肱踝脉搏波传导速度与冠心病的相关性研究

目的观察肱踝脉搏波传导速度(BaPWV)对冠心病及其严重程度的预测价值。方法对478例行冠状动脉造影者行临床资料收集,生化指标检测,BaPWV测定。结果冠心病组和非冠心病组的BaPWV(P<0.001)有显著性差异。Logistic回归分析显示:BaPWV是冠心病的独立影响因素。BaPWV对冠心病预测价值的ROC曲线曲线下面积为0.642±0.030(95%可信区间为0.583～0.700,P<0.001),BaPWV>1431cm/s预测冠心病的灵敏度为71%,特异度为52%。BaPWV在非冠心病、单支病变、双支病变、三支病变组之间有显著性差异(P<0.001),BaPWV随病变支数增加而逐渐增高。结论 BaPWV对于冠心病及其严重程度具有预测价值,且优于传统危险因素。BaPWV预测冠心病灵敏度较高,特异度偏低。     

脉搏波传导速度对冠心病的诊断价值

目的:探讨冠状动脉粥样硬化性心脏病(冠心病)患者各动脉段脉搏波传导速度的改变及其对冠心病的诊断价值。方法:根据冠状动脉造影结果将218例患者分为冠心病组(121例)和非冠心病组(97例),分别进行右侧颈-桡(RC-R)、右侧颈-股(RC-F)、右侧股-踝(RF-A)动脉段和相应左侧动脉段(LC-R、LC-F、LF-A)的脉搏波传导速度(pulsewavevelocity,PWV)检查,分析冠心病患者的PWV变化特征;以冠状动脉造影为金标准,应用受试者工作特征(ROC)曲线评价不同动脉段PWV诊断冠心病的敏感度和特异度。结果:非冠心病组及冠心病组的RC-FPWV(7.60±1.59和9.31±1.75P<0.01)、LC-FPWV(7.52±1.50和9.02±1.71P<0.01)、RC-RPWV(8.00±1.27和8.69±1.37P<0.01)和LC-RPWV(8.03±1.2和8.52±1.03P     

冠心病患者踝肱指数及肱踝脉搏波速度与冠状动脉造影Gensini评分的关系 ──附76例检测分析

目的：探讨冠状动脉粥样硬化性心脏病（冠心病）患者踝肱指数及肱踝脉搏波速度（baPWV）与冠状动脉造影Gensini评分的关系。方法：应用日本克林公司生产的全自动动脉硬化检测仪VP21000测量76例冠心病患者（冠心病组）和30名健康体检者（对照组）的baPWV、踝肱指数;对冠心病患者进行冠状动脉造影,并通过Gensini评分对其冠状动脉病变进行评分。结果：与对照组比较,冠心病组踝肱指数明显降低,baPWV明显升高（P〈0.05）;冠心病患者踝肱指数与冠状动脉造影Gensini评分呈负相关（r =-0.686,P〈0.001）;baPWV与冠状动脉造影Gensini评分呈正相关（r =0.634,P〈0.001）;在对性别、年龄、高血压、吸烟、体质量指数、尿酸变量作偏相关分析后,踝肱指数、baPWV与冠状动脉造影Gensini评分仍存在相关性,其相关系数分别为-0.703及0.665（P均〈0.001）。结论：冠心病患者踝肱指数降低及baPWV升高,踝肱指数及baPWV分别与冠状动脉病变积分呈负相关及正相关,提示踝肱指数及baPWV可作为评价冠状动脉病变程度的实用指标。     

颈动脉内中膜厚度和脉搏波速度对冠状动脉硬化早期联合应用的意义

目的 探讨颈动脉内膜中膜厚度(IMT)和脉搏波速度(PWV)对冠状动脉硬化早期预测的价值及其联合应用的意义.方法 随机选择102例行冠状动脉造影检查的患者同时行IMT、PWV测定.用SYNTAX积分评价冠状动脉病变的程度;分别用IMT、PWV预测冠心病并比较两者联合应用诊断的可靠程度.结果 随着冠状动脉病变程度的加重,IMT越来越厚,PWV越来越快,IMT在轻度病变组(1.60±0.43)mm、中度病变组(2.37±0.83)mm和重度病变组(2.63±0.60)mm均高于冠状动脉正常组(1.12±0.23)mm,中度病变组和重度病变组又高于轻度病变组(P<0.01);颈-股动脉(CF)的PWV在轻度病变组(11.20±1.40)m/s、中度病变组(11.20±1.40)m/s和重度病变组(15.82±4.42)m/s均高于高于冠状动脉正常组(9.37±1.47)m/s,中度病变组和重度病变组又高于轻度病变组,重度病变组又高于中度病变组(P相似文献   

