目的 分析颈动脉中重度狭窄与冠状动脉病变严重程度的相关性.方法 选取2012年1-12月首都医科大学附属北京安贞医院入院拟诊冠状动脉粥样硬化性心脏病(冠心病)患者554例,均行冠状动脉造影和颈动脉超声检查.记录纳入病例的临床资料,分析冠心病多支病变危险因素及颈动脉中重度狭窄与冠状动脉病变严重程度的相关性.结果 确诊冠心病442例,其中单支病变45例,双支病变81例,三支病变316例,非冠心病患者与冠心病单支、双支、三支病变患者年龄、男性比例、高血压史、糖尿病史、吸烟史、高密度脂蛋白胆固醇(HDL-C)、高敏C反应蛋白(hs-CRP)、尿素氮、血清肌酐、尿酸分别为(58±10)、(60±10)、(62±9)、(62±10)岁,56.3％ (63/112)、77.8％(35/45)、74.1％(60/81)、78.2％(247/316),46.4％(52/112)、75.6％(34/45)、75.3％ (61/81)、71.2％ (225/316),17.9％ (20/112)、28.9％(13/45)、54.3％ (44/81)、43.0％(136/316),33.9％(38/112)、40.0％(18/45)、55.6％ (45/81)、46.8％(148/316),(1.07±0.28)、(1.07 ±0.25)、(1.00±0.25)、(0.99 ±0.24) mmoL/L,(3.4±1.4)、(2.0±1.1)、(4.5±1.4)、(4.6±1.3)mg/L,(5.3±1.5)、(5.4±1.3)、(6.2±3.8)、(5.7±1.7)mmol/L,(72±15)、(72±14)、(83±29)、(80±31) μmol/L,(318±80)、(317 ±95)、(352±107)、(334±85) μmol/L,组间差异均有统计学意义(均P ＜0.05).颈动脉中重度狭窄(狭窄≥50％)115例,颈动脉轻度狭窄(狭窄＜50％)患者冠心病、单支病变、三支病变、多支病变比例与颈动脉中重度狭窄(狭窄≥50％)患者比较[75.2％ (330/439)比97.4％(112/115)、9.6％(42/439)比2.6％ (3/115)、52.2％(229/439)比75.7％(87/115)、65.6％(288/439)比94.8％ (109/115)],差异均有统计学意义(均P＜0.05);颈动脉轻度狭窄患者双支病变比例与颈动脉中重度狭窄患者比较,差异无统计学意义(P＞0.05).冠状动脉病变危险因素分析显示颈动脉斑块(比值比=82.04,95％置信区间:36.56 ～184.06,P＜0.01)是冠心病的独立危险因素;吸烟史(比值比=1.89,95％置信区间:1.02 ～3.51,P=0.042)、低HDL-C(比值比=1.89,95％置信区间:1.07～ 3.33,P=0.029)、颈动脉斑块(比值比=39.47,95％置信区间:19.64 ～79.31,P＜0.001)、颈动脉中重度狭窄(比值比=2.71,95％置信区间:1.09 ～6.76,P=0.032)是冠心病多支病变的独立危险因素.结论 冠状动脉病变与性别、年龄、高血压史、糖尿病史、吸烟史、低HDL-C、hs-CRP增高、肾功能异常关系密切;吸烟史、低HDL-C、颈动脉斑块及颈动脉中重度狭窄是冠心病多支病变的独立危险因素.
