中青年人群肱踝脉搏波传导速度分布与早发血管衰老
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摘要
目的:描述中青年人群肱踝脉搏波传导速度(baPWV)的分布特征,分析中青年人群合并早发血管衰老(EVA)的危险因素。方法:对2010-2017年参加体检并行baPWV检测的4 968名中青年人进行回顾性调查,分析baPWV的分布特征及正常值/参考范围。以baPWV值大于人群均值两个标准差作为EVA诊断标准,发现中青年人群中的EVA患者,并探讨其危险因素。结果:baPWV值随增龄升高,且各年龄层男性baPWV值高于女性(P<0.001)。<30、30～39、40～49、50～59岁男性baPWV均值及单侧95%参考范围分别为1 167/1 421、1 256/1 517、1 348/1 671、1 425/1 793cm/s;女性分别为1 043/1 270、1 158/1 331、1 209/1 489、1 371/1 745cm/s。EVA患者共203例(男141例,女62例),随机选择年龄性别匹配的非EVA对照组。单变量Logistic回归分析显示,EVA的危险因素包括吸烟、饮酒、心率、收缩压、舒张压、平均动脉压、空腹血糖、糖化血红蛋白、三酰甘油、肌酐、尿酸(均P<0.05);多变量Logistic回归分析显示,吸烟、心率、平均动脉压是EVA的独立危险因素(均P<0.05)。结论:根据不同性别年龄制定的参考值有价值;对于吸烟、心率偏快以及高血压人群,应警惕发生EVA的可能。
Objective:To describe the distribution of brachial-ankle pulse wave velocity(baPWV)and analyze the risk factors of early vascular aging in the youth and the middle-aged population.Method:The health reports of the youth and the middle-aged individuals who underwent physical examination from 2010 to 2017 were retrospectively analyzed.The distribution and the normal/reference values of baPWVwere described.The individuals whose baPWV were above the mean value of the population of the same age and gender with two standard deviations were diagnosed with early vascular aging(EVA),and the risk factors were discussed.Result:baPWV increased with age,and the baPWV of males were higher than that of females in every age group(P<0.001).The mean/lower limit of the 95 th percentile was 1 167/1 421,1 256/1 517,1 348/1 671,1 425/1 793 cm/s in the males of under 30,30-39,40-49,50-59 years old respectively;and were 1 043/1 270,1 158/1 331,1 209/1 489,1 371/1 745 cm/s in females.A total of 203 EVA patients(114 men and 64 women)were diagnosed,and the age-and gender-matched non-EVA individuals were randomly chosen as the control group.Univariate logistic regression analysis showed that smoking,drinking,heart rate,systolic blood pressure,diastolic blood pressure,mean arterial pressure,fasting blood glucose,glycated hemoglobin A1 c,total triglyceride,creatinine and uric acid were risk factors for EVA(all P<0.05).Smoking,heart rate and mean arterial pressure were still significant in the multivariate logistic regression model(all P<0.05),which indicated that they were independent risk factors for EVA.Conclusion:It is valuable to establish the reference value of baPWV according to different gender and age;smokers and individuals with higher heart rate or hypertension must be given attention to the occurrence of EVA.
Objective:To describe the distribution of brachial-ankle pulse wave velocity(baPWV)and analyze the risk factors of early vascular aging in the youth and the middle-aged population.Method:The health reports of the youth and the middle-aged individuals who underwent physical examination from 2010 to 2017 were retrospectively analyzed.The distribution and the normal/reference values of baPWVwere described.The individuals whose baPWV were above the mean value of the population of the same age and gender with two standard deviations were diagnosed with early vascular aging(EVA),and the risk factors were discussed.Result:baPWV increased with age,and the baPWV of males were higher than that of females in every age group(P<0.001).The mean/lower limit of the 95 th percentile was 1 167/1 421,1 256/1 517,1 348/1 671,1 425/1 793 cm/s in the males of under 30,30-39,40-49,50-59 years old respectively;and were 1 043/1 270,1 158/1 331,1 209/1 489,1 371/1 745 cm/s in females.A total of 203 EVA patients(114 men and 64 women)were diagnosed,and the age-and gender-matched non-EVA individuals were randomly chosen as the control group.Univariate logistic regression analysis showed that smoking,drinking,heart rate,systolic blood pressure,diastolic blood pressure,mean arterial pressure,fasting blood glucose,glycated hemoglobin A1 c,total triglyceride,creatinine and uric acid were risk factors for EVA(all P<0.05).Smoking,heart rate and mean arterial pressure were still significant in the multivariate logistic regression model(all P<0.05),which indicated that they were independent risk factors for EVA.Conclusion:It is valuable to establish the reference value of baPWV according to different gender and age;smokers and individuals with higher heart rate or hypertension must be given attention to the occurrence of EVA.
