极速脉搏波技术评价单纯收缩期高血压患者颈动脉弹性

doi:10.3877/cma.j.issn.1672-6448.2019.09.006

目的

应用极速脉搏波技术（UFPWV）评价单纯收缩期高血压（ISH）患者、双期高血压（SDH）患者颈总动脉弹性情况；比较UFPWV技术所检测的颈总动脉前壁心脏收缩起始脉搏波速度（BS）、心脏收缩末期脉搏波速度（ES）值与传统颈总动脉内中膜厚度（IMT）值在早期动脉硬化评估方面的优越性。

方法

选取于2017年12月至2018年9月就诊于华北理工大学附属医院的住院患者125例：包括ISH患者42例［（56.69±6.16）岁］、SDH患者39例［（55.97±7.23）岁］、正常血压人群44名为健康对照组［（55.18±8.20）岁］。常规二维测量IMT，采用UFPWV检测BS、ES。对上述各组间的BS、ES及IMT值进行单因素方差分析，组内采用LSD-t检验行两两比较。

结果

SDH组IMT、BS值明显高于健康对照组，差异均有统计学意义（t=-2.302、-3.143，P均<0.05）。ISH组IMT、BS、ES值均明显高于健康对照组，差异均有统计学意义（t=-5.024、-3.961、-4.010，P均<0.05）。ISH组BS、ES值均明显高于SDH组，差异均有统计学意义（t=2.596、-2.801，P均<0.05）。

结论

ISH患者较SDH患者血管弹性减低明显，更易发生动脉硬化。在评价早期评价动脉硬化方面，UFPWV较常规二维IMT测量更为敏感。

关键词: 脉搏波传导速度, 收缩期高血压, 动脉硬化, 颈动脉, 动脉弹性

Objective

To quantitatively assess the carotid artery elasticity using ultrafast pulse wave velocity (UFPWV) in patients with ISH and in those with combined systolic and diastolic hypertension (SDH), and to compare the performance of UFPWV versus intima media thickness (IMT) in early evaluation of atherosclerosis.

Methods

Eighty-one patients with hypertension were selected as a study group, including 42 patients with ISH and 39 patients with SDH. Meanwhile, 44 healthy volunteers were selected as a control group. The IMT was measured routinely. UFPWV was used to analyze the ultrafast pulse wave velocity at the beginning (BS) and ending of the systole (ES). All statistical analyses in this study were performed using SPSS statistical software. One-way ANOVA was used to analyze measurement parameters among the above groups, and LSD-t test was used for further comparison.

Results

For IMT, BS, and ES, there were significant differences among the three groups. The IMT and BS in the SDH group were significantly greater than those in the healthy control group (t=-2.302, -3.143, all P<0.05). The IMT, BS, and ES in the ISH group were significantly greater than those in the healthy control group (t=-5.024, -3.961, -4.010, all P<0.05). The BS and ES in the ISH group were significantly greater than those in the SDH group (t=2.596, -2.801, P<0.05).

Conclusions

Patients with ISH have a higher risk of arteriosclerosis compared with patients with SDH. UFPWV is more sensitive than IMT in early evaluation of atherosclerosis.

Key words: PWV, Isolated systolic hypertension, Arteriosclerosis, Carotid, Artery Elasticity

图1 健康人左侧颈总动脉极速脉搏波技术声像图。系统自动测量出颈总动脉前壁脉搏波速度（含收缩起始脉搏波速度5.48 m/s、收缩末期脉搏波速度8.29 m/s，Δ±为检测的稳定性0.41 m/s）

表1 健康对照组与ISH组及SDH组间一般资料比较

组别	例数	男性/女性	年龄（岁，±s）	心率（次/min，±s）	收缩压（mmHg，±s）	舒张压（mmHg，±s）	脉压（mmHg，±s）
健康对照组	44	21/23	55.18±8.20	69.02±10.85	124.38±10.39	76.92±7.31	47.52±8.61
ISH组	42	19/23	56.69±6.16	68.38±11.06	145.74±7.07^a	82.67±4.98^aC	63.17±8.39^aC
SDH组	39	18/21	55.97±7.23	69.15±10.59	147.87±10.12^b	94.33±7.33^b	53.64±7.02^b
统计值	?	χ²=0.06	F=0.46	F=0.06	F=82.86	F=72.26	F=40.86
P值	?	0.973	0.630	0.942	0.000	0.000	0.000

