- 脉动波传导速度在预测和诊断外周血管病中的意义
- 作者:李拥军|发布时间:2009-11-09|浏览量:1507次
李拥军、管珩、叶炜、刘昌伟
中国医学科学院,中国协和医科大学,北京协和医院,血管外科,北京,100730
摘要:
目的:探讨脉动波传导速度在预测和诊断外周血管病(PAD)中的意义。方法:对国内15个医疗中心,1500例50岁以上2型糖尿病,具有一项或多项心血管疾病相关危险因素的患者,一期同时测定踝-肱指数(ABI)和臂-踝脉动波传导速度(baPWV)。所有患者同时记录血压水平,高血压病程;血糖水平,糖化血红蛋白值,糖尿病病程;血脂水平;体重指数;吸烟状况;心血管事件和脑血管病的患病情况。并对数据进行统计分析、比较。结果:1、2型糖尿病患者在ABI值正常时,baPWV表现为异常加速,和男性比女性患者的baPWV异常更为明显(男性/女性,右侧:1647.0±347.7 vs. 1714.1±338.0,左侧:1638.1±368.0 vs. 1708.4±355.5,p<0.001);2、2型糖尿病患者合并PAD后,ABI降低(右侧:0.82±0.15,左侧:0.80±0.16),baPWV和非合并PAD患者相比明显减速(右侧:1652.6±428.7 vs. 1699.1±316.3,左侧:1655.3±477.2 vs. 1677.5±338.6, p<0.01);随着病情的加重,ABI值更低(右侧:0.69±0.12,左侧:0.71±0.14),baPWV下降更为明显(右侧:1595.4±417.0 vs. 1699.1±316.3,左侧:1573.5±455.3 vs. 1677.5±338.6, p<0.001);3、ABI、baPWV和年龄(OR:0.17,0.33,p<0.001)、糖尿病病程(OR:0.07,0.17,p<0.01),高血压(OR:0.18,0.39,p<0.001)等危险因素以及心血管事件(OR:0.25,0.10,p<0.001)间存在明确的一致性,均呈正相关关系;4、年龄是PAD的重要危险因素,非PAD患者,baPWV随年龄增大而加速(每增加10岁:1570.0±337.8,1707.7±356.4,1829.0±378.0,1955.6±430.5,p<0.001);PAD患者的baPWV则随年龄增加而明显减低(每增加10岁:1681.6±545.9,1678.2±494.9,1598.5±417.1,1493.9±444.8,p<0.001)。结论:在2型糖尿病人中,ABI正常时,baPWV则已经表现为异常;合并PAD时,baPWV降低,且和病变的严重程度相关。提示baPWV可以和ABI一起作为PAD筛查和诊断的指标,也可能会比ABI更早、更敏感的预测血管病变的存在和发生。
关键词:脉动波传导速度、踝肱指数、外周血管病、糖尿病
Pulse Wave Velocity a Sensitive Predicator for Peripheral Artery Disease among Diabetic Patients
Yongjun Li, Heng Guan, Wei Ye, Changwei Liu
Department for Vascular Surgery, Peking Union Medical College Hospital
PUMC & CAMS Beijing, 100730
Abstract:
Objective: To investigate the role of pulse wave velocity (PWV) on he predication and diagnosis for peripheral artery diseases among diabetic patients. Methods: Ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) were detected simultaneously in 1500 type 2 diabetic patients which over 50 years old with one or more risk factors.Results: 1, baPWV speeded up in enrolled diabetic patients when ABI showed normal; and more faster in female patients compared with males (male vs. female: right, 1647.0±347.7 vs. 1714.1±338.0; left, 1638.1±368.0 vs. 1708.4±355.5, p<0.001); 2, Compared with diabetic patients with PAD vs non-PAD, ABI was less than 0.9, baPWV slowed falling down (right, ABI: 0.82±0.15, baPWV: 1652.6±428.7 vs. 1699.1±316.3; left, ABI: 0.80±0.16, baPWV: 1655.3±477.2 vs. 1677.5±338.6, p<0.01), and this phenomena was positively relevant with the severity of PAD (right, ABI: 0.69±0.12, baPWV: 1595.4±417.0 vs. 1699.1±316.3; left, ABI: 0.71±0.14, baPWV: 1573.5±455.3 vs. 1677.5±338.6, p<0.01); 3, ABI and baPWV showed a consistently positive relationship with aging (OR: 0.17, 0.33, p<0.001), diabetes (OR: 0.07, 0.17, p<0.01), hypertension (OR: 0.18, 0.39, p<0.001), and rate of ischemic heart disease (OR: 0.25, 0.10, p<0.001); 4, Aging was an important risk factor for PAD. For diabetic patients with PAD, baPWV was stepped down with aging (per-decade up: 1681.6±545.9, 1678.2±494.9, 1598.5±417.1, 1493.9±444.8, p<0.001); For those without PAD, baPWV was expedited with aging (every 10-age-up: 1570.0±337.8, 1707.7±356.4, 1829.0±378.0, 1955.6±430.5, p<0.001).Conclusions: In type 2 diabetic patients, baPWV showed abnormal even when ABI was normal; When these patients combined with PAD, baPWV slowed down, and the phenomena was related with the severity of PAD. These data implicated baPWV could act as a screen and diagnosis factor for PAD as ABI did; and might be a more sensitive alarming predicator for artery lesions.
Key words: Pulse Wave Velocity; Ankle Brachial Index; Peripheral Artery Disease; Diabetes Mellitus
(本文发表于《中华外科杂志》)