血管回声跟踪技术定量评价系统性红斑狼疮患者颈动脉弹性功能

目的 应用血管回声跟踪技术定量检测系统性红斑狼疮(SLE)患者颈动脉弹性功能改变情况,探讨该技术在早期诊断SLE动脉粥样硬化方而的临床价值.方法 根据病程将50例SLE患者分为SLEI组(病史≤1年)和SLE2组(病史>1年),分别对SLE1组、SLE2组和25名健康对照组,应用血管回声跟踪技术检测双侧颈总动脉的压力应变弹性系数(Ep)、硬度指数(β)、顺应性(AC)、增大指数(AI)、脉搏波传导速度(PWVβ)及内-中膜厚度(IMT).结果 3组颈动脉弹性指标比较,表现为各组间AI差异无统计学意义(P>0.05),SLE1组、SLE2组较对照组右侧颈总动脉Ep、β、PWVβ指数增高[SLE1组、SLE2组、对照组右侧颈总动脉的Ep值分别为(69±20)、(103±40)、(48±18)kPa;β值分别为5.2±1.9、8.0±3.1,4.2±1.3;PWVβ值分别为5.2±0.7、6.3±1.1、4.5±0.7,AC指数降低(SLE1组、SLE2组、对照组右侧颈总动脉的AC值分别为(1.1±0.3)、(0.8±0.3)、(1.2±0.6)mm2/kPa],差异有统计学意义(P<0.01);SLE2组较SLE1组ED、β、PWVβ指数增高,AC指数降低,差异有统计学意义(P<0.01).结论 应用血管回声跟踪技术可诊断早期动脉粥样硬化并定量化,为早期诊断SLE心血管并发症提供依据,具有较高的临床价值.     

血管回声跟踪技术评价冠心病患者大动脉弹性功能的研究

目的:应用回声跟踪技术及脉搏波速度测定系统评价冠心病患者的大动脉弹性功能及单点脉搏波传导速度(PWVβ)与传统两点脉搏波传导速度(PWV)的比较与意义。方法:冠心病组51例,正常对照组51例,分别应用血管回声跟踪技术、脉搏波速度测定系统对颈动脉弹性功能改变进行评估。包括压力应变弹性系数、僵硬系数、动脉顺应性、PWVβ及PWV;比较各组间PWVβ值与PWV的差异。结果:冠心病组压力应变弹性系数、僵硬系数、PWVβ及PWV值明显高于正常对照组(P<0.01),而动脉顺应性低于正常对照组(P<0.05),差异均有统计学意义。两组PWVβ与PWV均呈正相关。结论:冠心病患者大动脉弹性功能明显降低。血管回声跟踪技术及动脉硬化检测技术能方便、快捷、无创评价动脉功能和结构的早期变化。单点脉搏波传导速度和传统两点脉搏波传导速度一样能较敏感地反映这些变化。     

糖调节受损患者颈动脉弹性与血清黏附因子的相关性

目的：探讨糖调节受损（ IGR）患者颈动脉弹性与血清炎性因子的相关性。方法应用超声多普勒中的血管回声跟踪技术,检测IGR患者颈内动脉内中膜厚度（ IMT）和颈总动脉压力应变弹性系数（ Eρ）、僵硬度参数（β）、动脉顺应性（ AC）、脉搏波传导速度（ PWVβ）,同时测定血压、体质量指数、血糖、血脂、胰岛素抵抗指数、血管细胞黏附因子－1（VCAM－1）、血清细胞黏附分子－1（ICAM－1）等指标,与正常糖耐量者（NGT）进行比较。结果 IGR患者颈总动脉Eρ、β、PWVβ显著高于NGT组（ P＜0．05）,颈动脉IMT无明显升高（ P＞0．05）;IGR患者VCAM－1、ICAM－1显著高于NGT组（P＜0．05）;IGR患者VCAM－1、ICAM－1与颈总动脉Eρ、β、PWVβ呈正相关,与AC呈负相关。结论 IGR人群已存在颈动脉弹性改变和内皮功能的紊乱,应及早对IGR人群进行干预。     

