The Vascular Function Study Group; Division of Cardiology, Tufts Medical Center, Boston, Massachusetts 02111, USA.
Clin Cardiol. 2010 Feb;33(2):94-8. doi: 10.1002/clc.20705.
Coronary artery disease (CAD) risk is not fully revealed by traditional risk factors. Identification of a simple, noninvasive tool that allows for detection of high-risk CAD patients and can be applied in large populations and clinical settings would prove valuable.
We sought to test the hypothesis that peripheral arterial tonometry (PAT) would be associated with residual risk in men with CAD.
In this study, finger PAT was used to measure pulse wave amplitude (PWA) during reactive hyperemia (RH) and taken as a measure of microvascular endothelial function in 42 men with stable CAD and well controlled low-density lipoprotein cholesterol (LDL-C) levels. Plasma levels of high-sensitivity C-reactive protein (hs-CRP) and lipoprotein-associated phospholipase A2 (Lp-PLA(2)) were measured and used to reclassify men into high-risk (elevated hs-CRP and Lp-PLA(2)), moderate-risk (either elevated hs-CRP or Lp-PLA(2)), or low-risk (low hs-CRP and Lp-PLA(2)) groups.
PWA-RH was significantly lower in the high-risk group (1.3 +/- 0.04) compared to the moderate-risk (1.6 +/- 0.07, P < 0.05) and low-risk (2.0 +/- 0.1, P < 0.05) groups. According to binary logistic regression, PWA-RH was a significant predictor of high-risk status among men with CAD (P < 0.05).
Measurement of peripheral microvascular endothelial function with PAT may be able to distinguish high-risk men from moderate- and low-risk men with stable CAD and well-controlled LDL-C levels and thus aid in residual risk stratification in this at risk cohort.
冠心病（CAD）的风险不能完全通过传统的危险因素来揭示。如果能找到一种简单、无创的工具，不仅能检测出高危 CAD 患者，而且能在大人群和临床环境中应用，将具有重要价值。
我们试图验证这样一个假说，即外周动脉张力测定（PAT）与 CAD 男性患者的残余风险有关。
本研究采用指端 PAT 测量反应性充血（RH）期间的脉搏波幅度（PWA），作为 42 例稳定 CAD 且低密度脂蛋白胆固醇（LDL-C）水平控制良好的男性患者微血管内皮功能的指标。测量高敏 C 反应蛋白（hs-CRP）和脂蛋白相关磷脂酶 A2（Lp-PLA2）的血浆水平，并用于将男性患者重新分为高危（hs-CRP 和 Lp-PLA2 升高）、中危（hs-CRP 或 Lp-PLA2 升高）或低危（hs-CRP 和 Lp-PLA2 均低）组。
高危组（1.3±0.04）的 PWA-RH 显著低于中危组（1.6±0.07，P<0.05）和低危组（2.0±0.1，P<0.05）。根据二项逻辑回归分析，PWA-RH 是 CAD 男性患者高危状态的显著预测指标（P<0.05）。
PAT 测量外周微血管内皮功能可能能够区分稳定 CAD 且 LDL-C 水平得到良好控制的高危、中危和低危男性患者，从而有助于该高危人群的残余风险分层。
