心-踝血管指数联合颈动脉内膜厚度对动脉粥样硬化评估

Value analysis of cardio ankle vascular index combined with carotid artery intima media thickness in evaluation of arterial stiffness

目的探究心—踝血管指数(CAVI)联合颈动脉内膜中膜厚度对动脉粥样硬化性疾病的诊断价值。方法选取本院2012年1月至2016年1月行CAVI和颈动脉内膜中膜厚度检查的门诊和住院患者936例,将其按照动脉粥样硬化类疾病的患病情况分为A组(无动脉粥样硬化危险因素)112例、B组(存在动脉粥样硬化危险因素)526例和C组(经造影证实存在冠状动脉狭窄或已发生心脑动脉粥样硬化终末事件)298例,B组按照不同危险因素分为B1组(高血压)267例、B2组(糖尿病)128例和B3组(高脂血症)131例共3个亚组;C组分为C_1组(无心脑动脉粥样硬化终末事件)187例、C_2组(心肌梗死)62例和C_3组(脑梗死)49例共3个亚组,比较各组CAVI与颈动脉内膜中膜厚度的差异,并探究糖尿病患者的病程与上述两指标的相关性。结果三组CAVI差异有统计学意义(P<0.05),由高到低依次为C组、B组和A组,两两比较差异均有统计学意义(P<0.05)。三组颈动脉内膜中膜厚度差异有统计学意义(P<0.05),由高到低依次为C组、B组和A组,两两比较差异均有统计学意义(P<0.05),但与CAVI相比,其表现出的差异明显减弱变小。B_2组CAVI和IMT值与C_1,C_2和C_3组差异均无统计学意义(P>0.05),但CAVI均值比较的P值均小于相应IMT均值比较的P值,甚至B_2组的IMT值高于C_2和C_3组。糖尿病病程与CAVI的相关性高于(r=0.498,P=0.00087)其与动脉内膜中膜厚度的相关性(r=0.194,P=0.036)数据。结论 CAVI与颈动脉内膜中膜厚度与动脉粥样硬化程度均有一定相关性,前者倾向于评价整体而非局部的动脉粥样硬化,与动脉粥样硬化的严重程度更加吻合,两种方法联合检测可提高诊断效度。

Objective To explore the diagnostic value of cardio ankle vascular index(CAVI) combined with carotid artery intima media thickness in arterial occlusive diseases. Methods 936 patients for CAVI and carotid intima-media thickness examination in our outpatient and inpatient from January 2012 to January 2016 were divided into group A(112 cases, without atherosclerotic risk factors), group B(526 cases, the presence of risk factors of atherosclerosis) and group C(298 cases, by angiography confirmed the presence of coronary artery stenosis or cardio cerebral arteriosclerosis has occurred at the end of the event). According to the different risk factors, group B was divided into 3 subgroups, group B1(hypertension) 267 cases, group B2(diabetes mellitus) 128 cases and group B3(hyperlipidemia) 131 cases. Group C was divided into 3 subgroups, group C1(no cerebral arteriosclerosis endpoint)187 cases and group C2(myocardial infarction) 62 cases and group C3(cerebral infarction) 49 cases. Compared CAVI and carotid intima-media thickness in patients with diabetes, and to explore the correlation between the course of diabetic patients and the two fingers Target. Results There were statistically significant differences between the three groups(P<0.05), from high to low in order was group C, group B and group A, the difference of pairwise comparison was statistically significant(P<0.05). Difference of carotid artery intima media thickness in the three groups had statistical significance(P<0.05), from high to low in order was group C, group B and group A, pairwise comparisons of the differences were statistically significant(P<0.05). But compared with CAVI, the differences decreased.CAVI and IMT values in B2 group had no differences with C1, C2 and C3(P<0.05), but P value compared by the CAVI value were less than the P value compared by IMT, and even the IMT in B2 was higher than the C2 and C3. The correlation between the duration of diabetes and CAVI was higher(r=0.498, P=0.00087) and the correlation between the duration of diabetes and the thickness of the intima of the artery(r=0.194, P=0.036). Conclusion CAVI has a certain correlation with carotid intimal film thickness and atherosclerosis, carotid intimal film thickness tend to overall evaluation rather than local arteriosclerosis, the severity and hardening of the arteries are more consistent. Combine the two methods can improve the diagnostic validity.