CAJ | 학술논문

目的探讨射频超声技术定量检测颈动脉内中膜厚度及弹性对评价冠状动脉粥样硬化性心脏病（简称冠心病）患者冠状动脉病变程度的诊断价值。方法选择2011年2月至2012年6月在第四军医大学唐都医院心内科住院的疑诊冠心病患者142例，根据冠状动脉造影结果分为4组：非冠心病组35例；冠状动脉存在粥样硬化但狭窄率＜50%且无血流动力学改变者33例为冠状动脉粥样硬化组；仅1支血管病变，且血管狭窄率≥50%者36例为单支病变组；2支及2支以上主要血管病变，且血管狭窄率≥50%者38例为多支病变组。测量左颈总动脉内中膜厚度（LIMT）及血管弹性指标，包括左颈总动脉脉搏波传导速度（LPWV）和硬度指数（Lβ）。应用受试者操作特性（ROC）曲线计算并比较左颈总动脉弹性参数诊断不同程度冠心病的曲线下面积及截断值、敏感度、特异度、约登指数。结果4组患者LIMT、LPWV及Lβ间差异均有统计学意义（F=3.621、4.769、4.756， P均＜0.05）。各参数ROC曲线下面积的最大值均出现在多支病变组，分别为0.759（LIMT）、0.770（LPWV）、0.764（Lβ）。左颈总动脉内中膜厚度的约登指数最大值出现在冠状动脉粥样硬化组，为0.513；左颈总动脉脉搏波传导速度及硬度指数的约登指数最大值均出现在多支病变组，为0.524和0.469。LIMT、LPWV和Lβ诊断冠心病多支病变的敏感度分别为71.0%、77.4%、71.0%，特异度分别为73.4%、74.7%、75.9%。结论颈总动脉血管各参数对冠心病多支病变患者的诊断效能最高，其中弹性指标LPWV、Lβ较LIMT具有更高的诊断预测价值。
목적탐토사빈초성기술정량검측경동맥내중막후도급탄성대평개관상동맥죽양경화성심장병（간칭관심병）환자관상동맥병변정도적진단개치。방법선택2011년2월지2012년6월재제사군의대학당도의원심내과주원적의진관심병환자142례，근거관상동맥조영결과분위4조：비관심병조35례；관상동맥존재죽양경화단협착솔＜50%차무혈류동역학개변자33례위관상동맥죽양경화조；부1지혈관병변，차혈관협착솔≥50%자36례위단지병변조；2지급2지이상주요혈관병변，차혈관협착솔≥50%자38례위다지병변조。측량좌경총동맥내중막후도（LIMT）급혈관탄성지표，포괄좌경총동맥맥박파전도속도（LPWV）화경도지수（Lβ）。응용수시자조작특성（ROC）곡선계산병비교좌경총동맥탄성삼수진단불동정도관심병적곡선하면적급절단치、민감도、특이도、약등지수。결과4조환자LIMT、LPWV급Lβ간차이균유통계학의의（F=3.621、4.769、4.756， P균＜0.05）。각삼수ROC곡선하면적적최대치균출현재다지병변조，분별위0.759（LIMT）、0.770（LPWV）、0.764（Lβ）。좌경총동맥내중막후도적약등지수최대치출현재관상동맥죽양경화조，위0.513；좌경총동맥맥박파전도속도급경도지수적약등지수최대치균출현재다지병변조，위0.524화0.469。LIMT、LPWV화Lβ진단관심병다지병변적민감도분별위71.0%、77.4%、71.0%，특이도분별위73.4%、74.7%、75.9%。결론경총동맥혈관각삼수대관심병다지병변환자적진단효능최고，기중탄성지표LPWV、Lβ교LIMT구유경고적진단예측개치。
Objective To explore the value of quantitative measurement of carotid intima-media thickness and elasticity for evaluating the degree of coronary heart disease by radio frequency ultrasonography. Methods From February 2011 to June 2012, a total of 142 subjects in cardiovascular internal medicine of the fourth military medical university Tangdu hospital with suspected CAD were enrolled in this study and were divided into non CAD group (n=35), atherosclerosis group in which coronary stenosis rate was less than 50%and no hemodynamic changes were detected (n=33), single artery involved group in which coronary stenosis rate was more than 50% (n=36) and multi-artery involved group in which coronary stenosis rate was more than 50%(n=38) based on the results of the coronary angiography (CAG). Measure the left common carotid artery intima-media thickness (IMT) and blood vessel elasticity index including the left common carotid artery pulse wave velocity (PWV) and stiffness index (β). Receiver operating characteristic (ROC) curves were used to calculate and compare the degrees of coronary heart disease, area under the curve of the left carotid artery elasticity parameters, cut-off value,sensitivity, speciifcity and Youden's index. Results LIMT, LPWV and Lβhad statistical signiifcance differences among four groups (F=3.621, 4.769 and 4.756, all P<0.05). The maximum values of parameter area under ROC curve were all observed in multi-artery involved groups and were 0.759 (LIMT), 0.770 (LPWV) and 0.764 (Lβ). The maximum value of Youden's index of the left common carotid artery intima-media thickness was observed in the coronary atherosclerosis group and was 0.513. The maximum value of Youden's index of the left common carotid artery pulse wave velocity and stiffnessβwere both observed in the multi-artery involved group and were 0.524 and 0.469. For diagnosing multivessel lesions, the sensitivities of LIMT, LPWV and Lβwere 71.0%, 77.4%and 71.0%, and the speciifcities were 73.4%, 74.7%and 75.9%. Conclusions The carotid elastic parameters have better predictive value for multivessel lesions. LPWV and Lβhave higher predictive value for coronary arterial disease than LIMT.