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目的探讨极速成像技术测定高血压患者的脉搏波传导速度(PWV)及相关影响因素。方法选择南京中医药大学附属医院自2015年5月至2016年8月收治的高血压患者(高血压组)110例和同期体检健康者(对照组)78人,利用极速成像技术测量颈动脉弹性参数,包括收缩期开始时PWV(BS-PWV)和收缩期结束时PWV(ES-PWV)。测量两组颈动脉内膜中层厚度(IMT)。采用Bland-Altman方法对两位医师测量数据的一致性进行评估。比较两组受检者的性别、年龄构成、体质量指数(BMI)、收缩压、舒张压、BS-PWV、ES-PWV以及肌酐、尿酸、总胆固醇、三酰甘油、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖和尿素氮水平。结果不同操作者测量的BS-PWV和ES-PWV数据具有较好的一致性。高血压组患者的年龄、BMI、收缩压、舒张压、三酰甘油、总胆固醇、空腹血糖、尿酸、肌酐、尿素氮、颈动脉IMT、BS-PWV及ES-PWV水平高于对照组(P<0.05),而HDL-C水平低于对照组(P<0.05)。随着血压分级的增加,颈动脉IMT、BS-PWV和ES-PWV在3组中呈增高趋势,高血压1、2级组间和1、3级组间IMT的差异有统计学意义,高血压1、3级组间BS-PWV的差异有统计学意义,而ES-PWV各组间差异均有统计学意义。Pearson相关分析显示,在全部受检者中,ES-PWV与年龄、收缩压、舒张压、三酰甘油、空腹血糖、尿酸呈正相关(r值分别为0.505、0.353、0.299、0.212、0.176、0.215,均P<0.05),与HDL-C呈负相关(r=-0.221,P<0.05);而BS-PWV与各因素均无明显相关性。多元线性逐步回归分析显示,年龄、舒张压、三酰甘油是ES-PWV的独立影响因素(β值分别为0.487、0.253和0.129,均P<0.05)。结论高血压患者BS-PWV及ES-PWV值明显升高,且ES-PWV敏感性高于BS-PWV,可作为评价颈动脉弹性功能的指标。
Objective To investigate the pulse wave velocity (PWV) and related influencing factors in patients with hypertension by means of speed imaging. Methods 110 patients with hypertension (hypertension group) and 78 healthy subjects (control group) were enrolled in the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from May 2015 to August 2016. The speed of carotid artery elasticity Parameters include PWV (BS-PWV) at onset of systole and PWV (ES-PWV) at systole. Carotid artery intima-media thickness (IMT) was measured in both groups. The Bland-Altman method was used to evaluate the consistency of the data measured by two physicians. The gender, age composition, body mass index (BMI), systolic blood pressure, diastolic blood pressure, BS-PWV, ES-PWV and creatinine, uric acid, total cholesterol, triglyceride and high density lipoprotein cholesterol HDL-C), low density lipoprotein cholesterol (LDL-C), fasting blood glucose and urea nitrogen levels. Results The BS-PWV and ES-PWV data measured by different operators had good agreement. The levels of BMI, systolic blood pressure, diastolic blood pressure, triglyceride, total cholesterol, fasting blood glucose, uric acid, creatinine, blood urea nitrogen, carotid IMT, BS-PWV and ES-PWV in hypertension group were higher than those in control group <0.05), while the level of HDL-C was lower than that of the control group (P <0.05). The carotid IMT, BS-PWV and ES-PWV tended to increase in the three groups with the increase of blood pressure classification. There was a significant difference in IMT between the two groups The difference of BS-PWV between the first and third level of blood pressure was statistically significant, while the difference of ES-PWV between the two groups was statistically significant. Pearson correlation analysis showed that there was a positive correlation between ES-PWV and age, systolic blood pressure, diastolic blood pressure, triglyceride, fasting blood glucose and uric acid in all the subjects (r = 0.505,0.353,0.299,0.212,0.176,0.215 , All P <0.05), but negatively correlated with HDL-C (r = -0.221, P <0.05). There was no significant correlation between BS-PWV and other factors. Multivariate linear stepwise regression analysis showed that age, diastolic blood pressure and triglyceride were independent risk factors of ES-PWV (β = 0.487,0.253 and 0.129, P <0.05, respectively). Conclusions The values of BS-PWV and ES-PWV in patients with hypertension are significantly higher than those in patients with BS-PWV. ES-PWV can be used as an index to evaluate the elasticity of carotid artery.