联合运用多普勒探头与脉搏波传感器检测脉搏波传导速度的可行性

目的 探讨联合运用超声多普勒探头与脉搏波传感器检测脉搏波传导速度(PWV)方法的可行性.方法 纳入30名正常人,分别将超声多普勒探头与脉搏波传感器放置于受试者左侧颈总动脉起始段及左侧踝部胫后动脉,将两测量点间距离与测得动脉多普勒血流流速曲线的起点和动脉脉搏波曲线起点间的传播时间相比,以所得比值作为颈-踝动脉段的PWV(caPWV);并对检测结果与动脉硬化仪检测同一受试者肱-踝动脉段PWV(baPWV)的检测结果进行相关性分析.结果 将脉搏波传感器放置于颈总动脉、多普勒探头放置于胫后动脉时的PWV与动脉硬化仪检测得到的baPWV呈显著正相关(r=0.657,P＜0.01).将多普勒探头放置于颈总动脉、脉搏波传感器放置于胫后动脉时的PWV与动脉硬化仪检测得到的baPWV呈显著正相关(r=0.526,P＜0.01).结论 联合运用超声多普勒探头与脉搏波传感器检测PWV为检测PWV提供了一种新方法,具有一定临床实用价值,值得推广.     

Arteriosclerosis and pulse wave velocity

Impairment of the arterial compliance or loss of Windkessel effect of elastic arteries causes increased afterload to the heart and increased pulsatile flow to the peripheral vasculatures. The former induces left ventricular hypertrophy or dysfunction and the latter induces small vessel damage or end organ dysfunction. Thus, the arterial compliance plays important roles in the course of hypertension. Therefore; it is worthwhile to measure the elastic properties of aortoarterial system in patient with hypertension. The velocity of the pressure wave along an arterial system, known as pulse wave velocity(PWV), is related to the average stiffness of an arterial segment between measurement sites. The measurement of PWV is inversely related to arterial wall distensibility, which offers a simple and potential approach. There are numerous reports which PWV is a forceful marker and predictor of the cardiovascular risk in hypertensive or other arteriosclerotic disorders. Thus, PWV measurement is recommended in patients with hypertension for early detection of organ damages or estimation of the cardiovascular risk, as well as for the evaluation of the effectiveness of the treatment as a surrogate marker.     

超声极速成像技术评价冠状动脉慢血流患者颈动脉脉搏波传导速度

目的 采用超声极速成像技术（UF）评价冠状动脉慢血流（CSF）患者颈动脉脉搏波传导速度（PWV）。方法 收集临床诊断为CSF的患者34例（CSF组）和40例健康者（对照组）,进行颈动脉超声检查,测量颈总动脉的内径（D）、内-中膜厚度（IMT）及收缩期峰值血流速度（PSV）,同时采用UF技术测量颈总动脉前壁收缩起始时和结束时PWV（BS和ES）。结果 CSF组的BS和ES均大于对照组（P均<0.05）,而D、IMT及PSV差异均无统计学意义（P均>0.05）。结论 CSF患者的BS和ES增大,CSF可能是动脉硬化的早期表现。UF技术可准确、敏感检测早期动脉硬化。     

冠心病患者血尿酸水平与脉搏波传导速度的相关性研究

目的 评价冠心病患者中,血尿酸水平（UA）与肱-踝脉搏波传导速度（baPWV）的关系.方法 入选经冠状动脉造影证实已明确诊断的冠心病患者301例,根据baPWV值,将其分为两组：baPWV正常组（baPWV＜ 1400 cm/s）94例,baPWV升高组（baPWV≥1400 cm/s）207例,完成体格检查及生化指标的检测,探讨冠心病患者baPWV增加的因素.结果 单因素分析显示两组患者年龄、合并高血压、合并糖尿病、吸烟率、身高、体重及UA差异有统计学意义（P＜0.05）.Logistic回归分析显示冠心病患者baPWV增加的独立预测因素包括年龄、合并高血压、合并糖尿病及UA水平（OR值分别为1.084、2.197、2.283、1.219,P均＜0.05）.结论 冠心病患者中,UA水平是baPWV增加的独立预测因素.     

