脉搏波传导速度与冠状动脉病变严重程度的相关性：324例老年病例分析

Pulse wave velocity and severity of coronary heart disease： analysis of 324 elderly patients

目的探讨脉搏波传导速度（PWV）与冠状动脉粥样硬化程度的相关性。方法2008年1月至2010年1月因胸痛入住解放军总医院老年心血管病研究所行冠状动脉造影检查的患者324例，其中男性213例，女性111例，年龄（61±12）岁。根据冠状动脉造影结果分为两组：冠心病组和正常组。冠心病组为冠状动脉造影显示至少有一支以上血管狭窄程度≥50％。同时根据冠状动脉血管病变的支数分为单支病变、双支病变、严重病变[三支病变或（和）左主干病变]组。采用全自动动脉硬化测定仪同步记录左右侧肱动脉一踝动脉脉搏波传导速度（baPWV）作为反映大动脉弹性的指标。结果对324例患者影响冠心病发生的多元logistic逐步回归分析表明，性别、吸烟、PWV是冠心病独立的危险因素。PWV与冠状动脉病变支数的Spearman等级相关分析显示，PWV与冠心病病变支数成正相关（r=0．307，P=0．005），在校正多种危险因素后相关性消失。多元回归分析表明，PWV≥1600cm／s的患者发生严重病变的危险度是Pwv〈1600cm／s者的5．736倍。结论动脉弹性减退与冠心病有关，冠心病严重病变者较轻度病变者动脉弹性减退更为明显。

Objective To investigate the relationship between pulse wave velocity（PWV） and severity of coronary atherosclerosis Methods Coronary angiography were performed on 324 patients admitted to Chinese PLA General Hospital for the chest pain between January 2008 and October 2010, including 213 males, 111 females, mean age （61.3 ± 12.1） years. The patients were divided into two groups according to the result of coronary angiography： coronary artery disease （CAD） group and non-CAD group. CAD was diagnosed if at least 50% diameter stenosis was found in one or more coronary segment. The CAD group was divided into single-vessel group, dual-vessel group and multiple-vessel group in term of the numbers of coronary artery with lesion. Aortic flexibility was assessed by measuring brachial-ankle pulse wave velocity （baPWV）. Results The logistic regression showed gender, smoking, PWV are the risk factors for CAD. PWV were found to have a positive correlation with severity of CAD （r = 0.307, P=0.005）, but the result became negative after normalizing with multiple cardiovascular risk factors. When the severity of CAD was expressed as single-, dualor multiple-vessel disease, the multivariate odds of multiple-vessel disease in subjects with PWV≥ 1600cm/s was 5.734 times higher than those with PWV 〈 1600cm/s. Conclusions Aortic flexibility has a positive correlation with CAD. Patients with multiple-vessel disease has a more severe aortic stiffness.