心脏脚踝指数对冠状动脉粥样硬化的预测诊断价值

Value of cardiac ankle index in predicting and diagnosing coronary atherosclerosis

目的探讨心脏脚踝指数(CAVI)对冠状动脉粥样硬化的预测诊断价值。方法选取2015年2月~2017年2月龙岗中心医院心内科及合作医院心内科收治的疑似冠心病拟行冠状动脉造影(CAG)的108例患者作为研究对象,根据冠脉造影检查结果及Gensini评分,分为冠脉正常组(0分,34例)、1~80分组(36例)、81~160分组(38例)。均于造影前空腹采血,测定CAVI、颈总动脉最大内膜中层厚度(Max IMT)及平均内膜中层厚度(Mean IMT)指标。结果三组患者CAVI、Max IMT及Mean IMT值水平随Gensini评分升高而递增,差异有统计学意义(P<0.05);CAVI、Max IMT及Mean IMT评分与Gensini评分均成正相关(r=0.57、0.29、0.46,P<0.01、0.05、0.01),且CAVI与Gensini评分的相关性最强;比较CAVI、Max IMT及Mean IMT对预测粥样硬化的ROC曲线下面积(AUC),CAVI显著大于Max IMT和Mean IMT;与Max IMT及Mean IMT相比,CAVI假阳性率、阴性似然比最低,阴性预测率最高。结论 CAVI水平随动脉粥样硬化程度加重而逐渐升高,与Max IMT、Mean IMT相比,CAVI与冠状动脉粥样硬化病变显著相关,判断动脉粥样硬化更为敏感准确。

Objective To explore the value of cardiac ankle index in predicting and diagnosing coronary atherosclerosis. Methods A total of 108 patients suspected with coronary artery disease (CAG) in Longgang Central Hospital cardiology department and cooperative hospitals from February 2015 to February 2017 were selected as the subjects of study. According to the results of coronary angiography and Gensini score, they were divided into normal coronary group (0 points, 34 cases), 1-80 points group (36 cases) and 81-160 points group (38 cases). The cardio-ankle vascular index (CAVI), the maximum intima-media thickness (Max IMT) of common carotid artery (CCA) and mean intima-media thickness (Mean IMT) were measured before angiography. Results The levels of CAVI, Max IMT and Mean IMT increased with the increase of Gensini score in the three groups, and the differences were statistically significant (P<0.05). The scores of CAVI, Max IMT and Mean IMT were positively correlated with Gensini score (r=0.57, 0.29, 0.46, P<0.01, 0.05, 0.01), and the correlation between CAVI and Gensini score was the strongest. CAVI, Max IMT and Mean IMT were compared to predict ROC curve of atherosclerosis. Under-line area (AUC), CAVI was significantly larger than Max IMT and Max IMT. Compared with Max IMT and Mean IMT, CAVI had the lowest false positive rate, the lowest negative likelihood ratio and the highest negative predictive rate. Conclusion The level of CAVI gradually increases with the severity of atherosclerosis. Compared with Max IMT and Mean IMT, CAVI is significantly correlated with coronary atherosclerosis lesions and is more sensitive and accurate in judging atherosclerosis.