Measurement of pulse wave velocity using pulse wave Doppler ultrasound: comparison with arterial tonometry

Pulse wave velocity (PWV), the speed of propagation of arterial pressure waves through the arterial tree, is related to arterial stiffness and is an important prognostic marker for cardiovascular events. In clinical practice PWV is commonly determined by arterial tonometry, with a noninvasive pressure sensor applied sequentially over carotid and femoral arteries. The electrocardiogram (ECG) is used as a timing reference to determine the time delay or "transit time" between the upstroke of carotid and femoral pulse waveforms. Commercially available vascular ultrasound scanners provide a pulsed wave (PW) Doppler velocity signal, which should allow determination of carotid-femoral transit time and hence PWV. We compared carotid-femoral PWV measured by tonometry and by PW Doppler ultrasound (Seimens, Apsen scanner with 7 MHz linear transducer) in asymptomatic subjects (n = 62, 26 male, aged 21 to 72 y). To test for intra-subject and inter-observer variation, ten subjects were scanned by one observer on two occasions 2 wk apart and by two observers on same day. PWV by tonometry ranged from 5.3 to 15.0 m/s. There was no significant difference between mean values of PWV obtained by the two techniques (mean difference: 0.3 m/s, standard deviation of difference: 1.5 m/s), which were closely correlated (r = 0.83). The coefficient of variation for repeated measures on the same subject by the same observer was 10.1% and the inter-observer coefficient of variation was 5.8%. These results suggest a commercial ultrasound scanner can be used to measure PWV, giving results that are reproducible and closely correlated with those obtained by arterial tonometry. (E-mail: ben_yu.jiang@kcl.ac.uk).     

脉搏波速度与冠状动脉病变程度相关性分析

目的:探讨不同脉搏波速度与冠状动脉病变程度的相关性.方法:选取176例行冠状动脉造影的患者,根据咏搏波速度水平分为正常组与增高组,比较2组患者冠状动脉病变的程度,并进行脉搏波速度与冠状动脉严重病变的多因素分析.结果:2组冠状动脉正常及冠状动脉单支病变发生率差异无统计学意义(P＞0.05),脉搏波速度增高组冠状动脉严重病变发生率高于脉搏波速度正常组(P＜0.05);脉搏波速度与冠状动脉严重病变的发生密切相关.结论:早期检查脉搏波速度有利于延缓冠状动脉病变的发展.     

血清对氧磷酶1活性与冠心病及其病变程度的关系

目的观察和探讨中国人血清对氧磷酶1(PON-1)活性与冠状动脉粥样硬化性心脏病及其病变程度的关系。方法分光光度法测定入选研究对象(包括非冠心病61例,冠心病151例)的血清PON-1活性;以冠状动脉造影结果作为分组依据,并分析PON-1活性与冠状动脉病变支数、Gensini评分的关系,并对影响冠心病Gensini评分的影响因子进行多因素分析。结果冠心病组血清PON-1活性明显低于对照组,(1.95±0.12)vs(2.28±0.13)(t=17.25,P<0.01);血清PON-1活性单支病变组明显高于双支、三支病变组(2.02±0.15)vs(1.95±0.11)vs(1.91±0.11)(F=9.356,P<0.05);而双支和三支病变组比较差异无统计学意义(P=0.13);血清PON-1活性与Gensini评分间呈负相关(rs=-0.315,P<0.01);PON-1活性、年龄、体质量指数(BMI)、性别、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)与冠状动脉病变的程度相关(P<0.05)。结论冠心病患者血清PON-1活性水平明显降低,随着病变程度加重,血清PON-1活性水平降低,二者呈负相关关系。     

