動脈硬化性疾患における非侵襲的動脈硬化診断法の意義

抄録

Arteriosclerosis was classified by the pathological study, but not due to the clinical examination. The purpose of the study is to develop the noninvasive methods for the clinical diagnosis of arteriosclerosis and to evaluate the relation of arteriosclerosis diagnosed by these methods to the arteriosclerotic vascular diseases such as coronary heart disease (CHD), cerebrovascular disease (CVD) and atherosclerosis obliterans (ASO).
The 291 in- and out-patients of both sexes aged 21 to 88 years inclusive of 83 CHD, 48 CVD, 41 ASO and 30 familiar hypercholesterolemic patients (FH), who were visited NCVC-Hospital, were investigated the severity of arteriosclerosis. The calcification index (C. I.) and the wall thickening and stenosis index (S. I.) were calculated from the computed tomography (CT) of the abdominal aorta (AA) and the common iliac artery (CIA) before and after the enhancement with 76% urographine. The C. I. and the S. I. of the AA were highly correlated with those of the lower part of the abdominal aorta (LAA) defined as the upper part within 4 cm of the aorto-iliac bifurcation, (r=0.957, n=54 and r=0.945, n=48) respectively. The C. I. of the LAA was also correlated with that of the CIA. (r=0.721, n=111)
The pulse wave velocity of the aorta (PWV) and ocular fundi were examined in a majority of patients on the same opportunity. Significant correlations between the C. I. and the S. I. of the LAA, (r=0.557, n=224) the C. I. of the LAA and the PWV (r=0.435, n=202) and the S. I, of the LAA and the PWV (r=0.224, n=177) were seen, but the grade of retinal arteriosclerosis was not correlated with the C. I., the S. I. or the PWV. Among the same age group, the most obvious personal variation and the remarkable difference between the arterioscleritic vascular disease (ASVD) and the non-vascular disease (NVD) groups appeared in the S. I. of the LAA, while no significant difference between the ASVD and the NVD groups was observed, in the PWV. Fifty-two per cent in the ASVD group, 25% in the male NVD group and 18% in the female NVD group showed higher value over 40 score of S. I., on the contrary, all CVD patients with 0 score of the S. I. had the retinal arteriosclerosis, as well as 5 of 7 vasospastic CHD patients got O score of the S. I. and the relative higher value of the C. I. compared with that of the S. I. In the FH group, high score of 52.7 of the S. I. but the normal PWV of 678 cm/sec were observed.
In conclusion, (1) the severity of atherosclerosis was diagnosed by the S. I. of the LAA, which might be the best predictable sign for the atherosclerotic vascular disease. (2) The C. I. would be useful for the diagnosis of Monckeberg's sclerosis or atherosclerosis when compared with the S. I. (3) Arteriolosclerosis could be assessed partly by the retinal findings. (4) The PWV would appear the change of the connective tissue of arteries due to the aging, the chronic inflammation and the other causes, but not the index of atherosclerosis.