本文關(guān)鍵詞：動(dòng)態(tài)動(dòng)脈硬化指數(shù)、頸動(dòng)脈超聲與冠心病的相關(guān)性研究，由筆耕文化傳播整理發(fā)布。

        研究背景與目的：動(dòng)脈血管壁結(jié)構(gòu)和功能的改變與心血管疾病的發(fā)病和死亡密切相關(guān)。隨著年齡的增加,血管僵硬度增加,收縮壓及脈壓差增大,導(dǎo)致血管壁成分和剪切力改變,進(jìn)一步加劇血管硬化。由于彈性成分下降,非彈性成分增加,導(dǎo)致動(dòng)脈血管壁增厚,血管內(nèi)-中膜厚度增加,同時(shí)動(dòng)脈彈性、血管擴(kuò)張性下降,動(dòng)脈僵硬度增加,已被證明可以引起心血管不良預(yù)后。作為研究動(dòng)脈彈性特征的指標(biāo),動(dòng)態(tài)動(dòng)脈硬化指數(shù)(AASI)及頸總動(dòng)脈內(nèi)中膜厚度(IMT)、斑塊形成情況等指標(biāo)由于其簡(jiǎn)便、可重復(fù)性及無(wú)創(chuàng)特點(diǎn)越來(lái)越受到臨床研究的重視。為了研究無(wú)創(chuàng)的外周動(dòng)脈粥樣硬化檢測(cè)技術(shù)與冠心病的相關(guān)性及其臨床意義,本研究將臨床常用的24h動(dòng)態(tài)血壓監(jiān)測(cè)技術(shù)和頸動(dòng)脈超聲技術(shù)相結(jié)合,通過(guò)計(jì)算動(dòng)態(tài)動(dòng)脈硬化指數(shù)、測(cè)量頸總動(dòng)脈內(nèi)中膜厚度、斑塊數(shù)量及其形態(tài)學(xué)特點(diǎn),并結(jié)合冠脈造影、血清學(xué)檢測(cè),研究動(dòng)態(tài)動(dòng)脈硬化指數(shù)、頸動(dòng)脈粥樣硬化指標(biāo)、血清hr-CRP與冠狀動(dòng)脈病變的相關(guān)性及其臨床意義。資料與方法：回顧性分析了我院2009年11月至2011年10月期間468例心內(nèi)科住院患者的一般資料、冠狀動(dòng)脈造影結(jié)果、頸動(dòng)脈超聲檢測(cè)結(jié)果、24h動(dòng)態(tài)血壓監(jiān)測(cè)結(jié)果。根據(jù)頸動(dòng)脈超聲檢測(cè)結(jié)果,我們對(duì)雙側(cè)頸總動(dòng)脈IMT、頸動(dòng)脈斑塊數(shù)量、斑塊評(píng)分及頸動(dòng)脈斑塊表面情況及內(nèi)部回聲特點(diǎn)進(jìn)行評(píng)估。分析所有入選對(duì)象的24h血壓監(jiān)測(cè)結(jié)果,通過(guò)24h動(dòng)態(tài)血壓數(shù)據(jù)計(jì)算各AASI:(AASI)=1-收縮壓與舒張壓直線回歸的斜率。同時(shí),對(duì)所有入選對(duì)象的冠脈造影結(jié)果進(jìn)行Gensini評(píng)分。根據(jù)冠狀動(dòng)脈造影所示冠狀動(dòng)脈病變情況將所有入選對(duì)象分為2組：冠心病組與非冠心病組(即正常對(duì)照組)；又按冠脈造影所示病變血管支數(shù)將冠心病組分為3組：冠脈1支病變組、2支病變組、3支病變組；按照冠脈造影所示冠脈狹窄程度將冠心病組分為2組：冠脈輕度狹窄組、重度狹窄組。根據(jù)冠脈造影及入院診斷將所有入選者分為穩(wěn)定性心絞痛組、急性冠脈綜合征組及對(duì)照組。將各組中的AASI、IMT、斑塊積分、斑塊發(fā)生率、Gensini積分、血清hr-CRP情況進(jìn)行比較。結(jié)果：(1)冠心病組和非冠心病組的性別構(gòu)成比、年齡、BMI、SBP、DBP、PP、左室舒張末徑、射血分?jǐn)?shù),合并高血壓、糖尿病及冠心病家族史等因素差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05),冠心病組吸煙者比例、合并高脂血癥者比例及血清hr-CRP水平高于對(duì)照組,AASI、IMT、頸動(dòng)脈斑塊積分、斑塊發(fā)生率顯著高于對(duì)照組(P<0．05)(2)正常對(duì)照組、冠脈1支病變組、2支病變組、3支病變組間SBP、DBP和PP差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05)。經(jīng)相關(guān)性分析得IMT、頸動(dòng)脈粥樣斑塊發(fā)生率、血清hr-CRP與冠狀動(dòng)脈病變支數(shù)無(wú)相關(guān)性；AASI、斑塊積分、冠脈評(píng)分與冠狀動(dòng)脈病變支數(shù)呈正相關(guān)性,其中AASI的相關(guān)系數(shù)最大。(3) AASI、粥樣硬化斑塊積分、冠脈評(píng)分與冠脈狹窄程度呈正相關(guān)性,其中AASI的相關(guān)系數(shù)較大,CIMT、頸動(dòng)脈粥樣斑塊發(fā)生率、hr-CRP與冠狀動(dòng)脈病變程度無(wú)相關(guān)性。(4)穩(wěn)定性心絞痛組、急性冠脈綜合征組間冠脈評(píng)分、CIMT、斑塊積分差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0.10)。急性冠脈綜合征組頸動(dòng)脈易損斑塊發(fā)生率、hs-CRP、 AASI高于穩(wěn)定性心絞痛組和對(duì)照組(P<0.05),穩(wěn)定性心絞痛組高于對(duì)照組(P<0.05),經(jīng)相關(guān)性分析得出頸動(dòng)脈易損斑塊發(fā)生率、hs-CRP、AASI與冠心病病情穩(wěn)定性成正相關(guān)性,其中易損斑塊發(fā)生率的相關(guān)系數(shù)最大。結(jié)論：(1)冠心病患者AASI、頸動(dòng)脈斑塊積分升高比IMT、頸動(dòng)脈斑塊發(fā)生率更能提示冠狀動(dòng)脈病變范圍廣、狹窄程度重。(2)頸動(dòng)脈易損斑塊的檢出、hr-CRP及AASI水平增高與冠心病病情穩(wěn)定性密切相關(guān)。(3) Gensini評(píng)分是根據(jù)冠脈管腔病變范圍及狹窄程度對(duì)病變嚴(yán)重程度進(jìn)行評(píng)估,而與冠心病病情穩(wěn)定性無(wú)直接關(guān)系。

