基于桡动脉波形分析的心血管功能评估方法研究
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摘要
动脉硬化是心血管病的病理生理学基础,早期筛查并干预动脉硬化是心血管病预防的根本途径。基于波形分析(PWA)的血流动力学指标检测,是一种常用的无创心血管功能评估方法。国外针对该方法的研究起步较早,并已提出了一些经典的评估指标。其中,采用两点法测量的主动脉脉搏波速度(aoPWV)是动脉硬化评估的“金标准”,基于主动脉PWA获取的心内膜下心肌活力率(SEVR)被广泛用于评估心肌灌注功能。根据这些指标及其测量方法开发的检测仪器(例如法国的Complior、澳大利亚的SphygmoCor和日本的HEM9000AI),已进入大型医院作为心血管病诊断和疗效评估的工具。但是,这些仪器均存在价格昂贵、操作过程烦琐、且对操作技能要求较高等应用瓶颈,难以在大众健康领域中普及推广。因此,建立适用于群体普查和个体动态检测的动脉硬化检测方法和技术十分必要。为适应这一需求,本论文开展了基于桡动脉PWA的心血管功能评估方法研究,主要包括：
1.评估指标体系的构建
综合国内外本领域的研究现状与趋势,遵照生理意义明确、实用性强等原则,构建了兼顾动脉功能和心脏功能的评估指标体系,包括脉搏波传递时间(PTT)、aoPWV等动脉功能评估指标和心率(HR)、SEVR等心脏功能评估指标。所有评估指标均基于易于测量的桡动脉PWA获取,适用于大众健康领域的群体普查和个体动态检测。
2.关键指标的测量方法研究
围绕着评估指标体系中关键指标PTT、aoPWV和SEVR的测量方法,本论文开展了如下研究并取得一些成果,进一步丰富和发展了脉搏波传播理论。
(1)PTT测量方法研究
提出一种基于单点桡动脉波形分析的PTT测量方法。基于平面张力法采集桡动脉脉搏波,采用PWA识别波形的第一和第二收缩波峰,并以这两点之间的时间差评估PTT。以266位健康人群为研究对象,采用新方法的测量结果与年龄显著高度负相关。因此,该操作简单、易于获取的PTT可以用于评估动脉弹性功能。
(2) aoPWV测量方法研究
在PTT研究基础上,进一步建立基于桡动脉PWA的aoPWV测量方法。以肚脐为有效反射点的体表测量点,采用胸骨切迹到肚脐的长度与PTT的比值评估aoPWV。在46位健康的中青年对象中,采用该方法测量的aoPWV与Complior测量的颈股动脉脉搏波速度(cfPWV)显著高度相关,且没有明显差异,week-to-week实验显示了很好的短期重复性。该方法适用于中青年健康人群的动脉硬化早期筛查。
(3)基于桡动脉提取SEVR的可行性
针对231位健康人群和高血压患者,同步采集桡动脉和颈动脉波形,基于PWA分别提取桡动脉和颈动脉SEVR,并分析它们之间的关系。研究结果显示,两者显著高度相关,且具有一致的独立影响因素和随年龄变化的规律。这说明基于桡动脉提取的SEVR可以提供与从颈动脉获得的SEVR同样的信息。
3.原型检测系统的设计、实现与验证
根据以上研究中建立的新方法和新技术,设计并实现了原型检测系统,包括自助式心血管功能检测仪ⅡM-2010A和多功能信号采集分析仪。ⅡM-2010A基于平面张力法采集桡动脉脉搏波信号,采用测量的腕部血压对其标定获取压力波形,基于PWA识别压力波形的特征点,计算包括增长指数(AI)、SEVR和HR等在内的10项血流动力学指标,适合群体普查和个体动态检测的需求。多功能信号采集分析仪集四路脉搏波信号同步采集、四肢同步加压、1路心电和1路光电信号检测于一体,可根据实验的具体需要形成多种配置方案,为后续研究提供实验条件。
以57位健康志愿者为研究对象,将ⅡM-2010A与经典仪器(SphygmoCor和HEM-9000AI)的测量结果进行对比分析。研究结果显示,三款仪器测量的AI和SEVR显著高度相关,并均具有很好的短期测量重复性。因此,该仪器适用于动脉功能和心肌灌注功能评估,为动脉硬化的早期筛查提供了一种操作简单、价格低廉的解决方案。
Artery stiffness is the pathophysiological basis of cardiovascular disease. Early detection and intervention of artery stiffness, therefore, is the essential way to prevent cardiovascular disease. Determination of hemodynamic parameters using PWA is a commonly used method for assessing artery stiffness. The study on the method was started very early in foreign countries and several representative indicators for assessing cardiovascular function have been proposed. For example, aoPWV obtained by two-site measurement is a gold standard of arterial stiffness, and SEVR derived from central pressure is widely accepted as a means of myocardial perfusion. Detecting devices based on these achievements have been used in large hospitals as tools for diagnosis of cardiovascular disease and assessment of treatment effect, including Complior (Artech Medical, Pantin, France), SphygmoCor (AtCor Medical, Sydney, Australia) and HEM-9010AI (Omron Healthcare Co. Ltd., Kyoto, Japan). However, the use of them is limited in the field of public health, as they are expensive and complicated to operate, in addition to the need for skilled operating techniques. Therefore, it is necessary to establish new methods and technologies for assessing artery stiffness suitable for group screening and dynamic detection of individuals. In order to meet the demand, in this thesis, the studies on assessment of cardiovascular function using PWA of radial pulse waveform are made as follows:
1. Construction of evaluation index system
