高血压患者血压与PWV、ABI相关性的研究进展

高血压是导致心血管疾病发生的重要危险因素.高血压所致的心、脑、肾等靶器官损害的主要机制是血管发生了动脉僵硬、动脉粥样硬化、狭窄和闭塞.脉搏波传导速度(PWV)和踝肱指数(ABI)是评估动脉硬度的早期重要指标,也是亚临床靶器官损害的检测参数之一.本综述旨在探讨PWV和ABI对高血压患者动脉硬化的早期诊断,以利于指导高血压...     

高血压患者脉压与早期动脉粥样硬化指标的关系

目的探讨高血压患者外周脉压,包括诊室脉压、24 h平均脉压(24 h MPP)和中心动脉脉压(CAPP)与早期动脉粥样硬化指标的关系。方法收集遵义医科大学附属医院高血压门诊未经治疗的高血压患者412例的临床资料,测量诊室脉压、24 h MPP、CAPP,测定踝肱指数(ABI)、肱踝脉搏波传导速度(baPWV)、颈股脉搏波传导速度(cfPWV)、反射波增强指数(Alx)。结果高血压患者中诊室脉压、24 h MPP和CAPP中男性宽脉压者分别占37.4%、41.2%、20.6%,女性分别占62.6%、58.8%、79.4%,不同性别间比较差异有统计学意义(P<0.05)。诊室脉压、24 h MPP、CAPP均随年龄增大而增大,老年组脉压增大更明显(P<0.05)。与非宽脉压组比较,诊室脉压、24 h MPP、CAPP宽脉压组ABI、Alx、baPWV、cfPWV均明显增高(P<0.05)。偏相关分析显示,诊室脉压、24 h MPP、CAPP与baPWV、cfPWV均呈正相关,且诊室脉压、24 h MPP与ABI,CAPP与Alx亦呈正相关,余无相关性。Bland-Altman分析显示,与诊室血压、脉压比较,24 h平均血压、24 h MPP与中心动脉血压和CAPP的一致性较好,其相关性亦较高。结论高血压患者脉压随年龄增大而增大,女性的脉压变化较男性更明显;脉压与ABI、baPWV、Alx、cfPWV均呈正相关,且诊室脉压与baPWV、24 h MPP与baPWV、CAPP与Alx的相关性较高。24 h MPP与CAPP的一致性和相关性均较诊室脉压高。     

北京社区人群糖代谢异常程度与动脉硬化的相关性研究

目的研究社区人群不同糖代谢状态与动脉硬化的相关性。方法以踝肱脉搏波传导速度(baPWV)反映动脉硬化程度。对北京市石景山区2个社区≥40岁居民行标准化问卷调查、实验室指标检测、踝肱指数(ABI)及baPWV测量。根据75g OGTT结果及糖尿病史将研究对象分为NGT组、IFG组、IGT组、IFG+IGT组、新诊断糖尿病(NDM)组及已发糖尿病(DDM)组,分析不同糖代谢状态与动脉硬化的相关性。结果随糖代谢异常的进展,从NGT组→IFG组→IGT组→IFG+IGT组→NDM组→DDM组,baPWV呈逐渐增高趋势[(1528±308)cm/s→(1625±370)cm/s→(1644±351)cm/s→(1747±485)cm/s→(1799±485)cm/s→(1841±456)cm/s,P0.001)]。除IFG与IGT组间比较差异无统计学意义外,其余各组间比较差异均有统计学意义(P0.05);校正年龄、性别及BMI等混杂因素后,各组两两比较差异均具有统计学意义(P0.001);且糖代谢异常程度、FPG、2hPG及HbA1c水平与baPWV独立相关(r=0.125,0.124,0.141,0.112.P0.001)。结论社区人群糖代谢异常程度与动脉硬化程度相关。因此,早期发现糖代谢异常,并对动脉硬化进行评估和干预对预防心脑血管事件发生有重要意义。     

