周围动脉硬化指标结合运动负荷试验预测冠状动脉狭窄程度的临床意义

Clinical significance of combined peripheral arteriosclerosis index and exercise load test in predictiing severity of coronary artery stenosis

目的探讨周围动脉硬化指标对早期预测冠心病及冠状动脉病变程度的临床意义。方法随机选取解放军总医院心内科住院患者56例,平板运动试验前后完成静息性及运动后即刻踝臂指数(ankle-brachial index,ABI);肱动脉踝动脉脉搏波速度(brachial ankle artery pulse wave velocity,baPWV)、上行主动脉-踝动脉脉搏波速度(haPWV)检测,同时完成冠状动脉造影检查,根据造影结果,分为无病变组9例,无意义狭窄组12例,单支病变组1 7例,双支病变组9例及3支病变组9例,对各组患者运动前后ABI、baPWV及haPWV进行统计学分析。结果静息状态下,与无病变组比较,冠状动脉病变各组ABI差异无统计学意义(P>0.05),baPWV、haPWV明显增高.差异有统计学意义(P<0.05);冠状动脉病变各组间,ABI、baPWV及haPWV值比较,差异无统计学意义(P>0.05);平板运动试验结束即刻,所有研究对象ABI均有不同程度下降,但差异无统计学意义(P>0.05);无病变组与冠状动脉病变各组baPWV、haPWV及变化值比较,差异无统计学意义(P>0.05)。结论静息baPWV、haPWV显著增高,可以预测冠状动脉存在病变,但不能预测冠状动脉病变程度。运动前后ABI及运动后baPWV、haPWV对冠状动脉病变及病变程度的预测价值均甚微。

Objectives To study the clinical significance of peripheral arteriosclerosis index in predicting early occurrence and severity of coronary heart disease. Methods Fifty-six patients admitted to Department of Cardiology, Chinese PLA General Hospital, were enrolled in this study. Their ankle-brachial index（ABI）, brachial ankle artery pulse wave velocity（baPWV） ,and haPWV were measured before and after exercise by treadmill test followed by coronary angiography and analyzed by chi-squre test. The patients were divided into non-disease group（n= 9）, non-signifi- cant stenosis group（n = 12）, single vessel lesion group（n = 17）, 2-vessel lesion group and 3-vessel lesion group according to their angiographic findings. Results No significant difference was found in ABI among the 4 groups at rest（P〉0.05）. The baPWV and haPWV were significantly higher in coronary heart disease group than in non-disease group （P〈0.05）. No significant difference was found in ABI, baPWV and haPWV in coronary heart disease group （P 〉 0.05）. The ABI, baPWV and haPWV decreased immediately after treadmill exercise. Conclusion The significantly increased resting baPWV and haPWV can predict coronary heart disease,but cannot predict its severity. The ABI before and after exercise and the baPWV and haPWV after exercise can hardly predict the occurrence and severity of coronary heart disease.