    Background and Purpose:The changes in the structure and function of arterial wall are closely related with the morbidity of cardiovascular disease. With age increasing, vascular stiffness increases and systolic blood pressure and pulse pressure increases, so that the composition of the vessel wall and shear stress change, further exacerbating the hardening of the arteries. As the elastic component decreased and the inelastic component increased, the thickness of arterial wall and vascular intima-media are thickening, the vasodilator and elasticity of arterial are decreasing, and the arterial stiffness are increasing. Those have been shown to cause adverse cardiovascular prognosis. In order to study the relation between the arterial elastic properties and coronary artery disease and its clinical significance, the ambulatory arterial stiffness index (AASI), intima-media thickness (IMT) and plaque formation index have been used increasingly in clinical studies as they are the simple and reproducible non-invasive techniques. In this paper,24h ambulatory blood pressure monitoring and carotid ultrasound technology are combined, and research the correlation and its clinical significance between AASI, carotid atherosclerosis, serum hr-CRP and coronary artery disease.Materials and Methods:Retrospectively analyzed the general information, coronary angiography, carotid ultrasound test results and24h ambulatory blood pressure monitoring data of468hospitalized patients in the Cardiology Department from2009November to2011October. The IMT, carotid artery plaque number, plaque score, plaque surface conditions and internal echo are assessed based on carotid ultrasound test results. Analysis the24h blood pressure monitoring results of all selected objects and calculate the AASI. At the same time, we calculate the Gensini’ score for all selected objects through coronary angiography. All subjects were divided into coronary heart disease group (CHD) and non-coronary heart disease group (control group) by coronary angiography; The patients in the CHD group were divided into three groups:single vascular disease group, double vascular disease group, triple vascular disease group; According to coronary angiography, the patients in the CHD group were divided into two groups:narrow group and occlusion group. All selected subjects were divided into ACS group, AS group and control group. To analyze the AASI, IMT, plaque score, plaque incidence and Gensini’scores of each group, and to determine its clinical significance.Results:(1)The gender composition, age, BMI, SBP and DBP, PP, left ventricle diastole diameter, ejection fraction, hypertension, diabetes and coronary heart disease and family history between CHD group and normal control group were no significant differences.In CHD group, smoking, Hyperlipidemia, hr-CRP, AASI, IMT, carotid plaque score and carotid artery plaque incidence was significantly higher than these in normal control group.(2) SBP, DBP and PP between the three groups were no significant differences. CIMT and hr-CRP ware no related with coronary artery lesions; AASI and plaque score coronary score was positively correlated with coronary artery lesions.(3) The difference of SBP, DBP and PP between the three groups was no statistically significant; AASI, atherosclerotic plaque score and coronary score was positively correlated with coronary artery stenosis.(4) AASI,hr-CRP and carotid artery atherosclerotic plaque incidence comparison:ACS group>SA group>control group.Conclusion:(1) AASI, plaque score in patients are more important to prompted the range and severerity of coronary lesions than IMT and carotid artery plaque incidence.(2) AASI, hr-CRP and carotid artery atherosclerotic plaque was more correlated with CHD stability than IMT.(3) Gensini score is not directly related to the stability of CHD condition.

          動(dòng)態(tài)動(dòng)脈硬化指數(shù)、頸動(dòng)脈超聲與冠心病的相關(guān)性研究

中文摘要4-6Abstract6-7縮略語(yǔ)/符號(hào)說(shuō)明9-10前言10-12    研究現(xiàn)狀、成果10    研究目的10-12資料與方法12-16    1 研究對(duì)象12    2 研究方法12-15    3 統(tǒng)計(jì)學(xué)處理15-16結(jié)果16-19    1 冠心病組和正常對(duì)照組間一般資料比較16    2 冠心病組和正常對(duì)照組間AASI及超聲參數(shù)比較16-17    3 4組間AASI、IMT與冠脈病變支數(shù)的比較17-18    4 4組間AASI、IMT與冠脈狹窄程度的比較18    5 各參數(shù)在穩(wěn)斑組、易損斑組及對(duì)照組的比較18-19討論19-29結(jié)論29-30參考文獻(xiàn)30-34發(fā)表論文和參加科研情況說(shuō)明34-35綜述35-53    綜述參考文獻(xiàn)48-53致謝53

  本文關(guān)鍵詞：動(dòng)態(tài)動(dòng)脈硬化指數(shù)、頸動(dòng)脈超聲與冠心病的相關(guān)性研究，，由筆耕文化傳播整理發(fā)布。