肱踝脉搏波速度对冠状动脉粥样硬化及外周动脉疾病的诊断价值

Diagnostic value of brachial-ankle pulse wave velocity in coronary atherosclerosis and peripheral artery diseases

目的探究肱踝脉搏波速度(baPWV)与冠状动脉粥样硬化病变和外周动脉狭窄病变程度的相关性及其在动脉硬化疾病中的诊断价值。方法选取心内科住院患者中45～92岁接受冠状动脉造影术(CAG)的患者共272例,部分患者同时接受了下肢动脉造影术。测量患者左右两侧baPWV,同步测量四肢血压,计算出两侧的踝臂指数。根据冠状动脉狭窄的严重性(按照 Gensini 评分法评估)分4组比较患者的踝臂指数及 baPWV;根据 baPWV 分5组比较患者的踝臂指数;根据下肢动脉造影结果分4组探讨动脉狭窄程度与踝臂指数及 baPWV 的相关性;并对冠心病罹患的危险因素进行回归分析。结果冠状动脉狭窄重度病变组踝臂指数(1.04±0.22)显著低于对照组,baPWV(1822±434)cm/s则显著高于对照组及轻度病变组;baPWV 重度升高组踝臂指数异常比例(13.9%)高于其余各组;下肢动脉狭窄程度与踝臂指数呈负相关,与 baPWV 呈正相关。均 P<0.05或 P<0.01。logistic 回归分析显示,baPWV 过高、踝臂指数过低、高血糖和吸烟是冠心病罹患的危险因素。结论 baPWV>1800 cm/s 提示有较严重冠状动脉事件可能,>2100 cm/s 提示有外周动脉疾病(PAD)可能。baPWV 对于预判冠心病发生及严重程度有重要意义,是继踝臂指数之后又一个预测外周动脉疾病的指标。

Objective To investigate the relationship between brachial-ankle pulse wave velocity （baPWV） and arterial atherosclerosis and peripheral artery diseases （PAD）, and its potential diagnostic value in arterial atherosclerosis. Methods Totally, 272 patients hospitalized at the Department of Cardiology aged 45 to 92 years receiving coronary angiography, 105 of them receiving angiography simultaneously at their lower extremities as well, were selected. They were measured with baPWV and blood pressure at their bilateral lower and upper extremities, and ankle-brachial index （ABI） was calculated. The patients were divided into four groups based on their severity of blood vessel stenosis （ Gensini score）, i. e. , control group, and groups of mild, moderate and severe stenosis. ABI and baPWV were compared among the four groups and ABI was compared among five groups according to their baPWV. Correlation between arterial stenosis and ASI and baPWV was analyzed in the four groups based on arterial angiography in their lower extremities. Risk factors for coronary heart disease （CHD） were studied with regression analysis. Results ABI in the group with severe stenosis of coronary artery based on Gensini score （ 1.04 ± 0. 22 ） was significantly lower than that in control group, while its baPWV （1822 ±434 cm/s） was significantly higher than that in control group and the group with mild stenosis. Proportion of the patients with ABI less than 0. 9 in the group with baPWV greater than 2100 cm/s （ 13.9% ） was significantly higher than that in other three groups. Severity of arterial stenosis in lower extremities reversely correlated with ABI, but positively correlated with baPWV, P 〈 0.05 and P 〈 0.01. Logistic regression analysis indicated that relatively low ABI, high baPWV and fasting blood glucose, and smoking all were risk factors for CHD. Conclusions Current study indicated that baPWV greater than 1800 cm/s often suggests more severe coronary artery event,while baPWV greater than 2100 cm/s may relate with potential PAD, which indicates an important significance of baPWV not only in predicting morbidity and severity of CHD, but also in predicting PAD, in addition to ABI.