Abstract: Background　At present，color Doppler ultrasound is the most direct and common method to diagnose atherosclerosis，but its popularization is limited by expensive equipment and technical conditions.Electrocardiogram ( ECG ) R wave-pulse wave velocity ( RWPWV ) can be obtained by ECG monitor, which can reflect the atherosclerosis.The operation is simple and economical.Objective　To investigate the diagnostic value and diagnostic threshold of RWPWV in carotid atherosclerosis.Methods　A total of 1 500 participants who took physical examination were selected by random sampling in Ganzhou Municipal Hospital from July 2016 to December 2018.A total of 986 participants were selected according to inclusion and exclusion criteria.The clinical history of the subjects was collected by interviews with trained personnel using standardized questionnaires.According to the results of color Doppler ultrasound, 675 cases were in the normal group and 311 cases in the carotid atherosclerosis group.The relationship between RWPWV and atherosclerosis was analyzed by binary Logistic regression model.The diagnostic value and diagnostic threshold of RWPWV were calculated by using receiver operating characteristic ( ROC ) curve based on the gold standard of color Doppler ultrasound results.Results　Age, systolic blood pressure ( SBP ), fasting blood sugar, total cholesterol, low density lipoprotein, homocysteine, fatty liver rate and RWPWV in carotid atherosclerosis group were higher than those in normal group ( P<0.05 )．Logistic regression analysis showed that RWPWV was the influencing factor of carotid atherosclerosis〔OR=8.403，95%CI（5.361，13.171），P<0.001〕.The diagnostic value of RWPWV for carotid atherosclerosis by ROC curve analysis showed that when RWPWV truncation value was 4.58 m/s, the sensitivity was 0.698, specificity was 0.637, Youden index was 0.335, area under the maximum ROC curve ( AUC ) was 0.717〔95%CI ( 0.683，0.751 )〕．Compared with the Kappa test ( AUC=0.500 ) , the difference was statistically significant ( P<0.001 )．Conclusion　The increase of RWPWV is a risk factor of carotid atherosclerosis, which has certain diagnostic value for carotid atherosclerosis; the best threshold value of RWPWV for carotid atherosclerosis is 4.58 m/s; RWPWV is a new method for screening carotid atherosclerosis, which is simple, economical and applicable, and worthy of clinical promotion.

Key words: Atherosclerosis, ECG R wave pulse wave velocity, Carotid atherosclerosis, Diagnostic threshold, Risk factors

摘要： 背景　彩色多普勒超声是目前诊断动脉粥样硬化最直接、普遍的方法，但因昂贵的仪器设备及技术条件受到一定的限制，通过心电监护仪获得心电R波-脉搏波传导速度（RWPWV），能反映动脉粥样硬化情况，且操作简单、经济实惠。目的　探讨RWPWV诊断颈动脉粥样硬化的价值及其诊断界值。方法　2016年7月—2018年12月在赣州市立医院体检人群中，采用随机抽样调查的方式抽取了1 500名参与者，根据纳入、排除标准共选出986名参与者作为研究对象。研究对象的临床病史由经过培训的人员采用标准化问卷进行访谈收集。根据彩色多普勒超声结果分为正常组675例、颈动脉粥样硬化组311例。利用二分类Logistic回归模型分析RWPWV与动脉粥样硬化的关系。以彩色多普勒超声结果为金标准时，利用受试者工作特征（ROC）曲线计算RWPWV的诊断价值及诊断界值。结果　颈动脉粥样硬化组年龄、收缩压（SBP）、空腹血糖、总胆固醇、低密度脂蛋白、同型半胱氨酸、脂肪肝患病率、RWPWV高于正常组（P<0.05）。二分类Logistic回归分析结果显示，RWPWV是颈动脉粥样硬化的影响因素〔OR=8.403，95%CI（5.361，13.171），P<0.001〕。ROC曲线显示，当RWPWV截断值取4.58 m/s时，灵敏度为0.698，特异度为0.637，约登指数为0.335，最大ROC曲线下面积（AUC）为0.717〔95%CI（0.683，0.751）〕，与机会一致性诊断（AUC=0.500）比较，差异有统计学意义（P<0.001）。结论　RWPWV升高是颈动脉粥样硬化的危险因素，对于颈动脉粥样硬化有一定的诊断价值；RWPWV诊断颈动脉粥样硬化的最佳界值为4.58 m/s；RWPWV作为筛查动脉粥样硬化的新方法，操作简单、经济、适用，值得临床推广。

关键词: 动脉粥样硬化, 心电R波-脉搏波传导速度, 颈动脉粥样硬化, 诊断界值, 危险因素