踝臂指数与老年冠心病患者冠状动脉病变严重程度的相关性研究

目的 探讨老年病患者踝臂指数与冠状动脉狭窄严重程度的相关性,评价踝臂指数对冠状动脉狭窄严重程度的预测价值.方法 选择2010年9月至2012年3月行冠状动脉造影的老年住院患者98例,其中男68例,女30例.根据踝臂指数分为踝臂指数≥0.9组(72例)和踝臂指数＜0.9组(26例).评价踝臂指数与SYNTAX评分的相关性、踝臂指数与不同病变支数的关系以及踝臂指数对3支或左主干病变的预测价值.结果 ①踝臂指数＜0.9组与踝臂指数≥0.9组的SYNTAX评分和左心室射血分数差异有统计学意义SYNTAX评分:(26±8)分比(12±6)分,左心室射血分数:(46±9)％比(54±10)％,均P＜0.05].②Pearson直线相关分析结果显示,踝臂指数与SYNTAX评分呈负相关(r=-0.598,P=0.001),即踝臂指数越低,冠状动脉病变程度越重,狭窄程度越重.③冠状动脉造影结果显示无病变、单支病变、2支病变、3支或左主干病变患者例数分别为8、33、29、28例,踝臂指数分别为1.02 ±0.19、1.01 ±0.19、1.03±0.09、0.81 ±0.16.3支或左主干病变的踝臂指数低于无病变、单支病变和2支病变者,差异有统计学意义(P＜0.01)；无病变、单支病变、2支病变的踝臂指数差异无统计学意义(P＞0.05).④受试者工作特征(ROC)曲线下面积为0.74895％置信区间(CI):0.668～0.829,P＜0.01],以踝臂指数＜0.9作为截断值预测3支或左主干病变具有较高的特异性(78.5％)和敏感性(67.6％).Logistic多元回归分析显示SYNTAX评分、踝臂指数＜0.9、左心室射血分数是预测3支或左主干病变的独立危险因素SYNTAX评分:优势比(OR)=3.004,95％ CI:2.001 ～6.007,P=0.022；踝臂指数＜0.9:OR=1.624,95％ CI:1.091 ～3.067,P=0.035；左心室射血分数:OR=2.185,95％ CI:2.042～5.815,P=0.016].结论 老年冠心病患者踝臂指数与冠状动脉狭窄严重程度呈负相关,踝臂指数可能是预测冠状动脉病变严重程度的指标之一.

Relation between ankle-brachial index and extent of coronary stenosis in the elderly coronary artery disease

Objective To observe the relation between ankle-brachial index （ABI）and the extent of coronary stenosis and evaluate the usefulness of ABI for predicting the extent of coronary stenosis in elderly coronary artery disease （CAD）.Methods Ninety-eight consecutive patients （age ≥ 65） who underwent coronary angiography were studied.All patients underwent ABI evaluation and blood biochemical examination in addition to history collection.We analyzed the relation between ABI and SYNTAX score,and the difference of ABI among patients with no CAD,1-vessel,2-vessel CAD and 3-vessel or main trunk CAD.Results ABI was inversely correlated with SYN-TAX score.ABI reduced significantly（P 〈 0.01） in patients with 3-vessel or left main lesion CAD.Among 1-vessel or 2-vessel CAD,there was no significant difference in ABI.The corresponding area under the receiver operating characteristic （ROC） curve in 3-vessel or main trunk CAD was （0.748,95 % CI：0.668-0.829,P 〈 0.01）.ABI 〈0.9 had relatively high specificity（78.5%） and sensitivity（67.6%） for predicting the presence of 3-vessel disease or left main trunk CAD.In multivariate logistic regression analysis,ABI 〈 0.9 was the independent predictor for 3-vessel disease or left main trunk CAD after adjusting for other variables.Conclusion Old patients ABI is inversely and significantly correlated with the extent of coronary stenosis.ABI 〈 0.9 has relatively high specificity and sensitivity for predicting the presence of 3-vessel or left main trunk CAD.