脉搏波传导速度及其在中医脉诊研究中的应用
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摘要
论述脉搏波传导速度(PWV)的临床应用及在中医脉诊研究中的应用进展。PWV是脉搏波传导距离与传导时间的比值,作为评价动脉硬化的指标,当前临床应用以臂踝脉搏波传导速度(ba-PWV)和颈股脉搏波传导速度(cf-PWV)为主,主要用于心血管疾病、糖尿病、肾脏疾病等的诊断和风险评估,可较好地反映血管损伤程度、预测发病率及病死率。在中医脉诊研究中,PWV和脉图指标密切相关,两者联合可应用于中医脉象分类,亦有助于临床诊断和预防。
This article discusses the application of pulse wave velocity( PWV) in clinic and its research progress in TCM pulse diagnosis. PWV is the ratio of pulse wave conduction distance to conduction time. As an indicator for arteriosclerosis assessment,PWV,especially brachial-ankle pulse wave velocity( ba-PWV) and carotid-femoral pulse wave velocity( cf-PWV),is mainly used for diagnosis and risk evaluation of cardiovascular diseases,diabetes and kidney diseases,which can better reflect the degree of vascular injury and predict the morbidity and mortality. In the study of TCM pulse diagnosis,PWV is closely related to the pulse graph indicators. The combination of PWV and pulse graph indicators can be applied in the classification of pulse condition,and also used in clinical diagnosis and prevention.
This article discusses the application of pulse wave velocity( PWV) in clinic and its research progress in TCM pulse diagnosis. PWV is the ratio of pulse wave conduction distance to conduction time. As an indicator for arteriosclerosis assessment,PWV,especially brachial-ankle pulse wave velocity( ba-PWV) and carotid-femoral pulse wave velocity( cf-PWV),is mainly used for diagnosis and risk evaluation of cardiovascular diseases,diabetes and kidney diseases,which can better reflect the degree of vascular injury and predict the morbidity and mortality. In the study of TCM pulse diagnosis,PWV is closely related to the pulse graph indicators. The combination of PWV and pulse graph indicators can be applied in the classification of pulse condition,and also used in clinical diagnosis and prevention.
引文
[1]谢晓亮,李觉.脉搏波传导速度测定方法及临床意义[J].中国心血管病研究杂志,2007,5(6):465-468.
[2]SKALAK R,KELLER S R,SECOMB T W.Mechanics of blood flow[J].J Biomech Eng,1981,103(2):102-115.
[3]MERILLON J P,MOTTE G,FRUCHAUD J,et al.Evaluation of the elasticity and characteristic impedance of the ascending aorta in man[J].Cardiovasc Res,1978,12(7):401-406.
[4]KEYT A T.Facts and New Experiments in Illustration of the variations of pulse wave velocity in man,and bearing upon the elucidation of the cause which produce them[J].JAMA,1883,1(21):605-612.
[5]GRIBBIN B,STEPTOE A,SLEIGHT P.Pulse wave velocity as a measure of blood pressure change[J].Psychophysiology,1976,13(1):86-90.
[6]ISNARD R N,PANNIER B M,LAURENT S,et al.Pulsatile diameter and elastic modulus of the aortic arch in essential hypertension:a noninvasive study[J].J Am Coll Cardiol,1989,13(2):399-405.
[7]ASMAR R,BENETOE A,TOPUCHIAN J,et al.Assessment of arterial distensibility by automatic pulse wave velocity measurement[J].Hypertension,1995,26(3):485-490.
[8]YAMASHINA A,TOMIYAMA H,TAKEDA K,et al.Validity,reproducibility,and clinical significance of noninvasive brachialankle pulse wave velocity measurement[J].Hypertens Res,2002,25(3):359-364.
[9]ZHANG Y,AGNOLETTI D,PROTOGROU A D,et al.Characteristics of pulse wave velocity in elastic and muscular arteries:a mismatch beyond age[J].J Hypertens,2013,31(3):554-559.
[10]ALIVON M,VO-DUC PHUONG T,VIGNON V,et al.A novel device for measuring arterial stiffness using finger-toe pulse wave velocity:Validation study of the p Opmètre[J].Arch Cardiovasc Dis,2015,108(4):227-234.
[11]王鸿懿,孙宁玲.2013欧洲高血压管理指南介绍[J].中国医学前沿杂志,2013,5(6):48-62.
