原发性高血压与颈动脉粥样硬化关系的临床研究
|
摘要
目的 探讨原发性高血压病(EH)患者颈动脉粥样硬化(CAS)的发病情况和特点，
以及其临床意义。
方法 选择180例EH患者，男性，144例，女性，36例，平均年龄63． 4±7． 22岁。
按照WHO的三期分期法标准将EH患者分成Ⅰ期、Ⅱ期、Ⅲ期三组，应用高分辨
率超声多谱勒对三组EH患者双侧颅外段颈总动脉(CCA)、颈内动脉(ICA)、颈外
动脉(ECA)进行超声检查(包括M超、二维显像、彩色多谱勒、脉冲多谱勒)，测
量颈总、颈内动脉平均血流速度(Vm)、血管搏动指数(PI)、血管阻力指数(RI)、
内-中膜厚度(IMT)、动脉内径，测定颈动脉斑块指数(plaque score)等指标，并与100
例健康对照者进行比较，用SPSS统计软件分析。
结果 (1) Ⅰ期EH组患者CCA和ICA的Vm、PI、RI与健康对照组比较差异无
显著性(P>0． 05) ；Ⅱ、Ⅲ期EH患者CCA和ICA的Vm、PI、RI与健康对照组比
较差异有显著性(P<0． 05，P<0． 01) ，EH患者颈动脉血流动力学改变表现为Vm降
低，PI、RI增高；Spearman’s相关分析结果表明，EH患者CCAVm与年龄呈负相
关(r=-0． 42,P<0． 01) ，PI与年龄呈正相关(r=0． 65，P<0． 01) ；(2) Ⅰ期EH组患者CCA
和ICA的IMT、血管内径、IMT／血管内径比值与健康对照组比较差异无显著性
(P>0． 05) ；Ⅱ、Ⅲ期EH组CCA和ICA的IMT、血管内径、IMT／血管内径比值
与健康对照组比较差异有显著性(P<0． 05) ，表现为颈动脉IMT增厚、血管内径增
宽、IMT／血管内径比值显著性增高；(3) Ⅰ、Ⅱ、Ⅲ期EH组颈动脉斑块检出率分别
为37． 5％、78． 6％、83． 3％，与健康对照组(18％)比较差异均有显著性(P<0． 05，
P<0． 01) ；随着EH严重程度增加，颈动脉斑块检出率有增加趋势；(4) 有中、重度
斑块者CCAIMT同无斑块和有轻度斑块者CCAIMT比较，IMT厚度增加差异有显
著性(P<0． 05) ，且随斑块的严重程度增加，其IMT呈增厚趋势；(5) 经逐步回归分析
安徽医科大学硕士学位论文
表明：年龄、吸烟量、收缩压、EH患者病程和严重程度均与CCAIMT厚度密切
相关。
结论 门）EH患者颈动脉病变多以血流速度减慢、血管阻力增高及顺应性降低、
IMT增厚、血管内径扩大、粥样硬化斑块形成为主要特点，颈动脉Vin、PI、、RI、
IMT厚度等是超声检查CAS的可靠指标；（2）颈动脉IMT厚度增加可能是CAS
的早期表现；（3）超声多谱勒能无创、直观动态地了解CAS程度，能为全面评价
大、中动脉粥样硬化提供一个窗口；对临床诊治、预防心脑血管疾病具有重要的
实用价值：抗高血压治疗的同时应兼顾防治动脉粥样硬化（＊S人
Objective This study was designed to determine the prevalence of carotid artery atherosclerosis(CAS) in patients with Essential Hypertension(EH).
Methods 180 patients with EH were selected, 144 male, 36 female; 100 normotensive control subjects were selected, 79 male, 21 female. Doppler scans ultrasonics were performed
on 180 participants of the EH in the patients and on 100 normotensive control subjects. To investigate the changes of carotid artery hemodynamics, the mean blood velocity(Vm),
blood pulse index(PI) and blood resisent index(RI) of common carotid artery(CCA) and internal carotid artery(ICA) were measured; To quantify the extent of CAS, the intima-media
thickness ( IMT ) and the intima-media thickness/diameter of CCA and ICA were measured, the maximal thickness measurements of all plaques were summed for an individual plaque score.
