踝臂指数和C反应蛋白与冠脉狭窄程度的相关性研究
摘要
目的
探讨冠心病患者中踝臂指数(ankle-brachial index, ABI)与C-反应蛋白(c- reactive protein,CRP),两参数和冠状动脉病变狭窄严重程度的关系。
方法
对85例入选病例均行选择性冠状动脉造影术,其中男性60例,女性25例,年龄42-77岁,平均(59.58±10.06)。所有入选病例均于冠脉造影术前设备使用日本日本Olympus AU640全自动生化仪,用免疫比浊法进行C -反应蛋白检测。用便携超声仪进行踝动脉收缩压(取胫后或足背动脉收缩压的高值)与双侧肱动脉收缩压测定,计算两侧的ABI,取低值进行分析。详细记录冠脉造影结果,冠脉病变的狭窄程度用病变血管支数及Gensini积分表示。根据冠脉造影结果分为两组,三支病变组(试验组)与非三支病变组(对照组)。
结果
1两组中,吸烟和糖尿病所占比例相比较,有统计学差别( P=0.007,P=0.000 )。两组ABI﹑ CRP﹑ CSS相比较,有统计学差别(P=0.000,P=0.000,P=0.002).
2 ABI﹑CRP与冠脉狭窄程度相关性分析ABI与冠脉狭窄程度呈负相关(P=0.036),CRP与冠脉狭窄程度呈正相关(P=0.004)。
3 CRP的ROC曲线下面积(0.893±0.035),95%可信区间(0.824～0.963)。ABI的曲线下面积(0.706±0.056),95%可信区间(0.569～0.816)。
4多因素逐步回归分析表明: ABI(回归系数=51.012,Wald=9.158,P=0.002)﹑糖尿病(回归系数=-3.647,Wald=4.571,P=0.033)﹑吸烟史(回归系数=-3.252,Wald=3.947,P=0.047)对CHD的发生有预测价值。
结论
1 CHD患者ABI与冠脉狭窄程度呈负相关,ABI数值越小,越能反应冠脉狭窄程度,CRP与冠脉狭窄程度呈正相关。
2 ABI与CRP都能一定程度预测冠脉病变,ABI比CRP在一定程度上更能预测冠脉病变。
Objective:
To detect the correlation between that two parameters ABIandCRPand that stenosis severity in the patient with coronary artery disease
Methods:
The coronary artery graph was done on 85 selected patients include male 60 and female 25,the age ranges from42 to77,the mean is 59.58±10.06.Serum CRP of 85 patients were measured by Japanese Olympus AU640Automatic Analyzer with immunonephelometry and get the systolic artery press of ankle arteries(the maximal value of posterior tibial artery or dorsal pedal artery) and bilateral brachial arteries, then compute the data for ABI and analyzed with the minimal values, describe arterial stenosis severity with amounts of lesion vessels and Gensini score system.Divide the patients into two teams : three-branch team(test team) and nonthree-branch team(control team) according coronary arteriography.
Results:
1 There was significant difference in smoking, diabetes ABI,CRP,CSS between test team group and control team group(p=0.007,p=0.000)
2 There is negative correlation between ABI and stenosis severity of lesion vessel(p=0.036)and positive correlation between CRP and stenosis severity of lesion vessel(p=0.036).
3 The CRP area under ROC curve is(o.893±0.035), 95℅confidence interval is (0.082～0.963);ABI data is (0.706±0.056)and(0.569～0.816).
4 Multiple linear gression equation illustrate that the CHD can be estimated by The diabete(sr=-3.647,wald=4.517P=0.033), smoking history (r=-0.252 , wald=3.947, p=0.047) and ABI (r=51.012,wald=9.158, p=0.002)
Conclusions:
1 there is negative correlation between CHD and stenosis severity of coronary artery ,the level of the ABI ,the more severity of the stenosis vessel; the positive correlation between CRP and stenosis severity of coronary artery.
2 Coronary artery disease can be estimated by ABI and CRP ,but in some way, ABI is better than CRP in estimating coronary artery disease.
探讨冠心病患者中踝臂指数(ankle-brachial index, ABI)与C-反应蛋白(c- reactive protein,CRP),两参数和冠状动脉病变狭窄严重程度的关系。
方法
对85例入选病例均行选择性冠状动脉造影术,其中男性60例,女性25例,年龄42-77岁,平均(59.58±10.06)。所有入选病例均于冠脉造影术前设备使用日本日本Olympus AU640全自动生化仪,用免疫比浊法进行C -反应蛋白检测。用便携超声仪进行踝动脉收缩压(取胫后或足背动脉收缩压的高值)与双侧肱动脉收缩压测定,计算两侧的ABI,取低值进行分析。详细记录冠脉造影结果,冠脉病变的狭窄程度用病变血管支数及Gensini积分表示。根据冠脉造影结果分为两组,三支病变组(试验组)与非三支病变组(对照组)。
结果
1两组中,吸烟和糖尿病所占比例相比较,有统计学差别( P=0.007,P=0.000 )。两组ABI﹑ CRP﹑ CSS相比较,有统计学差别(P=0.000,P=0.000,P=0.002).
