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目的:探讨颈-股动脉脉搏波传导速度(cfPWV)与颈总动脉结构、超声血流动力学及心脏功能参数的相关性。方法:选取2022年6月至2023年2月期间在开滦总医院完成颈部超声、心脏超声及cfPWV检测的420名体检者,以cfPWV>10 m/s为动脉硬化阈值将其分为高cfPWV组(140例,cfPWV>10 m/s)和低cfPWV组(280例,cfPWV≤10 m/s)。收集两组体检者的人口学资料(性别、年龄),比较两组间颈总动脉内径(CCAD)、内中膜厚度(CIMT)、斑块状态、收缩期峰值流速(PSV)、舒张末期流速(EDV)以及平均流速(MFV),分析心脏室间隔厚度(IVST)、左室后壁厚度(LVPWT)、二尖瓣舒张早期与晚期血流速度比值(E/A)以及每搏输出量(SV)等参数的差异。采用多因素logistic回归分析cfPWV升高的独立影响因素。结果:高cfPWV组平均年龄(61.31±9.66)岁,显著高于低cfPWV组的(51.06±10.47)岁,差异有统计学意义(t=-9.56,P<0.01)。颈总动脉参数中,高cfPWV组140名受检者中63名(占45.0%)检出斑块,低cfPWV组280名受检者中50名(占17.86%)检出斑块,两组比较差异有统计学意义(x2=34.97,P<0.05)。两组受检者右侧颈总动脉CCAD、CIMT、PSV、EDV及MV参数比较,差异有统计学意义(t=-2.16、-5.40、4.52、5.59、5.04,P<0.05)。心脏参数显示,高cfPWV组LVPWT增厚(9.35±1.13)mm、E/A<1比例增高77.86%,与cfPWV升高显著相关(r=0.27、0.38,P<0.01)。多因素回归显示,年龄(OR=1.05, 95%CI:1.02～1.08)、CCAD(OR=1.63, 95%CI:1.22～2.16)、斑块(OR=1.84, 95%CI:1.07～3.17)、LVPWT(OR=1.35, 95%CI:1.05～1.72)及E/A<1比例(OR=2.37, 95%CI:1.32～4.26)为cfPWV升高的独立预测因子。结论:cfPWV升高与高龄、颈总动脉重构(内径增宽、斑块形成)、左室肥厚及舒张功能异常密切相关,提示动脉硬化进程可能伴随血管-心脏交互作用机制的改变。
Abstract：Objective: To investigate the correlation between carotid-femoral pulse wave velocity(cfPWV) and carotid artery structural, hemodynamic, and cardiac functional parameters. Methods: A total of 420 healthy volunteers who underwent neck ultrasound, cardiac ultrasound, and cfPWV examination at Kailuan General Hospital from June 2022 to February 2023 were selected,and they were divided into two groups based on the atherosclerosis threshold value of cfPWV > 10 m/s, which included high cfPWV group(140 cases, cfPWV > 10 m/s) and low cfPWV group(280 cases, cfPWV ≤ 10 m/s). The demographic data(age, sex) of 420 persons were collected, and the common carotid artery diameter(CCAD), common carotid artery intima-media thickness(CIMT),plaque status, peak systolic velocity(PSV), end-diastolic velocity(EDV) and mean flow velocity(MFV) were compared between two groups. Then, the differences of interventricular septal thickness(IVST) of heart, left ventricular posterior wall thickness(LVPWT),the ratio of blood flow velocity at early stage to that at advanced stage in mitral valve(E/A) and stroke volume(SV) were analyzed.Multivariate logistic regression was adopted to analyze the independent influence factors of cfPWV enhancement. Results: The average age of high cfPWV group was(61.31±9.66) years old, which was significantly higher than(51.06±10.47) years old of low cfPWV group, and the difference of that was significant(t=-9.56, P<0.01). In the parameters of common carotid artery, 63 persons(45.0%) occurred plaque in 140 persons of high cfPWV group, which was significantly lower than 50 persons(17.86%) in 280persons of low cfPWV group, and the difference of that between two groups was significant(x2=34.97, P<0.05). The differences of CCAD, CIMT, PSV, EDV and MV of common carotid artery at right side of persons between two groups were significant(t=-2.16,-5.40, 4.52, 5.59, 5.04, P<0.05), respectively. The parameters of heart showed that the LVPWT thickness increased(9.35±1.13) mm,and the ratio of E/A<1 increased 77.86% in high cfPWV group, which were significantly related to the increase of cfPWV(r=0.27,0.38, P<0.01). Multivariate logistic regression analysis indicated that age(OR=1.05, 95%CI: 1.02-1.08), CCAD(OR=1.63, 95%CI:1.22-2.16), plaque presence(OR=1.84, 95%CI: 1.07-3.17), LVPWT(OR=1.35, 95%CI:1.05-1.72), and the ratio of E/A <1(OR=2.37,95%CI: 1.32-4.26) were independent predictors of cfPWV enhancement. Conclusion: The enhancement of cfPWV is closely related to high age, the reconstruction of common carotid artery(widening of inside diameter, and plaque formation), left ventricular hypertrophy, and diastolic abnormality, which indicates it is possible that atherosclerosis process accompanies by the change of interaction mechanism of blood vessels – heart.