Based on research and development of the field, an evaluation index system is established first, according to the principles such as clear physiological significance and strong practical. Indexes for assessing arterial function (such as PTT and aoPWV) and indexes for assessing cardiac function (such as HR and SEVR) are included. All of these indexes are derived by PWA of radial pressure waveform, which are suitable for group screening and dynamic detection of individuals.
2. Study on measurements of key indicators With regard to the measurements of PTT, aoPWV and SEVR in the evaluation index system, the following studies and corresponding research achievements are made, which enriches and develops the theory of wave propagation.
(1) Measurement of PTT
We propose a novel noninvasive method to obtain PTT from a single radial pressure waveform. Radial pulse waveform is easily recorded using applanation tonometry, the first and second systolic peaks of which are automatically detected using PWA. The time interval between them is calculated to estimate PTT. A total of266healthy adults are included in the study, among which PTT obtained using the new method is significantly highly corrected with age. Therefore, the simple and easily obtainable PTT is suggested as a useful index of arterial stiffness.
(2) Measurement of aoPWV
Based on the study of PTT, a new method is proposed consequently to calculate aoPWV using PWA of radial pulse waveform. The navel is selected as the surface measurement point of the major reflection site, and aoPWV is calculated as the length between navel and suprasternal notch divided by PTT. In46young and middle-aged healthy humans, there is a strong correlation between aoPWV obtained by the method and cfPWV obtained by Complior with no significant difference. Additional, good week-to-week reproducibility is found. These results suggest that the method has potential to detect premature arterial aging for the management of primary prevention.
(3) Validation of determining SEVR from radial artery
In231individuals including healthy and hypertensive subjects, carotid and radial SEVR are obtained from the simultaneously recordings of radial and carotid pulse waveforms, and the relationship between them is investigated. Radial SEVR is significantly correlated with carotid SEVR in the study population. They have consistent independent predictors. Additional, changes in radial SEVR with aging corresponds to changes in carotid SEVR. Therefore, SEVR obtained directly from radial pressure wave could provide equivalent information to central SEVR.
3. Design, implementation and validation of the prototype detection system
Based on the methods and technologies proposed in our studies, we design and implement prototype detection system, including automatic device for self-measurement of cardiovascular function (IIM-2010A; Institute of Intelligent of Machines, Hefei, China) and multi-function device for signal acquisition and analysis. Radial pulse waveform is recorded using applanation tonometry (IIM-2010A). BP measured at radial artery is used to calibrate radial tonometric pulse waveform. Feather points are detected automatically using PWA, and then used to calculate hemodynamic characteristics, which is suitable for group screening and dynamic detection of individuals. The multi-function device can record multi-channel pulse waveforms, BP of four limbs, ECG and photoelectric signals simultaneously. It provides experimental condition for future research.