[12]张辉,卢新政.2013欧洲高血压学会与欧洲心脏病学会高血压管理指南简介[J].中华高血压杂志,2013,21(11):1081-1084.
[13]LI X,JIANG J,ZHANG H,et al.Measurement of carotid pulse wave velocity using ultrafast ultrasound imaging in hypertensive patients[J].J Med Ultrason,2017,44(2):183-190.
[14]SZMIGIELSKI C,STYCZYNSKI G,SOBCZYNSKA M,et al.Pulse wave velocity correlates with aortic atherosclerosis assessed with transesophageal echocardiography[J].J Hum Hypertens,2016,30(2):90-94.
[15]韦宗凯,杨军,杨茹,等.超声极速成像技术评价代谢综合征颈动脉弹性的初步研究[J].中国医科大学学报,2016,45(11):988-991.
[16]赵迅冉,江杰,韩丹,等.ABI联合baPWV与双源CT冠状动脉成像的相关性研究[J].临床放射学杂志,2015,34(3):376-379.
[17]SAJI N,KIMURA K,YAGITA Y,et al.Comparison of arteriosclerotic indicators in patients with ischemic stroke:anklebrachial index,brachial-ankle pulse wave velocity and cardioankle vascular index[J].Hypertens Res,2015,38(5):323-328.
[18]TRIANTAFYLLIAS K,STORTZ M,DE BLASI M,et al.Assessment of cardiovascular risk in patients with fibromyalgia by carotid-femoral pulse wave velocity-results of a prospective study[J].Ann Rheum Dis,2018,77(2):465.
[19]REGNAULT V,LAGRANGE J,PIZARD A,et al.Opposite Predictive Value of Pulse Pressure and Aortic Pulse Wave Velocity on Heart Failure With Reduced Left Ventricular Ejection Fraction Novelty and Significance[J].Hypertension,2014,63(1):105-111.
[20]BEN-SHLOMO Y,SPEARS M,BOUSTRED C,et al.Aortic pulse wave velocity improves cardiovascular event prediction:an individual participant meta-analysis of prospective observational data from 17,635 subjects[J].J Am Coll Cardiol,2014,63(7):636-646.
[21]SUGAMATA W,NAKAMURA T,UEMATSU M,et al.The combined assessment of flow-mediated dilation of the brachial artery and brachial-ankle pulse wave velocity improves the prediction of future coronary events in patients with chronic coronary artery disease[J].J Cardiol,2014,64(3):179-184.
[22]NINOMIYA T,KOJIMA I,DOI Y,et al.Brachial-ankle pulse wave velocity predicts the development of cardiovascular disease in a general Japanese population:the Hisayama Study[J].JHypertens,2013,31(3):477-483.
[23]TAKASHIMA N,TURIN T C,MATSUI K,et al.The relationship of brachial-ankle pulse wave velocity to future cardiovascular disease events in the general Japanese population:the Takashima Study[J].J Hum Hypertens,2014,28(5):323-327.
[24]赵胜仙,彭年春,时立新,等.40岁以上人群肱踝脉搏波传导速度与心脑血管事件关系的前瞻性研究[J].天津医药,2016,44(8):963-966.
[25]LOEHR L R,SNYDER M,SELVIN E,et al.Diabetes and Impaired Fasting Glucose are Associated with Pulse Wave Velocity in Older Adults:the ARIC Study[J].Circulation,2014,129(1):336.
[26]TENTOLOURIS A,ELEFTHERIADOU I,GRIGOROPOULOU P,et al.The association between pulse wave velocity and peripheral neuropathy in patients with type 2 diabetes mellitus[J].J Diabetes Complications,2017,31(11):1624-1629.
[27]孙可欣,刘志科,曹亚英,等.北京某社区2型糖尿病患者血糖控制情况与肱踝脉搏波传导速度的相关性研究[J].北京大学学报(医学版),2015,47(3):431-436.
[28]KATAKAMI N,OSONOI T,TAKAHARA M,et al.Clinical utility of brachial-ankle pulse wave velocity in the prediction of cardiovascular events in diabetic patients[J].Cardiovasc Diabetol,2014,13(1):128.
[29]MAEDA Y,INOGUCHI T,ETOH E,et al.Brachial-ankle pulse wave velocity predicts all-cause mortality and cardiovascular events in patients with diabetes:the Kyushu Prevention Study of Atherosclerosis[J].Diabetes Care,2014,37(8):2383-2390.
