| BackgroundWith the improvement of people’s living standards, atherosclerosis, as a systemic disease, has caused widespread concern in the community, which mainly includes coronary heart disease, cerebrovascular disease, kidney disease, and the outer peripheral vascular disease. If you do not take effective measures, it will have a significant impact on the level of China’s population health. In recent years, the Western developed countries gradually reduce the occurrence of vascular disease by limiting fat intake, smoking cessation, taking lipid-lowering drugs and other measures. For instance, a United States’report which analyzed the causes of coronary heart disease death in1980-2000showed that:the mortality rate of the men’s coronary heart disease decreased from543to267per100,000people in the20years, and the women from263to134[1] However, the eating habits of high-salt, high-fat, high-sugar still continuing in our country. With the accelerated pace of life and the integration of urban and rural, the population whose main way of life is mental working still increases in our country. Sustained "three high" diet, long hours of desk work and lack of regular exercise will inevitably upregulate the incidence of atherosclerosis disease. Therefore, it will be an arduous task for doctors to prevent and control atherosclerosis.Atherosclerosis is the pathological basis of coronary heart disease and other cardiovascular and cerebrovascular disease. It is a lengthy and potential development process that lesions gradually accumulate in the blood vessel wall. Therefore, we have enough time and opportunities to identify this process in subclinical disease stages. Although the invasive vascular interventional technology has become the most direct and accurate method to diagnosis and treat coronary heart disease and other atherosclerotic disease, its clinical application still has some limitations to early atherosclerosis because of its invasive, hysteresis and high cost, inconvenient continuous observation and repeated follow-up. To use the indicators of peripheral atherosclerosis to evaluate and predict the coronary artery disease, has become the focus of medical research and application because of its non-invasive, easy to use, the standardized method and reproducible.In recent years, many scientists are long-term absorbed in the development and promotion of noninvasive atherosclerosis detection method and many non-invasive atherosclerosis detection methods appear in the world. Pulse wave velocity (PWV) is the first and most extensive application index to evaluate segmental arterial stiffness and is considered to be the gold standard for measuring arterial elasticity. The past studies have shown that there was a close relationship between the increase of arterial stiffness and the occurrence and development of atherosclerosis [2]. Ankle-brachial index (ABI), traditionally mainly as a screening indicator of peripheral arterial stenosis, the severity of the grading index and revascularization efficacy judgments, is the ratio of ankle blood pressure and upper arm blood pressure,which These indicators were followed with interest because of their safety, convenience sensitive, reliable, and good correlation with CHD. Ambulatory Arterial Stiffness Index (AASI) is an indicator to reflect the compliance of overall arterial. To some extent, it can reflect the extent of atherosclerosis [3] and predict the cardiovascular risk [4] Dyslipidemia is an important pathogenesis mechanism of atherosclerosis and small, dense low density lipoprotein (sLDL) is easy to induce the occurrence of atherosclerosis [5]. Atherogenic index of plasma (AIP) is positively correlated with sLDL particle diameter and can be used as an indirect indicator to reflect sLDL particle diameter, to evaluate the cardiovascular risk[6] and to estimate the degree of coronary atherosclerosis. Carotid intima-media thickness (cIMT) can reflect the scope and extent of atherosclerosis in a certain extent[8] and is the early mark of the atherosclerotic process. It has become a predictor of important indicators of therapy efficacy of lipid lowering to cardiovascular disease and a stratification factor to assess cardiovascular risk[9].Despite the variety of non-invasive arteriosclerosis detection methods can reflect the extent of atherosclerosis to a certain extent, their respective clinical value and the pros and cons of the diagnosis of coronary heart disease and other atherosclerotic disease is unclear, due to the crowd racial differences, the diversity of the types of atherosclerotic disease, complexity combined risk factors and their own limitations of non-invasive detection methods. The purpose of this study is to analysis of the relationship between the indexes and coronary atherosclerosis applying the combination of a variety of non-invasive atherosclerosis detection methods to the same study population, and to compare the value of these methods to detect the early coronary atherosclerosis and the value of the evaluation to the scope of coronary artery disease.Objective1. Combination of fully automated arteriosclerosis detector, ambulatory blood pressure meter, automatic biochemical analyzer, carotid color Doppler ultrasonic diagnostic equipment and other noninvasive atherosclerosis detection methods, we analysis relationship between the non-invasive detection indicators of baPWV, ABI, AASI, AIP, cIMT and the coronary atherosclerosis, and compare the evaluation value of early coronary atherosclerosis.2. To analysis the relationship between the non-invasive detection indicators of baPWV, ABI, AASI, AIP, IMT and the scope of coronary artery disease and compare the evaluation value of the scope severity of coronary artery disease.Subjects and Methods1. SubjectsWe selected190patients underwent coronary angiography (CAG) or percutaneous coronary intervention (PCI) in Department of Cardiology of Guangzhou General Hospital of Guangzhou Military Command from October in2011to June in2012. Those who suffer from aortic stenosis or regurgitation, aortic dissection or aortic aneurysm, peripheral arterial occlusion, myocarditis, severe cardiac dysfunction (NYHA Ⅲ-Ⅳ), severe liver and kidney disease, autoimmune diseases, blood diseases, severe infections were excluded.The general information of selected cases include:name, age, sex, smoking history, history of hypertension, history of diabetes confirmed. Patients were given the non-invasive atherosclerosis detection after relevant biochemical test. We can get the indicators of baPWV, ABI, AASI, AIP, cIMT. All selected cases were treated with coronary angiography or percutaneous coronary intervention and recorded the results.2. MethodsGroups:According to the results of coronary angiography, the subjects were divided into three groups:the coronary arteries without stenosis for the control group (29cases); coronary artery with mild stenosis group (coronary artery stenosis <50%,56cases); coronary heart disease (CHD) group (coronary stenosis≥50%,105 cases). CHD group was further divided into the single-vessel disease (35cases), the double vessel disease group (37cases), and three-vessel disease (including left main disease) group (33cases) according to the number of vessel disease.Detection methods:191patients enrolled, using fully automatic arteriosclerosis meter (Japan Colin production VP-1000) simultaneously records left and right side baPWV and ABI, whichever is greater at the final inspection as baPWV and ABI results. Ambulatory Blood Pressure detector (United States Space Lab production,90217) line24h ambulatory blood pressure monitoring. The election of the left brachial artery to measure24h ambulatory blood pressure monitoring during the day (8:00-22:00) measured every30minutes and the night (22:00-8:00)1h. The complete data using SPSS (19.0) statistical software was calculated to AASI. Using automatic biochemical detector (Germany Lee Pa production, XL-300type) detect all objects fasting12h blood, the application of enzymatic determination of TC, TG, HDL-C, LDL-C, and calculating AIP according to the AIP=log (TG/HDL-C). cIMT value were detected at the proximal end1cm to the carotid artery bifurcation by application of color Doppler ultrasonography (Germany Siemens Acuson Sequoia-512type).Statistical methods:All statistical analysis was performed with the solfware SPSS19.0. Data are expressed as the mean±SEM. Multiple comparisons were analyzed by the single-factor analysis of variance(One-way ANOVA), average number of pairwise comparisons using LSD test to homogeneity of variance, heterogeneity of variance using Dunnett T3test. Measurement data was shown by frequency and percentage, Comparison between groups used the X2test. The Spearman correlation analysis was used to analyze the correlation of the non-invasive arteriosclerosis indexs and the scope of coronary lesions. In all analyses,p<0.05was considered to indicate statistical significance. Results1. The relationship between the non-invasive detection indicators of baPWV, ABI, AASI, AIP, cIMT and the stenosis of coronary artery.Among the control group, coronary artery with mild stenosis group and coronary heart disease group, there was statistically significance between baPWV, ABI, AASI, AIP, cIMT each index (P<0.05). Compared with the control group and the coronary artery with mild stenosis group, baPWV, AASI, AIP and cIMT were significantly higher and ABI was significantly lower in the patients with coronary heart disease (P<0.05). In addition, compared with the control group, baPWV was significantly increased in coronary artery with mild stenosis group (P<0.05), but the difference was not statistically significant between baPWV, ABI, AASI, AIP and cIMT each index (P>0.05).2. The bivariation between the non-invasive detection indicators of baPWV, ABI, AASI, AIP, cIMT and the stenosis of coronary artery.Spearman rank correlation analysis showed that the baPWV, AASI, AIP, cIMT were positive correlation with the degree of coronary atherosclerosis (r=0.314, r=0.315, r=0.209, r=0.218, P<0.05). However, ABI was negative correlation with the degree of coronary atherosclerosis (r=-0.249, P<0.05).3. The relationship between the non-invasive detection indicators of baPWV, ABI, AASI, AIP, cIMT and the scope of coronary artery disease in patients with coronary heart disease.Among the single-vessel disease group, the double vessel disease group and three-vessel disease group, there was statistically significant between baPWV, AASI each index (P<0.05). Multiple comparisons:in the pairwise comparison of the single-vessel disease group, the double vessel disease group and three-vessel disease group, the differences of AASI were statistically significant (P<0.05). Compared with the single-vessel disease group, baPWV was significantly higher in three-vessel disease group and the double vessel disease group (P<0.05). However, baPWV was not significantly different between the double vessel disease group and three-vessel disease group (P>0.05).Conclusions1. Arteriosclerosis non-invasive indicators of baPWV, ABI, AASI, AIP, CIMT were associated with coronary artery stenosis, only baPWV was significantly different between the mild coronary stenosis group and the control group, baPWV may be an indicator to assess early coronary atherosclerosis.2. Arteriosclerosis non-invasive indicators of baPWV and AASI were significantly different among the different scope of coronary artery disease in patients with coronary heart disease, which may be good indicators to assess the scope of coronary assessment in patients with coronary heart disease. |
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