【作者】 王效浣； 高志凌； 李燕玲； 王博雯； 钟祥； 谢萍；

【Author】 WANG Xiao-huan;GAO Zhi-ling;LI Yan-ling;WANG Bo-wen;ZHONG Xiang;XIE ping;Cardiavascular Department,The People’s Hospital of Gansu Province;

【机构】 Cardiavascular Department,The People’s Hospital of Gansu Province；

【摘要】 目的研究肱动脉血流介导的血管舒张功能(FMD)和颈动脉内-中膜厚度(IMT)对绝经期后女性患者冠状动脉病变的预测和诊断价值。方法研究共纳入临床疑似冠心病的绝经期后女性患者(POST-MW)130例行冠状动脉造影术检查,存在冠状动脉狭窄≥50%列为冠心病组(CAD组),未达到标准的为正常组(NL组)。患者于术前24小时内应用高频超声对患者行FMD和IMT测定。结果冠状动脉造影结果示冠心病患者90例,正常组40例。POST-MW患者CAD组IMT明显高于NL组(P<0.05)。而POST-MW冠心病患者FMD较NL组患者降低(P<0.05)。FMD和IMT呈负相关(r=-0.29,P=0.0007)。多元回归分析表明FMD(OR:2.375,95%CI:1.717-3.285 p<0.0001)和IMT(OR:0.055,95%CI:0.009-0.352 p=0.0022)是冠心病的独立预测因素。ROC分析表明POST-MW(IMT≥0.9 mm)预测冠心病的敏感性67%和特异性72%阳性预测率(PPV)92%和阴性预测率(NPV)68%,FMD≤5.8%预测冠心病的敏感性82%和特异性85%,PPV84%和NPV49%。结论 FMD和IMT对绝经期后女性患者的冠状动脉病变有很强的预测价值。更多还原

【Abstract】 Objective To compare the predictive value of flow-mediated vasodilation(FMD) in the brachial artery(BA),endothelium-dependent vasodilatation,and intima media thickness(IMT) in the carotid artery for coronary artery disease(CAD) and to evaluate the diagnostic accuracy in post-menopausal women.Methods A total of130 consecutive patients with clinically suspected CAD underwent FMD in the BA as well as measurement of carotid artery IMT by using high-resolution ultrasound before coronary angiography.Results Ninty patients had significant CAD,and thirty patients showed no CAD(NL).FMD was significantly lower and IMT was significantly higher in patients with CAD compared with NL patients(FMD,3.7±3.0%vs.7.5±2.9%;IMT,1.1±0.2 mm vs.0.7±0.1 mm),there was a significant correlation between FMD and IMT(r=-0.29,P=0.0007).Mutiple logistic analysis revealed that only FMD(OR:2.375,95%CI:1.717-3.285,P<0.0001) and IMT(OR:0.055,95%CI:0.009-0.352,P=0.0022) are independent predictor for CVD.Analyzing the receiver operating characteristic curves we found that IMT values≥0.9 mm had 67%sensitivity,72%specificity,positive predictive value(PPV) 92%,and negative predictive value(NPV) 68%,FMD values≤5.8%had sensitivity 82%,specificity85%,PPV84%,and NPV 49%for the presence of signifi cant CAD.Conclusion In post-menopausal women,FMD and IMT could represent a surrogate diagnostic method for assessment of CAD更多还原