儿童青少年外周动脉顺应性、血管内皮功能的年龄变化规律及与心血管疾病危险因素的关系

摘要

Objective To investigate the distribution of peripheral arterial stiffness,endothelial function and their correlations with cardiovascular risk factors in the 7-17 year-olds.Methods Normal weight and obese subjects aged 7-17 years with completed data on questionnaires,anthropometric and blood biochemical tests,were recruited from a cross-sectional population-based study on childhood hypertension in Minhang district of Shanghai.Automatic waveform analyzer (BP-203RPE-I) and Endopat 2000 were used to measure the arterial stiffness.Endothelial function with brachial-ankle pulse wave velocity (baPWV) and reactive hyperemia index (RHI) were recorded.BaPWV and RHI were standardized by age.Skewed biochemical variables were log transformed.Linear correlation analysis was performed to observe association between baPWV,RHI and other measured variables.Results A total of 452 normal-weight and 94 obese subjects were recruited,including 299 males.Data showed that baPWV and RHI increased with age in normal weight subjects (r=0.33,P＜0.01;r=0.36,P＜0.01).Results from Linear correlation analysis revealed that baPWV was positively correlated with BMI (r=0.13,P=0.002),systolic blood pressure (SBP) (r=0.20,P＜0.01),diastolic blood pressure (DBP) (r=0.27,P＜0.01),triglycerides (TG) (r=0.11,P=0.010),insulin (r=0.21,P=0.004) and the HOMA insulin resistance index (r=0.21,P=0.005),but negatively correlated with high-density lipoprotein cholesterol (r=-0.09,P=0.039).RH1 was positively correlated with BMI (r=0.10,P=0.018) but negatively correlated with DBP (r=-0.10,P=0.016).Males had higher baPWVs than females (P=0.04).However,RHI did not differ between genders.Conclusions The fact that baPWV and RHI increased along with age,indicated that the arterial stiffness and endothelial function continued to develop in normal weight childhood and adolescence.Arterial stiffness was correlated with cardiovascular risk-related parameters whereas endothelial function was not.BaPWV might be more sensitive in evaluating the cardiovascular risk in children and adolescents than RHI did.%目的 探讨儿童青少年外周动脉顺应性和内皮功能的年龄变化规律及其与肥胖相关测量指标和心血管疾病危险因素的关系.方法 在上海市闵行区儿童青少年血压流行病学调查人群中选取7～17岁体重正常和超重/肥胖者,分别采用动脉硬化检测仪、Endopat2000无创内皮功能检测仪测定动脉顺应性、血管内皮功能,测量肱踝脉搏波速度(baPWV)、充血反应指数(RHI)及体格、血压和空腹血生化指标.分析baPWV、RHI随年龄的变化规律.对相关测量指标进行年龄标准化以及偏态分布的指标正态化转换后,使用简单线性相关分析观察baPWV、RHI与肥胖相关测量指标、心血管疾病危险因素的关系.结果 452名体重正常和94名超重/肥胖者完成动脉顺应性和血管内皮功能检测,其中299名(54.76％)为男性.简单线性相关分析显示,正常体重者中baPWV、RHI与年龄呈弱正相关关系(r=0.33,P＜0.01;r=0.36,P＜0.01).baPWV与标准化(z)BMI(r=0.13,P =0.002)、SBP (r=0.20,P＜0.01)、DBP(r=0.27,P＜ 0.01)、TG(r=0.11,P=0.010)、胰岛素(r=0.21,P=0.004)、胰岛素抵抗指数(r=0.21,P=0.005)呈正相关关系,与HDL-C呈负相关关系(r=-0.09,P=0.039).RHI与z BMI呈正相关关系(r=0.10,P=0.018),与DBP呈弱的负相关关系(r=-0.10,P=0.016),与其他测量指标无显著性相关.baPWV在男性略高于女性,而RHI无性别差异.结论 baPWV、RHI测量值在7～17岁间随年龄增长整体呈上升趋势,提示动脉顺应性和血管内皮功能在此期间处在不断发育的过程.动脉顺应性的变化与心血管疾病危险相关测量指标的变化具有相关性,而血管内皮功能则仅在超重/肥胖儿童中表现出提前发育的现象,与血压、胰岛素抵抗等心血管疾病的危险因素未表现出相关性.对儿童青少年人群心血管疾病危险的早期评估,测量动脉顺应性可能比血管内皮功能指标更敏感.