颈动脉超声和hs-CRP预测冠心病的临床应用  

Clinical Application of Carotid Ultrasonography and High-sensitivity C-reactive Protein Detection in Predicting Coronary Heart Disease

作　　者：陈莉[1] 吴婷[1] 李慎义[1] 杨智利[1] 赵景[1] 

机构地区：[1]南昌大学第一附属医院超声诊断科,南昌330006

出　　处：《南昌大学学报（医学版）》2012年第6期10-14,共5页Journal of Nanchang University：Medical Sciences

基　　金：江西省教育厅科学技术研究项目(GJJ11369)

摘　　要：目的就颈动脉内中膜厚度(CIMT)、斑块积分及超敏C-反应蛋白(hs-CRP)与冠心病的相关性进行研究,并对这几项指标是否是早期预测冠心病独立危险因子做出评价;应用受试者工作特征(ROC)曲线以确定CIMT和hs-CRP对冠心病最佳预测值。方法对经冠状动脉造影证实的冠心病患者87例(冠心病组)及健康体检者29例(对照组)行双侧颈动脉彩超检查,测量CIMT、计算颈动脉斑块积分。2组患者均检测血清hs-CRP、血糖、血脂等指标,记录其是否有吸烟史、高血压病史、糖尿病史,并根据结果进行统计学分析。结果冠心病组CIMT、颈动脉斑块积分、血清hs-CRP均明显高于对照组,2组比较差异均有统计学意义(均P<0.001)。多元回归分析证实CI-MT、hs-CRP是独立预测冠心病的危险因子。应用诊断试验建立ROC曲线,CIMT值为0.78mm、hs-CRP质量浓度为2.15mg.L-1时,诊断冠心病的敏感度分别为96.6%、85.1%,特异度分别为41.0%、72.3%。CIMT与吸烟史、高血压、糖尿病、TC呈显著性相关;hs-CRP与高血压、糖尿病呈显著性相关。结论吸烟史、高血压、糖尿病、TC是CIMT的主要危险因素,高血压、糖尿病是hs-CRP的主要危险因素。CIMT、hs-CRP是冠心病的独立危险因子,能早期预测冠心病的发生。Objective To explore the independent risk factors for coronary artery disease（CAD） through investigating the relationships of carotid intima-media thickness（CIMT）,paque scores and high-sensitivity C-reactive potein（hs-CRP） levels to coronary heart disease,and to determine the best predictive values of CIMT and hs-CRP levels by using the receiver operating characteristic（ROC） curve.Methods Color Doppler ultrasound of bilateral carotid arteries was performed to measure CIMT and paque scores in 87 patients with coronary angiography confirmed CAD（CAD group） and 29 healthy subjects（control group）.The levels of serum hs-CRP,blood glucose and blood lipids were determined and the history of diabetes,smoking and hypertension was recorded.Results Compared with control group,CIMT,paque scores and serum hs-CRP levels significantly increased in CAD group（P〈0.001）.Multiple logistic regression analysis showed that CIMT and hs-CRP were the independent risk factors for CAD.The cutoff levels obtained from ROC curves were 0.78 mm for CIMT（sensitivity 96.6%,specificity 41.0%） and 2.15 mg·L-1 for hs-CRP（sensitivity 85.1%,specificity 72.3%）.The CIMT was significantly correlated with diabetes,smoking and hypertension history and blood total cholesterol（TC） levels.The levels of serum hs-CRP were significantly correlated with diabetes and hypertension.Conclusion The history of diabetes,smoking and levels of TC are the risk factors for CIMT.The hypertension and diabetes are the risk factors for hs-CRP.The CIMT and hs-CRP are the independent risk factors for predicting CAD.

关 键 词：冠心病 内中膜厚度 超敏C-反应蛋白 颈动脉粥样斑块 超声 

分 类 号：R541.4[医药卫生—心血管疾病] R445.1[医药卫生—内科学]