肱—踝脉搏波速度和踝臂指数的临床应用
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摘要
目的和背景心脑血管疾病已成为威胁人类健康的主要疾病,动脉硬化在其中起着重要的作用,而高血压、糖尿病又促进动脉硬化的发展。考虑到动脉硬化程度评估在心脑疾病方面的潜在作用,脉搏波速度(Pulse Wave Velocity, PWV)和踝臂指数(Ankle-Brachial Index,ABI)作为无创的评估动脉僵硬度和动脉阻塞程度的指标,其作用也正日益引起重视。本研究希望通过无创测定脉搏波速度和踝臂指数来评估高血压、糖尿病的大动脉硬化情况及其影响因素,同时分析脉搏波速度和踝臂指数之间的关系。
方法(1)入选2005年12月至2007年3月期间我院心内科就诊的原发性高血压患者215例、内分泌科住院的2型糖尿病患者78例、高血压并糖尿病患者98例及健康者136例,共分为四组,各组研究对象分别测量肱一踝脉搏波速度(brachial-ankle Pulse Wave Velocity,baPWV)、ABI、血压及血生化指标等相关参数。采用方差分析对获得的数据进行比较,并用Pearson相关和多元逐步回归法分析baPWV的影响因素。(2)分析第一部分527例对象baPWV和ABI之间的关系,计算下肢外周动脉病患病率,并分析2型糖尿病患者ABI的危险因素。
结果(1)单纯高血压、单纯糖尿病、高血压并糖尿病组和健康对照组之间年龄、性别、体重指数等基本情况无统计学差异,前三组baPWV值明显高于健康对照组(P<0.05),高血压并糖尿病组的baPWV值明显高于单纯高血压组和单纯糖尿病组(P<0.05)。(2)健康对照组中,baPWV值和甘油三脂(TG)、总胆固醇(TC)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)均无相关性(P>0.05)。与体重指数呈正相关(r=0.417 P<0.01),baPWV值在各年龄组间比较有统计学差异(F=62.263 P<0.05),各年龄组男女之间baPWV比较有统计学差异(F=16.665 P<0.05)。(3)高血压患者中,baPWV值和TG(r=0.016 P>0.05)、TC(r=-0.005 P>0.05)、HDL(r=-0.077 P>0.05)、LDL(r=0.031 P>0.05)均无相关性。以baPWV为应变量的多元线性回归经stepwise方法计算,回归方程为baPWV(cm/s)=145.537+13.743×年龄(岁)+9.042×收缩压(mmHg)+6.035×脉压(mmHg)+11.971×体重指数(kg/m2)。(4)糖尿病患者中baPWV与空腹血糖、血脂无相关性(P>0.05),与糖尿病病程、糖化血红蛋白呈正相关(P<0.05),与年龄、血压呈正相关(P<0.01)。(5)直线回归分析表明baPWV和ABI有直线关系(P<0.05),2型糖尿病患者中,经多元线性回归分析表明ABI和HDL、LDL、TC及HbA1C有相关性,P值均小于0.05。
结论高血压、糖尿病增加了动脉硬化的危险性,两者同时存在更促进了动脉硬化的发展。年龄、性别、体重指数是大动脉僵硬度的影响因素,大动脉僵硬度随年龄的增长而升高。对高血压患者的研究中未发现大动脉僵硬度和血脂异常有关,而血压是影响大动脉僵硬度的重要因素。2型糖尿病患者大动脉僵硬度受年龄、血压、糖尿病病程和糖化血红蛋白的影响,与空腹血糖、血脂无关。血脂异常和糖化血红蛋白是下肢外周动脉病的危险因素。脉搏波速度的变化受到踝臂指数的影响。
Objective and Background The cardiovascular and cerebrovascular diseases have already become a major diease threatening people’s health . And the arteriosclerosis plays an important role in the onset of these diseases.Hypertension、diabetes can help the development of arteriosclerosis. Because of the potential effects of assessing the degree of arterioscle rosis in cardiovascular and cerebrovascular diseases,as non-invasive indexes of assessing the degree of artery stiffness and artery obstruct, the Pulse Wave Velocity(PWV) and the Ankle-Brachial Index(ABI) are causing the attention day by day too. So we are trying to estimate the large artery stiffness of hypertension and diabetes by non-invasive measurement of PWV and ABI, discussing the roles of PWV and ABI, and discussing the relation of Pulse Wave Velocity with Ankle-Brachial Index through this study.