目的 分析頸動脈中重度狹窄與冠狀動脈病變嚴重程度的相關性.方法 選取2012年1-12月首都醫科大學附屬北京安貞醫院入院擬診冠狀動脈粥樣硬化性心髒病(冠心病)患者554例,均行冠狀動脈造影和頸動脈超聲檢查.記錄納入病例的臨床資料,分析冠心病多支病變危險因素及頸動脈中重度狹窄與冠狀動脈病變嚴重程度的相關性.結果 確診冠心病442例,其中單支病變45例,雙支病變81例,三支病變316例,非冠心病患者與冠心病單支、雙支、三支病變患者年齡、男性比例、高血壓史、糖尿病史、吸煙史、高密度脂蛋白膽固醇(HDL-C)、高敏C反應蛋白(hs-CRP)、尿素氮、血清肌酐、尿痠分彆為(58±10)、(60±10)、(62±9)、(62±10)歲,56.3％ (63/112)、77.8％(35/45)、74.1％(60/81)、78.2％(247/316),46.4％(52/112)、75.6％(34/45)、75.3％ (61/81)、71.2％ (225/316),17.9％ (20/112)、28.9％(13/45)、54.3％ (44/81)、43.0％(136/316),33.9％(38/112)、40.0％(18/45)、55.6％ (45/81)、46.8％(148/316),(1.07±0.28)、(1.07 ±0.25)、(1.00±0.25)、(0.99 ±0.24) mmoL/L,(3.4±1.4)、(2.0±1.1)、(4.5±1.4)、(4.6±1.3)mg/L,(5.3±1.5)、(5.4±1.3)、(6.2±3.8)、(5.7±1.7)mmol/L,(72±15)、(72±14)、(83±29)、(80±31) μmol/L,(318±80)、(317 ±95)、(352±107)、(334±85) μmol/L,組間差異均有統計學意義(均P ＜0.05).頸動脈中重度狹窄(狹窄≥50％)115例,頸動脈輕度狹窄(狹窄＜50％)患者冠心病、單支病變、三支病變、多支病變比例與頸動脈中重度狹窄(狹窄≥50％)患者比較[75.2％ (330/439)比97.4％(112/115)、9.6％(42/439)比2.6％ (3/115)、52.2％(229/439)比75.7％(87/115)、65.6％(288/439)比94.8％ (109/115)],差異均有統計學意義(均P＜0.05);頸動脈輕度狹窄患者雙支病變比例與頸動脈中重度狹窄患者比較,差異無統計學意義(P＞0.05).冠狀動脈病變危險因素分析顯示頸動脈斑塊(比值比=82.04,95％置信區間:36.56 ～184.06,P＜0.01)是冠心病的獨立危險因素;吸煙史(比值比=1.89,95％置信區間:1.02 ～3.51,P=0.042)、低HDL-C(比值比=1.89,95％置信區間:1.07～ 3.33,P=0.029)、頸動脈斑塊(比值比=39.47,95％置信區間:19.64 ～79.31,P＜0.001)、頸動脈中重度狹窄(比值比=2.71,95％置信區間:1.09 ～6.76,P=0.032)是冠心病多支病變的獨立危險因素.結論 冠狀動脈病變與性彆、年齡、高血壓史、糖尿病史、吸煙史、低HDL-C、hs-CRP增高、腎功能異常關繫密切;吸煙史、低HDL-C、頸動脈斑塊及頸動脈中重度狹窄是冠心病多支病變的獨立危險因素.
목적 분석경동맥중중도협착여관상동맥병변엄중정도적상관성.방법 선취2012년1-12월수도의과대학부속북경안정의원입원의진관상동맥죽양경화성심장병(관심병)환자554례,균행관상동맥조영화경동맥초성검사.기록납입병례적림상자료,분석관심병다지병변위험인소급경동맥중중도협착여관상동맥병변엄중정도적상관성.결과 학진관심병442례,기중단지병변45례,쌍지병변81례,삼지병변316례,비관심병환자여관심병단지、쌍지、삼지병변환자년령、남성비례、고혈압사、당뇨병사、흡연사、고밀도지단백담고순(HDL-C)、고민C반응단백(hs-CRP)、뇨소담、혈청기항、뇨산분별위(58±10)、(60±10)、(62±9)、(62±10)세,56.3％ (63/112)、77.8％(35/45)、74.1％(60/81)、78.2％(247/316),46.4％(52/112)、75.6％(34/45)、75.3％ (61/81)、71.2％ (225/316),17.9％ (20/112)、28.9％(13/45)、54.3％ (44/81)、43.0％(136/316),33.9％(38/112)、40.0％(18/45)、55.6％ (45/81)、46.8％(148/316),(1.07±0.28)、(1.07 ±0.25)、(1.00±0.25)、(0.99 ±0.24) mmoL/L,(3.4±1.4)、(2.0±1.1)、(4.5±1.4)、(4.6±1.3)mg/L,(5.3±1.5)、(5.4±1.3)、(6.2±3.8)、(5.7±1.7)mmol/L,(72±15)、(72±14)、(83±29)、(80±31) μmol/L,(318±80)、(317 ±95)、(352±107)、(334±85) μmol/L,조간차이균유통계학의의(균P ＜0.05).경동맥중중도협착(협착≥50％)115례,경동맥경도협착(협착＜50％)환자관심병、단지병변、삼지병변、다지병변비례여경동맥중중도협착(협착≥50％)환자비교[75.2％ (330/439)비97.4％(112/115)、9.6％(42/439)비2.6％ (3/115)、52.2％(229/439)비75.7％(87/115)、65.6％(288/439)비94.8％ (109/115)],차이균유통계학의의(균P＜0.05);경동맥경도협착환자쌍지병변비례여경동맥중중도협착환자비교,차이무통계학의의(P＞0.05).관상동맥병변위험인소분석현시경동맥반괴(비치비=82.04,95％치신구간:36.56 ～184.06,P＜0.01)시관심병적독립위험인소;흡연사(비치비=1.89,95％치신구간:1.02 ～3.51,P=0.042)、저HDL-C(비치비=1.89,95％치신구간:1.07～ 3.33,P=0.029)、경동맥반괴(비치비=39.47,95％치신구간:19.64 ～79.31,P＜0.001)、경동맥중중도협착(비치비=2.71,95％치신구간:1.09 ～6.76,P=0.032)시관심병다지병변적독립위험인소.결론 관상동맥병변여성별、년령、고혈압사、당뇨병사、흡연사、저HDL-C、hs-CRP증고、신공능이상관계밀절;흡연사、저HDL-C、경동맥반괴급경동맥중중도협착시관심병다지병변적독립위험인소.
