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1、内中膜厚度论文：颈动脉超声联合超敏C-反应蛋白对冠状 动脉粥样硬化性心脏病的预测价值【中文摘要】就颈动脉内中膜厚度(CIMT)、颈动脉粥样斑块的稳 定性、斑块积分及超敏C-反应蛋白(hs-CRP)与冠心病的相关性进行 研究,并对这几项指标是否是早期预测冠心病独立危险因子做出评价, 应用受试者工作特征(ROC)曲线以确定颈动脉IMT和超敏C-反应蛋白 值对冠心病最佳预测值。方法：选择在我院心内科因胸痛、胸闷疑似 冠心病入院的患者116例,其中男性70例,平均年龄63.908.89岁, 入院后行冠状动脉造影,根据冠状动脉造影结果将患者分为对照组和 冠心病组,冠心病组根据血管受累支数不同分为单支血管
2、病变组、双 支血管病变组和三支血管病变组,患者入院后行双侧颈动脉彩超,测 量CIMT、颈动脉斑块积分并判断斑块的稳定性。纳入研究对象的所 有患者均检测血清hs-CRP、血糖、血脂等指标，并记录其是否有高血 压病史、吸烟史,根据结果进行统计学分析。结果：1.冠状动脉造影 检查确诊冠心病患者87例， 其中单支冠状动脉病变组33例，双支冠状 动脉病变组27例，三支冠状动脉病变组27例。 2.冠心病各组的 CIMT 均高于对照组，且随着冠脉病变支数的增加,CIMT也随之增加。冠心 病组与对照组CIMT之间有显著性差异(t=6.504,P0.001),冠心病各 组间CIMT也具有统计学意义，单支病变组与
3、双支病变组、双支病变组 与三支病变组均有显著性差异(t 1.2=-4.681, P1.20.001;t2.3=-3.131,P2.3=0.003)。 3. 颈动脉斑块的检出率在冠心病 组与对照组中均较高，但两组并无明显差异(P=0.511),冠心病组中有54例患者有颈动脉斑块,其中32例的颈动脉斑块属于不稳定性斑块, 而对照组中有16例患者有颈动脉粥样斑块,其中只有2例为不稳定型 斑块，两者之间有显著性差异(P=0.008)。在单支病变组、双支病变组 及三支病变组中不稳定斑块例数也随病变支数的增加而增加,且单支 病变组与双支病变组、双支病变组与三支病变组不稳定性斑块之间有 着显著性差异(P1.
4、2=0.037,P2.3=0.028)。冠心病组中颈动脉斑块积 分明显高于对照组，两者之间有显著性差异(P0.001)；对照组与单支 病变组、一支病变组与双支病变组、双支病变组与三支病变组均存在 显著性差异(P0.10.001； P1.2=0.002； P2.3=0.001)。4.冠心病组 的血清hs-CRP均明显高于对照组(t=4.855,P0.001),并随着CIMT增 大及不稳定斑块数量的增多,hs-CRP随之增加,单支病变组与双支病 变组之间、双支病变组与三支病变组之间均存在显著性差异(t 1.2=-3.489, P1.2=0.001; 12.3=2.140,P2.3=0.037),具
5、有统计学 意义。5.多元回归分析证实CIMT、hs-CRP是独立预测冠心病的危险 因子。应用诊断实验建立ROC曲线,CIMT值为0.78mm, hs-CRP浓度 为2.15mg/L时，诊断CAD的灵敏度分别为96.6%、85.1%,特异度分别 为41.0%、72.3%.6.颈动脉IMT与吸烟史、高血压、糖尿病、TC呈显 著性相关，；hs-CRP与高血压、糖尿病呈显著性相关。结论：1.随着 颈动脉IMT值增大、不稳定斑块的数量及斑块积分的增加，冠状动脉 的病变支数增加。 2. 颈动脉粥样硬化性质与冠心病有关。冠状动脉病 变支数与斑块的的数量无关,但与斑块的稳定性密切相关。 3.颈动脉 IMT、颈
6、动脉不稳定斑块与血清hs-CRP呈正相关,且随着hs-CRP浓度 升高, 冠状动脉病变支数也增加。4.吸烟史、高血压、糖尿病、 TC 是 颈动脉 IMT 的主要危险因素, 高血 1.压、糖尿病是 hs-CRP 的主要危 险囚素。5.颈动脉 IMT、 hs-CRP 是冠心病的独立危险因子, 能早期预 测冠心病的发生。【英文摘要】Through the detection of the IMT(Intima-media thickness) in the carotid artery.the stability of the plague and serum hs-CRP(high sensiti
7、vity C-reactive protein)levels, discuss the relationship between these factors and the Coronary Atherosclerotic Heart Disease(CAD)and clear whether they were the risk factors in predicting CAD. Furthermore, Receiver operating characteristic (ROC) curve were used to acquire appropriatesensitivityands
8、pecificityofIMTandserumhs-CRP for the concurrent CAD.MethodsThe study population included 116 patients(63.908.89 years old,70 men)who had suffered from chest pain.chest distress and were clinically suspected CAD. After admission, all patients had undergone coronary angiography, according to the resu
9、lts of the coronary angiography, the patients could be divided to the control group and CAD group. Considering the different level of disease, we madethefurtherclassificationasone-vesselgroup,two-vessel group and three-vessel group. Also, all patients had been detected carotid artery IMT and the car
10、otid plagues using high-frequency Ultrasound and measured serum hs-CRP level, blood total cholesterol(TC), blood triglyceride(TG), low density lipoprotein cholesterol(LDL), high density lipoprotein cholesterol(HDL), Finally, do the Statistic analysis of results.Result1.87 patients definitely were di
11、agnosed as CAD according coronary angiography, including 33 patients of one-vessel group,27 patients of two-vessel group,27 patients of three-vessel group and 29 patients were the control group.2. The results showed that the carotid artery IMT in CAD group was obviously higher than in the control gr
12、oup (t=6.504,P0.001),and there was significant different between one-vessel group and two-vessel group, also was between two-vessel group and three-vessel group (t1.2=-4.681,P1.20.001;t2.3=-3.131, P2.3=0.003).3. The detection rate of the plagues were also high in CAD group and the control group, the
13、re was no significant different between them (P=0.511). In CAD group,32 out 54 patients had instability plaques, while 2 out 16 patients in the control group, there was significant different between them(P=0.008).The percentage of the instability plaques increased with group category, and there was
14、significant different betweenone-vessel group and two-vessel group(P=0.037),also wasbetween two-vessel group and three-vessel group(P=0.028). The carotid artery plaques Crouse in CAD group was higher than the control group(P0.001).There was significant different between one-vessel group and the cont
15、rol group (P=0.000), also was between one-vessel group and two-vessel group(P=0.002),and two-vessel group and there-vessel group(P=0.001).4. Patients with CAD tended to have higher the serum hs-CRP level (t=4.855,P 0.001). and as the carotid artery IMT and the percentage of the instability plaques i
16、ncreased, the hs-CRP level increased. There was significant different between one-vessel group and two-vessel group(t=-0.348,P=0.001),also was two-vessel group and there-vessel group(t=2.140,P=0.037).5. Multiple logistic regression analysis was performing to identify the independent variables for predicting CAD. Carotid artery IMT, hs-CRP were the risk factors.6.The cut-off level determined by ROC curve analysis for the great sensitivity and specificity for IMT was 0.78