We compare IIM-2010A against the widely accepted devices (SphygmoCor and HEM9001AI) in57healthy subjects. A good agreement in calculating AI and SEVR and short-term reproducibility of the three devices suggest that, the new tonometric device IIM-2010A is suitable for assessing cardiovascular function, and provides a simply obtainable and low cost solution for early detection of artery stiffness.
1.评估指标体系的构建
综合国内外本领域的研究现状与趋势,遵照生理意义明确、实用性强等原则,构建了兼顾动脉功能和心脏功能的评估指标体系,包括脉搏波传递时间(PTT)、aoPWV等动脉功能评估指标和心率(HR)、SEVR等心脏功能评估指标。所有评估指标均基于易于测量的桡动脉PWA获取,适用于大众健康领域的群体普查和个体动态检测。
2.关键指标的测量方法研究
围绕着评估指标体系中关键指标PTT、aoPWV和SEVR的测量方法,本论文开展了如下研究并取得一些成果,进一步丰富和发展了脉搏波传播理论。
(1)PTT测量方法研究
提出一种基于单点桡动脉波形分析的PTT测量方法。基于平面张力法采集桡动脉脉搏波,采用PWA识别波形的第一和第二收缩波峰,并以这两点之间的时间差评估PTT。以266位健康人群为研究对象,采用新方法的测量结果与年龄显著高度负相关。因此,该操作简单、易于获取的PTT可以用于评估动脉弹性功能。
(2) aoPWV测量方法研究
在PTT研究基础上,进一步建立基于桡动脉PWA的aoPWV测量方法。以肚脐为有效反射点的体表测量点,采用胸骨切迹到肚脐的长度与PTT的比值评估aoPWV。在46位健康的中青年对象中,采用该方法测量的aoPWV与Complior测量的颈股动脉脉搏波速度(cfPWV)显著高度相关,且没有明显差异,week-to-week实验显示了很好的短期重复性。该方法适用于中青年健康人群的动脉硬化早期筛查。
(3)基于桡动脉提取SEVR的可行性
针对231位健康人群和高血压患者,同步采集桡动脉和颈动脉波形,基于PWA分别提取桡动脉和颈动脉SEVR,并分析它们之间的关系。研究结果显示,两者显著高度相关,且具有一致的独立影响因素和随年龄变化的规律。这说明基于桡动脉提取的SEVR可以提供与从颈动脉获得的SEVR同样的信息。
3.原型检测系统的设计、实现与验证
根据以上研究中建立的新方法和新技术,设计并实现了原型检测系统,包括自助式心血管功能检测仪ⅡM-2010A和多功能信号采集分析仪。ⅡM-2010A基于平面张力法采集桡动脉脉搏波信号,采用测量的腕部血压对其标定获取压力波形,基于PWA识别压力波形的特征点,计算包括增长指数(AI)、SEVR和HR等在内的10项血流动力学指标,适合群体普查和个体动态检测的需求。多功能信号采集分析仪集四路脉搏波信号同步采集、四肢同步加压、1路心电和1路光电信号检测于一体,可根据实验的具体需要形成多种配置方案,为后续研究提供实验条件。
以57位健康志愿者为研究对象,将ⅡM-2010A与经典仪器(SphygmoCor和HEM-9000AI)的测量结果进行对比分析。研究结果显示,三款仪器测量的AI和SEVR显著高度相关,并均具有很好的短期测量重复性。因此,该仪器适用于动脉功能和心肌灌注功能评估,为动脉硬化的早期筛查提供了一种操作简单、价格低廉的解决方案。
Artery stiffness is the pathophysiological basis of cardiovascular disease. Early detection and intervention of artery stiffness, therefore, is the essential way to prevent cardiovascular disease. Determination of hemodynamic parameters using PWA is a commonly used method for assessing artery stiffness. The study on the method was started very early in foreign countries and several representative indicators for assessing cardiovascular function have been proposed. For example, aoPWV obtained by two-site measurement is a gold standard of arterial stiffness, and SEVR derived from central pressure is widely accepted as a means of myocardial perfusion. Detecting devices based on these achievements have been used in large hospitals as tools for diagnosis of cardiovascular disease and assessment of treatment effect, including Complior (Artech Medical, Pantin, France), SphygmoCor (AtCor Medical, Sydney, Australia) and HEM-9010AI (Omron Healthcare Co. Ltd., Kyoto, Japan). However, the use of them is limited in the field of public health, as they are expensive and complicated to operate, in addition to the need for skilled operating techniques. Therefore, it is necessary to establish new methods and technologies for assessing artery stiffness suitable for group screening and dynamic detection of individuals. In order to meet the demand, in this thesis, the studies on assessment of cardiovascular function using PWA of radial pulse waveform are made as follows:
1. Construction of evaluation index system
Based on research and development of the field, an evaluation index system is established first, according to the principles such as clear physiological significance and strong practical. Indexes for assessing arterial function (such as PTT and aoPWV) and indexes for assessing cardiac function (such as HR and SEVR) are included. All of these indexes are derived by PWA of radial pressure waveform, which are suitable for group screening and dynamic detection of individuals.
