颅内-外血管颈脑一体化超声检查对冠状动脉狭窄程度的诊断价值

摘要/Abstract

摘要： 目的分析颈脑一体化超声（经颅多普勒超声和颈动脉血管超声）检查颅内-外动脉血管狭窄程度对冠状动脉血管狭窄程度的诊断价值。方法选取承德医学院附属医院2019年1月~2020年12月收治的186例经冠状动脉造影检查患者为研究对象,分为冠心病组（98例）和非冠心病组（88例）2组,再根据冠心病组患者的主要冠状动脉血管病变情况及受累支数分为单支血管病变组（32例）和多支血管病变组（66例）。2组患者均行经颅多普勒超声（TCD）和颈动脉血管超声检查,测量颈动脉内-中膜厚度（IMT）、斑块厚度、数量,计算斑块积分;另统计2组患者的颈动脉和颅内动脉狭窄情况,采用Logistic回归分析对影响冠状动脉粥样硬化病变程度的危险因素进行分析。结果冠心病组患者的体质指数、吸烟和合并高血压、高血脂比例以及血清hs-CRP水平显著高于非冠心病组;颈动脉血管超声检查结果冠心病组患者的IMT、斑块积分高于非冠心病组,冠心病组中的多支血管病变亚组IMT、斑块积分高于单支血管病变组,冠心病组患者颈动脉狭窄严重程度显著高于非冠心病组。TCD检查结果表明冠心病组患者的颅内动脉狭窄严重程度显著高于非冠心病组,患者颅内动脉、颈内动脉狭窄程度越严重,冠状动脉病变程度越高,病变血管支数越多。多因素Logistic回归分析,结果显示合并高血压、高血脂、颈内动脉狭窄程度、颅内动脉狭窄程度、体质指数、hs-CRP均是影响冠状动脉粥样硬化病变程度的独立危险因素。结论颈脑一体化超声联合检查可以有效诊断颅-内外血管狭窄程度,且颅内-外动脉狭窄程度与冠状动脉狭窄程度存在显著正相关性,颅内动脉和颈动脉狭窄程度均是影响冠状动脉狭窄程度的独立危险因素。

关键词: 冠状动脉, 粥样硬化, 经颅多普勒超声, 颈动脉血管超声

Abstract: Objective To analyze the diagnostic value of carotid cerebral integrated ultrasound (Transcranial Doppler and carotid artery ultrasound) in detecting the degree of intracranial external arterial stenosis in the diagnosis of coronary artery stenosis. Methods A total of 186 patients who underwent coronary angiography in the Affiliated Hospital of Chengde Medical University from January 2019 to December 2020 were selected as the study subjects, and were divided into two groups: the coronary heart disease group (98 cases) and the non coronary heart disease group (88 cases). The patients in the coronary heart disease group were then divided into a single vessel disease group (32 cases) and a multi vessel disease group (66 cases) based on the main coronary artery disease and the number of affected branches. Transcranial Doppler (TCD) and carotid artery ultrasound were performed in both groups to measure carotid intima-media thickness (IMT), plaque thickness, and number, and calculate plaque scores. In addition, carotid and intracranial artery stenosis were counted in both groups, and the risk factors affecting the degree of coronary atherosclerosis were analyzed by logistic regression analysis. Results The body mass index, smoking, hypertension, hyperlipidemia, and serum hs-CRP levels in the coronary heart disease group were significantly higher than those in the non coronary heart disease group. Carotid artery ultrasound examination results showed that the IMT and plaque score in patients with coronary heart disease were higher than those in patients without coronary heart disease. The IMT and plaque score in the subgroup of multi vessel disease in the coronary heart disease group were higher than those in the single vessel disease group. The severity of carotid stenosis in patients with coronary heart disease was significantly higher than those in the non coronary heart disease group. The results of TCD examination showed that the severity of intracranial artery stenosis in patients with coronary heart disease was significantly higher than that in patients without coronary heart disease. The more severe the stenosis of intracranial and internal carotid arteries was, the higher the degree of coronary artery disease was, and the more branches of diseased vessels were. Multivariate logistic regression analysis showed that hypertension, hyperlipidemia, internal carotid artery stenosis , intracranial artery stenosis, body mass index, hs-CRP are independent risk factors that affecting the degree of coronary atherosclerosis. Conclusion Combined carotid and cerebral ultrasound can effectively diagnose the degree of intracranial and external vascular stenosis, and there is a significant positive correlation between the degree of intracranial and external arterial stenosis and the degree of coronary artery stenosis. The degree of intracranial and carotid artery stenosis are independent risk factors that affect the degree of coronary artery stenosis.

Key words: arteria coronaria, atherosclerosis, transcranial doppler ultrasound, carotid artery ultrasound

中图分类号:

R541.4

沈健, 刘斌, 张皓然, 李莎. 颅内-外血管颈脑一体化超声检查对冠状动脉狭窄程度的诊断价值[J]. 承德医学院学报, 2023, 40(3): 203-208.

SHEN Jian, LIU Bin, ZHANG Hao-ran, LI Sha. The Diagnostic Value of Integrated Carotid Cerebral Ultrasound Examination of Intracranial and Extracranial Vessels in the Degree of Coronary Artery Stenosis[J]. Journal of Chengde Medical University, 2023, 40(3): 203-208.

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