超声技术评价中老年男性代谢综合征患者颈动脉僵硬度、左室功能及心室-动脉耦联情况
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摘要
目的应用超声技术评估中老年男性代谢综合征(MetS)患者颈动脉血管壁僵硬度、左室功能及心室-动脉耦联情况。方法选取在广西医科大学第一附属医院确诊的中老年男性MetS患者86例,分为射血分数(EF)正常者52例(EF≥50%,MetS N组)和EF减低者34例(EF<50%,MetS A组);另选同期50例健康男性为对照组。比较各组颈动脉血管壁僵硬度指标[扩张系数(DC)、杨氏弹性模量(YEM)、僵硬指数(SI)]、左室功能指标(Tei指数和EF),以及左心系统心室-动脉耦联参数:左室收缩末弹性(Ees)、有效动脉弹性(Ea)及心室-血管耦联指数(VVI)。结果①颈动脉血管壁僵硬度指标比较:与对照组比较,MetS N组、MetS A组DC减低,YEM、SI增高,差异均有统计学意义(均P<0.05);MetS N组与MetS A组比较差异均无统计学意义;②左室功能指标:MetS A组Tei指数高于MetS N组,MetS N组Tei指数高于对照组,差异均有统计学意义(均P<0.05);③与对照组比较,MetS N组、MetS A组Ea增高,差异均有统计学意义(均P<0.05),MetS N组与MetS A组比较Ea差异无统计学意义;MetS N组Ees增高,MetS A组Ees减低,差异均有统计学意义(均P<0.05);MetS A组VVI高于MetS N组,差异有统计学意义(P<0.05),对照组与MetS N组VVI比较差异无统计学意义。简单线性回归分析示:MetS A组VVI与Tei指数呈正相关(b=2.72,P=0.000),拟合线性回归的决定系数(R2)=0.565(P<0.05)。结论中老年男性MetS患者颈动脉血管壁僵硬度增高;左室整体功能减低,以射血分数降低者更为明显;MetS A患者心室-动脉失耦联,且心室-动脉失耦联情况随左室整体功能的下降而恶化。应用超声技术能够无创、敏感、准确地评估其心血管功能。
Objective To evaluate carotid arterial stiffness, left ventricular function and coupling in middle in middle and old age male patients with metabolic syndrome(Mets)by ultrasound Methods Eighty-six middle and old age male subjects with MetS in the first affliated hospital of guangxi medical university were divided into normal left ventricular ejection fraction(EF)group(MetS N group,EF≥50%,n=52)and abnormal EF group(MetS A group,EF<50%,n=34).50 age-matched healthy males were assigned to control group. Those indexes of vessel wall stiffiness including carotid arterial distensibility coefficient(DC),Young's elastic modulus(YEM),stiffness index(SI),left ventricular function(Tei index and EF)and parameters of left ventricular-arterial coupling[left ventricular end-systolic elastance(Ees),effective arterial elastance(Ea),and ventricular-vascular coupling index(VVI)]were compared and analyzed.Results ①Comparison of stiffness indexes of carotid artery:compared with the control group,the DC were decreased and the YEM,SI were increased respectively in the MetS N group and MetS A group(all P<0.05). Regarding the DC,the YEM and the SI had no significant difference between MetS N group and MetS A group. ② Comparison of left ventricular overall function:compared with the control,the Tei index was increased in MetS A group,which was higher than that in MetS N group.And the Tei index in MetS N group was higher than that in the control(all P<0.05). ③Comparison of parameters of left ventricular-arterial coupling:compared with the control,the Ea were increase respectively in the MetS N group and MetS A group(both P<0.05). And the Ea had no significant difference between MetS N group and MetS A group.decreased in the MetS A group(P<0.05).Besides,the VVI was increased in the MetS A group,which was higher than that in the MetS N group(P<0.05). And the VVI had no significant difference between control and MetS N groups. The simple regression analysis showed that the VVI was positively correlated with the Tei index(b=2.72,P=0.000),and R2 was 0.565(P<0.05).Conclusion In middle and old age male patients with MetS,the stiffness of carotid artery is increased,and the left ventricular global function reduced,which is obvious in the EF<50% patients. The ventricular-arterial coupling is abnormal in the MetS patients,and this state of suboptimal coupling is deteriorated with the decrease of left ventricular global function.Ultrasound is safe,sensitive and accurate in assessing cardiovascular function in those pantients.
