中国全科医学 ›› 2023, Vol. 26 ›› Issue (14): 1726-1732.DOI: 10.12114/j.issn.1007-9572.2022.0830

• 论著 • 上一篇    下一篇

踝肱指数和肱踝动脉脉搏波速度与血管舒张功能联合载脂蛋白B与载脂蛋白A-1比值对中青年冠心病血瘀证的预测价值研究

陈颖1, 王子涵1, 薛崇祥1, 陶诗怡1, 孙梓宜1, 黄力2,*()   

  1. 1.100029 北京市,北京中医药大学中日友好临床医学院
    2.100029 北京市,中日友好医院中西医结合心脏内科
  • 收稿日期:2022-10-08 修回日期:2023-01-10 出版日期:2023-05-15 发布日期:2023-01-18
  • 通讯作者: 黄力

  • 作者贡献:陈颖提出研究选题方向,负责临床病例资料的收集和整理,撰写论文初稿;王子涵协助临床数据收集、图表制作及数据核对;薛崇祥负责论文的梳理及修订;陶诗怡、孙梓宜协助论文图表制作;黄力负责论文设计指导、质量控制及审校,对文章整体负责。所有作者确认了论文的最终稿。
  • 基金资助:
    国家重点研发计划项目--心衰气虚证的辨证标准研究(2017YFC1700102); 国家重点研发计划项目--气虚证辨证标准的系统研究(2017YFC1700100)

The Predictive Value of Ankle Brachial Index, Brachial-ankle Pulse Wave Velocity, Flow-mediated Dilation Combined with Apolipoprotein B to Apolipoprotein A-1 Ration on Coronary Heart Disease with Blood Stasis Syndrome in Middle-aged and Young Adults

CHEN Ying1, WANG Zihan1, XUE Chongxiang1, TAO Shiyi1, SUN Ziyi1, HUANG Li2,*()   

  1. 1. China-Japan Friendship Clinical Medical College, Beijing University of Chinese Medicine, Beijing 100029, China
    2. Department of Integrative Cardiology, China-Japan Friendship Hospital, Beijing 100029, China
  • Received:2022-10-08 Revised:2023-01-10 Published:2023-05-15 Online:2023-01-18
  • Contact: HUANG Li

摘要: 背景 冠心病属中医"胸痹心痛"范畴,其证候分布以血瘀证最为多见,与老年人相比,中青年血瘀证的发生率更高。本研究在团队前期研究基础上进行拓展,首次运用动脉弹性和血管内皮功能检测联合载脂蛋白比值诊断中青年冠心病血瘀证,旨在为早期发现中青年冠心病血瘀证提供新思路,也可为优化补充冠心病血瘀证的诊断标准提供参考。 目的 探讨踝肱指数(ABI)、肱踝动脉脉搏波速度(baPWV)、血管舒张功能(FMD)联合载脂蛋白B与载脂蛋白A-1比值(apoB/apoA-1)与中青年冠心病血瘀证的关系及其预测价值。 方法 选取2016年12月至2021年12月于中日友好医院中西医结合心脏内科住院治疗的中青年(<50岁)冠心病患者,并根据《冠心病血瘀证诊断标准》分为血瘀证组和非血瘀证组。收集患者首次冠状动脉造影前的ABI、baPWV、FMD和apoB/apoA-1等临床资料。采用多因素Logistic回归分析构建中青年冠心病患者血瘀证的预测模型,并采用受试者工作特征(ROC)曲线进行预测价值评价。 结果 本研究共纳入中青年冠心病患者206例,其中血瘀证组127例,非血瘀证组79例。多因素Logistic回归分析结果显示,ABI、baPWV、FMD、apoB/apoA-1是中青年冠心病血瘀证的影响因素(P<0.05),预测模型方程P=1/[1+e-(5.519-0.599×ABI+0.297×baPWV -0.515×FMD+0.172×apoB/apoA-1)]。ROC曲线分析结果显示,ABI、baPWV、FMD、apoB/apoA-1和预测模型预测中青年冠心病血瘀证的ROC曲线下面积(AUC)分别为0.647、0.676、0.680、0.606和0.807(P<0.001),且预测模型预测中青年冠心病血瘀证的灵敏度为0.740,特异度为0.734。 结论 ABI、baPWV、FMD和apoB/apoA-1是中青年冠心病血瘀证的独立影响因素,且预测模型预测中青年冠心病血瘀证价值较高,可为临床早期识别中青年冠心病血瘀证患者提供依据。

关键词: 冠心病, 中青年, 血瘀证, 载脂蛋白B与载脂蛋白A-1比值, 动脉弹性, 血管内皮功能, 预测价值

Abstract:

Background

Coronary heart disease (CHD) belongs to the category of "pectoral stuffiness and pains" in traditional Chinese medicine (TCM) . Blood stasis syndrome is the most common syndrome distribution and the incidence of that in middle-aged and young adults is higher than old adults. Expending on the previous team study, the artery stiffness, vascular endothelial function and apolipoprotein ration were combined for the diagnosis of CHD with blood stasis syndrome in middle-aged and young adults for the first time in the study, in order to provide new approaches for the early detection and reference for optimising diagnostic criteria of CHD with blood stasis syndrome in middle-aged and young adults.

Objective

To investigate the correlation between ankle brachial index (ABI) , brachial-ankle pulse wave velocity (baPWV) , flow-mediated dilation (FMD) , apolipoprotein B to apolipoprotein A-1 ratio (apoB/apoA-1) and CHD with blood stasis syndrome in middle-aged and young adults (<50 years old) and their diagnostic predictive value, respectively.

Methods

Middle-aged and young patients with CHD hospitalized in the Department of Integrative Cardiology of China-Japan Friendship Hospital from December 2016 to December 2021 were selected as the objects and divided into blood stasis syndrome group and non-blood stasis syndrome group according to Diagnostic Criteria of Blood Stasis Syndrome of Coronary Heart Disease. Clinical data such as ABI, baPWV, FMD and apoB/apoA-1 were collected before the first coronary angiography (CAG) was collected. Multivariate Logistic regression analysis was used to construct a predictive model for CHD with blood stasis syndrome in middle-aged and young adults. Receiver operator characteristic (ROC) curve was used to evaluate the accuracy of the prediction model.

Results

A total of 206 middle-aged and young patients of CHD with blood stasis syndrome were included in this study, including 127 cases in the blood stasis syndrome group and 79 cases in the non-blood stasis syndrome group. The results of multivariate Logistic regression analysis showed that ABI, baPWV, FMD, apoB/apoA-1 are the influencing factors of CHD with blood stasis syndrome in middle-aged and young adults (P<0.05) . The predictive model equation was P=1/ [1+e- (5.519-0.599×ABI+0.297×baPWV-0.515×FMD+0.172×apoB/apoA-1) ] . The area under the curve (AUC) for ABI, baPWV, FMD, apoB/apoA-1 and predictive model were 0.647, 0.676, 0.680, 0.606 and 0.807, the sensitivity and specificity of the predictive model were 0.740 and 0.734, respectively.

Conclusion

ABI, baPWV, FMD and apoB/apoA-1 are independent influencing factors of the CHD with blood stasis syndrome in middle-aged and young adults. The combination of the four factors is of high value in predicting CHD with blood stasis syndrome, providing reference for the early detection of these patients.

Key words: Coronary heart disease, Young and middle-age, Blood stasis syndrome, apoB/apoA-1, Arterial elasticity, Vascular endothelial function, Predictive value