Methods (1) 215 essential hypertension patients、78 type II diabetes patients、98 essential hypertension patients and type II diabetes patients and 136 normal adults admitted during the period of 2005 to 2007 are studied. They are separated into four groups .Every object of these groups is measured relevant parameters, such as brachial-ankle Pulse Wave Velocity、ABI、blood pressure、biochemical markers of blood ,etc. The datas are analyzed by analysis of variance(ANOVA)、pearson correlation and multivariate stepwise regression to discuss the factors influencing brachial-ankle Pulse Wave Velocity.(2)Analyzing the correlation of baPWV with ABI of 527 objects in the first part,calculating the sick rate of lower limbs’peripheral artery diease, and analyzing the risk factors of ABI in type II diabetes patients.
Result (1) There is no statistical significance in basic situations of patients among groups of hypertension、diabetes、hypertension and diabetes、health,such as age、sex、body mass index,etc. BaPWV is higher in the first three groups than that in the group of normal adults signifycantly (P<0.05), baPWV is significantly higher in the group of hypertension and diabetes than that in the groups of hypertension and diabetes(P<0.05). (2)In the group of normal adults,there is no relation of baPWV with triglyceride(TG)、total cholesterol(TC)、low-density lipoprotein(LDL)、high-density lipoprotein(HDL) (P>0.05),but baPWV positively correlats with body mass index (r=0.417 P<0.01). There is statistical significance of baPWV among age groups (F=62.263 P<0.05), and there is also statistical significance of baPWV between the two genders in every age group(F=16.665 P<0.05). (3)There is no relation of baPWV with TG(r=0.016 P>0.05)、TC(r=-0.005 P>0.05)、HDL(r=-0.077 P>0.05)、LDL(r=0.031 P>0.05)in hypertension patients. A multivariate stepwise regression demonstrates that the equation is baPWV (cm/s)= 145.537+13.743×age(year)+9.042×systolic blood pressure(mmHg)+6.035×pulse pressure(mmHg)+11.971×body mass index(kg/m2).(4) There is no relation of baPWV with fasting blood glucose and blood fat in diabetes patients(P>0.05),but there is positive relation of baPWV with course of diabetes、blood glycosylated hemoglobin(P<0.05),as the situation of age and blood pressure(P<0.01). (5)There is linear relation of baPWV with ABI by linear regression analyzing(P<0.05).Futhermore,there is relation of ABI with HDL、LDL、TC and HbA1C by the analysis of multivariate linear regression in type II diabetes patients(P<0.05).
Conclusion Hypertension and diabetes increase the dangers of arteriosclerosis,and they togetherly accelerate the development of arteriosclerosis. Age、gender and body mass index are factors influencing large artery stiffness,which is increased by age.There is no relation between large artery stiffness and blood fat in the study of hypertension patients,but blood pressure is an important factor.Our study about Type II diabetes indicates that large artery stiffness is influenced by age、blood pressure、course of diabetes and blood glycosylated hemoglobin,but is independent of fasting blood glucose and blood fat.Novel blood fat and blood glycosylated hemoglobin are hazards of lower limbs’peripheral artery disease. The Pulse Wave Velocity is influenced by Ankle-Brachial Index.
