心脏脚踝指数对冠状动脉粥样硬化的预测价值分析

The Prediction Value of Cardio-Ankle Vascular Index in Coronary Atherosclerosis

目的探讨心脏脚踝指数（CAVI）、最大颈动脉内中膜厚度（Max IMT）及平均颈动脉内中膜厚度（Mean IMT）对冠状动脉粥样硬化的预测诊断价值。方法选取我院心内科冠心病拟行冠状动脉造影（CAG）病人100例作为研究对象,根据CAG结果及Gensini评分,分为正常组（A组,0分）,B组（1分~80分）及C组（81分~160分）,并以B组、C组作为CAG阳性组。对3组人员空腹采血检测CAVI、Max IMT及Mean IMT指标。结果 CAVI、Max IMT及Mean IMT三项指标中,CAVI曲线下面积显然大于其他两项指标;其次为Max IMT。说明CAVI预测动脉粥样硬化的价值显然高于其他两项指标。同时CAVI、Max IMT及Mean IMT对预测粥样硬化的CUT-OFF值、敏感性及特异性分别为8.84、84.01%及69.0%,1.33、74.51%及74%,0.92、68.85、73.22%。CAVI、Max IMT及Mean IMT的三项评分均与Gensini评分呈正相关,r值分别为0.55（P〈0.001）,0.31（P〈0.05）,0.40（P〈0.001）,其中CAVI与该项评分相关性最强。CAVI假阳性率显著高于Max IMT及Mean IMT,CAVI阴性预测性显著低于其余两项指标,Mean IMT阴性预测值最大。结论 CAVI相对于Max IMT及Mean IMT两个指标对判断动脉粥样硬化更具有预测价值,且该指数变化随动脉粥样硬化程度加重而逐渐升高,对临床判断冠心病及相关疾病风险具有重要意义。

Objectlve To study the prediction value of cardio - ankle vascular index （CAVI） in coronary arteriosclerosis , compared with max carotid intimamedia thickness（Max IMT） and mean carotid intima - media thickness （Mean IMT）,Methods Ninety patients with chest pain syndrom and suspceted diagnosis of coronary diseases were included in our study,All patients underwent coronary angiography（CAG）, blood samples analysis, CAVI, Max IMT and Mean IMT examination,According to the results of coronary angiography and Gensini score,subjects were divided into 3 groups： group A（the score of 0）, group B（the score of 1 to 80）, group C （the score of 81 to 160 ;.Blood samples,CAVI,Max IMT and Mean IMT were measured before CAG operation.Results Ninety con- secutive patients were enrolled in the current study, receiver operating characteristic curve （ROC）analysis of Mean IMT, Max IMT and CAVl showed that the area under the ROC defined by CAVI was the greatest among the 3 indexes.The values of CUT - OFF, sensitivity, specificity of CAVI, Max I MT and Mean I MT to predict were 8.84,84.01% and 69.0%, 1.33,74.51% and 74%, 0.92,68.85% and 73.22%, respectively.CAVI, Max IMT and Mean IMT were positively associated with Gensini score,the values of ＂r＂ were 0.55,0.31, 0.40（ P 〈0.05）, respectively, especially CAVI.False positive of CAVl was significantly higher than that of Max IMT and Mean IMT.and negative predictive value of CAVI was significantly lower than that of other 2 indexes.Conclusion Compared with Max IMT and Mean I MT,CAVI is significantly associated with the severity of coronary atherosclerosis ,which is a stronger predictor of a coronary therosclerosis,and can be used as a screening tool for coronary atherosclerosis.