颈动脉压力波形反射波点与冠心病关系研究

Relationship of reflected wave of carotid artery pressure waveform with coronary heart disease

目的探讨超声颈动脉局部压力波形反射波点对冠心病及冠状动脉病变程度的评估价值。方法行冠状动脉造影患者158例,冠状动脉未见异常者50例为非冠心病组,有冠状动脉病变患者108例为冠心病组,其中单支血管病变45例(单支病变组),多支血管病变63例(多支病变组),根据颈动脉射频血管压力波波形分析(quality arterial stiffness technique-pulse wave analysis,QAS-PWA)提取反射波幅值(H)、反射波斜率(R)及反射波增强指数(augmentation index,AIX)。分析各参数与冠状动脉病变程度的相关性。结果单支病变组、多支病变组H[(114.415±12.486)、(114.920±13.291)mm Hg]和R(0.513±0.104、0.561±0.111)均明显高于非冠心病组[(106.000±14.000)mm Hg,(0.449±0.119)],差异均有统计学意义(P<0.05),且多支病变组R高于单支病变组(P<0.05);各组AIX比较差异无统计学意义(P>0.05);logistic回归分析显示R对冠心病发生的影响力最大(回归系数β=7.005),Spearman秩相关分析显示R与冠状动脉病变程度呈明显正相关(r=0.532,P=0.000)。结论颈动脉压力波形图中反射波点幅值H与冠心病的发生可能有相关性,反射波点斜率R与冠心病及病变程度呈正相关,波形图反射波点位置随冠心病发生及病变程度加重逐渐前移,对冠心病及病变程度预估有一定价值。

Objective To investigate the value of wave reflection of local pressure waveform of the carotid artery to the assessment of the degree of coronary heart disease （CHD） and coronary artery lesions. Methods A total of 158 patients undergoing coronary angiography were divided into non-CHD group （n= 50） and CHD group （n= 108） including 45 patients with single vessel lesion （single vessel lesion group） and 63 patients with multi-vessel lesions （multi-vessel lesion group）. The reflected wave amplitude （H）, slope （R） and the augmentation index （AIX） were obtained by quality arterial stiffness technique-pulse wave analysis to analyze the correlation between the parameters and the degree of coronary artery lesions. Results H values （114. 415 ± 12. 486, 114. 920 ± 13. 291） and R values （0. 513 ± 0. 104, 0.561 ± 0.111） were significantly higher in single vessel lesion group and multi-vessel lesion group than those in non-CHD group （106. 000±14. 000, 0. 449±0. 119） （P〈0.05）, and R value was significantly higher in multi vessel lesion group than that in single vessel lesion group （P〈0.05）. There was no significant difference in AIX among groups （P〈0.05）. Logistic regression analysis showed that R had the greatest impact on the occurrence of CHD （β= 7. 005） and Spearman rank correlation analysis showed that R was positively correlated with the severity of coronary artery lesion （r= 0. 532, P=0. 000）. Conclusion H in reflected wave of local pressure waveform of the carotid artery is possibly correlated with CHD, and R is positively correlated with the occurrence and the severity of CHD. The reflection point position moves forward gradually with the exacerbation of CHD, which contributes to the prediction of CHD and its severity.