超高频超声测量动脉内膜厚度联合MHR预测早发冠心病患者冠状动脉狭窄严重程度的价值  

Value of ultra high-frequency ultrasound measurement of artery intima thickness combined with monocyte to high-density lipoprotein cholesterol ratio in predicting the severity of coronary artery stenosis in premature coronary artery disease

作　　者：徐晨靖 袁建军[2] 王丽霞[3] 楚英杰 张喜君[2] 吴铭 郭艳艳 余海歌 朱好辉[2] Xu Chenjing;Yuan Jianjun;Wang Lixia;Chu Yingjie;Zhang Xijun;Wu Ming;Guo Yanyan;Yu Haige;Zhu Haohui(Department of Ultrasound,People's Hospital of Zhengzhou University,Zhengzhou 450003,China;Department of Ultrasound,Henan Provincial People's Hospital,Zhengshou 450003,China;Department of Cardiology,Henan Provincial People's Hospital,Zhengzhou 450003,China)

机构地区：[1]郑州大学人民医院超声科,郑州450003 [2]河南省人民医院超声科,郑州450003 [3]河南省人民医院心内科,郑州450003

出　　处：《中华超声影像学杂志》2025年第2期114-121,共8页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金(82171963,82371980);2021年度河南省卫生健康中青年学科带头人培育项目;河南省科技攻关项目(222102310053);2024年度河南省医学科技攻关计划联合共建项目(LHGJ20240037)。

摘　　要：目的探讨颈动脉、桡动脉及足背动脉内膜厚度(CIT、RIT、PIT)联合单核细胞与高密度脂蛋白胆固醇比值(MHR)预测早发冠心病(PCAD)患者冠状动脉狭窄严重程度的价值。方法前瞻性连续纳入2023年10月至2024年5月在河南省人民医院就诊的PCAD患者80例,根据Gensini评分结果行中位数二分法分为高分组(≥41分,40例)和低分组(<41分,40例)。选取同期性别、年龄、体质指数(BMI)相匹配的34例健康志愿者作为对照组。使用24 MHz超高频超声分别测量研究对象CIT、RIT、PIT和颈、桡及足背动脉的中膜和内中膜厚度(CMT、RMT、PMT、CIMT、RIMT、PIMT),计算内膜与中膜厚度比值(CIT/CMT、RIT/RMT、PIT/PMT)。比较三组间一般临床资料、实验室指标及各超声参数的差异。通过二元Logistic回归分析探讨影响PCAD患者冠状动脉狭窄严重程度的危险因素。绘制ROC曲线并计算曲线下面积(AUC),评价MHR及各动脉内膜厚度独立与联合预测PCAD患者冠状动脉狭窄严重程度的价值。结果①三组间年龄、性别、BMI、总胆固醇、CMT、RMT及PMT比较差异无统计学意义(均P>0.05);低分组与高分组间吸烟史、高血压史、糖尿病史、收缩压、舒张压、低密度脂蛋白胆固醇、总胆固醇、三酰甘油比较差异无统计学意义(均P>0.05)。②与对照组比较,低分组与高分组MHR、CIT、CIMT、CIT/CMT、RIT、RIMT、RIT/RMT、PIT、PIMT、PIT/PMT增高(均P<0.05);高分组上述参数高于低分组,差异有统计学意义(均P<0.05)。③MHR、CIT、RIT、PIT单独预测PCAD患者冠状动脉狭窄严重程度的AUC值分别为0.781、0.767、0.780、0.722;四组参数联合诊断效能优于各参数独立诊断效能(AUC=0.885)。结论高分组PCAD患者CIT、RIT、PIT较低分组增厚,动脉内膜厚度联合MHR预测PCAD患者冠状动脉狭窄严重程度具有良好的诊断效能。Objective:To investigate the value of carotid,radial and podalic artery intima thickness(CIT,RIT,PIT)combined with monocyte to high-density lipoprotein ratio(MHR)in predicting the severity of coronary artery stenosis in patients with premature coronary artery disease(PCAD).Methods:A total of 80 patients with PCAD who received treatment in Henan Provincial People's Hospital from October 2023 to May 2024 were prospectively recruited,and they were divided into high group(≥41 score,40 cases)and low group(<41 score,40 cases)according to the median dichotomy of Gensini score.Thirty-four gender,age and body mass index(BMI)-matched healthy volunteers were selected as the control group.The CIT,RIT,PIT,media and intima media thickness of carotid,radial artery and podalic artery(CMT,RMT,PMT,CIMT,RIMT,PIMT)were measured using 24 MHz ultra-high frequency ultrasound probe,and the ratio of intima to media thickness(CIT/CMT,RIT/RMT,PIT/PMT)was calculated.The differences of general clinical data,laboratory indexes and ultrasonic parameters among the three groups were compared.Risk factors affecting the severity of coronary stenosis in PCAD patients were explored by binary logistic regression.Subject working characteristic curves were plotted,area under the curve(AUC)was calculated,and the values of each ultrasound parameter and MHR in the independent and combined diagnosis of the severity of coronary artery stenosis in PCAD patients were evaluated.Results:①There were no statistically significant differences in age,gender,BMI,total cholesterol,CMT,RMT and PMT among the three groups(all P>0.05).There were no statistically significant differences in the comparison of smoking,hypertension,diabetes mellitus,systolic blood pressure,diastolic blood pressure,low-density lipoprotein cholesterol,total cholesterol,and triglycerides between the two subgroups of the PCAD(all P>0.05).②CIT,CIMT,CIT/CMT,RIT,RIMT,RIT/RMT,PIT,PIMT,PIT/PMT were thickened in the high group compared with the low group,and MHR was higher than in the low group(al

关 键 词：超高频超声 早发冠心病 动脉内膜厚度 单核细胞与高密度脂蛋白胆固醇比值 冠状动脉狭窄程度 

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