Results (1) Vm of CCA and ICA in the second or third stage of EH was decreased significantly versus control group(P<0.01) and Vm of CCA in essential hypertensive group negatively
correlated with age(P<0.01); but PI and RI of CCA and ICA in the second or third stage of EH increased significantly versus controls(f<0.05) and PI of CCA positive correlation with
age(P<0.01); (2) IMTs of CCA and ICA were high significantly in the second or third stage of EH than those in normal subjects(P<0.05,P<0.01). There was an increasing trend for IMT
with the severity of carotid artery plaque. In multiple linear regression stepwise analysis of all the subjects
revealed that age, cigarette smoking, systolic blood pressure, length and severity of hypertension were independently associated with IMT of CCA. (3) The ratio of carotid artery plaque and plaque score were significantly increased in hypertensive groups versus control group(P<0.01).
Conclusions (1) Formation of atherosclerosis plaque , reduction of blood flow speed, increases in the PK RI and IMT of carotid artery are the frequent abnormal findings in carotid arteries in essential hypertensive patients .(2) Increase in IMT of carotid arteries are clearly related to atherosclerosis plaque . (3) The severity of CAS may be used as a reference index for the prediction of cerebrovascular disease.
以及其临床意义。
方法 选择180例EH患者，男性，144例，女性，36例，平均年龄63． 4±7． 22岁。
按照WHO的三期分期法标准将EH患者分成Ⅰ期、Ⅱ期、Ⅲ期三组，应用高分辨
率超声多谱勒对三组EH患者双侧颅外段颈总动脉(CCA)、颈内动脉(ICA)、颈外
动脉(ECA)进行超声检查(包括M超、二维显像、彩色多谱勒、脉冲多谱勒)，测
量颈总、颈内动脉平均血流速度(Vm)、血管搏动指数(PI)、血管阻力指数(RI)、
内-中膜厚度(IMT)、动脉内径，测定颈动脉斑块指数(plaque score)等指标，并与100
例健康对照者进行比较，用SPSS统计软件分析。
结果 (1) Ⅰ期EH组患者CCA和ICA的Vm、PI、RI与健康对照组比较差异无
显著性(P>0． 05) ；Ⅱ、Ⅲ期EH患者CCA和ICA的Vm、PI、RI与健康对照组比
较差异有显著性(P<0． 05，P<0． 01) ，EH患者颈动脉血流动力学改变表现为Vm降
低，PI、RI增高；Spearman’s相关分析结果表明，EH患者CCAVm与年龄呈负相
关(r=-0． 42,P<0． 01) ，PI与年龄呈正相关(r=0． 65，P<0． 01) ；(2) Ⅰ期EH组患者CCA
和ICA的IMT、血管内径、IMT／血管内径比值与健康对照组比较差异无显著性
(P>0． 05) ；Ⅱ、Ⅲ期EH组CCA和ICA的IMT、血管内径、IMT／血管内径比值
与健康对照组比较差异有显著性(P<0． 05) ，表现为颈动脉IMT增厚、血管内径增
宽、IMT／血管内径比值显著性增高；(3) Ⅰ、Ⅱ、Ⅲ期EH组颈动脉斑块检出率分别
为37． 5％、78． 6％、83． 3％，与健康对照组(18％)比较差异均有显著性(P<0． 05，
P<0． 01) ；随着EH严重程度增加，颈动脉斑块检出率有增加趋势；(4) 有中、重度
斑块者CCAIMT同无斑块和有轻度斑块者CCAIMT比较，IMT厚度增加差异有显
著性(P<0． 05) ，且随斑块的严重程度增加，其IMT呈增厚趋势；(5) 经逐步回归分析
安徽医科大学硕士学位论文
表明：年龄、吸烟量、收缩压、EH患者病程和严重程度均与CCAIMT厚度密切
相关。
结论 门）EH患者颈动脉病变多以血流速度减慢、血管阻力增高及顺应性降低、
IMT增厚、血管内径扩大、粥样硬化斑块形成为主要特点，颈动脉Vin、PI、、RI、
IMT厚度等是超声检查CAS的可靠指标；（2）颈动脉IMT厚度增加可能是CAS
的早期表现；（3）超声多谱勒能无创、直观动态地了解CAS程度，能为全面评价
大、中动脉粥样硬化提供一个窗口；对临床诊治、预防心脑血管疾病具有重要的
实用价值：抗高血压治疗的同时应兼顾防治动脉粥样硬化（＊S人
Objective This study was designed to determine the prevalence of carotid artery atherosclerosis(CAS) in patients with Essential Hypertension(EH).
