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目的探讨动态血压及其模拟家庭自测血压评价动态动脉硬化指数(ambulatory arterial stiffness index,AASI)的方法学简化。方法连续入选81例行24小时动态血压监测的患者。AASI的计算:首先根据血压监测所得舒张压与收缩压之间的关系计算出回归斜率,AASI定义为1减去该斜率。AASI2的计算:把动态血压监测数值按收缩压排序,从中选取收缩压的25%及75%分位数,计算出该两个收缩压对应的血压间关系的回归斜率。AASI2定义为1减去该斜率。家庭自测血压的模拟简化(AASI4):应用24小时动态血压监测期间7:00、12:00、18:00、22:00 4个时间点的血压模拟家庭自测的4次血压。AASI4定义为1减去该4点舒张压与收缩压关系的斜率。Sym-AASI的计算:1-(1-AASI)/r,其中r为动态血压直线回归模型的相关系数。结果 AASI为0.51±0.16,AASI2为0.50(0.24,0.68),两组比较差异无统计学意义(Z=-1.196,P>0.05),两者无相关性(r=0.186,P>0.05);AASI4为0.52(0.29,0.71),与标准AASI差异无统计学意义(Z=-0.480,P>0.05),两者无相关性(r=0.123,P>0.05);标准的sym-AASI为0.26±0.16,4点sym-AASI4为0.29(0.08,0.47),两组比较差异无统计学意义(Z=-0.005,P>0.05),且两者呈正相关关系(r=0.307,P<0.01)。Bland-Altman及Mountain plot分析显示标准AASI与AASI2、AASI4不能替换使用,sym-AASI与sym-AASI4不能够替换使用。结论简化AASI2不能替代标准AASI,不能利用1日内家庭自测血压值来简化AASI的计算。
Objective To explore the methodological simplification of ambulatory arterial stiffness index (AASI) using ambulatory blood pressure and mimicking home-based blood pressure measurement. Methods A total of 81 consecutive patients undergoing ambulatory blood pressure monitoring for 24 hours were enrolled. Calculation of AASI: The regression slope is first calculated from the relationship between diastolic blood pressure and systolic blood pressure monitored by the blood pressure monitor. The AASI is defined as 1 minus this slope. Calculation of AASI2: The ambulatory blood pressure monitoring values are sorted by systolic pressure, and the 25% and 75% quantile of systolic pressure are selected to calculate the regression slope of the relationship between the two systolic blood pressures. AASI2 is defined as 1 minus this slope. Simplified simulation of home-based blood pressure (AASI4): Blood pressure at 4:00:00, 12:00:00, 18:00, 12:00 at 24 hours of ambulatory blood pressure monitoring was used to simulate 4 home-based blood pressure measurements. AASI4 is defined as 1 minus the slope of the 4-point diastolic to systolic blood pressure. Calculation of Sym-AASI: 1- (1-AASI) / r, where r is the correlation coefficient of the ambulatory blood pressure linear regression model. Results The AASI was 0.51 ± 0.16 and the AASI2 was 0.50 (0.24,0.68). There was no significant difference between the two groups (Z = -1.196, P> 0.05). There was no correlation between them (r = 0.186, P> 0.05). AASI4 was 0.52 (0.29, 0.71), and there was no significant difference with standard AASI (Z = -0.480, P> 0.05). There was no correlation between them (r = 0.123, ± 0. 16, and sym-AASI4 were 0.29 (0.08,0.47) respectively. There was no significant difference between the two groups (Z = -0.005, P> 0.05) . Bland-Altman and Mountain plot analysis showed that the standard AASI and AASI2, AASI4 can not be replaced, sym-AASI and sym-AASI4 can not be used interchangeably. Conclusion Simplified AASI2 can not replace the standard AASI, can not use the family self-test blood pressure within 1 day to simplify the calculation of AASI.