表1 健康对照组与ISH组及SDH组间一般资料比较

组别	例数	男性/女性	年龄（岁，±s）	心率（次/min，±s）	收缩压（mmHg，±s）	舒张压（mmHg，±s）	脉压（mmHg，±s）
健康对照组	44	21/23	55.18±8.20	69.02±10.85	124.38±10.39	76.92±7.31	47.52±8.61
ISH组	42	19/23	56.69±6.16	68.38±11.06	145.74±7.07^a	82.67±4.98^aC	63.17±8.39^aC
SDH组	39	18/21	55.97±7.23	69.15±10.59	147.87±10.12^b	94.33±7.33^b	53.64±7.02^b
统计值	?	χ²=0.06	F=0.46	F=0.06	F=82.86	F=72.26	F=40.86
P值	?	0.973	0.630	0.942	0.000	0.000	0.000

表2 健康对照组与ISH组及SDH组间BS、ES、IMT参数比较（±s）

组别	例数	BS（m/s）	ES（m/s）	IMT（mm）
健康对照组	44	6.00±1.08	8.22±1.74	0.74±0.13
ISH组	42	7.70±1.57^ac	9.70±1.77^ac	0.90±0.18^a
SDH组	39	6.79±1.99^b	8.62±1.68	0.87±0.23^b
F值	?	12.623	8.308	9.015
P值	?	0.000	0.000	0.000

表2 健康对照组与ISH组及SDH组间BS、ES、IMT参数比较（±s）

组别	例数	BS（m/s）	ES（m/s）	IMT（mm）
健康对照组	44	6.00±1.08	8.22±1.74	0.74±0.13
ISH组	42	7.70±1.57^ac	9.70±1.77^ac	0.90±0.18^a
SDH组	39	6.79±1.99^b	8.62±1.68	0.87±0.23^b
F值	?	12.623	8.308	9.015
P值	?	0.000	0.000	0.000

[1]	Ettehad D, Emdin CA, Kiran A, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis [J]. Lancet, 2016, 387(10022): 957-967.
[2]	Tsimploulis A, Sheriff HM, Lam PH, et al. Systolic-diastolic hypertension versus isolated systolic hypertension and incident heart failure in older adults: Insights from the Cardiovascular Health Study [J]. Int J Cardiol, 2017, 235: 11-16.
[3]	Smulyan H, Mookherjee S, Safar ME. The two faces of hypertension: role of aortic stiffness [J]. J Am Soc Hypertens, 2016, 10(2): 175-183.
[4]	Kim NR, Kim HC. Prevalence and Trends of Isolated Systolic Hypertension among Korean Adults: the Korea National Health and Nutrition Examination Survey, 1998-2012 [J]. Korean Circ J, 2015, 45(6): 492-499.
[5]	曹培，梁冰. 脉搏波传导速度在老年高血压病中的研究进展 [J]. 海南医学, 2017, 28(1): 124-127.
[6]	Taivainen SH, Yli-Ollila H, Juonala M, et al. Interrelationships between indices of longitudinal movement of the common carotid artery wall and the conventional measures of subclinical arteriosclerosis [J]. Clin Physiol Funct Imaging, 2015, 37(3): 305-313.
[7]	Franklin SS, Jacobs MJ, Wong ND, et al. Predominance of isolated systolic hypertension among middle-aged and elderly US hypertensives: analysis based on National Health and Nutrition Examination Survey (NHANES) III [J]. Hypertension, 2001, 37(3): 869-874.
[8]	Wallace SM, Yasmin, McEniery CM, et al. Isolated systolic hypertension is characterized by increased aortic stiffness and endothelial dysfunction [J]. Hypertension, 2007, 50(1): 228-233.
[9]	Seo JY, Kim MK, Choi BY, et al. Elevated brachial-ankle pulse wave velocity is independently associated with microalbuminuria in a rural population [J]. J Korean Med Sci, 2014, 29(7): 941-949.
[10]	Ni Y, Wang H, Hu D, et al. The relationship between pulse wave velocity and pulse pressure in Chinese patients with essential hypertension [J]. Hypertens Res, 2003, 26(11): 871-874.
[11]	Satoh H, Saijo Y, Kishi R, et al. Brachial-ankle pulse wave velocity is an independent predictor of incident hypertension in Japanese normotensive male subjects [J]. Environ Health Prev Med, 2011, 16(4): 217-223.

