张英，刘健，王伟民，李琪，刘传芬，马玉良，卢明瑜，赵红



NVDA评分对预测冠状动脉临界病变最小管腔面积价值的研究

张英*，刘健，王伟民，李琪，刘传芬，马玉良，卢明瑜，赵红

摘要

关键词冠状动脉疾病；临界病变；超声检查，介入性；评分

作者单位：100044 北京市，北京大学人民医院 心内科

*现工作于承德医学院附属医院 心脏内科**Now work at Affiliated Hospital of Chengde Medical College,Chengde(067000),Hebei,China

Predictive Value of NVDA Score on Minimum Lumen Area in Patients With Coronary Artery Intermediate Lesions

ZHANG Ying**,LIU Jian,WANG Wei-min,LI Qi,LIU Chuan-fen,MA Yu-liang,LU Ming-yu,ZHAO Hong.
Department of Cardiology,Peking University People’s Hospital,Beijing(100044),China
Corresponding Author:LIU Jian,Email:drjianliu@163.com

Abstract

Objective:Based on scores by number of vessels diseased and age(NVDA),the minimum lumen area(MLA)of left anterior descending(LAD)proximal or middle intermediate lesions were examined by intravascular ultrasound(IVUS)to analyze the clinical characteristics,to find the factors affecting lumen area and to establish a scoring system for predicting MLA in relevant patients.

Methods:A total of 90 patients were enrolled including 58 male and 32 female with the age of(41-77)years.The demographic information,medical history and laboratory results were studied by simple linear regression analysis to screen relevant factors affecting MLA;multi regression analysis was conducted to establish a regression equation for predicting MLA and to calculate the risk factor coefficient for obtaining relevant scoring system.

Results:NVDA score≤4 was defined as negative result with speculated MLA≥3.0mm2,while NVDA score>4 was defined as positive result with speculated MLA<3.0mm2.The sensitivity,specificity and negative predictive value of NVDA scoring system for predicting MLA were 83.35%,75% and 90% respectively.

Conclusion:NVDA scoring system had the better accuracy,sensitivity and specificity for predicting MLA in coronary artery intermediate lesions,it had certain value for guiding coronary interventional therapy in relevant patients.

Key words Coronary artery disease;Intermediate lesions;Echocardiography,interventional;Score

(Chinese Circulation Journal,2016,31:240.)

冠状动脉造影将血管直径狭窄程度为40%～70%的病变称为临界病变[1]，心肌是否存在缺血与血管狭窄程度、侧支循环建立与开放情况、病变血管支配心肌范围、坏死心肌数量等多种因素相关。目前，对于冠状动脉临界病变的介入治疗策略的制定仍存在争议。血管内超声（IVUS）可以直接测定管腔面积及斑块负荷等定量指标，为冠状动脉介入治疗的策略选择提供了重要依据[2]，现阶段因卫生资源有限及医疗技术发展限制，我国尚不能于所有医疗机构内广泛开展此项技术。本研究按照病变血管数量及年龄进行评分（number of vessels diseased and age，简称NVDA危险评分），探讨基于IVUS检查的临界血管病变相关因素的分析，了解影响或预测血管最小管腔面积的因素，建立相关因素评分体系，用于更方便、经济的指导冠状动脉介入治疗策略的制定。

1　资料与方法

研究对象：选取2008-11至2014-04在北京大学人民医院心内科住院治疗，经冠状动脉造影检查提示前降支近段或中段存在临界病变，同时接受IVUS检查的患者共计90例，其中男性58例，女性32例，年龄41～77岁。排除标准：左主干病变、分叉病变、小血管病变（<2.5 mm）、血栓病变、严重钙化病变、支架再狭窄病变等情况。

冠状动脉造影：经桡动脉或股动脉途径，按标准Judkins法行冠状动脉造影检查。使……