肱动脉血管内皮功能检测预测冠心病的临床评价

The Evaluation of Forecasting Coronary Artery Disease with Flow Mediated Dilation of Brachial Artery by Echocardiography

目的探讨超声检测肱动脉血管内皮功能(FMD)在冠心病诊断中的临床预测价值.方法 (1)100例经冠脉造影的患者采用超声检测其肱动脉FMD,比较冠脉造影阳性组(CAG)+与冠脉造影阴性组(CAG)-的肱动脉FMD,分析FMD与冠心病危险因素的相关性,了解FMD预测冠心病的最佳临界值;(2)调查所有研究对象的冠心病主要危险因素.结果 (1)CAG+组肱动脉FMD明显低于CAG-组(P<0.01);(2)在CAG+组中随着冠状动脉病变支数增加,内皮功能下降越明显;(3)肱动脉FMD预测冠心病的临界点为<10.4%,如以肱动脉FMD<10%来预测冠心病,敏感性为65.9%,特异性为71.7%,阳性预测值为76%,阴性预测值为59.3%;(4)回归分析显示FMD降低与男性、高胆固醇血症等多种危险因素密切相关.结论以FMD<10%作为预测冠心病的临界参考值有较高的敏感性和特异性,是预测冠心病较为敏感的指标.

Objective To evaluate the value of predicting coronary artery atherosclerosis disease（CAD）with the flow mediated dilation（FMD）of the brachial artery in patients by echocardiography.Methods FMD of the brachial artery was measured by echocardiography in 100 subjects with suspected coronary artery diseases.All of the subjects had accepted coronary angiography（CAG）.The differences in FMD between the patients in CAG positive group（CAG＋ group）and CAG negative group（CAG-group）were compared.The relationship between FMD and CAD were tested,and the CAD was predicted by FMD.Risk factors of CAD such as age,sex,blood glucose breakfast ago,hypertension,total cholesterol（TC）,triglycerides（TG）,low-density lipoprotein cholesterol（LDL）and high-density lipoprotein cholesterol（HDL）levels were investigated.Results（1）The FMD in the CAG＋ group was significantly lower than that in the CAD-group,p0.01.（2） The vascular endothelial function was decreasing with increased the number of branches of involved coronary artery in the CAG＋ group.（3）The peak point of the ROC curve of the FMD was10.4%.The area under cure（AUC）of ROC was 0.77.If we predict CAD with FMD of the brachial artery10% the predictive sensitivity,specificity,the positive prediction and negative prediction were 65.9%,71.7%,76% and 59.3% respectively.（4）The FMD of brachial artery decreasing was closely related with male and high TC by binary Logistic regression.Conclusions It is a better sensitive predictor for coronary atherosclerosis.