颈动脉斑块及主动脉脉压与冠状动脉病变严重程度的相关性及预测价值

目的:探讨颈动脉斑块及主动脉脉压(PP)与冠状动脉病变严重程度的相关性和预测价值。方法:将276例均行冠脉造影、主动脉压测量、颈动脉超声的患者资料回顾性分析,根据有无颈动脉斑块和PP水平≥或65 mm-Hg分为4组:无颈动脉斑块+PP65 mmHg组,无颈动脉斑块+PP≥65 mmHg组,颈动脉斑块+PP65 mmHg组和颈动脉斑块+PP≥65 mmHg组,进行比较分析。结果:4组间年龄、血压、血脂有显著差异(P0.05,P0.01);多元线性逐步回归分析显示:年龄、PP、颈动脉斑块与冠脉积分正相关;颈动脉斑块和PP增大预测冠脉病变严重程度的敏感性为81%vs.77%、特异性为93%vs.91%、阳性预测值为57%vs.51%和阴性预测值为98%vs.97%,二者结合可提高敏感性(90%)和阳性预测值(77%,均P0.05)。结论:颈动脉斑块联合PP可更好地预测冠脉病变严重程度。

Relevance and predictive value of aortic plaque and aortic pulse pressure to degree of coronary disease

AIM: To study the relevance of carotid artery plaque (CAP) and aortic pulse pressure (PP) to the degree of CHD and to explore their predictive values. METHODS: A total of 276 patients with suspected CHD who underwent carotid artery ultrasound and coronary angiography were divided into four groups according to CAP and the level of PP: 1) positive CAP with PP≥65 mmHg group; 2) negative CAP with PP≥65 mmHg group; 3) positive CAP with PP<65 mmHg group; 4) negative CAP with PP<65 mmHg group. RESULTS: Significant differences were found in age, PP and LDL-C among the four groups (P<0.05). More three-vessel lesions were found in the first group, whereas more singe-vessel lesions were found in the fourth group. No significant difference was found in double-vessel lesions among all groups. Logistic multivariate analysis showed that age, LDL-C, PP and plaque were significantly related to coronary artery score (CAS). For the value of CAP and PP in predicting the presence of CHD, sensitivity was 81 vs. 77%, specificity was 93 vs. 91%, positive predictive value was 57 vs. 51%, and negative predictive value was 98 vs. 97%. The combination of these two parameters enhanced sensitivity to 90% and positive predictive value to 77%. CONCLUSION: The combination of CAP and PP is of higher diagnostic value in assessing the degree of CHD.