踝臂指数、颈动脉内中膜厚度对冠状动脉硬化早期预测价值

目的探讨踝臂指数（ABI）与颈动脉内中膜厚度（IMT）的相关性及其对冠心病的预测价值。方法随机选择150例行冠脉造影检查的患者行ABI、IMT测定，调查其年龄、性别、高血压史、糖尿病病史、吸烟史以及身高、体重，计算体重指数，并测量血压，化验血糖、甘油三酯（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL—C）和高密度脂蛋白胆固醇（HDL—C）等指标。用SYNTAX积分评价冠状动脉的病变程度，分析在不同病变程度下ABI和IMT之间的相关性。分别用ABI和IMT预测冠心病，并比较两者诊断的可靠程度。结果①以SYNTAX评分判定，ABI除冠脉正常组和轻病变组间差异无统计学意义（p=O．126）外，其余各组间差异均有统计学意义（P〈0．01），冠状动脉病变越严重，ABI越低。IMT除中、重病变组间差异无统计学意义（P=0．055）外，余各冠状动脉组问差异均有统计学意义（P〈0．05），冠状动脉病变越严重，IMT值越大。②以SYNTAX积分为协变量，计算ABI与IMT的偏相关系数，两者为负相关（r=一0．499，P=0．000）。SYNTAX积分为分组变量情况下分析ABI和IMT的相关性，显示在冠脉有病变的情况下两者呈负相关。③分别作ABI、IMT预测冠心病的ROC曲线，ABI=0．95，预测冠心病的灵敏度为85．2％，特异度为75．3％；IMT=1．51mm，预测冠心病的灵敏度为77．4％，特异度为64．4％。结论ABI、IMT与冠状动脉硬化程度密切相关，冠脉病变患者ABI越低则IMT越厚。ABI和IMT两种检测方法均对冠状动脉病变程度的评估具有价值，且二者协同互补，可以改善无创检查的敏感性及特异性。ABI和IMT作为非侵入性检测，对筛查无症状冠心病患者及评估冠心病严重程度具有重要意义。

The early prediction value of ankle brachial index and carotid intima-media thickness for coronary artery disease

Objective To investigate the relationship between ankle brachial index （ABI） and Carotid Intima-media Thickness （IMT） and its diagnostic value on coronary artery disease. To assess the impact of ABI, IMT and conventional cardiovascular risk factors on coronary arteriosclerosis. Methods 150 inpatients were per- formed coronary angiography, ABI and IMT. The cardiovascular risk factors including age, gender, hypertension, diabetes mellitus, smoking, body mass index （BMI）, triglycerifie （TG）, total cholesterol （TC）, low density lipoprotein （LDL）, high density lipoprotein （HDL）, blood pressure, blood glucose were investigated. The Syntax coronary angiography score were calculated to quantify the extent of coronary artery atherosclerosis. ABI and IMT were used to predict coronary artery disease and compare the diagnostic value. Results （1）According to SYNTAX score, ABI were not significantly different in Normal coronary group and light lesions（P=-0.126）, but were statisti- cally different in other groups （P〈0.O1）. The severity extent of coronary artery atherosclerosis was, the lower ABI was. IMT was significantly different in other groups depend on Syntax score, except in the median group and worst group （P〈0.01）. The severer extent of coronary artery atherosclerosis was, the higher IMT was. （2）Using Syntax coronary angiography score as concomitant variable to calculate the coefficient of partial correlation, ABI and IMT showed negatively correlation （r=-0.499, P=0.000）. （3）According to the ROC curve, when ABI=0.95 as critical point for predicting coronary artery disease, the sensitivity was 85.2%, and the specificity was 75.3%, when IMT= 1.51 mm as critical point for predicting coronary artery disease, the sensitivity was 77.4%, and the specificity was 64.4%. Conclusion ABI and IMT are significantly correlated with the extent of coronary artery atherosclero- sis and can predict the severe extent of coronary artery disease. ABI is significantly negatively correlated with IMT in coronary artery disease. ABI and IMT all can be used to evaluate the severe extent of coronary artery disease. Joint measurement ABI and IMT can enhance sensitivity and specific degrees of coronary atherosclerosis diagnosis. As noninvasive testing, ABI and IMT have important meaning for screening asymptomatic patients with coronary disease and coronary heart disease and predicting its severity.