摘要
目的和背景：随着人们生活水平的提高,生活习惯和饮食结构的改变及人口老龄化的来临,冠心病(CHD)的发病率呈逐年上升趋势,而急性冠状动脉综合征(ACS)由于其具有起病急、死亡率高的特点,已经成为当今社会重要的公共卫生问题。动脉硬化在ACS发病中起着重要的作用。ACS严重危害着人类健康,对其进行早期诊断、开展高危人群的预测,对指导预防和治疗有着重要的意义。本研究旨在探讨几种无创检测方法在ACS诊断中的应用价值。
方法：选取从2007年1月～2008年12月的二年间,在天津医科大学总医院干部保健科对高危人群(年龄在50岁以上)进行心脏专科体检的连续受检者171例,102例符合条件的受检者纳入本研究。其中入选ACS组52例,高危组50例。在2周内行MSCT冠状动脉成像、颈动脉超声检测及动脉硬化检测,并完善相关血液生化指标检测。观察指标包括冠状动脉钙化积分(CACS)、颈动脉内-中膜厚度(IMT)、臂-踝脉搏波速度(baPWV)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)及高密度脂蛋白(HDL)等。获得的数据采用两样本Wilcoxon符号秩和检验、两样本t检验、卡方检验等方法用SPSS 13.0软件在计算机上进行统计处理。P<0.05认为差异具有统计学意义。
结果：(1)ACS组的年龄及高血压、糖尿病和高脂血症的阳性率均高于高危组组,且差异均有统计学意义(P<0.05)。(2)ACS组的CACS、Mass、Volume均高于高危组,差异有统计学意义(P<0.001)。随着危险度的增高,ACS组所占的比例升高,反之高危组所占的比例减低,差异有统计学意义(P<0.001)。(3)ACS组受检者冠状动脉含钙化斑块的发生率高于高危组,’差异有统计学意义(P<0.001)。(4)冠状动脉分支含有钙化性斑块,其中最多发生于前降支(LAD),其次是右冠状动脉(RCA),较少发生于回旋支(LCX)和左主干(LMA)。(5)ACS组的左IMT、右IMT、IMT高值及斑块发生率均高于高危组,且ACS组和高危组的左IMT均高于右IMT。右IMT差异无统计学意义(P>0.05),左IMT、IMT高值及斑块发生率差异有统计学意义(P<0.05)。(6)ACS组受检者颈动脉硬化的发生率高于高危组,差异有统计学意义(P<0.001)。
(7)对颈动脉斑块利用半定量法进行积分后,在0和1的积分组,高危组所占的比例高于ACS组,在积分>2以后,ACS组所占的比例高于高危组。
(8)ACS组的左baPWV、右baPWV及baPWV高值均高于高危组,差异有统计学意义(P<0.05)。
(9)ACS组受检者四肢动脉硬化的发生率高于高危组,差异有统计学意义(P<0.001)。
(10)将所有受检者的baPWV按照四分位数分组,随着baPWV的升高,高危组的人数越来越少,所占的比例减低,ACS组的人数越来越多,所占的比例升高。
结论：外周动脉粥样硬化与冠状动脉粥样硬化有着共同的病理基础、发病机制和危险因素,外周动脉的变化可以间接反映冠状动脉的变化,外周动脉的检测方法无创、操作简单、可重复性强,可以广泛应用于ACS及高危人群早期筛查及监测中。
Objective and Background:With the improvement of people's living standard, the change of living habits and food structure, the aging of the population, the morbidity of coronary heart disease (CHD) show a tendency to rise year by year. It has already become an important public health problem of current society, because acute coronary syndrome (ACS)has the clinical features of urgent onset and high mortality. And the arteriosclerosis plays an important role in the onset of ACS.ACS harms people's health seriously. It is of great significance to early diagnosis, prediction of high risk patients, guiding for prevention and treatment. So we are trying to evaluate some non-invasive measurements in diagnosis of ACS.
Methods:There were 171 continuous subjects who were considered as high risk patients and did cardiac physical examination in Tianjin medical university general hospital geriatric department from Jan,2007 to Dec,2008.Finally, there were 102 who were conformity with the protocol and entered the study.These subjects were divided into acute coronary syndrome (ACS) group (n=52) and control group (n=50). All subjects received MSCT scan, carotid artery ultrasound, arteriosclerostic test and blood biochemical markers exam, observing CACS,IMT, baPWV,TC, TG, LDL, HDL, etc. The data are analyzed by Wilcoxon test, t-test, chi square test, with SPSS software version 13.0. A value of P<0.05 was considered significant in double-sided tests.
Results:(1)Age and the prevalence of hypertension, DM and hyperlipidemia are significantly higher in ACS group than in control group, and it has significant difference between them(P<0.05).
(2)The CACS,Mass and Volume are higher in ACS group than in high risk group(P<0.001).The ratio of people in ACS group increases by increased risk. There was significant differences(P<0.001).
(3)The prevalence of coronary arterial calcified plaques is higher in ACS group subjects than in high risk group(P<0.001).
(4)The calcified plaques in coronaries are more usual in LAD,and then in RCA, rare in LCX and LMA.
(5)The left IMT, right IMT, the greater value of both sides and the prevalence of plaque are higher in ACS group than in high risk group, and left IMT is higher than right IMT in two groups. The difference has no statistic significance in right IMT(P>0.05).There are significant differences of left IMT, the greater value of both sides and prevalence of plaque in two groups (P<0.05).
(6)The prevalence of carotid arterial arteriosclerosis is significantly higher in ACS than in high risk group (P<0.001).
(7)After semiquantitative scores of carotid arterial plaque, the ratio of high risk group is higher than the one of ACS in score=0 and 1.In score> 2, the ratio of ACS is higher than it of high risk group.
(8)The values of left baPWV,right baPWV, and the greater value of both side baPWV are higher in ACS group than control group(P<0.05)
(9)The prevalence of peripheral arteriosclerosis is significantly higher in ACS group than control group (P<0.001).
(10)All subjects were divided into 4 groups by quartile of baPWV.The number of people in high risk group is less and less, the ratio decreased, by increasing of baPWV, and the number of people in ACS group increases.
Conclusion:Peripheral atherosclerosis and coronary atherosclerosis have same pathological basis, pathogenesis and risk factors.Peripheral arterial changes reflect coronary disease directly. It is noninvasive, easier and repeatable to exam the atherosclerosis in peripheral arteries, so these methods can be used widely in high risk people early screening and monitoring.
引文
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