心-踝血管指数与颈动脉内膜中膜厚度在动脉硬化评价中的诊断效度比较  

The Comparisons Between Cardio-Ankle Vascular Index and Intima-Media Thickness for the Validity of Diagnosis in Arteriosclerosis Evaluation

作　　者：宋明强[1] 田海晔[1] 蛭田啓之 黑须巧 铃木醇 宫下洋 白井厚治 

机构地区：[1]滨州医学院附属威海市立医院,山东省滨州市256603 [2]日本东邦大学附属佐仓病院

出　　处：《中国动脉硬化杂志》2010年第2期141-145,共5页Chinese Journal of Arteriosclerosis

摘　　要：目的通过对新近开发应用的动脉硬化度测定指标——心-踝血管指数与已用于临床多年的颈动脉内膜中膜厚度两种非侵袭性测定方法的各自优势与不足的比较,获得各自的诊断效度,从而向临床医师提供依据,以求在今后的动脉硬化度评价中能够更为客观地反映临床实际。方法对受检的同时具备有心-踝血管指数和颈动脉内膜中膜厚度检查报告的连续病人183例,各自左右侧测定值的差异度进行了比较。按相差百分比的不同进行区段划分,求出各自区段内所出现的频数,由此比较不同相差百分比区段时各自出现的频度百分比。在30例连续的无动脉硬化危险因素和动脉硬化疾病的人群及42例冠状动脉狭窄和47例已患脑梗死的患者人群中,分别进行心-踝血管指数和颈动脉内膜中膜厚度各自特异度和敏感度的比较。并作出各自的ROC曲线,比较各自的曲线下面积。结果心-踝血管指数测定值左右两侧差异度在5%和10%以内的出现频度分别为86.7%和99.1%,而颈动脉内膜中膜厚度测定值其两侧浮动幅度在10%以内的人数仅占24.6%,浮动度〉20%而≤30%之间者占66.6%,甚至有8.8%的受检个体其两侧测定值的差异度超过了30%。即两侧测定值的不一致程度内膜中膜厚度要远远大于心-踝血管指数测定法。在心-踝血管指数和内膜中膜厚度的临床效度比较中,心-踝血管指数和内膜中膜厚度的ROC曲线下面积在心脏冠状动脉硬化组分别为0.894（95%CI 0.810~0.978）和0.700（（95%CI 0.566~0.834）,脑动脉硬化组分别为0.831（95%CI 0.747~0.914）和0.576（95%CI 0.458~0.695）,显然心-踝血管指数的ROC曲线下面积在心、脑动脉硬化均显著大于内膜中膜厚度。仅有的3例同时有心-踝血管指数和内膜中膜厚度检查报告的尸体大动脉血管解剖诊断证实,二者的测定数值与其对应血管壁的病理改变基本吻合。结论在整体而非局部的�Aim Cardio-ankle vascular index（CAVI） was newly developed index of arterial wall stiffness.To compare the validity of both diagnostic technique CAVI and carotid intima-media thickness（IMT） which was known to reflect cervical arterial atherosclerosis,both indices were measured in patients with coronary stenosis and cerevral infarction and non-atherosclerosis diseases.Methods Between January and June 2006,a total of 183（55~70 years old） consecutive subjects were measured with CAVI and IMT.The percentage of difference of left and right sidedness was compared with measured value for CAVI and IMT.In the comparison study for validity of both diagnostic technique,miocardial infarction（n=42）,cerebral infarction（n=47） and non-atherosclerosis（n=30）were included.CAVI and IMT were simultaneously measured.Validities of CAVI and IMT for various cardio-and cerebro-vascular diseases were evaluated by ROC analysis.Instrument for CAVI was applied in Sakura hospital（TOHO university）.In all,3 autopsied patients had performed concurrently CAVI measurement in life.The study compared respective agreement degree between measurement value and pathological change in main artery.Results The percentage of difference of left and right sideness with measured value for CAVI was remarkably smaller than IMT.The area under the ROC curves of CAVI and IMT for coronary stenosis were 0.894（95%CI 0.810～0.978） and 0.700（95%CI 0.566～0.834） respectvely.Andthe area under the ROC curves of CAVI and IMT for cerebral infarction were 0.831（95%CI 0.747 ~0.914） and 0.576（95%CI 0.458 ~0.695） respectively.Obviously areas under the ROC curve of CAVI were larger compared with areaunder ROC curve of IMTwhether in coronary artery or cerebro-artery atherosclerosis.Three autopsy cases demonstratedthat CAVI and IMTduring in life was agreement with severity of aortic atherosclerosis.Conclusion CAVI has a highvalidity for diagnosis to IMT,it is a good indicator of cardio-and cerebro-vascular event,and is more likely reflecti

关 键 词：动脉硬化 血管硬化指数 脉搏波速度 心-踝血管指数 颈动脉内膜中膜厚度 

分 类 号：R5[医药卫生—内科学]