肱-踝脉搏波传导速度与冠状动脉粥样硬化相关性的临床研究

目的探讨冠心病患者肱-踝脉搏波传导速度（baPWV）与冠状动脉粥样硬化及其病变程度的关系。方法将102例行冠脉造影的患者分为冠心病组和对照组,冠心病组按冠状动脉病变程度分为单支、双支和严重病变组。所有患者在冠脉造影前应用脉搏波速度测量系统测量baPWV。结果冠心病组baPWV值（1603．75±223．99）cm／s明显高于对照组（1328．37±178．52）cm／s,（P〈0．05）。应用Logistic回归分析显示在校正动脉粥样硬化多种危险因素后,baPWV的OR值为1．009,（95％CI：1．005—1．013,P〈0．010）。进一步分析baPWV以1400cm／s作为组界进行Logistic逐步回归分析,结果显示baPWV≥1400cm／s的患者发生冠心病的危险度是baPWV〈1400cm／s者的12．723倍（95％cI：4．625—34．997,P〈0．001）。冠状动脉病变程度分析中,aPWV在冠状动脉单支病变组（1437．78±221．89）cm／s即已明显高于对照组（1328．37±178．52）cm／s（P〈0．05）;严重病变组（1674．98±211．28）cm／s和双支病变组（1667．65±161．78）cm／s明显高于单支病变组和对照组（P〈0．05）。严重病变组baPWV和双支病变组组间比较没有明显差异性（P〉0．05）。结论baPWV与冠状动脉粥样硬化密切相关,baPWV升高可能是冠状动脉粥样硬化新的预测因子之一,检测baPWV在一定程度上能反映冠脉的病变程度。     

应用脉搏波传导速度评估重度子痫前期患者颈动脉弹性

目的探讨脉搏波传导速度(PWVβ)评估重度子痫前期(SPE)患者颈动脉弹性的临床价值。方法随机选取我院SPE患者64例(SPE组)和正常妊娠妇女31例(对照组),两组均于产前、产后记录一般临床资料并行双侧颈总动脉超声检查;使用M型超声获取双侧颈总动脉中段收缩末期内径(Ds)、舒张末期内径(Dd);使用血管内中膜定量分析(QIMT)技术获取双侧颈总动脉中段平均内中膜厚度(IMT),计算PWVβ,并进行统计学分析。结果 SPE组产前检查时间为孕(32.29±4.18)周,产后复查时间为(21.79±5.03)周;对照组产前检查时间为孕(33.45±5.38)周,产后复查时间为(21.97±3.80)周,两组比较差异均无统计学意义。①组间比较:产前,SPE组体质量、体质量指数(BMI)、收缩压、舒张压、Ds、Dd、IMT及PWVβ均较对照组增加(均P0.05);产后,SPE组体质量、BMI、收缩压、舒张压、IMT及PWVβ均较对照组增加(均P0.05);②组内比较:SPE组产后体质量、BMI、Ds、Dd、PWVβ均较产前减低(均P0.05);对照组产后体质量、BMI、Ds、Dd均较产前减低(均P0.05),PWVβ呈减低趋势,但差异无统计学意义。与对照组产前后PWVβ变化值比较,SPE组产前后PWVβ变化值呈增加趋势,但差异无统计学意义。所有受试者及SPE组PWVβ与年龄、体质量、BMI、收缩压、舒张压、Ds及Dd均呈正相关(Rall=0.23、0.29、0.30、0.43、0.28、0.24、0.38;RSPE=0.20、0.26、0.27、0.33、0.17、0.20、0.34,均P0.05);其中Ds、Dd、收缩压及舒张压均为影响颈动脉PWVβ的独立危险因素(均P0.01)。结论应用PWVβ可准确评估SPE患者颈动脉弹性;SPE患者产前PWVβ增加,颈动脉硬度增加,弹性功能已经受损;产后平均21.79周颈动脉弹性虽有明显恢复但未恢复至正常妊娠妇女产后同期状态,这与SPE患者产后Ds、Dd、收缩压及舒张压等恢复情况相关。     