Methods 180 patients with EH were selected, 144 male, 36 female; 100 normotensive control subjects were selected, 79 male, 21 female. Doppler scans ultrasonics were performed
on 180 participants of the EH in the patients and on 100 normotensive control subjects. To investigate the changes of carotid artery hemodynamics, the mean blood velocity(Vm),
blood pulse index(PI) and blood resisent index(RI) of common carotid artery(CCA) and internal carotid artery(ICA) were measured; To quantify the extent of CAS, the intima-media
thickness ( IMT ) and the intima-media thickness/diameter of CCA and ICA were measured, the maximal thickness measurements of all plaques were summed for an individual plaque score.
Results (1) Vm of CCA and ICA in the second or third stage of EH was decreased significantly versus control group(P<0.01) and Vm of CCA in essential hypertensive group negatively
correlated with age(P<0.01); but PI and RI of CCA and ICA in the second or third stage of EH increased significantly versus controls(f<0.05) and PI of CCA positive correlation with
age(P<0.01); (2) IMTs of CCA and ICA were high significantly in the second or third stage of EH than those in normal subjects(P<0.05,P<0.01). There was an increasing trend for IMT
with the severity of carotid artery plaque. In multiple linear regression stepwise analysis of all the subjects
revealed that age, cigarette smoking, systolic blood pressure, length and severity of hypertension were independently associated with IMT of CCA. (3) The ratio of carotid artery plaque and plaque score were significantly increased in hypertensive groups versus control group(P<0.01).
Conclusions (1) Formation of atherosclerosis plaque , reduction of blood flow speed, increases in the PK RI and IMT of carotid artery are the frequent abnormal findings in carotid arteries in essential hypertensive patients .(2) Increase in IMT of carotid arteries are clearly related to atherosclerosis plaque . (3) The severity of CAS may be used as a reference index for the prediction of cerebrovascular disease.
引文
1． O' leary DH, Polak JF, Kronmal RA, et al. Carotid artery intima and media thickness as arisk factor for myocardial infaraction and stroke in older adults. [J] N Eng1 J Med, 1999,340:14-22
2． 黄铮，龚兰生，施仲伟等．冠心病患者颈动脉粥样硬化与冠状动脉粥样硬化的关系．[J]中华 心血管病杂志，1996，24(3) ：194～196
3． 刘力生．关于制定我国高血压防治指南之我见．[J]中华心血管病杂 志，1998，26：328～331
4． Kim Sutton-Tyrrell, et al. Predictors of carotid stenosis in older adults with and without isolated systolic hypertension. [J]Stroke, 1993:24:355-356
5． Iannuzzi A, Wilcosky T, Mercuri M, et al. Ultrasonographic correlates of carotid atherosclerosis in transient ischemic attack and stroke. [J] Stroke, 1995,26:614-617
6． 王拥军．应加强颈动脉粥样硬化的基础和临床研究．[J]中华神经杂志，2001， 34(5) ：257～259
7． 中国高血压联盟．国际高血压联盟关于高血压治疗指南．[J]高血压病， 1999， 7(2) ：98～101
8． 许竹梅．超声检测动脉粥样硬化的进展：颈动脉内膜中层厚度的意义．[J]心血 管病学进展，1998，19(6) ：354～357
9． Prisant LM, Zemel PC, Nichols, et al. Carotid plague association among hypertensive patients . [J]Arch Inter Med, 1993,153:501-503
10． 黄铮，龚兰生，施仲伟等．冠心病患者颈动脉粥样硬化斑块的好发部位极其超声分型．中国超 声医学杂志，1996，12(5) ：34～37
11． Crous JR, et al. Evaluation of a scoring system for extracranial carotid atherosclerosis extent with B-mode ultrasound. [J]Stroke, 1986,7:311-
12． 张映琦．颈动脉粥样硬化与缺血性脑卒中．[J]卒中与神经疾病杂 志，2001，5：253～254
