高血压患者主动脉弹性与冠脉病变严重程度相关性及其对介入预后评价  

Correlation of aortic elasticity with the severity degree of coronary atheroscerosis and its significance for evaluating risk stratification outcomes in patients with essension hypertension receiving percutaneous coronary intervention

作　　者：杜大勇[1] 柳杨[1] 李运田[1] 王芳[1] 李沫言[1] 

机构地区：[1]解放军305医院冠心病诊疗中心,北京100017

出　　处：《山西医科大学学报》2009年第7期621-625,共5页Journal of Shanxi Medical University

基　　金：全军"十一五"医药卫生科研基金资助项目(06G145)

摘　　要：目的探讨主动脉弹性对高血压患者冠脉病变严重程度相关性,以及对其中接受冠脉介入术(percutaneous coronary intervention,PCI)患者的预后评价。方法符合高血压冠心病诊断标准入院患者208例,所有入选患者均进行颈股脉搏波传导速度(CFPWV)检测评价主动脉弹性、冠脉造影评价冠脉病变严重程度。根据CFPWV水平分为两组:Ⅰ组(C-FPWV0-13.0m/s,n=117)和Ⅱ组(C-FPWV>13.0m/s,n=91),观察两组患者临床特征,并对其中接受PCI患者182例随访(18.9±3.7)个月,并观察主要心血管事件。结果与Ⅰ组比较,Ⅱ组糖尿病和心肌梗死史多,C型病变和三支病变常见(P<0.05)。与Ⅰ组间比较,Ⅱ组围操作并发症发生率、远期非致死性心肌梗死和血运重建发生率显著增加(P<0.05)。多因素logistic分析CFPWV与冠脉病变严重程度呈正相关,OR为2.03(95%CI1.061-3.881);多因素logistic分析CFPWV与接受介入患者在住院期、远期MACE发生率呈正相关,OR为2.303(95%CI1.179-4.499)。结论主动脉弹性降低与冠状动脉病变的严重程度密切相关,与PCI远期MACE发生率增加密切相关,可作为心血管疾病的一个危险信号,为心血管疾病独立强有力预测因子。Objective To explore the relationship between aortic elasticity and the severity degree of coronary atherosclerosis in patients with essension hypertension who received coronary arteriography and/or percutaneous coronary intervention （PCI）, and to investi- gate the value of aortic elasticity in evaluation of risk stratification outcomes. Methods A total of 208 consecutive patients who received coronary arteriography were enrolled. Carotid-femoral pulse wave velocity（ CFPWV ）was measured to evaluate the aortic elasticity. The severity degree of coronary atherosclerosis was detected by the numbers of coronary artery stenosis. According to CFPWV, they were divided into 2 groups ： group I （ CFPWV 0 - 13.0 m/s, n = 117 ）, group II （ CFPWV 〉 13.0 m/s, n = 91 ）. The clinical characteristics and major cardiovascular event（MACE） of 182 cases who received PCI with a follow-up period of（ 18.9 ± 3.7 ） months were analyzed. Results The percentages of diabetes, myocardial infarction, type C lesion, and three artery stenosis were higher in group II than in group I （ P 〈 0.05 ）. The incidence of procedure-related complication, long-term non-fatal myocardial infarction and revascularization was significantly higher in group Ⅱ than in group Ⅰ （ P 〈 0.05 ）. Multi-logistic analysis showed that CFPWV was positively related to the severity of coronary artery stenosis（ OR = 2.03,95% CI 1. 061 - 3. 881 ）, the incidence of in-hospital and follow-up MACE in patients with PCI （ OR = 2. 303,95 % CI 1. 179 - 4. 499 ）. Conclusion Aortic elasticity is closely related to the severity of coronary artery ste- nosis, and also correlated with the increase of incidences of MACE and procedure-related complication. Aortic elasticity could be a risk factor of cardiovascular diseases, and also be a strong and independent factor for predicting the prognosis of coronary vascular disease.

关 键 词：主动脉弹性 冠脉病变 脉搏波传导速度 心血管事件 冠脉介入 

分 类 号：R544.1[医药卫生—心血管疾病]