[1]	曹雯佳, 刘学兵, 罗安果, 钟释敏, 邓岚, 王玉琳, 李赵欢. 超声矢量血流成像对2型糖尿病患者颈动脉壁剪切应力的研究[J/OL]. 中华医学超声杂志（电子版）, 2024, 21(07): 709-717.
[2]	袁晓峰, 惠品晶, 颜燕红, 张炎, 蔡忻懿. 椎动脉椎间段血流动力学参数评估椎动脉颅内段狭窄性病变的效能及可行性研究[J/OL]. 中华医学超声杂志（电子版）, 2024, 21(04): 399-407.
[3]	赫兰, 杨泽堃, 张颖, 王玉东, 陈伟导, 王一同, 申锷. 双输入BCNN-ResNet模型对超声颈动脉斑块稳定性的分类诊断价值[J/OL]. 中华医学超声杂志（电子版）, 2024, 21(02): 137-142.
[4]	张莲莲, 惠品晶, 丁亚芳. 颈部血管超声在粥样硬化斑块易损性评估中的应用价值[J/OL]. 中华医学超声杂志（电子版）, 2023, 20(08): 816-821.
[5]	马艳波, 华扬, 刘桂梅, 孟秀峰, 崔立平. 中青年人颈动脉粥样硬化病变的相关危险因素分析[J/OL]. 中华医学超声杂志（电子版）, 2023, 20(08): 822-826.
[6]	王珏, 陈赛君, 贲志飞, 詹锦勇, 徐开颖. 剪切波弹性成像联合极速脉搏波技术评估颈动脉弹性对糖尿病性视网膜病变的预测价值[J/OL]. 中华医学超声杂志（电子版）, 2023, 20(06): 636-641.
[7]	王卉, 薛宝睿, 李恭驰, 刘慧真, 雷霞, 李炳辉. 2型糖尿病患者下肢动脉硬化的影响因素分析[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(02): 147-152.
[8]	孙艺玮, 陈炜, 秦巍, 杜景辰, 孟昕, 周永军. 血管腔内介入治疗糖尿病足合并下肢动脉硬化闭塞症患者术后再狭窄与血清炎症因子的相关性[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(01): 34-40.
[9]	张月. 短暂性颈动脉血管周围炎导致颈部疼痛的诊疗分析[J/OL]. 中华口腔医学研究杂志(电子版), 2024, 18(05): 336-339.
[10]	赵峰, 邓默. 纤维蛋白原水平、踝肱指数与外周血管支架治疗下肢动脉硬化闭塞症后再狭窄的关系[J/OL]. 中华临床医师杂志(电子版), 2024, 18(02): 144-151.
[11]	史宛瑞, 崔立刚. 颈动脉一过性血管周围炎综合征的影像学诊断研究进展[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(05): 516-519.
[12]	刘焕亮, 崔慧娟, 曹慧, 付源. 颈动脉狭窄处剪切率对高同型半胱氨酸血症患者脑梗死的预测价值[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(04): 317-322.
[13]	张顺, 杨希孟, 陆军, 王海峰, 张东. 是否留置术区引流管对颈动脉内膜切除术围手术期安全性的影响[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(03): 210-214.
[14]	陈绚, 欧宁江, 叶洁梅, 邓瑾倩. 纤维蛋白原β链启动因子基因多态性与颈动脉粥样硬化斑块稳定性的关联性研究[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(01): 33-39.
[15]	王俊杰, 尹晓亮, 刘二腾, 陆军, 祁鹏, 胡深, 杨希孟, 陈鲲鹏, 张东, 王大明. 机器学习对预测颈内动脉非急性闭塞患者血管内再通术成功的潜在价值[J/OL]. 中华脑血管病杂志(电子版), 2023, 17(05): 464-470.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Evaluation of carotid arterial elasticity using ultrafast pulse wave velocity in patients with isolated systolic hypertension

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Evaluation of carotid arterial elasticity using ultrafast pulse wave velocity in patients with isolated systolic hypertension