肱-踝脉搏波传导速度与老年心血管病危险因素关系的研究

目的 探讨肱-踝脉搏波传导速度(baPWV)与心血管病危险因素的关系,为临床早期检测动脉硬化提供新途径.方法 选择2010年11月至2011年10月于我院体检或住院的老年人共348例作为研究对象,其中男232例,女116例;平均年龄(74.5±9.0)岁.所有对象均接受问卷调查,记录病史,并测定baPWV,同时测量身高、体质量、腰围、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)等指标.比较危险因素与baPWV的关系.结果 (1)心血管危险因素数量越多,baPWV升高发生率越高.(2)多因素Logistic回归分析显示:年龄(OR=5.223,95％CI:3.606 ～7.564)、LDL-C升高(OR=4.554,95％ CI:2.413 ～8.593)、吸烟(OR=6.007,95％ CI:3.775～9.560)、肥胖(OR=3.019,95％ CI:2.363 ～3.857)、高血压(OR=6.938,95％ CI:3.591 ～13.404)、高盐饮食(OR=2.555,95％ CI:2.108～3.096)是baPWV升高的独立危险因素(P均＜0.05);运动(OR =0.941,95％ CI0.915 ～0.967)、睡眠(OR=0.947,95％ CI0.927 ～0.968)是baPWV升高的保护因素(P均＜0.05).(3)按照运动时间将健康组分为运动组(运动时间≥1 h/d)和少运动组(运动时间＜1 h/d),按照是否失眠分失眠组和无失眠组,发现运动组的baPWV值明显低于少运动组[分别为:(1169.0±34.8)、(1370.0±51.7) cm/s,t =2.719,P=0.012],无失眠组的baPWV值明显低于失眠组[分别为:( 1205.0 ±29.4)、( 1358.0±36.2) cm/s,t =2.561,P=0.017],差异有统计学意义.(4)老年单纯高血压组baPWV为(1852.0±46.7) cm/s、糖尿病组baPWV为(1693.0±38.2) cm/s、冠心病组baPWV为( 1729.0±40.4)cm/s,较健康组[baPWV为(1356.0±31.3) cm/s]高,差异均有统计学意义(P均＜0.05).但单纯高血压组和高血压合并脑梗死组、单纯冠心病组和冠心病心肌梗死组baPWV差异均无统计学意义.结论 (1)年龄、LDL-C升高、吸烟、肥胖、高血压、高盐饮食是baPWV升高的独立危险因素;运动、良好的睡眠是baPWV升高的保护性因素.(2)baPWV检测可做为发现早期动脉僵硬度增高的手段之一.     

Repeatability of non-invasive measurement of intracerebral pulse wave velocity using transcranial Doppler

In the present study, the repeatability of three techniques for measuring peripheral PWV (pulse wave velocity) has been studied. A transcranial Doppler provided a wave reading from the middle cerebral artery. Using the transit time between the R-wave of an ECG and the 'foot' of this wave we were able to calculate a PWV (PWV-brain). An ear clip transducer provided a pressure wave reading (PWV-ear). A third pressure reading came from a Finapres transducer on the left middle finger (PWV-finger). The PWV was calculated as distance between two points/transit time of the pulse wave. Eleven volunteers had three sets of readings averaged for each technique taken in two separate sessions. There was good agreement between observers for the mean PWV values, and good agreement for mean results in different sessions. The RC%s (repeatability coefficient percentages) for between-observer repeatability in each session were good and approximately equivalent for PWV-finger (5-7%) and PWV-brain (5-7%). The repeatability of the PWV-ear measurement was less satisfactory (8-18%). The RC% for the same observer between sessions was less good, being 11% for the PWV-finger, 16-17% for PWV-brain and 11-19% for PWV-ear. The RC%s for the inter-session inter-observer measurements were between 10.7-12.1% for the PWV-finger, 14.7-19.5% for PWV-brain and 8.3-15% for PWV-ear. The transit time RC%s were lower in most measurements. The between-observer repeatability of all measures was satisfactory. Owing to the less good repeatability on different occasions, the use of PWV-brain and PWV-ear will depend on the magnitude of differences to be expected.     

Measurement of regional pulse wave velocity using very high frame rate ultrasound

Purpose

Pulse wave velocity (PWV) is the propagation velocity of the pressure wave along the artery due to the heartbeat. The PWV becomes faster with progression of arteriosclerosis and, thus, can be used as a diagnostic index of arteriosclerosis. Measurement of PWV is known as a noninvasive approach for diagnosis of arteriosclerosis and is widely used in clinical situations. In the traditional PWV method, the average PWV is calculated between two points, the carotid and femoral arteries, at an interval of several tens of centimeters. However, PWV depends on part of the arterial tree, i.e., PWVs in the distal arteries are faster than those in the proximal arteries. Therefore, measurement of regional PWV is preferable.

