颈动脉内膜中膜厚度联合踝臂指数对冠心病预测价值的研究

Clinical study on predictive value of ankle-brachial index combined with the media thickness of carotid artery intima in coronary heart disease

目的研究颈动脉内膜中膜厚度（IMT）联合踝臂指数（ABI）对冠心病的预测价值。方法选择2008至2010年在日照市人民医院住院并行冠状动脉造影或介入治疗患者194例，术前对其进行颈动脉内膜中膜厚度以及踝臂指数测量，血液生化检查，病史采集，并根据ABI≤0．90为阳性，ABI〉0．90为阴性，IMTI〉0．9mm为阳性，IMT〈0．9mm为阴性，设定为两项指标均为阴性为A组，ABI阳性为B1组，阴性为B2组，IMT阳性为C1组，阴性为C2组，两项指标均为阳性者为D组，并根据冠状动脉造影结果得出各组冠心病发病率。结果A组中冠心病发病率为9．1％，B1组为64．8％，B2组为29．9％，C1组为70．8％，C2组为28．4％，D组为89．1％，从以上结果中我们可以看出，踝臂指数阳性能较好预测冠心病发生（B1：64．8％比B2：29．9％，P〈0．05）；颈动脉内膜中膜厚度对冠心病的预测也有重要意义（C1：70．8％比C2：28．4％，P〈0．05），两项指标均为阳性对冠心病的预测价值要高于单一项指标（D：89．1％比B1：64．8％，C1：70．8％，P〈0．05），且两项指标阴性对冠心病的排除价值也要高于单一项指标阴性者（A：9．1％比B2：29．9％，C2：28．4％，P〈0．01）。结论联合应用ABI、IMT两项指标对冠心病的预测具有重要的临床意义。

Objective To study the predictive value of ankle-brachial index （ABI） combined with the media thickness of carotid artery intima in coronary heart disease. Methods One hundred and ninety-four patients undergone the coronary angiography or percutaneous coronary intervention were recrui-ted in our study from 2008 to 2010. The intima media thickness （IMT） of carotid artery and ABI were measured before operation. In addition, the hemostatic factors and history collection were also finished be-fore operation. According to our study criterion, ABI ≤0. 9 was defined as positive, ABI 〉 0. 9 was defined as negative, IMT≥0. 9 mm was defined as positive, IMT 〈0. 9 mm was defined as negative. The patients were divided into six groups： group A： the aboved two indicators were negative; group B1 ： ABI was posi-tive ; group BE ： ABI was negative; group C1 ： IMT was positive; group C2 ： IMT was negative; group D： the aboved two indicators were all positive. The incidence of coronary heart disease （CHD） was confirmed ac-cording to the results of the coronary angiography. Results The incidence of CHD was 9. 1% in group A, 64. 8% in group B1, 29. 9% in group B2, 70. 8% in group C1 , 28. 4% in group C2 and 89. 1% in group D. The abnormal ABI had better predictive value in CHD （ B1 ： 64. 8% versus B2 ： 29. 9%, P 〈 0. 05 ）. IMT also had statistical significance in the predictive value of CHD （ C1 ：70. 8% versus Cz ：28.4%, P 〈 0. 05 ）, the positive predictive value of aboved two abnormal indicators in CHD was higher than that of one abnormal indicator （D：89. 1% versus B1：64. 8%, C1：70. 8%, P 〈0. 05）, In addition, the negative pre-dictive value of two combined negative indicators was also higher than that of one negative indicator （ A ： 9. 1% versus B2：29. 9%, C2：28. 4%, P 〈0. 01）. Conclusions The combined two indicators of ABI and IMT have an important clinical significance in the predictive value of CHD.