| BACKGROUNDCoronary atherosclerotic heart disease(CAD)is usually referred to as "coronary heart disease".It mainly refers to coronary artery atherosclerosis(AS)changes,resulting in vascular lumen stenosis,obstruction,myocardial blood supply,oxygen shortage,serious illness and even lead to myocardial necrosis and other cardiac diseases.At present,there are many clinical diagnostic methods of CAD,among which dynamic electrocardiogram(AECG),echocardiography(UCG),multi-slice spiral CT(MDCT)and percutaneous coronary intervention(PCI)are widely used.It is concluded that AECG and MDCT have certain diagnostic value for CAD,but they are still not accurate enough;PCI,as the "gold standard" of CAD diagnosis,can make a definite diagnosis and help cardiologists restore the blood perfusion of damaged myocardium quickly and effectively.It is the first choice for diagnosis and treatment,but the operation is expensive,complicated and has a certain degree of wind.Risk,and the surgical results are closely related to the technical level of doctors,so the clinical application is limited,resulting in poor compliance with the treatment of grass-roots hospitals.UCG has many clinical applications in the diagnosis of CAD,mainly to detect aortic valve(AV),mitral valve and other left atrioventricular valvular calcification and left ventricular systolic and diastolic function,at the same time,because the above detection range of coronary artery lesions are indirect ultrasound manifestations,and there are many differences in patient conditions,operator skills,and so on.There are more controversies in previous studies.However,there are few studies on calcification at the aortic sinus junction(STJ),which is closest to the coronary artery opening and has similar hemodynamics.Many studies have shown that peripheral AS is closely related to the risk factors of CAD,[1].Among the peripheral arterial examination methods,color Doppler ultrasonography(CDUS)has gained more and more recognition because of its high repeatability,non-invasive,clear and low-cost development of most arteries.Among them,the predictive value of peripheral arteries such as carotid artery(CA),brachiocephalic bifurcation(BOBT),femoral artery and thoracic aorta to CAD has been studied by scholars and some clinical consensus has been reached.Among the influencing factors of CAD,age,sex,smoking history,hyperlipidemia,hypertension and diabetes mellitus are considered to be the main risk factors.Type 2 diabetes mellitus(T2DM)is considered to be the homologous disease of CAD.By examining the plaque of CA and BOBT in carotid artery,calcification of AV and STJ,and combining with the patient's T2DM history,the author illustrates the predictive value of multi-modality combined examination for CAD,and provides experience and basis for clinicians to diagnose and treat CAD.The above methods are simple,safe,reproducible and easy to accept.Objective To analyze the predictive value of blood glucose combined with CA,BOBT,AV and STJ in CAD.MethodsA retrospective analysis was made of 181 patients suspected of CAD in outpatient department of our hospital and Jiangsu People's Hospital from November 2014 to June 2018 who were admitted to Jiangsu People's Hospital for PCI.Among them,38 patients with suspected CAD in outpatient ECG and clinical signs were followed up and treated with PCI in Jiangsu People's Hospital.At the same time,the results of ultrasound examination in our hospital were retrospectively collected.143 patients with PCI in Jiangsu People's Hospital were randomly collected and their ultrasonographic data were retrospectively collected.At the same time,the basic clinical data such as age,smoking history,diabetes history,hypertension history and the results of blood lipid,blood pressure and blood sugar before operation were collected.The above examinations were completed within 1-2 weeks before the operation.All patients underwent PCI,which was performed in Jiangsu Provincial People's Hospital and was performed by physicians at or above the level of clinical experience.The diagnosis and evaluation of CAD were made according to the results of PCI,and the number of coronary artery lesions and Gensini score were calculated by the two international methods of diameter and Gensini score.According to the presence or absence of coronary artery lesions,group CAD(n=139)and non CAD group(n=42)were included.In CAD group,the patients were divided into single branch group(n = 32 cases)and multi-branch group(n = 107 cases)according to the number of lesions,and the patients were divided into low branch group(n = 52 cases)according to their Gensini score:<80,and>80 into high branch group(n = 87 cases).All patients were examined by two-dimensional ultrasound with CA and BOBT using Philips HD 11 and/or IU22 color Doppler ultrasound diagnostic apparatus.The intima-media thickness(IMT)was measured by measuring the vertical distance between the two parallel lines with lower echo and the outer membrane with high echo before and after CA and BOBT.The plaque was recorded as>1.5mm.The Crouse integral,the number of plaques and the IMT value of BOBT were calculated and recorded.Vivid 7 Dimension echocardiographic diagnostic instrument of GE company was used to examine the long axis of left ventricle and short axis of cardiac fundus.All data were processed by SPSS 20 software.Result:1.Comparison of basic dataThe proportion of male patients and the positive rate of T2DM in CAD group were higher than those in non-CAD group(P<0.05),but there was no significant difference in age,smoking history,hyperlipidemia and hypertension between the two groups(P>0.05),while the positive rate of T2DM in low-grade group and single-branch group was higher than that in high-grade group and multi-branch group,but there was no significant difference(P>0.05).The proportion of patients with T2DM in non-CAD group was lower than that in non-T2DM group(P<0.05);the proportion of patients with T2DM in high and multi-branch group was higher than that in non-T2DM group(P<0.05),and there was no significant difference between low and single-branch group(P<0.01).Significant difference(P>0.05).2.Comparison of test items in group CAD and non CAD groupThe Crouse score,number of plaques,IMT value of BOBT and positive rate of AVC and STJ calcification in CAD group were higher than those in non-CAD group(P<0.01).3.Comparison of different items in different Gensini scores and different branches.The positive rates of CA plaque Crouse score,plaque number,IMT value of BOBT and AV calcification in high group and multi-branch group were higher than those in low group and single-branch group(P<0.05),while the positive rates of STJ calcification in high group and multi-branch group were not significantly different from those in low group and single-branch group(P>0.05).4.Prediction efficiency of each item.The highest sensitivity,specificity,positive predictive value and negative predictive value of T2DM positive,CA,BOBT plaque and AV,STJ calcification were 92.8%and 97.6%for BOBT plaque,97.7%for STJ calcification and 69.7%for BOBT plaque respectively.The predicted values were 97.8%,21.4%,80.5%and 75%respectively.Conclusions The combined detection of T2DM positive,CA,BOBT plaque and calcification of AV and STJ can complement the deficiency of each single detection item and give full play to their respective advantages.STJ calcification predicted the high specificity of CAD,which confirmed its superiority in detection. |
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