道倉 雅仁¹, 柏瀬 一路², 長谷部 愛¹, 守安 謙志¹, 北出 和史¹, 前田 匡¹, 森 宏樹¹, 有田 勝¹, 辻本 正彦¹, 上田 恭敬²

Masahito MICHIKURA¹, Kazunori KASIWASE², Ai HASEBE¹, Kenji MORIYASU¹, Kazusi KITADE¹, Tadasi MAEDA¹, Hiroki MORI¹, Masaru ARITA¹, Masahiko TUJIMOTO¹, Yasunori UEDA²

¹大阪警察病院臨床検査科, ²大阪警察病院循環器科

¹Department of Laboratory Medicine, Osaka Police Hospital, ²Department of Cardiovascular Division, Osaka Police Hospital

キーワード : ultrasonogram, common carotid artery, coronary artery, atherosclerosis, atrovastatin

目的：頸動脈超音波像と冠動脈血管内視鏡検査での血管所見を比較し，頸動脈超音波検査が冠動脈の血管状態の予測や経過観察に有用であるかを検討した．また，スタチン製剤による冠動脈と頸動脈の治療効果についても検討した．対象と方法：心臓カテーテル検査を施行した際に血管内視鏡検査を行った症例のうち，検査前3日以内に頸動脈超音波検査を施行した症例を対象とした．対象者の頸動脈超音波像と冠動脈の状態を比較した．またスタチン製剤による経時的変化も比較した．結果：冠動脈のyellow plaque（YP）個数とplaque score（YPの個数×その冠動脈の最大のYP grade）が増加するに伴い，頸動脈のプラーク形状においてhigh-echo plaqueの占める割合が有意に増大した．しかし，YP gradeと頸動脈での平均の内膜中膜壁厚 （intima-media thickness：IMT）や最大プラーク径については有意な関連は認めなかった．また，アトルバスタチン投与群と非投与群において，頸動脈と冠動脈項目の平均4.2ヵ月の経時的変化を比較した結果，投与群の頸動脈平均IMTとプラークの大きさは，非投与群に比較し有意に縮小した．また非投与群のYP個数は，投与群に比し有意に増加した．結論：評価方法に制約があるものの，頸動脈超音波像は冠動脈の状態を推測出来る事が示唆された．

Purpose: We compared the condition of coronary arteries rendered in ultrasonograms of the common carotid artery (CCA) and attempted to determine if ultrasonography of the common carotid artery was useful in predicting the properties of the coronary artery and in follow-up studies. We also studied the effect statin therapy on the common carotid and coronary arteries. Subjects and Methods: Subjects were those patients who had undergone coronary artery endoscopy during cardiac catheterization and ultrasonography of common carotid artery within the previous 3 days. We also used coronary artery endoscopy to compare ultrasonograms of the common carotid artery and presence of yellow plaques (YP) in the coronary arteries and compared changes associated with statin drug therapy. Results: Varying with plaque shape, the ratio of the high-echo plaque in the common carotid artery significantly increased with number of yellow plaques and plaque scores of the coronary arteries. However, there was no significant correlation between grade of yellow plaque and average intima-media thickness (IMT), nor between grade of yellow plaque and maximum plaque diameter. Average intima-media thickness and plaque size in the common carotid artery in the atrovastatin-treated group had decreased significantly by a mean of 6 months later, but did not decrease in the nonatrovastatin-treated group. The number of yellow plaques in the coronary arteries significantly increased in the nonatrovastatin-treated group but not in the atrovastatin-treated group. Conclusion: Ultrasonography of the common carotid artery was useful in predicting atherosclerosis of the coronary arteries, although the method of evaluation imposed certain limitations.