[1]Munakata M.Brachial-ankle pulse wave velocity in the measurement of arterial stifness:recent evidence and clinical applications[J].Curr Hypertens Rev,2014,10(1):49-57.DOI:10.2174/157340211001141111160957.
[2]Kucharska-Newton AM,Stoner L,Meyer ML.Determinants of vascular age:An epidemiological perspective[J].Clin Chem,2019,65(1):108-118.DOI:10.1373/clinchem.2018.287623.
[3]Najjar SS,Scuteri A,Shetty V,et al.Pulse wave velocity is anindependent predictor of the longitudinal increase in systolic blood pressure and of incident hypertension in the Baltimore longitudinal study of aging[J].J Am Coll Cardiol,2008,51:1377-1383.DOI:10.1016/j.jacc.2007.10.065.
[4]Wardlaw JM,Smith EE,Biessels GJ,et al.Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration[J].Lancet Neurol,2013,12(8):822-838.DOI:10.1016/S1474-4422(13)70124-8.
[5]Poels MMF,Zaccai K,Verwoert GC,et al.Arterial stifness and cerebral small vessel disease:the Rotterdam scan study[J].Stroke,2012,43(10):2637-2642.DOI:10.1161/STROKEAHA.111.642264.
[6]Witt LS,Rotter J,Stearns SC,et al.Heart failure and cognitive impairment in the atherosclerosis pisk in communities(ARIC) study[J].J Gen Intern Med,2018,33(10):1721-1728.DOI:10.1007/s11606-018-4556-x.
[7]Sabayan B,van Buchem MA,Sigurdsson S,et al.Cardiac hemodynamics are linked with structural and functional features of brain aging:the age,gene/environment susceptibility(AGES)-reykjavik study[J].J Am Heart Assoc,2015,4(1):e001294.DOI:10.1161/JAHA.114.001294.
[8]Weber T,Chirinos JA.Pulsatile arterial haemodynamics in heart failure,Eur[J].Heart J,2018,39(43):3847-3854.DOI:10.1093/eurheartj/ehy346.
[9]Tsao C W,Lyass A,Larson M G,et al.Relation of central arterial stiffness to incident heart failure in the community[J].J Am Heart Assoc,2015,4(11):e002189.DOI:10.1161/JAHA.115.002189.
[10]Roth GA,Mensah GA,Johnson CO,et al.Global burden of cardiovascular diseases and risk factors,1990-2019:update from the GBD 2019 study[J].J Am Coll Cardiol,2021,77(15):1958-1959.DOI:10.1016/j.jacc.2021.02.039.
[11]Mitchell GF,Hwang SJ,Vasan RS,et al.Arterial stiffness and cardiovascular events:the Framingham heart study[J].Circulation,2010,121:505-511.DOI:10.1161/CIRCULATIONAHA.109.886655.
[12]Townsend RR,Wilkinson IB,Schiffrin EL,et al.American heart association council on hypertension.recommendations for improving and standardizing vascular research on arterial stiffness:a scientific statement from the American heart association[J].Hypertension,2015,66(3):698-722.DOI:10.1161/HYP.0000000000000033.
