CAVI和ABI改变与冠脉病变的关联性研究
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摘要
目的:探讨冠心病患者在动脉硬化及僵硬度指标心踝指数(cardio-ankle vascular index,CAVI)与踝臂指数(ankle-brachial index,ABI)上改变的研究价值,并研究CAVI与ABI在普通体检人群中的变化规律。方法:随机选取在我院心血管内科行选择性冠脉造影检查及治疗的患者342例,其中经冠脉造影证实的冠心病患者(狭窄≥50%)275例作为实验组(冠心病组),根据冠脉血管病变支数分为相应的亚组,其余67例(狭窄<50%)作为对照组(非冠心病组包括31例冠脉造影完全正常),比较两组间在CAVI、ABI上的差异,随机选择我院体检人群1123人,依据年龄段分组,比较它们在CAVI与ABI上的差异性。结果:(1)年龄、糖尿病、高血压、吸烟、血脂等是冠心病发生的危险因素。(2)随着冠脉狭窄程度的加重,CAVI进行性增高,组间的差异有统计学意义(P<0.01)。(3)非冠心病组与冠心病组的ABI均在正常范围,但冠心病组的ABI低于非冠心病组(P<0.01)。多支病变组ABI低于对照组、单支病变组(P<0.05)。(4)CAVI(+)预测冠心病的敏感性较高(66.4%),特异性欠佳(32.7%);ABI降低预测冠心病的敏感性低(18.0%),但特异性高(96.2%)。(5)在普通体检人群中同样随着年龄的增加CAVI值进行性增高,但ABI值由先升高而后减低,即在60至70岁年龄段内出现拐点。结论:CAVI(-)可能是非冠心病有意义的独立预测因子,CAVI(+)则有利于早期发现动脉硬化,而ABI降低则是冠心病独立的危险因子,可视为冠心病的诊断参考指标,60至70岁的老年人,ABI值小于1.16提示有发生下行动脉系统狭窄的可能性。
Objective: Discuss the values research of change on patients with coronary artery disease in arteriosclerosis and stiffness index Cardio-Ankle Vascular Index (cardio-ankle vascular index CAVI) and ankle-brachial index (ankle-brachial index ABI), Studies CAVI and ABI in the ordinary physical examination crowd's change rule.Methods: A randomly selected Cardiology in our hospital underwent selective coronary angiography examination and treatment of 342 patients, which confirmed by coronary angiography in patients with coronary heart disease (stenosis≥50%) 275 were used as the experimental group (CHD group) and coronary artery disease according to the count into the corresponding sub-group, and the remaining 67 cases (stenosis<50%) as a control group (non-CHD group Including 31 example crown arteries radiography complete normal person) were compared between the two groups in the CAVI,ABI differences. Random selection my courtyard physical examination crowd 1123 people, the basis age section grouping, compared with them on CAVI and ABI difference.Results: (1) confirmed that age, diabetes, hypertension, smoking, blood lipids are risk factors for coronary heart disease. (2) With the severity of coronary stenosis, CAVI progressive increase, the difference between the groups was statistically significant (P <0.01). (3) non-CHD group and the CHD group were in the normal range of ABI, but the CHD group ABI lower than without CHD (P <0.01). ABI multiple vessel disease group than the control group, single-vessel disease group (P <0.05). (4) CAVI (+) predicted a higher sensitivity of coronary heart disease (66.4%), poor specificity (32.7%); ABI prediction of coronary heart disease reduce the low sensitivity (18.0%), but high specificity (96.2% .). (5) Increases the CAVI value along with the age to carry on the markup in the ordinary physical examination crowd,but The ABI value by elevates first then decreases,
Namely in 60 to 70 year old of age section presents the inflection point.conclusion: CAVI (-) maybe non-significant independent predictor of coronary heart disease, CAVI (+) it will help early detection of atherosclerosis, and reduced ABI is an independent risk factor for coronary heart disease, can be regarded as Reference index for the diagnosis of coronary artery disease, 60 to 70 year-old senior citizen, the ABI value is smaller than 1.16 prompts has the downward artery system narrow possibility.
