【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1 579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1 579例行冠脉造影患者中（男性：68.8%；年龄：63岁±11岁），冠心病患者1 204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。更多还原

【Abstract】 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 1 579 consecutive patients undergoing coronary angiography. Multivariate analysis and receiver operating characteristic curve(ROC)were used to evaluate the predictive 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 1 579 patients undergoing coronary angiography [male:68.8%;aged(63±11)years],1 204(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.更多还原