13． Sacco RL, Ellengerg JH, Mohr JP, et al. Infarcts of undetermind cause: Stroke Data Bank. [J] Ann Neurol, 1999, 25:382-386
14． Fagan SC, Bindlish V, Robert S, et al. Transcranial Doppler to evaluate the effects of antihypertensive medicatiom on cerebral blood flow velocity. [J] Clin Pharmacol, 1992;32:66-69
15． Malation LS, Bellofiore S, Costa MP, et al. Cerebral blood flow velocity after hyperventilation-induced vasoconstriction in hypertensive patients. [J]Stroke, 1992; 23:1728-1732
16． Maeda H, Matsumoto m, Handa N, et al. Reactivity of cerebral blood flow to carbon dioxide in hypertensive patients : evaluation by the transcranial Doppler method. [J] Hypertens 1994; 12:191-195
17． 蒋崇福，张远全，吴妙英，等．经颅多普勒对高血压病脑血流动力学评价．[J]现 代诊断与治疗，1994；5：277～279
18． 宋本华，等．高血压并发脑动脉硬化经颅多普勒脑血流测定．[J]中华超声医学 杂志1992：(4) ：269～272
19． Sugimori H, Ibayashi S, Ooboshi H, et al. Age-related changes in intracranial artery velocity measured by transcranial Doppler sonography in normotensive, hypertensive and patients. [J] Hypertens , 1993; 30:610-614
20． Gnasso A, Irace C, Pujia PLM. Carotid intima-media thickness and coronary heart risk facts. [J] Atherosclesis , 1996, 119:7-9
21． Ferara IA, Mancin M, Celetano M, et al. Early changes of the arterial wall in umcomplicated primary hypertensiye patients. Study by ultrasound high-resolution B-mode imaging. [J]Arterioscler Thromb, 1994, 14:1290-1294
22． Wendelbag IA, Wikund O.Wikstand J. Intima-media thickness after cholesterol lowering in familiar hypercholesterolemia. A thr-year ultrasound study of common carotid and femoral arterial. [J] Atherosclerosis, 1995,117:225-259
23． Blanken DH, Selzer RH, Crawford DW, et al. Beneficial effects of cholestipol-niacin therapy on common carotid thickness measured by ultrasound. [J]Circulation, 1993,88:20-24
24． Craven TE, Ryu JE, Espeland MA, et al. Evaluation of the association between carotid atery atherosclerosis and coronary stenosis; a case control study . [J]Circulation, 1990, 82; 1230-1235
25． Pignoli P, Tremoli E, Poli A, et al. Intimal plus medial thickness of the arterial wall: a direct measurement with uitrasound imaging. [J]Circulation, 1986, 74:1399-1403
26． Wong M, Edelstein J, Wollman J, et al. Ultrasonic-pathological comparison of the human arterial wall; verification of intima-media thickness. [J] Arterioscler Thromb, 1993, 13:482-487
27． Salonen JT, Salonen R.Ultrasound B-mode in observational studies of atherosclerotic progression. [J]Circulation, 1993, 87(Suppl Ⅱ): 56-62
28． Howard G, Sharrett AR, Heiss G, et al. Carotid artery intimal-medial thickness distribution in general populations as evaluated by B-mode ultrasound. [J] Stroke, 1993, 24:12: 97-102
29． Heiss G, Sharret AR, Barenes R, et al. Carotid arterosclerosis measured by B mode ultrasound in population: Association with cardiovascular risk factor in the ARIC stydy. [J] AM J Epidemic, 1998, 134:250-253
30． Bonithon-kopp C, Touboul PJ, Berr C, et al. Relation of intima media thickness to atherosclerotic plaque in carotid arteries. [J]Arterioscler Thromb Vase Biol, 1996,163:310-314
31． Wong M, EdelsteinJ, Wollman J, et al. Ultrasonic pathological comparision
of human aterial wall: Verification of intima-mwdia thickness. [J] Atherosclerosis, 1993, 13:482-485
