主动脉瓣钙化对冠心病预测价值的探讨

Association between aortic valve calcification and coronary artery disease

目的探讨主动脉瓣钙化的形成因素和对冠心病的预测价值。方法回顾性分析北京协和医院2009年11月至2010年4月590例行冠脉造影并同期行超声心动图检查的患者的临床资料。结果 590例患者中有285例(48.3%)经超声心动图检查诊断为主动脉瓣钙化,与非主动脉瓣钙化患者相比年龄更高[(68.3±9.4)岁vs.(59.2±9.9)岁,P=0.000)],高血压(73.0%vs.61.0%,P=0.002)和糖尿病(36.8%vs.24.9%,P=0.002)患病率更高,同时收缩压[(132.6±20.8)mmHgvs.(126.1±16.8)mmHg,P=0.000]和血肌酐值[(107.6±69.3)μmol/Lvs.(94.3±19.5)μmol/L,P=0.001]更高。479例(81.2%)患者经冠脉造影诊断为冠心病,与非冠心病患者相比,其年龄更高[(64.2±10.6)岁vs.(61.0±10.8)岁,P=0.006],男性比例(69.3%vs.49.8%,P=0.000)、吸烟比例(56.6%vs.31.5%,P=0.000)、主动脉瓣钙化比例(52.0%vs.34.5%,P=0.001)更高。多元回归分析显示吸烟和主动脉瓣钙化预测冠心病发病的OR值为2.955(95%CI1.767～4.942)和1.860(95%CI1.063～3.256)。结论主动脉瓣的钙化形成与年龄、高血压、糖尿病及血肌酐水平密切相关,主动脉瓣钙化是冠心病的独立预测因素。

Objective To explore the reasons of aortic valve calcification （AVC） and its predictive valve for coronary artery disease （CAD）. Methods 590 patients underwent transthoracic echocardiography （TTE） and coronary angiography at the same time （from November 2009 to April 2010） were selected, and all the data were analyzed retrospectively. Results 285 （48.3%） patients were diagnosed AVC by TTE, they were elder in age [（68.3 ± 9.4）yrs vs. （59.2 ± 9.9）yrs, P = 0.000）, had higher hypertension morbidity （73.0% vs. 61.0,P = 0.002） as well as higher diabetes mellitus morbidity （36.8% vs. 24.9%, P = 0.002） when compared to other patients who did not have AVC. Their systolic blood pressure（SBP） [（132.6 ± 20.8） mmHg vs. （126.1 ± 16.8） mmHg, P = 0.000] and serum creatinine [（107.6 ± 69.3）μmol/L vs. （94.3±19.5）μmol/L, P = 0.001] level were higher than those of other patients. 479 （81.2%） patients were diagnosed CAD. This group of patients were more advanced in age [（64.2 ± 10.6）yrs vs. （61.0 ± 10.8）yrs, P = 0.006], more male gender （69.3% vs. 49.8%, P = 0.000）, and had higher smoking ratio （56.6% vs. 31.5%, P = 0.000） and higher aortic valve calcification ratio （52.0% vs. 34.5%, P = 0.001） than other patients. Multivariate analyses identified that AVC （OR 2.955, 95% CI 1.767～4.942） and smoking （OR 1.860, 95% CI 1.063～3.256） were associated with CAD. Conclusions AVC is strongly associated with age, hypertension, diabetes mellitus, serum creatinine level. AVC is an independent predictive factor for CAD.