颈动脉内中膜厚度及弹性定量指标对冠状动脉粥样硬化性心脏病诊断的预测价值  

The predictive value of carotid intima-media thickness and elasticity for coronary heart disease

作　　者：王怡[1] 段云友[1] 张莉[1] 袁丽君[1] 许磊[1] 杨一林[1] 曹铁生[1] 

机构地区：[1]第四军医大学唐都医院超声诊断科,西安710038

出　　处：《中华医学超声杂志（电子版）》2013年第9期735-740,共6页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的探讨射频超声技术定量检测颈动脉内中膜厚度及弹性对评价冠状动脉粥样硬化性心脏病(简称冠心病)患者冠状动脉病变程度的诊断价值。方法选择2011年2月至2012年6月在第四军医大学唐都医院心内科住院的疑诊冠心病患者142例,根据冠状动脉造影结果分为4组:非冠心病组35例;冠状动脉存在粥样硬化但狭窄率<50%且无血流动力学改变者33例为冠状动脉粥样硬化组;仅1支血管病变,且血管狭窄率≥50%者36例为单支病变组;2支及2支以上主要血管病变,且血管狭窄率≥50%者38例为多支病变组。测量左颈总动脉内中膜厚度(LIMT)及血管弹性指标,包括左颈总动脉脉搏波传导速度(LPWV)和硬度指数(Lβ)。应用受试者操作特性(ROC)曲线计算并比较左颈总动脉弹性参数诊断不同程度冠心病的曲线下面积及截断值、敏感度、特异度、约登指数。结果 4组患者LIMT、LPWV及Lβ间差异均有统计学意义(F=3.621、4.769、4.756,P均<0.05)。各参数ROC曲线下面积的最大值均出现在多支病变组,分别为0.759(LIMT)、0.770(LPWV)、0.764(Lβ)。左颈总动脉内中膜厚度的约登指数最大值出现在冠状动脉粥样硬化组,为0.513;左颈总动脉脉搏波传导速度及硬度指数的约登指数最大值均出现在多支病变组,为0.524和0.469。LIMT、LPWV和Lβ诊断冠心病多支病变的敏感度分别为71.0%、77.4%、71.0%,特异度分别为73.4%、74.7%、75.9%。结论颈总动脉血管各参数对冠心病多支病变患者的诊断效能最高,其中弹性指标LPWV、Lβ较LIMT具有更高的诊断预测价值。Objective To explore the value of quantitative measurement of carotid intima-media thickness and elasticity for evaluating the degree of coronary heart disease by radio frequency ultrasonography. Methods From February 2011 to June 2012, a total of 142 subjects in cardiovascular internal medicine of the fourth military medical university Tangdu hospital with suspected CAD were enrolled in this study and were divided into non CAD group (n=35), atherosclerosis group in which coronary stenosis rate was less than 50%and no hemodynamic changes were detected (n=33), single artery involved group in which coronary stenosis rate was more than 50% (n=36) and multi-artery involved group in which coronary stenosis rate was more than 50%(n=38) based on the results of the coronary angiography (CAG). Measure the left common carotid artery intima-media thickness (IMT) and blood vessel elasticity index including the left common carotid artery pulse wave velocity (PWV) and stiffness index (β). Receiver operating characteristic (ROC) curves were used to calculate and compare the degrees of coronary heart disease, area under the curve of the left carotid artery elasticity parameters, cut-off value,sensitivity, speciifcity and Youden's index. Results LIMT, LPWV and Lβhad statistical signiifcance differences among four groups (F=3.621, 4.769 and 4.756, all P<0.05). The maximum values of parameter area under ROC curve were all observed in multi-artery involved groups and were 0.759 (LIMT), 0.770 (LPWV) and 0.764 (Lβ). The maximum value of Youden's index of the left common carotid artery intima-media thickness was observed in the coronary atherosclerosis group and was 0.513. The maximum value of Youden's index of the left common carotid artery pulse wave velocity and stiffnessβwere both observed in the multi-artery involved group and were 0.524 and 0.469. For diagnosing multivessel lesions, the sensitivities of LIMT, LPWV and Lβwere 71.0%, 77.4%and 71.0%, and the speciifcities were 73.4%, 74.7%and 75.9%. Conclusions The carotid elas

关 键 词：超声心动描记术 冠状动脉疾病 颈动脉 

分 类 号：R541.4[医药卫生—心血管疾病]