32． Svendsen E, Tindall AR. The internal elastic membrane and intimal flods in ateries : important but neglected structures . [J]Acta Physiol Scand 1994;572(Suppl):10-14
33． Coutard M, Osborne-Pellegrin M. Rupture of the internal elastic lamina and vascular fragility in stroke-prone spontaneously hypertensive rats. [J]Stroke 1995:122:510-515
34． Mangiarua E , Lee RMKW. Morphometric study of cerebral arteries from spontaneously hypertensive and stroke-prone spontaneously hypertensive rats. [J] Hypertens 1993:10:1183-1187
35． 周山，肖克娜。高血压对脑血管的影响．[J]高血压病杂志，1998，6：144～149
36． Wendelhag I, Wiklund O, Wkstand J. On quantifying plaque size and intima media thickness in carotid and femoral arteries: Comments on result from a prospective ultrasound study in patients with familiar hypercholesterolemia [J] Arterioscler Thromb Vase Biol, 1999,19:366-370
37． Hennerici M, et al. Evaluation of a scoring system for extracanial carotid atherosclerosis extent with B-mode ultrasound. [J] Stroke, 1994,17;270-273
38． Bluth EL, et al. Sonographic characterization of carotid plaque. [J] AJNR, 1998, 7:311-315
39． Weinberger J, Ramos L, Ambrose J, et al. Morphologic and dynamic changes of atherosclerotic plaque of the carotid artery bifurcation ; sequential imaging by real-time B-mode ultrasonography. [J]AM Coll Carotid, 1997,12:1515-1520
40． Spagnole LG. Histopathological characterization of carotid plaques echotomography. [J] Int Angiot, 1998, 7(1) : 55-59
41． Khovidhunkit W, Memon RA, Feingild KD. Infection and inflammation-induced proatherogenic changes of lipoprotein[J].J Infect Dis, 2000,181:462-467
42． O' Donnell TF Jr, et al. Correiation of B-mode ultrasound imaging and arteriography with patologic findings at carotid endarterectomy. [J] Arch Surg, 1995, 120:443-446
43． Kranzhofer R, al. Angiotensin induces inflammatory activation of smooth muscle cell. [J]Arterioscler Thromb Vas Biol, 1999, 19:1623-1628
44． Liyama K, M, Nogano N, et al. Impaired endothelial function with essential hypertension assessed by ultrasonography. [J]Am Heart, 1996, 132:779-782
45． Comez CR. Carotid plaque morphology and risk for stroke. [J] Stroke, 1998,21 (1) : 148-152
46． Rubens J, Espeland MA, Ryu J, et al. Individual variation in susceptibility to extraccranial carotid atherosclerosis. [J] Arteriosclerosis, 1998,8:389-392
47． O' Leary DH, Polak JF, Kronmal RA, et al. Distributions and correlates of sonographically detected carotid artery disease in the Cardiovascular Health Study. [J]The CHS Collaborative Reaserch Group Stroke, 1992,23:1752-1755
48． Graven TE, Ryu JE, Espeland MA, et al. Evaluation of the associtions between carotid artery atherosclerosis and coronary artery stenosis: a case-control study. [J] Circula tion, 1996,82:1230-1236
2． 黄铮，龚兰生，施仲伟等．冠心病患者颈动脉粥样硬化与冠状动脉粥样硬化的关系．[J]中华 心血管病杂志，1996，24(3) ：194～196
3． 刘力生．关于制定我国高血压防治指南之我见．[J]中华心血管病杂 志，1998，26：328～331
4． Kim Sutton-Tyrrell, et al. Predictors of carotid stenosis in older adults with and without isolated systolic hypertension. [J]Stroke, 1993:24:355-356
5． Iannuzzi A, Wilcosky T, Mercuri M, et al. Ultrasonographic correlates of carotid atherosclerosis in transient ischemic attack and stroke. [J] Stroke, 1995,26:614-617
6． 王拥军．应加强颈动脉粥样硬化的基础和临床研究．[J]中华神经杂志，2001， 34(5) ：257～259
