踝臂指数与急性冠脉综合征患者冠状动脉病变的关系及其预测价值

Correlations of Ankle-Brachial Index with Coronary Artery Stenosis and Its Predictive Values in Acute Coronary Syndrome

目的探讨踝臂指数(ABI)与急性冠脉综合征(ACS)患者冠状动脉病变严重程度的关系,了解ABI预测ACS发病危险的价值。方法收集2009年8月—2010年8月云南省第二人民医院(昆明医学院第四附属医院)和河南黄河三门峡医院心内科共220例行冠状动脉造影患者的临床资料,根据临床诊断和冠状动脉造影结果分为非ACS和ACS组;根据冠状动脉受累的主要支数分为单支、双支和三支病变组3个亚组。结果非ACS和ACS组ABI比较差异有统计学意义(t=9.898,P<0.001)。3个亚组ABI比较,差异有统计学意义(F=5.93,P=0.0035),其中,三支组低于单支组,差异有统计学意义(q=4.1578,P<0.05);三支组低于双支组,差异有统计学意义(q=3.9208,P<0.01)。ABI≤0.9组Gensini积分高于ABI>0.9组,差异有统计学意义(t=4.0779,P=0.0001)。冠状动脉狭窄程度与ABI呈负相关(r=-0.311,P=0.001)。ABI≤0.9预测ACS的敏感性为30.2%,特异性为90.1%。结论 ABI是较好地反映动脉硬化的无创检查参数,与冠状动脉病变的严重程度密切相关;ABI降低可能是ACS有价值的预测指标。

Objective To study the correlations between ankle-brachial index（ABI） and the severity of acute coronary syndrome（ACS）;to discuss the values of ABI in prediction of acute coronary syndrome.Methods Clinical data of 220 coronary artery angiography（CAG） patients from cardiology departments of the Second People′s Hospital of Yunnan and Sanmenxia Yellow River Hospital between Aug 2009 and Aug 2010 were collected.These cases were divided as the ACS group and the non-ACS group according to clinical manifestations and CAG results;the ACS group was further divided into three subgroups（one-vessel,two vessels,three-vessels） according to numbers of affected vessels.Results ABI values were significantly different between the ACS group and the non-ACS group（t=9.898,P0.001）.ABI values were significantly different among the three subgroups（F=5.93,P=0.0035）,with the three-vessels group lower than the one-vessel group（q=4.1578,P0.05） and the two-vessels group（q=3.9208,P0.01）.Gensini scores in the group with ABI≤0.9 were higher than in the group with ABI0.9（t=4.0779,P=0.0001）.Degrees of coronary artery stenosis were negatively correlated with ABI（r=-0.311,P=0.001）.The sensitivity and specificity of ACS prediction using the criterion of ABI≤0.9 were 30.2% and 90.1%,respectively.Conclusion ABI reflects the severity of coronary artery stenosis and is non-invasive,both make its decrease an idea predictor of ACS.