方法(1)入选2005年12月至2007年3月期间我院心内科就诊的原发性高血压患者215例、内分泌科住院的2型糖尿病患者78例、高血压并糖尿病患者98例及健康者136例,共分为四组,各组研究对象分别测量肱一踝脉搏波速度(brachial-ankle Pulse Wave Velocity,baPWV)、ABI、血压及血生化指标等相关参数。采用方差分析对获得的数据进行比较,并用Pearson相关和多元逐步回归法分析baPWV的影响因素。(2)分析第一部分527例对象baPWV和ABI之间的关系,计算下肢外周动脉病患病率,并分析2型糖尿病患者ABI的危险因素。
结果(1)单纯高血压、单纯糖尿病、高血压并糖尿病组和健康对照组之间年龄、性别、体重指数等基本情况无统计学差异,前三组baPWV值明显高于健康对照组(P<0.05),高血压并糖尿病组的baPWV值明显高于单纯高血压组和单纯糖尿病组(P<0.05)。(2)健康对照组中,baPWV值和甘油三脂(TG)、总胆固醇(TC)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)均无相关性(P>0.05)。与体重指数呈正相关(r=0.417 P<0.01),baPWV值在各年龄组间比较有统计学差异(F=62.263 P<0.05),各年龄组男女之间baPWV比较有统计学差异(F=16.665 P<0.05)。(3)高血压患者中,baPWV值和TG(r=0.016 P>0.05)、TC(r=-0.005 P>0.05)、HDL(r=-0.077 P>0.05)、LDL(r=0.031 P>0.05)均无相关性。以baPWV为应变量的多元线性回归经stepwise方法计算,回归方程为baPWV(cm/s)=145.537+13.743×年龄(岁)+9.042×收缩压(mmHg)+6.035×脉压(mmHg)+11.971×体重指数(kg/m2)。(4)糖尿病患者中baPWV与空腹血糖、血脂无相关性(P>0.05),与糖尿病病程、糖化血红蛋白呈正相关(P<0.05),与年龄、血压呈正相关(P<0.01)。(5)直线回归分析表明baPWV和ABI有直线关系(P<0.05),2型糖尿病患者中,经多元线性回归分析表明ABI和HDL、LDL、TC及HbA1C有相关性,P值均小于0.05。
结论高血压、糖尿病增加了动脉硬化的危险性,两者同时存在更促进了动脉硬化的发展。年龄、性别、体重指数是大动脉僵硬度的影响因素,大动脉僵硬度随年龄的增长而升高。对高血压患者的研究中未发现大动脉僵硬度和血脂异常有关,而血压是影响大动脉僵硬度的重要因素。2型糖尿病患者大动脉僵硬度受年龄、血压、糖尿病病程和糖化血红蛋白的影响,与空腹血糖、血脂无关。血脂异常和糖化血红蛋白是下肢外周动脉病的危险因素。脉搏波速度的变化受到踝臂指数的影响。
Objective and Background The cardiovascular and cerebrovascular diseases have already become a major diease threatening people’s health . And the arteriosclerosis plays an important role in the onset of these diseases.Hypertension、diabetes can help the development of arteriosclerosis. Because of the potential effects of assessing the degree of arterioscle rosis in cardiovascular and cerebrovascular diseases,as non-invasive indexes of assessing the degree of artery stiffness and artery obstruct, the Pulse Wave Velocity(PWV) and the Ankle-Brachial Index(ABI) are causing the attention day by day too. So we are trying to estimate the large artery stiffness of hypertension and diabetes by non-invasive measurement of PWV and ABI, discussing the roles of PWV and ABI, and discussing the relation of Pulse Wave Velocity with Ankle-Brachial Index through this study.
Methods (1) 215 essential hypertension patients、78 type II diabetes patients、98 essential hypertension patients and type II diabetes patients and 136 normal adults admitted during the period of 2005 to 2007 are studied. They are separated into four groups .Every object of these groups is measured relevant parameters, such as brachial-ankle Pulse Wave Velocity、ABI、blood pressure、biochemical markers of blood ,etc. The datas are analyzed by analysis of variance(ANOVA)、pearson correlation and multivariate stepwise regression to discuss the factors influencing brachial-ankle Pulse Wave Velocity.(2)Analyzing the correlation of baPWV with ABI of 527 objects in the first part,calculating the sick rate of lower limbs’peripheral artery diease, and analyzing the risk factors of ABI in type II diabetes patients.