冠心病患者脉搏波传导速度与心功能的相关性

目的研究冠心病患者脉搏波传导速度(PWV)与心功能的相关性。方法选取经冠状动脉造影确诊为冠心病者366例,收集一般临床资料,测定肱踝PWV(baPWV),行超声心动图检查等,同时在入选患者中选取44例行多普勒组织成像。结果冠心病患者baPWV与室间隔厚度(r=0.306,P<0.001)、左心室后壁厚度(r=0.365,P<0.001)、左心室质量分数(r=0.293,P<0.001)和E/Ea(r=0.458,P<0.01)呈显著正相关,与射血分数(r=-0.210,P<0.001)、Ea(r=-0.428,P<0.01)、Ea/Aa(r=-0.331,P<0.05)呈显著负相关。在除外高血压等的影响后,偏相关分析显示,baPWV与室间隔厚度(r=0.231,P<0.001)、左心室后壁厚度(r=0.320,P<0.001)、左心室质量分数(r=0.233,P<0.001)、射血分数(r=-0.182,P<0.001)、Ea(r=-0.429,P<0.01)、Ea/Aa(r=-0.339,P<0.05)、E/Ea(r=0.437,P<0.01)仍显著相关。冠心病患者不同心功能分级组间的baPWV差异有统计学意义(P<0.05),baPWV随临床心功能恶化而升高。结论 baPWV与冠心病患者左心室肥厚、左心室收缩和舒张功能、临床心功能均具有相关性,baPWV可以作为评估冠心病患者心功能的一个指标。     

体检人群中老年人超重、肥胖与踝臂脉搏波传导速度和颈动脉斑块的相关性

目的探讨不同体重指数与踝臂脉搏波传导速度(ba PWV)和颈动脉斑块的相关性。方法在2014年1~12月健康体检无重大慢性疾病相对健康人群中,按单纯随机数字分类法收集1 243例40岁以上者,按体重指数(BMI)分为体重正常组(BMI<24.0 kg/m2)、超重组(BMI24.0~27.9 kg/m2)和肥胖组(BMI>28.0 kg/m2),比较3组间ba PWV的差异以及各组颈动脉斑块形成情况。结果随着BMI增高,ba PWV呈逐渐上升趋势,体重正常组为(1 361.4±189.8)cm/s,超重组为(1 527.8±221.4)cm/s,肥胖组为(1 636.5±305.7)cm/s;颈动脉斑块形成正常体重组为60例(8.32%),超重组为98例(25.45%),肥胖组为62例(45.26%);差异显著(均P<0.01)。结论超重、肥胖与踝臂脉搏波传导速度增快密切相关。控制体重,使体重指数保持在正常范围内,对维护血管健康、减缓动脉硬化的发展有重要意义。     

代谢综合征增加动脉硬化患病风险

目的:探讨代谢综合征各组分个数的递增会否增加动脉硬化的患病风险。方法:在上海市嘉定区40岁及以上居民中进行问卷调查、体格检查、血生化及肱-踝动脉脉搏波传导速度(baPWV)检测,对其中数据完整的2 097人进行统计分析。baPWV值>1 753 cm/s定义为动脉硬化;代谢综合征按美国国家胆固醇教育计划成人治疗组第3次报告(NCEP-ATPⅢ)标准诊断。采用多元线性回归和Logistic回归法分析代谢综合征及其组分与动脉硬化的相关性。结果:本研究人群中男、女性动脉硬化的患病率分别为23.64%和25.61%(P=0.195 2);代谢综合征患病率男性明显低于女性(31.28%比35.71%,P=0.034 5);将人群按代谢综合征组分个数的多少进行分组比较,发现随着代谢组分个数的递增,其动脉硬化患病率逐步增加,分别为2.69%、20.19%、29.81%、28.74%和37.16%,组间有显著差异(趋势P     

