绝经女性冠状动脉钙化积分与踝臂指数的相关性研究

Association between Coronary Artery Calcium Scoring and Ankle-brachial Index in Post-menopause Women

目的:研究绝经女性中冠脉钙化积分(CACS)与踝臂指数(ABI)之间的相关性。方法:从1918名社区人群筛选出608名无冠心病病史并可以进行CACS检查的绝经女性为样本,对其进行标准化问卷调查、实验室指标检测、ABI及CACS测量。根据CACS将研究对象分为钙化阴性组和钙化阳性组,并根据ABI结果分为五类:外周血管病组(ABI<0.9)、临界ABI组(ABI:0.90-0.99)、低-正常ABI组(ABI:1.00-1.09)、正常ABI组(ABI:1.10-1.29)和高ABI组(ABI≥1.3),分析不同冠脉钙化程度与不同等级ABI的相关性。结果:研究人群中钙化阴性514例(84.5%),钙化阳性94例(15.5%)。其中钙化阳性组在年龄、高血压、收缩压、总胆固醇、高密度脂蛋白、低密度脂蛋白及糖尿病方面均高于钙化阴性组,同时绝经女性多数集中在低-正常ABI组和正常ABI组,分别为235例(38.7%)和313例(51.5%)。钙化阳性组存在外周血管病变和临界ABI状态者多(5.3%vs.0.8%,9.6%vs.6.4%),两组间差异有统计学意义(P<0.001),并且Logistic回归发现,绝经女性年龄(OR=1.115,95%CI 1.060-1.174,P<0.001)、高血压(OR=1.941,95%CI 1.107-3.402,P=0.021)、收缩压(OR=1.018,95%CI 1.003-1.034,P=0.020)、外周血管病变(ABI<0.9)(OR=6.771,95%CI 1.483-30.923,P=0.014)是冠脉钙化的独立危险因素。高密度脂蛋白(OR=0.322,95%CI 0.104-0.994,P=0.049)则是防止冠脉钙化的有利因素。结论:绝经女性ABI降低与CACS相关,ABI可以作为一种评估冠脉钙化程度和心血管风险的有效手段为临床医生服务。

Objective： To assess the association between coronary artery calcium scoring（CACS）and ankle-brachial index（ABI）in post-menopause women. Methods： A total of 608 post-menopausal women without cardiovascular disease history collected from 1,918 people living in a community in He Bei province, underwent examinations of questionnaire interview, anthropometric measurements,biochemical indexes, ABI testing and CACS assessment. According to CACS, we divided study population into two groups： negative CAC group and positive CAC group and divided ABI into five categories： definite PAD（ABI〈0.9）, borderline ABI（ABI： 0.90-0.99）,low-normal ABI（ABI：1.00-1.09）, normal ABI（ABI：1.10-1.29）and high ABI（ABI≥1.3）. The association between ABI and CAC was analyzed by logistic regression. Results： There are 514 people（84.5%）in negative CAC group and 94 people（15.5%）in positive CAC group. Compared with the negative CAC group, the positive CAC group had obvious higher rates in age, hypertension, systolic blood pressure, total cholesterol, high density lipoprotein, low density lipoprotein and diabetes. And the higher prevalence of ABI in post-menopausal women were low-normal ABI and normal ABI,respectively 235（38.7%）and 313（51.5%）. And the higher prevalence of definite PAD and borderline ABI were in positive CAC group（5.3% vs.0.8%, 9.6% vs.6.4%）. From logistic regress analysis, we found age（OR=1.115,95% CI 1.060-1.174,P 〈0.001）, hypertension（OR=1.941, 95% CI 1.107-3.402, P=0.021）, systolic blood pressure（OR=1.018, 95%CI 1.003-1.034, P=0.020）and definite PAD（ABI〈0.9）（OR=6.771,95%CI 1.483-30.923, P=0.014）were CAC risk factors. And high density lipoprotein was CAC prospective factor（OR=0.322, 95%CI 0.104-0.994, P=0.049）. Conclusion： Lower ABI was significantly associated with the extent of CAC in post-menopausal women. ABI can provide clinicians with an additional effective tool to assess vascular health and cardiovascular risk.