指尖光学体积描记法检测血管内皮功能在冠心病患者筛查中的应用

Application of fingertip photoplethysmogram assessment of endothelial function in screening coronary heart disease patients

目的:探讨光学体积描记法在指尖脉搏容积(PAV)评价内皮功能在冠心病诊断中的应用,阐明其与心血管危险因素的关系。方法:选择409例行冠状动脉造影术(CAG)的胸痛患者,依据造影结果分为冠状动脉造影阳性(CAG+)组288例与冠状动脉造影阴性(CAG-)组121例。应用内皮功能诊断仪,采用光学体积描记法分析反应性缺血后的PAV,并分析PAV值与冠心病危险因素的相关性,确定PAV作为预测冠心病指标的临界参考值。分析各组受试者年龄、性别、血清总胆固醇(TC)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、非高密度脂蛋白(non-HDL)、甘油三酯(TG)、高血压、糖尿病、吸烟、冠心病家族史和体质量指数(BMI)等危险因素,将PAV与冠心病危险因素的关系进行Logistic回归分析。结果:CAG+组患者PAV值明显低于CAG-组(P<0.01);PAV预测冠心病的临界点为1.37,如以PAV值<1.37来预测冠心病,其敏感度为74.65%,特异度为44.63%,阳性预测值为76.24%,阴性预测值为42.52%;Logistic回归分析,PAV与高血压、吸烟史和TG呈负相关关系(OR=1.476,OR=2.002,OR=1.844,P<0.01)。结论:PAV与冠心病及其危险因素高血压、吸烟史和TG相关,PAV=1.37可作为预测冠心病的临界参考值。

Objective：To investigate the application of photoplethysmogram in analyzing the fingertip pulse amplitude volume （PAV）to evaluate the endothelial function in diagnosing coronary heart disease,and to clarify its relationship with the risk factors of cardiovascular diseases.Methods：Total 409 patients with chest pain accepted coronary angiography （CAG）were selected and diveded into positive group （CAG＋）（n=288）and negative group （CAG-） （n = 121）according to angiographic results.Fingertip photoplethysmogram was used to analyze the fingertip PAV by the way of applying endothelial function diagnostic after reactive ischemia,and the relationship between the PAV value and the risk factors of coronary heart diseases was analyzed,and the critical reference value of prediction index of coronary heart disease was determined.The risk factors such as age,gender,serum total cholesterol （TC ）, low density lipoprotein （LDL ）, high density lipoprotein （HDL ）, non-HDL, serum triglyceride （TG）,hypertension,diabetes,smoking,family history of coronary heart disease,body mass index （BMI）of the subjects in various groups were analyzed,and the relationship between the risk factors of coronary heart disease and PAV was analyzed by Logistic regression analysis.Results：The PAV of patients in CAG＋group＆amp;nbsp;was significantly lower than that in CAG-group （P 〈0.01）.The peak point of PAV was〈1.37,if PAV〈1.37 was used to predict the coronary heart disease,the predictive sensitivity,the specificity,the positive prediction and the negative prediction were 74.65%,44.63%, 76.24%, and 42.52%.The Logistic regression analysis showed that PAV was negatively associated with hypertension,smoking history,TG （OR= 1.476,OR=2.002, OR = 1.844;P 〈 0.01 ）. Conclusion： PAV is associated with coronary heart disease and its risk factors （hypertension,smoking history,TG）,and PAV=1.37 can be used as the peak point to predict the coronary heart disease.