代谢综合征对脉搏波速度的影响

目的 分析某查体人群合并代谢综合征对踝臂脉搏波传导速度的影响.方法 某单位健康查体人群,常规体检及测定相关代谢指标,用动脉硬化测定仪测定双侧肢体的踝臂脉搏波传导速度.按中华医学会糖尿病学分会代谢综合征评估标准,确定有无代谢异常并分组,比较各组踝臂脉搏波传导速度的变化特点,分析代谢异常与踝臂脉搏波传导速度的相关性.结果 该人群代谢综合征的患病率是13.26%,其中四项代谢异常者占2.43%.随着代谢异常组分和年龄的增加,踝臂脉搏波传导速度逐渐增加,各组间差异有统计学意义(P<0.05),均明显高于对照组,男女各组趋势与总趋势一致.即使单一代谢成分异常,踝臂脉搏波传导速度也显著高于对照组(P<0.05),以单纯高血压组增高最显著.以年龄分为<40岁组,40～59岁组及≥60岁组,前两组均有随着代谢异常数增加,踝臂脉搏波传导速度逐渐增加趋势,≥60岁组此趋势不明显.相关分析可见代谢异常与踝臂脉搏波传导速度存在相关性(左侧r=0.42,P<0.01,右侧r=0.45,P<0.01).结论 踝臂脉搏波传导速度及代谢综合征患病率均随着年龄增加而增加.代谢综合征各组分均是踝臂脉搏波传导速度增加的危险因素,随着代谢异常数的增多,踝臂脉搏波传导速度进一步增加.     

伴代谢综合征的高血压病患者动脉功能的变化

目的 探讨伴有代谢综合征的高血压病患者动脉功能的变化.方法 64例门诊高血压病患者分为高血压病合并代谢综合征组(简称为伴代谢综合征组,32例)和单纯高血压病组(32例),31例健康受试者作为对照组,检测受检者的肱-踝脉搏波传导速度、大动脉弹性和小动脉弹性.比较三组受试者肱-踝脉搏波传导速度、大动脉弹性和小动脉弹性变化,分析动脉功能与各危险因素的相关性.结果 与对照组(1 517.9±315.0 cm/s)相比,伴代谢综合征组(1 916.5±318.0 cm/s)和单纯高血压病组(1 757.6±313.9 cm/s)肱-踝脉搏波传导速度均显著增加(P<0.01和0.05),且伴代谢综合征组显著高于单纯高血压病组(P<0.05).对照组、单纯高血压病组和伴代谢综合征组受试者大动脉弹性(113.2±46.2、91.1±35.0和66.6±31.1 mL/mmHg,P<0.01)和小动脉弹性(505±244、355±195和253±116 mL/mmHg,P<0.05)依次降低.Peason相关分析表明肱-踝脉搏波传导速度与年龄、收缩压、脉压差、甘油三酯呈显著正相关(P<0.01),与高密度脂蛋白胆固醇呈显著负相关(P<0.01);大动脉弹性、小动脉弹性与高密度脂蛋白胆固醇呈正相关(P<0.05和0.01),而与年龄、收缩压、脉压差和甘油三酯呈负相关(P均<0.01).结论 代谢综合征加重高血压病患者动脉功能的减退.     

脉搏波传导速度临床意义及其与代谢综合征相关性研究进展

脉搏波传导速度(pulse wave velocity,PWV)作为评估动脉僵硬度的指标其重要意义在于其是心血管事件的独立预测因子。本文就PWV的监测原理、种类、测量方法、影响因素及其与代谢综合征的相关性研究进展进行综述。     

Prevalence and determinants of metabolically healthy obesity in Spain

Background and aims

Obesity is a heterogeneous disorder, so some obese individuals do not have cardiometabolic abnormalities (CA) which mediate the association between obesity and coronary heart disease. This study assessed the prevalence of metabolically healthy obesity and its determinants in Spain.