动脉僵硬度指数与冠脉狭窄程度的相关性研究

目的 探讨动态血压参数动脉僵硬度指数(AASI)与冠脉病变严重程度的关系.方法 对252例入选病例行冠脉造影术.冠状动脉病变损害程度采用Gensini法计分,所有病例均于术前监测24 h动态血压.记录参数:24 h收缩压(sBP)、24 h舒张压(DBP),以DBP为纵坐标,SBP为横坐标,求出斜率(β),动脉僵硬度指数=1-β.结果 高血压组较非高血压组冠心病患病率明显增高(P＜0.05).高血压组患者冠脉三支血管病变的患病率显著高于非高血压组(P＜0.05).冠脉狭窄组24 h动态血压监测,无论24 h、白昼还是夜间动脉僵硬度指数均显著高于冠脉正常组(P＜0.05).多因素Logistic回归分析结果显示:各动脉僵硬度指数与冠心病(CHD)冠脉狭窄程度的关系最为密切,且夜问动脉僵硬度指数较其他因素与CHD冠脉狭窄程度的关系更密切(P＜0.05).结论 动脉僵硬度指数是CHD冠脉狭窄发生发展的独立危险因素,动脉僵硬度指数与CHD冠昧狭窄程度的关系较为密切.     

应用超声检查评价高血压患者血管僵硬度与心功能的关系

Objective To assess the relationship between arterial stiffness and heart function in patients with hypertension using ultrasonography. Methods A total of 167 patients with hypertension and 165 controls were enrolled, and the parameters of arterial stiffness and heart function were measured and calculated. The results were analyzed and compared. Results The ratio of peak early-diastolic mitral orifice flow velocity and peak early-diastolic mitral annular velocity in left ventricular posterior wall (E/e), and Tei index were significantly higher in hypertension group than in controls(E/e: 10.92±3.14 vs. 7.70 ±1.56, Teiindex: 0.58±0.13 vs. 0.45±0.09, both P＜0.05), but there was no significant difference in ejection fraction (EF) between the two groups. In hypertension group, the parameters of arterial stiffness including β value, pressure-strain elastic modulus (Ep), pulse wave velocity (PWVβ) and arterial compliance were 11.0±5.2, (172.6±83.8)kPa, (7.8±1.6) m/s and (0.6±0.2) mm2/ kPa. In control group, the corresponding data were 7.5±3.0, (97.1±45.4) kPa, (5.9±1.3) m/s and (0.8±0.3) mm2/kPa. There were significant differences between the two groups (all P＜0.05). The E/e was positively correlated with Ep and PWVβ(γ=0.316 and 0.296, both P＜0.05). The Tei index was positively correlated with Ep,augmentation index (AI) and PWVβ(γ=0.278, 0.300 and 0.323, P＜0.05-0.01). There was no significant correlation between EF and arterial stiffness. Conclusions The arterial stiffness and damage of heart function can result from hypertension. The arterial stiffness can be one of monitoring indexes for the heart function damage in early time.     

应用超声检查评价高血压患者血管僵硬度与心功能的关系

Objective To assess the relationship between arterial stiffness and heart function in patients with hypertension using ultrasonography. Methods A total of 167 patients with hypertension and 165 controls were enrolled, and the parameters of arterial stiffness and heart function were measured and calculated. The results were analyzed and compared. Results The ratio of peak early-diastolic mitral orifice flow velocity and peak early-diastolic mitral annular velocity in left ventricular posterior wall (E/e), and Tei index were significantly higher in hypertension group than in controls(E/e: 10.92±3.14 vs. 7.70 ±1.56, Teiindex: 0.58±0.13 vs. 0.45±0.09, both P＜0.05), but there was no significant difference in ejection fraction (EF) between the two groups. In hypertension group, the parameters of arterial stiffness including β value, pressure-strain elastic modulus (Ep), pulse wave velocity (PWVβ) and arterial compliance were 11.0±5.2, (172.6±83.8)kPa, (7.8±1.6) m/s and (0.6±0.2) mm2/ kPa. In control group, the corresponding data were 7.5±3.0, (97.1±45.4) kPa, (5.9±1.3) m/s and (0.8±0.3) mm2/kPa. There were significant differences between the two groups (all P＜0.05). The E/e was positively correlated with Ep and PWVβ(γ=0.316 and 0.296, both P＜0.05). The Tei index was positively correlated with Ep,augmentation index (AI) and PWVβ(γ=0.278, 0.300 and 0.323, P＜0.05-0.01). There was no significant correlation between EF and arterial stiffness. Conclusions The arterial stiffness and damage of heart function can result from hypertension. The arterial stiffness can be one of monitoring indexes for the heart function damage in early time.     

