外周动脉斑块与冠状动脉粥样硬化程度的相关性及其预测价值

Correlation between peripheral artery plaque and severity of coronary atherosclerosis and its predictive value

目的探讨外周动脉斑块(颈动脉分叉处、股动脉斑块)与冠状动脉(冠脉)粥样硬化严重程度的相关性,分析外周斑块对严重冠状动脉粥样硬化性心脏病(冠心病)的临床预测价值。方法纳入149例患者,依据颈部超声所示病变等级评分将患者分为5组,基于冠脉造影检查结果(CAG)计算患者冠脉钙化积分(Gensini积分、Leaman积分),比较各组间冠脉钙化积分差异;同时对有无股动脉斑块受试对象的冠脉钙化积分进行差异比较。用接受者操作特征曲线(ROC)对颈动脉分叉斑块、股动脉斑块及联合两者对严重冠心病进行预测效能分析,对结果的灵敏度、特异性及其曲线下面积(AUC)进行比较。结果对于颈动脉分叉处及股动脉处斑块形成程度不同的患者,其冠脉钙化积分大小均存在显著差异(P均<0.0001)。颈动脉分叉处斑块性质更严重时或存在股动脉斑块时,冠脉钙化程度往往更严重。ROC曲线分析颈部分叉斑块、股动脉斑块对严重冠心病预测的AUC分别是0.7394,0.6826;联合两者可提高AUC至0.7686。基于颈动脉分叉处斑块,预测冠心病严重性的灵敏度89.19%,特异度58.70%;基于股动脉斑块斑块,灵敏度81.08%,特异度55.43%;若两种因素同时考虑则灵敏度93.33%,特异度60.38%。结论外周动脉斑块与冠脉粥样硬化严重程度存在相关性,颈动脉、股动脉血管超声可作为一个简单的非侵入性操作来评估冠脉粥样硬化的严重程度,颈动脉分叉斑块相较股动脉斑块对严重冠脉粥样硬化预测价值更高,联合两者,增加CAG术前筛查严重冠心病的可靠性。

Objective To investigate the association between peripheral artery plaques(carotid bifurcation,femoral artery plaques)and the severity of coronary atherosclerosis,and to analyze the clinical predictive value of peripheral plaques for severe coronary heart disease.Method In this study,149 patients were divided into 5 groups according to the lesion grade score of cervical ultrasound results.The coronary artery calcification score(Gensini score and Leaman score)was calculated based on the coronary angiography(CAG)results,and the differences of coronary artery calcification score among the groups were compared.At the same time,the coronary artery calcification scores of subjects with or without femoral artery plaque were also compared.Receiver operating curve(ROC)was used to analyze the predictive efficacy of carotid bifurcation plaque,femoral artery plaque and the combination of the two for severe coronary heart disease.The sensitivity,specificity and area under the curve(AUC)of the results were compared.Results For patients with different degree of plaque formation at carotid bifurcation and femoral artery,there were significant differences in coronary artery calcification scores(all P<0.0001).The degree of coronary artery calcification is often more serious in patients with carotid bifurcation plaque or femoral artery plaque.ROC curve analysis showed that AUC of neck bifurcation plaque and femoral artery plaque in predicting severe coronary heart disease were 0.7394 and 0.6826,respectively.The AUC can be increased to 0.7686 by combining the two.Based on the plaque at the carotid bifurcation,the sensitivity and specificity of predicting the severity of coronary heart disease were 89.19%and 58.70%,respectively.Based on the femoral artery plaque,the sensitivity was 81.08%,and the specificity was 55.43%.If the two factors were considered at the same time,the sensitivity was 93.33%and the specificity was 60.38%.Conclusion There is a correlation between peripheral artery plaque and the severity of coronary arteriosclerosis.Carotid artery and femoral artery vascular ultrasound can be used as a simple non-invasive operation to evaluate the severity of coronary atherosclerosis.Carotid artery bifurcation plaque is more valuable in clinical prediction than femoral artery plaque.Combination carotid artery bifurcation plaque and femoral artery plaque can improve the predictive ability,which will increase the reliability of screening significant coronary heart disease before CAG.