[30]CRUICKSHANK K,RISTE L,ANDERSON S G,et al.Aortic pulse-wave velocity and its relationship to mortality in diabetes and glucose intolerance[J].Circulation,2002,106(16):2085-2090.
[31]BAUMANN M,WASSERTHEURER S,SUTTMANN Y,et al.Aortic pulse wave velocity predicts mortality in chronic kidney disease stages 2-4[J].J Hypertens,2014,32(4):899-903.
[32]GREENWOOD S A,KOUFAKI P,MERCER T H,et al.Aerobic or resistance training and pulse wave velocity in kidney transplant recipients:a 12-week pilot randomized controlled trial(the Exercise in Renal Transplant[ExeRT]Trial)[J].Am J Kidney Dis,2015,66(4):689-698.
[33]ZHONG W,CRUICHSHANKS K J,SCHUBERT C R,et al.Pulse wave velocity and cognitive function in older adults[J].Alz Dis Assoc Disord,2014,28(1):44-49.
[34]费兆馥.脉诊仪的研究现状及对寸口三部脉象客观检测的初步设想[J].上海中医药大学学报,2012,26(4):7-10.
[35]费兆馥.现代中医脉诊学[M].北京:人民卫生出版社,2003:115,163-179.
[36]吴宏进,张志枫,许家佗,等.677例健康人群体表面积,体质指数与采脉压力及脉图参数的关系探讨[J].中华中医药杂志,2013,28(5):1361-1365.
[37]朱丽萍,吴宏进,张志枫,等.54例不同性别健康大学生“寸口”脉象及脉图参数分析[J].上海中医药大学学报,2013,27(2):28-31.
[38]张绍良.阵列式脉图采集、分析与分类技术研究[D].上海:上海中医药大学,2016.
[39]张绍良,崔骥,许家佗,等.51例大学生寸口三部脉图参数研究[J].世界中医药,2016,11(8):1618-1621.
[40]王超臣,杨学智,张建,等.高血压患者脉搏波参数与脉搏波传导速度的相关性研究[J].现代生物医学进展,2014,14(23):4459-4462.
[41]郭苗苗.高血压患者脉象仪参数与肱动脉-踝动脉脉搏波波速相关性研究[D].福州:福建中医药大学,2013.
[42]刘玥,齐新,冀云萍,等.动脉硬化患者臂踝脉搏波传导速度、臂踝指数影响因素分析及与中医脉象的相关性[J].中医杂志,2011,52(7):578-581.
[43]王炳和,杨敬林.一种无创测定桡动脉脉搏波速度的方法及影响脉搏波速度的因素[J].生物医学工程学杂志,2000,17(2):179-182.
[44]李慧,张尚尚,芦煜,等.2型糖尿病中医数字化、量化的四诊特征研究[J].云南中医学院学报,2015,38(2):43-46.
[45]王京平,谢春娥,牛婷立,等.肾小球肾炎中医四诊合参诊断信息的数字化研究[J].世界中医药,2016,11(4):728-730.
[46]张治霞,王京平,牛婷立,等.原发性肝癌中医数字化、量化四诊信息特征研究[J].中华中医药杂志,2016,31(6):2324-2327.
[2]SKALAK R,KELLER S R,SECOMB T W.Mechanics of blood flow[J].J Biomech Eng,1981,103(2):102-115.
[3]MERILLON J P,MOTTE G,FRUCHAUD J,et al.Evaluation of the elasticity and characteristic impedance of the ascending aorta in man[J].Cardiovasc Res,1978,12(7):401-406.
[4]KEYT A T.Facts and New Experiments in Illustration of the variations of pulse wave velocity in man,and bearing upon the elucidation of the cause which produce them[J].JAMA,1883,1(21):605-612.
[5]GRIBBIN B,STEPTOE A,SLEIGHT P.Pulse wave velocity as a measure of blood pressure change[J].Psychophysiology,1976,13(1):86-90.
[6]ISNARD R N,PANNIER B M,LAURENT S,et al.Pulsatile diameter and elastic modulus of the aortic arch in essential hypertension:a noninvasive study[J].J Am Coll Cardiol,1989,13(2):399-405.