多种无创检测方法评价糖尿病患者早期动脉硬化

目的多种无创检测方法联合评价2型糖尿病(DM)患者早期动脉硬化情况。方法无并发症的DM患者30例,对照组27例,行颈动脉内膜中层厚度(IMT)、踝臂指数(ABI)、肱踝脉搏波传导速度(baPWV)、压力波增强指数(AI)及血管回声跟踪技术(ET技术)检查,比较两组动脉硬化参数及其相关性。结果 DM组及对照组IMT、ABI均在正常范围,且差异无统计学意义(均为P0.05);左右两侧baPWV[(1449±232)cm/s比(1291±171)cm/s,(1452±222)cm/s比(1280±178)cm/s;P0.01]及ET技术中压力-应变弹性系数(Ep)[(137±51)kPa比(101±34)kPa,P0.01]、硬化参数(β)[(10.6±4.2)比(8.2±2.7),P0.05]、单点脉搏波传导速度(PWVβ)[(7.0±1.2)m/s比(6.1±1.0)m/s,P0.01]在DM组均明显高于对照组。DM组动脉硬化的发生率较对照组升高[67%(20/30)比26%(7/27),P0.01];Ep、PWVβ分别与左右两侧baPWV呈正相关。结论 DM患者动脉硬化发生率较对照组明显增加;ET技术中Ep、β、PWVβ与baPWV均可敏感地反映糖尿病患者早期动脉硬化。     

高血压患者药物治疗前后股、腘动脉结构及功能变化分析

目的 :探讨高血压患者药物治疗前后股、腘动脉结构及功能变化情况。方法:选择2010-03至2016-01期间我院门诊就诊及住院的高血压患者201例,按高血压级别共分为3组,即Ⅰ组(1级高血压患者72例)、Ⅱ组(2级高血压患者68例)、Ⅲ组(3级高血压患者61例),持续3个月降压治疗,血压降至140/90 mmHg(1mm Hg=0.133 kPa)以下。应用二维超声心动图检测3组高血压患者治疗前后股、腘动脉的内-中膜厚度(IMT),应用血管回声跟踪(ET)技术检测上述血管的弹性功能参数:僵硬度(β)、压力应变弹性系数(Ep)、顺应性(AC)及脉搏波传导速度(PWV)。分析各组治疗前、后IMT及弹性参数的变化。结果:与治疗前比,三组高血压患者治疗后股动脉IMT减低,差异有统计学意义(P0.05),治疗后三组高血压患者腘动脉IMT较治疗前未见减低,差异无统计学意义(P0.05);治疗后,三组高血压患者的股、腘动脉的弹性参数β、Ep、PWV值均较治疗前减低,AC增加,差异有统计学意义(P0.05)。结论:药物治疗能有效改善高血压病患者股、腘动脉的弹性;二维超声心动图联合ET技术可动态监测高血压患者下肢动脉的血管弹性变化,为评价临床疗效提供客观依据。     

非酒精性脂肪性肝病患者动脉僵硬度的变化及其影响因素分析

目的研究不同年龄段非酒精性脂肪性肝病(NAFLD)患者外周动脉僵硬度的变化,探讨影响动脉僵硬度增高的相关危险因素。方法根据超声检查是否存在脂肪肝将2382例健康体检者分为NAFLD组和无NAFLD组。使用欧姆龙BP-203RPE III动脉硬化检测装置同时检测左右两侧肱踝脉搏波传导速度(ba PWV)值。以ba PWV≥1400 cm/s为动脉僵硬度增高,采用Logistic回归分析影响动脉僵硬度增高的危险因素。结果在2382例体检者中,发现NAFLD患者935例(39.3%),在1595例男性中,检出NAFLD患者726例(45.5%),在787例女性中,检出NAFLD患者209例(26.6%,P0.001);20~39岁年龄段NAFLD组ba PWV水平为(1340.0±180.7)cm/s,显著高于无NAFLD组【(1203.9±155.2)cm/s,P0.001】;40~59岁年龄段NAFLD组ba PWV水平为(1437.1±232.6)cm/s,显著高于无NAFLD组【(1355.8±217.9)cm/s,P0.001】;大于60岁年龄段NAFLD组ba PWV水平为(1885.8±404.0)cm/s,与无NAFLD组的ba PWV水平【(1830.2±430.6)cm/s】无统计学差别(P0.05);不同性别NAFLD对ba PWV增高发生率的影响不同,以女性患NAFLD对ba PWV影响较大;在1643例血压正常者,采用二分类Logistic回归分析发现,年龄、性别、NAFLD和血清总胆固醇为ba PWV升高的独立危险因素。结论 NAFLD患者较无NAFLD人群动脉僵硬度增高,以青中年NAFLD患者增高更为明显。NAFLD为动脉僵硬度增高的独立危险因素。     