Result (1) There is no statistical significance in basic situations of patients among groups of hypertension、diabetes、hypertension and diabetes、health,such as age、sex、body mass index,etc. BaPWV is higher in the first three groups than that in the group of normal adults signifycantly (P<0.05), baPWV is significantly higher in the group of hypertension and diabetes than that in the groups of hypertension and diabetes(P<0.05). (2)In the group of normal adults,there is no relation of baPWV with triglyceride(TG)、total cholesterol(TC)、low-density lipoprotein(LDL)、high-density lipoprotein(HDL) (P>0.05),but baPWV positively correlats with body mass index (r=0.417 P<0.01). There is statistical significance of baPWV among age groups (F=62.263 P<0.05), and there is also statistical significance of baPWV between the two genders in every age group(F=16.665 P<0.05). (3)There is no relation of baPWV with TG(r=0.016 P>0.05)、TC(r=-0.005 P>0.05)、HDL(r=-0.077 P>0.05)、LDL(r=0.031 P>0.05)in hypertension patients. A multivariate stepwise regression demonstrates that the equation is baPWV (cm/s)= 145.537+13.743×age(year)+9.042×systolic blood pressure(mmHg)+6.035×pulse pressure(mmHg)+11.971×body mass index(kg/m2).(4) There is no relation of baPWV with fasting blood glucose and blood fat in diabetes patients(P>0.05),but there is positive relation of baPWV with course of diabetes、blood glycosylated hemoglobin(P<0.05),as the situation of age and blood pressure(P<0.01). (5)There is linear relation of baPWV with ABI by linear regression analyzing(P<0.05).Futhermore,there is relation of ABI with HDL、LDL、TC and HbA1C by the analysis of multivariate linear regression in type II diabetes patients(P<0.05).
Conclusion Hypertension and diabetes increase the dangers of arteriosclerosis,and they togetherly accelerate the development of arteriosclerosis. Age、gender and body mass index are factors influencing large artery stiffness,which is increased by age.There is no relation between large artery stiffness and blood fat in the study of hypertension patients,but blood pressure is an important factor.Our study about Type II diabetes indicates that large artery stiffness is influenced by age、blood pressure、course of diabetes and blood glycosylated hemoglobin,but is independent of fasting blood glucose and blood fat.Novel blood fat and blood glycosylated hemoglobin are hazards of lower limbs’peripheral artery disease. The Pulse Wave Velocity is influenced by Ankle-Brachial Index.
引文
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[1] 柳兆荣,李惜惜.血液动力学原理与方法.上海复旦大学出版社,1997, 12:97,168-196.
[2] Shalak R,Keller SR,Secomb TW.Mechanics of blood flow,ASME Trans. Biomech.Eng, 1981,103:102.
[3] Bramwell JC,Hill AV.The velocity of the pulse wave in man .Proc R Soc Lond B Biol Sci,1922,93:298-306.
[4] Bramwell JC,Hill AV.Velocity of transmission of the pulse-wave and elasticity of arteries.Lancet,1922,1:891-892.
[5] Cameron R, Benetos A, Topouchian J, et al. Assessment of arterial distensi bility automatic pulse wave velocity measurement. Validation and clinical application studies. Hypertension 1995,26: 485一90.
[6] Paolo Salvia, Giuseppe Liob,et al. Validation of a new non-invasive portable tonometer for determining arterial pressure wave and pulse wave velocity: Journal of Hypertension 2004, 22:2285–2293.
[7] Hashimoto, Junichiro; Chonan, Kenichi,et al. Pulse wave velocity and the second derivative of the finger photoplethysmogram in treated hypertensive patients: their relationship and associating factors.2002,10:2341
[8] Gary F. Mitchell, Helen Parise, et al.Changes in Arterial Stiffness and Wave Reflection With Advancing Age in Healthy Men and Women. Hypetension,2004,43:1230-1245.
[9] Sandrine C. Millasseau, Andrew D. Stewart, et al. Evaluation of Carotid –Femoral Pulse Wave Velocity Influence of Timing Algorithm and Heart Rate. Hypertension, 2005, 45:222-226.
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[11] Franklin S ,Khan S ,Wong N ,et al . Is pulse pressure useful in predicting risk for coronary heart disease ? The Framingham Heart Study. Circulation ,1999 ,100 :354-360.
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