肱动脉血流介导的内皮依赖性舒张功能的变化对冠状动脉病变的预测价值  

Predictive value of flow mediated dilatation for coronary artery lesions

作　　者：郭丛丛 彭艳梅[2] 张亚芹 黄力[4] GUO Congcong;PENG Yanmei;ZHANG Yaqin;HUANG Li(First Clinical Medical College,Shandong University of Traditional Chinese Medicine,Jinan,Shangdong 250355,China;Beijing University of Traditional Chinese Medicine,Beifing 100029,China;Division of Endocrinology,Depart-ment of Internal Medicine,Shandong Provincial Qianfoshan Hospital,Shandong University,Jinan,Shandong 250014,Chi-na;National Integrated Traditional and Western Medicine Center for Cardiovascular Disease,China-Japan Friendship Hos-pital,Bering 100029,China)

机构地区：[1]山东中医药大学,山东省济南市250355 [2]北京中医药大学,北京市100029 [3]山东大学,山东省济南市250014 [4]中日友好医院中西医结合心内科,北京市100029

出　　处：《中国动脉硬化杂志》2018年第7期715-719,共5页Chinese Journal of Arteriosclerosis

基　　金：国家自然科学基金资助项目(81573777)

摘　　要：目的探讨肱动脉血流介导的内皮依赖性舒张功能（FMD）变化与冠状动脉病变程度的相关性,为血管内皮功能检测可用于筛查早期冠心病提供临床依据。方法纳入临床疑似冠心病拟行冠状动脉造影（CAG）的患者,共130例。所有患者均于CAG检查前行FMD检查。根据造影结果将患者分为冠心病组和非冠心病组。将冠心病组、非冠心病组进一步分为不同亚组,分析FMD与冠状动脉病变程度的相关性。绘制ROC曲线,寻找FMD诊断冠心病的最佳界值。结果冠心病组收缩压、同型半胱氨酸、糖化血红蛋白均高于非冠心病组（P〈0.01或P〈0.05）。冠心病组FMD较非冠心病组明显降低（P〈0.01）。各亚组间分析显示,正常组FMD分别高于冠状动脉硬化组、单支病变组、双支病变组及三支病变组（P〈0.05或P〈0.01）,冠状动脉硬化组FMD均高于双支病变组及多支病变组（P〈0.01）,单支病变组FMD高于三支病变组（P〈0.05）。多元回归分析显示,FMD是诊断冠心病的独立预测因素（OR=0.182,95%CI为0.068~0.487,P〈0.01）。ROC曲线分析显示,FMD≤6.05%是预测冠状动脉病变最佳界值,其敏感性为91.1%,特异性为80.4%,阳性预测值为87.8%,阴性预测值为85.4%。结论 FMD可较好地反映冠状动脉病变程度,对冠心病的诊断具有较好的预测价值。Aim To investigate the correlation between flow mediated dilatation（ FMD） and the degree of coronary artery lesion and provide a clinical basis for the detection of vascular endothelial function in early coronary heart disease. Methods A total of 130 patients with suspected coronary heart disease（ CHD） who underwent coronary angiography（ CAG） were recruited. The FMD was performed before CAG. The patients were divided into CHD group and nonCHD group according to the result of CAG. Meanwhile,the differences were analyzed about FMD in different lesion degree of coronary artery. ROC curves were drawn to find the optimal cut-off value for diagnosis of CHD. Results Systolic blood pressure,homocysteine and Hb A1 c in CHD group were higher than those in non-CHD group（ P〈0.01 or P〈0.05）. The FMD in CHD group was significantly lower than that in non-CHD group（ P〈0.01）. Further subgroup analysis showed that the FMD in normal group was higher than that in coronary atherosclerosis group,single branch lesion group,double branch lesion group and three branch lesion group（ P〈0.05 or P〈0.01）,the FMD in coronary atherosclerosis group was respectively higher than that in double branch lesion group and three branch lesion group（ all P〈0.01）,the FMD in single branch lesion group was higher than that in three branch lesion group（ P〈0.05）. Logistic regression analysis indicated that the FMD was an independent predictor of CHD（ OR = 0.182,95%CI was 0.068 ~ 0.487,P〈0.01）. ROC curve analysis showed that FMD≤6.05% was the best cut-off value for predicting CHD,and the sensitivity was 91.1%,the specificity was 80.4%,positive predictive value was 87.8% and the negative predictive value was 85.4%. Conclusion The FMD can better reflect the degree of coronary artery lesions and has a good predictive value for the diagnosis of coronary heart disease.

关 键 词：冠状动脉病变 肱动脉血流介导的内皮依赖性舒张功能 预测价值 

分 类 号：R543.3[医药卫生—心血管疾病]