心-踝血管指数与颈动脉内膜中膜厚度在动脉硬化疾病评价中的价值

Comparison of the Clinical Value of Cardio-Ankle Vascular Index and Intima-Media Thickness in the Evaluation of Arteriosclerosis

目的比较心-踝血管指数与颈动脉内膜中膜厚度对不同动脉硬化疾病严重程度的判断价值。方法在849例同时行心-踝血管指数和颈动脉内膜中膜厚度测定的门诊和住院患者中,筛选出年龄55～70岁之间的351例作为最终研究对象。按临床动脉硬化疾病的有无与程度分为三个层面:A层:无动脉硬化危险因素组;B层:包括高血压、糖尿病、心绞痛和高脂血症组;C层:经造影证实存在冠状动脉狭窄和已有临床心脑动脉硬化终末事件如心肌梗死和脑梗死组。从不同层面比较心-踝血管指数和内膜中膜厚度与动脉硬化性疾病严重程度的相关性。849例中,未做年龄范围限制时,共有糖尿病患者112例,对其病程与心-踝血管指数和内膜中膜厚度的相关性作比较分析。结果除单纯高脂血症组之外,心-踝血管指数测定值在A、B、C三个不同层面能够表现出显著的差异,呈现出"阶梯效应";而内膜中膜厚度测定值相对于心-踝血管指数在三个不同层面表现出的差别明显减弱,甚至糖尿病组的测定值远远高于已有明确动脉硬化终末事件组如心肌梗死和脑梗死。在已有明确糖尿病病程的患者中,心-踝血管指数与糖尿病病程呈显著正相关(r=0.499,P<0.001),而内膜中膜厚度与病程的相关性(r=0.195,P<0.038)明显弱于心-踝血管指数。结论心-踝血管指数和内膜中膜厚度与大动脉硬化性疾病均有不同程度的相关性,而心-踝血管指数在评价整体而非局部的动脉硬化程度上相对于内膜中膜厚度具有一定的优势,其与动脉硬化的严重程度具有更大的吻合性,而内膜中膜厚度则更多地偏重于对局部动脉壁硬化的判断。

Aim To compare the advantages and weaknesses of two kinds of noninvasive measurements with cardio-ankle vascular index（CAVI） and intima-media thickness（IMT） in the evaluation of arteriosclerosis.Methods The subjects were 351 persons（55~70 years old） who came to our clinics because of arteriosclerosis disease.They were divided into three classes of A,B and C.A class was non-arterioscletotic disease group and B class included diabetes mellitus,hypertension,hyperlipidemia and angina pectoris group and C class included coronary stenosis,myocardial infarction（MI） and cerebral infarction（CI）.CAVI and IMT for the subjects were simultaneously measured.The relationship between CAVI and IMT and the duration of diabetes was analyzed in 112 of diabetic patients（21~84 years old）.Results In age-matched subjects（55~70 years old）,CAVI was higher in myocardial infarction,coronary artery stenosis,cerebral infarction;diabetes mellitus,angina pectoris,and hypertension was the second;non-arterioscletotic diseases group constituted together a ＂ladder effect＂ with three layers of mean values;Each layer presented the meaningful difference（P0.05 or P0.01） after exclusion of which P value between DM and MI or CS were appreciably high（P=0.130 and 0.118 respectively）.IMT showed much more uncertainties with mean value,and IMT value was even lower in CI and CS groups than that in DM group.The correlation of the duration of diabetes mellitus was stronger with CAVI than with IMT.Significant positive correlations were observed between the CAVI measurement value and the duration of diabetes（r=0.499,P0.001）.However in IMT,there was only a weakly correlations with the duration of diabetes（r=0.195,P=0.038）. Conclusions CAVI is a good indicator of cardio-and cerebro-vascular event,and is more likely reflecting arterioscleosis in a whole body than IMT.