颈动脉斑块和ABI协同预测老年人群远期新发心脑血管不良事件临床价值探讨

Clinical value of carotid plaque combined with ABI in predicting long-term new cardiovascular and cerebrovascular adverse events in elderly

目的探讨颈动脉斑块和踝臂指数(ABI)协同预测老年人群远期新发心脑血管不良事件的临床价值。方法研究纳入2013年1月至2015年1月于我院参加职工体检并完善颈动脉超声及ABI检查的老年人共821例,根据有无颈动脉斑块及ABI水平分组,其中A组未合并颈动脉斑块且ABI>0.9,B组合并颈动脉斑块且ABI>0.9,C组合并颈动脉斑块且ABI≤0.9,比较各组临床资料并随访新发心脑血管事件发生情况,采用多因素Cox比例风险模型评价颈动脉斑块及ABI水平预测远期缺血性心脑血管事件发生风险的价值。结果3组年龄、性别、吸烟饮酒比例、SBP、FPG、LDL-C、HDL-C及接受调脂药物治疗比例差异均有统计学意义(P<0.05);3组缺血性心脑血管事件和急性心肌梗死(AMI)发生率比较,差异有统计学意义(P<0.05);单因素Cox比例风险模型分析结果显示,B组和C组病人远期缺血性心脑血管事件、AMI及脑梗死发生风险均显著高于A组(P<0.05);多因素Cox比例风险模型分析结果显示,校正年龄、性别、吸烟饮酒情况、SBP、FPG、LDL-C、HDL-C及接受调脂药物治疗情况后,B组和C组病人远期缺血性心脑血管事件发生风险分别是A组的4.76倍(HR=4.76,95%CI:1.32~7.07)、8.51倍(HR=8.51,95%CI:1.65~11.80)。结论老年人群如存在颈动脉斑块且ABI水平≤0.9则远期更易出现新发心脑血管不良事件。

Objective To investigate the clinical value of carotid plaque combined with ankle branchial index(ABI)in predicting long-term new cardiovascular and cerebrovascular adverse events in the elderly.Methods A total of 821 elderly subjects participating in physical examination and receiving carotid ultrasound and ABI examination from January 2013 to January 2015 in our hospital were enrolled.All patients were divided into 3 groups,group A with no carotid plaque and ABI>0.9,group B with carotid plaque and ABI>0.9,and group C with carotid plaque and ABI≤0.9.The clinical characteristics and cardiovascular and cerebrovascular events were compared among the groups.Multivariate Cox proportional hazard model was used to evaluate the value of carotid plaque combined with ABI level in predicting the risk of long-term ischemic cardiovascular and cerebrovascular events.Results There were significant differences in age,gender,smoking and drinking ratio,systolic blood pressure(SBP),fasting plasma glucose(FPG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C)and the proportion of receiving lipid-lowering drugs among the three groups(P<0.05).There were significant differences in the incidence rates of ischemic cardiovascular and cerebrovascular events and acute myocardial infarction(AMI)among the three groups(P<0.05).Univariate analysis of Cox proportional risk model showed that the risk of long-term ischemic cardio-cerebrovascular events,AMI and cerebral infarction in group B and group C were significantly higher than those in group A(P<0.05).Multivariate Cox proportional hazards model analysis showed that the risk of long-term ischemic cardiovascular and cerebrovascular events in group B and group C was 4.76 times(HR=4.76,95%CI:1.32-7.07),8.51 times(HR=8.51,95%CI:1.65-11.80)of that in group A after adjusting for age,gender,smoking and alcohol consumption,SBP,FPG,LDL-C,HDL-C and treatment with lipid-lowering drugs(P<0.05).Conclusions The elderly population with carotid plaque and ABI≤0.9 are more likely to present with long-term new cardiovascular and cerebrovascular adverse events.