2 ABI﹑CRP与冠脉狭窄程度相关性分析ABI与冠脉狭窄程度呈负相关(P=0.036),CRP与冠脉狭窄程度呈正相关(P=0.004)。
3 CRP的ROC曲线下面积(0.893±0.035),95%可信区间(0.824～0.963)。ABI的曲线下面积(0.706±0.056),95%可信区间(0.569～0.816)。
4多因素逐步回归分析表明: ABI(回归系数=51.012,Wald=9.158,P=0.002)﹑糖尿病(回归系数=-3.647,Wald=4.571,P=0.033)﹑吸烟史(回归系数=-3.252,Wald=3.947,P=0.047)对CHD的发生有预测价值。
结论
1 CHD患者ABI与冠脉狭窄程度呈负相关,ABI数值越小,越能反应冠脉狭窄程度,CRP与冠脉狭窄程度呈正相关。
2 ABI与CRP都能一定程度预测冠脉病变,ABI比CRP在一定程度上更能预测冠脉病变。
Objective:
To detect the correlation between that two parameters ABIandCRPand that stenosis severity in the patient with coronary artery disease
Methods:
The coronary artery graph was done on 85 selected patients include male 60 and female 25,the age ranges from42 to77,the mean is 59.58±10.06.Serum CRP of 85 patients were measured by Japanese Olympus AU640Automatic Analyzer with immunonephelometry and get the systolic artery press of ankle arteries(the maximal value of posterior tibial artery or dorsal pedal artery) and bilateral brachial arteries, then compute the data for ABI and analyzed with the minimal values, describe arterial stenosis severity with amounts of lesion vessels and Gensini score system.Divide the patients into two teams : three-branch team(test team) and nonthree-branch team(control team) according coronary arteriography.
Results:
1 There was significant difference in smoking, diabetes ABI,CRP,CSS between test team group and control team group(p=0.007,p=0.000)
2 There is negative correlation between ABI and stenosis severity of lesion vessel(p=0.036)and positive correlation between CRP and stenosis severity of lesion vessel(p=0.036).
3 The CRP area under ROC curve is(o.893±0.035), 95℅confidence interval is (0.082～0.963);ABI data is (0.706±0.056)and(0.569～0.816).
4 Multiple linear gression equation illustrate that the CHD can be estimated by The diabete(sr=-3.647,wald=4.517P=0.033), smoking history (r=-0.252 , wald=3.947, p=0.047) and ABI (r=51.012,wald=9.158, p=0.002)
Conclusions:
1 there is negative correlation between CHD and stenosis severity of coronary artery ,the level of the ABI ,the more severity of the stenosis vessel; the positive correlation between CRP and stenosis severity of coronary artery.
2 Coronary artery disease can be estimated by ABI and CRP ,but in some way, ABI is better than CRP in estimating coronary artery disease.
引文
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[10] Yeh ET , Anderson HV , Pasceri V , Willerson J T. C-reactive protein : linking inflammation to cardiovascular complications. Circulation , 2001 , 104 (9) :974—975.
[11] Blake GJ , Ridker PM. C-reactive protein and other inflammatory risk markers in acute coronary syndromes. J Am Coll Cardiol ,2003 , 41 (4 Suppl S) :S37—42
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[2] Hiatt WR,Hoag S,Hamman RF.Effect of diagnostic criteria on theprevalence of peripheral arterial disease.The San Luis Valley Diabetes Study.Circulation,1995;91:1472—1479
[3] Sikkink CJ,Van Asten W N,Van’t Hof MA,et a1.Decreased ankle—brachial indices in relation to morbidity and mortality in patients withperipheral arterial disease.Vasc Med,1997;2:169—173
[4] Hooi JD , Kester AD , Stoffers HE ,et al.Asymptomatic peripheral arterial occlu-sive disease predicted cardiovascular morbidity and mortality in a 7一year follow—up study[J].J C1in Epidemiol。20O4,57:294—300. [5 ] Oltrona L ,Ardissino D ,Merlini PA , et al. C -reactive protein elevation and early outcome in patients with unstable pectoris [ J ] . Am JCardiol ,1997 ,80 (8) :1002—1006. [ 6 ] Jeffery L ,Anderson MD ,Facc J F ,et al. Evaluation of C reactive pro-tein ,an inflammatory marker and infection serology as risk factors for coronary ,disease and myocardial infarction [ J ] . J Am Coll Cardiol ,1998 ,32 (1) :35—35. [ 7 ] Blake GJ , Ridker PM. C-reactive protein and other inflammatoryrisk markers in acute coronary syndromes. J Am Coll Cardiol ,2003 ,41 (4Suppl S) :S37—42.
[8] Gensini GG. A more meaningful scoring system for determiningthe severity of coronary heart disease[J] .Am J Cardiol ,1983 ,51(3) :606—609.
[9] Sacks D , Bakal CW , Beatty PT , et al. Position statement on the use of the ankle-brachial index in the evaluation of patient s with peripheral vascular disease : a consensus statement developed by the Standards Division of the Society of Cardiovascular & Interventional Radiology [J ] . J Vasc Interv Radiol , 2002 ,13 (4) :353.
[10] Yeh ET , Anderson HV , Pasceri V , Willerson J T. C-reactive protein : linking inflammation to cardiovascular complications. Circulation , 2001 , 104 (9) :974—975.
[11] Blake GJ , Ridker PM. C-reactive protein and other inflammatory risk markers in acute coronary syndromes. J Am Coll Cardiol ,2003 , 41 (4 Suppl S) :S37—42
[12] Ridker PM. Clinical application of C-reactive protein for cardiovasculardisease detection and prevention. Circulation , 2003 , 107 (3) :363—369.
[13] Kenneth Ourie1.Peripheral arterial disease J .Lancet,2001.358:1257—1264.
[14] Nenci GG:Unifying concept of arterial vascular disease [J].Eur HeartJ Suppl,l999,(suppl A):A27—3O.
[15] Newman AB,Shemanski L,Manolio TA,et al.Ankle—arm index as a predictor of cardiovascular disease and mortality in the Cardiovascular Health study [J]. Arterioseler Thromb Vasc Bio1.1999,19:538—545.
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