中心动脉压与冠状动脉病变程度及预后的关系

Association between outcome and severity of coronary artery lesion and central arterial pressure

目的：探讨中心动脉压与冠心病患者冠状动脉病变程度及预后的关系。方法选择2011年11月至2012年10月烟台市莱阳中心医院心内科冠状动脉造影确诊为冠心病患者98例，年龄45～82岁，其中合并高血压组54例，根据病变支数分为单支病变组（48例）和多支病变组（50例），冠状动脉造影结束后，同步测量升主动脉根部（直接测量法）和肱动脉（袖带加压法）的血压，记录中心动脉及肱动脉压力参数，随访2年并比较两组患者主要心血管事件（ MACE）的发生情况。结果多支病变组中心动脉收缩压（ CASP）、中心动脉脉压（ CAPP）、肱动脉收缩压（ SBP）、肱动脉舒张压（DBP）水平高于单支病变组（均为P＜0.05）。 Kaplan？Meier生存分析显示：CAPP≥49 mmHg（中位数）时MACE发生风险明显增高（χ2＝11.216，P＝0.001），冠状动脉多支病变患者MACE发生风险明显高于单支病变患者（χ2＝7.716，P＝0.005）。在校正年龄、BMI、吸烟及血压水平等因素后，多变量Cox回归分析显示：CAPP（RR：1.095，95％CI：1.030～1.165，P＝0.004）是MACE的危险因素。结论中心动脉压水平与冠心病患者冠状动脉病变程度关系密切，CAPP是MACE的危险因素。

Objective To investigate the relationship between central arterial pressure （ CAP） and severity of coronary artery lesions,and predictive value of CAP. Methods The 98 coronary heart disease （ CHD） patients proved by coronary angiography were enrolled in this study from November 2011 to October 2012 in our hospital. The average age was （ 65. 7 ± 9. 8 ） years old. The 54 patients combined with hypertension. There were two groups according to the number of lesional vessels：single vessel group （ n=48） and multi-vessels group （n=50）. Ascending aortic pressure was measured by catheter during coronary angiography,and brachial blood pressure （ BP） was measured by a standard sphygmomanometer. BP data was collected for all participants. MACE was recorded during two years follow up. Results CASP,CAPP, SBP and DBP were all higher in multi vessels group than those in the single vessel group （ all P〈0. 05 ） . Kaplan？Meier survival curves showed that MACE was significantly higher when CAPP was≥49 mmHg （χ2 =11. 216,P=0. 001）. MACE was obviously higher in multi-vessels group than in single vessel group （χ2 =7. 716,P=0. 005）. CAPP was the risk factor for MACE after adjustment by age,BMI,smoke and BP （RR：1. 095,95%CI：1. 030-1. 165,P=0. 004）. Conclusions There is a close relationship between CAP and severity of coronary artery lesion. CAPP is a main risk factor for MACE in patients with CHD.