Objective: Discuss the values research of change on patients with coronary artery disease in arteriosclerosis and stiffness index Cardio-Ankle Vascular Index (cardio-ankle vascular index CAVI) and ankle-brachial index (ankle-brachial index ABI), Studies CAVI and ABI in the ordinary physical examination crowd's change rule.Methods: A randomly selected Cardiology in our hospital underwent selective coronary angiography examination and treatment of 342 patients, which confirmed by coronary angiography in patients with coronary heart disease (stenosis≥50%) 275 were used as the experimental group (CHD group) and coronary artery disease according to the count into the corresponding sub-group, and the remaining 67 cases (stenosis<50%) as a control group (non-CHD group Including 31 example crown arteries radiography complete normal person) were compared between the two groups in the CAVI,ABI differences. Random selection my courtyard physical examination crowd 1123 people, the basis age section grouping, compared with them on CAVI and ABI difference.Results: (1) confirmed that age, diabetes, hypertension, smoking, blood lipids are risk factors for coronary heart disease. (2) With the severity of coronary stenosis, CAVI progressive increase, the difference between the groups was statistically significant (P <0.01). (3) non-CHD group and the CHD group were in the normal range of ABI, but the CHD group ABI lower than without CHD (P <0.01). ABI multiple vessel disease group than the control group, single-vessel disease group (P <0.05). (4) CAVI (+) predicted a higher sensitivity of coronary heart disease (66.4%), poor specificity (32.7%); ABI prediction of coronary heart disease reduce the low sensitivity (18.0%), but high specificity (96.2% .). (5) Increases the CAVI value along with the age to carry on the markup in the ordinary physical examination crowd,but The ABI value by elevates first then decreases,
Namely in 60 to 70 year old of age section presents the inflection point.conclusion: CAVI (-) maybe non-significant independent predictor of coronary heart disease, CAVI (+) it will help early detection of atherosclerosis, and reduced ABI is an independent risk factor for coronary heart disease, can be regarded as Reference index for the diagnosis of coronary artery disease, 60 to 70 year-old senior citizen, the ABI value is smaller than 1.16 prompts has the downward artery system narrow possibility.
引文
1. Hansson GK. Inflammation atherosclerosis and coronary artery disease [ J ]. N Engl J Med, 2005, 352 (16) : 1685-1695.
2. Shirai K, Utino J, Otsuka K, Takata M. A novel blood pressure-independent arterial wall stiffness parameter: cardio-ankle vascular index (CAVI)[J].Journal of atherosclerosis thrombosis,2006,13(2):101-107.
3.葛萱,胡申江.冠脉造影96例临床分析[J].浙江预防医学,2008,2O(6):90-91.
4.Fowkes FG, Honsley E, Cawood EH, et al. Edinburgh arter study: prevalence of asymptomatic and symptomatic peripheral arterial disease in the general population[J]. Int J Epidemiol,1991,20:384-391.
5.Walker SR. A 10-year follow-up of patients presenting with isch-emic rest pain of the lower limbs[J]. Eur J Endovasc Surg,1998,15:478-482.
6.王继光.动脉血管早期病变的检测.中国实用内科杂志[J],2007,24(27):1917-1919.
7. Cohn JN, Duprez DA. Arerial elastility as part of a comprehensive assessment of cardiovascular risk and drug treatment [J]. Hypertension, 2005,46(7):217-220.
8.朱彤,李婉媚.PW V和A BI的测定在动脉硬化早期检测中的应.科学前沿,2006,8:4-6.
9.刘晓方,曲娜.PWV和ABI的测定在冠状动脉粥样硬化检测中的应用.宁夏医学杂志,2OO7,4,4(29):379-381
10.蔡凯愉,张维忠,邱惠丽,等.影响动脉弹性功能的临床因素分析[J].中华心血管病杂志,2007,35:237-240.
11.Igarashi Y,Chikamori T.Clinical significance of inter-arm pressure difference and ankle-brachial pressure index in patients with suspec-ted coronaryartery disease[J].Cardiol,2007,50(5):281-289.
12.Stefan F, Hans-Joachim T. Profound influece of different methods for detemination of the ankle-brachial index on the prevalence esti-mate of peripheral arterial disease[J].BMC Public Health,2007,7:147-149.
13.Laurent S, Boutouyrie P. Recent advances in arterial stiffness and wave reflection in human hypertension. Hypertension, 2007, 49 (6) : 1202-1206.
14.黄江南,李浪,宋梦莹.心踝血管指数与冠状动脉狭窄程度的关系[J].中国动脉硬化杂志,2009,6(17):487-490.
15. Yambe T, Yoshizawa M, Saijo Y, Yamaguchi T, Shibata M. Brachio-ankle pu1se wave vel0city and cardio-ankle Vascularindex(CAVI) [J].Biomed Phannacother,2004,58(1):95-98.
