联合腹主动脉和颈动脉粥样硬化可提高冠心病的预测价值  

Combining abdominal aorta and carotid atherosclerosis can improve the predictive value of coronary artery disease

作　　者：于佳雪 李威[1] 周颖玲[1] 罗建方 刘媛[2] 董豪坚 YU Jia-xue;LI Wei;ZHOU Ying-ling;LUO Jian-fang;LIU Yuan;DONG Hao-jian(Jinwan Central Hospital of Zhuhai,Zhuhai Hospital of Guangdong Provincial People′s Hospital,Zhuhai,Guangdong 519041,China;Guangdong Cardiovascular Institude,Guangdong Provincial People′s Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China)

机构地区：[1]广东省人民医院珠海医院(珠海市金湾中心医院)心血管科,广东珠海519041 [2]广东省心血管病研究所广东省人民医院(广东省医学科学院)心内科血管病诊疗中心,广州510080

出　　处：《岭南心血管病杂志》2022年第1期7-11,36,共6页South China Journal of Cardiovascular Diseases

基　　金：广东省“登峰计划”科研专项(项目编号:DFJH201807)。

摘　　要：目的探讨腹主动脉粥样硬化和颈动脉粥样硬化对冠状动脉(冠脉)粥样硬化性心脏病(冠心病)和冠脉病变严重程度的预测价值。方法本研究前瞻性连续性入选2015年10月至2016年3月在广东省人民医院住院,行冠脉造影的患者1579例,同时行腹主动脉和颈动脉超声检查,通过腹主动脉斑块厚度、颈动脉斑块Crouse积分、颈动脉内中膜厚度(IMT)等指标,采用多因素分析和受试者工作特征曲线(receiver operating characteristic curve,ROC)评价腹主动脉粥样硬化和颈动脉粥样硬化对冠心病和冠脉病变严重程度的预测价值。结果在1579例行冠脉造影患者中(男性:68.8%;年龄:63岁±11岁),冠心病患者1204例(76.3%)。经多因素Logistic回归分析,腹主动脉斑块厚度(OR=1.20;95%CI=1.10~1.30;P<0.001)、颈动脉斑块Crouse积分(OR=1.29;95%CI=1.20~1.38;P<0.001)、颈动脉IMT(OR=3.42;95%CI=1.48~7.90;P=0.004)为冠心病的独立预测因素。经ROC曲线分析,联合采用腹主动脉粥样硬化和颈动脉粥样硬化指标可提升对冠心病的预测价值。根据冠脉病变支数分类,经有序多分类Logistic回归分析,腹主动脉斑块厚度、颈动脉斑块Crouse积分、颈动脉IMT为冠脉病变严重程度的独立预测因素。结论腹主动脉斑块厚度、颈动脉斑块Crouse积分、颈动脉IMT为冠心病和冠脉病变严重程度的独立预测因素。联合腹主动脉粥样硬化、颈动脉粥样硬化等指标可提高对冠心病的预测价值。Objectives To evaluate the predictive value of abdominal aortic atherosclerosis and carotid atherosclerosis for the prevalence and severity of coronary artery disease(CAD).Methods Between October 2015 to March 2016,a prospective study was conducted in the department of cardiology at Guangdong Provincial People′s Hospital.Ultrasound scanning of the abdominal aortas and carotid arteries were performed in 1579 consecutive patients undergoing coronary angiography.Multivariate analysis and receiver operating characteristic curve(ROC)were used to evaluate the predic⁃tive value of abdominal aortic plaque thickness,carotid plaque Crouse score and carotid intima-media thickness(IMT)for the prevalence and severity of CAD.Results Among 1579 patients undergoing coronary angiography[male:68.8%;aged(63±11)years],1204(76.3%)patients had CAD.In multivariate Logistic regression analysis,abdominal aortic plaque thickness(OR=1.20;95%CI:1.10-1.30;P<0.001),carotid plaque Crouse score(OR=1.29;95%CI:1.20-1.38;P<0.001)and carotid IMT(OR=3.42;95%CI:1.48-7.90;P=0.004)were independent predictors of the prevalence of CAD.According to ROC analysis,the combined use of abdominal aortic atherosclerosis and carotid atherosclerosis may improve the predictive value of CAD.In an ordinal Logistic regression model,abdominal aortic plaque thickness,carotid plaque Crouse score and carotid IMT were independent predictors of the severity of CAD according to the number of stenotic coronary vessels.Conclusions Abdominal aortic plaque thickness,carotid plaque Crouse score and carotid IMT were independent predictors of the prevalence and severity of CAD.The combined use of abdominal aortic atherosclerosis and carotid atherosclerosis may improve the predictive value of CAD.

关 键 词：腹主动脉粥样硬化 颈动脉粥样硬化 冠心病 预测因素 

分 类 号：R654.4[医药卫生—外科学]