2. Study on measurements of key indicators With regard to the measurements of PTT, aoPWV and SEVR in the evaluation index system, the following studies and corresponding research achievements are made, which enriches and develops the theory of wave propagation.
(1) Measurement of PTT
We propose a novel noninvasive method to obtain PTT from a single radial pressure waveform. Radial pulse waveform is easily recorded using applanation tonometry, the first and second systolic peaks of which are automatically detected using PWA. The time interval between them is calculated to estimate PTT. A total of266healthy adults are included in the study, among which PTT obtained using the new method is significantly highly corrected with age. Therefore, the simple and easily obtainable PTT is suggested as a useful index of arterial stiffness.
(2) Measurement of aoPWV
Based on the study of PTT, a new method is proposed consequently to calculate aoPWV using PWA of radial pulse waveform. The navel is selected as the surface measurement point of the major reflection site, and aoPWV is calculated as the length between navel and suprasternal notch divided by PTT. In46young and middle-aged healthy humans, there is a strong correlation between aoPWV obtained by the method and cfPWV obtained by Complior with no significant difference. Additional, good week-to-week reproducibility is found. These results suggest that the method has potential to detect premature arterial aging for the management of primary prevention.
(3) Validation of determining SEVR from radial artery
In231individuals including healthy and hypertensive subjects, carotid and radial SEVR are obtained from the simultaneously recordings of radial and carotid pulse waveforms, and the relationship between them is investigated. Radial SEVR is significantly correlated with carotid SEVR in the study population. They have consistent independent predictors. Additional, changes in radial SEVR with aging corresponds to changes in carotid SEVR. Therefore, SEVR obtained directly from radial pressure wave could provide equivalent information to central SEVR.
3. Design, implementation and validation of the prototype detection system
Based on the methods and technologies proposed in our studies, we design and implement prototype detection system, including automatic device for self-measurement of cardiovascular function (IIM-2010A; Institute of Intelligent of Machines, Hefei, China) and multi-function device for signal acquisition and analysis. Radial pulse waveform is recorded using applanation tonometry (IIM-2010A). BP measured at radial artery is used to calibrate radial tonometric pulse waveform. Feather points are detected automatically using PWA, and then used to calculate hemodynamic characteristics, which is suitable for group screening and dynamic detection of individuals. The multi-function device can record multi-channel pulse waveforms, BP of four limbs, ECG and photoelectric signals simultaneously. It provides experimental condition for future research.
We compare IIM-2010A against the widely accepted devices (SphygmoCor and HEM9001AI) in57healthy subjects. A good agreement in calculating AI and SEVR and short-term reproducibility of the three devices suggest that, the new tonometric device IIM-2010A is suitable for assessing cardiovascular function, and provides a simply obtainable and low cost solution for early detection of artery stiffness.
引文
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