老年冠状动脉粥样硬化性心脏病患者冠状动脉病变程度与无创中心动脉压的相关性研究

摘要

目的 探讨老年冠状动脉粥样硬化性心脏病(冠心病)患者冠状动脉病变程度与无创中心动脉压的相关性.方法 选取2013年4月至2015年4月北京大学第一医院老年冠心病住院患者102例,测量患者无创中心动脉压和肱动脉压.根据冠状动脉造影结果将患者分为单支病变组(34例)、双支病变组(36例)和多支病变组(32例);计算冠状动脉Gensini评分,根据Gensini评分将所有患者分为Gensini评分≤20分组(43例)、21 ～ 70分组(38例)、≥71分组(21例).观察无创中心动脉压与冠状动脉病变支数及冠状动脉Gensini评分的关系.结果 冠状动脉病变支数及Gensini评分各分组比较均显示,随着冠状动脉病变程度加重,无创中心动脉脉压增高[单支病变组:(65±15) mmHg(1mmHg =0.133 kPa),双支病变组(71±16) mmHg,多支病变组(77±17) mmHg;Gensini评分≤20分组:(61±14) mmHg、21 ～ 70分组:(70±16) mmHg、≥71分组:(77±16) mmHg],各组两两比较差异均有统计学意义(均P＜0.05).冠状动脉Gensini评分与无创中心动脉脉压呈正相关(r=0.567,P=0.001).Logistic回归分析显示:无创中心动脉脉压升高(比值比=1.196,95％置信区间:1.153 ～1.247,p=0.001)、糖尿病(比值比=1.175,95％置信区间:1.135～1.726,P=0.003)是冠心病多支病变的危险因素.结论 老年冠心病患者冠状动脉病变程度与无创中心动脉脉压呈正相关,无创中心动脉脉压升高是冠心病多支病变的危险因素.%Objective To explore the correlations between coronary artery disease and central aortic pressure measured by non-invasive method in elderly patients with coronary artery disease.Methods Totally 102 patients with suspected coronary artery disease (CAD) from April 2013 to April 2015 were enrolled.According to results of coronary angiography,the patients were divided into single vessel disease group (34 cases),double-vessel group (36 cases) and multi-vessel group (32 cases).The brachial.artery pressure was measured and the central aortic pressure was also measured by non-invasive method.The Gensini score was calculated and then the patients were divided into ≤20 scores group (43 eases),21-70 scores group (38 cases) and ≥71 scores group (21 cases).The correlations between non-invasive central aortic pressure with Gensini score,number of diseased coronary artery were analyzed.Results According to the number of diseased vessel and Gensini scores of coronary artery,the non-invasive central aortic pulse pressure increased with severity of coronary atherosclerotic lesion [single vessel disease group:(65 ± 15) mmHg,double-vessel group:(71 ± 16) mmHg,multi-vessel group:(77 ± 17) mmHg;Gensini scores ≤20 scores group:(61 ± 14) mmHg,21-70 scores group:(70 ± 16) mmHg,≥71 scores group:(77 ± 16) mmHg] (P ＜0.05).The non-invasive central pulse pressure was positively correlated with Gensini scores (r =0.567,P =0.001).Multivariable Logistic analysis showed that increased non-invasive central pulse pressure and diabetes were risk factors of multi-vessel lesions (odds ratio =1.196,1.175,95％ confidence interval:1.153-1.247,1.135-1.726,P =0.001,0.003).Conclusion Non-invasive central aortic pulse pressure is positively related to the severity of CAD;increased non-invasive central aortic pulse pressure is the risk factor of multi-coronary artery lesions.