Methods

The data were taken from a cross-sectional study conducted in 2008–2010 among 11,520 individuals representative of the population of Spain aged ≥18 years. Normal-weight was defined as body mass index (BMI) <25 kg/m², and obesity as BMI ≥30 kg/m². Six CA were considered: elevated blood pressure, low high-density lipoprotein cholesterol, and elevated levels of triglycerides, fasting glucose, homeostasis model assessment of insulin resistance value, and C-reactive protein. Then, two phenotypes were defined: healthy (0–1 CA) and abnormal (≥2 CA).

Results

The prevalence of metabolically healthy obesity was 6.5% overall (95% confidence interval: 6.0–7.1), and corresponds to 28.9% of obese individuals. Lower age, being female, current smoking, moderate alcohol consumption, and high level of physical activity were independently associated with the healthy phenotype among the obese. The prevalence of normal weight with a metabolically abnormal phenotype was 6.4% overall (95% confidence interval: 5.8–6.9) and corresponds to 16.8% of normal-weight subjects. Factors associated with this phenotype in normal-weight persons were higher age, being male, never smoking, no alcohol consumption and larger waist circumference.

Conclusion

Metabolically healthy obesity represents almost one-third of the obese population in Spain. Since this was a cross-sectional study, the association of metabolic healthy obesity with smoking consumption, alcohol intake and physical activity warrants more research.     

Association of metabolically abnormal but normal weight (MANW) and metabolically healthy but obese (MHO) individuals with arterial stiffness and carotid atherosclerosis

Objective

Despite recent interest in differential impact of body size phenotypes on cardiovascular outcomes and mortality, studies evaluating the association between body size phenotypes and indicators of atherosclerosis are limited. This study investigated the relationship of metabolically abnormal but normal weight (MANW) and metabolically healthy but obese (MHO) individuals with arterial stiffness and carotid atherosclerosis in Korean adults without cardiovascular disease.

Methods

A total of 1012 participants (575 men and 437 women, mean age 50.8 years), who underwent a health examination between April 2012 and May 2013 were prospectively enrolled based on inclusion and exclusion criteria. Study subjects were classified according to body mass index (BMI) and the presence/absence of metabolic syndrome.

Results

The prevalence of metabolically healthy normal weight (MHNW), MANW, MHO, and metabolically abnormal obese (MAO) were 54.84%, 6.42%, 22.83%, and 15.91%, respectively. Individuals with MANW had significantly higher brachial-ankle pulse wave velocity and maximal carotid intima-media thickness values than those with MHO, after adjusting for age and gender (P = 0.026 and P = 0.018, respectively). The odds ratio (OR) of arterial stiffness and carotid atherosclerosis in the MANW group were significantly higher than in the MHNW group in unadjusted models. Furthermore, multivariable models showed that increased OR of carotid atherosclerosis in the MANW group persisted even after adjusting for confounding factors (OR = 2.98, 95% CI = [1.54, 5.73], P = 0.011).

Conclusions

Compared to MHNW or MHO subjects, Korean men and women with the MANW phenotype exhibited increased arterial stiffness and carotid atherosclerosis.

Clinical trials no

NCT01594710.     

Transition from metabolically healthy to unhealthy overweight/obesity and risk of cardiovascular disease incidence: A systematic review and meta-analysis

AimsDiscrepant results have been demonstrated regarding the cardiovascular (CV) risk of populations with metabolically healthy overweight/obesity (MHO) who were transitioned into metabolically unhealthy states. So, the objective of this systematic review and meta-analysis was to estimate the risk of cardiovascular diseases (CVD) incidence in individuals with transitional MHO phenotype.Data synthesisA literature review was done in PubMed, Scopus, EMBASE, and google scholar databases. Pooled HRs for all fatal and nonfatal CV events were computed using random-effect models for transitional MHOs in general as well as for each sex subgroup separately.This systematic review and meta-analysis included a total of 7 prospective observational studies with a total of 7,720,165 participants, published between 2018 and 2020. The mean follow-up duration of participants was 11.7 (5.5) years. Overall, the transitional MHO individuals had a significant risk of CVD incidence [HR = 1.42, 95% CI (1.24–1.60)]. In addition, in both male and female subgroups, unstable MHO phenotype demonstrated a significant CVD risk and HRs for incident CVD in males and females were 1.51 (1.07–1.96) and 1.71 (1.08–2.34), respectively.ConclusionTransition from MHO to unhealthy state throughout follow-up elevated the risk of CVD in both male and female groups. This can explain the association between MHO and incidence of CV events especially with longer follow up period.Registration code in prosperoCRD42021270225.     

