标题：超声评价老年退行性心脏瓣膜病与颈动脉粥样硬化关系的价值

      作者：郑斌，李丽芬，叶淑芬    佛山市第五人民医院功能检查科，广东 佛山 528211

      卷次： 2019年30卷5期

      【摘要】 目的 探讨超声检查对老年退行性心脏瓣膜病与颈动脉粥样硬化关系的评价价值。方法 选择2016年7月至2018年7月间佛山市第五人民医院诊治的150例退行性心脏瓣膜病患者纳入观察组，另选择30例健康志愿者为对照组，比较对照组与不同心脏瓣膜钙化程度分级患者心功能指标、颈动脉硬化情况的差异。根据有无心脏形态改变对观察组患者进行分组，比较两组患者颈动脉硬化情况。结果 随着心脏瓣膜钙化分级的增加，观察组中1级、2级及3级患者左室舒张末内径(LVD)[(43.86±4.28) mm vs (50.35±5.86) mm vs (56.37±6.72) mm]、左房内径(LAD)[(33.24±4.83) mm vs (42.25±4.98) mm vs (49.68±5.37) mm]逐渐增大，左室射血分数(LVEF)[(69.28±9.25)% vs (60.32±7.65)% vs (51.98±6.25)%]逐渐降低，不同分级间两两比较差异均有统计学意义(P<0.05)；2级及3级患者LVD、LAD及LVEF与对照组[(41.23±4.66) mm，(31.25±4.28) mm，(71.32±9.25) mm]比较差异均有统计学意义(P<0.05)；随着心脏瓣膜钙化分级的增加，观察组 1级、2级及 3级患者颈动脉内膜厚度(IMT)逐渐增大[(1.09±0.36)mm vs (1.22±0.40) mm vs (1.28±0.43) mm]，颈动脉斑块积分[(1.66±0.48)分 vs (2.43±0.82)分 vs (2.88±0.96分)]逐渐增高，不同分级间两两比较差异均有统计学意义(P<0.05)；2级及 3级患者 IMT及颈动脉斑块积分与对照组[(1.06±0.33) mm，(1.62±0.50)分]比较差异均有统计学意义(P<0.05)；与无心脏形态改变患者比较，存在心脏形态改变患者的 IMT更大[(1.26±0.46) mm vs(1.19±0.32) mm]，颈动脉斑块积分更高[(1.96±0.55)分 vs (2.62±0.78)分]，差异均有统计学意义(P<0.05)。结论 超声检查能够准确评价老年退行性心脏瓣膜病及颈动脉粥样硬化的关系，随着老年退行性心脏瓣膜病病情的加重，患者颈动脉硬化程度也加重。
      【关键词】 超声；颈动脉；老年；退行性心脏瓣膜病；瓣膜；钙化
      【中图分类号】 R541 【文献标识码】 A 【文章编号】 1003—6350（2019）05—613—03R

elationship between senile degenerative valvular heart disease and carotid atherosclerosis.
ZHENG Bin, LI Li-fen,YE Shu-fen. Department of Functional Examination Section, Foshan Fifth People's Hospital, Foshan 528211, Guangdong,CHINA
【Abstract】 Objective To investigate the value of ultrasonography in evaluating the relationship between de-generative valvular heart disease and carotid atherosclerosis in the elderly. Methods From July 2016 to July 2018, 150patients with degenerative valvular heart disease were selected as the observation group, and 30 healthy volunteers as thecontrol group. The cardiac function and carotid atherosclerosis were compared between the two groups. Patients in theobservation group were divided into two subgroups according to whether there were cardiac morphological changes, andcarotid atherosclerosis was compared between the two groups. Results In the observation group, Left ventricularend-diastolic diameter (LVD), left atrial diameter (LAD) increased with the increase of cardiac valve calcification grading(grade 1 vs grade 2 vs grade 3): LVD (43.86±4.28) mm vs (50.35±5.86) mm vs (56.37±6.72) mm, LAD (33.24±4.83) mmvs (42.25 ± 4.98) mm vs (49.68 ± 5.37) mm; Left ventricular ejection fraction (LVEF) decreased gradually (P<0.05):(69.28±9.25)% vs (60.32±7.65)% vs (51.98±6.25)%. LVD, LAD and LVEF in grade 2 and grade 3 patients were signifi-cantly different from those in control group (P<0.05), which were (41.23±4.66) mm, (31.25±4.28) mm, (71.32±9.25) mm in thecontrol group. With the increase of heart valve calcification grading, carotid intima thickness (IMT) increased gradually:(1.09±0.36) mm vs (1.22±0.40) mm vs (1.28±0.43) mm; and carotid plaque score increased gradually: (1.66±0.48) vs(2.43±0.82) vs (2.88±0.96); the difference was statistically significant (P<0.05). The IMT and carotid plaque scores ofgrade 2 and grade 3 patients were significantly different from those of the control group (P<0.05), which were (1.06±0.33) mm, 1.62±0.50. Compared with patients without cardiac morphological changes, patients with cardiac morphologi-cal changes had significantly higher IMT and significantly higher carotid plaque score (P<0.05): IMT (1.26±0.46) mm vs(1.19±0.32) mm, carotid plaque score (1.96±0.55) vs (2.62±0.78). Conclusion Ultrasonography can accurately evaluatethe relationship between senile degenerative heart valvular disease and carotid atherosclerosis. With the severity of seniledegenerative heart valvular disease, the degree of carotid atherosclerosis aggravated.
      【Key words】 Ultrasound; Carotid artery; The elderly; Degenerative heart valvular disease; Valve; Calcification