男性較易因高血壓症發生內頸動脈粥狀硬化

過去研究曾指出，頸動脈分叉處的構造在解剖學上是有性別差異的。所以我們推測男性和女性在頸動脈分叉處的血流模式也會有所不同，並進而導致男女不同的內頸動脈硬化機率。這個現象也許更顯見於高血壓患者，因為高血壓患者較血壓正常的人更容易出現血液動力學的異常現象。因此我們進行本研究以驗證上述推論。本研究從1996-1998在本院進行健康檢查者中選取研究對象，只納入接受過頸動脈超音波檢查者。研究收集的資料包括：年齡、性別、血壓、高血壓病史以及頸動脈超音波檢查結果。以SAS統計程式比較男性與女性研究對象之既存內頸動脈與外頸動脈粥狀硬化斑塊機率。本研究總共納入1,554名研究對象。在557位高血壓患者之中，男性內頸動脈粥狀硬化的機率明顯高於女性（以人數計，男女內頸動脈粥狀硬化機率依序為57/332及22/225，卡方檢定p值＜0.05；以頸動脈樣本數計，男女內頸動脈粥狀硬化機率依序為77/664及28/450，卡方檢定p值＜0.01）。分析997名血壓正常者，則未發現內頸動脈粥狀硬化機率與性別之間有顯著的相關性。而無論罹患高血壓與否，性別差異不會影響外頸動脈粥狀硬化發生的機率。對年齡、糖尿病、高血脂症、抽煙資料進行校正的多變項迴歸分析仍呈現類似的結果。本研究結果顯示，男性高血壓患者的內頸動脈粥狀硬化發生率，比女性患者有意義地偏高。其原因可能與文獻上已發表，男女二者間頸動脈分叉處結構上的差異有關。我們推論，男性頸動脈分叉處的結構特徵，例如，比起女性有較小的（內頸動脈管徑/總頸動脈管徑）比值，會使其內頸動脈壁因為高血壓的存在而承受較大血液動力學上的傷害。

關鍵字

動脈粥狀硬化；性別；高血壓；內頸動脈；頸動脈疾病

並列摘要

Gender differences in carotid bifurcation anatomy have been reported and led us to think that, in men and women, the carotid branches may have different blood flow patterns and thus different chances of developing atherosclerosis. This may be especially true in the hypertensive subjects whose arteries are under more hemodynamic insult than the normotensive subjects. This study was conducted to test this viewpoint. Subjects were selected from the participants in a health check program at our hospital from 1996 to 1998. Only those who had received carotid duplex study were enrolled. The following information was collected: age, gender, blood pressure, history of hypertension, and the results of carotid duplex study. The rates of preexisting atherosclerotic plaque in the internal carotid artery (ICA) and the external carotid artery (ECA) were compared between two genders using the SAS statistical program. A total of 1,554 study subjects were enrolled. Among the 557 hypertensive subjects, the rate of ICA plaque in men was significantly higher than that in women (57/332 vs 22/225 cases, respectively, p＜0.05; and 77/664 vs 28/450 ICAs, respectively, p＜0.01 by chi-square test). Among the 997 normotensive subjects, the rates of ICA plaque in men and women were not significantly different. There was no gender difference in the rates of ECA plaque in either hypertensive or normotensive subjects. Multivariate regression analyses with adjustments for age and the presence of diabetes, hyperlipidemia, and smoking habit revealed similar results. Together with the findings of gender differences in carotid bifurcation anatomy in previous studies, our results suggest that the structural characters of carotid bifurcation in men, for example, a smaller ICA/CCA dimension ratio as compared with that in women, may be associated with a higher risk of ICA atherosclerosis, and such a risk may be aggravated by the coexistence of hypertension.

並列關鍵字

atherosclerosis ； gender ； hypertension ； internal carotid artery ； carotid artery diseases

國際替代計量

男性較易因高血壓症發生內頸動脈粥狀硬化

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