颈动脉内中膜厚度和脉搏波速度对冠状动脉硬化早期联合应用的意义

Early predictive value of pulse wave velocity plus carotid intima-media thickness for coronary artery atherosclerosis patients

目的探讨颈动脉内膜中膜厚度(IMT)和脉搏波速度(PWV)对冠状动脉硬化早期预测的价值及其联合应用的意义。方法随机选择102例行冠状动脉造影检查的患者同时行IMT、PWV测定,用SYNTAX积分评价冠状动脉病变的程度;分别用IMT、PWV预测冠心病并比较两者联合应用诊断的可靠程度。结果随着冠状动脉病变程度的加重,IMT越来越厚,PWV越来越快,IMT在轻度病变组(1.60±0.43)mm、中度病变组(2.37±0.83)mm和重度病变组(2.63±0.60)mm均高于冠状动脉正常组(1.12±0.23)mm,中度病变组和重度病变组又高于轻度病变组(P<0.01);颈-股动脉(CF)的PWV在轻度病变组(11.20±1.40)m/s、中度病变组(11.20±1.40)m/s和重度病变组(15.82±4.42)m/s均高于高于冠状动脉正常组(9.37±1.47)m/s,中度病变组和重度病变组又高于轻度病变组,重度病变组又高于中度病变组(P<0.01);分别作IMT、PWV预测冠心病的ROC曲线,PWV=11.50 m/s预测冠心病的灵敏度为78.8%,特异度为86.4%;IMT=1.50 mm预测冠心病的灵敏度为77.3%,特异度为64.3%。两者联合应用的灵敏度为95.1%,特异度为95.1%。结论 IMT、PWV和冠状动脉硬化程度有密切关系;联合应用两种方法检测冠状动脉病变程度可以提高灵敏性和特异性。

Objective To explore the early predictive value of carotid intima-media thickness（IMT） and pulse wave velocity（PWV） for the coronary artery atherosclerosis patients. Methods One hundred and two inpatients who needed coronary angiography measure were randomly chosen to perform PWV and IMT at the same time. The extent of coronary artery atherosclerosis was quantified by the Syntax coronary angiography score. We explored predictive value of PWV plus IMT for coronary artery atherosclerosis. Results Patients were divided into four groups according to the Syntax score：normal group,light disease group,moderate disease group and severe disease group. PWV and IMT were significantly different among the four groups （ P 〈 0.01）. The more severe coronary artery atherosclerosis always associated with the higher PWV and IMT. IMT in the light disease group （1.60± 0.43） mm, moderate disease group （2.37±0.83） mm and severe disease group （2.63±0.60） mm were higher than normal coronary group （1.12±0.23） mm,moderate and severe disease group were higher than the light disease group （ P 〈0, 01） ;CF of PWV in the light disease group of （11.20±1.40） m/s,moderate disease group （11.20±1.40） m/s and severe disease group （15.82± 4.42） m/s was all higher than normal coronary group （9.37±1.47） m/s, moderate and severe disease group were higher than the light disease group,and the severe disease group was higher than the moderate disease group （ P 0.01）. According to the receiver operating characteristic curve （ROC）,when PWV： 11.50 m/s as critical point for predicting coronary artery disease,the sensitivity was 78.8% ,and the specificity was 86.4% ;when IMT：1. 50 mm as critical point for predicting coronary artery disease, the sensitivity was 77.3%, and the specificity was 64.3%. When PWV plus IMT used for predicting coronary artery atherosclerosis, the sensitivity was 95.1%, the specificity was 95.1%. Conclusion PWV-CF and IMT both significantly correlated with the extent of coronary artery atherosclerosis. Combination of the two methods had higher sensitivity and specificity for predicting coronary artery atheroselerosis.