动脉整体顺应性与颈-股脉搏波传播速度的相关性

摘要

Objective To explore the correlation between arterial total compliance indices, stroke volume/pulse pressure (SV/PP), SV adjusted by body surface area/PP (SV′/PP) and carotid-femoral pulse wave velocity (PWV), and investigate the value of SV/PP, SV′/PP in the evaluation of clinical arterial stiffness (AS). Methods Forty-five hospitalized patients with coronary heart disease (CHD) in Tangdu Hospital of Fourth Military Medical University from March to December 2016 were included in this study (CHD group). Forty-five healthy volunteers who took a health checkup in Tangdu Hospital at the same period were also included as healthy controls. SV was measured by echocardiography, and the PP was calculated through traditional blood pressure measurement. Body surface area was calculated by Du Bois formula. Carotid-femoral PWV was measured by Doppler ultrasonography. Unpaired t test was used to compare the AS indices between CHD group and healthy controls. Spearman correlation analysis was used to evaluate the correlation between SV/PP, SV′/PP and carotid-femoral PWV.Results SV/PP, SV′/PP were decreased [(1.23±0.26) ml/mmHg vs(1.37±0.27) ml/mmHg, (0.66±0.13) ml/m2?mmHg vs(0.74±0.15) ml/m2?mmHg, 1 mmHg=0.133 kPa], carotid-femoral PWV was increased [(9.49±2.05) m/s vs(8.16±1.07) m/s] in CHD patients when compared with control group with statistical significance (t=2.0971,P<0.05;t=2.1643,P<0.05;t=2.8321,P<0.01, respectively). Both SV/PP and SV′/PP in healthy controls and CHD group inversely correlated with the corresponding Carotid-femoral PWV (healthy controls:r=-0.64,-0.56, bothP<0.001; CHD group:r=-0.53, P=0.0002,r=0.61,P<0.001). While SV′/PP showed a stronger correlation with carotid-femoral PWV. Conclusions Arterial total compliance decreases and AS increases in CHD patients compared with healthy controls. SV/PP, derived from echocardiography and blood pressure measurement, correlates with carotid-femoral PWV, the″golden standard″ index of AS. After adjusted by body surface area, SV′/PP correlates more strongly with carotid-femoral PWV. SV/PP and SV′/PP are expected to provide a simple and convenient way for clinical noninvasive AS evaluation.%目的 分析动脉整体顺应性指标每搏量/脉压(SV/PP)、经过体表面积矫正后的每搏量/脉压(SV′/PP)与颈-股脉搏波传播速度(PWV)的相关性,以探讨SV/PP、SV′/PP在临床动脉僵硬度(AS)评估中的应用价值.方法 选择2016年3至12月第四军医大学唐都医院收治的冠状动脉粥样硬化性心脏病(简称冠心病)患者45例(冠心病组).同时选择同期在第四军医大学唐都医院体检的健康志愿者45名作为健康对照组.采用超声心动图测量并计算SV,同时测量PP,并计算体表面积,采用超声多普勒法测量颈-股PWV.采用非配对t检验比较冠心病患者与健康对照组受试者AS及相关指标.采用Spearman相关分析评价SV/PP、经体表面积矫正后的SV′/PP与颈-股PWV的相关性.结果 与健康对照组受检者比较,冠心病组患者SV/PP、SV′/PP均降低[(1.23±0.26)ml/mmHg vs(1.37±0.27)ml/mmHg,(0.66±0.13)ml/m2?mmHg vs(0.74±0.15)ml/m2?mmHg,1 mmHg=0.133 kPa],颈-股PWV增高[(9.49±2.05)m/s vs(8.16±1.07)m/s],且差异均有统计学意义(t=2.0971,P<0.05;t=2.1643,P<0.05;t=2.8321,P<0.01).健康对照组受检者及冠心病组患者SV/PP、SV′/PP均与颈-股PWV呈负相关(健康对照组:r=-0.64、-0.56,P均<0.001;冠心病组:r=-0.53、P=0.0002,r=0.61、P<0.001),且SV′/PP较SV/PP与颈-股PWV相关性更高.结论 冠心病患者动脉整体顺应性较健康人群显著降低,AS明显增加.基于超声心动图和血压测量获得的动脉整体顺应性指标SV/PP与AS的"金指标"颈-股PWV存在显著相关关系,且经过体表面积矫正后,SV′/PP与颈-股PWV相关性更高.SV/PP、SV′/PP有望为临床AS无创性评价提供简便的指标和方法.