Influence of dietary patterns on the metabolically healthy obesity phenotype: A systematic review

AimsIn many individuals (35%) obesity is not accompanied by cardiometabolic disorders, a condition referred to as metabolically healthy obesity. Since the effectiveness of dietary interventions for this condition is not well established, this study reviews the influence of dietary patterns on the phenotype of metabolically healthy obesity in adults and elderly.Data SynthesisThe review was carried out following the PRISMA guidelines and registered in the PROSPERO. The search was conducted in the MEDLINE, SCOPUS, Web of Science, Science Direct, LILACS, and SciELO databases. A total of 236 articles were identified, seven of which were selected for synthesis after application of the eligibility criteria.ConclusionsThe overall result found out in this synthesis was that the greater adherence to healthy eating patterns was considered a preventive to the transition from metabolically healthy obesity to metabolic unhealthy obese phenotypes, by improving metabolic health, and reducing the risk of cardiovascular disease and mortality from all causes. In contrast, unhealthy eating patterns resulted in increased inflammation and risks of developing noncommunicable diseases. This review indicates that adherence to healthy eating patterns may interfere with metabolic phenotypes of obesity and positively affect metabolically healthy obesity.Systematic Review RegistrationPROSPERO registration number CRD42020159783.     

代谢综合征各成分与臂踝脉搏波速度的关系研究

目的:探讨代谢综合征异常各成分与臂踝脉搏波速度(baPWV)的关系.方法:按照2005年国际糖尿病联盟(IDF)代谢综合征诊断标准,将571例研究对象(男269例,女302例,平均年龄56.2岁)分为对照组40例、1项代谢异常组108例、2项代谢异常组154例、3项代谢异常组269例,应用脉搏波速度自动测量系统测定baPWV,并结合各临床观察指标进行分析.结果:简单相关分析结果显示年龄、收缩压、舒张压、空腹血糖、总胆固醇、甘油三酯和腰围与baPWV的相关性有统计学意义(P<0.05).采用多元线性逐步回归方法分析显示年龄、平均动脉压、空腹血糖及甘油三酯与baPWV呈正向独立相关.调整性别和年龄后,baPWV值在对照组13.1 m/s,1项代谢异常组14.5 m/s,2项代谢异常组15.1 m/s,3项代谢异常组15.9 m/s,各组间比较差异均有统计学意义(P<0.05).结论:baPWV在代谢综合征异常者中显著增加,提示代谢综合征异常项目的增加反映动脉僵硬度的指标变化.     

