定結果進行分組,以CS值300為界限,CS≥300為異常組,CS300為正常組。 結果:1、在健康人組、高血壓組及冠心病組中均顯示隨年齡增長,C1、C2降低,而CS隨年齡增長而增大,有顯著性差異。2、高血壓組及冠心病組與健康人組比較,CS數值在各年齡段均明顯高于健康組,(P0.01),冠心病組C1、C2值下降達到統(tǒng)計學差異(P0.05);高血壓組C1下降未達到統(tǒng)計學差異,但C2在年輕組中即表現出顯著下降(P0.01)。3、冠心病組與高血壓組相比,CS隨年齡增高達顯著性統(tǒng)計學差異,而C1、C2值在兩組間無統(tǒng)計學差異。4、CS與C1、C2呈顯著性負相關,相關系數分別為-0.102,-0.322(P0.01)。5、CS≥300者較CS300者C1、C2值顯著降低。 結論:1、冠狀動脈鈣化積分CS和大動脈彈性指數C1、小動脈彈性指數C2是兩種能發(fā)現早期動脈硬化的敏感、無創(chuàng)的特異性指標。2、冠狀動脈鈣化積分CS與C1、C2可同樣反映各種心血管危險因素對動脈血管功能及結構的損傷。3、動脈彈性指標C1、C2揭示的是血管病變早期的功能改變,而CS反映的是血管病變的結構改變,兩者可作為早期心血管病變的預測指標。4、CS、C1、C2的監(jiān)測不僅可預示心血管疾病的發(fā)生還提示動脈血管病變損害的程度。
[Abstract]:Objective: Coronary artery disease (CAD) is one of the main diseases endangering human health, and has become an important cause of human death. Coronary atherosclerosis (CAA) is the main pathophysiological basis of coronary heart disease. Coronary artery calcification (CAC) is the main cause of coronary atherosclerosis. The best way to detect coronary artery calcification is to use multi-slice computed tomography (MSCT) to calculate calcium score CS, which is well matched with selective coronary angiography (SCA) in detecting coronary artery stenosis. Customs.
Abnormal arterial elasticity is a risk factor for coronary heart disease. It may affect the occurrence of coronary atherosclerosis through two mechanisms: one is to increase arterial pressure; the other is that arterial elasticity abnormalities and coronary atherosclerosis have the same mechanism, such as endothelial dysfunction, calcification and so on. There may be some relationship between coronary artery calcification and arterial elasticity abnormality, and both of them can reveal coronary atherosclerosis. The elastic index C1 and C2 derived from the principle of pulse wave conduction are ideal indicators to reflect the elastic function of large arteries and the elastic function of small arteries. One is that C2 is closely related to arterial endothelial function. The reduction of C2 can be used as a sensitive marker of arterial endothelial dysfunction. C1 and C2 were detected in 80 normal CS subjects and 52 abnormal CS subjects. The aim of this study was to study the correlation between CS and C1 and C2, and to explore the influence of coronary heart disease risk factors on CS and C1 and C2.
Methods: 132 patients (including 34 healthy subjects, 46 patients with coronary heart disease and 52 patients with hypertension) were examined by 16-slice spiral CT (GE-MSCT) and HDI CV Profiler Do-2020 noninvasive arterial function tester (HDI Company). The body mass index (BMI Kg/m2), systolic blood pressure (SBP) and diastolic blood pressure (D) were recorded simultaneously. BP, PP, PR and MP were grouped according to the results of CS. CS value 300 was taken as the limit, CS (> 300) as abnormal group and CS300 as normal group.
Results: 1. In the healthy group, hypertension group and coronary heart disease group, C1, C2 decreased with age, while CS increased with age, there was a significant difference. 2. Compared with the healthy group, the CS values in the hypertension group and coronary heart disease group were significantly higher than those in the healthy group (P 0.01), and the values of C1 and C2 in the coronary heart disease group decreased significantly (P 0.01). There was no significant difference between the two groups in the values of C1 and C2, but the correlation coefficients were - 0.102 and - 0.322 (P 0.01). The values of.5, CS or 300 were significantly lower than those of CS300, C1 and C2 values.
Conclusion: 1. Coronary artery calcification score CS and arterial elasticity index C1, small artery elasticity index C2 are two sensitive and noninvasive specificity indicators to detect early atherosclerosis. 2. Coronary artery calcification score CS and C1, C2 can also reflect the damage of various cardiovascular risk factors to arterial function and structure. 3. Artery elasticity index C1, C2. CS can be used as a predictor of early cardiovascular disease. 4. Monitoring of CS, C1, C2 can not only predict the occurrence of cardiovascular disease, but also indicate the extent of vascular lesion damage.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2007
【分類號】：R363

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