Objective To evaluate carotid arterial stiffness, left ventricular function and coupling in middle in middle and old age male patients with metabolic syndrome(Mets)by ultrasound Methods Eighty-six middle and old age male subjects with MetS in the first affliated hospital of guangxi medical university were divided into normal left ventricular ejection fraction(EF)group(MetS N group,EF≥50%,n=52)and abnormal EF group(MetS A group,EF<50%,n=34).50 age-matched healthy males were assigned to control group. Those indexes of vessel wall stiffiness including carotid arterial distensibility coefficient(DC),Young's elastic modulus(YEM),stiffness index(SI),left ventricular function(Tei index and EF)and parameters of left ventricular-arterial coupling[left ventricular end-systolic elastance(Ees),effective arterial elastance(Ea),and ventricular-vascular coupling index(VVI)]were compared and analyzed.Results ①Comparison of stiffness indexes of carotid artery:compared with the control group,the DC were decreased and the YEM,SI were increased respectively in the MetS N group and MetS A group(all P<0.05). Regarding the DC,the YEM and the SI had no significant difference between MetS N group and MetS A group. ② Comparison of left ventricular overall function:compared with the control,the Tei index was increased in MetS A group,which was higher than that in MetS N group.And the Tei index in MetS N group was higher than that in the control(all P<0.05). ③Comparison of parameters of left ventricular-arterial coupling:compared with the control,the Ea were increase respectively in the MetS N group and MetS A group(both P<0.05). And the Ea had no significant difference between MetS N group and MetS A group.decreased in the MetS A group(P<0.05).Besides,the VVI was increased in the MetS A group,which was higher than that in the MetS N group(P<0.05). And the VVI had no significant difference between control and MetS N groups. The simple regression analysis showed that the VVI was positively correlated with the Tei index(b=2.72,P=0.000),and R2 was 0.565(P<0.05).Conclusion In middle and old age male patients with MetS,the stiffness of carotid artery is increased,and the left ventricular global function reduced,which is obvious in the EF<50% patients. The ventricular-arterial coupling is abnormal in the MetS patients,and this state of suboptimal coupling is deteriorated with the decrease of left ventricular global function.Ultrasound is safe,sensitive and accurate in assessing cardiovascular function in those pantients.
引文
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[3] P?lve KS,Pahkala K,Magnussen CG,et al. Association of physical activity in childhood and early adulthood with carotid artery elasticity21 years later:the cardiovascular risk in young finns study[J]. J Am Heart Assoc,2014,3(2):e000594.
[4] Tei C,Ling LH,Hodge DO,et al. New index of combined systolic and diastolic myocardial performance:a simple and reproducible measure of cardiac function—a study in normals and dilated cardiomyopathy[J]. J Cardiol,1995,26(6):357-366.
[5] Kelly RP,Ting CT,Yang TM,et al.Effective arterial elastance as index of arterial vascular load in humans[J].Circulation,1992,86(2):513-521.
[6] Burkhoff D,Mirsky I,Suga H. Assessment of systolic and diastolic ventricular properties via pressure-volume analysis:a guide for clinical,translational,and basic researchers[J]. Am J Physiol Heart Circ Physiol,2005,289(2):501-512.
[7] Chantler PD,Lakatta EG,Najjar SS. Arterial-ventricular coupling:mechanistic insights into cardiovascular performance at rest and during exercise[J]. J Appl Physiol,2008,105(4):1342-1351.
[8] Holvoet P. Stress in obesity and associated metabolic and cardiovascular disorders[J]. Scientifica,2012,2012(1):205027.
[9]金文胜,潘长玉,陆菊明,等.代谢综合征人群超声检测的动脉僵硬度研究[J].中老年多器官疾病杂志,2006,5(3):204-207.
[10]陈明,罗建文,王金锐,等.心脏与血管超声生物力学[M].上海:上海科技教育出版社,2014:62-75.
[2] Alberti KG,Eckel RH,Grundy SM,et al. Harmonizing the metabolic syndrome:a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention;National Heart,Lung,and Blood Institute;American Heart Association;World Heart Federation;International Atherosclerosis Society;and International Association for the Study of Obesity[J]. Circulation,2009,120(6):1640-1645.
[3] P?lve KS,Pahkala K,Magnussen CG,et al. Association of physical activity in childhood and early adulthood with carotid artery elasticity21 years later:the cardiovascular risk in young finns study[J]. J Am Heart Assoc,2014,3(2):e000594.
[4] Tei C,Ling LH,Hodge DO,et al. New index of combined systolic and diastolic myocardial performance:a simple and reproducible measure of cardiac function—a study in normals and dilated cardiomyopathy[J]. J Cardiol,1995,26(6):357-366.
[5] Kelly RP,Ting CT,Yang TM,et al.Effective arterial elastance as index of arterial vascular load in humans[J].Circulation,1992,86(2):513-521.
[6] Burkhoff D,Mirsky I,Suga H. Assessment of systolic and diastolic ventricular properties via pressure-volume analysis:a guide for clinical,translational,and basic researchers[J]. Am J Physiol Heart Circ Physiol,2005,289(2):501-512.
[7] Chantler PD,Lakatta EG,Najjar SS. Arterial-ventricular coupling:mechanistic insights into cardiovascular performance at rest and during exercise[J]. J Appl Physiol,2008,105(4):1342-1351.
[8] Holvoet P. Stress in obesity and associated metabolic and cardiovascular disorders[J]. Scientifica,2012,2012(1):205027.
[9]金文胜,潘长玉,陆菊明,等.代谢综合征人群超声检测的动脉僵硬度研究[J].中老年多器官疾病杂志,2006,5(3):204-207.
[10]陈明,罗建文,王金锐,等.心脏与血管超声生物力学[M].上海:上海科技教育出版社,2014:62-75.