外周动脉超声检查预测冠状动脉粥样硬化性心脏病的探讨

目的探讨外周动脉超声检查对冠状动脉硬化性心脏病(CAD)的诊断价值.方法对135例连续冠状动脉造影(CAG)受检者术前进行外周动脉超声检查,并与CAG结果及心血管危险因素进行单因素的t、χ2检验及多元逐步回归、Logistic模式回归分析.结果CAG阳性组颈动脉(CA)、锁骨下动脉(SA)、腹主动脉(AbAO)、髂总动脉(CIA)和股动脉(FA)粥样硬化发生率以及内中膜厚度评分显著高于阴性组;Logistic回归显示FA、AbAO和CIA粥样硬化的发生与否与冠心病存在显著的相关性(β分别为3.6220、3.1169和2.5742,OR值分别为37.4123、22.5760和13.1211,P分别<0.005、<0.01、<0.05);CIA、FA的内中膜厚度评分与冠状动脉病变的严重程度显著相关(P<0.0001),CIA与FA的内中膜厚度每增加1mm,LOG(1+Gensini′s评分)分别增加0.227、0.219;CA的内中膜厚度与LOG也显著相关(P<0.05);外周动脉粥样硬化程度和范围总评分与CAD发生及其严重程度显著相关(P<0.0001),外周动脉粥样硬化(EcAS)每增加一处,CAD发生的OR值、LOG则分别增加4.98倍.以各EcAS的发生与否为指标建立对CAG结果的判别函数,此函数对本组阳性判断的正确率为91.5%、阴性正确率为93.8%、总的正确率为92.5%.结论EcAS与CAD密切相关,通过超声对EcAS程度和范围进行总体评估,可预测CAD的发生及其严重程度;CIA、FA粥样硬化是两个独立于其他因素之外、与冠状动脉粥样硬化密切相关的因素,可作为研究冠状动脉粥样硬化的替代指标和窗口.

Predictive value of peripheral artery ultrasonography for coronary artery disease

OBJECTIVE: To investigate the diagnostic value of peripheral artery ultrasonography for coronary atherosclerotic disease (CAD). METHODS: Peripheral artery ultrasonography was conducted among 135 consecutive examinees of coronary arteriography before the CAG. The results of peripheral artery ultrasonography and of coronary arteriography were analyzed with Stepwise multiple regression analysis and Logistic regression. RESULTS: The incidence of atherosclerotic plaques of carotid, subclavicular, abdominal aortic, iliac and femoral arteries in patients with positive coronary arteriography was significantly higher than that in the subjects with negative coronary arteriography (P < 0.01); Logistic regression indicated that the presence of atherosclerotic plaques in femoral, abdominal aortic, and common iliac arteries was significantly closely correlated with CAD (P < 0.005, < 0.01, and < 0.05 respectively). Stepwise multiple regression analysis showed that common iliac IMT and femoral IMT were significant closely associated with the severity of coronary atherosclerosis (P < 0.0001). For each increased 1mm of iliac and femoral IMT, the LOG (1 + Gensini's score) of coronary arteriography increased by 0.227 and 0.219 respectively. The carotid artery IMT was partly associated with the LOG (1 + Gensini's score) of coronary arteriography (P < 0.05). The total score of extracoronary atherosclerosis (TSEcAS) was significantly correlated with the occurrence and severity of CAD (P < 0.0001). For 1 more extracoronary atherosclerotic plaques, the odds ratio and LOG (1 + Gensini's scores) for CAD increased 4.98 times and 0.323 respectively. Common iliac atherosclerosis was closely correlated with the occurrence of acute myocardial infarction. The positive predictive value of femoral, iliac atherosclerosis is 87.9%, 86.7%, 80.0% respectively; the positive predictive value for 2 and 3 sites of 3 above sites and is 88.6% and 94.9% respectively. Accuracy of discriminative function for positive and negative results and total was 91.5%, 93.8% and 92.5% respectively. CONCLUSION: EcAS is closely correlated with CAD. It is possible to predict the occurrence, development, extent and severity of coronary artery atherosclerosis by extracoronary atherosclerosis. Common iliac atherosclerosis and femoral atherosclerosis are two independent factors closely correlated with the occurrence and progression of coronary atherosclerosis and can be used as the alternative indicators in study of coronary atherosclerosis.