颈动脉斑块患者大动脉功能与冠心病和下肢动脉疾病的关系

摘要

Objective:To evaluate the relationship between large artery elastic function and coronary heart disease (CHD) or lower extremity arterial disease (LEAD) in patients with carotid plaque.Methods:A total of 491 patients with carotid plaque were enrolled into the study with complete data of arterial stiffness detection and blood test [male:208 and female:283,and mean age:(61.66 11.60) years].All the subjects were divided into 2 groups according to CHD or LEAD,namely non-CHD&LEAD group (neither CHD nor LEAD) and CHD/LEAD group (either CHD or LEAD).According to the mean age level (age ＜61.66 years or age ＞61.66 years),the independent association was analyzed between higher large arterial stiffness (carotid-femoral pulse wave velocity,CF-PWV,CF-PWV ＞ 9 m/s) and CHD/LEAD.Results:In the present research population,the mean level of arterial stiffness was high (the mean CF-PWV was 10.71 m/s),and 76.6％ of them had arteriosclerosis,and 36.9％ CHD/LEAD.The age,male and smoking proportion,systolic blood pressure (SBP),glycosylated hemoglobin (HbA1c),homocysteine (Hcy),creatinine (Cr),CF-PWV,prevalence rate of hypertension and diabetes mellitus,medication on hypertension,diabetes and hyperlipidemia were higher in CHD/LEAD group,and total cholesterol (TC),high density lipoprotein cholesterol (HDL-C),and low density lipoprotein cholesterol (LDL-C) were lower in CHD/LEAD group than in non-CHD&LEAD group (all P ＜ 0.05).In multivariate Logistic regression analysis,the results showed that in the patients with age below 61.66 years,large artery stiffness (CF-PWV ＞ 9 m/s) was an independent risk factor of CHD/LEAD (OR =3.229,95％ CI 1.156-9.022,P ＜ 0.05);In the patients with age above 61.66 years,there was no independent association between large artery stiffness and CHD/LEAD (P ＞ 0.05).Conclusion:The large artery elasticity function in the patients with carotid plaque was poor.In the patients with carotid plaque and higher large artery stiffness below 61.66 years,the risk of the prevalence of CHD/LEAD was increased significantly than with normal arterial stiffness.In the patients with carotid plaque below or above 61.66 years,the independent influencing factors on the prevalence of CHD/LEAD were different.%目的:探讨颈动脉斑块人群的大动脉弹性功能与冠心病(coronary heart disease,CHD)或下肢动脉疾病(lower extremity arterial disease,LEAD)的关系.方法:入选存在颈动脉斑块且动脉硬化检查、血生化检查及病史资料完整者491例,包括男性208例、女性283例,平均年龄(61.66±11.60)岁,按照有无CHD或LEAD分为两组:无CHD和LEAD组,记为无病组;有CHD或LEAD组,记为CHD/LEAD组.分别进行单因素和多因素分析,研究大动脉硬化[即颈-股动脉脉搏波传导速度(carotid-femoral pulse wave velocity,CF-PWV) ＞9 m/s]对于不同年龄水平(年龄＜ 61.66岁和年龄＞61.66岁)CHD/LEAD患病的独立影响.结果:本组人群大动脉硬化水平较高(平均CF-PWV为10.71 m/s),其中76.6％存在大动脉硬化,36.9％存在CHD/LEAD.CHD/LEAD组的年龄、男性比例、吸烟比例、收缩压、糖化血红蛋白、同型半胱氨酸、肌酐和CF-PWV水平,以及高血压、糖尿病患病率,降压药、降糖药和降脂药的服药率均显著高于无病组,而总胆固醇、高密度脂蛋白胆固醇和低密度脂蛋白胆固醇显著低于无病组(P均＜0.05).多因素Logistic回归分析提示,在年龄＜61.66岁的颈动脉斑块人群中,大动脉硬化是CHD/LEAD患病的独立影响因素(OR=3.229,95％CI 1.156～9.022,P＜0.05);在年龄＞61.66岁的颈动脉斑块人群中,大动脉硬化对于CHD/LEAD患病无独立影响关系(P＞0.05).结论:颈动脉斑块患者的大动脉弹性功能普遍较差,年龄＜61.66岁的颈动脉斑块人群若同时合并大动脉硬化,其CHD/LEAD的患病风险明显增加.不同年龄水平的颈动脉斑块患者CHD/LEAD患病的影响因素不同.