原发性高血压与颈动脉粥样硬化关系的临床研究

目的:探讨原发性高血压(EH)患者颈动脉粥样硬化(CAS)的发病情况、特点以及临床意义.方法:选择80例EH患者,按照WHO的危险分层法将EH患者分成低危、中危、高危和极高危3组,应用高分辨率超声多谱勒对3组EH患者双侧颅外段颈总动脉(CCA)进行超声检查,测量颈总动脉内-中膜厚度(IMT)、斑块检出率等指标,并与30名健康对照者进行比较分析.结果:低、中危EH组患者CCA的IMT与健康对照组差异均无显著性(P>0.05);高危和极高危EH组CCA的IMT与健康对照组比较差异有显著性(P<0.01),表现为颈动脉IMT增厚;低危、中危、高危和极高危 EH组颈动脉斑块检出率分别为34.6%、75.0%和82.4%,与健康对照组(16.7%)比较差异均有显著性(P<0.01);随着EH危险分层增加而增加,颈动脉斑块检出率有增加趋势.结论:颈动脉IMT厚度增加可能是CAS的早期表现;IMT厚度等是超声检查CAS的可靠指标;超声多谱勒能无创、直观动态地了解CAS程度,能为全面评价高血压是否引起大、中动脉粥样硬化提供一个窗口.

Relation of essential hypertension to carotid atherosclerosis

Objective:To determine the prevalence of carotid artery atherosclerosis(CAS) in patients with essential hypertension(EH).Methods:Eighty patients with EH were divided into three groups(mild,moderate,severe and very severe)according to WHO's risky classification.Doppler ultrasonics was performed in 80 patients with EH and 30 control subjects.To quantify the extent of CAS,the intima-media thicknesses(IMT)of common carotid artery(CCA) were measured.Results:The IMTs of CCA were significantly higher in the middle or high stage of EH patients than those in normal subjects (P<0.01).There was an increasing trend for IMT with the severity of carotid artery plaque.The ratio of carotid artery plaque increased significantly in the hypertensive group versus the control group(P<0.01).Conclusions:Formation of atherosclerosis plaque and IMT of carotid artery are the frequent abnormal findings in the carotid arteries of essential hypertensive patients.Increase in IMT of carotid arteries are clearly related to atherosclerosis plaque.The severity of CAS may be used as a reference index for the prediction of cerebrovascular disease.