引文
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[13]陶军,周紫婷,袁勇.早期血管衰老的临床识别和干预[J].中华保健医学杂志,2018,20(4):273-275.
[14]Papakatsika S,Stabouli S,Antza C,et al.Early vascular aging:A new target for hypertension treatment[J].Curr Pharm Des,2016,22(1):122-126.
[15]Cunha PG,Cotter J,Oliveira P,et al.Pulse wave velocity distribution in a cohort study:from arterial stiffness to early vascular aging[J].J Hypertens,2015,33(7):1438-1445.
[16]Wang M,Luo X,Xu S,et al.Trends in smoking prevalence and implication for chronic diseases in China:serial national cross-sectional surveys from 2003to 2013[J].Lancet Respir Med,2019,7(1):35-45.
[17]Lu J,Lu Y,Wang X,et al.Prevalence,awareness,treatment,and control of hypertension in China:data from 1.7million adults in a population-based screening study(China PEACE Million Persons Project)[J].Lancet,2017,390(10112):2549-2558.
[2]Kotsis V,Stabouli S,Karafillis I,et al.Early vascular aging and the role of central blood pressure[J].J Hypertens,2011,29(10):1847-1853.
[3]Ji H,Xiong J,Yu S,et al.Northern Shanghai Study:cardiovascular risk and its associated factors in the Chinese elderly-a study protocol of a prospective study design[J].BMJ Open,2017,7(3):e013880.
[4]Cunha PG,Boutouyrie P,Nilsson PM,et al.Early vascular ageing(EVA):Definitions and clinical applicability[J].Curr Hypertens Rev,2017,13(1):8-15.
[5]中华医学会老年医学分会心血管学组.血管衰老临床评估与干预中国专家共识(2018)[J].中华老年医学杂志,2018,37(11):1177-1184.
[6]Yamashina A,Tomiyama H,Takeda K,et al.Validity,reproducibility,and clinical significance of noninvasive brachial-ankle pulse wave velocity measurement[J].Hypertens Res,2002,25(3):359-364.
[7]Reference Values for Arterial Stiffness'Collaboration.Determinants of pulse wave velocity in healthy people and in the presence of cardiovascular risk factors:'establishing normal and reference values'[J].Eur Heart J,2010,31(19):2338-2350.
[8]高竞生,宋路,吴云涛,等.开滦研究人群臂-踝脉搏波传导速度的正常值及参考范围[J].中华心血管病杂志,2016,44(12):1047-1051.
[9]Ai Z S,Li J,Liu ZM,et al.Reference value of brachialankle pulse wave velocity for the eastern Chinese population and potential influencing factors[J].Braz JMed Biol Res,2011,44(10):1000-1005.
[10]Wang X,Xie J,Zhang LJ,et al.Reference values of brachial-ankle pulse wave velocity for Northern Chinese[J].Chin Med J(Engl),2009,122(18):2103-2106.
[11]O'Rourke MF,Nichols WW.Aortic diameter,aortic stiffness,and wave reflection increase with age and isolated systolic hypertension[J].Hypertension,2005,45(4):652-658.
[12]黄葵,张存泰.血管老化概述[J].中华老年医学杂志,2016,35(10):1030-1033.
[13]陶军,周紫婷,袁勇.早期血管衰老的临床识别和干预[J].中华保健医学杂志,2018,20(4):273-275.
[14]Papakatsika S,Stabouli S,Antza C,et al.Early vascular aging:A new target for hypertension treatment[J].Curr Pharm Des,2016,22(1):122-126.
[15]Cunha PG,Cotter J,Oliveira P,et al.Pulse wave velocity distribution in a cohort study:from arterial stiffness to early vascular aging[J].J Hypertens,2015,33(7):1438-1445.
[16]Wang M,Luo X,Xu S,et al.Trends in smoking prevalence and implication for chronic diseases in China:serial national cross-sectional surveys from 2003to 2013[J].Lancet Respir Med,2019,7(1):35-45.
[17]Lu J,Lu Y,Wang X,et al.Prevalence,awareness,treatment,and control of hypertension in China:data from 1.7million adults in a population-based screening study(China PEACE Million Persons Project)[J].Lancet,2017,390(10112):2549-2558.