心脏彩色多普勒超声和血脂诊断冠心病的临床价值

Clinical value of echocardiography and blood lipid measurements in diagnosis of coronary heart disease

目的探讨心脏彩色多普勒超声、血脂诊断冠状动脉粥样硬化性心脏病(简称冠心病)的临床价值。方法选择2013年6月至2014年10月东南大学附属南京市第二医院心内科因拟诊冠心病入院治疗的240例患者。采用Judkins法行冠状动脉造影,根据冠状动脉造影结果将患者分为非冠心病组(n=58)和冠心病组(n=182),再将冠心病组患者分为单支病变亚组(n=84)和多支病变亚组(n=98)。比较非冠心病组和冠心病组、单支病变亚组和多支病变亚组患者的心脏彩色多普勒超声检查指标及血脂水平。采用logistic回归模型对冠心病影响因素行多因素分析。结果冠心病组舒张早期E峰血流速度(E)、E峰和舒张晚期A峰血流速度比值(E/A)均低于非冠心病组,E峰减速时间(DT)、左心室等容舒张期(IVRT)均长于非冠心病组,左心房内径(LAD)、室间隔厚度(IVS)、左心室后壁厚度(LVPW)、左心室内径(LVD)均大于非冠心病组(P均<0.05));冠心病患者中多支病变亚组E高于单支病变亚组,E/A低于单支病变亚组,DT、IVRT均长于单支病变亚组,LAD、IVS、LVPW、LVD均大于单支病变亚组(P均<0.05)。冠心病组血清总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)水平均高于非冠心病组,高密度脂蛋白胆固醇(HDL-C)水平低于非冠心病组(P均<0.05);冠心病患者多支病变亚组血清TC、TG、LDL-C水平均高于单支病变亚组,血清HDL-C水平低于单支病变亚组(P均<0.05)。Logistic回归分析示年龄、TC、IVRT、LAD、LDL-C是冠心病的独立危险因素(P均<0.05)。结论血脂和左心室舒张功能异常与冠心病的发生、发展密切相关,其异常对冠心病的临床诊断有着重要意义。

Objective To evaluate the clinical value of echocardiography and blood lipid level in the diagnosis of coronary heart disease (CAD). Methods A retrospective analysis was conducted on 240 suspected CAD in-patients who were treated in the Second Hospital of Nanjing, Southeast University from Jun. 2013 to Oct. 2014. The patients were divided into non-CAD group (n=58) and CAD group (n=182) according to the results of coronary angiography. The patients in CAD group were further divided into single vessel lesion group (n=84) and multi-vessel lesion group (n=98). The indexes of color Doppler echocardiography and blood lipid levels were compared between non-CAD group and CAD group, and single vessel disease subgroup and multiple vessel disease subgroup. Logistic regression was used to analyze the influencing factors of CAD. Results E-peak velocity (E) in early diastolic phase and the ratio of E peak velocity to late diastolic phase A-peak velocity (E/A) in CAD group were lower than those in non-CAD group;the E-peak deceleration time (DT) and left ventricular isovolumetric relaxation time (IVRT) were longer than those in non-CAD group;the left atrial diameter (LAD), interventricular septal thickness (IVS) and left ventricular posterior wall thickness (LVPW) were higher than those in non- CAD group;and the left ventricular diameter (LVD) was larger than that of non-CAD group (all P<0.05). In patients with CAD, E in multi-vessel lesion subgroup was higher than that in single vessel lesion subgroup;E/A in multi-vessel lesion subgroup was lower than that in single vessel lesion subgroup;DT and IVRT were longer than those in single vessel lesion subgroup;and LAD, IVS, LVPW and LVD were larger than those in single vessel lesion subgroup (P<0.05). The levels of serum total cholesterol (TC), triglyceride (TG), and low-density lipoprotein cholesterol (LDL-C) in CAD group were higher than those in non-CAD group, and the level of high-density lipoprotein cholesterol (HDL-C) was lower than that in non-CAD group (all P<0.05). The levels of serum TC, TG and LDL-C in multi-vessel lesion subgroup were higher than those in single vessel lesion subgroup, and the HDL-C level was lower than that in single vessel lesion subgroup (all P<0.05). Logistic regression analysis showed that age, TC, IVRT, LAD and LDL-C were independent risk factors for CAD (all P<0.05), and E and HDL-C were independent protective factors for CAD (both P<0.05). Conclusion Abnormal blood lipid and left ventricular diastolic function are closely related to the development and progression of CAD, and their abnormalities are of great significance for the clinical diagnosis of CAD.