外周血管动脉硬化对冠状动脉病变程度的预测价值

Peripheral Atherosclerosis as a Predictive Value to the Coronary Artery Disease

目的了解外周血管动脉硬化(包括眼底动脉硬化程度、肱踝脉搏波传导速度及踝臂指数)与冠状动脉造影结果的相关性,探讨其对冠状动脉病变程度的预测价值。方法根据冠状动脉造影的结果,将472例怀疑冠状动脉粥样硬化性心脏病(coronary artery disease,CAD)的患者分为非CAD组和CAD组。CAD组又根据冠状动脉病变的程度分为非多支病变组和多支病变(含左主干病变)组。收集患者的基线资料,包括年龄、性别、体质指数、吸烟、既往病史、胸痛症状、心电图改变、彩色多普勒超声心动图及生化检查等指标。对所有患者进行眼底照相、肱踝脉搏波传导速度(BaPWV)及踝臂指数(ABI)的测量。用Logistic回归模型评价眼底动脉硬化程度、BaP-WV、ABI及其他相关指标对冠状动脉病变程度的预测能力。结果 (1)对CAD的预测价值:糖尿病、BaPWV>14m/s、典型胸痛、超声心动室壁运动异常及眼底动脉硬化Ⅱ级以上进入方程,其中典型胸痛(OR=7.220,ROC曲线下面积0.736±0.024,P=0.000)对预测CAD有统计学意义,眼底动脉硬化Ⅱ级以上(OR=3.969,P=0.056)、BaPWV>14 m/s(OR=2.846,P=0.061)、糖尿病(OR=2.769,P=0.063)及超声心动室壁运动异常(OR=2.513,P=0.070)对预测CAD无统计学意义。(2)对冠状动脉多支病变的预测:糖尿病(OR=3.210,P=0.054)、眼底动脉硬化Ⅱ级以上(OR=3.014,P=0.062)、BaPWV>14 m/s(OR=2.860,P=0.063)进入方程,但是对预测冠状动脉多支病变均无统计学意义,将三者任意两两联合,则眼底动脉硬化Ⅱ级以上联合BaPWV>14 m/s对冠状动脉多支病变的预测有统计学意义(OR=6.428,ROC曲线下面积0.736±0.024,P=0.041);而三者联合对冠状动脉多支病变的预测也有统计学意义(OR=43.466,ROC曲线下面积0.736±0.024,P=0.000)。结论典型胸痛与冠状动脉造影结果关系密切,对预测CAD有重要价值;糖尿病、眼底动脉硬化Ⅱ级以上及BaPWV>14 m/s与冠状动脉多支病变关系密切,三者联合对预测冠状动脉多支病变有重要价值。

Aim To evaluate the value of peripheral atherosclerosis, including ocular fundus atherosclerosis （OFA）, brachial-ankle pulse wave velocity（BaPWV） and ankle-brachial index（ ABI）, in predicting the extent of coronary artery lesions according to coronary angiography （CAG）. Methods 472 consecutive patients who had taken CAG were studied . All patients were underwent OFA, BaPWV, ABI, color doppler echocardiography（UCG） examination and serum factors evaluation in addition to history collection, which were divided into two groups according to the result of the CAG. Group one was non-coronary artery disease （CAD） ,which has a normal result of CAG; group two was CAD group, which has an abnormal result of CAG（ coronary lesions ~〉50% ）. CAD group was divided into two sub-groups according to the lesions of the vessels. Sub-group one has single or two vessels lesion; sub-group two has three or more vessels lesion or left main lesion. A Logistic regression model for predicting, coronary lesions on the basis of OFA and other risk factors was obtained. A receiver operating characteristic （ROC） curve was used to assess the performance of the Logistic regression model. Results On the one hand, the CAD group as the dependent variable and the risk factors as the independent variable： diabetes mellitus, BaPWV 〉 14 m/s, typical symptom of chest pain, two or more grade of OFA and UCG showing abnormal motion of ventricular were applied into the model. Only typical symptom of chest pain had a statistical significance to the CAD （ OR = 7. 220, ROC = 0. 736 ± 0. 024, P = 0. 000 ）. But other factors such as two or more grade of OFA（ OR = 3. 969, P = 0. 056） , BaPWV 〉 14 m/s （ OR = 2. 846, P = 0. 061 ） , diabetes mellitus （ OR = 2. 769, P = 0. 063 ） and UCG showing abnormal motion of ventricular（ OR = 2. 513, P = 0. 070） had no statistical significance to the CAD. On the other hand, the sub-group as the dependent variable and the risk factors as the independent variable ： diabetes mellitus（ OR = 3. 210, P = 0. 054）, two or more grade of OFA （ OR = 3. 014, P = 0. 062）, BaPWV 〉 14 m/s （ OR = 2. 860, P = 0. 063 ） were applied into the model, all these factors had no statistical significance to predict the three or more vessels lesion. However, if any two of them were combined, two or more grade of OFA and BaPWV 〉 14 m/s had a statistical significance to predict the three or more vessels lesion （ OR =6. 428, ROC =0. 736 ±0. 024, P =0. 041 ） ; If all the three factors were combined, they bad a very statistical significance to predict the three or more vessels lesion of the coro- nary （ OR = 43. 466, ROC = 0. 736 ± 0. 024, P = 0. 000）. Conclusion The typical symptom of chest pain is positively correlated with the result of CAG, which is useful for predicting the coronary artery disease. Diabetes mellitus,two or more grade of OFA and BaPWV 〉 14 m/s are positively correlated with the vessels lesion of the coronary and these three factors combination is powerful for predicting the three or more vessels lesion of the coronary.