代谢正常肥胖合并非酒精性脂肪性肝病的临床特征及内皮功能研究

目的 探讨代谢正常肥胖(MHO)合并非酒精性脂肪性肝病(NAFLD)患者的临床、生化特征及内皮功能.方法 收集湖南省人民医院体检中心2006年4月-2014年1月体检人群的资料,排除资料不完整者,共5 147名.选择诊断为MHO患者(共478例)纳入研究,其中234例合并NAFLD(MHO合并NAFLD组),244例未合并NAFLD(MHO未合并NAFLD组).共获得56例MHO(29例为MHO合并NAFLD,27例为MHO未合并NAFLD)患者的血标本,检测C反应蛋白(CRP)、血清空腹胰岛素(FINS)、脂联素、内皮素-1,计算稳态模型评估-胰岛素抵抗指数(HOMA-IR),记录受检者身高、体重、收缩压、舒张压、甘油三酯、总胆固醇、低密度脂蛋白-胆固醇(LDL-C)、高密度脂蛋白-胆固醇(HDL-C)、空腹血糖、谷丙转氨酶(ALT)、尿酸、外周血白细胞计数(WBCC)及腹部B超结果.比较MHO合并NAFLD组与MHO未合并NAFLD组临床、生化特征、炎性因子及内皮素-1水平的差异.结果 MHO合并NFALD组与MHO未合并NAFLD组相比,年龄(t=-4.164)、体重指数(t=-4.519)、收缩压(t =-3.892)、空腹血糖水平(t=-2.549)、ALT(t =-2.019)、HOMA-IR(u=-2.091)、内皮素-1水平(u=-3.632)升高,脂联素水平(u=-2.206)降低(P均＜0.05).而性别、舒张压、甘油三酯、总胆固醇、LDL-C、HDL-C、尿酸、WBCC、FINS、CRP在两组间差别无统计学意义.结论 MHO合并NAFLD患者者代谢异常加重,内皮功能紊乱.     

Phenotyping obesity: A focus on metabolically healthy obesity and metabolically unhealthy normal weight

Over the past 4 decades, research has shown that having a normal body weight does not automatically imply preserved metabolic health and a considerable number of lean individuals harbour metabolic abnormalities typically associated with obesity. Conversely, excess adiposity does not always equate with an abnormal metabolic profile. In fact, evidence exists for the presence of a metabolically unhealthy normal weight (MUHNW) and a metabolically healthy obese (MHO) phenotype. It has become increasingly recognised that different fat depots exert different effects on the metabolic profile of each individual by virtue of their location, structure and function, giving rise to these different body composition phenotypes. Furthermore, other factors have been implicated in the aetiopathogenesis of the body composition phenotypes, including genetics, ethnicity, age and lifestyle/behavioural factors. Even though to date both MHO and MUHNW have been widely investigated and documented in the literature, studies report different outcomes on long-term cardiometabolic morbidity and mortality. Future large-scale, observational and population-based studies are required for better profiling of these phenotypes as well as to further elucidate the pathophysiological role of the adipocyte in the onset of metabolic disorders to allow for better risk stratification and a personalised treatment paradigm.     

中老年人规律有氧运动对臂踝脉搏波传导速度的影响

目的:探讨规律有氧运动对中老年人臂踝脉搏波传导速度(baPWV)的影响。方法:采用横断面研究方法,抽取2019年3月至2020年1月江苏省太湖疗养院体检者7 993例,其中男性4 371例,女性3 622例,年龄(55.8±7.9)岁。收集受检者运动、饮酒、吸烟、体质指数、收缩压、舒张压、静息心率、空腹血糖、总胆固醇、...     

Current issues in the identification and treatment of metabolically healthy but obese individuals

A unique subset of obese individuals who appear to be protected from the development of metabolic disturbances has been identified in the medical literature and is termed metabolically healthy but obese (MHO). Part of the issue is that there are no clear accepted criteria on the definition of MHO and the biological mechanisms to explain this phenotype are still unknown which render findings and/or conclusions difficult to interpret and making the application of this concept difficult in clinical practice. With the current definitions, the true prevalence of the MHO phenotype in the general population varies widely from approximately 3–57% of obese adults. In several prospective studies, the MHO individual has been associated with a similar risk of developing type 2 diabetes, cardiovascular disease and mortality when compared to healthy normal weight subjects; however, there is evidence to refute this concept. Furthermore, the current evidence cannot confirm that MHO subjects are permanently protected from the risk of developing metabolic disturbances associated with obesity. Currently, no standard practice guidelines for the treatment of MHO can be proposed, however, a regular surveillance of the waist circumference and cardio-metabolic risk factors such as elevated triglycerides, glycaemia, HOMA, C-reactive protein and low HDL, as well as the prevention of any further weight gain seem to represent the most prudent and sound attitude in the management of MHO subjects.