血管回声跟踪技术对肝硬化患者颈动脉弹性功能的定量检测

目的:探讨血管回声跟踪(echo-tracking,ET)技术检测肝硬化患者颈动脉弹性功能指标β、Ep、AC、AI、PWVβ及其意义．方法:应用ET技术检测20例肝硬化患者颈动脉的弹性指标,包括僵硬度参数β、压力应变弹性系数Ep、动脉顺应性AC、脉搏波放大指数AI及脉搏波传递速度PWVβ,并采用协方差分析与同期检查的150例正常人进行比较．结果:排除年龄因素影响后,肝硬化组与正常人相比颈动脉的β、AI有差别(P=0．02;P= 0．00),Ep、AC、PWVβ差异无差异(P>0．05)．结论:肝硬化患者的颈动脉弹性较正常人差; ET术能够定量检测肝硬化患者的颈动脉弹性功能改变．     

高原心脏病心功能指数与B型利钠肽相关研究

目的 通过观察高原心脏病心力衰竭患者心功能综合指数(Tei)和外周血N末端B型利钠肽前体(NT-proBNP)水平,探讨右室Tei指数、NT-proBNP在高原心脏病中的诊断价值.方法 对2008-2010年在解放军第二十二医院心内科住院的34例高原心脏病患者进行超声指标Tei指数和NT-proBNP水平测定,并进行相关性比较.结果 根据超声心动图征象将高原心脏病患者分为A、B两组,A组与健康对照组(C组)相比,肺动脉收缩压[86.6 mm Hg比9.7 mm Hg(1 mum Hg =0.133kPa)]、右室Tei指数(0.90比0.33)均显著增高(P＜0.05);B组C组相比,肺动脉收缩压(57.1比9.72) mm Hg、右室Tei指数(0.78比0.33)显著增高(P＜0.05);A、B两组患者外周血NT-proBNP水平分别为(1246.8±512.6)ng/L、( 637.3±351.3) ng/L,均显著高于C组(98.6±21.7) ng/L水平,P＜0.05.结论 右心室Tei指数和NT-proBNP浓度是反映右心整体功能的较敏感指标,两者对于诊断高原心脏病具有一定的临床意义.     

原发性高血压患者动脉僵硬度与心脏重构的相关性研究

目的 探讨原发性高血压患者动脉僵硬度与左心功能的相关性.方法 纳入原发性高血压患者79例,根据颈桡脉搏波传导速度（PWV）将患者分为对照组（PWV＜0.9m/s,n=42）和观察组（PWV≥0.9m/s,n=37）,两组患者均行心脏彩超检查比较心功能参数差异.结果 两组患者间左室舒张末期内径（LVEDd）、左室射血分数（LVEF）、左室质量指数（LVMI）、二尖瓣舒张早期血流峰速（E）、舒张晚期血流峰速（A）及二者比值（E/A）差异具有统计学意义（P＜0.05）;Pearson相关分析显示PWV与LVMI存在显著的相关性（r=0.347,P＜0.05）.结论 原发性高血压患者动脉僵硬度与左心重构存在显著的相关性,在临床上检测动脉弹性对于评价高血压患者心脏重构具有显著的临床意义.     

Arterial stiffening as a possible risk factor for both atherosclerosis and diastolic heart failure.