7． 中国高血压联盟．国际高血压联盟关于高血压治疗指南．[J]高血压病， 1999， 7(2) ：98～101
8． 许竹梅．超声检测动脉粥样硬化的进展：颈动脉内膜中层厚度的意义．[J]心血 管病学进展，1998，19(6) ：354～357
9． Prisant LM, Zemel PC, Nichols, et al. Carotid plague association among hypertensive patients . [J]Arch Inter Med, 1993,153:501-503
10． 黄铮，龚兰生，施仲伟等．冠心病患者颈动脉粥样硬化斑块的好发部位极其超声分型．中国超 声医学杂志，1996，12(5) ：34～37
11． Crous JR, et al. Evaluation of a scoring system for extracranial carotid atherosclerosis extent with B-mode ultrasound. [J]Stroke, 1986,7:311-
12． 张映琦．颈动脉粥样硬化与缺血性脑卒中．[J]卒中与神经疾病杂 志，2001，5：253～254
13． Sacco RL, Ellengerg JH, Mohr JP, et al. Infarcts of undetermind cause: Stroke Data Bank. [J] Ann Neurol, 1999, 25:382-386
14． Fagan SC, Bindlish V, Robert S, et al. Transcranial Doppler to evaluate the effects of antihypertensive medicatiom on cerebral blood flow velocity. [J] Clin Pharmacol, 1992;32:66-69
15． Malation LS, Bellofiore S, Costa MP, et al. Cerebral blood flow velocity after hyperventilation-induced vasoconstriction in hypertensive patients. [J]Stroke, 1992; 23:1728-1732
16． Maeda H, Matsumoto m, Handa N, et al. Reactivity of cerebral blood flow to carbon dioxide in hypertensive patients : evaluation by the transcranial Doppler method. [J] Hypertens 1994; 12:191-195
17． 蒋崇福，张远全，吴妙英，等．经颅多普勒对高血压病脑血流动力学评价．[J]现 代诊断与治疗，1994；5：277～279
18． 宋本华，等．高血压并发脑动脉硬化经颅多普勒脑血流测定．[J]中华超声医学 杂志1992：(4) ：269～272
19． Sugimori H, Ibayashi S, Ooboshi H, et al. Age-related changes in intracranial artery velocity measured by transcranial Doppler sonography in normotensive, hypertensive and patients. [J] Hypertens , 1993; 30:610-614
20． Gnasso A, Irace C, Pujia PLM. Carotid intima-media thickness and coronary heart risk facts. [J] Atherosclesis , 1996, 119:7-9
21． Ferara IA, Mancin M, Celetano M, et al. Early changes of the arterial wall in umcomplicated primary hypertensiye patients. Study by ultrasound high-resolution B-mode imaging. [J]Arterioscler Thromb, 1994, 14:1290-1294
22． Wendelbag IA, Wikund O.Wikstand J. Intima-media thickness after cholesterol lowering in familiar hypercholesterolemia. A thr-year ultrasound study of common carotid and femoral arterial. [J] Atherosclerosis, 1995,117:225-259
23． Blanken DH, Selzer RH, Crawford DW, et al. Beneficial effects of cholestipol-niacin therapy on common carotid thickness measured by ultrasound. [J]Circulation, 1993,88:20-24
24． Craven TE, Ryu JE, Espeland MA, et al. Evaluation of the association between carotid atery atherosclerosis and coronary stenosis; a case control study . [J]Circulation, 1990, 82; 1230-1235
25． Pignoli P, Tremoli E, Poli A, et al. Intimal plus medial thickness of the arterial wall: a direct measurement with uitrasound imaging. [J]Circulation, 1986, 74:1399-1403
26． Wong M, Edelstein J, Wollman J, et al. Ultrasonic-pathological comparison of the human arterial wall; verification of intima-media thickness. [J] Arterioscler Thromb, 1993, 13:482-487
27． Salonen JT, Salonen R.Ultrasound B-mode in observational studies of atherosclerotic progression. [J]Circulation, 1993, 87(Suppl Ⅱ): 56-62
28． Howard G, Sharrett AR, Heiss G, et al. Carotid artery intimal-medial thickness distribution in general populations as evaluated by B-mode ultrasound. [J] Stroke, 1993, 24:12: 97-102
