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背景：随着动脉粥样硬化发病率的增多，彩色超声逐渐成为评价颈动脉乃至全身血管病变程度的首选监测手段。 目的：对心血管疾病患者的颈动脉彩超表现与血脂、血糖和血黏度进行对照分析，探讨颈动脉斑块的发生机制及其早期症状。 设计：病例对比观察。 单位：上海第二医科大学附属第九人民医院的超声诊断科和心内科。 对象：选择2002-10／2003-12在上海第二医科大学附属第九人民医院心内科住院的首诊心血管疾病患者154例，均知情同意。 方法：应用LOGIQ700及DU-5彩超仪，纵切面和横切面扫查整个颈动脉观察全部情况。测量患者的血液检验指标，如总胆固醇、三酰甘油、果糖胺、血清血糖、高、低密度脂蛋白胆固醇及红细胞比容等，评估其与斑块形成的关系。 主要观察指标：①颈动脉的管径、扭曲程度。②有无斑块。③患者的甲状腺段颈总动脉测量频谱参数及验血指标。 结果：154例患者全部进入结果分析，无脱落。①患者颈动脉形态的相关彩超参数：颈总动脉前后径(9．10±0．94)mm，横径(9．02±1．03)mm。扭曲有25例，大多数为单个扭曲。内中膜增厚最明显者为4．9mm。有斑块64例，较大斑块长8．7mm，宽5．6mm，厚4．3mm。②患者的血液检验指标结果：血清总胆固醇、三酰甘油在斑块形成过程中具有显著性意义(X~2=4．686，4．529，P<0．05)。有斑块组患者的血清总胆固醇、三酰甘油水平均处于正常范围内[(4．45±0．98)，(1．36±0．60)mmol／L(正常值上限：5．2mmol／L；2．25mmol／L)]。③甲状腺段颈总动脉有无斑块患者的频谱参数：频带较宽为10cm／s左右，都有声窗。 结论：血管内膜功能异常，正常水平的胆固醇或三酰甘油也会引起斑块。说明引起颈动脉粥样硬化的主要因素是血管内膜功能，而血清胆固醇和三酰甘油水平是次要因素。动脉粥样硬化病变在血管壁上的反映可能早于血液检验。
Background: With the increase of the incidence of atherosclerosis, color ultrasound has gradually become the first choice for monitoring the degree of carotid artery and systemic vascular disease. Objective: To compare the performance of carotid ultrasound, blood lipid, blood glucose and blood viscosity in patients with cardiovascular diseases and explore the mechanism of carotid plaque and its early symptoms. Design: Case comparison. SETTING: Department of Ultrasound and Cardiology, Ninth People’s Hospital Affiliated to Shanghai Second Medical University. PARTICIPANTS: A total of 154 patients with first cardiovascular disease who were hospitalized in Department of Cardiology, Ninth People’s Hospital Affiliated to Shanghai Second Medical University from 2002 to 2003 were selected and informed consent was obtained. Methods: The whole carotid artery was examined by using LOGIQ700 and DU-5 color Doppler ultrasonography with longitudinal and transverse sections. The patient’s blood test indicators, such as total cholesterol, triglyceride, fructosamine, serum glucose, high and low-density lipoprotein cholesterol, and hematocrit, were measured to assess their association with plaque formation. MAIN OUTCOME MEASURES: ① carotid artery diameter, degree of distortion. ② whether the plaque. ③ patients with thyroid carotid artery measuring spectral parameters and blood tests. Results: All 154 patients entered the result analysis without falling off. ①The carotid artery morphology correlated with color ultrasound parameters: carotid artery anteroposterior diameter (9.10 ± 0.94) mm, transverse diameter (9.02 ± 1.03) mm. Twisted in 25 cases, most of them single twisted. Intimal thickening of the most obvious person is 4.9mm. There are 64 plaques, a larger plaque length 8.7mm, width 5.6mm, thickness 4.3mm. Results of blood test in patients: The serum total cholesterol and triglyceride had significant significance in the process of plaque formation (X ~ 2 = 4.686, 4.529, P <0.05). Serum total cholesterol and triglyceride levels in patients with plaque group were within the normal range (4.45 ± 0.98, 1.36 ± 0.60 mmol / L (upper limit of normal: 5.2 mmol /L;2.25mmol/L)]. ③ thoracic carotid artery with or without plaque in patients with spectral parameters: a wide band of about 10cm / s, there are sound windows. Conclusion: Intimal dysfunction, normal levels of cholesterol or triglyceride also cause plaque. Explain that the main cause of carotid atherosclerosis is intima-media function, while serum cholesterol and triglyceride levels are secondary factors. Atherosclerotic lesions in the vessel wall may be earlier than the blood test.