评价桡动脉反射波增强指数与冠心病及病变程度的关系Association of radial augmentation index with coronary heart disease
李学宇,赵威,郭丽君,高炜
摘要(Abstract)：
目的分析桡动脉反射波增强指数(radial augmentation index,rAI)与冠心病、冠脉病变严重程度的关系,探讨无创法检测桡动脉脉搏波增强指数的临床价值。方法于2009年2月至2009年4月间非连续性纳入150例接受冠状动脉造影检查的患者,年龄为(64.2±10.3)岁,其中男性101例。收集患者的一般及临床资料,并根据冠脉造影结果计算Gensini积分评价冠脉病变程度。应用基于平面压力测定原理的无创测量仪按照标准方法检测桡动脉脉搏波形获得rAI,并记录由仪器内置软件计算出的按照心率为75次标准化的rAI值(rAIP75),分析其与冠心病、冠脉病变严重程度的关系。结果冠心病组(119例)的rAIP75(80.42±11.33)%显著高于非冠心病组(31例)的rAIP75(74.65±13.96)%,P=0.017;Logistic回归分析示rAIP75与冠心病发病显著相关(OR=1.041,95%CI=1.005～1.079,P=0.026)。多元线性回归分析显示rAIP75与Gensini积分呈显著正相关,标准化偏回归系数0.363(95%CI0.684～1.713,P<0.001)。结论 rAIP75升高与冠心病发病及冠脉病变程度显著相关,提示动脉僵硬度一定程度上可反映冠脉粥样硬化的严重程度,可能成为冠心病及病变程度的无创评价指标之一。
关键词(KeyWords)： 反射波增强指数;冠心病;Gensini评分
基金项目(Foundation):
作者(Author): 李学宇,赵威,郭丽君,高炜
参考文献(References)：
- [1]O'Rourke MF.Arterial stiffness,systolic blood pressure,and logical treatment of arterial hypertension.Hypertension,1990,15:339-347.
- [2]O'Rourke MF,Mancia G.Arterial stiffness.J Hypertens,1999,17:1-4.
- [3]Kingwell BA,Waddell TK,Medley TL,et al.Large artery stiffness predicts ischemic threshold in patients with coronary artery disease.J Am Coll Cardiol,2002,40:773-779.
- [4]Munir S,Guilcher A,Kamalesh T,et al.Peripheral augmentation index defines the relationship between central and peripheral pulse pressure.Hypertension,2008,51:112-118.
- [5]Ghiadonil L,Penno G,Giannarelli C,et al.Metabolic syndrome and vascular alterations in normotensive subjects at risk of diabetes mellitus.Hypertension,2008,51:440-445.
- [6]Weber T,O'Rourke MF,Ammer M,et al.Arterial stiffness and arterial wave reflections are associated with systolic and diastolic function in patients with normal ejection fraction.Am J Hypertens,2008,21:1194-1202.
- [7]Doi M,Miyoshi T,Hirohata S,et al.Increased augmentation index of the radial pressure waveform in patients with paroxysmal atrial fibrillation.Cardiology,2009,113:138-145.
- [8]Gensini GG.A more meaningful scoring system for determining the severity of coronary heart disease.Am J Cardiol,1983,51:606-607.
- [9]Mancia G,De Backer G,Dominiczak A,et al.2007Guidelines for the management of arterial hypertension:The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension(ESH)and of the European Society of Cardiology(ESC).Eur Heart J,2007,28:1462-1536.
- [10]Sugawara J,Komine H,Hayashi K,et al.Agreement between carotid and radial augmentation index:does medication status affect the relation?Artery Res,2008,2:74-76.
- [11]Covic A,Haydar A.A,Bhamra-Ariza P,et al.Aortic pulse wave velocity and arterial wave reflections predict the extent and severity of coronary artery disease in chronic kidney disease patients.J Nephrol,2005,18:388-396.
- [12]Hope SA,Antonis P,Adam D,et al.Arterial pulse wave velocity but not augmentation index is associated with coronary artery disease extent and severity:implications for arterial transfer function applicability.J Hypertens,2007,25:2105-2109.
- [13]Weber T,Auer J,O'Rourke MF,et al.Arterial stiffness,wave reflections,and the risk of coronary artery disease.Circulation,2004,109:184-189.
- [14]Weber T,O'Rourke M.F,Lassnig E,et al.Pulse waveform characteristics predict cardiovascular events and mortality in patients undergoing coronary angiography.J Hypertens,2010,28:797-805.