[7]ASMAR R,BENETOE A,TOPUCHIAN J,et al.Assessment of arterial distensibility by automatic pulse wave velocity measurement[J].Hypertension,1995,26(3):485-490.
[8]YAMASHINA A,TOMIYAMA H,TAKEDA K,et al.Validity,reproducibility,and clinical significance of noninvasive brachialankle pulse wave velocity measurement[J].Hypertens Res,2002,25(3):359-364.
[9]ZHANG Y,AGNOLETTI D,PROTOGROU A D,et al.Characteristics of pulse wave velocity in elastic and muscular arteries:a mismatch beyond age[J].J Hypertens,2013,31(3):554-559.
[10]ALIVON M,VO-DUC PHUONG T,VIGNON V,et al.A novel device for measuring arterial stiffness using finger-toe pulse wave velocity:Validation study of the p Opmètre[J].Arch Cardiovasc Dis,2015,108(4):227-234.
[11]王鸿懿,孙宁玲.2013欧洲高血压管理指南介绍[J].中国医学前沿杂志,2013,5(6):48-62.
[12]张辉,卢新政.2013欧洲高血压学会与欧洲心脏病学会高血压管理指南简介[J].中华高血压杂志,2013,21(11):1081-1084.
[13]LI X,JIANG J,ZHANG H,et al.Measurement of carotid pulse wave velocity using ultrafast ultrasound imaging in hypertensive patients[J].J Med Ultrason,2017,44(2):183-190.
[14]SZMIGIELSKI C,STYCZYNSKI G,SOBCZYNSKA M,et al.Pulse wave velocity correlates with aortic atherosclerosis assessed with transesophageal echocardiography[J].J Hum Hypertens,2016,30(2):90-94.
[15]韦宗凯,杨军,杨茹,等.超声极速成像技术评价代谢综合征颈动脉弹性的初步研究[J].中国医科大学学报,2016,45(11):988-991.
[16]赵迅冉,江杰,韩丹,等.ABI联合baPWV与双源CT冠状动脉成像的相关性研究[J].临床放射学杂志,2015,34(3):376-379.
[17]SAJI N,KIMURA K,YAGITA Y,et al.Comparison of arteriosclerotic indicators in patients with ischemic stroke:anklebrachial index,brachial-ankle pulse wave velocity and cardioankle vascular index[J].Hypertens Res,2015,38(5):323-328.
[18]TRIANTAFYLLIAS K,STORTZ M,DE BLASI M,et al.Assessment of cardiovascular risk in patients with fibromyalgia by carotid-femoral pulse wave velocity-results of a prospective study[J].Ann Rheum Dis,2018,77(2):465.
[19]REGNAULT V,LAGRANGE J,PIZARD A,et al.Opposite Predictive Value of Pulse Pressure and Aortic Pulse Wave Velocity on Heart Failure With Reduced Left Ventricular Ejection Fraction Novelty and Significance[J].Hypertension,2014,63(1):105-111.
[20]BEN-SHLOMO Y,SPEARS M,BOUSTRED C,et al.Aortic pulse wave velocity improves cardiovascular event prediction:an individual participant meta-analysis of prospective observational data from 17,635 subjects[J].J Am Coll Cardiol,2014,63(7):636-646.
[21]SUGAMATA W,NAKAMURA T,UEMATSU M,et al.The combined assessment of flow-mediated dilation of the brachial artery and brachial-ankle pulse wave velocity improves the prediction of future coronary events in patients with chronic coronary artery disease[J].J Cardiol,2014,64(3):179-184.
[22]NINOMIYA T,KOJIMA I,DOI Y,et al.Brachial-ankle pulse wave velocity predicts the development of cardiovascular disease in a general Japanese population:the Hisayama Study[J].JHypertens,2013,31(3):477-483.
[23]TAKASHIMA N,TURIN T C,MATSUI K,et al.The relationship of brachial-ankle pulse wave velocity to future cardiovascular disease events in the general Japanese population:the Takashima Study[J].J Hum Hypertens,2014,28(5):323-327.
[24]赵胜仙,彭年春,时立新,等.40岁以上人群肱踝脉搏波传导速度与心脑血管事件关系的前瞻性研究[J].天津医药,2016,44(8):963-966.
[25]LOEHR L R,SNYDER M,SELVIN E,et al.Diabetes and Impaired Fasting Glucose are Associated with Pulse Wave Velocity in Older Adults:the ARIC Study[J].Circulation,2014,129(1):336.