29． Heiss G, Sharret AR, Barenes R, et al. Carotid arterosclerosis measured by B mode ultrasound in population: Association with cardiovascular risk factor in the ARIC stydy. [J] AM J Epidemic, 1998, 134:250-253
30． Bonithon-kopp C, Touboul PJ, Berr C, et al. Relation of intima media thickness to atherosclerotic plaque in carotid arteries. [J]Arterioscler Thromb Vase Biol, 1996,163:310-314
31． Wong M, EdelsteinJ, Wollman J, et al. Ultrasonic pathological comparision
of human aterial wall: Verification of intima-mwdia thickness. [J] Atherosclerosis, 1993, 13:482-485
32． Svendsen E, Tindall AR. The internal elastic membrane and intimal flods in ateries : important but neglected structures . [J]Acta Physiol Scand 1994;572(Suppl):10-14
33． Coutard M, Osborne-Pellegrin M. Rupture of the internal elastic lamina and vascular fragility in stroke-prone spontaneously hypertensive rats. [J]Stroke 1995:122:510-515
34． Mangiarua E , Lee RMKW. Morphometric study of cerebral arteries from spontaneously hypertensive and stroke-prone spontaneously hypertensive rats. [J] Hypertens 1993:10:1183-1187
35． 周山，肖克娜。高血压对脑血管的影响．[J]高血压病杂志，1998，6：144～149
36． Wendelhag I, Wiklund O, Wkstand J. On quantifying plaque size and intima media thickness in carotid and femoral arteries: Comments on result from a prospective ultrasound study in patients with familiar hypercholesterolemia [J] Arterioscler Thromb Vase Biol, 1999,19:366-370
37． Hennerici M, et al. Evaluation of a scoring system for extracanial carotid atherosclerosis extent with B-mode ultrasound. [J] Stroke, 1994,17;270-273
38． Bluth EL, et al. Sonographic characterization of carotid plaque. [J] AJNR, 1998, 7:311-315
39． Weinberger J, Ramos L, Ambrose J, et al. Morphologic and dynamic changes of atherosclerotic plaque of the carotid artery bifurcation ; sequential imaging by real-time B-mode ultrasonography. [J]AM Coll Carotid, 1997,12:1515-1520
40． Spagnole LG. Histopathological characterization of carotid plaques echotomography. [J] Int Angiot, 1998, 7(1) : 55-59
41． Khovidhunkit W, Memon RA, Feingild KD. Infection and inflammation-induced proatherogenic changes of lipoprotein[J].J Infect Dis, 2000,181:462-467
42． O' Donnell TF Jr, et al. Correiation of B-mode ultrasound imaging and arteriography with patologic findings at carotid endarterectomy. [J] Arch Surg, 1995, 120:443-446
43． Kranzhofer R, al. Angiotensin induces inflammatory activation of smooth muscle cell. [J]Arterioscler Thromb Vas Biol, 1999, 19:1623-1628
44． Liyama K, M, Nogano N, et al. Impaired endothelial function with essential hypertension assessed by ultrasonography. [J]Am Heart, 1996, 132:779-782
45． Comez CR. Carotid plaque morphology and risk for stroke. [J] Stroke, 1998,21 (1) : 148-152
46． Rubens J, Espeland MA, Ryu J, et al. Individual variation in susceptibility to extraccranial carotid atherosclerosis. [J] Arteriosclerosis, 1998,8:389-392
47． O' Leary DH, Polak JF, Kronmal RA, et al. Distributions and correlates of sonographically detected carotid artery disease in the Cardiovascular Health Study. [J]The CHS Collaborative Reaserch Group Stroke, 1992,23:1752-1755
48． Graven TE, Ryu JE, Espeland MA, et al. Evaluation of the associtions between carotid artery atherosclerosis and coronary artery stenosis: a case-control study. [J] Circula tion, 1996,82:1230-1236