Objective To explore the correlation between the degree of carotid stenosis and the severity of carotid artery diseases.Methods Totally 554 patients with suspected coronary heart disease (CHD) from January to December 2012 underwent coronary angiography and ultrasonography of carotid artery.The clinical data were recorded; the correlation between the degree of carotid stenosis and the severity of carotid artery diseases plus the risk factors of multiple-vessel disease were analyzed.Results Totally 442 patients were diagnosed of CHD,including 45 cases of single-vessel disease,81 cases of double-vessel disease and 316 cases of triple-vessel disease.Among patients of non-CHD,CHD with single-vessel disease,CHD with double-vessel disease and CHD with triple-vessel disease,the corresponding age was (58 ± 10),(60 ± 10),(62 ±9),(62 ± 10) years old; male was 56.3％ (63/112),77.8％ (35/45),74.1％ (60/81),78.2％ (247/316) ; hypertension was 46.4％ (52/112),75.6％ (34/45),75.3％ (61/81),71.2％ (225/316); diabetes was 17.9％ (20/112),28.9％ (13/45),54.3％ (44/81),43.0％ (136/316) ; smoker was 33.9％ (38/112),40.0％ (18/45),55.6％ (45/81),46.8％ (148/316) ; high density lipoprotein cholesterol (HDL-C) was (1.07 ± 0.28),(1.07 ± 0.25),(1.00 ± 0.25),(0.99 ± 0.24) mmol/L; high sensitivity C reactive protein was (3.4 ± 1.4),(2.0±1.1),(4.5±1.4),(4.6±1.3)mg/L; blood urea nitrogen was (5.3±1.5),(5.4±1.3),(6.2± 3.8),(5.7 ± 1.7) mmol/L; serum creatinine was (72 ± 15),(72 ± 14),(83 ±29),(80 ±31) μmol/L; uric was (318 ± 80),(317 ± 95),(352 ± 107),(334 ± 85) μmol/L; there were all significant differences among different patients (P ＜ 0.05).Carotid arteries ultrasound showed that 115 patients were affected by moderateto-severe carotid artery stenosis (stenosis ≥50％).The proportions of CHD,CHD with single-vessel disease,CHD with double-vessel disease,CHD with triple-vessel disease,CHD with multiple-vessel disease were significantly different between patients with carotid artery stenosis ＜ 50％ and ≥ 50％ [75.2％ (330/439) vs 97.4％ (112/115),9.6％ (42/439) vs2.6％ (3/115),52.2％ (229/439) vs75.7％ (87/115),65.6％ (288/439) vs 94.8％ (109/115)] (P ＜ 0.05).The analysis of risk factors of coronary diseases showed that carotid artery plaque was an independent risk factor of C HD (OR =82.04,95 ％ CI:36.56-184.06,P ＜ 0.001) ;smoking history (OR =1.89,95％ CI:1.02-3.51,P =0.042),low HDL-C level (OR =1.89,95％ CI:1.07-3.33,P =0.029),carotid artery plaque (OR =39.47,95％ CI:19.64-79.31,P ＜ 0.001) and moderateto-severe carotid artery stenosis (OR =2.71,95％ CI:1.09-6.76,P =0.032) were independent risk factors of multiple-vessel disease.Conclusion Coronary diseases are closely related to gender,age,hypertension,diabetes,smoking,low HDL-C level,increasing hs-CRP and renal function impairment; smoking history,low HDL-C level,carotid artery plaque and moderate-to-severe carotid artery stenosis are independent risk factors of multiple-vessel disease.
