健康体检人群脉压与脑血流动力学指标变化的关系

摘要

Objective To investigate the effect of the increased pulse pressure on cerebrovascular hemodynamic index.Methods From January 2014 to October 2016,the application of the method of cross-sectional study,6 006 consecutive health subjects examined and detected with ultrasound noninvasive cerebral hemodynamic index (CVHI) at the Physical Examination Center,Pu′er People′s Hospital,Yunnan Province were enrolled.In order to control the influence of age and gender on the results,according to age and gender in the increased pulse pressure group (≥60 mmHg),and the same sex and age difference of not more than 1 years old were selected as the inclusion criteria in the normal pulse pressure group (60 mmHg).Finally,1 115 subjects were enrolled as a control group for comparative analysis.The study population was divided into an increased pulse pressure group (n=590) and a normal pulse pressure group (n=1 115) in a mixed manner.The differences of CVHI index and its integral score of both groups were compared.The correlation of the increased pulse pressure level and changes of cerebrovascular hemodynamic accumulative scores were analyzed.Results The minimum velocity,mean velocity,and critical pressure in the increased pulse pressure group were significantly lower than those in the normal pulse pressure group (P<0.05),while the differences of the peripheral vascular resistance,characteristic impedance,pulse wave velocity,dynamic resistance,diastolic blood pressure,and critical pressure were significant higher than those in the normal pulse pressure group.There were significant differences (P<0.01).The integral values of cerebral hemodynamics in the increased pulse pressure group and the normal pulse pressure group were 76±22 and 88±19 respectively.There was significant difference (P<0.01).The proportion of the integral value <75 was 34.4% (203/590) and 15.6% respectively (174/1 115,P<0.01).With the increase of pulse pressure level,the integral value of cerebral hemodynamics showed a significant downward trend,there was a significant negative correlation between the two (r=-0.312,P<0.01).Conclusion The increased pulse pressure may result in the changes of cerebral hemodynamic indexes and its integral values.There is a significant negative correlation between the pulse pressure level and the integral value of cerebral hemodynamics.%目的 探讨脉压增高对脑血流动力学的影响.方法 应用横断面研究方法,连续纳入 2014年1月至2016年10月在云南省普洱市人民医院健康体检中心参加健康体检并接受超声无创性脑血流动力学指标(CVHI)检测的6 006人.为了控制年龄、性别因素对研究结果的影响,根据脉压增高组(≥60 mmHg)的年龄和性别,在脉压正常组(<60 mmHg)中选择相同性别且年龄相差不超过1岁者作为入选标准,最终纳入1 115人作为对照进行对比分析.将研究人群以配比的方式分为脉压增高组590人和脉压正常组1 115人,比较两组CVHI指标及其积分值的差异,分析脉压水平升高与脑血流动力学积分值变化的相关性.结果 脉压增高组颈动脉的最小流速、平均流速、临界压显著低于正常脉压组(P<0.05),外周阻力、特性阻抗、脉搏波波速、动态阻力、舒张压与临界压的差值等指标则显著高于脉压正常组,差异均有统计学意义(P<0.01).脉压增高组和脉压正常组的脑血流动力学积分值分别为(76±22)、(88±19)分,差异有统计学意义(P<0.01).两组积分值<75分的比例分别为34.4%(203/590)和15.6%(174/1 115,P<0.01).随着脉压水平升高,脑血流动力学积分值呈显著降低趋势,两者呈显著负相关(r=-0.312,P<0.01).结论 脉压升高可导致脑血流动力学指标及其积分值的变化,脉压水平与脑血流动力学积分值呈显著负相关.