Methods

To evaluate regional PWV in the present study, the minute vibration velocity of the human carotid arterial wall was measured at intervals of 0.2 mm at 72 points in the arterial longitudinal direction by the phased-tracking method at a high temporal resolution of 3472 Hz, and PWV was estimated by applying the Hilbert transform to those waveforms.

Results

In the present study, carotid arteries of three healthy subjects were measured in vivo. The PWVs in short segments of 14.4 mm in the arterial longitudinal direction were estimated to be 5.6, 6.4, and 6.7 m/s, which were in good agreement with those reported in the literature. Furthermore, for one of the subjects, a component was clearly found propagating from the periphery to the direction of the heart, i.e., a well known component reflected by the peripheral arteries. By using the proposed method, the propagation speed of the reflection component was also separately estimated to be ?8.4 m/s. The higher magnitude of PWV for the reflection component was considered to be the difference in blood pressure at the arrivals of the forward and reflection components.

Conclusion

Such a method would be useful for more sensitive evaluation of the change in elasticity due to progression of arteriosclerosis by measuring the regional PWV in a specific artery of interest (not the average PWV including other arteries).     

中青年和老年疑似冠心病患者冠状动脉病变特点比较

目的 应用256排冠状动脉CT分析中青年和老年疑似冠心病患者冠状动脉病变特点。方法 2018年6月至2018年11月因疑诊冠心病在保定市第一中心医院就诊并行冠状动脉CT检查为冠状动脉病变的患者972例。根据年龄分为中青年组（<60岁,528例）和老年组（≥60岁,444例）,比较两组危险因素及冠状动脉病变特点。结果 中青年组男性比例、体重指数（BMI）、吸烟、三酰甘油（TG）水平明显高于老年组;老年组高血压比例明显高于中青年组（P<0.05）。老年组钙化斑块及混合斑块所占比例高于中青年组（均P<0.01）。中青年组主要为单支,低钙化积分病变,而老年组主要为多支,高钙化积分病变。Logistic回归分析显示中青年组高钙化积分的独立危险因素依次为吸烟、高血压、糖尿病,而老年组高钙化积分的独立危险因素依次为糖尿病、性别构成。结论 不同年龄段的冠状动脉病变特点有其自身的临床特征。     

速度向量成像技术评价冠心病患者颈动脉病变

目的探讨速度向量成像技术分析冠心病患者颈动脉壁的运动速度、应变率及扭转运动。方法根据冠状动脉造影,将71例受检者分为冠心病组45例及正常组26例。在速度向量成像模式下,分别取左颈总动脉距颈内外动脉分叉处1．5cm及2．5cm处两个短轴切面,勾画动脉内膜,分析颈动脉壁的运动速度及应变率,并计算其扭转角度。结果45例冠心病患者左颈总动脉各壁运动速度及应变率大于正常组（P〈0．05）。冠心病组颈动脉壁的扭转角度与正常组无统计学差异（P〉0．05）。结论利用速度向量成像技术测量患者颈动脉壁的运动速度及应变率,可以评估冠心病患者的血管病变,并有望成为预测冠心病的新指标。     

冠心病患者心率变异性与冠状动脉病变的关系

摘要： 目的 通过对比研究冠心病患者心率变异性（HRV）和冠状动脉病变程度，探讨两者间是否存在联系，为诊断冠心病提供更多途径。 方法 随机选取冠心病患者120例作为实验组，分别为SAP、 UAP、STEMI和NSTEMI，每组平均30例。选取健康体检者31例作为正常对照组。所有入选对象于入院后24小时内行24小时动态心电图（DCG）检查，冠心病患者均接受选择性冠状动脉造影检查。采用SPSS 13.0统计软件进行统计学分析。结果 随冠状动脉病变程度加重，反映交感神经系统功能的心率变异性指标SDNN 、SDANN、SDNN Index等显著降低(P＜0.05)，而反映副交感神经系统功能的心率变异性指标rMSSD、pNN50则无显著变化。 结论 HRV可作为一个无创伤性指标间接反映冠状动脉病变程度，为冠心病临床诊断提供依据。