踝臂指数、臂踝脉搏波传导速度及高敏C反应蛋白在冠心病诊断中的临床意义
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The Clinical Significance of Ankle-Brachial Index,Brachial-Ankle Pulse Wave Velocity and C-Reactive Protein in the Diagnosis of Coronary Heart Disease
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    摘要:

    目的探讨踝臂指数、臂踝脉搏波传导速度联合血清高敏C反应蛋白在冠心病诊断中的价值。方法选择2008年11月~2009年11月期间在宁夏医科大学附属医院心内科住院治疗并行冠状动脉造影术的拟诊或已诊断冠心病的患者195例,以上患者均合并至少一项动脉粥样硬化危险因素。根据冠状动脉造影结果,将入选患者分为冠状动脉病变组(150例)和非冠状动脉病变组(45例);根据冠状动脉狭窄程度将冠状动脉病变组分为狭窄≥50%组(97例)和狭窄<50%组(53例)。采集动脉粥样硬化相关危险因素并测定血清高敏C反应蛋白、踝臂指数及臂踝脉搏波传导速度,并选择39例健康体检者作对照。结果踝臂指数在冠状动脉病变组、非冠状动脉病变组和对照组之间差异无统计学意义,臂踝脉搏波传导速度在冠状动脉病变组、非冠状动脉病变组和对照组之间差异有统计学意义(P><0.01),在狭窄≥50%组和狭窄<50%组之间差异也有统计学意义(P><0.01);非冠状动脉病变组高敏C反应蛋白水平与对照组比较差异无统计学意义,但冠状动脉病变组高敏C反应蛋白水平显著高于非冠状动脉病变组和对照组(P><0.01),而高敏C反应蛋白水平在狭窄≥50%组与狭窄<50%组之间差异无统计学意义。以冠状动脉造影结果为金标准绘制ROC曲线,踝臂指数对冠心病无明显预测价值;臂踝脉搏波传导速度对冠心病具有高等预测价值,其截断点为1700cm/s;高敏C反应蛋白对冠心病具有中等预测价值,其截断点为0.67mg/L。臂踝脉搏波传导速度联合高敏C反应蛋白诊断冠心病的灵敏度为98.0%,特异度为95.8%,误诊率为4.2%,漏诊率为2.0%,阳性预测值为99%,阴性预测值为92%,两者联合具有更高的诊断价值。结论踝臂指数与冠状动脉病变无明显相关性;臂踝脉搏波传导速度随冠状动脉病变程度逐渐增大,对冠心病有高等预测价值;高敏C反应蛋白在冠状动脉病变人群中明显增高,对冠心病具有中等预测价值。

    Abstract:

    Aim To discuss the changes of ankle brachial index (ABI),brachial-ankle pulse wave velocity (baPWV) and high sensitive C-reactive protein (hs-CRP) in 195 patients with different risk factors of atherosclerosis,and analyse its effect in the diagnosis of coronary heart disease (CHD). Methods 195 patients with possible diagnosis or having been diagnosed as coronary heart disease (CHD) with at least a merger of atherosclerosis risk factors who were hospitalized Affiliated Hospital of Ningxia Medical University on November 2008-2009 November were selected and divided into coronary artery disease (CAD) group (150 cases) and non-CAD group (45 cases). Then according to at least one coronary stenosis ≥ 50%,CAD group was divided into ≥50% group (97 cases) and <50% group (53 cases). The atherosclerosis risk factors were recorded and ABI,baPWV,hs-CRP of serum were measured. 39 healthy cases were chosen as control. Results In CAD group,non-CAD group and control group ABI had no significant difference (P>0.05),baPWV had statistically significant difference (P><0.01) and there were significant differences between the ≥50% group and <50% group (P><0.01). In non-CAD group and control group hs-CRP had no significant difference (P>0.05). However,in CAD group hs-CRP levels were significantly higher than the other two groups,there were significant differences between the two groups (P><0.01),the level of hs-CRP showed no significant difference between the two subgroups of CAD group (P>0.05). With coronary angiography as the gold standard for drawing ROC curve,ABI had no significant predictive value for CAD. CHD with higher baPWV had the predictive value with the cut-off point of 1700 cm/s,hs-CRP had a moderate predictive value with its cut-off point of 0.67 mg/L. For the combination of baPWV and CRP,the sensitivity rate was 98.0%,the specific rate was 95.8%,misdiagnosis rate was 4.2%,miss rate was 2.0%,positive predicatire value was 99% and negative predicative value was 92%,which had higher diagnostic value. Conclusions ABI and CHD was not related. baPWV increases with the extent of CHD,which had higher predictive value for CHD. hs-CRP had moderate predictive value for CHD.

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薛莉,梁婷.踝臂指数、臂踝脉搏波传导速度及高敏C反应蛋白在冠心病诊断中的临床意义[J].中国动脉硬化杂志,2010,18(6):479~482.

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  • 收稿日期:2010-02-26
  • 最后修改日期:2010-06-10
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