16. Takaki A, Ogawa H, Wakeyama T, Iwami T, Kimura M, Hadano Y, Matsuda S, Miyazaki Y, Matsuda T, Hiratsuka A, Matsuzaki M. Cardio-ankle vascular index is a new noninvasive parameter of arterial stiffness[J].Circulation Journal, 2007, 71(11):1710-1714.
17.李方洁,郭小玉,王静.大动脉僵硬度新指标CAVI的临床应用[J].中国民康医学,2008,15(20):1691-1695.
18.Hiatt WR. Medical treatment of peripheral arterial disease and claudication[J]. N Engl J Med,2001,344(21):1608-1621.
19. Papamicheal CM,Lekakis JP,Stamatelopoulos KS.Ankle-brachial index as a predictor ofthe extent of coronary atheroscleresis and cardiovascular events in patients with coronary artery disease[J].Am J Cardiol,2000,86:615-618.
20.胡大一,杨士伟,陈捷.踝臂指数对冠状动脉狭窄程度的预测价值[J].中国医刊,2005,40(4):46-48.
21.Hiatt WR.Medical treatment of peripheral arterial disease and claudication[J]..N Engl J Med,2001,344(21):1608-1621.
22.Raman,Thakur,Mathew.Ankle Ankle brachial index as a predictor of generalized atherosclerosis. J Assoc Physicians India. 2001 Nov;49:1074-7.
23.王宏宇.心-踝血管指数(Cardio-ankle vascular index, CAVI)——一项新的动脉硬化评价指标[J].中国民康医学,2007,19(11):929-930.
24. Otah KE, Madan A, Otah E, Badero O, Clark LT, Salifu MO.Usefulness of an abnorma1 ankle-brachia1 index to predict presence of coronary artery disease in African-Americans [J].American Journal of Cardiology,2004,93(4):481-483.
25. Safar ME,Levy BI,St Ruijker-Boudier H. Current perspectives on arterial Stiffness and pulse pressure in hypertension and cardiovascular diseases [J]. Circulation, 2003,107(10):2 864-869.
1 Burker AP,Tracy RP. Elevated C-reactive pro-tein values and atherosclerosis in sudden coronary death:associa-tion with differen pathologies[J].Circulation,2002,105 (17):2019-2023.
2卢娜,王宏宇等.血管病变检测方法概述[J].中国民康医学杂志,2005,5(2):106-111.
3 LIU Y, LV HW. Value of plasma high-sensitivity C-reactive protein and lipoprotein (a) in diagnosis of coronary heart ,disease [J]. China Journal of Modern Medicine, 2006, 16 (6): 904-906.
4 Jia XC,Raya R.A novel method of Multiplexed Com-petitive Antibody Binning for the characterization of monoclonal an-tibodies[J].J Immunol Methods,2004,288(1-2):91-98.
5 Dunbar SA.Applications of Luminex xMAP technology for rapid,high-throughput multiplexed nucleic acid detection[J].Clin Chim Acta,2006,363(1-2):71-82.
6李健洪,刘映峰.编码微珠悬浮芯片集成检测冠状动脉粥样硬化性心脏病相关蛋白因子:可行性分析[J].中国组织工程研究与临床康复,2008,22(12):4287-4290.
7阵文强,张立,张梅,等.血管内超声的病理学分析对比研究动脉粥样硬化兔不稳定斑块的破裂和血栓形成[J].中华超声影像学杂志,2004,13:777-779.
8张春东,勇强,李治安等.动脉硬化的影像学检测方法[J].中华血管病杂志,2008,5(27):311-312.
9 Nonent M,Serfaty JM. Concordance rate differences of 3 moninvasive imaging technique to measure carotid stenosis in clinical routine practice: results of the CARM EDAS multicenter study[J].Stroke,2004,35:682-688.
10朱彤,李婉媚. PWV和ABI的测定在动脉硬化早期检测中的应用[J].医疗保健器具,2006,8:4-5.
11胡大一,向小平.动脉粥样硬化早期检测的临床应用——大动脉僵硬度(弹性)和功能检查[J].中国心血管病研究杂志,2007,2(5):81-82.
12 Yambe T,Yoshizawa M,sa 0 Y,et a1.Brachio—ankle pu1se wave vel0city and cardio-ankle Vascularindex(cAVI)[J].Biomed Phannacother,2O04,58(1):95-98.
