踝-臂血压指数与冠状动脉硬化程度的关系

目的:研究踝-臂血压指数(ABI)和冠状动脉硬化程度的关系。方法:2008年1月～2008年6月在本院行选择性冠状动脉造影检查的住院患者111例,男性79例,女性32例,年龄56.9±7.8岁。其中经冠状动脉造影证实有冠状动脉病变者81例,冠状动脉正常者30例。患者在术前取平卧位,测量四肢血压后计算踝-臂血压指数,即胫后动脉或足背动脉收缩压与肱动脉收缩压之比,正常值≥1.0。选择性冠状动脉造影(CAG)用Judikin’s法按常规选择投照体位。采用Gensini积分系统,对每支血管病变程度进行定量评定,每例患者冠状动脉病变程度的最终积分为各分支积分之和。结果:冠状动脉正常组(30例)的冠状动脉积分为(0.43±10.85;ABI=1.14±0.21);单支病变组(33例)的冠状动脉积分为(13.54±9.96;ABI=0.95±0.25);双支病变组(30例)的冠状动脉积分为(24.26±11.26;ABI=0.96±0.29);3支病变组(18例)的冠状动脉积分为(39.55±12.36;ABI=0.68±0.35)。冠状动脉正常组和有冠状动脉病变组的ABI有显著统计学差异(P<0.001),冠状动脉单支病变、双支病变组和3支病变组的ABI比较有显著统计学差异(P<0.001),冠状动脉病变越严重ABI越小。冠状动脉造影积分和ABI的相关系数为-0.536(P=0.0001),即冠状动脉造影积分越高,ABI越低,呈负相关。多元Logistic回归提示糖尿病、空腹血糖增高和冠状动脉积分增高是ABI<0.9的预测因素。结论:ABI是预测冠状动脉硬化程度的一种简单可靠的指标。

Ankle-brachial Index as a Predictor of the Extent of Coronary Atherosclerosis

Objective:To examine the relation between resting ankle-brachial pressure index(ABI) and the extent of coronary atherosclerosis.Methods: Since January 2008 to June 2008,111 consecutive patients underwent coronary angiography,they age were 56±7.8;among they 79 were male.Significant coronary artery disease was diagnosed in 81 patients by ≥50% diameter reduction of the luminal diameter of≥1 coronary artery,30 patients coronary artery was normal.All patients were evaluated in the supine position,Systolic blood pressure was measured in arms posterior tibial and dorsalis pedis artery,the resting ABI was determined for each leg by dividing the systolic blood pressure at the ankle by the brachial pressure,ABI≥1 was normal.All patients underwent catheterization using standard Judkins techniques.Gensini score was calculated to give a measure of the extent and severity of coronary atherosclerosis.Results: Among the group with 0-vessel disease(30 cases) Gensini score was 0.43±10.85 and ABI was 1.14±0.21;among the 1-vessel disease group(33 cases)Gensini score was 13.54±9.96 and ABI was 0.95±0.25;among the group with 2-vessel disease(30cases) Gensini score was 24.26±11.26 and ABI was 0.96±0.29;among the group with 3-vessel disease(18 cases) Gensini score was 39.55±12.36 and ABI was 0.68±0.35.Between the group with 0-vessel disease and the group with 1-vessel to 3-vessl disease,ABI had statistically significant(p<0.001),betweee group with 1-vessel、2-vessal disease and 3-vessel disease,ABI had statistically significant(p<0.001),the seriours the coronary atherosclerosis disease,the lower of ABI.The correlate index of Gensini score and ABI was-0.536(p<0.0001),the higher of Gensini score the lower of ABI,they had a negative correlate relationship.In multiple Logistic regression analysis,diabetes and blood glucose increase were predict facts of ABI<0.9.Conclusion: In conclusion,ABI should be a simple index related to the extent of atherosclerosis in coronary arterial beds,reflecting generalized atherosclerosis.