While arterial stiffness is known to be related to atherosclerosis, the association between arterial stiffness and cardiac systolic and diastolic function in hypertension has not been fully evaluated. The present study was conducted to simultaneously evaluate the relationship of brachial-ankle pulse wave velocity (PWV) to parameters reflecting atherosclerosis and to those reflecting the risk of congestive heart failure in patients with hypertension. In 147 patients with hypertension, the left ventricular ejection fraction, the ratio of the peak velocity of early rapid filling and the peak velocity of atrial filling (E/A ratio), and left ventricular mass index were obtained from echocardiographs, the intima-media thickness of the common carotid artery was obtained by ultrasonography, the plasma B-type natriuretic peptide (BNP) level was measured by radioimmunoassay, and the brachial-ankle PWV was measured by the volume rendering method. Brachial-ankle PWV correlated positively with the intima-media thickness of the carotid artery, E/A ratio and BNP. Multiple linear regression analysis demonstrated that the relationship between the brachial-ankle PWV and the E/A ratio was significantly independent from other clinical variables. The receiver operator characteristic curve demonstrated that a brachial-ankle PWV of 1,600 cm/s was useful to discriminate mild cardiac diastolic dysfunction (E/A ratio of < or =0.75) (sensitivity=78% and specificity=58%). The present study demonstrated that increased brachial-ankle PWV relates not only to the parameters reflecting atherosclerosis but also to those reflecting cardiac diastolic dysfunction. Therefore, increased arterial stiffness is a possible simultaneous risk for atherosclerotic cardiovascular disease and diastolic heart failure in patients with hypertension.     

老年高血压和糖尿病患者动脉僵硬度的影响因素分析

目的 评价老年高血压和(或)糖尿病患者动脉僵硬度及其影响因素. 方法 320例老年患者分为4组:对照组、糖尿病组、高血压组、高血压并存糖尿病组(联合患病组).收集年龄、体质指数、性别、吸烟、血压、脉压及平均动脉压,测定血清空腹血糖、血脂、糖化血红蛋白、超敏C反应蛋白等;并应用COLIN-VP1000动脉硬化测定仪测量入选者踝臂脉搏波传导速度(baPWV)以评价对动脉硬化的影响. 结果 联合患病组、糖尿病组、高血压组、对照组baPWV值分别为(2165.9±479.9)cm/s、(2158.6±386.9)cm/s、(1881.2±383.8)cm/s和(1667.2±279.3)cm/s,联合患病组、高血压组及糖尿病组的baPWV水平与对照组比较,差异均有统计学意义(F=8.473,P＜0.05),联合患病组与糖尿病组的baPWV值比较,差异无统计学意义,高血压组与糖尿病组及联合患病组的baPWV值比较,差异有统计学意义(均P＜0.05).联合患病组脉压、超敏C反应蛋白最高,与对照组比较,差异有统计学意义(均P＜0.05).多元线性回归分析结果显示,血清空腹血糖、平均动脉压、脉压、超敏C反应蛋白、低密度脂蛋白胆固醇与baPWV水平呈正相关(均P＜0.05). 结论 糖尿病、高血压是老年人动脉僵硬度增高的影响因素,而高血糖对老年人动脉僵硬度的影响可能起了更重要的作用.血糖、平均动脉压、脉压、超每C反应蛋白、低密度脂蛋白胆固醇均是影响动脉僵硬度的独立危险因素.     

Early identification of vascular damage in patients with systemic sclerosis

Vascular involvement in systemic sclerosis (SSc) plays a key role in the pathogenesis of fibrosis. We assessed arterial stiffness using a new echo-tracking technique in patients with SSc asymptomatic for cardiovascular diseases. We enrolled 22 patients (21 female, 63 ± 14 years) and 20 controls (12 female, 62 ± 3 years). Carotid intima-media thickness (IMT) was comparable between the 2 groups (1.1 ± 0.3 vs 1.0 ± 0.4 mm, P = ns), whereas the stiffness parameters were significantly increased in patients (β: 9.5 ± 4.2 vs 5.8 ± 1.1, P = .001; pulse wave velocity [PWV]: 6.5 ± 1.5 vs 5.2 ± 0.6 m/sec, P = .003). A correlation between stiffness parameters, anti-Scl-70 antibodies (β: r = .46, P = .03; PWV: r = .50, P = .02), and anticentromere antibodies (β: r = -.54, P = .020; PWV: r = -.53, P = .023) was found. Echo-tracking technique may be valuable in early identification of vascular involvement in patients with SSc.     