13李方洁,郭小玉,王静,等.大动脉僵硬度新指标CAVI的临床应用[J].中国民康医学,2008,15(20):1691-1695.
14 Shah P.Pathophysiology of coronary thrombosis:role of plaque rupture and plaque erosion[J].Prog Cardiovasc Dis, 2002,44(5):357-368.
15 Buschman H,Motz J,Romer TJ,et al.Diagnosis of human coronary atherosclerosis by morphology-based Raman spectroscopy[J].Cardiovasc Pathol,2001,10(2):59-68.
16宋英姿,张云革.彩超在颈动脉硬化及冠心病诊断中的临床价值探讨[J].中国冶金工业医学杂志,2006,5(23):594-595.
17胡翠芬.颈动脉内中膜超声检测在心脑血管疾病中的临床应用及评价[J].中国医学创新,2008,31(5):27-29.
18李馨,高云华.动脉粥样硬化的超声检测及其应用前景[J].中国医学影像学杂志,2004,1(12):56-57.
2. Shirai K, Utino J, Otsuka K, Takata M. A novel blood pressure-independent arterial wall stiffness parameter: cardio-ankle vascular index (CAVI)[J].Journal of atherosclerosis thrombosis,2006,13(2):101-107.
3.葛萱,胡申江.冠脉造影96例临床分析[J].浙江预防医学,2008,2O(6):90-91.
4.Fowkes FG, Honsley E, Cawood EH, et al. Edinburgh arter study: prevalence of asymptomatic and symptomatic peripheral arterial disease in the general population[J]. Int J Epidemiol,1991,20:384-391.
5.Walker SR. A 10-year follow-up of patients presenting with isch-emic rest pain of the lower limbs[J]. Eur J Endovasc Surg,1998,15:478-482.
6.王继光.动脉血管早期病变的检测.中国实用内科杂志[J],2007,24(27):1917-1919.
7. Cohn JN, Duprez DA. Arerial elastility as part of a comprehensive assessment of cardiovascular risk and drug treatment [J]. Hypertension, 2005,46(7):217-220.
8.朱彤,李婉媚.PW V和A BI的测定在动脉硬化早期检测中的应.科学前沿,2006,8:4-6.
9.刘晓方,曲娜.PWV和ABI的测定在冠状动脉粥样硬化检测中的应用.宁夏医学杂志,2OO7,4,4(29):379-381
10.蔡凯愉,张维忠,邱惠丽,等.影响动脉弹性功能的临床因素分析[J].中华心血管病杂志,2007,35:237-240.
11.Igarashi Y,Chikamori T.Clinical significance of inter-arm pressure difference and ankle-brachial pressure index in patients with suspec-ted coronaryartery disease[J].Cardiol,2007,50(5):281-289.
12.Stefan F, Hans-Joachim T. Profound influece of different methods for detemination of the ankle-brachial index on the prevalence esti-mate of peripheral arterial disease[J].BMC Public Health,2007,7:147-149.
13.Laurent S, Boutouyrie P. Recent advances in arterial stiffness and wave reflection in human hypertension. Hypertension, 2007, 49 (6) : 1202-1206.
14.黄江南,李浪,宋梦莹.心踝血管指数与冠状动脉狭窄程度的关系[J].中国动脉硬化杂志,2009,6(17):487-490.
15. Yambe T, Yoshizawa M, Saijo Y, Yamaguchi T, Shibata M. Brachio-ankle pu1se wave vel0city and cardio-ankle Vascularindex(CAVI) [J].Biomed Phannacother,2004,58(1):95-98.
16. Takaki A, Ogawa H, Wakeyama T, Iwami T, Kimura M, Hadano Y, Matsuda S, Miyazaki Y, Matsuda T, Hiratsuka A, Matsuzaki M. Cardio-ankle vascular index is a new noninvasive parameter of arterial stiffness[J].Circulation Journal, 2007, 71(11):1710-1714.
17.李方洁,郭小玉,王静.大动脉僵硬度新指标CAVI的临床应用[J].中国民康医学,2008,15(20):1691-1695.
18.Hiatt WR. Medical treatment of peripheral arterial disease and claudication[J]. N Engl J Med,2001,344(21):1608-1621.
19. Papamicheal CM,Lekakis JP,Stamatelopoulos KS.Ankle-brachial index as a predictor ofthe extent of coronary atheroscleresis and cardiovascular events in patients with coronary artery disease[J].Am J Cardiol,2000,86:615-618.
