Kin K, Iwamoto T, Koyama T, Sugiyama T, Takasaki M
Department of Geriatric Medicine, Tokyo Medical University Hospital.
Nihon Ronen Igakkai Zasshi. 2000 Mar;37(3):239-44. doi: 10.3143/geriatrics.37.239.
To clarify carotid arterial changes in female patients with arteriosclerosis obliterans (ASO) and aortic aneurysm (AA), ultrasonographic (US) findings of the extra-cranial carotid arteries were studied in 26 patients with ASO (ASO group), and 31 patients with AA (AA group), compared to 38 controls (control group) with neither ASO nor AA. ASO was diagnosed with an ankle pressure index less than 0.9, while AA was done with computed tomography or angiography. Half of the patients with ASO were in stage II of the Fontaine clinical staging, and angiography, performed in 12, showed femoral arterial obstruction in 10. Most AA patients were abdominal aortic aneurysm. Using a high-resolution, real-time, B-mode US instrument, the diameter and wall thickness of the common carotids were measured bilaterally in the end-diastolic phase, and occlusive changes and plaque were estimated. As a risk factor for arteriosclerosis, hypertension, diabetes, hyperlipidemia, and cigarette smoking were assessed, in addition to the age, body height and weight. Mean ages of each group were 73 to 76.3 year-old. There was no significant difference between them in body height and weight. Diabetes, cigarette smoking, and cerebrovascular disease were frequent in the ASO group, whereas ischemic heart disease was frequent in the AA group. US findings revealed that carotid lesions were mostly plaque, and bilateral carotid lesions were significantly more frequent in the ASO and AA groups. The mean wall thickness of the carotids was greater in the AA and ASO groups, although dilated carotid arteries, namely arteriomegaly, was more frequent in the AA group than in the ASO and control groups. Stepwise regression analyses demonstrated that strong correlations were seen between carotid lesion and two variables [vessel diseases (ASO/AA) and cigarette smoking], between carotid diameter and three variables (age, AA, and wall thickness), and between the wall thickness and three variables (age, vessel diseases and diameter). These findings showed that atherosclerosis was not only frequent in female patients with ASO and AA, but arteriomegaly was characteristic in female patients with AA. Therefore, it suggested that circulatory disturbance in whole organs due to arteriosclerosis should be paid attention even in female patients with ASO and AA as well as male patients. Furthermore, it is considered that systemic fragility of the arterial media and ectasia could be present extensively in patients with AA.
为明确患有闭塞性动脉硬化(ASO)和主动脉瘤(AA)的女性患者的颈动脉变化,我们对26例ASO患者(ASO组)和31例AA患者(AA组)的颅外颈动脉超声(US)检查结果进行了研究,并与38例既无ASO也无AA的对照组(对照组)进行比较。ASO通过踝压指数小于0.9诊断,而AA通过计算机断层扫描或血管造影诊断。ASO患者中有一半处于Fontaine临床分期的II期,12例患者进行了血管造影,其中10例显示股动脉阻塞。大多数AA患者为腹主动脉瘤。使用高分辨率实时B型超声仪,在舒张末期双侧测量颈总动脉的直径和壁厚,并评估闭塞性变化和斑块情况。作为动脉硬化的危险因素,除了年龄、身高和体重外,还评估了高血压、糖尿病、高脂血症和吸烟情况。每组的平均年龄为73至76.3岁。他们的身高和体重没有显著差异。糖尿病、吸烟和脑血管疾病在ASO组中较为常见,而缺血性心脏病在AA组中较为常见。US检查结果显示,颈动脉病变大多为斑块,ASO组和AA组双侧颈动脉病变明显更常见。AA组和ASO组颈动脉的平均壁厚更大,尽管AA组中颈动脉扩张即动脉肿大比ASO组和对照组更常见。逐步回归分析表明,颈动脉病变与两个变量[血管疾病(ASO/AA)和吸烟]、颈动脉直径与三个变量(年龄、AA和壁厚)以及壁厚与三个变量(年龄、血管疾病和直径)之间存在强相关性。这些发现表明,动脉硬化不仅在患有ASO和AA的女性患者中常见,而且动脉肿大是患有AA的女性患者的特征。因此,这表明即使在患有ASO和AA的女性患者以及男性患者中,也应关注因动脉硬化导致的全身器官循环障碍。此外,认为AA患者可能广泛存在动脉中层的系统性脆弱和扩张。