桡动脉增强指数与心血管病危险及动脉僵硬度相关分析

目的 探讨桡动脉增强指数(rAI)与心血管病危险及动脉僵硬度相关性。方法 北京地区4985例(男2417例,女2568例),年龄18 ～96(50.9±14.7)岁,测量左侧rAI;应用脉搏波传播速度(PWV)自动测量系统测定颈-股动脉PWV(CFPWV)和颈-桡动脉PWV(CRPWV)。并对其中没有心血管病的人群应用Framingham危险评分和中国缺血性心血管病危险评分分别计算个体心血管病风险。结果 女性的rAI显著高于男性[(83.18±12.36)％比(71.93±15.22)％,P＜0.01]。相关分析rAI无论与两种心血管评分还是与CFPWV、CRPWV均有显著相关性;当校正了年龄、舒张压、吸烟、心率、身高、腰围及空腹血糖后rAI仍与Framingham评分及中国心血管评分有相关性,其中男、女性相关系数r分别为0.17、0.09和0.12、0.08(P值均＜0.05),rAI仅与CFPWV有相关性(男女分别为r=0.14、0.10,P＜0.01),而与CRPWV无相关性。在相对年老的人群中(＞50岁)rAI与心血管病危险评分及PWV的相关性减弱。结论 rAI可能是一种预测心血管病风险及评估动脉僵硬度的有价值工具;作为危险分层的工具,rAI可能更适用于相对年轻的人群。     

血压、脉压水平及高血压病程对高血压患者动脉僵硬度的影响

目的探讨血压、脉压水平及高血压病程对高血压患者动脉僵硬度的影响。方法从上海市宝山区6家社区卫生中心及本院入选1026例高血压患者,收集相关病史信息,检测其颈-股动脉(C-F)、颈-桡动脉(C-R)、颈-足背动脉(C-D)脉搏波传导速度(PWV),672例患者在随访1年后复测PWV。从血压、脉压、高血压病程3者的不同水平进行分组比较及随访前后对照分析。结果 (1)1、2、3级高血压患者的C-FPWV随血压水平的增高而增快,分别为(12.61±2.76)m/s,(14.35±3.41)m/s,(15.50±2.93)m/s(均为P<0.01)。1级高血压组较2级、3级高血压组C-FPWV差异有统计学意义(均为P<0.01)。(2)随访前后C-FPWV在1级和2级高血压组分别为(12.73±2.91)m/s和(13.39±3.25)m/s,(13.96±3.07)m/s和(14.75±4.10)m/s,差异有统计学意义,而在3级高血压组差异无统计学意义。(3)脉压<40 mm Hg,40～60 mm Hg,≥60 mm Hg 3组C-FPWV随脉压的增大而增快,分别为(11.95±2.60)m/s,(12.94±2.85)m/s,(14.89±3.22)m/s(均为P<0.01)。随访1年后3组的C-FPWV分别较前增快0.70 m/s,0.65 m/s,0.85 m/s,差异均有统计学意义。(4)高血压病程<5年、5～10年、≥10年3组C-FPWV分别为(12.77±2.75)m/s,(12.85±3.07)m/s,(13.76±3.05)m/s,3组比较差异有统计学意义(均为P<0.01),病程越长,C-FPWV越快。结论(1)C-FPWV较C-RPWV、C-DPWV更能反映动脉僵硬度的变化。(2)C-FPWV随血压、脉压水平的增高及高血压病程的延长而增快,3者均为动脉僵硬度的重要影响因素。     

血管回声跟踪技术检测2型糖尿病患者股动脉弹性

目的应用血管回声跟踪（echotracking,ET）技术评价2型糖尿病患者早期股动脉硬化。方法选择60例2型糖尿病患者（糖尿病组）和60名体检结果正常者（对照组）,以上对象均已行双侧股动脉常规高频超声检查排除斑块形成及狭窄,应用血管ET技术检测2组的双侧股动脉,比较2组的压力-应变弹性系数（Ep）、硬度指数（β）、顺应性（AC）及脉搏波传导速度（PWVβ）。结果糖尿病组的股动脉Ep、β、PWVβ均较对照组升高（均为P〈0．01）,AC较对照组降低（P〈0．01）。结论血管ET技术能准确评价2型糖尿病患者早期股动脉弹性改变,为临床提供血管早期病变的诊断依据。