20.胡大一,杨士伟,陈捷.踝臂指数对冠状动脉狭窄程度的预测价值[J].中国医刊,2005,40(4):46-48.
21.Hiatt WR.Medical treatment of peripheral arterial disease and claudication[J]..N Engl J Med,2001,344(21):1608-1621.
22.Raman,Thakur,Mathew.Ankle Ankle brachial index as a predictor of generalized atherosclerosis. J Assoc Physicians India. 2001 Nov;49:1074-7.
23.王宏宇.心-踝血管指数(Cardio-ankle vascular index, CAVI)——一项新的动脉硬化评价指标[J].中国民康医学,2007,19(11):929-930.
24. Otah KE, Madan A, Otah E, Badero O, Clark LT, Salifu MO.Usefulness of an abnorma1 ankle-brachia1 index to predict presence of coronary artery disease in African-Americans [J].American Journal of Cardiology,2004,93(4):481-483.
25. Safar ME,Levy BI,St Ruijker-Boudier H. Current perspectives on arterial Stiffness and pulse pressure in hypertension and cardiovascular diseases [J]. Circulation, 2003,107(10):2 864-869.
1 Burker AP,Tracy RP. Elevated C-reactive pro-tein values and atherosclerosis in sudden coronary death:associa-tion with differen pathologies[J].Circulation,2002,105 (17):2019-2023.
2卢娜,王宏宇等.血管病变检测方法概述[J].中国民康医学杂志,2005,5(2):106-111.
3 LIU Y, LV HW. Value of plasma high-sensitivity C-reactive protein and lipoprotein (a) in diagnosis of coronary heart ,disease [J]. China Journal of Modern Medicine, 2006, 16 (6): 904-906.
4 Jia XC,Raya R.A novel method of Multiplexed Com-petitive Antibody Binning for the characterization of monoclonal an-tibodies[J].J Immunol Methods,2004,288(1-2):91-98.
5 Dunbar SA.Applications of Luminex xMAP technology for rapid,high-throughput multiplexed nucleic acid detection[J].Clin Chim Acta,2006,363(1-2):71-82.
6李健洪,刘映峰.编码微珠悬浮芯片集成检测冠状动脉粥样硬化性心脏病相关蛋白因子:可行性分析[J].中国组织工程研究与临床康复,2008,22(12):4287-4290.
7阵文强,张立,张梅,等.血管内超声的病理学分析对比研究动脉粥样硬化兔不稳定斑块的破裂和血栓形成[J].中华超声影像学杂志,2004,13:777-779.
8张春东,勇强,李治安等.动脉硬化的影像学检测方法[J].中华血管病杂志,2008,5(27):311-312.
9 Nonent M,Serfaty JM. Concordance rate differences of 3 moninvasive imaging technique to measure carotid stenosis in clinical routine practice: results of the CARM EDAS multicenter study[J].Stroke,2004,35:682-688.
10朱彤,李婉媚. PWV和ABI的测定在动脉硬化早期检测中的应用[J].医疗保健器具,2006,8:4-5.
11胡大一,向小平.动脉粥样硬化早期检测的临床应用——大动脉僵硬度(弹性)和功能检查[J].中国心血管病研究杂志,2007,2(5):81-82.
12 Yambe T,Yoshizawa M,sa 0 Y,et a1.Brachio—ankle pu1se wave vel0city and cardio-ankle Vascularindex(cAVI)[J].Biomed Phannacother,2O04,58(1):95-98.
13李方洁,郭小玉,王静,等.大动脉僵硬度新指标CAVI的临床应用[J].中国民康医学,2008,15(20):1691-1695.
14 Shah P.Pathophysiology of coronary thrombosis:role of plaque rupture and plaque erosion[J].Prog Cardiovasc Dis, 2002,44(5):357-368.
15 Buschman H,Motz J,Romer TJ,et al.Diagnosis of human coronary atherosclerosis by morphology-based Raman spectroscopy[J].Cardiovasc Pathol,2001,10(2):59-68.
16宋英姿,张云革.彩超在颈动脉硬化及冠心病诊断中的临床价值探讨[J].中国冶金工业医学杂志,2006,5(23):594-595.
17胡翠芬.颈动脉内中膜超声检测在心脑血管疾病中的临床应用及评价[J].中国医学创新,2008,31(5):27-29.
18李馨,高云华.动脉粥样硬化的超声检测及其应用前景[J].中国医学影像学杂志,2004,1(12):56-57.