| 摘要: |
| 目的 探讨颈动脉斑块积分和内中膜厚度对冠状动脉慢性完全闭塞（CTO）病变的预测价值。方法 选择在海军军医大学（第二军医大学）长海医院就诊、同时行颈动脉超声和首次冠状动脉血管造影检查的患者608例，根据冠状动脉血管造影结果将其分为CTO组（150例）和非CTO组（458例），比较两组患者的基线资料和颈动脉超声检查结果，并对冠状动脉CTO发生的危险因素进行单因素和多因素logistic回归分析。绘制ROC曲线分析颈动脉斑块积分、内中膜厚度及多个危险因素构成的综合预测变量对CTO的预测价值。结果 CTO组患者的年龄、男性比例、BMI、高血压病患者比例、血肌酐水平、颈动脉斑块检出率、两侧颈动脉斑块平均厚度、总斑块积分、平均内中膜厚度均高于非CTO组（P均<0.05）。多因素logistic回归分析结果显示，高龄、高BMI、高血肌酐水平、高总斑块积分及高平均内中膜厚度是CTO发生的独立危险因素（P均<0.05）。ROC曲线分析显示颈动脉总斑块积分、平均内中膜厚度及综合预测变量（年龄、BMI、血肌酐、总斑块积分、平均内中膜厚度的联合参数）的AUC值（95% CI）分别为0.676（0.637~0.713）、0.633（0.593~0.671）和0.738（0.701~0.772），综合预测变量的AUC值与总斑块积分、平均内中膜厚度相比差异均有统计学意义（P均<0.05）。结论 颈动脉总斑块积分和平均内中膜厚度对冠状动脉CTO有一定预测价值，综合年龄、BMI、血肌酐、总斑块积分、平均内中膜厚度的联合参数对CTO的预测效能优于两者单独的预测效能。 |
| 关键词: 颈动脉 超声检查 斑块积分 冠状动脉疾病 动脉闭塞性疾病 |
| DOI：10.16781/j.0258-879x.2021.04.0385 |
| 投稿时间：2020-10-25修订日期：2021-03-04 |
| 基金项目:上海市卫生和计划生育委员会优秀青年人才项目（2017YQ029）. |
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| Predictive value of carotid plaque score in patients with chronic total occlusion of coronary artery |
| XU Zhi-chao△,HOU Pan△,TANG Wen-dong,ZHU Ting-fang,MA Chao-qun,LI Pan,ZHAO Xian-xian* |
(Department of Cardiovasology, Changhai Hospital, Naval Medical University(Second Military Medical University), Shanghai 200433, China
△Co-first authors.
* Corresponding author) |
| Abstract: |
| Objective To investigate the predictive value of carotid plaque score and intima-media thickness (IMT) in patients with chronic total occlusion (CTO) of coronary artery. Methods A total of 608 patients who underwent carotid artery ultrasonography and the first coronary angiography in Changhai Hospital of Naval Medical University (Second Military Medical University) were divided into CTO group (150 cases) and non-CTO group (458 cases) according to the results of coronary angiography. Baseline data and carotid artery ultrasonography results were compared between the two groups, and the risk factors of coronary CTO were analyzed by univariate and multivariate logistic regression analyses. Receiver operating characteristic (ROC) curve was drawn to analyze the predictive values of carotid plaque score, IMT and comprehensive predictive variables composed of multiple risk factors for CTO. Results The age, proportion of male sex, body mass index (BMI), proportion of hypertension, serum creatinine level, detection rate of carotid plaque, mean thickness of bilateral carotid plaques, total plaque score and mean IMT in the CTO group were significantly higher than those in the non-CTO group (all P<0.05). Multivariate logistic regression analysis showed that older age, high BMI, high serum creatinine level, high total plaque score and high mean IMT were independent risk factors for CTO (all P<0.05). ROC curve analysis showed that the area under curve (AUC) values (95% confidence interval[CI]) of total plaque score, mean IMT and comprehensive predictive variables (combined parameters of age, BMI, serum creatinine level, total plaque score, and mean IMT) were 0.676 (0.637-0.713), 0.633 (0.593-0.671) and 0.738 (0.701-0.772), respectively. The AUC value of comprehensive predictive variable was significantly different from those of total plaque score and mean IMT (both P<0.05). Conclusion Carotid total plaque score and mean IMT have certain predictive value for coronary artery CTO. The combined parameter of age, BMI, serum creatinine, total plaque score and mean IMT is superior to the two alone in predicting CTO. |
| Key words: carotid arteries ultrasonography plaque score coronary artery disease arterial occlusive diseases |
