冠状动脉病变程度与踝臂指数的关系研究

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【摘要】 目的 探讨冠状动脉病变狭窄程度与踝臂指数(ABI)的关系。方法 入选180例冠脉造影患者,术前收集患者基线资料,行ABI及冠状动脉造影检查,根据ABI值分为对照组(≥0.9)80例,观察组(

【关键词】 冠状动脉疾病;踝臂指数

The study on relationship between severity of coronary arterystenosis and ankle-brachial index

PAN Guang-Jie, CHANG Xue-wei,GU Yun-fei.Department of Cardiology ,Luoyang Central Hospital,Henan, Luoyang 471000,China

【Abstract】 Objective To study the relationship between the severity of coronary artery stenosis and ankle-brachial index(ABI). Methods This study enrolled 180 patients, who underwent coronary angiography and ABI measurement in addition to date collection regarding cardiovascular risk factors. They were divided into two groups according to ABI. The correlation between cardiovascular risk factors, ABI and the CAD severity were analyzed. Results Compared with control group, Gensini score, three vessel and B2/C type stenotic lesion was significantly higher in observation group. Binary regression analysis showed that ABI correlated with several risk factors,and ABI was a statistically significant independent predictor for three vessel or complex (B2/C) stenotic lesions and odds ratio were 3.620 and 4.011 respectively. The stepwise multivariable regression analysis shown, ABI and age enter the gensini score regression equation. Conclusion The patients with ABI

【Key words】 Coronary disease; Ankle-brachial index

作者单位:471000 河南省洛阳市中心医院心内科

外周血管病变(PAD)是系统性动脉粥样硬化疾病的一种表现,此类患者发生心肌梗死和脑卒中的危险明显增高,且10年内的死亡危险为非PAD患者的6倍[1]。踝臂指数(ABI)不但是诊断下肢PAD的一种有效手段,而且是患者发生心血管事件强有力的预测因子[2]。本研究观察临床患者中冠状动脉病变程度与踝臂指数的关系,评价ABI对冠状动脉病变严重程度的预测价值。

1 资料与方法

1.1 病例选择 选择2008年11月至2009年6月在洛阳市中心医院心内科行冠状动脉造影的患者180例,平均(61.6±10.1)岁,男103例,女77例。所有患者在行CAG前均接受ABI测定,ABI

1.2 研究方法 所有受试者入院时晨起抽血检测各项血液学指标。在冠脉造影前行ABI检查。患者取仰卧位,休息至少5 min,测量由熟练操作的专人负责,采用日本collin公司的VP1000动脉硬化检测仪进行检测。计算方法参考ACC/AHA推荐的方法:单侧ABI的计算为该侧踝动脉收缩压与双侧肱动脉收缩压的平均值之比,若两侧肱动脉收缩压差值>10 mm Hg,则以高值作为肱动脉收缩压;最后取左右两侧ABI的低值作为该患者的ABI进行统计学分析。

采用Judkins法进行冠状动脉造影。冠脉造影发现狭窄≥50%为有意义冠脉病变;形态学分类按ACC/AHA标准[3]分为A、B(B1及B2)、C型病变,B2/C型病变为复杂病变。若患者多处病变中不仅有A/B1型又有B2/C型复杂病变,该患者定义为复杂病变患者。冠状动脉狭窄程度采用Gensini评分标准[4],无狭窄记0分,狭窄≤25%记1分,26%～50%记2分,5l%～75%记4分,76%～90%记8分,91%～99%记l6分,100%记32分,不同节段评分系数按Gensini评分标准,每例患者冠状动脉病变程度的最终积分为各积分之和。

1.3 统计学方法

采用SPSS 13.0软件进行统计分析,计量资料以平均值±标准差(x±s)表示,计数资料用χ2检验,组间比较采用t检验,各变量间用多元逐步回归分析,同时用有序多元Logistic逐步回归法,分析危险因素。以P

2 结果

2.1 两组组基本临床资料的比较 两组患者性别、年龄、病史、体质量指数、血脂及血尿酸水平差异无统计学意义(P>0.05); 观察组Gensini积分、三支病变及复杂的B2/C病变构成比例高于对照组,差异有统计学意义(P

2.2 有序多元Logistic逐步回归分析的结果

为进一步了解冠脉病变严重程度与ABI的关系,分别以是否为三支病变、B2/C型病变为因变量,以基线资料及ABI是否异常为自变量,建立多元Logistic回归分析模型,结果发现:ABI和抽烟史是三支病变的独立预测因子,其中ABI的OR值最高为3.62(95% CI 1.505-7.094,P=0.016);而对于B2/C病变来说,ABI是惟一的独立预测因子,OR值4.011(95% CI 1.985-9.074,P=0.01)。

2.3 多元逐步回归分析

以Gensini积分为因变量,以其他指标为自变量进行多元逐步回归分析,进入回归方程的变量为ABI与年龄,见表2。

表1

对照组与观察组临床资料比较

对照组(80例)观察组(100例)

性别(男/女)45/3558/42

年龄(岁,x±s)60.1±9.863.0±10.3

抽烟史(例,%)32(40%)51(51)

高血压病(例,%)28(35)35(35)

糖尿病(例,%)18(22.5)29(29)

体质量指数(kg/m2,x±s)23.9±3.524.8±3.9

TC(mmol/L,x±s)4.61±1.034.80±1.15

TG(mmol/L,x±s)1.83±0.771.90±0.81

HDL-C(mmol/L,x±s)1.09±0.151.05±0.15

LDL-C(mmol/L,x±s)2.72±0.812.90±0.85

UA(umol/L,x±s)357.9±53.5350.9±55.9

Gensini积分(x±s)50.7±17.669.0±20.1**

三支病变(例,%)19(23.8)56(56)*

B2/C病变(例,%)31(38.8)79(79)*

注:与正常对照组比较*P

3 讨论

本研究对180例行冠状动脉造影和动脉硬化检测的资料进行分析,结果显示与对照组相比ABI0.05),而Gensini积分、三支病变及复杂的B2/C病变构成比例显著增高(P

ABI是诊断PAD的良好指标,主要用于评价下肢血管狭窄和阻塞的情况,可以反映外周血管动脉粥硬化。由于动脉粥样硬化是一种全身性系统性疾病,外周动脉和冠状动脉病变可能存在一定的相关性,ABI在一定程度上可以反映冠状动脉的病变程度[5,6]。Lee AJ等[2]随访研究发现:调整其他危险因素后,ABI≤0.9对致死性MI、心源性死亡的危险性有预测价值,而且包含ABI的危险因素较不包括ABI的传统危险因素与致死性MI发病率、死亡率的相关性更加显著。Koji Y等[7]研究发现ABI值越低,冠状动脉3支或3支以上病变的发生率越高。Papamicheal等[8]研究显示:ABI

表2

对Gensini评分进行多元逐步回归分析的结果

因变量自变量回归系数回归系数标准误t值P值

Gensini评分ABI-3.0180.9583.0730.004

年龄1.2060.4312.3260.025

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