踝臂指数联合颈动脉斑块积分对老年人冠状动脉病变的预测分析

Predictive values of ankle-brachial index combined with carotid plaque scores for coronary artery disease in the elderly

目的 探讨踝臂指数（ABI）联合颈动脉斑块积分（Crouse积分）对老年人冠状动脉病变的判定价值.方法 选择2013年11月1日至2014年4月30日在解放军总医院心内科住院并首次行冠状动脉造影的153例老年患者（＞ 60岁）,收集其ABI及颈动脉斑块Crouse积分的数值,根据冠状动脉造影的病变血管数量把患者分成冠状动脉正常组（0组）、单支病变组（1组）、双支病变组（2组）及多支病变组（3组）;再根据冠状动脉病变狭窄程度（Gessini积分）分为冠状动脉严重病变组和非严重病变组.结果 ABI在0组、1组、2组均与3组有统计学差异,Crouse积分在0组与2组、3组有统计学差异;分别对Crouse积分、ABI和冠状动脉病变血管数进行相关性分析,采用Spearman分析,在置信度（双侧）为0.01时,相关性是显著的,相关系数分别为0.484和-0.491;以ABI≤0.9为截断值,其预测冠状动脉严重病变的敏感性为24％,特异性为96.1％,以Crouse积分≥1.9为截断值,其预测冠状动脉严重病变的敏感度为76％,特异度为21.4％.结论 ABI、颈动脉Crouse积分的水平变化与冠状动脉的病变程度密切相关.对于冠状动脉是否存在严重病变,二者联合检测具有更高的预测价值.

Objective To determine the values of ankle-brachial index （ABI） combined with carotid plaque scores （Crouse scores） for the prediction of coronary artery disease （CAD） in the elderly population. Methods A total of 153 elderly inpatients （over 60 years old） undergoing coronary angiography for the first time in our department from November 2013 to April 2014 were enrolled in this study. Their clinical data such as ABI and the Crouse scores were collected. They were divided into 4 groups according to the number of stenosed coronary arteries, that is, normal coronary arteries group （group 0）, and the groups involving 1 （group 1）, 2 （group 2） or 3-or-more vessels （group 3）. Based on the severity of coronary artery stenosis （estimated by Gessini score）, they were also assigned into severe group and non-severe group. Results There were significant differences in ABI among group 0, group 1, group 2 and group 3. The Crouse scores also had significant differences among the group 0, group 2 and group 3. Spearman analysis indicated that the relativities were significant in ABI, Crouse and the number of stenosed vessels when double-sided confidence level was 0.01, with the correlation coefficients of 0.484 and -0.491. With ABI 〈 0.9 or Crouse score〉 1.9 as the cutoff value to predict severe stenosis, the sensitivity was 24% and 76% respectively, and the specificity was 96.1% and 21.4% respectively. Conclusion ABI and Crouse score are closely related to the severity of CAD. Combination of ABI with Crouse scores has more significant value in the prediction of the severity of the disease.