臂踝脉搏波速度评估冠心病患者冠脉病变程度的临床价值

Assessment value of brachial-ankle pulse wave velocity on severity of coronary disease in patients with coronary heart disease

目的：研究臂一踝脉搏波传导速度（baPWV）评估冠心病患者冠脉病变程度的临床价值。方法：选择我院206例冠心病患者，按照冠脉造影心脏外科与介入治疗狭窄冠脉研究评分（SYNTAX）积分分为轻度组（74例，SYNTAX积分G23分），中度组（72例，SYNTAX积分23～32分）和重度组（60例，SYNTAX积分〉32分）。并选择同期正常健康体检者80例为健康对照组。检测并比较各组baPWV、踝臂指数（ABI）与颈一股脉搏波传导速度（cfPWV）的差异。应用Pearson相关分析分析冠心病患者baPWV、cfPWV及ABI与SYNTAX积分的相关性；应用多元Logistic回归模型分析baPWV、cfPWV及ABI是否为SYNTAX积分的危险因素。结果：与健康对照组比较，轻度组，中度组和重度组baPWV[（1．2±0．3）m／s比（1.5±0．4）m／s比（1．8±0．6）m／s比（2．0±0．7）m／s]和cfPWV[（1．3±0．5）m／s比（2．5±0．7）m／s比（2．9±0．8）m／s比（3．4±0．7）m／s]均显著升高（P〈0．05或〈0．01），且重度组〉中度组〉轻度组，两两比较有显著差异（P均〈0．05）；ABI显著降低[（1．02±0．32）比（0．82±0．24）比（0．73±0．16）比（0．56±0．09）]，且重度组〈中度组〈轻度组，两两比较均有显著差异（P均〈0．05）。Pearson相关分析显示baPWV、cfPWV水平与SYNTAX积分显著正相关（r=0．613，P=0．007及r=0．528，P=0．023），而ABI水平与SYNTAX积分无相关性。多元Logistic回归分析表明糖尿病，高血压，baPWV及cfPWV是SYNTAX积分的危险因素（OR=4．016~5．809，PG0．05或〈0．01）。结论：baPwV检测能有效评估冠心病患者冠脉病变程度。

Objective： To study assessment value of brachial-ankle pulse wave velocity （baPWV） for severity of coro- nary disease in patients with coronary heart disease （CHD）. Methods： According to SYNTAX score of coronary an- giography, a total of 206 CHD patients from our hospital were divided into mild group （n = 74, SYNTAX score 〈23 scores）, medium group （n = 72, SYNTAX score 23~32 scores） and severe group （n = 60, SYNTAX score 〉32 scores）. Another 80 healthy subjects undergoing physical examinations were selected as healthy control group during the same period. BaPWV, ankle brachial index （ABI） and carotid - femoral pulse wave velocity （cfPWV） were measured and compared among all groups. Pearson correlation analysis was used to analyze the correlation among baPWV, cfPWV, ABI and SYNTAX score in CHD patients; multi- factor Logistic regression model was used to analyze whether baPWV, cfPWV and ABI were risk factors for SYNTAX scores. Results.. Compared with healthy control group, there were significant rise in baPWV [- （1.2±0.3） m/s vs. （1.5 ± 0.4） m/s vs. （1.8 ± 0.6） m/s vs. （2.0±0.7） m/s7 andcfPWVE （1.3±0.5） m/svs. （2.5±0.7） m/svs. （2.9±0.8） m/svs. （3.4±0.7） m/s] in mild group, medium group and severe group （P〈0.05 or 〈0.01）, and that of severe group was more than that of medium group, and〉mild group in turn, there was significant difference by pairwise comparisons （P〈0.05 all）; significant reduction in ABI [- （1.02 ± 0.32） vs. （0.82± 0.24） vs. （0.73 ± 0.16） vs. （0.56 ± 0.09）1 in mild group, medium group and severe group, and that of severe group was 〈 medium group, and ~ mild group in turn, there was significant difference by pairwise comparisons （P〈0.05 all）. Pearson correlation analysis indicated that baPWV and cfPWV were positively correlated with SYNTAX score （r = 0. 613, P = 0. 007; r = 0. 528, P = 0. 023）, while ABI had no correlation with SYNTAX score. Multi- factor Logistic regression analysis indicated that diabetes melli- tus, hypertension, baPWV and cfPWV were risk factors for SYNTAX score （OR = 4. 016~5. 809, P〈0.05 or 〈0.01）. Conclusion.. The baPWV can effectively assess severity of coronary disease in CHD patients.