大动脉炎患者同步四肢血压及踝臂脉搏波速度特征

目的:调查大动脉炎患者同步四肢血压(4LBP)及踝臂脉搏波速度(baPWV)特征。方法:回顾性(注册研究:ClinicalTrials.gov.NCT Number:NCT03521739)连续收集2013年1月至2016年1月阜外医院住院诊治的182例大动脉炎患者(大动脉炎组),并选取182例性别、年龄、体重指数和肱动脉收缩压高侧相匹配的原发性高血压患者或健康体检者作为对照组。分析大动脉炎患者同步4LBP及baPWV测量9个参数:舒张压(DBP)、脉压差、脉动指数、臂间收缩压压差(IASBPD)、踝间收缩压压差(ILSBPD)、踝臂指数(ABI)及ABI差值(ΔABI)、baPWV和baPWV差值(ΔbaPWV)的特征,以及这些特征与大动脉炎病变分型的关系。结果:与对照组相比,大动脉炎组DBP更低[(67.4±23.7)mmHg vs(84.1±15.0)mmHg,1 mmHg=0.133 kPa]、脉压差更大[(69.7±23.6)mmHg vs(53.7±10.6)mmHg]、脉动指数更高(1.3±2.1 vs 0.6±0.1)、IASBPD更大[(18.2±24.1)mmHg vs(4.2±3.3)mmHg]、ILSBPD更大[(10.7±15.0)mmHg vs(5.3±4.1)mmHg]、ΔABI更大(0.1±0.1 vs 0.0±0.0)以及ΔbaPWV更大[(269.3±537.0)cm/s vs(46.7±41.7)cm/s],差异均有统计学意义(P均<0.001);进一步分析大动脉炎组脉压差>70 mmHg(36.8%vs 4.4%)、脉动指数>0.9(50.0%vs 5.5%)、IASBPD>10 mmHg(43.4%vs 5.5%)、ABI>1.4(17.6%vs 0%)、ILSBPD>15 mmHg(14.8%vs 3.3%)、ABI<0.9(22.5%vs 0%)、双ABI<0.9且ΔABI≤0.1(16.5%vs 0%)和ΔbaPWV>160 cm/s(31.3%vs 2.2%)所占比例均显著高于对照组(P均<0.001)。存在以上8项参数特征的其中1项,大动脉炎组的比例显著高于对照组(84.6%vs 18.1%,P<0.01)。并且这些参数特征与大动脉炎患者的病变分型密切相关。结论:大多数大动脉炎患者同步4LBP及baPWV存在一些显著异常特征,并且与病变分型密切相关,可初步预测和评估病变的位置。建议对大动脉炎及其疑似患者应常规行4LBP及baPWV测量。

Features of Four-limb Blood Pressure and Brachial-ankle Pulse Wave Velocity of Patients With Aortoarteritis

Objectives:To investigate the features of four-limb blood pressure(4LBP)and brachial-ankle pulse wave velocity(baPWV)in patients with Aortoarteritis(AA).Methods:In this retrospective study,182 consecutive patients with AA were collected in Fuwai Hospital from January 2013 to January 2016.182 subjects with primary hypertension or healthy volunteers matched by sex,age,body mass index and brachial systolic pressure served as control group.The following nine parameters were measured,including diastolic blood pressure(DBP),pulse pressure(PP),pulsatile indices(PI),inter-arm systolic blood pressure difference(IASBPD),interleg systolic blood pressure difference(ILSBPD),ankle-brachial index(ABI)and difference between right and left ABI(ΔABI),baPWV and difference between right and left baPWV(ΔbaPWV).Their association with the Fuwai classification of AA was analyzed.Results:In AA group,DBP was lower([67.4±23.7]mmHg vs[84.1±15.0]mmHg),PP was larger([69.7±23.6]mmHg vs[53.7±10.6]mmHg),PI was higher(1.3±2.1 vs 0.6±0.1),IASBDP was larger([18.2±24.1]mmHg vs[4.2±3.3]mmHg)and ILSBPD was larger([10.7±15.0]mmHg vs[5.3±4.1]mmHg),ΔABI was larger(0.1±0.1 vs 0.0±0.0),ΔbaPWV was larger([269.3±537.0]cm/s vs[46.7±41.7]cm/s)as compared to control group(all P<0.001).The proportions of subjects with PP>70 mmHg(36.8%vs 4.4%),PI>0.9(50.0%vs 5.5%),IASBDP>10 mmHg(43.4%vs 5.5%),ABI>1.4(17.6%vs 0%),ILSBPD>15 mmHg(4.8%vs 3.3%),ABI<0.9(22.5%vs 0%),bilateral ABI<0.9 and ΔABI≤0.1(16.5%vs 0%),and ΔbaPWV>160 cm/s(31.3%vs 2.2%)were significantly higher in AA group than in control group(all P<0.001).Moreover,84.6%of AA patients presented at least one of the eight defined cutoff values,while only 18.1%control subjects presented at least one of the eight defined cutoff(P<0.001).These features were closely related to the Fuwai classification of AA.Conclusions:Abnormal characteristics of 4LBP and baPWV could be found in most AA patients and were related to the Fuwai classification of AA.These measurements should thus be routinely recommended in AA and suspected AA patients.