[26]TENTOLOURIS A,ELEFTHERIADOU I,GRIGOROPOULOU P,et al.The association between pulse wave velocity and peripheral neuropathy in patients with type 2 diabetes mellitus[J].J Diabetes Complications,2017,31(11):1624-1629.
[27]孙可欣,刘志科,曹亚英,等.北京某社区2型糖尿病患者血糖控制情况与肱踝脉搏波传导速度的相关性研究[J].北京大学学报(医学版),2015,47(3):431-436.
[28]KATAKAMI N,OSONOI T,TAKAHARA M,et al.Clinical utility of brachial-ankle pulse wave velocity in the prediction of cardiovascular events in diabetic patients[J].Cardiovasc Diabetol,2014,13(1):128.
[29]MAEDA Y,INOGUCHI T,ETOH E,et al.Brachial-ankle pulse wave velocity predicts all-cause mortality and cardiovascular events in patients with diabetes:the Kyushu Prevention Study of Atherosclerosis[J].Diabetes Care,2014,37(8):2383-2390.
[30]CRUICKSHANK K,RISTE L,ANDERSON S G,et al.Aortic pulse-wave velocity and its relationship to mortality in diabetes and glucose intolerance[J].Circulation,2002,106(16):2085-2090.
[31]BAUMANN M,WASSERTHEURER S,SUTTMANN Y,et al.Aortic pulse wave velocity predicts mortality in chronic kidney disease stages 2-4[J].J Hypertens,2014,32(4):899-903.
[32]GREENWOOD S A,KOUFAKI P,MERCER T H,et al.Aerobic or resistance training and pulse wave velocity in kidney transplant recipients:a 12-week pilot randomized controlled trial(the Exercise in Renal Transplant[ExeRT]Trial)[J].Am J Kidney Dis,2015,66(4):689-698.
[33]ZHONG W,CRUICHSHANKS K J,SCHUBERT C R,et al.Pulse wave velocity and cognitive function in older adults[J].Alz Dis Assoc Disord,2014,28(1):44-49.
[34]费兆馥.脉诊仪的研究现状及对寸口三部脉象客观检测的初步设想[J].上海中医药大学学报,2012,26(4):7-10.
[35]费兆馥.现代中医脉诊学[M].北京:人民卫生出版社,2003:115,163-179.
[36]吴宏进,张志枫,许家佗,等.677例健康人群体表面积,体质指数与采脉压力及脉图参数的关系探讨[J].中华中医药杂志,2013,28(5):1361-1365.
[37]朱丽萍,吴宏进,张志枫,等.54例不同性别健康大学生“寸口”脉象及脉图参数分析[J].上海中医药大学学报,2013,27(2):28-31.
[38]张绍良.阵列式脉图采集、分析与分类技术研究[D].上海:上海中医药大学,2016.
[39]张绍良,崔骥,许家佗,等.51例大学生寸口三部脉图参数研究[J].世界中医药,2016,11(8):1618-1621.
[40]王超臣,杨学智,张建,等.高血压患者脉搏波参数与脉搏波传导速度的相关性研究[J].现代生物医学进展,2014,14(23):4459-4462.
[41]郭苗苗.高血压患者脉象仪参数与肱动脉-踝动脉脉搏波波速相关性研究[D].福州:福建中医药大学,2013.
[42]刘玥,齐新,冀云萍,等.动脉硬化患者臂踝脉搏波传导速度、臂踝指数影响因素分析及与中医脉象的相关性[J].中医杂志,2011,52(7):578-581.
[43]王炳和,杨敬林.一种无创测定桡动脉脉搏波速度的方法及影响脉搏波速度的因素[J].生物医学工程学杂志,2000,17(2):179-182.
[44]李慧,张尚尚,芦煜,等.2型糖尿病中医数字化、量化的四诊特征研究[J].云南中医学院学报,2015,38(2):43-46.
[45]王京平,谢春娥,牛婷立,等.肾小球肾炎中医四诊合参诊断信息的数字化研究[J].世界中医药,2016,11(4):728-730.
[46]张治霞,王京平,牛婷立,等.原发性肝癌中医数字化、量化四诊信息特征研究[J].中华中医药杂志,2016,31(6):2324-2327.