[13]Mancia G,Fagard R,Nar kiewicz K,et al.E S H/ESC guidelines for the management of arterial hypertension:the task force for the management of arterial hypertension of the European Society of Hypertension(ESH) and of the European Society of Cardiology(ESC)[J].Eur Heart J,2013,34:2159-2219.DOI:10.1093/eurheartj/eht151.
[14]DuPont JJ,Kenney RM,Patel AR,et al.Sex differences in mechanisms of arterial stiffness[J].Br J Pharmacol,2019,176(21):4208-4225.DOI:10.1111/bph.14624.
[15]Sumbul HE,Koc AS,Demirtas D.Increased carotidfemoral pulse wave velocity and common carotid artery intima-media thickness obtained to assess target organ damage in hypertensive patients are closely related[J].Clin Exp Hypertens,2019,41(5):466-473.DOI:10.1080/10641963.2018.1506471.
[16]Agbaje AO,Zachariah JP,Tuomainen TP.Arterial stiffness but not carotid intima-media thickness progression precedes premature structural and functional cardiac damage in youth:a 7-year temporal and mediation longitudinal study[J].Atherosclerosis,2023,380:117197.DOI:10.1016/j.atherosclerosis.2023.117197.
[17]Benetos A,Laurent S,Hoeks AP,et al.Arterial alterations with aging and high blood pressure.a noninvasive study of carotid and femoral arteries[J].Arterioscler Thromb,1993,13(1):90-97.DOI:10.1161/01.atv.13.1.90.
[18]Riley WA,Evans GW,Sharrett AR,et al.Variation of common carotid artery elasticity with intimal-medial thickness:the ARIC study.atherosclerosis risk in communities[J].Ultrasound Med Biol,1997,23(2):157-164.DOI:10.1016/s0301-5629(96)00211-6.
[19]Ikonomidis I,Aboyans V,Blacher J,et al.The role of ventricular-arterial coupling in cardiac disease and heart failure:assessment,clinical implications and therapeutic interventions.a consensus document of the European Society of Cardiology Working Group on Aorta&Peripheral Vascular Diseases,European Association of Cardiovascular Imaging,and Heart Failure Association[J].Eur J Heart Fail,2019,21(4):402-424.DOI:10.1002/ejhf.1436.
[20]Chirinos JA,Segers P,Rietzschel ER,et al.Asklepios investigators.early and latesystolic wall stress differentially relate to myocardial contraction and relaxationin middleaged adults:the Asklepios study[J].Hypertension,2013,61:296-303.DOI:10.1161/HYPERTENSIONAHA.
[21]Yang L,Sun X,Tao H,et al.Arterial stiffness and left ventricular diastolic function in subjects with euthyroidism[J].Rev Cardiovasc Med,2022,23(5):150.DOI:10.31083/j.rcm2305150.
[22]Ripley DP,Negrou K,Oliver JJ,et al.Aortic remodelling following the treatment and regression of hypertensive left ventricular hypertrophy:a cardiovascular magnetic resonance study[J].Clin Exp Hypertens,2015,37(4):308-316.DOI:10.3109/10641963.2014.960974.
[23]Wang J,Zheng X,Sun M,et al.REACTION Study group.low serum free thyroxine concentrations associate with increased arterial stiffness in euthyroid subjects:a population-based cross-sectional study[J].Endocrine,2015,50(2):465-473.DOI:10.1007/s12020-015-0602-1.
[24]Shah AS,Gidding SS,El Ghormli L,et al.TODAYStudy group.relationship between Arterial Stiffness and Subsequent cardiac structure and function in young adults with youth-onset type 2 diabetes:results from the TODAYstudy[J].J Am Soc Echocardiogr,2022,35(6):620-628.DOI:10.1016/j.echo.2022.02.001.
[25]Chirinos JA,Akers SR,Schelbert E,et al.Arterial properties as determinants of left ventricular mass and fibrosis in severe aortic stenosis:findings from ACRINPA 4008[J].J Am Heart Assoc,2019,8(1):e03742.DOI:10.1161/JAHA.118.010271.
基本信息:
DOI：
中图分类号:R445.1;R54
引用信息:
[1]马霞,惠颖,王建姣等.颈-股动脉脉搏波传导速度与颈总动脉及心脏超声血流动力学参数的关联性研究[J].中国医学装备,2025,22(05):16-21.
基金信息:
国家自然科学基金(82400676)~~