| Objective: to explore the relationship between Framingham score(FRS),lipid level,noninvasive atherosclerosis index,carotid intima-media thickness(CIMT),carotid artery plaque and coronary artery disease.And study the predictive value of these indicators for coronary artery disease.Methods: 333 patients who underwent selective coronary angiography were included in the study.By reviewing the case data,the demographic profiles,blood lipid level,carotid ultrasound results,non-invasive atherosclerosis indicators and other data of the patients were obtained.FRS was calculated by combining age,gender,smoking,hypertension,High density lipoprotein(HDL)and Total cholesterol(TC).According to the results of angiography,the severity of coronary artery lesions was assessed by Gensini score,and the patients were divided into normal coronary artery group(n=101)and coronary artery disease group(n=232),and the differences in various indicators between the groups were compared.SPSS22 was used for data analysis,and the regression equation was established with the coronary artery lesions as the response variable,FRS and the selected indicators as independent variables.A scoring system was established according to the OR value of the included indexes,and the total score was used as the combined index to predict coronary artery lesions.Another 19 cases of selective coronary angiography were selected to verify the predictive value of the combined index.Results: 1)correlation analysis of each index with Gensini score: Gensini score was positively correlated with FRS,apolipoprotein B/apolipoprotein A1(ApoB/A1),total triglyceride(TG),brachial ankle pulse wave velocity(BaPWV),arterial stiffness index(ASI),interventricular septum thickness(IVST),CIMT,carotid artery plaques,and diabetes,while negatively correlated with ankle arm index(ABI),large artery elasticity index(C1)and small artery elasticity index(C2).2)Binary logistic regression analysis results: Coronary lesion as dependent variable,forward stepwise method is used to screen the independent variables.The final regression equation is: Log(P)= 0.846 + 0.812(plaque,yes = 1,no = 0)+ 1.332(diabetes,yes = 1,no = 0)+ 0.688(FRS,greater than 13.5 = 1,otherwise = 0)+ 0.852(ApoB/A1,greater than 0.746 = 1,otherwise = 0)+ 0.787(ABI,greater than 1.025 = 0,otherwise = 1)+ 0.764(CIMT,greater than 0.95 = 1,otherwise = 0).Hosmer-lemeshow was used to test the goodness of fit of the equation,chi-square =3.368,significance 0.849 > 0.05,indicating that the equation was well fitted.3)ApoB/A1 > 0.746(OR: 2.343,95%CI: 1.171-4.688)ABI 1.025(OR: 2.197,95% CI: 1.062-4.545,P: 0.016),carotid plaque formation(OR: 2.252,95% CI: 1.310-3.871,P: 0.003),CIMT > 0.95(OR: 2.148,95% CI: 1.191-3.872,P: 0.011),FRS > 13.5(OR:Diabetes mellitus(OR: 3.790,95% CI: 1.683-8.537,P: 0.001)were independent risk factors for coronary artery disease.4)ROC curves of ApoB/A1,ABI,CIMT and FRS in predicting coronary artery diseases were analyzed respectively,and the intercept values corresponding to the maximum values of the youden index were 0.746,1.025,0.95 and 13.5,respectively.The sensitivity was 33.6%,27.2%,50.9%,76.3%,and the specificity was 86.1%,88.1%,77.2%,and 53.5%,respectively.5)establishment of scoring system: ApoB/A1 > 0.746,ABI 1.025,carotid plaque formation,CIMT > 0.95,FRS > 13.5 were scored as 2 points,while diabetes was scored as 4 points.Total score was used as the combined index to predict coronary artery disease,with the optimal cut-off value of 5 points,sensitivity of 72.8% and specificity of 60.4%.The diagnostic value of the total score in predicting coronary artery disease was tested in 19 patients.By comparing with the gold standard of coronary heart disease,the coronary angiography,the sensitivity of the total score in diagnosing coronary artery disease was 72.73%,the specificity was 75%,the diagnostic accuracy was 73.68%,the positive likelihood ratio was 2.91,the negative likelihood ratio was 0.36,and the Kappa value of consistency test was 0.469 > 0.4,P: 0.04,indicating a high diagnostic value.Conclusions: The severity of coronary artery lesions was positively correlated with FRS,ApoB/A1,TC,BaPWV,ASI,IVST,IMT,plaque,and diabetes,but negatively correlated with ABI,C1,and C2.Indicators such as ApoB/A1,ABI,carotid plaque,CIMT,FRS and diabetes are independent predictors of coronary artery disease,which have certain predictive value for coronary artery disease.Among them,indexes such as ApoB/A1,ABI and CIMT have high specificity but low sensitivity,whereas FRS has high sensitivity but low specificity in predicting coronary artery lesions.Combined with the above indicators,it is helpful to improve the prediction ability of FRS for individual coronary artery lesions and improve its specificity.In this study,we found that in groups with no significant difference in LDL levels,ApoB/A1 was still positively correlated with the severity of coronary artery disease and could still serve as an independent predictor of coronary artery disease.Therefore,ApoB/A1 may serve as a predictor of residual coronary heart disease risk after LDL treatment reaching the standard. |
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