| Objective:Coronary heart disease is one of the major diseases that threaten the health of human today.How to discover the early vascular changes as soon as possible,predict and interfere with the risk of CHD have attracted attention. Arteriosclerosis plays an important role in the onset of the diseases.And IR can help the development of arteriosclerosis.The abnormality of arterial elasticity is one characteristic of vascular changes in the occurrence and development of CHD.As non-invasive index of assessing the degree of artery stiffness and artery obstruct,the pulse wave velocity and the ankle-brachial index are causing the extensive attention.We measured blood insulin level and brachial-ankle pulse wave velocity and ankle-brachial index in patients with coronary artery disease and control subjects in order to prospectively evaluate the relationship of IR with baPWV and ABI and compare the applicability of ABI and baPWV to identify if associate IR with baPWV and ABI can be a simple non-invasive screening test for high risk group of CHD.At the same time,this study further to evaluate the sensitivity and specificity of baPWV and ABI with coronary angiography(CAG) as the reference standard in the assessment of CHD and to research the threshold value of baPWV and ABI screening test in predicting CHD.Methods:In the study,259 patients were selected in the department of cardiology in hospital from September,2007 to June,2008.According to coronary angiography the patients were divided into two groups:CHD group with 133 patients diagnosed by coronary angiography including 102 male and 31 female(63.11±10.86 years old ) and control group with 126 patients without CHD including 65 male and 61 female(57.23±11.85 years old ).All patients underwent ABI and baPWV by the VP1000 automatic arteriosclerosis arteriosclerosis measurement system,in addition to collection of sex and body mass index(BMI),etc.Every object of these groups is measured biochemical markers of blood respectively Triglyceride(TG), Total Cholesterol(TC),Low Density Lipoprotein(LDL),High Density Lipoprotein (HDL),Fasting Blood Glucose(FBG),Fasting Serum Insulin(FINS).Results:The differences of basic situation of control group and CHD group including age and sex are statistically significant.Triglyceride(TG),Total Cholesterol (TC),Low Density Lipoprotein(LDL),Fasting Blood Glucose(FBG),Body Mass Index(BMI) are higher in the CHD group than that in the group of normal adults (P＜0.05),FINS and baPWV are significantly higher in the CHD group than that in the group of normal adults(P＜0.001).There were sigficant difference in HOMA-IR and insulin sensitivity between two groups.From the characteristic of ROC curve,among of baPWV and ABI and IR,IR could predict CHD with highest sensitivity and specificity and Yuedden index.The best cut-off of baPWV(left) for predicting of CHD without IR was 1652.50cm/s,the best cut-off of baPWV(right) for predicting of CHD without IR was 1633cm/s;the best cut-off of ABI(left) for predicting of CHD with IR was 1.175,the best cut-off of ABI(right) for predicting of CHD with IR was 1.115;which respectively predicted the presence of CHD with the sensitivity of 82.7%,82.7%,63.8%,43.1%;the specificity of 67.6%,67.6%,46.7%,66.7%,the Yuedden index of 0.503,0.503,0.105,0.098.Conclusion:(1) A high brachial-ankle PWV and low ABI are markers of the presence of CHD in subjects at high risk of CHD.(2) There were increased level of blood insulin and decreased insulin sensitivity in patients with coronary artery disease.(3) The correlation of IR between PWV and ABI indicate IR play a valuable role in the atherosclerosis and CHD.(4) IR seems to be risk factor of CHD,PWV and ABI are predictor of atherosclerosis.Increased level of blood insulin together with high brachial-ankle PWV and low ABI are sensitive and effective indicators for evaluating the cardiovascular risk factors and predicting CHD. |
PDF Full Text Request