- 學位論文
高敏感度C-反應蛋白與頸動脈內膜中層厚度對於預測有意義冠狀動脈狹窄的效力
Validity of High Sensitivity C-Reactive Protein and Intimal Medial Thickness of Carotid Artery in predicting patients with significant Coronary Artery Disease
摘要
研究背景 : 在台灣動脈粥狀硬化症的發生率有增加的趨勢。大型的前瞻性 ( prospective study ) 研究証實高敏感度C-反應蛋白 ( high sensitivity C- reactive protein ) 對於未來心血管疾病產生及病人的預後是一個強力的預測指標。統計學及臨床研究證實白血球數目增加對日後的心血管事件是個獨立預測值。在診斷周邊血管疾病時 , 非侵入性檢查如測量頸動脈內膜中層厚度 ( intimal medial thickness of carotid artery ) 和踝臂指數 ( ankle brachial index ) 已被廣泛使用。但是它們和冠狀動脈疾病之間的關係並不明確。本研究的目的是對疑似冠狀動脈疾病的病人 評估其發炎指標如高敏感度C-反應蛋白 、 白血球數目、測量頸動脈內膜中層厚度和踝臂指數與冠狀動脈有意義狹窄之間的關係。 研究方法 : 從2004年11月1日到2005年4月30日之間在光田綜合醫院接受心導管手術檢查之疑似冠狀動脈疾病的病人連續選擇31 位無意義冠狀動脈狹窄以及 30 位冠狀動脈有意義狹窄的病人。全部的病人在心導管手術前皆接受血液檢查包括高敏感度C-反應蛋白 、白血球數目 、 飯前血糖 、 血脂檢查 、 非侵入性檢查如頸動脈內膜中層厚度 ( intimal medial thickness) 和踝臂指數 ( ankle brachial index ) 之測量。所有本次研究資料使用SPSS 10 version 的統計軟體來分析以及 Student ‘t’ test 檢定來比較兩組之間是否有統計學上的差異。在有意義冠狀動脈狹窄那一組頸動脈內膜中層厚度 ( IMT ) 、 高敏感度C-反應蛋白和其他變項之間用線性迴歸和多重線性迴歸來分析是否相關。P值 <0.05為統計學上有顯著。 結果 : 兩組病人之間的血脂指數、血糖、身體質量指數、年齡、危險因子、腰圍並沒有差異。但是在有意義冠狀動脈狹窄這一組的頸動脈內膜中層厚度 ( IMT ) (P-value = 0.025 ) 和高敏感度C-反應蛋白( P-value =0.046 ) 都較高並有統計學上的顯著。線性回歸分析頸動脈內膜中層厚度與年齡有顯著相關性 ( P-value=0.02 ) 。白血球數目的變化以及踝臂指數的變化與有意義的冠狀動脈狹窄之間不相關。 結論 : 在疑似有心血管疾病的病人未接受心導管手術檢查前 , 測量頸動脈內膜中層厚度及高敏感度C-反應蛋白可預測並且提高有意義冠狀動脈狹窄的診斷陽性率。另外我們又發現頸動脈內膜中層厚度跟病人的年齡有明顯相關。
並列摘要
Background : The incidence of atherosclerosis is increased in Taiwan 。 Large prospective trials have shown high sensitivity C-reactive protein ( hsCRP ) to be a strong predictor of future cardiovascular events and prognosis of the patients。Epidemiologic and clinical studies have shown leucocytosis to be an independent predictor of future cardiovascular events。 Measurement of carotid artery intimal medial thickness ( IMT ) and ankle brachial index ( ABI ) are widely used as non invasive modalities for evaluating peripheral arterial occlusive disease。 But the relationship of these with the diagnosis of coronary artery disease ( CAD ) are not well determined。 In the present study , we determine the relationship between significant coronary artery stenosis in stable coronary artery disease and each of hsCRP , white blood cell counts , carotid IMT and ABI measured before coronary angiography。 Methods : This prospective study enrolled the consecutive patients admitted to our hospital from 1st November 2004 to 30th April 2005 , who was clinically suspected coronary artery disease 。 31 patients without significant CAD and 30 patients with significant CAD were included。 All patients are received blood examination including hsCRP , white blood cell counts , lipid profile , fasting blood sugar, and non invasive investigation such as carotid IMT and ABI measurements。All data are analysed with SPSS 10 version。 Compare between two groups normally distributed continuous variables are used independent student “t” test。 Regression analysis was done between carotid IMT and hsCRP with other variables。 Result : The patients characteristics and parameter between two groups such as lipid profile , fasting blood sugar , body mass index , age , waist circumference , ankle brachial index and white blood cell counts did not show any statistically significant。 Only the carotid IMT and hsCRP show statistically significant ( P-value =0.025 and 0.046 respectively ) 。 With linear regression analysis carotid IMT also shows relationship with age ( P- value=0.02 )。 Conclusion : In patient with suspected coronary artery disease before coronary angiography , the measurement of intimal medial thickness of carotid artery and hsCRP can increase the positive diagnostic rate in significant coronary artery stenosis。 Carotid IMT which is also has relationship with age。