糖尿病患者颈股脉搏波传导速度与冠状动脉病变关系研究

目的探讨糖尿病（DM）患者颈股脉搏波传导速度（cfPWV）与冠状动脉狭窄程度的相关性,研究cfPWV对糖尿病患者合并冠心病的预测价值。方法将我院2010年1月~2011年2月收治的疑诊冠心病（CHD）并行冠脉造影术患者依据有无CHD和DM分为4组（每组n=40）,无CHD且无DM为对照组,有CHD无DM（CHD组）和无CHD有DM（DM组）统称单病组,同时合并CHD和DM为合并组。应用脉搏波传导速度测定装置检测患者cfPWV,冠状动脉狭窄的严重程度根据美国心脏协会制定的Gensini评分系统评定,并与cfPWV进行相关性分析。结果合并组、单病组和对照组cfPWV呈下降趋势,且差异均有统计学意义（P〈0.05）;合并组、CHD组、DM组和对照组Gensini积分呈下降趋势,且合并组与其他三组和CHD组与其他三组之间均有统计学差异（P〈0.05）。相关性分析显示,合并组患者cfPWV与Gensini积分呈正相关（r=0.408,P〈0.01）。绘制糖尿病患者cfPWV预测冠心病的ROC曲线,其曲线下面积为0.873±0.034（95%可信区间：0.808～0.937）,阈值11.74m/s预测糖尿病患者合并冠心病的灵敏度为89.4%,特异度为86.9%。结论糖尿病合并冠心病组的cfPWV、Gensini积分明显增高,且cfPWV与Gensini积分呈正相关,cfPWV对糖尿病患者冠心病的发生具有预测价值。

Relationship between carotid-femoral pulse wave velocity and coronary artery lesions

Objective To investigate the correlation between carotid-femoral pulse wave velocity （ cfPWV ） and severity of coronary artery stenosis in the patients with diabetes mellitus （ DM ） , and study the predictive value of cfPWV to complicating coronary heart disease （ CHD ） in the patients with DM. Methods The patients with suspected CHD after coronary angiography hospitalized from Jan. 2010 to Feb. 2011 were divided, according to sex and age matching principle and whether having CHD and DM, into four groups （ each n =40 ） including control group （ without both CHD and DM ） , CHD group （ with only CHD ） , DM group （ with only DM ） and combining group （ with CHD and DM ） . The determinator of pulse wave velocity was used for detecting patients ’ cfPWV. The severity of coronary artery stenosis was reviewed according to Gensini scoring system of the American Heart Association, and the correlation between cfPWV and age, blood fat, blood pressure and Gensini integral were analysed. Results cfPWV trended to reduce in all groups and the difference had statistical significance （ P 0.05 ） . Gensini integral showed reducing tendency in all group, and there was statistical difference between combining group and other groups or between CHD group and other groups （ P 0.05 ） . The correlation analysis showed that cfPWV was correlated positively to age, systolic blood pressure, diastolic blood pressure and Gensini integral （ correlation coefficient was, respectively, 0.231, 0.229, 0.281 and 0.348, P 0.05 ） . In combining group, cfPWV was correlated to Gensini integral （ r =0.408, P 0.01 ） . A ROC curve of cfPWV for predicting CHD was drawn, and the area under the curve was 0.873 ± 0.034 （ 95% CI =0.808-0.937 ） , cut- off point was 11.74 m/s, and sensitivity and specificity for predicting CHD was 89.4% and 86.9% in the patients with DM. Conclusion In combining group, cfPWV and Gensini integral increased significantly and cfPWV was correlated to Gensini integral, so cfPWV is accurate in the prediction of CHD incidence in DM patients. cfPWV can be taken as a non-invasive examination index for predicting the severity of CHD in DM patients, and it is important in screening and severity-evaluation of CHD.