冠動脈疾患患者における末梢動脈硬化の進展に関する研究 特に四肢・頚動脈動脈硬化病変合併の臨床像と冠疾患臨床背景との関連性について

Abstract

Coexisted peripheral vascular disease (PVD: ankle/brachial pressure index A/PBI less than 0.75) or carotid artery disease (CTD: Brochenbrough's supraorbital Doppler flow analysis) were diagnosed by non-invasive testings, and correlated with clinical pictures and coronary backgrounds in 121 consecutive patients with confirmed coronary artery disease. PVD were found in 16.5%, CTD in 33.1% and both PVD and CTD in 9.9%. The mean age of PVD(+) patients was significantly higher than that of PVD(-) patients, furthermore CTD(+) patients displayed a significantly larger number of coronary risk factors than CTD(-) patients. Concerning the subjective symptoms, 20% of PVD(+) patients and 45% of CTD(+) patients were asymptomatic regarding PVD or CTD symptoms. However the degree of calcification of the aortic arch on the chest X-film (n = 104) significantly correlated with A/BPI. In patients with AMI, PVD patients showed significantly higher peak CK and CK-MB values than those in PVD(-) patients, which suggested large infarct size in coexistent PVD patients. With respect to the relationship between coronary risk factors, there was a statistically significant difference between PVD(+) patients and PVD(-) patients in terms of the obesity ratio in males as well as hypercholesterolemia ratio and obesity ratio in females. In CTD patients, significant differences between CTD(+) and CTD(-) patients were found with respect to the smoking ratio and obesity ratio in males as well as the smoking ratio in females. In whole study patients, A/BPI with lowered and A.I. (atherogenic index) increased significantly when patients possessed coronary risk factors equal or more than 4 items, which suggested the progression of PVD with increasing number of coronary risk factors.