流量介导的肱动脉扩张与颈动脉内中膜厚度对冠心病诊断作用比较

Comparison of flow-mediated brachial artery dilatation and carotid intima-media thickness in the diagnosis of coronary artery disease

目的:冠心病患者流量介导的肱动脉扩张(flow-mediated vasodilation,FMD)减低,颈动脉内中膜厚度(intima-mediathickness,IMT)增厚,但两者对冠心病是否具有诊断作用尚未可知,本文主要探讨肱动脉FMD与颈动脉IMT对冠心病有无诊断作用。方法:在具有冠心病危险因素、具有典型的冠心病临床表现而且行冠状动脉造影检查的患者中,选取50位经冠状动脉造影明确患有冠心病的患者作为冠心病组,50位经冠状动脉造影检查明确没有冠心病的患者作为对照组,分别测量每位患者的肱动脉FMD和颈动脉IMT,通过单因素分析及多因素分析观察两者对冠心病的诊断作用。结果:冠心病组的肱动脉FMD较对照组低,颈动脉IMT较对照组厚,单因素分析发现高脂血症、糖尿病、肱动脉FMD以及颈动脉IMT与冠心病的发生密切相关,而在多因素回归分析中,仅有肱动脉FMD与冠心病的发生密切相关,以FMD<6%为标准,其对冠心病的诊断的敏感性为92%,特异性为88%。结论:肱动脉FMD对冠心病具有诊断价值,IMT则不能用来诊断冠心病。

Objective： Brachial artery FMD is lower and carotid artery IMT is thicker in CAD, but it is still not known if these markers can be used to diagnose CAD. We examined whether CAD can be detected by brachial artery FMD and carotid artery IMT. Methods： For the patients undergoing coronary angiography with CAD risk factors and typical chnical presentation, fifty patienes selected as CAD group with coronary angingraphy diagnosis of CAD, Fifty were selected as control group with coronary angingraphy diagnosis of having no GAD. Brachial artery FMD and carotid artery IMT were measured for the selected patients respectively, based on univariate analysis and multivariate logistic regression analysis, we can see if brachial artery FMD and carotid artery IMT can be used to diagnose CAD. Results： Brachial artery FMD was lower and carotid artery IMT was thicker in CAD group than in control group, based on univariate analysis, the factors associated with the presence of CAD were hypercholesterolemia, diabetes mellitus, braehial artery FMD and carotid artery IMT. Multivariate logistic regression analysis using these factors demonstrated that brachial artery FMD was the only predictor for the detection of CAD. FMD 〈 6% can be used to diagnose CAD with a sensitivity of 92% and a specificity of 88%. Conclusion： The findings suggest that FMD but not IMT may be used to diagnose CAD.